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To systematically review studies that evaluated the impact of employer-led efforts in the United States to improve the value of health spending, where employers have implemented changes to their health benefits to reduce costs while improving or maintaining quality.We included all studies of employer-led health benefit strategies that reported outcomes for both employer health spending and employee health outcomes.Our search returned 44 studies of employer health benefit changes that included measures of both health spending and quality. The most promising efforts were those that lowered or eliminated cost sharing for primary care or medications for chronic illnesses. High deductible health plans with a savings option appeared less promising.More research is needed on the characteristics and contexts in which these benefit changes were implemented, and on actions that address employers' current concerns.

Background Approximately, 350-400 patients are admitted to a level 4 hospital for hip-fractures yearly (2019). According to the Irish Hip Fracture Database (2020) the average age for a hip-fracture is 81 years old. Patients post-hip fractures are commenced on Zoledronic acid; a bisphosphonate which is given intravenously 10 days post-surgery and then annually in year two and three. Zoledronic acid is a first line choice of bisphosphonate for the ≥65 population with a fragility fracture. Methods 274 patients were transferred from the level 4 Hospital waiting list to a level 2 hospital waiting list to streamline the service. Meetings occurred to establish a pathway for the transition of services. A rapid improvement of the level 2 Day Hospital (DH) was commenced. Essential resources, training and information leaflets were developed in order to begin the service. A policy review, procedure guidelines and referral pathway were implemented. An excel database of patient information was transferred between organisations. The 274 patients were triaged by the DH. Pre-assessment phone calls were conducted determining if patients were still eligible for Zoledronic acid. Results Of the 274 referrals; 24 had died; 30 refused; 37 were on other bone treatments and another 7 patients haven’t made creatinine clearance, leaving 176. All 176 patients were allocated an appointment for 2022. Of the 176 patients; currently 57 patients have received their Zoledronic acid infusion in the DH. 69 of these referrals had an indicative date for their next Zoledronic acid infusion for dates after April 2022. There are 50 patients yet to receive their treatment which is overdue. Conclusion With the prospect of service demands increasing due to Irelands aging population inevitably placing extra pressures on infusion suites in a level 4 hospital. The level 2 hospital has effectively managed to focus on tackling the backlog, streamlining referrals to the bone health service and thus reducing the risk of subsequent hip fractures.

Background Minimum training recommendations to become a specialist geriatrician in the EU have been published. In this study we sought to evaluate the curriculum of the higher specialist training scheme in Geriatric Medicine in Ireland and examine how it compares with the knowledge recommendations from the European post-graduate curriculum in Geriatric medicine, which is endorsed by both the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA). Methods In this study we examined the content of didactic study-day lectures given over a five-year rolling period which is the minimum duration of the higher specialist training programme in Geriatric medicine in Ireland. We also examined the published Irish curriculum and compared how both the Irish curriculum and content of the study-days matches up with the 36 items that are identified as the core knowledge content in the European post-graduate curriculum. Results There were 24 study days delivered over a five-year time period. The Irish geriatric medicine curriculum formally outlined that 30 of the 36 knowledge areas proposed in the European curriculum should be formally covered during post-graduate geriatric training in Ireland. The European curriculum recommended formal teaching in sarcopenia, sleep disorders, tissue viability, iatrogenic care delivered disorders, sexuality in older adults and geron-technology/e-health, none of which were referred to in the Irish curriculum. However, despite this discrepancy, formal teaching was delivered on 92% (n = 33) of proposed areas. Pain assessment, sleep disorders and tissue viability were areas not covered in Irish didactic study-days. 24 of 36 topics were covered at least twice. Conclusion There was high concordance between the content of the Irish and European post-graduate curriculum in Geriatric medicine. Benchmarking against European training standards is an opportunity to ensure that parity of education and training is achieved across the EU.

Significance In hippocampal neurons, gene expression is triggered by electrical activity and Ca2+ entry via L-type Cav1.2 channels in a process called excitation–transcription coupling. We identified a domain on the voltage-gated K+ channel Kv2.1 that promotes the clustering of L-type Cav1.2 channels at endoplasmic reticulum–plasma membrane junctions in the soma of neurons. Importantly, we discovered by disrupting this domain that the Kv2.1-mediated clustering of Cav1.2 at this somatic microdomain is critical for depolarization-induced excitation–transcription coupling., In mammalian brain neurons, membrane depolarization leads to voltage-gated Ca2+ channel-mediated Ca2+ influx that triggers diverse cellular responses, including gene expression, in a process termed excitation–transcription coupling. Neuronal L-type Ca2+ channels, which have prominent populations on the soma and distal dendrites of hippocampal neurons, play a privileged role in excitation–transcription coupling. The voltage-gated K+ channel Kv2.1 organizes signaling complexes containing the L-type Ca2+ channel Cav1.2 at somatic endoplasmic reticulum–plasma membrane junctions. This leads to enhanced clustering of Cav1.2 channels, increasing their activity. However, the downstream consequences of the Kv2.1-mediated regulation of Cav1.2 localization and function on excitation–transcription coupling are not known. Here, we have identified a region between residues 478 to 486 of Kv2.1’s C terminus that mediates the Kv2.1-dependent clustering of Cav1.2. By disrupting this Ca2+ channel association domain with either mutations or with a cell-penetrating interfering peptide, we blocked the Kv2.1-mediated clustering of Cav1.2 at endoplasmic reticulum–plasma membrane junctions and the subsequent enhancement of its channel activity and somatic Ca2+ signals without affecting the clustering of Kv2.1. These interventions abolished the depolarization-induced and L-type Ca2+ channel-dependent phosphorylation of the transcription factor CREB and the subsequent expression of c-Fos in hippocampal neurons. Our findings support a model whereby the Kv2.1-Ca2+ channel association domain-mediated clustering of Cav1.2 channels imparts a mechanism to control somatic Ca2+ signals that couple neuronal excitation to gene expression.

