1,721,168 research outputs found
Effect of healthcare personnel in e-health interventions on glycated haemoglobin in adults with type 2 diabetes - a systematic review
Get PDFThis systematic review shows that providing e-health with tailored HCP feedback to patients with type 2 diabetes, does not have added health benefits when the control group also receives e-health. While all of the included studies had some reduction in HbA1c levels, none of the study groups reach treatment target of HbA1c, less than 7%. Furthermore, there was no clinically relevant impact on blood pressure, low density lipoprotein or weight. The review studies were highly heterogeneous, with different characteristics of participants, interventions and control conditions. There is a need for additional high quality RCTs and subsequently systematic reviews in order to draw firm conclusions about the effect of including HCP in e-health interventions. For policy makers to assess the overall effectiveness of HCP involvement in e-health interventions, future reviews must also address other types of diabetes related outcomes. Furthermore, future primary studies must address the long-term effects of HCP involvement in e-health when it comes to cost-effectiveness and patient utilization
Individualized dietary counseling on nutritional status in head and neck cancer patients undergoing radiotherapy: A systematic review
Get PDFIndividualized dietary counseling given with or without oral nutritional supplements, on the outcome of nutritional status, in head and neck cancer patients undergoing radiotherapy, compared to standard routine clinical care, with or without other nutritional interventions: A systematic review.
Background: Malnutrition and unintentional weight loss is common in patients with head and neck cancer. Malnutrition is a serious risk factor for morbidities, mortality, and heavily increased health care costs.
Nutritional interventions available today include individualized dietary counseling by a registered dietitian (RD), use of oral nutritional supplements, and the application of nutritional support by enteral tube feeding, and parenteral intravenous nutrition. Emerging research suggests that nutritional interventions may be helpful in decreasing unintended weight loss and malnutrition, reversing malnutrition and reducing its devastating consequences, but groups of experts recommend more research to draw firm conclusions about these effects.
Individualized regular dietary counseling by an RD throughout radiotherapy cancer treatment is not a standard treatment provided for head and neck cancer patients today. Rather, doctors may refer patients to an RD once malnutrition is already determined. Studies have shown effect of dietary counseling by an RD as one important nutritional intervention for patients at risk of malnutrition. More research is needed in order to ascertain the harms and benefits of making the intervention available to patients at risk of malnutrition and to patients with head and neck cancer undergoing radiotherapy, on a regular basis.
Objectives: To determine the effects of individualized dietary counseling by an RD, given with or without the use of oral nutritional supplements, on nutritional status, in adult patients with a diagnosis of head and neck cancer, who are, or will be undergoing radiotherapy treatment.
Methodology: This is a systematic review of randomized controlled trials (RCTs). It was conducted in accordance with the steps in The Cochrane Handbook of Systematic Reviews for Interventions 5th Edition.
The population was both genders ≥19 years with a medical diagnosis of cancer of the head and neck who underwent radiotherapy cancer treatment with the intervention of one or more individualized dietary counseling sessions performed by an RD, given with or without the use of oral nutritional supplements. The comparator was standard routine clinical care with no individualized dietary counseling, with or without other nutritional interventions. The primary outcome was nutritional status measured by changes in weight and/or measured by changes in caloric intake. Secondary outcomes were quality of life, physical fitness, hospital readmissions, and mortality. Searches were technically performed by a skilled librarian in the following databases: MEDLINE (OVID), EMBASE (OVID), Cochrane Library (CENTRAL) (Wiley), CINAHL (EBSCO), Web of Science Core Collection (SCI-EXPANDED & SSCI) (Clarivate). Relevant data was extracted onto an excel sheet, and a narrative summary was constructed in a word document. Studies’ risk of bias (RoB) was performed for every included RCT in accordance with criteria of Cochrane. The Review Manager 5.4.1 (Revman 2020) tool, was used to generate forest plots for displaying results of two of the outcome measures, though not pooling results in meta-analysis, and tables displaying results for two outcome measures. A narrative summary grading of recommendations assessment, development, and evaluation (GRADE) assessment was performed to assess the certainty of the evidence.
Results: The database searches resulted in 969 studies after deletion of duplicates, the screening-process, full-text reading, and selection of studies that met inclusion criteria finally resulted in 3 studies presented in 4 articles. Three RCTs presented in four articles met the inclusion criteria for this systematic review, (n = 146 participants). The three RCTs were conducted in high income countries. The nutritional intervention for all three RCTs was dietary counseling by an RD where two of the studies included the use of oral nutritional supplements if this was deemed appropriate for participants, while one study only gave dietary counseling of ordinary foods without the use of oral nutritional supplements. Follow-up time for all included RCTs was 12 weeks, two studies gave nine dietary counseling sessions and one study gave seven sessions. Only two participants from the control group of one of the studies were given tube feeding due to rapid deterioration in nutritional status during the study period. All the three RCTs were assessed as having high risk of bias. All three studies measured outcomes on changes in weight, two studies measured outcomes on changes in energy intake, quality of life and physical function. None of the included studies measured mortality and hospital readmission. Results were not statistically pooled for any of the outcome measures due to insufficient data reporting. Further, meta-analyses were deemed inappropriate due to the studies’ high risk of bias which could further produce erroneous pooled results. All results favored dietary counseling given with or without oral nutritional supplements, although the effect estimates greatly differed. Results of the included studies suggest, with low and very low quality of evidence, that dietary counseling given with or without the use of oral nutritional supplements, may improve nutritional status in patients with head and neck cancer undergoing radiotherapy compared to standard clinical care with or without other nutritional interventions.
