Bakgrund: Frusen skuldra (FS) är ett smärttillstånd som drabbar 2-5% av befolkningen och som påverkar skulderfunktionen. I dagsläget finns det ingen konsensus kring den bästa behandlingsformen vid FS, dock anses proprioceptiv neuromuskulär facilitering (PNF) ge minskad smärta och ökad rörlighet (ROM) samt skulderfunktion.   Syfte: Att kartlägga evidensen av PNF som behandling vid FS. Det var även att granska kvaliteten i inkluderade studier och att studera effekten av PNF på skulderfunktion och ROM. Metod: En systematisk litteraturstudie. Sökningen utfördes i databaserna PubMed, Cochrane, Web of Science samt Google scholar. Artiklarna kvalitetsgranskades med PEDro scale och tillförlitligheten graderades med GRADEstud.  Resultatsammanfattning: Åtta artiklar inkluderades i studien med totalt 360 deltagare. Enligt PEDro scale varierade kvaliteten i studierna mellan tre till åtta poäng. Evidensgraderingen enligt GRADEstud visade mycket låg (+) evidens gällande skulderfunktion och låg (++) evidens gällande ROM. Graderingen baserades på fyra studier av hög kvalitet vid skulderfunktion respektive ROM. Studiernas resultat var motstridiga gällande huruvida PNF ger en signifikant positiv effekt på skulderfunktion och ROM vid FS. Konklusion: Det finns mycket låg (+) evidens för att PNF skulle ha en effekt på skulderfunktionen och en låg (++) evidens för att PNF har en effekt på ROM. För att förtydliga evidensen och användningen av PNF behövs fler studier av hög kvalitet och med liknande tillvägagångssätt. / Background: Frozen shoulder (FS) is a painful condition affecting 2-5% of the population and it affects the shoulder function. Currently there’s no consensus to which treatment is most effective in FS. However, proprioceptive neuromuscular facilitation (PNF) is assumed to bring pain relief and increase range of motion (ROM) and shoulder function.  Objective: To review the evidence regarding the effect of PNF as treatment in patients with FS. It’s also to examine the quality of included studies and to study the effect of PNF on shoulder function and ROM.  Method: A systematic review. The search was conducted in the databases of PubMed, Cochrane, Web of Science and Google scholar. The quality was assessed according to PEDro scale and the reliability with GRADEstud.  Results: Eight studies were included with a total of 360 participants. The quality of the studies ranged between three to eight points according to PEDro scale. According to GRADEstud PNF received very low (+) evidence for shoulder function and low (++) evidence for ROM. The grading was based on four, high quality studies for both shoulder function and ROM. The included studies were conflicting regarding whether PNF had a significant, positive effect on shoulder function and ROM in FS.   Conclusion: There’s very low (+) evidence that PNF would have an effect on shoulder function and low (++) evidence that PNF has an effect on ROM. In order to clarify the evidence there’s a need for future well-conducted studies with a similar approach.

Aims and objectives: To analyse the perceived characteristics of an effective nursing clinical instructor and methods for measure instructor effectiveness. This review also examined importance of characteristics based on student age. Background: The clinical instructor has a vital role in clinical education. While the role may be well defined, the characteristics these instructors need to do their jobs effectively are not. Design: An integrative review from 1985 to present using four key terms: nursing, clinical, teaching and effectiveness. This review revealed 37 articles that met the inclusion criteria for analysis. Methods: Inclusion criteria included studies related to nursing clinical teaching effectiveness of the clinical instructor in a direct patient care setting. An integrative review table of the studies was made by the author. Keywords were analyzed in the results column, and same concepts were grouped together. Results: A synthesis of current research revealed three dominant themes: competency, the ability to develop interpersonal relationships and certain personality traits. The analysis of the literature suggests the ability to develop interpersonal relationships is the most valued skill. Overall, approachability emerged as the most important personality trait needed to be an effective clinical instructor. The analysis also revealed a difference regarding the priority of characteristics based on age of the student. Conclusion: The analysis of the literature suggests the ability to develop interpersonal relationships is the most valued skill for clinical instructors. Overall, approachability emerged as the most important personality trait needed to be an effective clinical instructor. Relevance to clinical practice: Future studies should continue to evaluate the extent of the dominant themes especially considering the rise of the millennial student generation.