Background Successful maintenance of a heart transplant (HTx) graft requires adherence to a triple-drug regimen of immunosuppression. However, achieving adequate adherence can be difficult secondary to complicated dosing regimens, side effects, and mental/emotional barriers. A detailed review of current patterns of adherence to immunosuppression in adult HTx recipients is lacking. Objective This systematic review aims to detail the current landscape of adherence to immunosuppression in adult heart transplant patients, including the measurement of adherence, correlates to adherence, health outcomes associated with nonadherence, as well as strategies to improve adherence in HTx patients. Methods We conducted searches in PubMed MEDLINE, Embase, CENTRAL register of Controlled Trials (Wiley), and Scopus, from inception to March 2020. Studies were eligible if they outlined an aspect of adherence (as noted above in the objective) to immunosuppression in adult HTx patients. The HTx cohort had to contain at least 10 patients and measurement of adherence had to be done with an objective or otherwise validated measure of adherence (e.g. drug levels, automated pill bottles or adherence questionnaires). Two authors independently screened the articles for inclusion, then subsequently reviewed the full texts of the included articles. Data was extracted into standardized forms and bias evaluations were done using the Newcastle-Ottawa or modified Newcastle-Ottawa tools, depending on the study type. The authors followed all guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results The titles/abstracts of 880 articles were reviewed. Ultimately, 23 articles were included in the final review. The median number of participants was 101, with a range of 19 to 1397. Studies provided information on baseline levels of adherence (17 studies), correlates to adherence (14 studies), health outcomes related to nonadherence (3 studies) and interventions to improve adherence (3 studies). Baseline adherence estimates varied greatly depending on the adherence measure. Multiple significant correlates to nonadherence exist and appear to affect patients with certain sociodemographic backgrounds, those with psychological/psychiatric comorbidities and those with poor support structures. Nonadherence is associated with transplant coronary artery disease and acute late rejection; it may also be associated with long-term mortality. Finally, a simplified dosing regimen with once-a-day tacrolimus as well as use of a mobile phone-based intervention were associated with improved adherence. Bias scores were most deficient due to self-reported outcomes in 18 studies, and lack of controls/adjustments for confounders, in 7 studies. Conclusions Adherence to immunosuppression in transplant patients varies, but is associated with observable and modifiable factors which are worth addressing. Further high-quality studies regarding strategies to improve adherence are needed in the literature.

Objective This review aims to inform research and clinical care on the current state of knowledge on the relationship between positive affect and medication adherence. Method Searches were carried out in PsycINFO, PubMed MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and Embase. There were no limits on study type, publication date, language, or participant demographics. Studies reporting a relationship between positive affect and medication adherence were eligible for inclusion if positive affect was measured prior to or concurrently with medication adherence. Results Nine studies met inclusion criteria. All studies were prospective cohort or cross-sectional and examined positive affect and medication adherence in people living with HIV or cardiovascular conditions. The majority of results indicated positive associations between positive affect and medication adherence, with Cohen's d effect sizes ranging from -0.40 to 1.27. Conclusions Consistent with previous theoretical work, this systematic review provides evidence of a link between positive affect and improved medication adherence. Better measurement of both affect and medication adherence across chronic conditions is an important focus for future research and will inform targeted interventions to improve adherence and, ultimately, decrease the morbidity, mortality, and cost associated with suboptimal adherence in chronic physical conditions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Aims To summarize evidence for the efficacy of smoking cessation interventions in low‐ and middle‐income countries (LMICs). Design Systematic review and meta‐analysis of randomized controlled trials. Setting LMICs as defined by the World Bank. Participants Adult current cigarette smokers residing in LMICs. Interventions Behavioral and/or pharmacotherapy smoking cessation interventions. Measurements PubMed MEDLINE, EMBASE (embase.com), Cochrane Central Register of Controlled Trials (Wiley), PsycINFO (Ebsco), SciELO, WHO Global Index Medicus and Scopus were searched from inception to 4 April 2018. Only studies with at least 6 months of follow‐up were included. We used the most rigorous assessment of abstinence reported by each study. Effect sizes were computed from abstracted data. Where possible, a meta‐analysis was performed using Mantel–Haenzel random‐effect models reporting odds ratios (OR) and 95% confidence intervals (CI). Findings Twenty‐four randomized controlled trials were included. Six investigated the efficacy of pharmacological agents. Four trials that compared nicotine replacement therapy (NRT) to placebo found NRT improved cessation rates (n : NRT 546, control 684, OR = 1.76, 95% CI = 1.30–2.77, P

Background The success of antiretroviral therapy has led to an increase in life expectancy and an associated rise in the risk of cardiometabolic diseases (CMDs) among people living with HIV. Objective Our aim was to conduct a systematic review to synthesize the existing literature on the patterns of use and effects of mobile health (mHealth) interventions for improving treatment adherence and outcomes of care for CMD among people living with HIV. Methods A systematic search of multiple databases, including PubMed-MEDLINE, Embase, CINAHL, Scopus, Web of Science, African Journals online, ClinicalTrials.gov, and the World Health Organization Global Index Medicus of peer-reviewed articles, was conducted with no date or language restrictions. Unpublished reports on mHealth interventions for treatment adherence and outcomes of care for CMD among adults living with HIV were also included in this review. Studies were included if they had at least 1 component that used an mHealth intervention to address treatment adherence or 1 or more of the stated outcomes of care for CMD among people living with HIV. Results Our search strategy yielded 1148 unique records. In total, 10 articles met the inclusion criteria and were included in this review. Of the 10 studies, only 4 had published results. The categories of mHealth interventions ranged from short messaging, telephone calls, and wearable devices to smartphone and desktop web-based mobile apps. Across the different categories of interventions, there were no clear patterns in terms of consistency in the use of a particular intervention, as most studies (9/10, 90%) assessed a combination of mHealth interventions. Short messaging and telephone calls were however the most common interventions. Half of the studies (5/10, 50%) reported on outcomes that were indirectly linked to CMD, and none of them provided reliable evidence for evaluating the effectiveness of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. Conclusions Due to the limited number of studies and the heterogeneity of interventions and outcome measures in the studies, no definitive conclusions could be drawn on the patterns of use and effects of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. We therefore recommend that future trials should focus on standardized outcomes for CMD. We also suggest that future studies should consider having a longer follow-up period in order to determine the long-term effects of mHealth interventions on CMD outcomes for people living with HIV. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42018086940; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018086940

