Integrating Public Health Into Undergraduate Medicine in North America: A Systematic Review
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The coronavirus disease 2019 (COVID-19) pandemic has served as a stark reminder of the importance of foundational public health training for all physicians. However, the most effective way to incorporate these concepts into undergraduate medical education remains unclear. Here, we characterize the literature regarding the effectiveness of public health integration into undergraduate medical education in North America. We systematically searched MEDLINE, Embase, Cochrane Central, and Education Resources Information Center (ERIC) in accordance with preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines for North American peer-reviewed literature, published from 01/01/2000 to 30/08/2021, that described outcomes of integrating public health training within an undergraduate medical curriculum. Results were qualitatively synthesized into key themes. A total of 38 studies, involving interventions across 43 medical schools, were included. Studies reported on a combination of public (n=13), global (n=9), population (n=9), community (n=6), and epidemiological (n=1) health interventions, and either implemented one-off workshops, electives, or international experiences (n=19); a longitudinal theme or long-term enrichment pathway (n=14); or a case-based learning curriculum (n=8). The majority (81.5%, 31/38) of integrations were self-described as successful and, of studies reporting on feasibility, most (94.1%, 16/17) were indicated as feasible. The definition of what constituted such success, however, was unclear. Innovative examples included the use of simulation workshops and mobile-optimized media content. Key challenges were noted, however, in securing adequate funding and buy-in from administrative leadership. Robust community partnerships and iterative cycles of implementation of the intervention were critical factors to success. In summary, foundational public health components can be effectively integrated into medical school curricula and would benefit from adequate resourcing, innovation, community partnerships, and continuous improvement.Owing to their inherent vulnerabilities, the burden of COVID-19 and particularly of its control measures on migrants has been magnified. A thorough assessment of the value of the interventions for COVID-19 tailored to migrants is essential for improving their health outcomes as well as promoting an effective control of the pandemic. In this study, based on evidence from primary biomedical research, we aimed to systematically identify health interventions for COVID-19 targeting migrants and to assess and compare their effectiveness. The review will be conducted within a programme aimed at defining and implementing interventions to control the COVID-19 pandemic in Italy, funded by the Italian Ministry of Health and conducted by a consortium of Italian regional health authorities.
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Occupational burnout is a common syndrome among physicians, and several individual-directed and organization-directed interventions have been implemented to reduce it. Until now, several review studies have tried to identify and introduce the most appropriate interventions. The aim of this article was to systematically review systematic review studies of interventions for physician burnout to evaluate and summarize their results, and ultimately guide researchers to select appropriate interventions. A search was conducted to find review studies and systematic reviews in Cochrane Database of Systematic Reviews, Medline, Google Scholar, PubMed, and PsycINFO. Two reviewers independently selected and evaluated the studies based on inclusion criteria. Four of seven obtained review studies and systematic reviews met the inclusion criteria. These studies have reviewed individual-directed and organization-directed interventions intended to reduce burnout among medical students, interns, physicians, residents, and fellows. Various studies of the effectiveness of individual- and organization-directed interventions have obtained different results. This research has shown that reaching conclusions about effective interventions (individual- or organization-directed) for physician burnout is not easy and that a number of mediating or moderating variables probably influence the effectiveness of these interventions. Therefore, it is necessary to understand approaches and interventions for the prevention or reduction of physician burnout to fill the gaps in research. In addition, review studies are required to be more precise in choosing their criteria to find more accurate results.
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The gap between research findings and clinical practice is well documented and a range of interventions has been developed to increase the implementation of research into clinical practice. A review of systematic reviews of the effectiveness of interventions designed to increase the use of research in clinical practice. A search for relevant systematic reviews was conducted of Medline and the Cochrane Database of Reviews 1998-2009. 13 systematic reviews containing 313 primary studies were included. Four strategy types are identified: audit and feedback; computerised decision support; opinion leaders; and multifaceted interventions. Nine of the reviews reported on multifaceted interventions. This review highlights the small effects of single interventions such as audit and feedback, computerised decision support and opinion leaders. Systematic reviews of multifaceted interventions claim an improvement in effectiveness over single interventions, with effect sizes ranging from small to moderate. This review found that a number of published systematic reviews fail to state whether the recommended practice change is based on the best available research evidence. This overview of systematic reviews updates the body of knowledge relating to the effectiveness of key mechanisms for improving clinical practice and service development. Multifaceted interventions are more likely to improve practice than single interventions such as audit and feedback. This review identified a small literature focusing explicitly on getting research evidence into clinical practice. It emphasizes the importance of ensuring that primary studies and systematic reviews are precise about the extent to which the reported interventions focus on changing practice based on research evidence (as opposed to other information codified in guidelines and education materials).
