No / The objective of this article was to evaluate the effectiveness of pharmacist-led medication review in chronic pain management. Six electronic databases (Medline, Embase, PsycInfo, CINHAL, CENTRAL, International Pharmaceutical Abstracts) reference lists of retrieved articles and relevant websites were searched for randomized controlled trials published in the English language involving adults with chronic pain. Studies were included if one of the intervention arms had received pharmacist-led medication review independently or as part of a multidisciplinary intervention. Risk of bias was assessed for all the included studies. The search strategy yielded 583 unique articles including 5 randomized controlled trials. Compared with control, meta-analysis showed that participants in the intervention group had: a 0.8-point reduction in pain intensity on a 0 to 10 numerical rating scale at 3 months [95% confidence interval (CI), -1.28 to -0.36] and a 0.7-point reduction (95% CI, -1.19 to -0.20) at 6 months; a 4.84 point (95% CI, -7.38 to -2.29) and -3.82 point (95% CI, -6.49 to -1.14) improvement in physical functioning on a 0- to 68-point function subscale of Western Ontario and McMaster Universities Osteoarthritis Index at 3 and 6 months, respectively; and a significant improvement in patient satisfaction equivalent to a "small to moderate effect." Pharmacist-led medication review reduces pain intensity and improves physical functioning and patient satisfaction. However, the clinical significance of these findings remain uncertain due to small effect size and nature of reported data within clinical trials that limits recommendation of wider clinical role of pharmacist in chronic pain management.

Introduktion: Barncancer är ett samlingsnamn på en grupp av cancerformer som drabbar barn och ungdomar. Varje år drabbas ungefär 350 barn i Sverige. Att drabbas av cancer som barn är en traumatisk upplevelse som påverkar alla aspekter av livet. Sjukdomen påverkar inte bara barnet, utan familjen som helhet drabbas. För föräldrarna innebär det en omställning med emotionella och sociala anpassningar. Sjuksköterskan har en viktig roll i omhändertagandet av hela familjen. Syfte: Syftet är att undersöka föräldrars upplevelser av att ha ett barn med en cancersjukdom som genomgår behandling. Metod: En litteraturstudie med deskriptiv design användes. Tolv kvalitativa studier från PubMed eller CINAHL har granskats. Studierna analyserades med utgångspunkt i en artikel av Popenoe och medarbetare.   Resultat: Av analysen framkom tre kategorier: När världen vänds upp och ner, Obalans i vardagen och Någonting gott av det tillslut samt nio underkategorier. Föräldrarna beskrev en känslomässig påverkan som innefattade chock, rädsla, oro, ångest, skuld och hjälplöshet under barnets behandling. Då sjukdomen resulterade i ensamhet, oro för ekonomin och svåra påfrestningar upplevdes även en obalans i vardagen. Trots utmaningar och känslomässiga svårigheter beskrev föräldrarna även positiva upplevelser av sjukdomen. Detta beskrevs som trygghet i form av stöd, förbättrade relationer eller ny syn på livet. Slutsats: Föräldrarna till barn med en cancersjukdom upplever förändringar i livet, från chock och rädsla till obalans och påfrestningar i vardagen. Trots utmaningarna kan de uppleva trygghet, nya perspektiv eller förbättrade relationer. Examensarbetet belyser vikten av att arbeta familjefokuserat och att sjuksköterskans har en betydande roll gällande stöd till familjen. / Introduction: Childhood cancer is a collective name for a group of cancer forms that affect children and adolescents. Approximately 350 children in Sweden are diagnosed each year. Being diagnosed with cancer as a child is a traumatic experience that affects all aspects of life. The disease not only affects the child, but also has an impact on the entire family. For the parents, it means significant adjustments with emotional and social adaptations. The nurse has an important role in caring for the whole family.  Aim: The aim is to investigate parents' experiences of having a child with a cancer disease undergoing treatment. Method: A literature review with descriptive design was used. Twelve qualitative studies from PubMed or CINAHL have been reviewed for the results. The studies were analyzed based on an article by Popenoe and colleagues. Results: Three categories emerged from the analysis: when the world turns upside down, imbalance in everyday life and finding something good in it eventually, along with nine subcategories. The parents experienced a significant emotional impact such as shock, fear, worry, anxiety, guilt and helplessness during their child's treatment. An imbalance in everyday life was also experienced as the disease resulted in loneliness, financial worries and severe strains. Despite challenges and emotional difficulties, a number of parents also experienced positive aspects of the disease. This was described as security in form of support, improved relationships and a new outlook on life.  Conclusion: The parents of children with a cancer disease experienced a variety of changes in life, from shock and fear to imbalance and stress in everyday life. Despite many challenges, they experienced safety, new perspectives, and improved relationships. The thesis emphasizes the importance of working with a family-focused view and the nurse's significant role in supporting the family.

