Studies Of Health Care Interventions Research Articles

The Generalized Risk-Adjusted Cost-Effectiveness (GRACE) Model for Measuring the Value of Gains in Health: An Exact Formulation

AbstractThe generalized risk-adjusted cost-effectiveness (GRACE) analysis method modifies standard cost-effectiveness analysis (CEA), the primary method currently used worldwide to value health improvements arising from healthcare interventions. Generalizing standard CEA, GRACE allows for decreasing or even increasing returns to health. Previous presentations of GRACE have relied extensively on Taylor Series expansion methods to specify key model parameters, including those that properly adjust for illness severity and preexisting disability, consequences of uncertain treatment outcomes, and the marginal rate of substitution between life expectancy and health-related quality of life. Standard CEA cannot account for these sources of value or cost in its valuation of medical treatments. However, calculations of GRACE measures based on Taylor Series are approximations, which may be poorly behaved in some contexts. This paper provides a new approach for implementing GRACE, using exact utility functions instead of Taylor Series approximations. While any proper utility function will suffice, we illustrate with three well-known functions: constant relative risk aversion (CRRA) utility; hyperbolic absolute risk aversion (HARA) utility, of which CRRA is a special case; and expo-power (EP) utility, of which constant absolute risk aversion (CARA) is a special case. The analysis then extends from two-period to multiperiod models. We discuss methods to estimate parameters of HARA and EP functions using two different types of data, one from discrete choice experiments and the other from “happiness economics” methods. We conclude with some reflections on how this analysis might affect benefit-cost analysis studies of healthcare interventions.

Critical Appraisal for Systematic Review: Focused on A MeaSurement Tool to Assess Systematic Reviews 2

Researchers and healthcare professionals need to assess the confidence of review results before accepting results of a single systematic review, considering its reputation and influence based on the hierarchy of evidence in an evidence-based practice. A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2), an updated version of AMASTAR, was published in 2017, consists of 16 domains, and is useful as a critical appraisal tool for systematic review of randomized or non-randomized studies of healthcare interventions, or both, in terms of inter-rater agreement and intuitiveness of items. Notably, AMSTAR 2 was not designed to generate an overall score. Moreover, the assessors should evaluate overall confidence in the results of systematic review, by determining critical domains and taking account of the potential impact of critical flaw of each domain on the confidence of the review results.

What is the Added Value of Social Network Analysis when Developing and Evaluating Complex Interventions

IntroductionMost complex interventions target upon a network of multiple (health care) professionals. Social Network Analysis (SNA) is a powerful technique that aims to characterize and study how social relationships within a network establish and evolve. This study identified the added value of using SNA in the developing and evaluation of complex interventions.Theory/Methods A scoping review was conducted by identifying the research question, identifying relevant studies, selecting studies, charting the data; and collating, summarizing and reporting the results. EMBASE, PsycInfo, CINAHL and PubMed were searched with a timeframe of 15 years. Complex healthcare intervention studies using SNA were included. The study selection and data extraction were conducted by two researches independently. We identified the characteristics, the reported strengths and limitations and reported implications of SNA application in complex intervention studies.ResultsThe search identified, after removal of duplicates, 2466 studies. After abstract screening, 40 full text studies were assessed for eligibility resulting in 25 studies that were included. Fifteen studies used SNA to examine effectiveness, one study in examining acceptability, one in identifying interventionists, five in process evaluation studies, and three in implementation studies.Reported strengths of SNA application were that primary data can be collected through several methods, and the easy feasibility of data collection and visualization of results. A reported limitation in data analysis was the challenge for untrained researchers to use SNA programs.Reported implications of using SNA when developing complex interventions was identifying key individuals who can be harnessed for dissemination of innovations or selected as interventionists. When evaluating complex interventions, SNA can support the conclusions from traditional analysis and generated new information such as revealing important intervention dynamics that would not have been found with classical methods. SNA allows analysis of the network as whole system and on individual level. When implementing, SNA can provide understanding of the barriers and/or facilitators of the diffusion and implementation of the intervention which offers actionable insights. DiscussionThe application of SNA is wide but at the same time very underutilized in complex intervention research. The optimal use of SNA in developing and evaluating complex interventions is therefore currently underexposed.ConclusionSNA is a widely applicable method that can be used in different phases of complex intervention research. Studies reported more strengths than limitation in the application of SNA. The reported implications emphasized the diverse and added value of using SNA in the development and evaluation of complex interventions.Lessons learnedThe potential value of SNA in unravelling and characterizing networks in the development and evaluation of complex interventions needs more attention in health care research.LimitationThere is no sharp boundary between simple and complex health care interventions. Therefore, search terms that widely cover complex interventions in health care were used and a hand search of reviews was performed.Suggestion for future researchRoutine use of SNA in developing and evaluating complex interventions could gain actionable insights which are useful in a transactional context as in complex interventions.

