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Rural and Remote Health May 2022Providing postgraduate rural training programs has been recognised as central for successful recruitment and retention of medical workforce. While there have been many...
INTRODUCTION
Providing postgraduate rural training programs has been recognised as central for successful recruitment and retention of medical workforce. While there have been many documented cases of rural training program development, documented program outcome evaluations are few. This review investigated how postgraduate training and educational programs for rural and remote medicine are evaluated worldwide. Through the use of a systematic review, the study explored three questions: 'What are the outcomes of postgraduate rural and remote training programs worldwide?', 'How are the program evaluations conducted?' and 'What evaluation models and approaches are used in evaluating the effectiveness of these training programs?'
METHODS
A qualitative synthesis was undertaken of evaluations of postgraduate rural training programs published in the English language in medical education journals. The study involved pooling quantitative and mixed-methods research data and findings from qualitative studies, which were aggregated, integrated and interpreted. PubMed, PsycINFO, ERIC and Web of Science databases were searched to identify studies that satisfy the search criteria.
RESULTS
Of the 1297 articles identified through the database search, 26 studies were included in the analysis. Most of the evidence from the studies consists of descriptive studies with some longitudinal tracking programs and cohort studies. Nine themes were identified: practice location after training completion; training location and decentralised model; educational aspects; incentives, political contexts and regulations; personal, social and cultural issues; professional development; rural orientation and community engagement; support system; and gender and racial issues. Key outcomes were analysed and cross-validated against the 2020 WHO guideline on health workforce development, attraction, recruitment and retention in rural and remote areas. These studies' most frequent evaluation methods were surveys, followed by interviews, questionnaires and secondary data from existing databases. Methodological characteristics, the relationship between rural background and program outcomes, and implications for decentralised training, telehealth and tele-assessment during the COVID-19 pandemic are discussed. Analysis from the key outcomes suggests evaluation as a strategy to uncover outcomes in postgraduate rural and remote training and medical education.
CONCLUSION
Regardless of the similar outcomes, the program evaluations implemented and the robustness of evidence vary across programs and medical schools. The absence of solid evaluation designs and their alignment to the program objectives will lessen the strengths of evidence. Better quality research and evaluation design, objective settings, qualitative inquiry to uncover the contexts, and developing appropriate indicators and benchmarks for monitoring and evaluating strategies must be considered during program development and implementation.
Topics: COVID-19; Humans; Pandemics; Rural Health Services; Schools, Medical; Workforce
PubMed: 35581958
DOI: 10.22605/RRH7118 -
Substance Abuse Treatment, Prevention,... Sep 2023The COVID-19 pandemic led to an unprecedented relaxation of restrictions on take-home doses in opioid agonist treatment (OAT). We conducted a mixed methods systematic... (Review)
Review
The impact of relaxing restrictions on take-home doses during the COVID-19 pandemic on program effectiveness and client experiences in opioid agonist treatment: a mixed methods systematic review.
BACKGROUND
The COVID-19 pandemic led to an unprecedented relaxation of restrictions on take-home doses in opioid agonist treatment (OAT). We conducted a mixed methods systematic review to explore the impact of these changes on program effectiveness and client experiences in OAT.
METHODS
The protocol for this review was registered in PROSPERO (CRD42022352310). From Aug.-Nov. 2022, we searched Medline, Embase, CINAHL, PsycInfo, Web of Science, Cochrane Register of Controlled Trials, and the grey literature. We included studies reporting quantitative measures of retention in treatment, illicit substance use, overdose, client health, quality of life, or treatment satisfaction or using qualitative methods to examine client experiences with take-home doses during the pandemic. We critically appraised studies using the Mixed Methods Appraisal Tool. We synthesized quantitative data using vote-counting by direction of effect and presented the results in harvest plots. Qualitative data were analyzed using thematic synthesis. We used a convergent segregated approach to integrate quantitative and qualitative findings.
RESULTS
Forty studies were included. Most were from North America (23/40) or the United Kingdom (9/40). The quantitative synthesis was limited by potential for confounding, but suggested an association between take-home doses and increased retention in treatment. There was no evidence of an association between take-home doses and illicit substance use or overdose. Qualitative findings indicated that take-home doses reduced clients' exposure to unregulated substances and stigma and minimized work/treatment conflicts. Though some clients reported challenges with managing their medication, the dominant narrative was one of appreciation, reduced anxiety, and a renewed sense of agency and identity. The integrated analysis suggested reduced treatment burden as an explanation for improved retention and revealed variation in individual relationships between take-home doses and illicit substance use. We identified a critical gap in quantitative measures of patient-important outcomes.