Reliability generalization (RG) is a method for meta-analysis of reliability coefficients to estimate average score reliability across studies, determine variation in reliability, and identify study-level moderator variables influencing score reliability. A total of 107 peer-reviewed RG studies published from 1998 to 2013 were systematically reviewed to characterize the meta-analytic methods employed and to evaluate quality of reporting practice against standards for transparency in meta-analysis reporting. Most commonly, RG studies meta-analyzed alpha coefficients, which were synthesized using an unweighted, fixed-effects model applied to untransformed coefficients. Moderator analyses most frequently included multiple regression and bivariate correlations employing a fixed-effects model on untransformed, unweighted coefficients. Based on a unit-weighted scoring system, mean reporting quality for RG studies was statistically less than that for a comparison study of 198 meta-analyses in the organizational sciences across 42 indicators; however, means were not statistically significantly different between the two studies when evaluating reporting quality on 18 indicators deemed essential to ethical reporting practice in meta-analyses. Since its inception a wide variety of statistical methods have been applied to RG, and meta-analysis of reliability coefficients has extended to fields outside of psychological measurement, such as medicine and business. A set of guidelines for conducting and reporting RG studies is provided.

Endodontic treatments are significantly improved by the efficacy of root canal sealers against microbial invasion. This systematic review and meta-analysis focus on comparing the antimicrobial efficacy of nanoparticle-modified bio-ceramic endodontic sealers with conventional bio-ceramic sealers. This review adhered to PRISMA guidelines and included both in vitro and ex vivo studies after a comprehensive search in PubMed, Embase, and Web of Science. The antimicrobial property of the bioceramic sealers was analyzed through the colony forming units (CFU), the diameter of inhibition zone and microbial viability. Eleven studies were used for the analysis. Overall, results from the meta-analysis indicated that modified bio-ceramic sealers exhibit an enhanced antibacterial effect compared to their conventional counterparts. A standardized mean difference was computed across 11 studies and 28 sub study groups, revealing a significant antimicrobial effect size in favor of the nanoparticle-modified bio-ceramic sealer. However, high heterogeneity among studies was observed. Chitosan, silver and bioactive glass were among the common nanoparticles used to modify bio-ceramic sealers. A 2% concentration of chitosan nanoparticles showed the highest antimicrobial effect size. Despite the heterogeneity found in the study, the findings suggest that the modification of bio-ceramic sealers with nanoparticles possesses the potential to advance endodontic treatments. The promising direction of these nanoparticle enhancements indicates a valuable progression in endodontics, advocating for additional research and development to optimize the use of nanoparticles in clinical settings. / Oral Biology

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13599号 / 論医博第2309号 / 新制||医||1072(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 山本 洋介, 教授 近藤 尚己, 教授 西浦 博 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

No / RATIONALE, AIMS & Tools for the assessment of the quality of research studies tend to be specific to a particular research design (e.g. randomized controlled trials, or qualitative interviews). This makes it difficult to assess the quality of a body of research that addresses the same or a similar research question but using different approaches. The aim of this paper is to describe the development and preliminary evaluation of a quality assessment tool that can be applied to a methodologically diverse set of research articles. METHODS: The 16-item quality assessment tool (QATSDD) was assessed to determine its reliability and validity when used by health services researchers in the disciplines of psychology, sociology and nursing. Qualitative feedback was also gathered from mixed-methods health researchers regarding the comprehension, content, perceived value and usability of the tool. RESULTS: Reference to existing widely used quality assessment tools and experts in systematic review confirmed that the components of the tool represented the construct of 'good research technique' being assessed. Face validity was subsequently established through feedback from a sample of nine health researchers. Inter-rater reliability was established through substantial agreement between three reviewers when applying the tool to a set of three research papers (kappa = 71.5%), and good to substantial agreement between their scores at time 1 and after a 6-week interval at time 2 confirmed test-retest reliability. CONCLUSIONS: The QATSDD shows good reliability and validity for use in the quality assessment of a diversity of studies, and may be an extremely useful tool for reviewers to standardize and increase the rigour of their assessments in reviews of the published papers which include qualitative and quantitative work.