Objectives: Age is the most common predictor of hearing loss; however, many older adults are not screened. Hearing screening could improve healthcare access, participation, and outcomes. Establishing whether hearing screening in older adults is cost-effective could improve the availability and utilization of screening. Methods: We searched nine databases in January 2020. Studies with populations aged 50+ and provided data on the cost-effectiveness of hearing screening were included in the review. Results: Five studies met the inclusion criteria and all found hearing screening programs to be cost-effective compared to no hearing screening, regardless of screening method (i.e., instrument or strategy). The maximum number of repeated screenings, coupled with younger ages, was most cost-effective. Discussion: This review suggests that hearing screening in older adults is cost-effective, however, the evidence is limited. There is pressing need for research focused on economic impacts of hearing healthcare in older adults to inform research, policy and practice.

Introduction HIV self-testing (HIV-ST) is an effective means of improving HIV testing rates. Low- and middle-income countries (LMIC) are taking steps to include HIV-ST into their national HIV/AIDS programs but very few reviews have focused on implementation in LMIC. We performed a scoping review to describe and synthesize existing literature on implementation outcomes of HIV-ST in LMIC. Methods We conducted a systematic search of Medline, Embase, Global Health, Web of Science, and Scopus, supplemented by searches in HIVST.org and other grey literature databases (done 23 September 2020) and included articles if they reported at least one of the following eight implementation outcomes: acceptability, appropriateness, adoption, feasibility, fidelity, cost, penetration, or sustainability. Both quantitative and qualitative results were extracted and synthesized in a narrative manner. Results and discussion Most (75%) of the 206 included articles focused on implementation in Africa. HIV-ST was found to be acceptable and appropriate, perceived to be convenient and better at maintaining confidentiality than standard testing. The lack of counselling and linkage to care, however, was concerning to stakeholders. Peer and online distribution were found to be effective in improving adoption. The high occurrence of user errors was a common feasibility issue reported by studies, although, diagnostic accuracy remained high. HIV-ST was associated with higher program costs but can still be cost-effective if kit prices remain low and HIV detection improves. Implementation fidelity was not always reported and there were very few studies on, penetration, and sustainability. Conclusions Evidence supports the acceptability, appropriateness, and feasibility of HIV-ST in the LMIC context. Costs and user error rates are threats to successful implementation. Future research should address equity through measuring penetration and potential barriers to sustainability including distribution, cost, scale-up, and safety.

BACKGROUND The success of antiretroviral therapy has led to an increase in life expectancy and an associated rise in the risk of cardiometabolic diseases (CMDs) among people living with HIV. OBJECTIVE Our aim was to conduct a systematic review to synthesize the existing literature on the patterns of use and effects of mobile health (mHealth) interventions for improving treatment adherence and outcomes of care for CMD among people living with HIV. METHODS A systematic search of multiple databases, including PubMed-MEDLINE, Embase, CINAHL, Scopus, Web of Science, African Journals online, ClinicalTrials.gov, and the World Health Organization Global Index Medicus of peer-reviewed articles, was conducted with no date or language restrictions. Unpublished reports on mHealth interventions for treatment adherence and outcomes of care for CMD among adults living with HIV were also included in this review. Studies were included if they had at least 1 component that used an mHealth intervention to address treatment adherence or 1 or more of the stated outcomes of care for CMD among people living with HIV. RESULTS Our search strategy yielded 1148 unique records. In total, 10 articles met the inclusion criteria and were included in this review. Of the 10 studies, only 4 had published results. The categories of mHealth interventions ranged from short messaging, telephone calls, and wearable devices to smartphone and desktop web-based mobile apps. Across the different categories of interventions, there were no clear patterns in terms of consistency in the use of a particular intervention, as most studies (9/10, 90%) assessed a combination of mHealth interventions. Short messaging and telephone calls were however the most common interventions. Half of the studies (5/10, 50%) reported on outcomes that were indirectly linked to CMD, and none of them provided reliable evidence for evaluating the effectiveness of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. CONCLUSIONS Due to the limited number of studies and the heterogeneity of interventions and outcome measures in the studies, no definitive conclusions could be drawn on the patterns of use and effects of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. We therefore recommend that future trials should focus on standardized outcomes for CMD. We also suggest that future studies should consider having a longer follow-up period in order to determine the long-term effects of mHealth interventions on CMD outcomes for people living with HIV. CLINICALTRIAL PROSPERO International Prospective Register of Systematic Reviews CRD42018086940; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018086940

Aims Employers in the United States incur substantial costs associated with substance use disorders. Our goal was to examine the effectiveness of employer‐led interventions to reduce the adverse effects of drug misuse in the workplace. Methods We conducted a systematic review of studies that evaluated the effectiveness of recommended workplace interventions for opioids and related drugs: employee education, drug testing, employee assistance programs, supervisor training, written workplace drug‐free policy, and restructuring employee health benefit plans. We searched PubMed MEDLINE, EMBASE (embase.com), PsycINFO (Ebsco), ABI Inform Global, Business Source Premier, EconLit, CENTRAL, Web of Science (Thomson Reuters), Scopus (Elsevier), Proquest Dissertations, and Epistemonikos from inception through May 8, 2019, with no date or language restrictions. We included randomized controlled trials, quasi‐experimental studies, and cross‐sectional studies with no language or date restrictions. The Downs and Black questionnaire was used to assess the quality of included studies. The results were reported using the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines. Results In all, 27 studies met our inclusion criteria and were included in the systematic review. Results were mixed, with each intervention shown to be effective in at least one study, but none showing effectiveness in over 50% of studies. Studies examining the impact of interventions on workplace injuries or accidents were more commonly reported to be effective. Although four studies were randomized controlled trials, the quality of all included studies was “fair” or “poor.” Conclusions Despite the opioid epidemic, high‐quality studies evaluating the effectiveness of employer‐led interventions to prevent or reduce the adverse effects of substance use are lacking. Higher quality and mixed methods studies are needed to determine whether any of the interventions are generalizable and whether contextual adaptations are needed. In the meantime, there is a reason to believe that commonly recommended, employer‐led interventions may be effective in some environments.