Are internal lengthening devices effective and associated with less complications compared to other lengthening devices? A systematic review and meta-analysis.

Internal lengthening devices became more popular than external fixators. This was attributed to their effectiveness and lower complication rates. However, this is an assumption that is not on the basis of solid scientific evidence. Therefore, this study systematically reviewed the quality and strength of evidence supporting femoral internal lengthening devices' effectiveness and their associated complications. Six electronic databases (PubMed, Cochrane, Sage, Embase, Web of Science and Scopus) were searched from inception until 20 June 2020. Further, all included articles' bibliographies were searched manually. After screening of retrieved articles, five studies were eligible for qualitative and quantitative synthesis. Studies were assessed by two independent assessors using a modified 'assessment of the methodological quality both of randomized and nonrandomized studies of health care interventions'. Further, meta-analysis was conducted to compare the procedure's effectiveness, in terms of healing index and major complications incidence. Our findings showed internal validity as the major source of bias whereas external validity was the least. For healing index, there is limited evidence that internal lengthening devices lower healing index by 0.45 months/cm (95% CI, -0.62 to -0.28; P < 0.01) compared to LON/external fixators. The incidence of major complications, that were directly related to the procedures, did not differ between internal lengthening devices and other fixators (risk ratio=0.97; 95% CI, 0.39-2.44; P < 0.95). This review provides evidence that supports lower healing index and similar complications associated with internal lengthening devices compared to other procedures of femoral lengthening. However, the evidence is very limited to draw a solid conclusion.

Surgery Versus Non-surgery Interventions on Rectus Abdominis Diastasis With or Without Hernias: a Systematic Review

Rectus abdominis diastasis is a common pathology and an esthetic and symptomatic problem; its reconstruction, either through a surgical strategy, standard vertical plication, or endoscopic surgery with or without mesh or through non-surgical physical training, is under debate. This study further aimed to compare the results of surgery and non-surgery interventions in cases with rectus abdominis diastasis. A systematic literature search of PubMed, Embase, and the Cochrane Library databases from the earliest data available to November 2018 was performed. Studies assessing symptomatic relief, adverse events, or symptomatic recurrence after surgery or a physical training program were included. A modified Downs and Black checklist for randomized and non-randomized studies of healthcare interventions was used to evaluate the methodological quality of the studies. Of 3908 citations, there were 27 studies with a total of 2372 patients finally being included in this study. In the surgery group, there was no patient relapsed after a follow-up of 12 months, while a 40% recurrence rate was reported after a follow-up of 5 years in one study. The adverse events associated with surgery mainly included seroma (5.13%), a sensibility disorder of the abdominal skin (2.26%), and minor scarring (1.56%). There were no adverse events or reports of recurrence in patients with physical training; however, negative effects of improving rectus muscle function were reported in 4 studies (40%). In conclusion, this review found a limited strength of evidence that abdominoplasty and diastasis recti repair were effective at restoring the functions of the rectus muscles and at improving the stability of the abdominal wall and quality of life in the short-term. A moderate strength of evidence was found that strength training has a limited effect, especially for patients suffering from rectus abdominis diastasis combined with a hernia.

Computer-assisted surgery and patient-specific instrumentation improve the accuracy of tibial baseplate rotation in total knee arthroplasty compared to conventional instrumentation: a systematic review and meta-analysis.

