Search

BackgroundDespite the potential of technology-based mental health interventions for young people, limited uptake and/or adherence is a significant challenge. It is thought that involving young people in the development and delivery of services designed for them leads to better engagement. Further research is required to understand the role of participatory approaches in design of technology-based mental health and well-being interventions for youth. ObjectiveTo investigate consumer involvement processes and associated outcomes from studies using participatory methods in development of technology-based mental health and well-being interventions for youth. MethodsFifteen electronic databases, using both resource-specific subject headings and text words, were searched describing 2 broad concepts-participatory research and mental health/illness. Grey literature was accessed via Google Advanced search, and relevant conference Web sites and reference lists were also searched. A first screening of titles/abstracts eliminated irrelevant citations and documents. The remaining citations were screened by a second reviewer. Full text articles were double screened. All projects employing participatory research processes in development and/or design of (ICT/digital) technology-based youth mental health and well-being interventions were included. No date restrictions were applied; English language only. Data on consumer involvement, research and design process, and outcomes were extracted via framework analysis. ResultsA total of 6210 studies were reviewed, 38 full articles retrieved, and 17 included in this study. It was found that consumer participation was predominantly consultative and consumerist in nature and involved design specification and intervention development, and usability/pilot testing. Sustainable participation was difficult to achieve. Projects reported clear dichotomies around designer/researcher and consumer assumptions of effective and acceptable interventions. It was not possible to determine the impact of participatory research on intervention effectiveness due to lack of outcome data. Planning for or having pre-existing implementation sites assisted implementation. The review also revealed a lack of theory-based design and process evaluation. ConclusionsConsumer consultations helped shape intervention design. However, with little evidence of outcomes and a lack of implementation following piloting, the value of participatory research remains unclear.

Background Multimorbidity is prevalent in general practice and general practitioners internationally report challenges in its management. Understanding the perspectives of general practitioners at the frontline of care is important for system sustainability and accessibility as populations age. Objective To explore Australian general practitioner perspectives on managing multimorbidity, the factors supporting their work, and those impeding their ability to meet their own standards of care provision. Method A qualitative study conducted with Australian general practitioners using semistructured, in-depth interviews and inductive thematic data analysis. Results Twelve interviews with general practitioners were conducted. Three main themes were constructed from the data: Multimorbidity as an encounter with complexity and contingency; Evidence constraints in multimorbidity care; and Concerns for patient safety. System structure and the Australian general practice model restrict general practitioners' ability to provide care to their level of satisfaction by linking short consultation times to practice remuneration. Attitudes toward the applicability of guideline evidence were mixed despite most general practitioners questioning its generalizability. Patient safety concerns pervaded most interviews and largely centered on system fragmentation and insufficient intersectoral communication. General practitioners rely on multiple sources of information to provide patient-centered care but chiefly the accumulated knowledge of their patients. Conclusions Australian general practitioners share many multimorbidity concerns with international colleagues. While multimorbidity-specific evidence may be unrealistic to expect in the immediate term, system investment and adaptation is needed to support general practice sustainability and clinician ability to provide adequate multimorbidity care, suitably remunerated, into the future. [ABSTRACT FROM AUTHOR]

Abstract Background Heart failure is a highly debilitating syndrome with a poor prognosis primarily affecting the elderly. Clinicians wanting timely access to heart failure evidence to provide optimal patient care can face many challenges in locating this evidence. This study developed and validated a search filter of high clinical utility for the retrieval of heart failure articles in OvidSP Medline. Methods A Clinical Advisory Group was established to advise study investigators. The study set of 876 relevant articles from four heart failure clinical practice guidelines was divided into three datasets: a Term Identification Set, a Filter Development Set, and a Filter Validation Set. A further validation set (the Cochrane Validation Set) was formed using studies included in Cochrane heart failure systematic reviews. Candidate search terms were identified via word frequency analysis. The filter was developed by creating combinations of terms and recording their performance in retrieving items from the Filter Development Set. The filter's recall was then validated in both the Filter Validation Set and the Cochrane Validation Set. A precision estimate was obtained post-hoc by running the filter in Medline and screening the first 200 retrievals for relevance to heart failure. Results The four-term filter achieved a recall of 96.9% in the Filter Development Set; 98.2% in the Filter Validation Set; and 97.8% in the Cochrane Validation Set. Of the first 200 references retrieved by the filter when run in Medline, 150 were deemed relevant and 50 irrelevant. The post-hoc precision estimate was therefore 75%. Conclusions This study describes an objective method for developing a validated heart failure filter of high recall performance and then testing its precision post-hoc. Clinical practice guidelines were found to be a feasible alternative to hand searching in creating a gold standard for filter development. Guidelines may be especially appropriate given their clinical utility. A validated heart failure filter is now available to support health professionals seeking reliable and efficient access to the heart failure literature.