BACKGROUND: A small subset of patients account for a substantial proportion of hospital readmissions. Programs to reduce utilization among this subset of frequently hospitalized patients have the potential to improve health and reduce unnecessary spending. PURPOSE: To conduct a systematic review of interventions targeting frequently hospitalized patients. DATA SOURCES: PubMed MEDLINE; Embase (embase.com); and Cochrane Central Register of Controlled Trials, January 1, 1980 to January 1, 2018. STUDY SELECTION: Four physicians screened 4762 titles and abstracts for inclusion. Authors reviewed 116 full-text studies and included 9 meeting criteria. DATA EXTRACTION: Study characteristics, outcomes, and details regarding interventions were extracted. Risk of bias was assessed by the Downs and Black Scale. DATA SYNTHESIS: Out of the nine included studies, three were randomized controlled trials, three were controlled retrospective cohort studies, and three were uncontrolled pre-post studies. Inclusion criteria, interventions used, and outcomes assessed varied across studies. While all nine studies demonstrated reduced utilization, studies with lower risk of bias generally found similar reductions in utilization between intervention and control groups. Interventions commonly consisted of interdisciplinary teams interacting with patients across health care settings. CONCLUSIONS: Interventions targeting high need, high-cost patients are heterogeneous, with many studies observing a regression to the mean. More rigorous studies, using multifaceted interventions which can adapt to patients’ unique needs should be conducted to assess the effect on outcomes relevant to both providers and patients.

Background Telemedicine, including video-, web-, and telephone-based interventions, is used in adult and pediatric populations to deliver health care and communicate with patients. In the realm of hematology, telemedicine has recently been used to safely and efficiently monitor treatment side-effects, perform consultations, and broaden the reach of subspecialty care. Objective We aimed to synthesize and analyze information regarding the feasibility, acceptability, and potential benefits of telemedicine interventions in malignant and nonmalignant hematology, as well as assess the recognized limitations of these interventions. Methods Studies were identified through a comprehensive Medical Subject Headings (MeSH) search on the PubMed MEDLINE, Controlled Register of Clinical Trials (Cochrane CENTRAL from Wiley), Embase, and CINAHL (EBSCO) databases on February 7, 2018. A second search, utilizing the same search strategy, was performed on October 1, 2020. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in the reporting of included evidence. Included studies were original articles researching the feasibility, acceptability, and clinical outcomes of telemedicine or telehealth interventions in pediatric or adult populations with malignant or nonmalignant hematological conditions. Data items in the extraction form included first author name, publication year, country, malignant or nonmalignant hematological condition or disease focus of the study, participant age, participant age subgroup (pediatric or adult), study design and setting, telemedicine intervention type and description, study purpose, and main study outcomes. Results A total of 32 articles met the preset criteria and were included in this study. Most (25/32) studies were conducted in adults, and the remaining (7/32) were conducted in the pediatric population. Of the 32 studies, 12 studied malignant hematological conditions, 18 studied nonmalignant conditions, and two studied both malignant and nonmalignant conditions. Study types included pilot study (11/32), retrospective study (9/32), randomized controlled trial (6/32), cross-sectional study (2/32), case study (1/32), pre-post study (1/32), noncomparative prospective study (1/32), and prospective cohort study (1/32). The three main types of telemedicine interventions utilized across all studies were video-based (9/32), telephone-based (9/32), and web-based interventions (14/32). Study results showed comparable outcomes between telemedicine and traditional patient encounter groups across both pediatric and adult populations for malignant and nonmalignant hematological conditions. Conclusions Evidence from this review suggests that telemedicine use in nonmalignant and malignant hematology provides similar or improved health care compared to face-to-face encounters in both pediatric and adult populations. Telemedicine interventions utilized in the included studies were well received in both pediatric and adult settings. However, more research is needed to determine the efficacy of implementing more widespread use of telemedicine for hematological conditions.

Good crystalline quality CaF 2 sub-micron size particles doped with neodymium ions have been produced by the co-precipitation process and their crystallinity have been further improved by thermal treatment at 500 °C. Core and surface related luminescence defect centres have been identified and the effects of Y 3+ and Yb 3+ codopants are also investigated. Core defects centres are associated with single-ion and multi-ion defect centres as observed in bulk single crystal whereas the origin of the surface or near surface defect, A′, centre has been ascertained to be derived from a single-ion centre most probably charge compensated by a hydroxyl group.

BackgroundPrevious reviews have demonstrated that shift work and long work hours are associated with increased risk for chronic conditions. However, these reviews did not comprehensively assessed the body of evidence, and some were not conducted in a systematic manner. A better understanding of the health consequences of shift work and long work hours will aid in creating policy and practice recommendations. This review revisits the epidemiologic evidence on the association of shift work and long work hours with chronic conditions with particular emphasis on assessing the quality of the evidence.Methods and findingsWe conducted a systematic review of systematic reviews with meta-analyses (SR-MA) that assessed the link between shift work or long work hours and chronic conditions (PROSPERO CRD42019122084). We evaluated the risk of bias of each SR-MA using AMSTAR v2 and assessed the overall evidence for each condition using the GRADE approach. We included 48 reviews covering cancers, cardiovascular diseases, metabolic syndrome and related conditions, pregnancy complications, depression, hypertension, and injuries. On average, only 7 of 16 AMSTAR items were fulfilled. Few SR-MAs had a registered protocol and nearly all failed to conduct a comprehensive search. We found moderate grade evidence linking shift work to breast cancer and long work hours to stroke. We found low grade evidence linking both shift work and long work hours with low to moderate increase in risk for some pregnancy complications and cardiovascular diseases. Low grade evidence also link long work hours and depression.ConclusionsModerate grade evidence suggest that shift work and long work hours increase the risk of breast cancer and stroke, but the evidence is unclear on other chronic conditions. There is a need for high-quality studies to address this gap. Stakeholders should be made aware of these increased risks, and additional screening and prevention should be considered, particularly for workers susceptible to breast cancer and stroke.

