Positive Effect Of Interventions Research Articles

Impact of COVID-19 pandemic on vaccinations in children in a primary health centre in Northern India

Background: Pandemics and disease outbreaks necessitate the continuation of routine immunization and vaccination for a specific age group along with safety measures for healthcare professionals. India witnessed the COVID-19 pandemic with a drastic rise in the number of cases across the states and union territories in 2020. Routine childhood immunizations suffered mainly because of an overburdened health system coupled with the fear of COVID-19 infection. The present audit is aimed to study the impact of the interventions made to improve routine immunization in the post-COVID-19 period in children in the age group of 0-16 years suitable for immunization under the National Immunization Scheme. Methods: A cross sectional study was conducted by retrieving records in the PHC for the impact of COVID-19 on routine immunizations for vaccine preventable disease in the 0-16 age group. Data were retrieved and collected in a predesigned proforma. Archives of each of the years 2019, 2020, 2021, and 2022 for the month of April. The effect of the interventions for improving vaccine coverage in the rural population was evaluated. Results: A comparison of pre-covid and covid periods showed a significant drop in routine immunization (p=0.007). Higher immunization rates were observed in post covid compared to the COVID period indicating the positive effect of interventions (p=0.0000014) Conclusions: Vaccination rates improved significantly following interventions in the rural population. Health education on safety precautions for COVID-19 and the importance of routine immunization in the pediatric age group has helped to improve vaccination status.

Comparing the Effectiveness of Neurofeedback, Neuropsychology, and Phonological Awareness Methods in Improving Dyslexia Symptoms of Students: A Network Meta-analysis

Context: There is evidence of the positive effect of neurofeedback, neuropsychology, and phonological awareness interventions on improving dyslexia symptoms. However, no agreement exists on the effectiveness of these interventions and the most efficient intervention. Objectives: This research aimed to compare the effectiveness of interventions based on neurofeedback, neuropsychology, and phonological awareness in improving dyslexia symptoms in students with the network meta-analysis method to determine the most efficient intervention. Evidence Acquisition: A network meta-analysis was conducted to identify studies on neurofeedback, neuropsychology, and phonological awareness interventions. A systematic review was done using Scopus, PubMed, Magiran, SID, and Civilica databases to find studies related to the research objectives, which led to the analysis of 49 studies with 1,741 participants and 15 types of interventions compared to controls. Individual interventions were classified into neurofeedback, neuropsychology, and phonological awareness. The studies were evaluated in terms of the risk of bias. The data were analyzed using the frequency approach through R and R studio software to compare the direct and indirect evidence of the effectiveness of the interventions. Results: Neurofeedback, neuropsychology, and phonological awareness interventions were effective in improving dyslexia symptoms compared to controls. The perceptual-motor method, among individual interventions, and neuropsychological interventions, among group interventions, were ranked as "interventions with greater effectiveness" in reducing dyslexia symptoms. Subgroup analysis was also performed to find the sources of heterogeneity and inconsistency. Conclusions: To the perceptual-motor method and neuropsychology intervention group were ranked as the best interventions.. However, most of these studies were conducted in Iran, and further studies in different cultural fields and countries can help clarify the issue.

Comparing the Effectiveness of Neurofeedback, Neuropsychology, and Phonological Awareness Methods in Improving Dyslexia Symptoms of Students: A Network Meta-analysis

Context: There is evidence of the positive effect of neurofeedback, neuropsychology, and phonological awareness interventions on improving dyslexia symptoms. However, no agreement exists on the effectiveness of these interventions and the most efficient intervention. Objectives: This research aimed to compare the effectiveness of interventions based on neurofeedback, neuropsychology, and phonological awareness in improving dyslexia symptoms in students with the network meta-analysis method to determine the most efficient intervention. Evidence Acquisition: A network meta-analysis was conducted to identify studies on neurofeedback, neuropsychology, and phonological awareness interventions. A systematic review was done using Scopus, PubMed, Magiran, SID, and Civilica databases to find studies related to the research objectives, which led to the analysis of 49 studies with 1,741 participants and 15 types of interventions compared to controls. Individual interventions were classified into neurofeedback, neuropsychology, and phonological awareness. The studies were evaluated in terms of the risk of bias. The data were analyzed using the frequency approach through R and R studio software to compare the direct and indirect evidence of the effectiveness of the interventions. Results: Neurofeedback, neuropsychology, and phonological awareness interventions were effective in improving dyslexia symptoms compared to controls. The perceptual-motor method, among individual interventions, and neuropsychological interventions, among group interventions, were ranked as "interventions with greater effectiveness" in reducing dyslexia symptoms. Subgroup analysis was also performed to find the sources of heterogeneity and inconsistency. Conclusions: To the perceptual-motor method and neuropsychology intervention group were ranked as the best interventions.. However, most of these studies were conducted in Iran, and further studies in different cultural fields and countries can help clarify the issue.