Background: PubMed translations of OvidSP Medline search filters offer searchers improved ease of access. They may also facilitate access to PubMed's unique content, including citations for the most recently published biomedical evidence. Retrieving this content requires a search strategy comprising natural language terms ('textwords'), rather than Medical Subject Headings (MeSH). We describe a reproducible methodology that uses a validated PubMed search filter translation to create a textword-only strategy to extend retrieval to PubMed's unique heart failure literature. Methods: We translated an OvidSP Medline heart failure search filter for PubMed and established version equivalence in terms of indexed literature retrieval. The PubMed version was then run within PubMed to identify citations retrieved by the filter's MeSH terms (Heart failure, Left ventricular dysfunction, and Cardiomyopathy). It was then rerun with the same MeSH terms restricted to searching on title and abstract fields (i.e. as 'textwords'). Citations retrieved by the MeSH search but not the textword search were isolated. Frequency analysis of their titles/ abstracts identified natural language alternatives for those MeSH terms that performed less effectively as textwords. These terms were tested in combination to determine the best performing search string for reclaiming this 'lost set'. This string, restricted to searching on PubMed's unique content, was then combined with the validated PubMed translation to extend the filter's performance in this database. Results: The PubMed heart failure filter retrieved 6829 citations. Of these, 834 (12%) failed to be retrieved when MeSH terms were converted to textwords. Frequency analysis of the 834 citations identified five high frequency natural language alternatives that could improve retrieval of this set (cardiac failure, cardiac resynchronization, left ventricular systolic dysfunction, left ventricular diastolic dysfunction, and LV dysfunction). Together these terms reclaimed 157/834 (18.8%) of lost citations. Conclusions: MeSH terms facilitate precise searching in PubMed's indexed subset. They may, however, work less effectively as search terms prior to subject indexing. A validated PubMed search filter can be used to develop a supplementary textword-only search strategy to extend retrieval to PubMed's unique content. A PubMed heart failure search filter is available on the CareSearch website (www.caresearch.com.au) providing access to both indexed and non-indexed heart failure evidence. [ABSTRACT FROM AUTHOR]

Background: Heart failure is a highly debilitating syndrome with a poor prognosis primarily affecting the elderly. Clinicians wanting timely access to heart failure evidence to provide optimal patient care can face many challenges in locating this evidence. This study developed and validated a search filter of high clinical utility for the retrieval of heart failure articles in OvidSP Medline. Methods: A Clinical Advisory Group was established to advise study investigators. The study set of 876 relevant articles from four heart failure clinical practice guidelines was divided into three datasets: a Term Identification Set, a Filter Development Set, and a Filter Validation Set. A further validation set (the Cochrane Validation Set) was formed using studies included in Cochrane heart failure systematic reviews. Candidate search terms were identified via word frequency analysis. The filter was developed by creating combinations of terms and recording their performance in retrieving items from the Filter Development Set. The filter's recall was then validated in both the Filter Validation Set and the Cochrane Validation Set. A precision estimate was obtained post-hoc by running the filter in Medline and screening the first 200 retrievals for relevance to heart failure. Results: The four-term filter achieved a recall of 96.9% in the Filter Development Set; 98.2% in the Filter Validation Set; and 97.8% in the Cochrane Validation Set. Of the first 200 references retrieved by the filter when run in Medline, 150 were deemed relevant and 50 irrelevant. The post-hoc precision estimate was therefore 75%. Conclusions: This study describes an objective method for developing a validated heart failure filter of high recall performance and then testing its precision post-hoc. Clinical practice guidelines were found to be a feasible alternative to hand searching in creating a gold standard for filter development. Guidelines may be especially appropriate given their clinical utility. A validated heart failure filter is now available to support health professionals seeking reliable and efficient access to the heart failure literature. [ABSTRACT FROM AUTHOR]