Supplemental Digital Content is Available in the Text., Background: Use of outcome measures (OMs) in adult neurologic physical therapy is essential for monitoring changes in a patient's status over time, quantifying observations and patient-reported function, enhancing communication, and increasing the efficiency of patient care. OMs also provide a mechanism to compare patient and organizational outcomes, examine intervention effectiveness, and generate new knowledge. This clinical practice guideline (CPG) examined the literature related to OMs of balance, gait, transfers, and patient-stated goals to identify a core set of OMs for use across adults with neurologic conditions and practice settings. Methods: To determine the scope of this CPG, surveys were conducted to assess the needs and priorities of consumers and physical therapists. OMs were identified through recommendations of the Academy of Neurologic Physical Therapy's Evidence Database to Guide Effectiveness task forces. A systematic review of the literature on the OMs was conducted and additional OMs were identified; the literature search was repeated on these measures. Articles meeting the inclusion criteria were critically appraised by 2 reviewers using a modified version of the COnsensus-based Standards for the selection of health Measurement INstruments. (COSMIN) checklist. Methodological quality and the strength of statistical results were determined. To be recommended for the core set, the OMs needed to demonstrate excellent psychometric properties in high-quality studies across neurologic conditions. Results/Discussion: Based on survey results, the CPG focuses on OMs that have acceptable clinical utility and can be used to assess change over time in a patient's balance, gait, transfers, and patient-stated goals. Strong, level I evidence supports the use of the Berg Balance Scale to assess changes in static and dynamic sitting and standing balance and the Activities-specific Balance Confidence Scale to assess changes in balance confidence. Strong to moderate evidence supports the use of the Functional Gait Assessment to assess changes in dynamic balance while walking, the 10 meter Walk Test to assess changes in gait speed, and the 6-Minute Walk Test to assess changes in walking distance. Best practice evidence supports the use of the 5 Times Sit-to-Stand to assess sit to standing transfers. Evidence was insufficient to support use of a specific OM to assess patient-stated goals across adult neurologic conditions. Physical therapists should discuss the OM results with patients and collaboratively decide how the results should inform the plan of care. Disclaimer: The recommendations included in this CPG are intended as a guide for clinicians, patients, educators, and researchers to improve rehabilitation care and its impact on adults with neurologic conditions. The contents of this CPG were developed with support from the APTA and the Academy of Neurologic Physical Therapy (ANPT). The Guideline Development Group (GDG) used a rigorous review process and was able to freely express its findings and recommendations without influence from the APTA or the ANPT. The authors declare no competing interest. Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A214.

SUMMARY Health care disparities affecting the care of multiple disease groups are of growing concern internationally. Research guidelines, governmental institutions, and scientific journals have attempted to minimize disparities through policies regarding the collection and reporting of racial/ethnic data. One area where shortcomings remain is in gastroesophageal reflux disease (GERD). This systematic review, which adheres to the PRISMA statement, focuses on characterizing existing methodological weaknesses in research focusing on studies regarding the assessment, prevalence, treatment, and outcomes of GERD patients. Search terms included GERD and typical symptoms of GERD in ethnic groups or minorities. We reviewed 62 articles. The majority of studies did not report the race/ethnicity of all participants, and among those who did, very few followed accepted guidelines. While there were diverse participants, there was also diversity in the manner in which groups were labeled, making comparisons difficult. There appeared to be a disparity with respect to countries reporting race/ethnicity, with certain countries more likely to report this variable. Samples overwhelmingly consisted of the study country's majority population. The majority of studies justified the use of race/ethnicity as a study variable and investigated conceptually related factors such as socioeconomic status and environment. Yet, many studies wrote as if race/ethnicity reflected biological differences. Despite recommendations, it appears that GERD researchers around the world struggle with the appropriate and standard way to include, collect, report, and discuss race/ethnicity. Recommendations on ways to address these issues are included with the goal of preventing and identifying health care disparities.

Background Providers need to be comfortable addressing obesity and gestational weight gain so they may give appropriate care; however, health care providers lack guidelines for the most effective educational strategies to assist in providing optimal care. Objective To identify studies that involved the obstetric provider in interventions for either the perinatal management of obesity and/or gestational weight gain in a systematic review. Search strategy A keyword search of databases was performed up to April 2017. Selection criteria Obstetric providers who participated in an intervention with the aim to change a provider’s clinical practice, knowledge, and/or satisfaction with the intervention in relation to the perinatal management of obesity or gestational weight gain were included. Provider intervention could include training or education, changes in systems or organization of care, or resources to support practice. PROSPERO database #42016038921. Data collection and analysis Bias was assessed according to the validated Mixed Methods Appraisal Tool. The following variables were synthesized: study location and setting, provider and patient characteristics, intervention features, outcomes and efficacy, and strengths and weakness. Main results Of the 6,821 abstracts screened, seven studies (4 quantitative, 3 mixed-methods) with a total of 335 providers met the inclusion criteria; two of which focused on the management of obesity, three focused on gestational weight gain, and two focused on both topics. Interventions that incorporated motivational interviewing skills (n = 2), required additional training for the research study and addressed specific knowledge deficits such as nutrition and exercise (n = 3), and interfaced with the electronic medical record (n = 1) demonstrated the greatest impact on provider outcomes. Provider reported satisfaction scores were generally favorable, but none addressed provider-level efficacy in practice change. Conclusions Given the limited number of studies, varying range of provider participation, and lack of provider-level efficacy, further evaluation of provider training and involvement in interventions for perinatal obesity or gestational weight gain is indicated to determine best practices for provider and patient outcomes.