Yes / Objectives To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. Methods Using the World Health Organisation definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs and data were systematically extracted using electronic data extraction proforma. Results 407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n=7) focussing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The papers were generally considered to be of low to moderate quality with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No papers reported data relating to time to diagnosis, time to recovery or patient mortality. Conclusions Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited. Advances in knowledge This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality. Powered by

Yes / It has been argued that transition points in life, such as the approach towards, and early years of retirement present key opportunities for interventions to improve the health of the population. Research has also highlighted inequalities in health status in the retired population and in response to interventions which should be addressed. We aimed to conduct a systematic review to synthesise international evidence on the types and effectiveness of interventions to increase physical activity among people around the time of retirement. A systematic review of literature was carried out between February 2014 and April 2015. Searches were not limited by language or location, but were restricted by date to studies published from 1990 onwards. Methods for identification of relevant studies included electronic database searching, reference list checking, and citation searching. Systematic search of the literature identified 104 papers which described study populations as being older adults. However, we found only one paper which specifically referred to their participants as being around the time of retirement. The intervention approaches for older adults encompassed: training of health care professionals; counselling and advice giving; group sessions; individual training sessions; in-home exercise programmes; in-home computer-delivered programmes; in-home telephone support; in-home diet and exercise programmes; and community-wide initiatives. The majority of papers reported some intervention effect, with evidence of positive outcomes for all types of programmes. A wide range of different measures were used to evaluate effectiveness, many were self-reported and few studies included evaluation of sedentary time. While the retirement transition is considered a significant point of life change, little research has been conducted to assess whether physical activity interventions at this time may be effective in promoting or maintaining activity, or reducing health inequalities. We were unable to find any evidence that the transition to retirement period was, or was not a significant point for intervention. Studies in older adults more generally indicated that a range of interventions might be effective for people around retirement age. / This work was funded by the National Institute for Health Research as part of the Public Health Research Programme, (grant number 12/133/20).

Yes / Health services in many countries are investing in inter-organisational networks, linking patients’ records held in different organisations across a city or region. The aim of the systematic review was to establish how, why, and in what circumstances these networks improve patient safety, fail to do so, or increase safety risks, for people living at home. Design Realist synthesis, drawing on both quantitative and qualitative evidence, and including consultation with stakeholders in nominal groups and semi-structured interviews. Eligibility criteria The co-ordination of services for older people living at home, and medicine reconciliation for older patients returning home from hospital. Information sources 17 sources including Medline, Embase, CINAHL, Cochrane Library, Web of Science, ACM Digital Library and Applied Social Sciences Index and s (ASSIA). Outcomes Changes in patients’ clinical risks. Results We did not find any detailed accounts of the sequences of events that policy makers and others believe will lead from the deployment of interoperable networks to improved patient safety. We were, though, able to identify a substantial number of theory fragments, and these were used to develop programme theories. There is good evidence that there are problems with the co-ordination of services in general, and the reconciliation of medication lists in particular, and it indicates that most problems are social and organisational in nature. There is also good evidence that doctors and other professionals find interoperable networks difficult to use. There was limited high quality evidence about safety-related outcomes associated with the deployment of interoperable networks. Conclusions Empirical evidence does not currently justify claims about the beneficial effects of interoperable networks on patient safety. There appears to be a mismatch between technology-driven assumptions about the effects of networks and the socio-technical nature of co-ordination problems. Review registration: PROSPERO CRD42017073004 / NIHR Grant 16/53/03

Yes / To examine the impact of acute classroom movement break (CMB) and physically active learning (PAL) interventions on physical activity (PA), cognition, academic performance and classroom behaviour. Systematic review. PubMed, EBSCO, Academic Search Complete, Education Resources Information Center, PsycINFO, SPORTDiscus, SCOPUS and Web of Science. Studies investigating school-based acute bouts of CMB or PAL on (PA), cognition, academic performance and classroom behaviour. The Downs and Black checklist assessed risk of bias. Ten PAL and eight CMB studies were identified from 2929 potentially relevant articles. Risk of bias scores ranged from 33% to 64.3%. Variation in study designs drove specific, but differing, outcomes. Three studies assessed PA using objective measures. Interventions replaced sedentary time with either light PA or moderate-to-vigorous PA dependent on design characteristics (mode, duration and intensity). Only one study factored individual PA outcomes into analyses. Classroom behaviour improved after longer moderate-to-vigorous (>10 min), or shorter more intense (5 min), CMB/PAL bouts (9 out of 11 interventions). There was no support for enhanced cognition or academic performance due to limited repeated studies. Low-to-medium quality designs predominate in investigations of the acute impacts of CMB and PAL on PA, cognition, academic performance and classroom behaviour. Variable quality in experimental designs, outcome measures and intervention characteristics impact outcomes making conclusions problematic. CMB and PAL increased PA and enhanced time on task. To improve confidence in study outcomes, future investigations should combine examples of good practice observed in current studies. CRD42017070981.