-
The Permanente Journal 2012The practice-guideline process of collecting, critically appraising, and synthesizing available evidence, then developing expert panel recommendations based on appraised... (Review)
Review
INTRODUCTION
The practice-guideline process of collecting, critically appraising, and synthesizing available evidence, then developing expert panel recommendations based on appraised evidence, makes it possible to provide high-quality care for patients. Unwanted variability in the quality and rigor of evidence summaries and Clinical Practice Guidelines has been a long-standing challenge for clinicians seeking evidence-based guidance to support patient care decisions.
METHODS
A multidisciplinary group of stakeholders, with representation from all eight Kaiser Permanente Regions, is responsible for creating National Guidelines. Conducting high-quality systematic reviews and creating clinical guidelines are time-, labor-, and resource-intensive processes, which raises challenges for an organization striving to balance rigor with efficiency. For these reasons, the National Guideline Program elected to allow for the identification, assessment, and possible adoption of existing evidence-based guidelines and systematic reviews using the ADAPTE; Appraisal of Guidelines Research and Evaluation; Assessment of Multiple Systematic Reviews (AMSTAR); and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) frameworks. If no acceptable external guidelines are identified, the Guideline Development Team then systematically searches for relevant high-quality systematic reviews, meta-analyses, and original studies. Existing systematic reviews are assessed for quality using a measurement tool to assess systematic reviews (the AMSTAR systematic review checklist).
STUDY APPRAISAL
Following the screening and selection process, the included studies (the "body of evidence") are critically appraised for quality, using the GRADE methodology, which focuses on four key factors that must be considered when assigning strength to a recommendation: balance between desirable and undesirable effects, quality of evidence, values and preferences, and cost. The evidence is then used to create preliminary clinical recommendations. The strength of these recommendations is graded to reflect the extent to which a guideline panel is confident that the desirable effects of an intervention outweigh undesirable effects (or vice versa) across the range of patients for whom the recommendation is intended.
DISSEMINATION
The Care Management Institute disseminates all KP national guidelines to its eight Regions via postings on its Clinical Library Intranet site, a Web-based internal information resource.
Topics: Evidence-Based Medicine; Health Maintenance Organizations; Humans; Practice Guidelines as Topic; United States
PubMed: 22529761
DOI: 10.7812/TPP/11-134 -
BMC Public Health Nov 2023Hepatitis E can potentially progress to HEV-related acute liver failure (HEV-ALF). East and South Asia bear a substantial burden of HEV infection, with Bangladesh,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Hepatitis E can potentially progress to HEV-related acute liver failure (HEV-ALF). East and South Asia bear a substantial burden of HEV infection, with Bangladesh, China, and India facing the most severe threat in this region. Therefore, we conducted a systematic review and meta-analysis to evaluate the burden of HEV-ALF in these three high-risk countries.
METHODS
A systematic literature search was performed utilizing PubMed, the Cochrane Library, Medline, Embase, and Web of Science databases. Studies in English or Chinese that reported data on the burden of HEV-ALF in Bangladesh, China and India were included. Outcomes were pooled with meta-analysis utilizing R software. Estimates were calculated with random-effects models, and subgroup analysis and sensitivity analysis were conducted to address heterogeneity. Egger's test and Begg's test were performed to assess publication bias.
RESULTS
A total of 20 eligible studies were included in this study. The pooled HEV-attributable proportion of viral-related acute liver failure was estimated to be 40.0% (95% CI: 0.28-0.52), 30.0% (95% CI: 0.18-0.44), and 61.0% (95% CI: 0.49-0.72) among non-pregnant individuals in India, China and Bangladesh, while in Indian pregnant females, it was 71.0% (95% CI: 0.62-0.79). The combined prevalence among non-pregnant HEV-infected participants was 28.0% (95% CI: 0.20-0.37) and 10.0% (95% CI: 0.01-0.28) in India and China, and it was 34.0% (95% CI: 0.27-0.42) in Indian pregnant females with HEV infection. The overall mortality of HEV-ALF was estimated to be 32.0% (95% CI: 0.23-0.42) and 64.0% (95% CI: 0.50-0.77) among the non-pregnant and the pregnant participants in India, and it was 23.0% (95% CI: 0.14-0.34) in Chinese non-pregnant participants.