Author’s conclusions: From this systematic review, evidence of low and very low quality suggests that dietary counseling during radiotherapy for head and neck cancer patients, given with or without oral nutritional supplements may improve weight, energy intake, quality of life and physical function. Adequately powered RCTs, performed with pristine methodology ensuring appropriate blinding, and even multi-center studies are required to evaluate these effects in the future
Effects of psychological and psychosocial interventions for refugees: a systematic review
Get PDFIn this systematic review, I investigated the effect of psychological and psychosocial interventions for refugees. The objective of this master thesis was to look at the effects of psychological and psychosocial intervention on PTSD and/or depression for adult refugees in Europe who suffers from PTSD and/or depression
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Self-assessment of the outcome of first trimester medical abortion compared to routine clinic follow-up: A systematic review
Get PDFBackground: Home self-administration of misoprostol for medical abortion has been suggested as safe, efficient, feasible and acceptable. However, it remains inaccessible for many women especially in low-resource settings. Administration of misoprostol at home and self-assessment by urine pregnancy tests (UPTs) to confirm complete termination of pregnancy with follow-up by home visits or telephone call after 12-15 days after the intake of mifepristone helps to de-medicalize abortion and provides privacy to women.
Objective: To assess the effectiveness, safety, and acceptability of self-assessment of the outcome of medical abortion in a non-inferiority comparison with routine clinic follow-up after medical abortion at home.
Methodology: A systematic review for randomized controlled trials (RCTs) of self-assessment of the outcome of medical abortion compared with routine clinic follow-up was conducted. The systematic review followed the Cochrane Handbook of Systematic Reviews for Intervention. A thorough search was performed in databases such as Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, CINAHL, British Nursing Index and Archive, Scopus and Google Scholar. Searches were also done in ClinicalTrials.Gov and WHO-ICTRP for ongoing studies.
The population was women of reproductive age, 15 years or above, who had a confirmed pregnancy and who had requested a medical termination of pregnancy up to 9 weeks (63 days) of gestation age, which they performed at home. The intervention, self-assessment of outcome done by UPTs by women themselves at home combined with a follow-up by telephone call or home visit to confirm the complete termination of pregnancy, was compared with assessment of the outcome of medical abortion performed by medical/health care personnel during routine clinic follow-up visits. The primary outcome was effectiveness of self-assessment of the outcome of medical abortion compared to routine clinic follow-up, while its safety and acceptability were the secondary outcomes.
Risk of bias (RoB) assessment was performed for each included RCT in accordance with the criteria in the Cochrane Handbook for Systematic Reviews of Interventions. The outcomes were analysed as risk ratios (RR) with 95% confidence intervals (CI). Review Manager 5.3 (RevMan 2014) was used to pool the data (meta-analysis) and to generate forest plots to display the results. A GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment was conducted to assess the certainty of the evidence.
Results: Four studies met the inclusion criteria (n = 5394 participants). All were RCTs, two of these were non-inferiority RCTs, which described the results of self-assessment of the outcome of induced abortion with mifepristone and misoprostol at home. The studies were conducted in low to high resource setting countries. There was low risk of bias associated with the included studies. Pooled analyses from all studies showed no statistically significant difference in complete abortion rates between self-assessment and routine clinic follow-up: RR= 1.00; 95% CI = 0.99 to 1.01 (high quality evidence). The point estimates for the pooled safety measures were: need for surgery (RR= 0.92; 95% CI = 0.7 to 1.21), occurrence of haemorrhage (RR= 1.48; 95% CI = 0.84 to 2.60), occurrence of fever and infection (RR= 0.41; 95% CI = 0.08 to 2.12), and drug administration for haemorrhage (RR= 1.81; 95% CI = 0.61 to 5.35). There were no statistically significant differences between the groups with respect to safety of the assessment technique (moderate to low quality evidence). The results showed that the preference of follow-up method is significantly greater for self-assessment compared to routine clinic follow-up. Overall, these results show that self-assessment at home is as safe as routine clinic follow-up.