Current advances in the pharmacological prevention and management of cognitive dysfunction in multiple sclerosis

ABSTRACT Introduction Cognitive impairment (CI) is a core feature of Multiple Sclerosis (MS), being detectable in up to 65% of subjects. Treatment of CI can be considered of paramount importance. However, no standardized strategies are available to date to define the best treatment approach, especially for the pharmacological management. Areas covered In this narrative review, the authors outline the latest advances in pharmacological management of CI in MS, including Disease Modifying Treatments (DMTs) which indirectly may or may not influence CI and symptomatic drugs. Selected publications were restricted to those written in English, reporting on an adult relapsing-remitting MS or progressive MS sample, assessing the effects of (at least) 1 DMT or treatment in a longitudinal design, reporting data on (at least) one standardized cognitive test performed at baseline and follow-up, and published between January 2018 and May 2022. Expert opinion Recent data can be considered encouraging and inspiring for future studies. Overall, there is preliminary evidence of a beneficial effect of DMTs on cognition, particularly for high-efficacy DMTs. As for symptomatic treatments, dalfampridine appears to be the only medication with robust evidence of a positive effect on cognition. However, the definition of clinically meaningful change/improvement in cognitive functions remains an unmet need. Future studies should assess the role of other patient-related factors that can be associated with a better cognitive response to treatments and investigate the possible positive effect of multimodal interventions on cognition.

Positive Effect of Natural Resources Management Interventions on Bio-physical Indictors in Polla Watershed Project of Srikakulam District, Andhra Pradesh, India

Aim: This Investigation was taken up to detect the changes in the Bio-Physical Indicators of Polla Watershed project implemented under Pradhan Mantri Krishi Sinchayee Yojana (PMKSY) watershed project in Srikakulam District of Andhra Pradesh, India.
 Place and Duration of Study: This study was conducted at the Polla watershed area of Seetham pet mandal of Srikakulam District, which is under drought Prone Area Project (DPAP) by the Panchayat Raj and Rural Development (PR and RD) Department, Andhra Pradesh during 2013 to 2020.
 Methodology: High-resolution satellite data like Resourcesat-2, Linear Imaging and Self Scanning-IV (LISS-IV) of 2013 (pre-treatment) and 2020 (post-treatment) and ArcGIS 10.8 software were used in this project to measure the changes in land use/land cover and biomass during the project period (2013-20).
 Result: The results showed a reduction in wastelands by 59.67% (786.59 ha) and an increase in cropland and plantation by 32.68% (756.34ha) and 2.16% (24.55ha) respectively. There is an increase in dense vegetation 49.36 ha (3.93 %), medium vegetation412.04ha (28.36 %), Low Vegetation 247.93ha (19.25 %) and a decrease in nil vegetation 709.33 ha (-57.99 %). Another positive indicator of watershed development in the project area is the increase in waterbodies by 17.10 %, due to the construction of rainwater harvesting structures i.e., 21 percolation tanks, 10 rockfill dams,18 loose boulder structures, 19 Mini Percolation Tanks etc.
 Conclusion: This study reveals that an additional area of 5.69ha (17.10%) increased under water bodies and 786.59 ha of wasteland converted to cultivable land due to the construction of rockfill dams, percolation tanks, mini percolation tanks, check walls and loose boulder structures. This area is reflected in cropland and plantations.

Assessment of the effectiveness of parent-targeted interventions for the use of child restraint systems: a systematic review and meta-analysis.