Introduction: Integrated care IC is a multifaceted concept, with a vast range of overlapping terminologies. Bibliometric analyses have demonstrated the evidence base for IC is diffuse. Peer-reviewed research is published in a range of journals which are indexed in bibliographic databases with subject coverage extending beyond health. A significant amount of relevant IC literature is found outside conventional publishing channels in the grey literature. Thus, practitioners and researchers face significant challenges to finding relevant IC literature. To address the issues associated with retrieving integrated care literature, an IC search filter, badged as Integrated Care Search ICS, was developed. A search filter is an evidence-based search strategy with a known level of retrieval effectiveness. Various "value adding" products were also developed to enhance the effectiveness and usability of the search filter. Methods: Following a well-established experimental methodology [1], and informed by bibliometric analyses and consultation with an established Expert Advisory Group EAG, ICS was developed and validated for use in PubMed. Additionally, a research librarian translated the validated search filter for use in other databases, and developed a guide for searching the grey literature for content relevant to IC. Finally, input from the EAG was solicited via survey to guide the development of relevant topic searches to be combined with the search filter to further refine results. Results: Given the challenges associated with IC literature retrieval, two versions of the validated search filter were developed. ICS Narrow enables more precise searching, whereas ICS Broad enables more sensitive searching. Supplementary topic searches covering care settings, populations, geographic regions and facets of IC are provided, to enable more focused searching by end-users. Both search filters were translated for use in other databases including: Medline Ovid, Embase Ovid, PsycINFO Ovid, CINAHL EBSCOhost, Cochrane Library Wiley, Scopus, Web of Science, and ProQuest. Finally, step-by-step instructions for searching for relevant IC grey literature were developed. These products are available on an interim site https://www.caresearch.com.au/caresearch/tabid/4757/Default.aspx, and it is planned that they will be moved to the IFIC website in time for launch at ICIC18. Discussion: ICS and its associated value-adding products provide end users with the ability to locate difficult-to-retrieve published and unpublished IC literature. Conclusions: A flexible approach to database searching using a combination of keyword and subject headings is required for optimal retrieval of the published IC literature across a range of databases. Lessons learned: The polymophous nature of IC necessitated the development of not one but two validated search filters, and an additional suite of products, including guidance for IC grey literature retrieval. Limitations: The envisioned functionality of the search filters has not been fully achieved, as they are currently hosted on an interim site. Suggestions for future research: Further research studies could include an evaluation of the impact of Integrated Care Search on end-user satisfaction with retrievals and search confidence. [ABSTRACT FROM AUTHOR]

Introduction: Evidence from quality research is vital for demonstrating the effectiveness of integrated care in reducing health care fragmentation. Locating that evidence should be a crucial precursor to its use in informed policy making and organisational reform. Finding integrated care research may, however, present challenges due to a multiplicity of definitions and frameworks, and relevance across a range of sectors, organisations, and professional groups. Understanding difficulties in finding integrated care evidence could aid in the development of practical measures to make it more visible. This might include customised repositories, search tools, or strategies for improving dissemination. Bibliometric analysis is one method for examining published literature relevant to a field of research or practice. It is particularly useful for mapping complex, fluid and diffuse fields such as integrated care. This study builds on and extends a previous bibliometric analysis by Sun[1] by investigating: the growth of the integrated care literature; the core journals in which it is published; the combination of bibliographic databases required to find the majority of the literature; and the value of the PubMed standardized term Medical Subject Heading for retrieving it. Methods: The broad term 'Integrated care' was searched across the title, abstract, and subject heading fields within PubMed, CINAHL, EMBASE Ovid, PsycINFO Ovid, EconLit Ovid and Cochrane Central Register of Controlled Trials. The citations retrieved were analysed for frequency by year and country of publication, author, journal name, natural language terms, and subject headings. In addition, the performance of the Medical Subject Heading MeSH term 'Delivery of Health Care, Integrated' was tested by asking an advisory group of integrated care experts n=8 to each screen a set of 100 citations retrieved by this heading and indicating relevance of each. Results: A wide range of terms and journal titles contribute to the integrated care body of evidence and multiple databases provide access to a significant number of unique citations beyond PubMed. Furthermore, Interrater agreement was low on the relevance of citations retrieved by PubMed's main integrated care MeSH term. Discussion: This study confirms the diffuse nature of the integrated care research literature and highlights factors that may make it inherently difficult to find via search mechanisms. This includes a lack of consensus between experts as to the relevance of literature retrieved by its main indexing term in PubMed. Conclusions: Our findings suggest a need for search solutions to enhance the identification and, by extension, utilisation, of the integrated care literature. Limitations: The use of the single broad term 'integrated care' to find citations across databases was a pragmatic approach to finding a core set of literature for analysis. We acknowledge that integrated care is described by a variety of terms and this approach would not find a substantial subset of relevant citations. Suggestions for future research: Following this study, an integrated care search filter was developed for finding the literature in PubMed. Other practical tools for finding integrated care literature are advocated. [ABSTRACT FROM AUTHOR]