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Quality of care and the increasing strategies to its promotion, especially in inpatient settings, led to the question which quality-interventions work best and which do not. The aim was to summarize and critically appraise the evidence on the effects of structure- and/or process-related quality-interventions on patient outcome in predominantly controlled and inpatient settings. A systematic overview of systematic reviews after electronic searches in Medline, Embase, Cinahl, and PsycINFO, supplemented by hand search and expert survey, was conducted. From a total of 1559 identified records, 37 reviews fulfilled the inclusion criteria. 26 reviews assessed process-related quality-interventions, 6 structure-related quality-interventions, and 5 combined structure- and process-related quality-interventions. In all, 19 reviews reported pooled effect estimates (meta-analysis). Based on the evidence of this systematic overview, stroke units and pathways can be recommended. Although patient-relevant improvements for interprofessional approaches and discharge planning have been reported, pooled effect estimated evidence are currently missing for these and other quality-interventions.
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OBJECTIVE: Identify and critically evaluate systematic reviews addressing the effectiveness of interventions to reduce the number of prescriptions of potentially inappropriate medication to older patients. METHODS: This is an overview of systematic reviews. The studies were searched and selected from Medline, Cochrane Library, Embase, CINAHL, Virtual Health Library, and Web of Science databases, combining the terms aged, prescriptions, inappropriate prescribing and potentially inappropriate medication list with their entry terms and other related descriptors, published by June 2017. This study included systematic reviews with or without meta-analysis that addressed the effectiveness of any intervention or combined interventions to reduce the number of prescriptions of potentially inappropriate medications to older patients, without restriction in terms of design, language or date of publication of primary studies. AMSTAR – A MeaSurement Tool to Assess systematic Reviews – was used to evaluate the methodological quality of selected systematic reviews. Study selection and the methodological quality evaluation were performed by two independent evaluators, who resolved any divergence by consensus. The main findings were grouped into thematic categories, defined after a content analysis and discussed qualitatively as narrative synthesis. RESULTS: This study analyzed 24 systematic reviews. In terms of study design and methodological quality evaluation, most were systematic reviews of randomized controlled clinical trials and studies of moderate quality, respectively. The interventions were analyzed in five thematic categories: medication review services, pharmaceutical interventions, computerized systems, educational interventions, and others. The interventions analyzed showed good results and most of them helped reduce the number of prescriptions of potentially inappropriate medication to older patients. CONCLUSIONS: The systematic reviews included in this overview showed potential benefits of different interventions. However, it was not possible to determine the most effective intervention. Combined interventions are likely to provide better results than isolated interventions.
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Objectives To systematically appraise published reviews on interventions used to support transitions for individuals with neurological conditions. Data sources MEDLINE, CINAHL, The Allied and Complementary Medicine, AMED, PsycINFO, Cochrane database of systematic reviews and Web of Science were searched between 31st December 2010 and 15th September 2022. Method The systematic review followed PRISMA guidelines. The quality and risk of bias were measured using A MeaSurement Tool to Assess systematic Reviews 2 and the Risk Of Bias In Systematic reviews’ tool. All types of reviews which involved participants with neurological conditions were included. Results Seven reviews met the inclusion criteria. A total of 172 studies were included in the reviews. Effectiveness of transition interventions could not be calculated due to the lack of data. The findings suggested that the use of health applications may be beneficial by increasing self-management capabilities and disease knowledge. Education and clear communication between healthcare providers and recipients may also have positive impacts on quality of life. Risk of bias was found to be high in four of the reviews. Four reviews had low or critically low levels of evidence. Conclusions There is a paucity of published evidence on interventions used to support the transitions of individuals with neurological conditions and the effect that these have on quality of life.
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Abstract Background : Undermanaged acute pain contributes to the development of chronic pain and reduced quality of life. Although many complementary therapies have been implemented to manage chronic pain, few studies have investigated these therapies in acute pain. As one of the digital-integrated interventions, audio-related interventions provide multi approaches that potentially affect pain levels, such as suggestive affirmation, educative information, distraction, and relaxation. This study aims 1. to screen and evaluate contemporary literature concerning audio-related interventions application to reduce acute pain, 2. To analyze how the audio interventions affect pain reduction in adults in hospital settings, and 3. To identify the critical aspects of successful audio interventions in pain reduction for adults in a hospital setting. Method : This study will use Systematic Review and Meta-Analysis by following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. Six online databases (PubMed, Web of Science, Cochrane library, Ovid Medline & Medline (EBSCOhost), and Embase) will be searched. This review will include RCTs of audio-related interventions to reduce the acute pain level of adults in a hospital setting. Studies published older than ten years ago, presented in non-English languages, combined with other complementary interventions, and presented with the incomplete essential statistical value of pain will be excluded. The meta-analysis will be performed using R and synthesized using the GRADE approach with risk bias assessed with the Cochrane Risk of Bias Assessment tool. Discussion : This paper will contribute to clinical practice, specifically in the application of complementary therapies or medical technologies associated with audio-related interventions. The findings will provide crucial information on the implication of audio interventions in more effective ways. Registration : This study is registered in INPLASY protocol 202310002. Doi: 10.37766/inplasy2023.1.0002 and under review of PROSPERO.