It is essential to implement parent-targeted interventions to increase the use of child restraint systems (CRS) and thus reduce the injuries and deaths of children due to motor vehicle collisions. To optimize future intervention designs, this meta-analysis sought to quantify the effects of parent-targeted interventions and explore potential intervention moderators. Studies met inclusion criteria if they included a parents-targeted intervention that focused on increasing CRS use for children, published from the inception of the databases to January 2022, were systematically retrieved from the PubMed, Embase, Cochrane library, Web of Science, Sinomed, Wanfang, and CNKI databases. Next, 2 researchers independently screened the retrieved articles, evaluated their quality according to the Cochrane Tool, and extracted the data. Finally, Stata12.0 was used for the meta-analysis. Heterogeneity was examined with I2, stratified analyses, and meta-regression. Of the 1,690 articles retrieved, 9 studies, comprising 22,329 parents of children aged 0-12 years, were ultimately included in the analysis. The results of the meta-analysis showed that the CRS use rate of the intervention group was 1.62 times higher than that of the control group [95% confidence interval (CI): 1.25-2.11, Z=3.616, P<0.001], indicating the positive effect of parent-targeted interventions on promoting the use of CRS. The subgroup analysis found that interventions guided by behavioral theories increased the use of CRS (odds ratio: 1.44, 95% CI: 1.27-1.63, n=5). The difference in the use of CRS between the groups in the studies that were not guided by theories was not statistically significant, indicating that interventions guided by behavioral theories may be the source of the heterogeneity. Risk of bias was low in most studies. It is necessary to conduct interventions with parents to increase the use of CRS. The effects on CRS use appear to differ depending on whether the interventions are guided by behavioral theories. In-depth research needs to be conducted to explore the characteristics of the interventions, especially those guided by different behavioral theories, to reduce child vehicle injuries.

Consideration for Positive and Negative Effect of Multi-Sensory Environment Interventions on Disabled Patients through Electrocardiography

Many studies have supported the efficacy of multi-sensory environment (MSE) interventions in reducing behavioral and psychological symptoms and improving the quality of life for disabled patients. However, it is difficult to identify the groups that are helped and those who are harmed. This study verified the effect of multi-sensory environment interventions on disabled patients by using thermal images, then addressed the precaution using electrocardiography (ECG). Twenty disabled patients participated in experiments for 12 min: ten with muscular dystrophy (MD) and ten with severe motor and intellectual disabilities (SMID). The continuous measurement of nasal temperature evaluated the emotional arousal after facial detection. The QT-RR relation was used to assess the risk degree. It was found that the continuous measurement of nasal temperature enabled us to evaluate the emotional arousal of disabled patients in MSE with the comparison of ECG. Through the QT-RR relation, it was found that the risk assessment for the patient with SMID was 11 times higher than those with MD because the QT was below 300 ms. Therefore, it was concluded that the specification for the risky group was related to the kind of prescribed medication through continuous measurement.

Effectiveness of mindfulness-based therapy, stress reduction in hypertension and prehypertension: a systematic review

Aim. To collect and analyze currently available clinical studies on the effectiveness of mindfulness-based stress reduction (MBSR) for lowering blood pressure in individuals with normal, high normal blood pressure and hypertension.Material and methods. The systematic review was prepared according to the PRISMA algorithm with minor modifications. The search algorithm included articles in Russian and English, indexed in the Pubmed/MEDLINE and Cochrane Library databases. The study included studies on the impact of mindfulness interventions on blood pressure levels in individuals aged ≥18 years with an established diagnosis of hypertension, with normal (120-129/80-84 mm Hg) and high normal office blood pressure (130-139/85-89 mm Hg).Results. A total of 4785 publications were identified and included in the study, of which, after a multistage sampling, including screening of articles, 6 studies were included in a qualitative systematic review.Conclusion. Qualitative synthesis of the results of clinical studies revealed that the evidence currently available indicates a possible positive effect of mindfulness interventions on blood pressure levels in individuals with normal, high normal blood pressure and hypertension. However, further studies with larger samples and measurement of more primary and secondary endpoints are required.