CONCLUSIONS
The burden of HEV-ALF in Bangladesh, China, and India is non-negligible despite geographic and population heterogeneity. The prevention of HEV infection and early recognition of HEV-ALF are of great significance, especially in high-risk countries and populations.
REGISTRATION
PROSPERO registration ID is CRD42022382101.
Topics: Pregnancy; Female; Humans; Bangladesh; Hepatitis E virus; Liver Failure, Acute; India; China
PubMed: 38031080
DOI: 10.1186/s12889-023-17302-2 -
Developmental Medicine and Child... Oct 2018To identify and critically appraise standardized measures of power mobility skill used with children (18y or younger) with mobility limitations and explore the measures'... (Review)
Review
AIM
To identify and critically appraise standardized measures of power mobility skill used with children (18y or younger) with mobility limitations and explore the measures' application for 'exploratory', 'operational', and 'functional' learners.
METHOD
Five electronic databases were searched along with hand-searching for peer-reviewed articles published in English to July 2017 (updated 31st August 2017). Key terms included power(ed) mobility, power(ed) wheelchair, and database-specific terms. Studies included at least one child with a disability, and a detailed description of the measure of power mobility skill. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed with inclusion criteria set a priori. Two reviewers independently screened titles, abstracts, and full-text articles.
RESULTS
Of 96 titles, 24 articles met inclusion criteria, describing nine measures of power mobility skill. The Wheelchair Skills Checklist, the Powered Mobility Program (PMP), and the Power Mobility Training Tool were augmented by three adaptations of the PMP. Two additional measures were further developed to create a third, the Assessment of Learning Powered mobility use. Validity evidence related primarily to content development while reliability evidence was reported on only two measures.
INTERPRETATION
All measures are in the initial stages of development and testing. Research investigating the measures' appropriateness for different types of learners and environments is warranted.
WHAT THIS PAPER ADDS
There are four distinct measures of paediatric power mobility skill: three task-based, one process-based. Power mobility learners may be divided into three groups: exploratory, operational, and functional. Application of measures of power mobility skill differs for these three groups.
Topics: Adolescent; Child; Disabled Children; Humans; Learning; Mobility Limitation; Motor Skills; Wheelchairs
PubMed: 29542110
DOI: 10.1111/dmcn.13709 -
PloS One 2023Previous studies examining the impact of heritage tourism have focused on specific ecological, economic, political, or cultural impacts. Research focused on the extent...
Previous studies examining the impact of heritage tourism have focused on specific ecological, economic, political, or cultural impacts. Research focused on the extent to which heritage tourism fosters host communities' participation and enhances their capacity to flourish and support long-term health and wellbeing is lacking. This systematic review assessed the impact of heritage tourism on sustainable community development, as well as the health and wellbeing of local communities. Studies were included if they: (i) were conducted in English; (ii) were published between January 2000 and March 2021; (iii) used qualitative and/or quantitative methods; (iv) analysed the impact of heritage tourism on sustainable community development and/or the health and wellbeing of local host communities; and (v) had a full-text copy available. The search identified 5292 articles, of which 102 articles met the inclusion criteria. The included studies covering six WHO regions (Western Pacific, African, Americas, South-East Asia, European, Eastern Mediterranean, and multiple regions). These studies show that heritage tourism had positive and negative impacts on social determinants of health. Positive impacts included economic gains, rejuvenation of culture, infrastructure development, and improved social services. However, heritage tourism also had deleterious effects on health, such as restrictions placed on local community participation and access to land, loss of livelihood, relocation and/or fragmentation of communities, increased outmigration, increases in crime, and erosion of culture. Thus, while heritage tourism may be a poverty-reducing strategy, its success depends on the inclusion of host communities in heritage tourism governance, decision-making processes, and access to resources and programs. Future policymakers are encouraged to adopt a holistic view of benefits along with detriments to sustainable heritage tourism development. Additional research should consider the health and wellbeing of local community groups engaged in heritage tourism. Protocol PROSPERO registration number: CRD42018114681.