CONCLUSION
The relaxation of restrictions on take-home doses was associated with improved client experience and retention in OAT. We found no evidence of an association with illicit substance use or overdose, despite the expansion of take-home doses to previously ineligible groups. Including patient-important outcome measures in policy, program development, and treatment planning is essential to ensuring that decisions around take-home doses accurately reflect their value to clients.
Topics: Humans; COVID-19; Analgesics, Opioid; Pandemics; Quality of Life; Program Evaluation
PubMed: 37777766
DOI: 10.1186/s13011-023-00564-9 -
Nepal Journal of Epidemiology Mar 2021To date, there is no comprehensive systematic review and meta-analysis to assess the suitability of COVID-19 vaccines for mass immunization. The current systematic...
BACKGROUND
To date, there is no comprehensive systematic review and meta-analysis to assess the suitability of COVID-19 vaccines for mass immunization. The current systematic review and meta-analysis was conducted to evaluate the safety and immunogenicity of novel COVID-19 vaccine candidates under clinical trial evaluation and present a contemporary update on the development and implementation of a potential vaccines.
METHODS
For this study PubMed, MEDLINE, and Embase electronic databases were used to search for eligible studies on the interface between novel coronavirus and vaccine design until December 31, 2020.
RESULTS
We have included fourteen non-randomized and randomized controlled phase I-III trials. Implementation of a universal vaccination program with proven safety and efficacy through robust clinical evaluation is the long-term goal for preventing COVID-19. The immunization program must be cost-effective for mass production and accessibility. Despite pioneering techniques for the fast-track development of the vaccine in the current global emergency, mass production and availability of an effective COVID-19 vaccine could take some more time.
CONCLUSION
Our findings suggest a revisiting of the reported solicited and unsolicited systemic adverse events for COVID-19 candidate vaccines. Hence, it is alarming to judiciously expose thousands of participants to COVID-19 candidate vaccines at Phase-3 trials that have adverse events and insufficient evidence on safety and effectiveness that necessitates further justification.
PubMed: 33868742
DOI: 10.3126/nje.v11i1.36163 -
Journal of Clinical Medicine Mar 2021In recent years, different computer-based cognitive training (CT) programs for people with dementia (PwD) have been developed following a psychosocial approach. (Review)
Review
Methodological Designs Applied in the Development of Computer-Based Training Programs for the Cognitive Rehabilitation in People with Mild Cognitive Impairment (MCI) and Mild Dementia. Systematic Review.
UNLABELLED
In recent years, different computer-based cognitive training (CT) programs for people with dementia (PwD) have been developed following a psychosocial approach.
AIM
This systematic review aims to identify the methodological designs applied in the development of computer-based training (CCT) programs for the rehabilitation of cognitive functioning in people with mild cognitive impairment (MCI) or mild dementia.
METHODS
A systematic review was conducted using the databases PubMed and PsycINFO. The search period was between 2000-2019. The study selection and data extraction processes were carried out by two independent reviewers. The protocol was registered in International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42020159027.
RESULTS
Thirteen studies met the inclusion criteria. The most frequently used methodological design in the development of CCT programs for people with MCI or mild dementia was the user-centered design (UCD). This design involves an interactive system characterized by the inclusion of end users from the initial stages of its development, throughout the establishment of functional requirements, and in the evaluation of the program's usability and user-experience (UX).
CONCLUSION
UCD was the most used methodological design for the development of CCT programs although there was quite some variation in how this design was applied. Recommendations for future studies about the development of CCT programs for people with MCI and mild dementia are given. Central focus should be the inclusion and active participation of end users from the initial stages of development.
PubMed: 33809445
DOI: 10.3390/jcm10061222 -
BMC Public Health Nov 2015Community development is a health promotion approach identified as having great potential to improve Indigenous health, because of its potential for extensive community... (Review)
Review
A systematic review of studies evaluating Australian indigenous community development projects: the extent of community participation, their methodological quality and their outcomes.
BACKGROUND
Community development is a health promotion approach identified as having great potential to improve Indigenous health, because of its potential for extensive community participation. There has been no systematic examination of the extent of community participation in community development projects and little analysis of their effectiveness. This systematic review aims to identify the extent of community participation in community development projects implemented in Australian Indigenous communities, critically appraise the qualitative and quantitative methods used in their evaluation, and summarise their outcomes.
METHODS
Ten electronic peer-reviewed databases and two electronic grey literature databases were searched for relevant studies published between 1990 and 2015. The level of community participation and the methodological quality of the qualitative and quantitative components of the studies were assessed against standardised criteria.
RESULTS
Thirty one evaluation studies of community development projects were identified. Community participation varied between different phases of project development, generally high during project implementation, but low during the evaluation phase. For the majority of studies, methodological quality was low and the methods were poorly described. Although positive qualitative or quantitative outcomes were reported in all studies, only two studies reported statistically significant outcomes.