Author’s Conclusions: This systematic review summarizes and presents that there is high quality evidence that the effectiveness of self-assessment of the outcome of medical abortion at home is not inferior to routine clinic follow-up. Further, it shows that self-assessment with telephone or home follow-up is safe and acceptable compared to routine clinic follow-up. This intervention is feasible to implement. Therefore, it can be incorporated as an alternative to abortion services in both low and high resource settings, giving women a choice whether to do the assessment by themselves or in clinics
Prevalence and predictors of fatigue among people living with HIV in Northern and Southern Norway. From the cross-sectional study of mental health and quality of life among people living with HIV in Northern and Southern Norway, 2014-2015
Get PDFFatigue is described as a sensation of tiredness and exhaustion that potentially interferes with daily life functioning, and is a common symptom in people living with HIV (PLWH). This study aim is to investigate the prevalence and the predictors of fatigue among PLWH in Northern and Southern Norway. A cross-sectional survey was conducted at two hospitals in 2014-2015. Fatigue was measured with the Chalder Fatigue scale, and logistic regression was used to identify predictors of fatigue. 244 patients; 94 fatigued (38.5%) and 150 non-fatigued; were included in the analysis. The final regression model consisted of ten covariates; age, gender, men who have sex with men, CD4+-count, cohabitation, education, multimorbidity, mental distress, bodily pain and trouble sleeping. The strongest predictors of fatigue were symptoms of anxiety and depression measured as presence of mental distress (aOR 8.98, 95% CI 3.81-21.15) and increased bodily pain on a scale from 0-10 (aOR 1.44, 95% CI 1.25-1.67). Other significant predictors were living alone (aOR 2.99, 95% CI 1.36-6.56), trouble sleeping (aOR 2.67, 95% CI 1.06-6.71) and multimorbidity (aOR 5.64, 95% CI 1.52-20.95). In conclusion the prevalence of fatigue among PLWH in Southern and Northern Norway is 38%, almost two times higher than the estimated prevalence in the Norwegian general population (22%). We identified mental distress, bodily pain, trouble sleeping, living alone and multimorbidity as predictors of fatigue. If fatigue and its predictors, are identified and addressed, it may improve the quality of life for many. More research on prevention and treatment strategies for fatigued PLWH is needed, and should be implemented in the daily clinical routines
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Effect of group psychoeducation for major depressive disorder: a systematic review
Get PDFBackground: Depression is a common mental disorder and a major contributor to the overall global burden of disease. Healthcare systems struggle to provide effective and acceptable treatment to meet the needs of the growing number of patients suffering from depression. Although there are some known, effective medical treatments for depression, far from all of those affected receive such treatments, and there is a corresponding patient- and stakeholder demand for drug-free alternatives to treat depression. Group psychoeducation is a low threshold, drug-free intervention which has proven to be beneficial in the treatment of other mental disorders and which can be adapted to different populations. Use of group psychoeducation for major depressive disorder (MDD) will increase the availability of treatment, if proven to be effective, because it allows for treating several patients in the same session and meets calls for drug-free treatment.
Objective: To systematically review the effectiveness of group psychoeducation for adults with MDD, as sole treatment or in conjunction with treatment as usual (TAU), compared to pharmacological treatment and/or other psychological treatment. Included effect measures are quality of life, depression severity, mortality (suicide), psychosocial functioning, relapse, and compliance.
Methods: The review was planned and described in a PROSPERO (CRD42017077110) registered protocol. The search strategy was executed by a search librarian and it was peer reviewed by another librarian. The search included electronic searches in MEDLINE, Embase, the Cochrane Library, PsycINFO, PubMed, CINAHL, Epistemonikos and a hand search of 29 systematic reviews. The search yielded a total of 4219 records, which were screened independently by two reviewers. We assessed eligible studies for risk of bias using the Cochrane risk of bias tool for RCTs. We conducted meta-analyses when studies were sufficiently similar in terms of design, population, intervention, and outcomes. Lastly, we evaluated the certainty of the body of evidence using the GRADE approach.
Results: Nine randomized controlled studies (RCTs) with a total of 1249 patients met the inclusion criteria. The meta-analytic results showed that group psychoeducation in conjunction with TAU compared to TAU lead to a reduction in depression at 4-6 weeks, SMD= -0.32 (95% CI: -0.59 to -0.04), and 6 months, SMD= -0.21 (95% CI: -0.38 to -0.04). The effect of psychoeducation in conjunction with TAU was not significant at 12 months follow up, SMD= 0.22 (95% CI:-0.02 to 0.45). Family psychoeducation (groups including patient and caregiver) in conjunction with TAU showed a greater effect on depression than patient group psychoeducation. This was particularly prominent at 3 months follow-up, SMD= -1.21 (95% CI: -1.64 to -0.78). Family psychoeducation in conjunction with TAU also showed greater effect than TAU alone on psychosocial functioning at 3 months follow-up, SMD= 0.98 (95% CI: 0.56 to 1.40). The confidence in the certainty of the evidence varies from high to low. Results for psychosocial functioning was downgraded due to small sample size.
Conclusions: While the current body of research on group psychoeducation shows promise for its effects on depression and psychosocial functioning, further evidence on the short- and long-term effects is needed. Family group psychoeducation seems to give better results than patient group psychoeducation. Robust studies to build a solid evidence on the effect of psychoeducation and knowledge on the effects for different patient groups in various socioeconomic- and cultural settings are necessary, prior to a generalised recommendation on this intervention for patients with major depressive disorder.
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