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Using avatars in weight management settings: a systematic reviewHorne, M., Hill, A., Murells, T., Ugail, Hassan, Irving, Chinnadorai, R., Hardy, Maryann L. 05 March 2020 (has links)
Yes / Background: Obesity interventions rely predominantly on managing dietary intake and/or increasing physical activity but sustained adherence to behavioural regimens is often poor. Avatar technology is well established within the computer gaming industry and evidence suggests that virtual representations of self may impact real-world behaviour, acting as a catalyst for sustained weight loss behaviour modification. However, the effectiveness of avatar technology in promoting weight loss is unclear.
Aims: We aimed to assess the quantity and quality of empirical support for the use of avatar technologies in adult weight loss interventions.
Method: A systematic review of empirical studies was undertaken. The key objectives were to determine if: (i) the inclusion of avatar technology leads to greater weight loss achievement compared to routine intervention; and (ii) whether weight loss achievement is improved by avatar personalisation (avatar visually reflects self).
Results: We identified 6 papers that reported weight loss data. Avatar-based interventions for weight loss management were found to be effective in the short (4–6 weeks) and medium (3–6 months) term and improved weight loss maintenance in the long term (12 months). Only 2 papers included avatar personalisation, but results suggested there may be some added motivational benefit.
Conclusions: The current evidence supports that avatars may positively impact weight loss achievement and improve motivation. However, with only 6 papers identified the evidence base is limited and therefore findings need to be interpreted with caution. / National Institute for Health Research (NIHR) [RfPB programme (project reference PB-PG-1215-20016)].
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Barriers and facilitators to the uptake of new medicines into clinical practice: a systematic reviewMedlinskiene, Kristina, Tomlinson, Justine, Marques, Iuri, Richardson, S., Stirling, K., Petty, Duncan R. 02 February 2022 (has links)
Yes / Implementation and uptake of novel and cost-effective medicines can improve patient health outcomes and healthcare efficiency. However, the uptake of new medicines into practice faces a wide range of obstacles. Earlier reviews provided insights into determinants for new medicine uptake (such as medicine, prescriber, patient, organization, and external environment factors). However, the methodological approaches used had limitations (e.g., single author, narrative review, narrow search, no quality assessment of reviewed evidence). This systematic review aims to identify barriers and facilitators affecting the uptake of new medicines into clinical practice and identify areas for future research.
A systematic search of literature was undertaken within seven databases: Medline, EMBASE, Web of Science, CINAHL, Cochrane Library, SCOPUS, and PsychINFO. Included in the review were qualitative, quantitative, and mixed-methods studies focused on adult participants (18 years and older) requiring or taking new medicine(s) for any condition, in the context of healthcare organizations and which identified factors affecting the uptake of new medicines. The methodological quality was assessed using QATSDD tool. A narrative synthesis of reported factors was conducted using framework analysis and a conceptual framework was utilised to group them.
A total of 66 studies were included. Most studies (n = 62) were quantitative and used secondary data (n = 46) from various databases, e.g., insurance databases. The identified factors had a varied impact on the uptake of the different studied new medicines. Differently from earlier reviews, patient factors (patient education, engagement with treatment, therapy preferences), cost of new medicine, reimbursement and formulary conditions, and guidelines were suggested to influence the uptake. Also, the review highlighted that health economics, wider organizational factors, and underlying behaviours of adopters were not or under explored.
This systematic review has identified a broad range of factors affecting the uptake of new medicines within healthcare organizations, which were grouped into patient, prescriber, medicine, organizational, and external environment factors. This systematic review also identifies additional factors affecting new medicine use not reported in earlier reviews, which included patient influence and education level, cost of new medicines, formulary and reimbursement restrictions, and guidelines.
PROSPERO database (CRD42018108536). / This work presents research funded by the Pharmacy Research UK (grant reference: PRUK-2018-GA-1-KM) and Leeds Teaching Hospitals NHS Trust.