General practitioners (GPs) are increasingly expected to provide palliative care as ageing populations put pressure on specialist services. Some GPs, however, cite barriers to providing this care including prognostication challenges and lack of confidence. Palliative care content within clinical practice guidelines might serve as an opportunistic source of informational support to GPs. This review analysed palliative care content within Australian guidelines for life-limiting conditions to determine the extent to which it might satisfy GPs' stated information needs and support them to provide quality end-of-life care. Six databases and guideline repositories were searched (2011–2018). Eligible guidelines were those for a GP audience and explicitly based on an appraisal of all available evidence. Content was mapped against an established palliative care domain framework (PEPSI-COLA) and quality was assessed using AGREE-II. The nine guidelines meeting inclusion criteria were heterogenous in scope and depth of palliative care domain coverage. The 'communication' needs domain was best addressed while patient physical and emotional needs were variably covered. Spiritual, out-of-hours, terminal care and aftercare content was scant. Few guidelines addressed areas GPs are known to find challenging or acknowledged useful decision-support tools. A template covering important domains might reduce content variability across guidelines. [ABSTRACT FROM AUTHOR]

Introduction: This workshop is an interactive demonstration of a validated search filter which has been developed to assist clinicians and managers in locating published research on integrated care. The presenters will give a brief overview of the project and the methodology used. They will demonstrate the beta version of the search filter and invite comment and feedback from the audience. Attendees are encouraged to share their experiences in locating the peer-reviewed literature on IC, including specific questions on aspects of IC for which evidence is sought. Integrated care (IC) is a prime driver of healthcare policy and practice reform internationally as governments and healthcare organisations endeavour to enhance efficiencies and patientcentred care. It is, however, a multifaceted concept, with a vast range of overlapping terminologies, and arguably lacks a unifying definition [1]. Search filters represent one innovative solution to this problem, by enabling brokered access to the underlying evidence base for rapid utilisation. Methods: The International Foundation for Integrated Care (IFIC), Central Coast Local Health District (NSW), The University of Newcastle (NSW), and Flinders Filters, Flinders University (SA)[2] collaborated to create an IC search filter (or "search strategy") with known retrieval effectiveness in the PubMed Database, using a well-established experimental methodology[3]. Results: An IC search filter with a known level of sensitivity has been developed and validated for PubMed. This filter will be combined with a range of topics of interest to the IC community for more focused retrieval. These topics will include patient-centred care; health and social care integration; and chronic disease management. The search filter, badged as Integrated Care Search, will be made available on the IFIC website at https://integratedcarefoundation.org/. Discussions: IC is a polymorphous topic with contextually different meanings. Despite inherent complexities, under the guidance of international experts, it was possible to develop and validate a search filter which is capable of retrieving PubMed indexed IC literature at multiple levels of granularity through simple, one-click links. In tegrated Care Search will improve the ease, speed, and accuracy by which IC evidence is found. End-users can rely on the fact that it comprises a range of core IC concept terms, comprehensively identified and tested in a set of literature deemed of importance by IC experts. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis synthesised the post-1990 literature examining the effect of human milk on morbidity, specifically necrotising enterocolitis (NEC), late onset sepsis (LOS), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) and neurodevelopment in infants born ≤28 weeks’ gestation and/or publications with reported infant mean birth weight of ≤1500 g. Online databases including Medline, PubMed, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials were searched, and comparisons were grouped as follows: exclusive human milk (EHM) versus exclusive preterm formula (EPTF), any human milk (HM) versus EPTF, higher versus lower dose HM, and unpasteurised versus pasteurised HM. Experimental and observational studies were pooled separately in meta-analyses. Risk of bias was assessed for each individual study and the GRADE system used to judge the certainty of the findings. Forty-nine studies (with 56 reports) were included, of which 44 could be included in meta-analyses. HM provided a clear protective effect against NEC, with an approximate 4% reduction in incidence. HM also provided a possible reduction in LOS, severe ROP and severe NEC. Particularly for NEC, any volume of HM is better than EPTF, and the higher the dose the greater the protection. Evidence regarding pasteurisation is inconclusive, but it appears to have no effect on some outcomes. Improving the intake of mother’s own milk (MOM) and/or donor HM results in small improvements in morbidity in this population. [ABSTRACT FROM AUTHOR]