To determine whether patient-specific instrumentation (PSI), computer-assisted surgery (CAS) or robot-assisted surgery (RAS) enable more accurate rotational alignment of the tibial baseplate in primary total knee arthroplasty (TKA) compared to conventional instrumentation, in terms of deviation from the planned target and the proportion of outliers from the target zone. The authors independently conducted three structured electronic literature searches using the PubMed, Embase®, and Cochrane Central Register of Controlled Trials databases from 2007 to 2020. Studies were included if they compared rotational alignment of the tibial baseplate during TKA using conventional instrumentation versus PSI, CAS, and/or RAS, and reported deviation from preoperatively planned rotational alignment of the tibial baseplate in terms of absolute angles and/or number of outliers. Methodological quality of eligible studies was assessed by two researchers according to the Downs and Black Quality Checklist for Health Care Intervention Studies. Fifteen studies, that reported on 2925 knees, were eligible for this systematic review, of which 6 studies used PSI, and 9 used CAS. No studies were found for RAS. Of the studies that reported on angular deviation from preoperatively planned rotational alignment, most found smaller deviations using PSI (0.5° to 1.4°) compared to conventional instrumentation (1.0° to 1.6°). All studies that reported on proportions of outliers from a target zone (± 3°), found lower rates of outliers using PSI (0 to 22%) compared to conventional instrumentation (5 to 96%). Most studies reported smaller angular deviation from preoperatively planned rotational alignment using CAS (0.1° to 6.9°) compared to conventional instrumentation (1.1° to 7.8°). Of the studies that reported on proportions of outliers from a target zone (± 3°), most found fewer outliers using CAS (10 to 61%) compared to conventional instrumentation (17 to 78%). This systematic review and meta-analysis revealed that both CAS and PSI can improve the accuracy of rotational alignment of the tibial baseplate by decreasing angular deviation from the preoperatively planned target and reducing the proportion of outliers from the target zone. The clinical relevance is that PSI and CAS can improve alignment, though the thresholds necessary to grant better outcomes and survival remain unclear. IV.

Value of social network analysis for developing and evaluating complex healthcare interventions: a scoping review

ObjectivesMost complex healthcare interventions target a network of healthcare professionals. Social network analysis (SNA) is a powerful technique to study how social relationships within a network are established and evolve....

Interventions to prevent or treat childhood obesity in M\u0101ori & Pacific Islanders: a systematic review

BackgroundMāori and Pacific Islander people are a priority population originating from Australasia. Māori and Pacific Islander children exhibit greater risk of obesity and associated morbidities compared to children of other descent, secondary to unique cultural practices and socioeconomic disadvantage. Despite these known risk factors, there is limited synthesised evidence for preventing and treating childhood obesity in this unique population. The objective of this systematic review was to identify and evaluate global prevention or treatment interventions for overweight or obesity that targeted Māori and Pacific Islander children and adolescents (aged 2–17 years).MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The databases PubMed, EMBASE, Scopus, Web of Science and CINAHL were searched from inception to August 2018. Study quality and risk of bias was assessed using a modified Downs and Black Quality Checklist for Health Care Intervention Studies. Studies were included if RCT/intervention/case control/ or prevention study designs. The study group was defined under the search term ‘Oceanic Ancestry Group’.ResultsOf the initial 94 articles identified, six were included describing two prevention and three treatment interventions. Interventions were heterogenous in setting, design, length and outcomes. Four interventions were implemented in New Zealand. Most studies were of ‘fair’ quality. One study recruited an exclusive population of Māori and Pacific Islander participants. In the five studies that recruited mixed populations, one performed sub-group analysis on Māori and Pacific Islander participants. No study reported an improvement in anthropometric outcomes post-intervention in complete or sub-group analysis. Improvements in cardiometabolic or psychological secondary outcomes were inconsistent across all studies.ConclusionsThere is a lack of evidence to recommend specific intervention characteristics to optimise obesity prevention or treatment outcomes for Māori and Pacific Islander children. Future research requires greater consideration of cultural values and beliefs, community engagement, exclusive targeting of Māori and Pacific Islander children and families, and sub-group analyses for mixed-population studies. Incorporating co-design principles during study design and implementation can maximise the cultural specificity of interventions and may contribute to improved health and weight-related outcomes for this at-risk, priority population.Trial registrationPROSPERO CRD42019121790 (26 March 2019).