Topics: Tourism; Sustainable Development; Poverty; Public Health
PubMed: 36989275
DOI: 10.1371/journal.pone.0282319 -
EClinicalMedicine Sep 2022Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease, and among the non-invasive tests, controlled attenuation parameter (CAP) and liver stiffness...
Accuracy of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) for assessing steatosis and fibrosis in non-alcoholic fatty liver disease: A systematic review and meta-analysis.
BACKGROUND
Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease, and among the non-invasive tests, controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) have shown better diagnostic performance in NAFLD. This meta-analysis aimed to evaluate the performance of CAP and LSM for assessing steatosis and fibrosis in NAFLD.
METHODS
We searched the PubMed, Web of Science, Cochrane Library, and Embase databases for relevant articles published up to February 13, 2022, and selected studies that met the inclusion and exclusion criteria, and evaluated the quality of evidence. Then we pooled sensitivity (SE), specificity (SP), and area under receiver operating characteristic (AUROC) curves. A random effect model was applied regardless of heterogeneity. Meta-regression analysis and subgroup analysis were performed to explore heterogeneity, and Fagan plot analysis was used to evaluate clinical utility. This meta-analysis was completed in Nanjing, Jiangsu and registered on PROSPERO (CRD42022309965).
FINDINGS
A total of 10537 patients from 61 studies were included in our meta-analysis. The AUROC of CAP were 0·924, 0·794 and 0·778 for steatosis grades ≥ S1, ≥ S2 and = S3, respectively, and the AUROC of LSM for detecting fibrosis stages ≥ F1, ≥ F2, ≥ F3, and = F4 were 0·851, 0·830, 0·897 and 0·925, respectively. Subgroup analysis revealed that BMI ≥ 30 kg/m² had lower accuracy for diagnosing S ≥ S1, ≥ S2 than BMI<30 kg/m². For the mean cut-off values, significant differences were found in CAP values among different body mass index (BMI) populations and LSM values among different regions. For diagnosing S ≥ S1, ≥ S2 and = S3, the mean CAP cut-off values for BMI ≥ 30 kg/m² were 30·7, 28·2, and 27·9 dB/m higher than for BMI < 30 kg/m² ( = 0·001, 0·001 and 0·018, respectively). For diagnosing F ≥ F2 and = F4, the mean cut-off values of Europe and America were 0·96 and 2·03 kPa higher than Asia ( 0·027, 0·034), respectively. In addition, the results did not change significantly after sensitivity analysis and the trim and fill method to correct for publication bias, proving that the conclusions are robust.
INTERPRETATION
The good performance of CAP and LSM for the diagnosis of mild steatosis (S ≥ S1), advanced liver fibrosis (F ≥ F3), and cirrhosis (F = F4) can be used to screen for NAFLD in high-risk populations. Of note, the accuracy of CAP for the detection of steatosis in patients with obesity is reduced and requires specific diagnostic values. For LSM, the same diagnostic values can be used when the appropriate probes are selected based on BMI and the automated probe selection tool. The performance of CAP and LSM in assessing steatosis in patients with obesity, moderate to severe steatosis, and low-grade fibrosis should be further validated and improved in the future.
FUNDING
The study was funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD).
PubMed: 35844772
DOI: 10.1016/j.eclinm.2022.101547 -
Journal of Education and Health... 2021Evaluation is one of the most important tools for determining the quality of any educational program, which can lead to reformation, revision, or termination of... (Review)
Review
BACKGROUND
Evaluation is one of the most important tools for determining the quality of any educational program, which can lead to reformation, revision, or termination of programs. Quality in higher education requires assessment and judgment of goals and strategies, executive policies, operational processes, products, and outcomes. The Context, Input, Process, and Product (CIPP) model is a comprehensive perspective that attempts to provide information in order to make the best decisions related to CIPP. Due to the importance of this topic, the present study examined the application of the CIPP model in the evaluation of medical education programs through a systematic review.