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Self-Directed Learning Research: A Systematic ReviewReynolds, Sara Nicole 05 1900 (has links)
This study serves to collate and evaluate measures of self-directed learning (SDL), with the goal of guiding the measurement and discussion of SDL. Used in a variety of settings, many applications of SDL have been proposed, but a consistent definition has yet to be formulated. Despite the lack of a cohesive definition, several tools exist to measure SDL. Within this study, which implemented the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and Consensus-Based Standards for the Selection of Health Status Measurement Instruments (COSMIN) protocols, 157 articles were analyzed for content and themes were identified. An important finding of this study was a definite lack of cohesion in application and understanding of SDL as a framework. While some regard it as a stand-alone learning intervention, others address it as a personality trait. Close examination of the instruments used to measure SDL led to the conclusion that it is both inappropriate and ineffective to continue using, as they broadly lack construct validity and generalizability. Limitations of this study are single subject research, number studies available within databases used, and lack of raw data from studies covered. Future research surrounding the conceptual framework and instrumentation is indicated to further develop the field's understanding of SDL's value and implications.
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Successful care transitions for older people: a systematic review and meta-analysis of the effects of interventions that support medication continuityTomlinson, Justine, Cheong, V-L., Fylan, Beth, Silcock, Jonathan, Smith, H., Karban, Kate, Blenkinsopp, Alison 28 February 2020 (has links)
Yes / Background: medication-related problems occur frequently when older patients are discharged from hospital. Interventions
to support medication use have been developed; however, their effectiveness in older populations are unknown. This review
evaluates interventions that support successful transitions of care through enhanced medication continuity.
Methods: a database search for randomised controlled trials was conducted. Selection criteria included mean participant age
of 65 years and older, intervention delivered during hospital stay or following recent discharge and including activities that
support medication continuity. Primary outcome of interest was hospital readmission. Secondary outcomes related to the safe
use of medication and quality of life. Outcomes were pooled by random-effects meta-analysis where possible.
Results: twenty-four studies (total participants=17,664) describing activities delivered at multiple time points were included.
Interventions that bridged the transition for up to 90 days were more likely to support successful transitions. The meta-analysis,
stratified by intervention component, demonstrated that self-management activities (RR 0.81 [0.74, 0.89]), telephone followup
(RR 0.84 [0.73, 0.97]) and medication reconciliation (RR 0.88 [0.81, 0.96]) were statistically associated with reduced
hospital readmissions.
Conclusion: our results suggest that interventions that best support older patients’ medication continuity are those that
bridge transitions; these also have the greatest impact on reducing hospital readmission. Interventions that included self management,
telephone follow-up and medication reconciliation activities were most likely to be effective; however, further
research needs to identify how to meaningfully engage with patients and caregivers to best support post-discharge medication
continuity. Limitations included high subjectivity of intervention coding, study heterogeneity and resource restrictions. / National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant PB-PG-0317-20010).
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Assessing efficacy of stuttering treatments using single-subject design research : a systematic reviewTimson, Melissa J. 01 January 2010 (has links)
In the ongoing discussion of treatment efficacy, some researchers have argued for the use of evidence from randomized controlled trials while others have argued the case for the use of non-randomized designs (Ingham 2003) in the study of the treatment of stuttering. Few attempts have been made to integrate findings from the research on stuttering intervention {Andrews, et al.1980; Howard, Nye, & Vanryckegbem, 2005; Herder, Howard, Nye & Vanryckeghem 2006; Thomas and Howell, 2001). Since the usual approach to the study of treatment efficacy uses experimental and quasi-experimental sources, a summary of the data available from single subject design {SSD) studies would seem warranted. The purpose of this project was to conduct a systematic review and meta-analysis of the effectiveness of stuttering treatment for children and adults by summarizing studies and determining an overall effect by calculating the percentage of non-overlapping data points (PND). The resulting review provides a summary of the effects of stuttering treatment, the nature of the treatment program characteristics and their associated effectiveness, and a general mapping of the research landscape in stuttering treatment terms of its' strengths and weaknesses and areas of need for future research.