Urological cancers and mental wellbeing: are we helping our patients? A systematic review of current interventions to support patients

Urological cancers and mental wellbeing: are we helping our patients? A systematic review of current interventions to support patients

Uneasy talking about costs of stillbirth?

In this BJOG stillbirth-themed issue, Campbell et al. (BJOG 2018;125:108–17) report on a population-based cost-of-illness study. Although reports on costs in healthcare are not uncommon – even quality-of-life studies now sometimes incorporate quality-of-life into cost estimates – one may feel uneasy when talking about money in relation to stillbirth; it seems insensitive towards the people suffering the loss. How can one put a monetary value on a life not yet lived? However, these authors should be congratulated for building upon earlier work (Heazell et al., Lancet 2016;387:604–616) in their effort to tackle this difficult and long-neglected topic. I remember vividly the debates with the funding body for an earlier grant application of mine proposing a study on stillbirth. In the 1990s, cost-effectiveness was the key word for health care intervention studies, and at that time I could argue with the committee that a dead child was less expensive than a living one. The embarrassment the committee felt was probably the basis for a positive response in the end. Counting and naming stillbirths all around the world has been very important over the last 10 years in putting stillbirth and its effects on people and society on global and local agendas. Knowledge of the numbers, causes, and long-term effects is vital for good clinical care and future prevention. Campbell et al. describe several relevant domains in which these costs are estimated. They show that although the costs are a fraction of overall healthcare costs, they percolate beyond the healthcare system into society. One of the domains is the increasing costs of litigation even though most cases will not be satisfactorily settled in court. Most cases will not be satisfactorily settled in court. This illustrates our moral obligation to honest disclosure of possible substandard care to parents, effective audits to make sure recurrence is as rare as possible, and an effective process for settlement. This knowledge strengthens the urgent case for performing further studies of stillbirth, its causes, and its sequelae. I hope parents can also see the importance of this and are not offended by talk of money issues in relation to stillbirth. Objective and financial considerations may seem insensitive when discussing a baby's life, but these data can help health professionals and researchers make the case for continued work in this area. We need more funding to perform the necessary studies to diminish this tragedy. Full disclosure of interests available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Analytical Methods for a Learning Health System: 3. Analysis of Observational Studies.

The third paper in a series on how learning health systems can use routinely collected electronic health data (EHD) to advance knowledge and support continuous learning, this review describes how analytical methods for individual-level electronic health data EHD, including regression approaches, interrupted time series (ITS) analyses, instrumental variables, and propensity score methods, can also be used to address the question of whether the intervention “works.”The two major potential sources of bias in non-experimental studies of health care interventions are that the treatment groups compared do not have the same probability of treatment or exposure and the potential for confounding by unmeasured covariates. Although very different, the approaches presented in this chapter are all based on assumptions about data, causal relationships, and biases. For instance, regression approaches assume that the relationship between the treatment, outcome, and other variables is properly specified, all of the variables are available for analysis (i.e., no unobserved confounders) and measured without error, and that the error term is independent and identically distributed. The instrumental variables approach requires identifying an instrument that is related to the assignment of treatment but otherwise has no direct on the outcome. Propensity score methods approaches, on the other hand, assume that there are no unobserved confounders. The epidemiological designs discussed also make assumptions, for instance that individuals can serve as their own control.To properly address these assumptions, analysts should conduct sensitivity analyses within the assumptions of each method to assess the potential impact of what cannot be observed. Researchers also should analyze the same data with different analytical approaches that make alternative assumptions, and to apply the same methods to different data sets. Finally, different analytical methods, each subject to different biases, should be used in combination and together with different designs, to limit the potential for bias in the final results.