Background Delirium is a common condition in hospitalized patients and is associated with multiple adverse outcomes. There is increasing evidence to support interventions that prevent delirium, so the identification of patients at high risk is of significant clinical value. Numerous risk factors have been identified, including both premorbid patient characteristics and acute precipitants. Despite this, predicting the occurrence of delirium remains a clinical challenge. Objective This article reviews studies of validated risk-stratification models for delirium. We discuss possible barriers to use of these models and future directions for research. Methods A comprehensive review of the literature was completed using PubMed and Embase. The resulting citations were filtered in a structured process. Inclusion criteria were original research, adult medical inpatient population and presence of a validation group in the study design. Results Ten cohort studies met inclusion criteria. The quality of the studies was moderate to good. All studies proposed models using clinical data to predict the risk of patients' developing delirium. Conclusion The most common risk factors identified were preexisting cognitive impairment, medical comorbidity, elevated Blood Urea Nitrogen, and impairment in activities of daily living. While multiple validated predictive models exist, there is substantial heterogeneity between models, and only one replication study has been performed. In addition, difficulties in implementation may be a barrier to broader use of these models. There is limited support for an accurate and reliable tool to predict inpatient delirium. Further research is needed in this clinically important area.

Surveillance after colorectal cancer (CRC) treatment is routine, but intensive follow-up may offer little-to-no overall survival benefit. Given the growing population of CRC survivors, we aimed to systematically evaluate the literature for the patient perspective on two questions: (1) How do CRC patients perceive routine surveillance following curative treatment and what do they expect to gain from their surveillance testing or visits? (2) Which providers (specialists, nursing, primary care) are preferred by CRC survivors to guide post-treatment surveillance? Systematic searches of PubMed MEDLINE, Embase, the CENTRAL Register of Controlled Trials, CINAHL, and PsycINFO were conducted. Studies were screened for inclusion by two reviewers, with discrepancies adjudicated by a third reviewer. Data were abstracted and evaluated utilizing validated reporting tools (CONSORT, STROBE, CASP) appropriate to study design. Citations (3691) were screened, 91 full-text articles reviewed, and 23 studies included in the final review: 15 quantitative and 8 qualitative. Overall, 12 studies indicated CRC patients perceive routine surveillance positively, expecting to gain reassurance of continued disease suppression. Negative perceptions described in six studies included anxiety and dissatisfaction related to quality of life or psychosocial issues during follow-up. Although 5 studies supported specialist-led care, 9 studies indicated patient willingness to have follow-up with non-specialist providers (primary care or nursing). Patients’ perceptions of follow-up after CRC are predominantly positive, although unmet needs included psychosocial support and quality of life. Survivors perceived follow-up as reassuring, however, surveillance care should be more informative and focused on survivor-specific needs.

Scoping reviews are preliminary assessments intended to characterize the extent and nature of emerging research evidence, identify literature gaps, and offer directions for future research. We conducted a systematic scoping review to describe published scientific literature on strategies to identify and reduce opioid misuse among patients with gastrointestinal (GI) symptoms and disorders. We performed structured keyword searches to identify manuscripts published through June 2016 in the PubMed MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science databases to extract original research articles that described healthcare practices, tools, or interventions to identify and reduce opioid misuse among GI patients. The Chronic Care Model (CCM) was used to classify the strategies presented. Twelve articles met the inclusion criteria. A majority of studies used quasi-experimental or retrospective cohort study designs. Most studies addressed the CCM’s clinical information systems element. Seven studies involved identification of opioid misuse through prescription drug monitoring and opioid misuse screening tools. Four studies discussed reductions in opioid use by harnessing drug monitoring data and individual care plans, and implementing self-management and opioid detoxification interventions. One study described drug monitoring and an audit-and-feedback intervention to both identify and reduce opioid misuse. Greatest reductions in opioid misuse were observed when drug monitoring, self-management, or audit-and-feedback interventions were used. Prescription drug monitoring and self-management interventions may be promising strategies to identify and reduce opioid misuse in GI care. Rigorous, empirical research is needed to evaluate the longer-term impact of these strategies.

The field of physical medicinerehabilitation (PMR), along with all the disciplines it encompasses, has evolved rapidly in the past 50 years. The number of controlled trials, systematic reviews, and meta-analyses in PMR increased 5-fold from 1998 to 2013. In recent years, professional, private, and governmental institutions have identified the need to track function and functional status across providers and settings of care and on a larger scale. Because function and functional status are key aspects of PMR, access to and sharing of reliable data will have an important impact on clinical practice. We reviewed the current landscape of PMR databases and data repositories, the clinical applicability and practice implications of data sharing, and challenges and future directions. We included articles that (1) addressed any aspect of function, disability, or participation; (2) focused on recovery or maintenance of any function; and (3) used data repositories or research databases. We identified 398 articles that cited 244 data sources. The data sources included 66 data repositories and 179 research databases. We categorized the data sources based on their purposes and uses, geographic distribution, and other characteristics. This study collates the range of databases, data repositories, and data-sharing mechanisms that have been used in PMR internationally. In recent years, these data sources have provided significant information for the field, especially at the population-health level. Implications and future directions for data sources also are discussed.