Multidisciplinary Neuromuscular and Endurance Interventions on Youth Basketball Players: A Systematic Review with Meta-Analysis and Meta-Regression.

The main aims of this systematic review with meta-analysis and meta-regression were to describe the effect of multidisciplinary neuromuscular and endurance interventions, including plyometric training, mixed strength and conditioning, HIIT basketball programs and repeated sprint training on youth basketball players considering age, competitive level, gender and the type of the intervention performed to explore a predictive model through a meta-regression analysis. A structured search was conducted following PRISMA guidelines and PICOS model in Medline (PubMed), Web of Science (WOS) and Cochrane databases. Groups of experiments were created according to neuromuscular power (vertical; NPV and horizontal; NPH) and endurance (E). Meta-analysis and sub-groups analysis were performed using a random effect model and pooled standardized mean differences (SMD). A random effects meta-regression was performed regressing SMD for the different sub-groups against percentage change for NPV and NPH. There was a significant positive overall effect of the multidisciplinary interventions on NPV, NPH and E. Sub-groups analysis indicate differences in the effects of the interventions on NPV and NPH considering age, gender, competitive level and the type of the intervention used. Considering the current data available, the meta-regression analysis suggests a good predictability of U-16 and plyometric training on jump performance. Besides, male and elite level youth basketball players had a good predictability on multidirectional speed and agility performance.

The Effect of Psychosocial Interventions for Reducing Co-occurring Symptoms of Depression and Anxiety in Individuals withProblematic Internet Use: A Systematic Review and Meta-analysis.

The objective of this study is to conduct a systematic review and meta-analysis to assess the effect of psychosocial interventions in reducing problematic Internet use (PIU), anxiety, and depression symptoms in a sample of people. This review was registered on the PROSPERO database (CRD42020181912) and a total of 15 studies were included. Analyses of the effect of the interventions were conducted based on the standardized mean difference of the studied outcomes (PIU, anxiety, and depression). Most studies reported a positive effect of psychosocial interventions on reducing symptoms of PIU, depression, and anxiety among people with PIU. However, only one detected a robust effect in reducing symptoms of anxiety. For depression, this effect was more modest, and there was no difference between the different modalities of psychosocial interventions. The results suggest that psychosocial interventions are effective in reducing both symptoms of PIU and co-occurring symptoms of depression and anxiety in individuals with PIU.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11469-022-00846-6.

Effects of mHealth Interventions on Improving Antenatal Care Visits and Skilled Delivery Care in Low- and Middle-Income Countries: Systematic Review and Meta-analysis.

BackgroundThe poor coverage of essential maternal services, such as antenatal care (ANC) and skilled delivery care utilization, accounts for higher maternal and infant mortality in low- and middle-income countries (LMICs). Although mobile health (mHealth) interventions could potentially improve the service utilization in resource-limited settings, their effectiveness remains unclear.ObjectiveThis review aimed to summarize the effect of mHealth interventions on improving the uptake of ANC visits, skilled birth attendance at the time of delivery, and facility delivery among pregnant women in LMICs.MethodsWe conducted a comprehensive search on 9 electronic databases and other resources from inception to October 2020. We included individual randomized controlled trials and cluster randomized controlled trials that assessed the effectiveness of mHealth interventions for improving perinatal health care utilization among healthy pregnant women in LMICs. We performed a random-effects meta-analysis and estimated the pooled effect size by using risk ratios (RRs) with 95% CIs. In addition, 2 reviewers independently assessed the risk of bias of the included studies by using the Cochrane risk of bias tool and the certainty of the evidence by using the Grading of Recommendation, Assessment, Development and Evaluation approach.ResultsA total of 9 studies (10 articles) that randomized 10,348 pregnant women (n=6254, 60.44% in the intervention group; n=4094, 39.56% in the control group) were included in this synthesis. The pooled estimates showed a positive effect of mHealth interventions on improving 4 or more ANC visit utilizations among pregnant women in LMICs, irrespective of the direction of interventions (1-way communications: RR 2.14, 95% CI 1.76-2.60, I2=36%, 2 studies, moderate certainty; 2-way communications: RR 1.17, 95% CI 1.08-1.27, I2=59%, 3 studies, low certainty). Only 2-way mHealth interventions were effective in improving the use of skilled birth attendance during delivery (RR 1.23, 95% CI 1.14-1.33, I2=0%, 2 studies, moderate certainty), but the effects were unclear for 1-way mHealth interventions (RR 1.04, 95% CI 0.97-1.10, I2=73%, 3 studies, very low certainty) when compared with standard care. For facility delivery, the interventions were effective in settings where fewer pregnant women used facility delivery (RR 1.68, 95% CI 1.30-2.19, I2=36%, 2 studies, moderate certainty); however, the effects were unclear in settings where most pregnant women already used facility delivery (RR 1.01, 95% CI 0.97-1.04, I2=0%, 1 study, low certainty).ConclusionsmHealth interventions may contribute to improving ANC and skilled delivery care utilization among pregnant women in LMICs. However, more studies are required to improve their reproducibility and efficiency or strengthen the evidence of different forms of mHealth interventions because of the considerable heterogeneity observed in the meta-analyses.Trial RegistrationPROSPERO CRD42020210813; https://tinyurl.com/2n7ny9a7