MATERIALS AND METHODS
In this systematic review, Persian databases including ISC, SID, Mag Iran, CivilicaL, and Noormags and English databases including PubMed, Web of Science, Scopus, ProQuest Dissertations, Embase, CINAHL, ERIC, and Google Scholar were searched using relevant keywords, such as evaluation, program evaluations, outcome and process assessment, educational assessment, and educational measurements. The search was done with no time limits and 41 papers were obtained until May 22, 2020. This systematic review was performed by following the data extraction steps and assessing the quality of the studies and findings. Critical Appraisal Skills Programs and Mixed-Methods Appraisal Tool checklists were used to check the quality of the papers.
RESULTS
This systematic review was conducted on 41 studies, 40 of which were research papers and one was a review paper. From the perspective of the CIPP model of evaluation, most papers showed quite a good level of evaluation of educational programs although some studies reported poor levels of evaluation. Moreover, factors such as modern teaching methods, faculty members, financial credits, educational content, facilities and equipment, managerial and supervisory process, graduates' skills, produced knowledge, and teaching and learning activities were reported as the factors that could influence the evaluation of educational programs.
CONCLUSION
Due to the important role of evaluation in improvement of the quality of educational programs, policymakers in education should pay special attention to the evaluation of educational programs and removal of their barriers and problems. To promote the quality of educational programs, policymakers and officials are recommended to make use of the CIPP model of evaluation as a systemic approach that can be used to evaluate all stages of an educational program from development to implementation.
PubMed: 34250133
DOI: 10.4103/jehp.jehp_1115_20 -
International Journal of Environmental... Jan 2023Urban agriculture (UA) can be used as an action to promote sustainability in cities and inform public health policies for urban populations. Despite this growing... (Review)
Review
UNLABELLED
Urban agriculture (UA) can be used as an action to promote sustainability in cities and inform public health policies for urban populations. Despite this growing recognition, its implementation still presents challenges in countries in the Global North and Global South.
BACKGROUND
In this context, this systematic review aims to identify the development of frameworks for the implementation of UA as a sustainable action and its main opportunities and shortcomings in meeting urban socio-environmental demands.
METHODS
In this review, using the PRISMA protocol, we evaluated 26 studies on the interplay between UA and sustainability surveyed on the Web of Science to provide an overview of the state of the art.
CONCLUSIONS
In summary, it was possible to identify many key challenges in UA adoption, which regard air and soil contamination, availability of green areas, layout of urban infrastructure, food distribution, among others. Due to numerous socio-economic and environmental contextual factors in cities, especially when comparing realities of the Global North and Global South, there is a need to develop a model that can be adaptable to these different contexts. Thus, it is recognized that the concept of sustainability does not present a universal understanding and that in its search it could be argued that one of the most important gaps is still to address social issues in relation to environmental ones.
Topics: Humans; Cities; Agriculture; Soil; Urban Population; Public Policy
PubMed: 36767476
DOI: 10.3390/ijerph20032110 -
BMC Oral Health Dec 2023The development of deep learning (DL) algorithms for use in dentistry is an emerging trend. Periodontitis is one of the most prevalent oral diseases, which has a notable... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The development of deep learning (DL) algorithms for use in dentistry is an emerging trend. Periodontitis is one of the most prevalent oral diseases, which has a notable impact on the life quality of patients. Therefore, it is crucial to classify periodontitis accurately and efficiently. This systematic review aimed to identify the application of DL for the classification of periodontitis and assess the accuracy of this approach.
METHODS
A literature search up to November 2023 was implemented through EMBASE, PubMed, Web of Science, Scopus, and Google Scholar databases. Inclusion and exclusion criteria were used to screen eligible studies, and the quality of the studies was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology with the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tool. Random-effects inverse-variance model was used to perform the meta-analysis of a diagnostic test, with which pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, and diagnostic odds ratio (DOR) were calculated, and a summary receiver operating characteristic (SROC) plot was constructed.