Background Although cervical cancer is largely preventable through screening, detection and treatment of precancerous abnormalities, it remains one of the top causes of cancer-related morbidity and mortality globally. Objectives The objective of this systematic review is to understand the evidence of the effect of cervical cancer education compared to control conditions on cervical cancer screening rates in eligible women population at risk of cervical cancer. We also sought to understand the effect of provider recommendations for screening to eligible women on cervical cancer screening (CCS) rates compared to control conditions in eligible women population at risk of cervical cancer. Methods We used the PICO (Problem or Population, Interventions, Comparison and Outcome) framework as described in the Cochrane Collaboration Handbook to develop our search strategy. The details of our search strategy has been described in our systematic review protocol published in the International Prospective Register of systematic reviews (PROSPERO). The protocol registration number is CRD42016045605 available at: http://www.crd.york.ac.uk/prospero/display_record.asp?src=trip&ID=CRD42016045605. The search string was used in Pubmed, Embase, Cochrane Systematic Reviews and Cochrane CENTRAL register of controlled trials to retrieve study reports that were screened for inclusion in this review. Our data synthesis and reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). We did a qualitative synthesis of evidence and, where appropriate, individual study effects were pooled in meta-analyses using RevMan 5.3 Review Manager. The Higgins I2 was used to assess for heterogeneity in studies pooled together for overall summary effects. We did assessment of risk of bias of individual studies included and assessed risk of publication bias across studies pooled together in meta-analysis by Funnel plot. Results Out of 3072 study reports screened, 28 articles were found to be eligible for inclusion in qualitative synthesis (5 of which were included in meta-analysis of educational interventions and 8 combined in meta-analysis of HPV self-sampling interventions), while 45 were excluded for various reasons. The use of theory-based educational interventions significantly increased CCS rates by more than double (OR, 2.46, 95% CI: 1.88, 3.21). Additionally, offering women the option of self-sampling for Human Papillomavirus (HPV) testing increased CCS rates by nearly 2-fold (OR = 1.71, 95% CI: 1.32, 2.22). We also found that invitation letters alone (or with a follow up phone contact), making an appointment, and sending reminders to patients who are due or overdue for screening had a significant effect on improving participation and CCS rates in populations at risk. Conclusion Our findings supports the implementation of theory-based cervical cancer educational interventions to increase women’s participation in cervical cancer screening programs, particularly when targeting communities with low literacy levels. Additionally, cervical cancer screening programs should consider the option of offering women the opportunity for self-sample collection particularly when such women have not responded to previous screening invitation or reminder letters for Pap smear collection as a method of screening.

Objective To assess the economic burden of food allergy (FA) worldwide. Data Sources PubMed MEDLINE, Embase, and Cochrane Central Register of Controlled Trials on the Wiley platform were searched to identify literature that assessed direct, out-of-pocket, and opportunity costs of FA. All databases were searched back to their inception, and no language or date limits were applied. Study Selections We included primary studies that examined direct medical, out-of-pocket, or opportunity costs and/or lost labor productivity in food allergic adults and/or children and their families. Results Eleven papers met our inclusion criteria, of which ed7 addressed direct medical, 7 addressed out-of-pocket, and 5 addressed opportunity costs. Estimates were based on data that reflected costs for a patient with FA (individual level) or costs for a household with a food allergic patient (household level). The mean individual-level direct medical costs ($2081) were much higher than the mean household-level costs ($806). The mean individual-level out-of-pocket ($1874) and opportunity ($1038) and opportunity cost were lower than the mean household-level out-of-pocket ($3339) and opportunity ($4881) costs. Household-level estimates of lost opportunity costs imposed the largest economic burden attributable to FA. Conclusion Most of the economic burden studies reviewed measured components of economic burden that are unique to individuals with FA but did so in noncomparable ways. Addressing cost burdens and measuring them using standardized instruments and methods will be critical to better understand the economic burden of FA globally.

The original version of this article unfortunately contained a mistake. The online supplementary files are missing. The complete version of online supplementary materials are published with this erratum.

Embora a discussão sobre anuência prévia e repartição de benefícios tenha ganhado projeção no Brasil em 1992, com a Convenção sobre Diversidade Biológica e a ECO-92, somente 10 anos depois foi publicada a primeira legislação para dispor sobre a proteção, o acesso ao conhecimento tradicional associado (CTA) e a repartição de benefícios (MP 2186-16 de 2001). Quinze anos mais tarde foi emitida a primeira autorização de acesso ao CTA com fins de bioprospecção no Brasil, sendo esta para o presente trabalho. Sendo assim, o objetivo deste artigo é discutir, através de um estudo de caso, envolvendo a Universidade Federal do Rio de Janeiro e a Associação de Comunidades Remanescentes de Quilombo do Município de Oriximiná, as dificuldades para se obter a autorização de acesso pelo Conselho de Gestão do Patrimônio Genético, o laudo antropológico e o contrato de repartição de benefícios. Embora seja notório o despreparo do governo para lidar com o assunto, o que muitas vezes prejudica e inviabiliza a pesquisa nacional, por outro lado há os direitos das comunidades que devem ser respeitados, buscando-se que o acesso traga benefícios aos provedores do CTA. Assim, a garantia desses benefícios deve vir através do cumprimento da legislação vigente, que ainda necessita ser aperfeiçoada.

Syncope is a common condition, with an overlap of falls and syncope experienced more commonly in the older adult. Admission for syncope work-up should occur in certain circumstances such as syncope resulting in traumatic injury or where a strong suspicion of cardiac syncope arises. However, the majority of individuals presenting with an episode of syncope do not require admission and a dedicated syncope clinic in an outpatient setting has been shown to be beneficial. This should provide readily available testing such as Head-up tilt table testing and carotid sinus massage as well as access to cardiac and neurology services should they be required.

Nurses are expected to use evidence-based knowledge when planning and caring for patients and their families. For nurses who practice evidence-based care, knowing how to effectively search the literature for evidence is an important skill. The objectives of this article are to provide an overview of key sources of evidence and offer instruction on how to do an effective MEDLINE search in PubMed and how to critically review research articles. A sample literature search is performed using the example case study question, “How effective are compression stockings in preventing deep vein thrombosis or pulmonary embolism for thrombotic stroke patients who are on an oral anticoagulant regimen?”

We report on an electrochemical process whereby regular, ordered and periodic V-grooves are etched into an InP(0 0 1) surface during constant potential anodization in a 1 mol dm−3 KOH solution in dark conditions. Transmission electron microscopy and atomic force microscopy were employed to characterize the morphological changes induced by the etch process. V-grooves with a periodicity of 0.15 μm were observed delineated by the {1 1 1} etch-stop planes and are preferentially elongated in the [1 1 0] direction. X-ray photoelectron and reflection anisotropy spectroscopies show that the terminating faces of the grooves are very ordered and In-rich. It is hoped that such textured surfaces can be employed in the realization of massively parallel quantum wire laser growth.