DISCUSSION
Partnerships between researchers, community members and service providers have great potential to improve methodological quality and community participation when research skills and community knowledge are integrated to design, implement and evaluate community development projects.
CONCLUSION
The methodological quality of studies evaluating Australian Indigenous community development projects is currently too weak to confidently determine the cost-effectiveness of community development projects in improving the health and wellbeing of Indigenous Australians. Higher quality studies evaluating community development projects would strengthen the evidence base.
Topics: Australia; Community Health Services; Community Participation; Health Promotion; Health Services, Indigenous; Humans; Native Hawaiian or Other Pacific Islander; Program Development; Qualitative Research; Social Change
PubMed: 26590869
DOI: 10.1186/s12889-015-2514-7 -
American Journal of Obstetrics &... May 2023This study was a systematic review aimed to assess published literature regarding healthcare-based interventions addressing food insecurity during pregnancy and their... (Review)
Review
OBJECTIVE
This study was a systematic review aimed to assess published literature regarding healthcare-based interventions addressing food insecurity during pregnancy and their effects on patient-reported, pregnancy, or nutritional outcomes.
DATA SOURCES
A systematic search was performed in February 2022 (subsequently updated in August 2022) using Embase, Medline, Cochrane Library, and Scopus using terms related to food insecurity interventions during pregnancy.
STUDY ELIGIBILITY CRITERIA
Studies examining healthcare-based interventions addressing food insecurity during pregnancy with patient-reported outcomes (eg, program satisfaction), adverse pregnancy outcomes (eg, preterm birth), or nutritional outcomes (eg, dietary intake) were included. Studies using data before 1995, conducted outside the United States, or focused solely on dietary content or the Special Supplemental Nutrition Program for Women, Infants, and Children or Supplemental Nutrition Assistance Program as the intervention of interest were excluded.
METHODS
Of note, 3 authors screened the abstracts and full articles for inclusion. The final cohort included 5 studies. Moreover, 3 authors independently extracted data from each article and assessed the study quality using the Grading of Recommendations, Assessment, Development, and Evaluations and the risk of bias using the National Institutes of Health Study Quality Assessment tools.
RESULTS
Overall, 5 studies describing the interventions addressing food insecurity during pregnancy were included. Study designs included prospective cohort (n=1) and retrospective cohort (n=4) studies. There was heterogeneity in the type of intervention, with 3 using food vouchers, 1 focusing on a group prenatal service with nutrition and food management education, and 1 using a food connection program. Most studies (4 [80%]) shared patient-reported outcomes (eg, food security levels and program utilization rates), with 2 studies examining pregnancy-related outcomes (ie, glucose level, blood pressure, and preterm birth) and 2 studies examining nutritional outcomes. The interventions were associated with improved levels of food insecurity, reduced odds of preterm birth, and improved blood pressure trends; the findings demonstrated a 56% to 81% program utilization rate. All studies exhibited moderate to low study quality, with fair to good internal validity.
CONCLUSION
Although data on healthcare-based interventions targeted at food insecurity during pregnancy are limited, the few studies identified suggest that such interventions may affect pregnancy outcomes. A better understanding of the local scope and context of food insecurity and community-based organizations' efforts not captured by the literature in this area can help inform the development of interventions targeting food access during pregnancy.
Topics: Child; Infant; Pregnancy; Humans; Infant, Newborn; Female; United States; Premature Birth; Retrospective Studies; Prospective Studies; Food Insecurity; Delivery of Health Care
PubMed: 36739912
DOI: 10.1016/j.ajogmf.2023.100884 -
Health Research Policy and Systems Nov 2021There are increasing expectations for researchers and knowledge users in the health system to use a research partnership approach, such as integrated knowledge... (Review)
Review
BACKGROUND
There are increasing expectations for researchers and knowledge users in the health system to use a research partnership approach, such as integrated knowledge translation, to increase the relevance and use of research findings in health practice, programmes and policies. However, little is known about how health research trainees engage in research partnership approaches such as IKT. In response, the purpose of this scoping review was to map and characterize the evidence related to using an IKT or other research partnership approach from the perspective of health research trainees in thesis and/or postdoctoral work.
METHODS
We conducted this scoping review following the Joanna Briggs Institute methodology and Arksey and O'Malley's framework. We searched the following databases in June 2020: MEDLINE, Embase, CINAHL and PsycINFO. We also searched sources of unpublished studies and grey literature. We reported our findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.
RESULTS
We included 74 records that described trainees' experiences using an IKT or other research partnership approach to health research. The majority of studies involved collaboration with knowledge users in the research question development, recruitment and data collection stages of the research process. Intersecting barriers to IKT or other research partnerships at the individual, interpersonal and organizational levels were reported, including lack of skills in partnership research, competing priorities and trainees' "outsider" status. We also identified studies that evaluated their IKT approach and reported impacts on partnership formation, such as valuing different perspectives, and enhanced relevance of research.