RESULTS
Thirteen studies were included in the meta-analysis. After excluding an outlier, the pooled sensitivity, specificity, positive LR, negative LR and DOR were 0.88 (95%CI 0.82-0.92), 0.82 (95%CI 0.72-0.89), 4.9 (95%CI 3.2-7.5), 0.15 (95%CI 0.10-0.22) and 33 (95%CI 19-59), respectively. The area under the SROC was 0.92 (95%CI 0.89-0.94).
CONCLUSIONS
The accuracy of DL-based classification of periodontitis is high, and this approach could be employed in the future to reduce the workload of dental professionals and enhance the consistency of classification.
Topics: Humans; Sensitivity and Specificity; Deep Learning; ROC Curve; Algorithms; Odds Ratio
PubMed: 38114946
DOI: 10.1186/s12903-023-03751-z -
Virus Genes Apr 2022African swine fever virus (ASFV) is the causative agent of African swine fever (ASF). The virus causes an acute highly hemorrhagic disease in domestic pigs, with high... (Review)
Review
African swine fever virus (ASFV) is the causative agent of African swine fever (ASF). The virus causes an acute highly hemorrhagic disease in domestic pigs, with high mortality. Although the overall genome mutation rate of ASFV, a large DNA virus, is relatively low, ASFV exhibits genetic and antigenic diversity. ASFV can be classified into 24 genotypes on the basis of the B646L gene. Cross-protected ASFV strains can be divided into eight serogroups on the basis of antibody-mediated hemadsorption inhibition. Here, we review research progress on ASFV genotyping and serogrouping, and explain how this information assists in the rapid identification of virus origin during ASF outbreaks and will aid in the development of ASF vaccines.
Topics: African Swine Fever; African Swine Fever Virus; Animals; Genotype; Phylogeny; Serogroup; Sus scrofa; Swine
PubMed: 35061204
DOI: 10.1007/s11262-021-01879-0 -
Human Resources For Health Jan 2022The strength of a health system-and ultimately the health of a population-depends to a large degree on health worker performance. However, insufficient support to build,... (Review)
Review
BACKGROUND
The strength of a health system-and ultimately the health of a population-depends to a large degree on health worker performance. However, insufficient support to build, manage and optimize human resources for health (HRH) in low- and middle-income countries (LMICs) results in inadequate health workforce performance, perpetuating health inequities and low-quality health services.
METHODS
The USAID-funded Human Resources for Health in 2030 Program (HRH2030) conducted a systematic review of studies documenting supervision enhancements and approaches that improved health worker performance to highlight components associated with these interventions' effectiveness. Structured by a conceptual framework to classify the inputs, processes, and results, the review assessed 57 supervision studies since 2010 in approximately 29 LMICs.
RESULTS
Of the successful supervision approaches described in the 57 studies reviewed, 44 were externally funded pilots, which is a limitation. Thirty focused on community health worker (CHW) programs. Health worker supervision was informed by health system data for 38 approaches (67%) and 22 approaches used continuous quality improvement (QI) (39%). Many successful approaches integrated digital supervision technologies (e.g., SmartPhones, mHealth applications) to support existing data systems and complement other health system activities. Few studies were adapted, scaled, or sustained, limiting reports of cost-effectiveness or impact.
CONCLUSION
Building on results from the review, to increase health worker supervision effectiveness we recommend to: integrate evidence-based, QI tools and processes; integrate digital supervision data into supervision processes; increase use of health system information and performance data when planning supervision visits to prioritize lowest-performing areas; scale and replicate successful models across service delivery areas and geographies; expand and institutionalize supervision to reach, prepare, protect, and support frontline health workers, especially during health emergencies; transition and sustain supervision efforts with domestic human and financial resources, including communities, for holistic workforce support. In conclusion, effective health worker supervision is informed by health system data, uses continuous quality improvement (QI), and employs digital technologies integrated into other health system activities and existing data systems to enable a whole system approach. Effective supervision enhancements and innovations should be better integrated, scaled, and sustained within existing systems to improve access to quality health care.
Topics: Community Health Workers; Developing Countries; Health Inequities; Humans; Poverty; Quality of Health Care
PubMed: 34991604
DOI: 10.1186/s12960-021-00692-y