Effective Health Promotion Interventions for Targeted Audience using Social Networking Sites: A Systematic Review

Objectives: This study carried out a systematic review on the literature that evaluated the various health promotion interventions based on social networking sites such as Facebook, Twitter and YouTube. Statistical Analysis: In social media, user messages carry the traits of health related activities such as interactions, emotional support, vaccination campaigns and nutrition improvement. These types of traits in the social media can be leveraged to identify the audience and effective approaches for health related activities. The work analysed the user engagement in each platform, behaviour and response efficacies achieved, targeted audience for different interventions, effectiveness of each platform and technologies used in the studies. Findings: The evaluation studies conducted on health interventions using social media for vaccination, smoking cessation, heart disease and sexually transmitted infections are reviewed. There are eight items used including response efficacy and behaviour efficacy to report about the target audience on social media for health campaigns. The target audience are identified using age or ethnicity. Implementing a social marketing approach through social media to initiate interest and engagement for a web-based software package is both hands-on and reliable with the way young individuals practice the media to share ideas and promote them, thus the intervention was considered a central focus of a greater campaign. Objective measures such as behaviour change and response are measured using summative and outcome evaluations. The technologies used for data collection and analysis substantiate the relevant technique for individual media, variables considered for particular disease health intervention, statistical models, survey methods and randomized control trials. The evidences from the studies reveal that Facebook and YouTube can be effectively used to target audience at the age group of nineteen – twenty-nine for smoking cessation and sexually transmitted health care interventions. Based on the evidences, the suitable social networking sites were identified for the targeted audience to the specific disease health interventions. Applications/Improvements: To build healthcare educated online communities in the social media, auto message feature and auto feedback system can help to increase the audience interaction. Vaccination healthcare intervention studies suggest on the road to increasing the reliability of the contents and educating the audience with the positive impacts of vaccination. Keywords: Behaviour Efficacy, Health Hazards, Health Interventions, Health Promotion, Targeted Audience, Vaccination

Effective Health Promotion Interventions for Targeted Audience using Social Networking Sites: A Systematic Review

Objectives: This study carried out a systematic review on the literature that evaluated the various health promotion interventions based on social networking sites such as Facebook, Twitter and YouTube. Statistical Analysis: In social media, user messages carry the traits of health related activities such as interactions, emotional support, vaccination campaigns and nutrition improvement. These types of traits in the social media can be leveraged to identify the audience and effective approaches for health related activities. The work analysed the user engagement in each platform, behaviour and response efficacies achieved, targeted audience for different interventions, effectiveness of each platform and technologies used in the studies. Findings: The evaluation studies conducted on health interventions using social media for vaccination, smoking cessation, heart disease and sexually transmitted infections are reviewed. There are eight items used including response efficacy and behaviour efficacy to report about the target audience on social media for health campaigns. The target audience are identified using age or ethnicity. Implementing a social marketing approach through social media to initiate interest and engagement for a web-based software package is both hands-on and reliable with the way young individuals practice the media to share ideas and promote them, thus the intervention was considered a central focus of a greater campaign. Objective measures such as behaviour change and response are measured using summative and outcome evaluations. The technologies used for data collection and analysis substantiate the relevant technique for individual media, variables considered for particular disease health intervention, statistical models, survey methods and randomized control trials. The evidences from the studies reveal that Facebook and YouTube can be effectively used to target audience at the age group of nineteen – twenty-nine for smoking cessation and sexually transmitted health care interventions. Based on the evidences, the suitable social networking sites were identified for the targeted audience to the specific disease health interventions. Applications/Improvements: To build healthcare educated online communities in the social media, auto message feature and auto feedback system can help to increase the audience interaction. Vaccination healthcare intervention studies suggest on the road to increasing the reliability of the contents and educating the audience with the positive impacts of vaccination. Keywords: Behaviour Efficacy, Health Hazards, Health Interventions, Health Promotion, Targeted Audience, Vaccination

Compression of the Fourth Ventricle Using a Craniosacral Osteopathic Technique: A Systematic Review of the Clinical Evidence.

Compression of the fourth ventricle (CV4) is a well-known osteopathic procedure, utilized by osteopaths, osteopathic physicians, craniosacral therapists, physical therapists, and manual therapists as part of their healthcare practice based on some evidence suggesting impact on nervous system functions. The main objective of the study was to identify randomized controlled trials (RCTs) assessing the clinical benefits of CV4 and to show the evidence supporting clinical prescriptions, guides, and advice in treating. A computerized search of the PubMed, CINAHL Complete, Scopus, Web of Science, and ScienceDirect databases was performed. Two filters were used (article type: RCTs; species: humans). The methodological quality of the trials was assessed using the Downs and Black quality checklist for healthcare intervention studies. Only six studies met the inclusion criteria, of which four were RCTs and two were observational studies. The Downs and Black score ranged from 17 to 24 points out of a maximum of 27 points. The present review revealed the paucity of CV4 research in patients with different clinical problems, as five out of six included studies investigated healthy adults. According to the results of the included studies, CV4 may be beneficial for patients with different functional problems.