Emerging evidence has demonstrated the strong link between cardiorespiratory fitness and multiple aspects of health (i.e., physiological, physical, psychosocial, cognitive), independent of physical activity, among school-aged children and youth. Cardiorespiratory fitness is a trait that does not vary substantially from day-to-day, and provides an indication of recent physical activity levels, making it an important possible indicator of population health. Thus, the objective of this dissertation was to investigate the utility of cardiorespiratory fitness, measured using the 20 m shuttle run test, as a broad, holistic health indicator for population health surveillance among children and youth. To achieve this objective we completed seven manuscripts, all prepared for submission to peer-reviewed, scientific journals: 1. Systematic review of the relationship between 20 m shuttle run performance and health indicators among children and youth. 2. Review of criterion-referenced standards for cardiorespiratory fitness: What percentage of 1 142 026 international children and youth are apparently healthy? 3. Cardiorespiratory fitness is associated with physical literacy among Canadian children aged 8 to 12 years. 4. International variability in 20 m shuttle run performance in children and youth: Who are the fittest from a 50-country comparion? A systematic review with pooling of aggregate results. 5. Making a case for cardiorespiratory fitness surveillance among children and youth. 6. International normative 20 m shuttle run values from 1 142 026 children and youth representing 50 countries. 7. Temporal trends in the cardiorespiratory fitness of 965 264 children and youth representing 19 countries since 1981. Combined, this dissertation provides support for the importance of cardiorespiratory fitness for health surveillance among school-aged children and youth. Results from the international analysis highlighted the variability across countries, with countries in North-Central Europe and Africa having the highest cardiorespiratory fitness, and countries in South America having the lowest cardiorespiratory fitness. The results indicated that declines in cardiorespirtory fitness may have stabilized in recent years in some high- and middle-income countries. This dissertation also identified two methods (criterion- and normative-referenced standards) to interpret cardiorespirtory fitness levels among children and youth, methods that could be used to inform future consensus, surveillance, and cardiorespiratory fitness guidelines.

En la actualidad, los investigadores dedican una buena cantidad de tiempo en la detección y búsqueda de artículos científicos relevantes de forma manual. El desarrollo de estas investigaciones se realiza de forma empírica sin tener en cuenta un modelo tecnológico para el cumplimiento de estándares en su proceso. Por ello, de un tema particular, el proceso rara vez es sustentado con algún procedimiento sistemático para garantizar que se revisó de manera objetiva y que todo el material pertinente está incluido. Existen procedimientos y marcos de trabajo en otras disciplinas como la medicina, pero no son ampliamente conocidas o utilizadas en las demás carreras. Este proyecto propone un Modelo de Gestión, soportado por distintas herramientas de software, con el fin de automatizar la fase de planificación de la revisión sistemática. Esta propuesta se realizó mediante la necesidad de mejorar la satisfacción del investigador al momento de realizar búsquedas de papers relacionados a sus trabajos de investigación. Se desarrolló una interfaz web como canal entre el Modelo de Gestión propuesto y el investigador, con el fin de mostrar el resultado obtenido por el modelo indicando mejoras en tiempo y calidad al momento de realizar búsquedas de papers. Además, como Plan de continuidad se propone un proyecto en base a las siguientes fases de la revisión sistemática, apoyándonos en la revisión de la literatura obtenida en la etapa de análisis del modelo propuesto. / Currently, researchers spend a good amount of time detecting and searching for relevant scientific articles manually. The development of these investigations is done empirically without taking into consideration a technological model for compliance with standards and process. Therefore, on a particular issue, the process is rarely supported by any systematic procedure to ensure that it was objectively reviewed and that all relevant material is included. There are procedures and frameworks in other disciplines such as medicine, but they are not widely known or used in other careers. This project proposes a Management Model supported by different software tools, in order to automatize the planning phase of the systematic review. This proposal was made through the need to improve the satisfaction of the researcher when searching papers related to their research work. A web interface was developed as a link between the proposed Management Model and the researcher, in order to show the result obtained by the model giving improvements in time and quality when searching papers. In addition, as a Continuity Plan, a project is proposed based on the following phases of the systematic review, based on the review of the literature obtained in the analysis stage of the proposed model. / Tesis

OBJECTIVE: To conduct a cost-effectiveness analysis of riociguat and bosentan in the management of chronic thromboembolic pulmonary hypertension (CTEPH) from a United States payer perspective. METHODS: A Markov model was developed following the recommendations of the International Society of Pharmacoeconomics and Outcomes Research - Society for Medical Decision Making Modeling Good Research Practices. A cohort of patients with inoperable CTEPH or post-pulmonary endarterectomy CTEPH were simulated over their lifetime. Health outcomes were measured as quality-adjusted life years (QALY). Efficacy and safety data were obtained from BENEFiT and CHEST-1 trials. Drugs costs, associated costs for the management of CTEPH, were obtained from Redbook and published information such as the Healthcare Cost and Utilization Project (HCUPnet) and Centers for Medicare & Medicaid Services Physician Fee Schedule. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the model projections. RESULTS: Riociguat was more effective than bosentan with an incremental cost of $132,065 and an incremental quality-adjusted life year (QALY) of 0.20, corresponding to an incremental cost-effectiveness ratio (ICER) of -$649,380 per QALY (in favor of riociguat). Riociguat had a lower total discounted lifetime cost compared to bosentan ($2,307,488 versus $2,439,555). Probabilistic sensitivity analyses confirmed dominance of riociguat in 74% of the Monte Carlo simulations. CONCLUSIONS: Results of this model indicates that riociguat is more effective and less costly than bosentan in the management of patients with inoperable CTEPH or post-pulmonary endarterectomy CTEPH.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Background: Pulmonary tuberculosis is a highly prevalent disease in low-income countries; clinical prediction tools allow healthcare personnel to catalog patients with a higher risk of death in order to prioritize medical attention. Methodology: We conducted a literature search on prognostic models aimed to predict mortality in patients diagnosed with pulmonary tuberculosis. We included prospective and retrospective studies where prognostic models predicting mortality were either developed or validated in patients diagnosed with pulmonary tuberculosis. Three reviewers independently assessed the quality of the included studies using the PROBAST tool (Prediction model study Risk of Bias Assessment Tool). A narrative review of the characteristics of each model was conducted. Results: Six articles (n = 3553 patients) containing six prediction models were included in the review. Most studies (5 out of 6) were retrospective cohorts, only one study was a prospective case-control study. All the studies had a high risk of bias according to the PROBAST tool in the overall assessment. Regarding the applicability of the prediction models, three studies had a low concern of applicability, two high concern and one unclear concern. Five studies developed new prediction rules. In general, the presented models had a good discriminatory ability, with areas under the curve fluctuating between 0.65 up to 0.91. Conclusion: None of the prognostic models included in the review accurately predict mortality in patients with pulmonary tuberculosis, due to great heterogeneity in the population and a high risk of bias. / Revisión por pares