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When is refraction stable following routine cataract surgery? A systematic review and meta-analysisCharlesworth, Emily, Alderson, Alison J., de Juan, V., Elliott, David B. 21 December 2020 (has links)
Yes / Purpose: We systematically reviewed the literature to investigate when refraction is stable following routine cataract surgery implanting monofocal intraocular lenses. Current advice recommends obtaining new spectacles 4–6 weeks following surgery. Due to advancements in surgical techniques, we hypothesised that refractive stability would be achieved earlier, which could have major short-term improvements in quality of life for patients. Methods: Medline, CINAHL, AMED, Embase, Web of Science and the Cochrane Library were searched with key words chosen to find articles, which assessed refraction following uncomplicated cataract surgery. Citation chains and the reference lists of all included papers were searched. Unpublished literature was identified using OpenGrey (www.opengrey.eu). The review considered studies that measured refraction at regular intervals following surgery until stability was achieved. Results: The search identified 6,680 papers. Two reviewers independently screened the abstracts and nine papers were found to fit the criteria, of which five were included in the meta-analysis. The quality of the papers was evaluated using the Methodological Index for Non-Randomised Studies (MINORS) instrument. Meta-analysis of 301 patients’ data of spherical, cylindrical and spherical equivalent correction were performed using Review Manager 5 (RevMan 5.3) (https://revman.cochrane.org/). Refraction at 1-week versus the gold standard of 4-weeks showed no significant difference for sphere data (effect size and 95% confidence interval of; ES = 0.00, 95% CI: −0.17, 0.17; p = 1.00), cylindrical data (ES = +0.06; 95% CI: −0.05, 0.17; p = 0.31), and spherical equivalent (ES = −0.01; 95% CI: −0.12, 0.10; p = 0.90). Heterogeneity was non-significant (I2
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Cochrane ‘Living’ Systematic Review on Diagnostic Accuracy of Imaging for COVID-19Islam, Nayaar 28 September 2022 (has links)
Background: The coronavirus disease 2019 (COVID-19) presents diagnostic evaluation and patient management challenges, including uncertainty regarding the role of imaging tests. This series of reviews from the suite of Cochrane ‘living systematic reviews’ aims to evaluate the accuracy of chest imaging (computed tomography (CT), X-ray and ultrasound) for diagnosis and management of individuals with suspected COVID-19.
Methods: The Bern COVID-19 Living Database, Cochrane COVID-19 Register, and CDC Library were searched through 30 September 2020 (for review version 3) and 17 February 2021 (for review version 4). Diagnostic accuracy studies involving participants with suspected COVID-19 were included. Screening, data extraction, and risk of bias assessments (using the QUADAS-2 tool) were completed independently, in duplicate. Pooled accuracy estimates and 95% confidence intervals (CIs) were determined using a bivariate random effects model.
Results: In the third version of the review, chest CT (41 studies, 16133 participants, 8110 (50%) cases) had a pooled sensitivity of 87.9% (95%CI 84.6-90.6) and specificity of 80.0% (74.9-84.3). Chest X-ray (9 studies, 3694 participants, 2111 (57%) cases) had a pooled sensitivity of 80.6% (69.1-88.6) and specificity of 71.5% (59.8-80.8). Ultrasound of the lungs (5 studies, 446 participants, 211 (47%) cases) had a pooled sensitivity of 86.4% (72.7-93.9) and specificity of 54.6% (35.3-72.6). Indirect comparisons showed that chest CT gave higher specificity (P=0.0052) and similar sensitivity (P=0.77) compared to ultrasound. There were no differences (P≥0.05) in accuracy between CT and X‐ray, or X‐ray and ultrasound. In the fourth version of the review, chest CT (69 studies, 28285 participants, 14342 (51%) cases) had a pooled sensitivity of 86.9% (83.6-89.6) and specificity of 78.3% (73.7-82.3). Chest X‐ray (17 studies, 8530 participants, 5303 (62%) cases) had a pooled of sensitivity=73.1% (64.1-80.5) and specificity of 73.3% (61.9-82.2). Ultrasound of the lungs (15 studies, 2410 participants, 1158 (48%) cases) had a pooled sensitivity of 88.9% (84.9-92.0) and specificity of 72.2% (58.8-82.5). Indirect comparisons showed that chest CT and ultrasound had similar sensitivities (P=0.42), and each gave higher sensitivities than X-ray (P=0.0003 and P=0.001, respectively). All modalities had similar specificities (P≥0.05).
Conclusion: The most recent evidence indicates that both chest CT and ultrasound of the lungs are sensitive and moderately specific for diagnosing individuals with suspected COVID-19, while chest X-ray is moderately sensitive and moderately specific. Chest CT and ultrasound may be useful for ruling out COVID‐19, but not for distinguishing COVID-19 from other illnesses. Research assessing the prognostic value of imaging for predicting morbidity and mortality in individuals with COVID-19 is underway and will also be published in the suite of Cochrane ‘living' systematic reviews.