Interventions for Reducing Parenting Stress in Families With Pediatric Conditions: An Integrative Review.

Parenting stress increases in the presence of serious-acute or chronic pediatric health conditions, potentially triggering negative outcomes for families. Parenting stress reduction interventions have been widely disseminated. The current review describes the types, components, and outcomes of these interventions in diverse pediatric populations. A systematic literature search yielded 26 experimental and quasi-experimental studies describing such interventions. Quality assessment was conducted by two doctorally prepared nursing researchers using the Downs and Black's checklist for randomized and nonrandomized studies of health care interventions. Interventions were categorized as follows: interventions with supporting and cognitive components (n = 3), interventions with empowerment and skill development components (n = 18), interventions targeted to children's condition (n = 9), and interventions focusing on the parent-child relationship (n = 5). Most interventions reduced immediate parenting stress levels (n = 23), but failed to demonstrate long-term gains. Future family interventions should target long-term parenting stress, while focusing on specific family needs across pediatric conditions.

Reporting of Adverse Events in Published and Unpublished Studies of Health Care Interventions: A Systematic Review.

BackgroundWe performed a systematic review to assess whether we can quantify the underreporting of adverse events (AEs) in the published medical literature documenting the results of clinical trials as compared with other nonpublished sources, and whether we can measure the impact this underreporting has on systematic reviews of adverse events.Methods and FindingsStudies were identified from 15 databases (including MEDLINE and Embase) and by handsearching, reference checking, internet searches, and contacting experts. The last database searches were conducted in July 2016. There were 28 methodological evaluations that met the inclusion criteria. Of these, 9 studies compared the proportion of trials reporting adverse events by publication status.The median percentage of published documents with adverse events information was 46% compared to 95% in the corresponding unpublished documents. There was a similar pattern with unmatched studies, for which 43% of published studies contained adverse events information compared to 83% of unpublished studies.A total of 11 studies compared the numbers of adverse events in matched published and unpublished documents. The percentage of adverse events that would have been missed had each analysis relied only on the published versions varied between 43% and 100%, with a median of 64%. Within these 11 studies, 24 comparisons of named adverse events such as death, suicide, or respiratory adverse events were undertaken. In 18 of the 24 comparisons, the number of named adverse events was higher in unpublished than published documents. Additionally, 2 other studies demonstrated that there are substantially more types of adverse events reported in matched unpublished than published documents. There were 20 meta-analyses that reported the odds ratios (ORs) and/or risk ratios (RRs) for adverse events with and without unpublished data. Inclusion of unpublished data increased the precision of the pooled estimates (narrower 95% confidence intervals) in 15 of the 20 pooled analyses, but did not markedly change the direction or statistical significance of the risk in most cases.The main limitations of this review are that the included case examples represent only a small number amongst thousands of meta-analyses of harms and that the included studies may suffer from publication bias, whereby substantial differences between published and unpublished data are more likely to be published.ConclusionsThere is strong evidence that much of the information on adverse events remains unpublished and that the number and range of adverse events is higher in unpublished than in published versions of the same study. The inclusion of unpublished data can also reduce the imprecision of pooled effect estimates during meta-analysis of adverse events.