The effectiveness of champions in increasing the use of innovations and improving outcomes across health care contexts is not well synthesized in the literature. A systematic review was conducted using the JBI systematic review method. A total of 35 studies (37 articles) were included in the review. The use of champions was related to improvements in system/facility use of innovations. However, the evidence pertaining to causal relationships between use of champions and use of innovations or outcomes is currently inconclusive according to the findings of systematic review. Key limitations of the included primary studies were the use of observational study designs (n = 28) and the lack of detailed description of the champion strategy (n = 26). Future studies that evaluate the effectiveness champions should:1) clearly describe the champion strategy in detail, 2) use experimental design in conjunction to process evaluation, 3) and evaluate the cost-effectiveness of deploying champions.

In the United States, at least 65% of adults have gambled and/or played a video game in the past year. An emerging form of entertainment combines gambling and video game play and has led to an approximately $30 billion per year industry. Despite an explosion in growth, this form of potentially high-risk behavior has received little research attention. This paper will present a systematic review of the available peer-reviewed and grey literature related to gambling on video games. Our review identifies three major methods of combining gambling and video games. First is betting directly on the outcomes of eSports, either with money or via skin gambling. Second is gambling within video games where players purchase a chance to win a valued prize or consumable virtual item (e.g., loot box, prize crate, gacha). Prizes change the within game experience, from superficial items that change an in-game character’s appearance to items that substantially improve a player’s chance of winning. Further, if desired, these items can be sold for actual money in secondary marketplaces. Third, there are gamified casino games with the sequential, skill-based feel of video games and real money at stake. Implications: This paper is the first comprehensive review of this nascent literature. Results will provide clinicians with important insights into the language and behaviors of clients who gamble on video games. Further, findings may have future policy implications as some gambling on video games is potentially accessible to underage gamblers.

Children diagnosed with Autism Spectrum Disorder (ASD) often engage in impulsive, dysfunctional, and maladaptive behaviors (Dawson, Matson, & Cherry, 1998). Research has shown the individuals diagnosed with ASD often exhibit problem behavior when they are required to wait for a preferred item. In fact, research has demonstrated that individuals diagnosed with ASD often choose smaller, immediate reinforcer over larger, delayed reinforcer. Most of the research conducted, however, has previously focused on teaching waiting for a preferred item within the ADHD population. The purpose of the current literature review was to evaluate recent research utilizing behavior interventions to increase socially appropriate waiting with individuals diagnosed with ASD. This review assessed the age of participants, setting(s), research design, independent variables, results, and effectiveness. This review also evaluated the rigor of those studies included utilizing the Quality and Rigor Checklist (Ledford, Lane, & Tate, 2018). Lastly, this review provides recommendations to clinicians currently practicing with the field. / Applied Behavioral Analysis

The aim of this systematic review is to present the current literature on the therapeutic potential of the classic psychedelic compound psilocybin for depressive disorders and the neurocognitive mechanisms involved recorded with functional magnetic resonance imaging (fMRI). A comprehensive literature search was conducted in the electronic databases Web of Science, Scopus and Medline EBSCO using a Boolean search string containing the keywords psilocybin, depression, fMRI, MRI and PET. Our inclusion criteria require original neuroimaging research articles published in scientific peer-reviewed journals involving participants diagnosed with depression receiving psilocybin in conjunction with psychological support. Five articles were identified including a total of 104 participants with depression and 75 who received treatment, resulting in significant reduction of depressive symptoms associated with observable changes in neural activity. Specifically reduced cerebral blood flow (CBF) in amygdala, decreased brain modularity along with functional changes in default mode network (DMN), executive network (EN), salience network (SN), decrease in functional connectivity (FC) between ventromedial prefrontal cortex (vmPFC) to amygdala and increased amygdala reactivity to fearful faces. Limitations of our systematic review include a currently limited amount of articles published and thus lack of control groups in most studies. The current evidence indicates that the therapeutic potential of psilocybin-assisted therapy may provide fast acting and efficient amelioration of depressive symptoms and the effects may be mediated by neurocognitive changes acute and post-treatment. The preliminary results warrants further research in order to optimize treatment and establish safety and efficacy long term.