Waking During Pregnancy: Literature Review

There is no agreement among researchers whether exercise is salutary during pregnancy. Utmost studies report that physical activity poses no trouble to either pregnant woman or her fetus. On the other hand, walking is the most generally chosen type of physical activity during pregnancy where it provides several health benefits to the lady and her baby. Standard quest procedures were followed to determine sources from the literature specific to walking during pregnancy for use in this review. Included studies were presented narratively, and appraisal of their methodological quality was conducted using the Jadad quality assessment tool. Walking found to be useful in easing gravidity- related pain and psychological symptoms and reducing gestational weight gain. Nevertheless, inconsistencies in findings between studies hamper the delineation of establishment conclusions on these ultimate issues. Overall, studies demonstrated a positive effect of physical exertion interventions on the well- being and physical and psychological health of pregnant women. Future studies are encouraged and advised to utilise well recognised assessment tools. Community and antenatal health programs advocated to recommend physical activity and exercise during pregnancy.

Effectiveness of interventions on the stress management of schoolteachers: a systematic review and meta-analysis

BackgroundThis systematic review aimed to analyse the effectiveness of interventions on the stress management of schoolteachers.MethodsWe searched the Medline, PsycINFO, CINAHL and Education Research Complete until 30 November 2021, to...

The Effects of Dual-Task Training on Cognitive and Physical Functions in Older Adults with Cognitive Impairment; A Systematic Review and Meta-Analysis.

Individuals with Alzheimer disease and dementia experience cognitive decline and reduction in physical capabilities. Engaging in cognitive challenges and physical exercises is effective in reducing age-related cognitive and physical decline. It is believed that physical activity in the context of cognitive challenges might enhance the process of neurogenesis in the adult brain, but how effective are such interventions? Is there enough evidence to support that dual-task training is more effective than cognitive or physical training alone? To what extent can such training improve cognitive and physical functions in patients at various stages of cognitive decline? This systematic review with meta-analysis summarizes the emerging evidence of dual-task training for enhancing cognitive and physical functions in older individuals with cognitive impairment, dementia or Alzheimer's disease. A systematic search was carried out in MEDLINE, PubMed, EMBASE, and Cochrane Library with the following search terms: randomized control trials, dual-task training, SCD, MCI, dementia, and Alzheimer's disease. A total of 21 studies with 2,221 participants were identified. The results of dual-task tanning intervention are summarized as change in global cognitive function; SMD = 0.24, (P= 0.002), memory; SMD = 0.28, (P = 0.000), executive function; SMD = 0.35, (P = 0.000), attention; SMD = -0.19, (P = 0.1), gait speed; SMD = 0.26, (P = 0.007), dual-task cost; SMD 0.56, (P = 0.000), and balance; SMD 0.36, (P = 0.004). Primary analysis showed a small-to-medium positive effect of dual-task training interventions on cognitive functions and medium-to-large positive effect on gait functions and balance.