Objective To systematically review evidence of treatments for cognitive impairments experienced by at least 20% of all women who undergo chemotherapy for breast cancer. Data Sources Searches of 5 databases (PubMed, Embase, Cochrane CENTRAL, PsycINFO, CINAHL), with no date or language restrictions, identified 1701 unique results. Search terms included breast cancer, chemotherapy, chemobrain, chemofog, and terms on cognition and language deficits. Study Selection Included only peer-reviewed journal articles that described therapies for cognitive dysfunction in women undergoing (or who had undergone) chemotherapy for breast cancer and provided objective measurements of cognition or language. Data Extraction Data were extracted according to Cochrane recommendations, including characteristics of participants, interventions, outcomes, and studies. Quality assessment of all 12 eligible studies was performed using the Physiotherapy Evidence Database scale and treatment fidelity criteria. Screening, data extraction, and quality assessment reliability were performed. Data Synthesis Six articles described interventions for cognition that took place during cancer treatment; 6, afterward. Five interventions were medical (including a strength-training program), 2 were restorative, and 5 were cognitive. Medicinal treatments were ineffective; restorative and exercise treatments had mixed results; cognitive therapy had success in varying cognitive domains. The domains most tested and most successfully treated were verbal memory, attention, and processing speed. Conclusions Cognitive therapy protocols delivered after chemotherapy and aimed at improving verbal memory, attention, and processing speed hold the most promise. Future research is needed to clarify whether computerized cognitive training can be effective in treating this population, and to identify objective assessment tools that are sensitive to this disorder.

The present research investigates how consumer choice is affected by Terror Management Theory’s proposition of Mortality Salience increasing one’s cultural worldview defense and self-esteem striving. The study builds empirically upon prior theorizing by Arndt, Solomon, Kasser and Sheldon (2004). During an experiment, we manipulated Mortality Salience and measured product preferences for conspicuousness and familiarity. Participants primed with death were more likely to choose conspicuous products, corroborating previous research of mortality salience raising materialistic tendencies. In addition, participants showed a tendency to prefer familiar brands. These results are in line with the Terror Management Theory framework.

Approximately 75% of the Victorian Box-Ironbark ecosystem has been cleared since European settlement. There are few public land areas of high habitat quality, and significant Box-Ironbark remnant vegetation (BIR) is known to exist on private land. A landholder mail survey collected information about BIR to ascertain its size, use and habitat quality. Ground-truthing validated the landholder assessment of habitat quality. Livestock grazing had impacted 50% of BIR, and approximately 20–50% was of moderate to high quality. Fifty-four percent of BIR were less than 15 ha. Remnant size had the largest impact on quality, with larger remnants being of higher quality.

Summary A procedure is described for obtaining allometric relationships between stem diameter and aboveground biomass for grey box. Eucalyptus microcarpa. a commonly occurring tree in the Victorian and New South Wales Riverina. While usually having a single trunk, a significant proportion of grey box individuals have multiple stems from near the ground. This is an artifact of enhanced epicormic growth when juvenile, often resulting from stock grazing disturbance. The procedure treats each stem formed from below 30 cm above ground as a discrete tree that shares a proportion of the butt and other elements common to all stems. Significant allometric relationships, using both the commonly-applied log-transformed method, and a recently proposed additive error method, were developed between stem diameter at breast height and at 30 cm above ground, tree height and width, and the dry weights of each aboveground component. These relationships were similar to those previously obtained for single-stemmed trees in so...

Endoscopic retrograde cholangiopancreatography (ERCP) has become a predominantly therapeutic intervention with a resultant increase in complexity. The relationship between ERCP volume and outcomes is unclear. We aimed to conduct a systematic review and meta-analysis assessing the relationship between endoscopist and center ERCP volume with ERCP success and adverse event (AE) rates.A comprehensive search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted from inception to January 2017. Studies providing outcomes stratified by endoscopist and/or center volume were included in the final analysis. Endoscopist/center volume was stratified as low volume (LV) and high volume (HV). The definition of ERCP success varied between studies. The overall AE rate was a composite rate including pancreatitis, perforation, and bleeding.A literature search resulted in 1264 citations. Of those, 13 articles (n = 59,437 ERCPs) met inclusion criteria. LV endoscopist (25 to156 annual ERCPs) and center (87 to200 annual ERCPs) definitions varied between studies. HV endoscopists were significantly more likely to achieve ERCP success compared with LV endoscopists (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2-2.1). HV centers were significantly more likely to achieve ERCP success (OR, 2; 95% CI, 1.6-2.5). The post-ERCP AE risk was lower for HV endoscopists (OR, 0.7; 95% CI, 0.5-0.8) but not HV centers (OR, 0.7; 95% CI, 0.3-1.5).This study identifies a significant relationship between increasing endoscopist and center ERCP volume with overall procedure success. Increasing endoscopist volume also was associated with a decreased AE rate. Given these compelling findings, we propose that providers and payers consider consolidating ERCP to HV endoscopists to improve ERCP outcomes and value.

BackgroundThe number of adolescents with chronic health conditions (CHCs) continues to increase. Medication nonadherence is a global challenge among adolescents across chronic conditions and is associated with poor health outcomes. While there has been growing interest in the use of mHealth technology to improve medication adherence among adolescents with CHCs, particularly text messaging and mobile phone apps, there has been no prior systematic review of their efficacy. ObjectiveThe purpose of this review was to systematically evaluate the most recent evidence for the efficacy of text messaging and mobile phone apps as interventions to promote medication adherence among adolescents with CHCs. MethodsPubMed, Embase, CENTRAL, PsycINFO, Web of Science, Google Scholar, and additional databases were searched from 1995 until November 2015. An additional hand search of related themes in the Journal of Medical Internet Research was also conducted. The Preferred Reporting Results of Systematic Reviews and Meta-Analyses guidelines were followed. Two reviewers independently screened titles/abstracts, assessed full-text articles, extracted data from included articles, and assessed their quality using Grades of Recommendation, Assessment, Development, and Evaluation criteria. Included studies were described in original research articles that targeted adherence in adolescents with CHCs (12-24 years-old). ResultsOf the 1423 records examined, 15 met predefined criteria: text messaging (n=12) and mobile phone apps (n=3). Most studies were performed in the United States (11/15, 73%), were randomized-controlled trials (8/15, 53%), had a sample size