CONCLUSION
Our review provides insights for trainees interested in IKT or other research partnership approaches and offers guidance on how to apply an IKT approach to their research. The review findings can serve as a basis for future reviews and primary research focused on IKT principles, strategies and evaluation. The findings can also inform IKT training efforts such as guideline development and academic programme development.
Topics: Humans; Knowledge; Research Personnel; Translational Research, Biomedical
PubMed: 34727926
DOI: 10.1186/s12961-021-00784-0 -
Journal of Perinatology : Official... Jan 2016Summarize policies that support maternal and neonatal transport among states and territories. (Review)
Review
OBJECTIVE
Summarize policies that support maternal and neonatal transport among states and territories.
STUDY DESIGN
Systematic review of publicly available, web-based information on maternal and neonatal transport for each state and territory in 2014. Information was abstracted from published rules, statutes, regulations, planning documents and program descriptions. Abstracted information was summarized within two categories: transport and reimbursement.
RESULTS
Sixty-eight percent of states and 25% of territories had a policy for neonatal transport; 60% of states and one territory had a policy for maternal transport. Sixty-two percent of states had a reimbursement policy for neonatal transport, whereas 20% reimbursed for maternal transport. Thirty-two percent of states had an infant back-transport policy while 16% included back-transport for both. No territories had reimbursement or back-transport policies.
CONCLUSION
The lack of development of maternal transport reimbursement and neonatal back-transport policies negatively impacts the achievements of risk-appropriate care, a strategy focused on improving perinatal outcomes.
Topics: Female; Humans; Infant, Newborn; Insurance, Health, Reimbursement; Perinatal Care; Pregnancy; Transportation of Patients; United States
PubMed: 26334399
DOI: 10.1038/jp.2015.109 -
Food and Waterborne Parasitology Sep 2020The taeniid is the causative agent of the zoonotic disease echinococcosis/hydatidosis and is associated with economic losses in livestock production. This review...
The taeniid is the causative agent of the zoonotic disease echinococcosis/hydatidosis and is associated with economic losses in livestock production. This review summarizes available scientific literature on circulating species of in humans, wild and domestic animals in countries of Southern Africa Development Community, and identifies knowledge gaps and recommend research priorities. Data were systematically accessed from Google Scholar, MEDLINE/PubMed and from library resources from December 2017 to June 2019. Meta-analysis was conducted in STATA program and heterogeneity and prevalence values were pooled by host species with 95% confidence interval. In intermediate hosts, the overall prevalence of by meat inspection was 10% (CI: 9-11%) in small ruminants, 7% (CI: 5-8%) in cattle, 1% (CI: 0-1%) in pigs and 9% (CI: 0-29%) in wild herbivores. In canids by CoproAg-ELISA and necropsy the prevalence was of 10% (CI: 8-10%) and 6% (CI: 3-10%) respectively. A high level of heterogeneity (I > 65%) was observed for all study groups. , , and were reported from wildlife and , and from humans. There is paucity of research in echinococcosis and gaps in prevalence reports over time in both humans and animals in the SADC region and we recommend an increase in future studies on the epidemiology of disease, risk factors for transmission in animals and humans and its relation with human health specially in the advent of HIV pandemic following a "One Health" approach.
PubMed: 32995581
DOI: 10.1016/j.fawpar.2020.e00087 -
Frontiers in Oncology 2023Breast surgery has evolved from mastectomy to breast-conserving surgery (BCS). Breast oncoplastic surgery later emerged with the inclusion and development of techniques...
Breast surgery has evolved from mastectomy to breast-conserving surgery (BCS). Breast oncoplastic surgery later emerged with the inclusion and development of techniques used in plastic surgery for breast neoplasms. Recently, a new paradigm has been considered for mastectomy candidates with large multifocal and multicentric tumours, designated extreme oncoplasty (EO), which has allowed new techniques to be applied to tumours that would have been ineligible for BCS before. There are few publications and no uniform descriptions grouping all the technical possibilities and new indications together. We performed this a review with the objective of evaluating the indications and surgeries performed in the EO context, representing a new perspective for BCS. We observed new indications as extensive microcalcifications, locally advanced breast carcinoma with partial response to chemotherapy, small to moderate-sized non-ptotic central tumours and extreme ptosis. Small breasts are able for EO since the presence of ptosis. New surgeries are reported as disguised geometric compensation, perforators flaps, local/regional flaps, latissimus dorsi miniflap and partial breast amputation. It is important to decrease barriers to oncoplastic surgery if we want to increase the use of EO and BCS rates.
PubMed: 38352300
DOI: 10.3389/fonc.2023.1215284