Physiotherapy interventions facilitating recovery in COVID-19 patient on immunosuppressive therapy and with multiple comorbidities: a case report

&lt;p class="abstract"&gt;The global pandemic of the Coronavirus disease 2019 (COVID-19) has increasingly emerged as a multisystem infection with a wide spectrum of patient presentation, clinical severity and eventual outcomes. Physiotherapy treatment is pivotal to combat the consequences of the viral infection assisting timely functional recovery. Early intervention, routine assessments and tailormade rehabilitation programs aid in the comprehensive management of the patient and reduce further debilitating long COVID sequelae. This case report describes the course of a COVID-19 patient admitted in a COVID dedicated ICU, on immunosuppressive therapy and with multiple comorbidities, receiving daily physiotherapy treatment from admission to discharge. The change in the functional status was assessed using various outcome measures namely single breath count, breath holding time, Medical Research Council sum score, 30 sec sit to stand, timed up and go and 6 min walk test demonstrating a positive effect of physiotherapy interventions in facilitating recovery in the patient. &lt;/p&gt;

The effectiveness of stress regulation interventions with athletes: A systematic review and multilevel meta-analysis of randomised controlled trials

ABSTRACT We conducted a pre-registered systematic review of seven databases and meta-analysis of randomised controlled trials with athletes to examine the effectiveness of stress regulation interventions on performance outcomes, and the conditions under which their effects are strongest. We found a positive and significant moderate overall effect of stress regulation interventions on performance outcomes (65 effects, k = 21, N = 2022, g = 0.52, 95% CI = 0.19, 0.84) and a significant large effect on physiological outcomes (28 effects, k = 10, N = 368, g = 2.13, se = 0.81, 95% CI = .47, 3.79), yet the effect on psychological dimensions was statistically inconsequential (28 effects, k = 10, N = 787, g = 0.35, 95% CI = −0.12, 0.81). Sensitivity and meta-bias analyses generally supported the robustness of the pooled effect of stress regulation interventions on athlete performance, yet the prediction intervals suggested some interventions may be inefficacious or detrimental for athlete performance. The strongest effects on performance were observed at follow-up when compared with post-test. Collectively, our findings offer a high-quality assessment on the effectiveness of stress regulation interventions for athlete performance and provide direction for future research in terms of conceptual and methodological issues.

Effect and quality of couple-based interventions of middle-aged and older adults with type 2 diabetes mellitus: a scoping review.

Studies have shown the existence of health concordance between patients with type 2 diabetes mellitus (T2DM) and their spouses, and also that spouses could influence the effect of self-management, benefiting patients' health. However, these studies are heterogeneous and the evidence is inconclusive. To synthesize evidence from published randomized controlled trials: the interventional effects and the quality of study performance, also to identify the research gap and the directions for future studies. We performed the scoping review by following the PRISMA-ScR guidance. We searched and examined the reports from MEDLINE, EMBASE, PsychInfo, CINAHL Plus by the pre-specified criteria. Key characteristics and information of eligible reports were extracted, analysed and synthesized comprehensively, and the results were presented in the form of words and diagrams. We identified 5 reports from 4 studies out of 3479 records included. Qualified studies indicated a positive effect of couple-based interventions on couples' distress. Insufficient evidence on physiological health or health behaviours was identified owing to the small number of included studies and inconsistent assessment outcomes. The methodological quality across these studies was generally low due to inadequate reporting of study process and substantial biases. Couple-based interventions for patients with T2DM showed small effects on the couple's distress while the effects of other outcomes were inconclusive. Future studies should strengthen methodologies by using standard measures of core diabetic outcomes, including detailed assessments of implementation process, and taking a dyadic approach to systematically examine the effects.