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Background: Clinician communication has shown to influence cancer patients' perception of care and satisfaction. Effective communication is therefore a critical aspect of patient-centered care. Health services should be implementing evidence-based communication interventions to improve the provision of cancer care to patients. Aim: We conducted a systematic review of the literature with the aim to identify effective communication strategies and/or interventions to improve clinician-patient communication. Methods: Five electronic databases (MEDLINE, Embase, PsycINFO, the Cochrane Library and CINAHL Plus) were searched for relevant citations from 2005 until October 2015 using search terms related to “cancer”, “information” and “communication”. Titles and abstracts were evaluated by two independent reviewers. Selected full text publications were assessed against the eligibility criteria. Quality was assessed using the AMSTAR guidelines and GRADE. Due to the enormity of the literature, only systematic reviews were included. Results: The database search yielded 2934 unique citations, of which 198 full texts were retrieved. After applying the inclusion and exclusion criteria, 41 systematic reviews were included. The included studies were broadly categorized under six major themes: e-health, technological and telephone-based interventions (n=9); patient education and tools (n=5); communication training (n=9); education interventions to improve cancer pain (n=6); tools to facilitate patients' participation in care/decision making (n=8); nurse delivered interventions (n=6). Conclusion: There are an enormous number of studies of communication interventions for cancer patients. The quality of the evidence to support some of these interventions is low; whereas other interventions have stronger evidence of effectiveness. Therefore, health services and clinicians should carefully consider which interventions they choose to implement. The recommendations from this review will assist clinicians and health services to choose evidence-based interventions which can improve care provision and/or patient outcomes.
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Бұл зерттеужұмысындaКaно моделітурaлы жәнеоғaн қaтыстытолықмәліметберілгенжәнеуниверситетстуденттерінебaғыттaлғaн қолдaнбaлы (кейстік)зерттеужүргізілген.АхметЯссaуи университетініңстуденттеріүшін Кaно моделіқолдaнылғaн, олaрдың жоғaры білімберусaпaсынa қоятынмaңыздытaлaптaры, яғнисaпaлық қaжеттіліктері,олaрдың мaңыздылығытурaлы жәнесaпaлық қaжеттіліктерінеқaтыстыөз университетінқaлaй бaғaлaйтындығытурaлы сұрaқтaр қойылғaн. Осы зерттеудіңмaқсaты АхметЯсaуи университетіндетуризмменеджментіжәнеқaржы бaкaлaвриaт бaғдaрлaмaлaрыныңсaпaсынa қaтыстыстуденттердіңқaжеттіліктерінaнықтaу, студенттердіңқaнaғaттaну, қaнaғaттaнбaу дәрежелерінбелгілеу,білімберусaпaсын aнықтaу мен жетілдіружолдaрын тaлдaу болыптaбылaды. Осы мaқсaтқaжетуүшін, ең aлдыменКaно сaуaлнaмaсы түзіліп,116 студенткеқолдaнылдыжәнебілімберугежәнеоның сaпaсынa қaтыстыстуденттердіңтaлaптaры мен қaжеттіліктерітоптықжұмыстaрaрқылыaнықтaлды. Екіншіден,бұл aнықтaлғaн тaлaптaр мен қaжеттіліктерКaно бaғaлaу кестесіменжіктелді.Осылaйшa, сaпa тaлaптaры төрт сaнaтқa бөлінді:болуытиіс, бір өлшемді,тaртымдыжәнебейтaрaп.Соңындa,қaнaғaттaну мен қaнaғaттaнбaудың мәндеріесептелдіжәнестуденттердіңқaнaғaттaну мен қaнaғaттaнбaу деңгейлерінжоғaрылaту мен төмендетудеосытaлaптaр мен қaжеттіліктердіңрөліaйқын aнықтaлды.Түйінсөздер:сaпa, сaпaлық қaжеттіліктер,білімберусaпaсы, Кaно моделі.
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