Examining Intervention Design: Lessons from the Development of Eight Related Malaria Health Care Intervention Studies

—Rigorous evidence of “what works” to improve health care is in demand, but methods for the development of interventions have not been scrutinized in the same ways as methods for evaluation. This article presents and examines intervention development processes of eight malaria health care interventions in East and West Africa. A case study approach was used to draw out experiences and insights from multidisciplinary teams who undertook to design and evaluate these studies. Four steps appeared necessary for intervention design: (1) definition of scope, with reference to evaluation possibilities; (2) research to inform design, including evidence and theory reviews and empirical formative research; (3) intervention design, including consideration and selection of approaches and development of activities and materials; and (4) refining and finalizing the intervention, incorporating piloting and pretesting. Alongside these steps, projects produced theories, explicitly or implicitly, about (1) intended pathways of change and (2) how their intervention would be implemented.The work required to design interventions that meet and contribute to current standards of evidence should not be underestimated. Furthermore, the process should be recognized not only as technical but as the result of micro and macro social, political, and economic contexts, which should be acknowledged and documented in order to infer generalizability. Reporting of interventions should go beyond descriptions of final intervention components or techniques to encompass the development process. The role that evaluation possibilities play in intervention design should be brought to the fore in debates over health care improvement.

Costs, effects and implementation of routine data emergency admission risk prediction models in primary care for patients with, or at risk of, chronic conditions: a systematic review protocol

IntroductionEmergency admission risk prediction models are increasingly used to identify patients, typically with one or more chronic conditions, for proactive management in primary care to avoid admissions, save costs and...

Effectiveness of technologies in the treatment of post-stroke anomia: A systematic review

Event Abstract Back to Event Effectiveness of technologies in the treatment of post-stroke anomia: A systematic review Monica Lavoie1*, Joël Macoir1 and Nathalie Bier2 1 Université Laval, Rehabilitation, Canada 2 Université de Montréal, Rehabilitation, Canada Problem: In recent years, use of technology in rehabilitation has been growing significantly and therapies delivered by computer, teletreatment and smart tablet are becoming more and more common. However, before proposing the implementation of these types of treatment on a larger scale, it is essential to measure their effectiveness and efficiency in significantly improving language capacities of people with aphasia but also their functional impact in everyday life. The aim of this literature review is to examine the effectiveness of specific intervention programs provided by technologies (i.e. computer, smart tablet and telerehabilitation) in the management of post-stroke anomia. Procedures and analyses: The PRISMA statement(1) for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions was used as a guideline to conduct the present review. A systematic search of publications on PubMed and PsycInfo was conducted. Experimental studies designed to assess the effectiveness of an intervention delivered by a technology, namely computer, smart tablet or teletreatment, to specifically improve anomia in post-stroke participants were selected, without limitations as to the dates of publication. The main outcomes studied were improvement in naming skills and generalization to untreated items and daily communication. The Downs and Black checklist for randomised and non-randomised studies of health care interventions(2) was used by two reviewers (ML and JM) to conduct the methodological quality assessment. Results: A total of 20 studies were included in this review. Up to now, computer is by far the most popular technology, whereas only a few studies aimed at exploring the effectiveness of smart tablet or teletreatment. In some studies, technology was used as a therapy tool in a clinical setting, in the presence of the clinician, while in others, therapy with technology was self-administered at home, without the clinician. All studies confirmed the effectiveness of therapy provided by technology to improve naming of trained items. However, generalization to untrained items is unclear and assessment of generalization to daily communication is scarce. Conclusions: The results of this systematic review confirm that technology is a promising avenue in the management of post-stroke anomia. Self-administered therapies are particularly interesting since they allow increasing significantly the intensity and frequency of therapeutic activities, a factor that has been explicitly recognized as a positive determinant of the efficacy of language treatment(3). In future studies, ecological tasks aiming to evaluate therapy’s effectiveness on word retrieval in real-life situations should be added since the ultimate goal of improving anomia is for the participant to retrieve words more easily in his everyday life.

Biobehavioral Measures as Outcomes: A Cautionary Tale

This article discusses the use of biobehavioral measures as outcomes for health care intervention studies. Effect size (ES) values for salivary cortisol and observation-based measures of pain and agitation were examined. Effects pre to post treatment were assessed separately for nursing home residents with and without acute psychotic symptoms. This study revealed large positive effects on both pain and agitation measures in the group with acute psychotic symptoms and small-to-medium positive effects on these same measures in the group without acute psychotic symptoms. In both of these groups, the ES values were not consistently positive on the cortisol measures. Prior to determining whether a measure can be used to estimate minimum clinically important differences, it is essential to consider if the biomarker will be responsive to therapy in the populations and contexts being studied.