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The Effect of Digital Media on Emergent Literacy Skills: A Systematic ReviewMills, Ciera B. 01 January 2016 (has links)
This review examines the effectiveness of digital media on emergent literacy skills, specifically alphabet knowledge, print awareness, and phonological awareness, on children birth to four. A systematic search of the literature identified 13 studies that met the pre-determined inclusion criteria. Two independent raters evaluated each study for methodological quality and assigned appropriate levels of evidence based on ASHA levels of evidence. Results found that specific features of digital media can lead to positive effects on emergent literacy skills. A checklist with the highlighted features was created to guide clinicians, parents, and others in making decisions about the true educational quality of various screen media.
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Cognitive behavioural therapies for social anxiety disorder (SAnD) reviewMcKenna, Ian January 2013 (has links)
Background: Social anxiety disorder (SAnD) is a highly prevalent condition, characterised by an intense fear of social or performance situations where individuals worry about being negatively evaluated by others. An up to date systematic review of the effectiveness of cognitive behavioural therapies for SAnD is required to guide practice. Objectives: To assess the efficacy and acceptability of cognitive behavioural therapy (CBT) compared with treatment as usual/waiting list (TAU/WL) for individuals with SAnD. Search methods: We searched the Cochrane Depression, Anxiety and Neurosis Group (CCDAN) Controlled Trials Register and conducted supplementary searches of MEDLINE, PsycInfo, EMBASE, and international trial registers (ICTRP; ClinicalTrials.gov) in October 2011 and CINAHL in October 2012. We also searched reference lists of retrieved articles, and contacted trial authors for information on ongoing/completed trials. Selection criteria: Randomised and quasi-randomised controlled trials undertaken in out-patient settings, involving adults aged 18-75 years with a primary diagnosis of SAnD, assigned either to CBT or TAU/WL. Data collection and analysis Data on patients, interventions and outcomes were extracted by two review authors independently, and the Risk of bias in each study was assessed. The primary outcomes were social anxiety reduction (based on relative risk (RR) of clinical response and mean difference in symptom reduction), and treatment acceptability (based on RR of attrition). Results: Thirteen studies (715 participants) were included in the review, of which 11 studies (599 participants) contributed data to meta-analyses. Based on four studies, CBT was more effective than TAU/WL in achieving clinical response at post-treatment (RR 3.60, 95% CI 1.35 to 9.57), and on eleven studies (599 participants) it was more effective than TAU/WL in reducing symptoms of social anxiety. No significant difference was found between CBT and TAU/WL for attrition. No significant difference was demonstrated for social anxiety at follow-up and no studies examined follow-up data for clinical response or attrition. Authors' conclusions: The available evidence suggests that cognitive behavioural therapy might be effective in reducing anxiety symptoms for the short-term treatment of SAnD. However, the body of evidence comparing CBT with TAU/WL is small and heterogeneous.
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A mixed methods investigation into aspects of medication wastage in MaltaWest, Lorna Marie January 2015 (has links)
Reducing medication wastage is a paramount objective in promoting appropriate utilisation of finite resources and preventing negative consequences. The aim of this research was to investigate aspects of medication wastage in Malta by applying mixed methods research and, by doing so, contribute original knowledge to this area. A systematic review was conducted to appraise critically, synthesize and present the available evidence on the possible causative factors associated with medication wastage and the effectiveness of any interventions focusing on wastage reduction as an outcome measure. Findings indicated that only one published paper reported a definition of medication wastage. The main factors contributing to wastage were ‘change in medication’, ‘patient's death’, ‘resolution of patient's condition’ and ‘passed expiry date’. Very few studies reported medication wastage as an outcome measure. The Delphi technique was applied to define ‘medication wastage’ and its contributory factors in the context of the Maltese population. A definition for medication wastage was generated with 86% of panellists agreeing/totally agreeing and sixty-one possible factors leading to wastage were identified by the panellists. The perspectives of the Maltese population, healthcare professionals and students on medication wastage were investigated through cross-sectional surveys. Results of questionnaires indicate lack of patient education and knowledge with the free healthcare system and the overstocking of medication by patients due to previous or potential out of stock situations as contributors to medication wastage. The beliefs and behaviours regarding medication wastage of the Maltese public and healthcare professionals were explored during focus groups. The theoretical domains framework was adopted to design the focus group guide and to interpret systematically the findings. Five key themes emerged which were proposed as solutions to minimise medication wastage: system effects, practitioner effects, patients effects, political effects and awareness and educational effects Research results and findings from all four phases will facilitate the systematic development of strategies and policies, with emphasis on prioritisation, with the aim of minimising medication wastage at all levels.
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