A counterfactual approach to measure the impact of wet grassland conservation on U.K. breeding bird populations

AbstractWet grassland populations of wading birds in the United Kingdom have declined severely since 1990. To help mitigate these declines, the Royal Society for the Protection of Birds has restored and managed lowland wet grassland nature reserves to benefit these and other species. However, the impact of these reserves on bird population trends has not been evaluated experimentally due to a lack of control populations. We compared population trends from 1994 to 2018 among 5 bird species of conservation concern that breed on these nature reserves with counterfactual trends created from matched breeding bird survey observations. We compared reserve trends with 3 different counterfactuals based on different scenarios of how reserve populations could have developed in the absence of conservation. Effects of conservation interventions were positive for all 4 targeted wading bird species: Lapwing (Vanellus vanellus), Redshank (Tringa totanus), Curlew (Numenius arquata), and Snipe (Gallinago gallinago). There was no positive effect of conservation interventions on reserves for the passerine, Yellow Wagtail (Motacilla flava). Our approach using monitoring data to produce valid counterfactual controls is a broadly applicable method allowing large‐scale evaluation of conservation impact.

Nutritional status improvement in elderly CKD patients: a systematic review.

Almost all CKD patients have a poor nutritional status, while elderly CKD patients are specifically frail and malnourished. Our aim is to conduct a systematic review of the up to date primary studies that look at methods of improving nutritional status in CKD patients in the elderly demographic. A focussed and sensitive search strategy was applied to the PUBMED database to identify relevant English language articles. Once articles were identified a detailed quality and bias assessment was performed. Two independent researchers (MZ and SM) then subsequently carried out detailed data extraction and analysis and this was subsequently verified by a third researcher (IN). A total of 19 studies were included in our systematic review which included 7 non-randomised control trials and 15 randomised controlled trials. The outcomes that we considered to be most relevant for our subject title were: mortality data, SGA, albumin, total protein, isoleucine, leucine, prealbumin, transferrin, leptin, valine, TAG, HDL, LDL and total amino acids. Detailed bias analysis of the different studies was also conducted. This is the first systematic review of the literature, so far, on the subject, involving elderly CKD patients. The quality of trials is low, very heterogenic in patients, methods and outcomes. However, we found a positive effect of dietary interventions on the nutritional status of most patients studied, highlighted by improvement in serum albumin and SGA, the most measured outcomes.

Effect of Interactive eHealth Interventions on Improving Medication Adherence in Adults With Long-Term Medication: Systematic Review.

BackgroundMedication nonadherence leads to suboptimal treatment outcomes, making it a major priority in health care. eHealth provides an opportunity to offer medication adherence interventions with minimal effort from health care providers whose time and resources are limited.ObjectiveThe aim of this systematic review is twofold: (1) to evaluate effectiveness of recently developed and tested interactive eHealth (including mHealth) interventions on medication adherence in adult patients using long-term medication and (2) to describe strategies among effective interventions.MethodsMEDLINE, EMBASE, Cochrane Library, PsycINFO, and Web of Science were systematically searched from January 2014 to July 2019 as well as reference lists and citations of included articles. Eligible studies fulfilled the following inclusion criteria: (1) randomized controlled trial with a usual care control group; (2) a total sample size of at least 50 adult patients using long-term medication; (3) applying an interactive eHealth intervention aimed at the patient or patient’s caregiver; and (4) medication adherence as primary outcome. Methodologic quality was assessed using the Cochrane risk of bias tool. Selection and quality assessment of studies were performed by 2 researchers (BP and BvdB or JV) independently. A best evidence synthesis was performed according to the Cochrane Back Review Group.ResultsOf the 9047 records screened, 22 randomized clinical trials were included reporting on 29 interventions. Most (21/29, 72%) interventions specified using a (mobile) phone for calling, SMS text messaging, or mobile apps. A majority of all interactive interventions (17/29) had a statistically significant effect on medication adherence (P<.05). Of these interventions, 9 had at least a small effect size (Cohen d ≥ 0.2) and 3 showed strong odds for becoming adherent in the intervention group (odds ratio > 2.0). Our best evidence synthesis provided strong evidence for a positive effect of interventions using SMS text messages or interactive voice response, mobile app, and calls as mode of providing adherence tele-feedback. Intervention strategies “to teach medication management skills,” “to improve health care quality by coordinating medication adherence care between professionals,” and “to facilitate communication or decision making between patients and health care providers” also showed strong evidence for a positive effect.ConclusionsOverall, this review supports the hypothesis that interactive eHealth interventions can be effective in improving medication adherence. Intervention strategies that improve patients’ treatment involvement and their medication management skills are most promising and should be considered for implementation in practice.