Exploring the challenges of implementing e-health: a protocol for an update of a systematic review of reviews.

There is great potential for e-health to deliver cost-effective, quality healthcare and spending on e-health systems by governments and healthcare systems is increasing worldwide. However, the literature often describes problematic and unsuccessful attempts to implement these new technologies into routine clinical practice. To understand and address the challenges of implementing e-health, a systematic review was conducted in 2009, which identified several conceptual barriers and facilitators to implementation. As technology is rapidly changing and new e-health solutions are constantly evolving to meet the needs of current practice, an update of this review is deemed necessary to understand current challenges to the implementation of e-health. This research aims to identify, summarise and synthesise currently available evidence, by undertaking a systematic review of reviews to explore the barriers and facilitators to implementing e-health across a range of healthcare settings

Computer-assisted versus oral-and-written dietary history taking for diabetes mellitus

Background: Diabetes is a chronic illness characterised by insulin resistance or deficiency, resulting in elevated glycosylated haemoglobin A1c (HbA1c) levels. Diet and adherence to dietary advice is associated with lower HbA1c levels and control of disease. Dietary history may be an effective clinical tool for diabetes management and has traditionally been taken by oral-and-written methods, although it can also be collected using computer-assisted history taking systems (CAHTS). Although CAHTS were first described in the 1960s, there remains uncertainty about the impact of these methods on dietary history collection, clinical care and patient outcomes such as quality of life. Objectives: To assess the effects of computer-assisted versus oral-and-written dietary history taking on patient outcomes for diabetes mellitus. Search methods: We searched The Cochrane Library (issue 6, 2011), MEDLINE (January 1985 to June 2011), EMBASE (January 1980 to June 2011) and CINAHL (January 1981 to June 2011). Reference lists of obtained articles were also pursued further and no limits were imposed on languages and publication status. Selection criteria: Randomised controlled trials of computer-assisted versus oral-and-written history taking in patients with diabetes mellitus. Data collection and analysis: Two authors independently scanned the title and abstract of retrieved articles. Potentially relevant articles were investigated as full text. Studies that met the inclusion criteria were abstracted for relevant population and intervention characteristics with any disagreements resolved by discussion, or by a third party. Risk of bias was similarly assessed independently. Main results: Of the 2991 studies retrieved, only one study with 38 study participants compared the two methods of history taking over a total of eight weeks. The authors found that as patients became increasingly familiar with using CAHTS, the correlation between patients' food records and computer assessments improved. Reported fat intake decreased in the control group and increased when queried by the computer. The effect of the intervention on the management of diabetes mellitus and blood glucose levels was not reported. Risk of bias was considered moderate for this study. Authors' conclusions: Based on one small study judged to be of moderate risk of bias, we tentatively conclude that CAHTS may be well received by study participants and potentially offer time saving in practice. However, more robust studies with larger sample sizes are needed to confirm these. We cannot draw on any conclusions in relation to any other clinical outcomes at this stage

Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review

OBJECTIVE: To systematically review the literature on the implementation of e-health to identify: (i) barriers and facilitators to e-health implementation, and (ii) outstanding gaps in research on the subject.METHODS: MEDLINE, EMBASE, CINAHL, PSYCINFO and the Cochrane Library were searched for reviews published between 1 January 1995 and 17 March 2009. Studies had to be systematic reviews, narrative reviews, qualitative metasyntheses or meta-ethnographies of e-health implementation. Abstracts and papers were double screened and data were extracted on country of origin; e-health domain; publication date; aims and methods; databases searched; inclusion and exclusion criteria and number of papers included. Data were analysed qualitatively using normalization process theory as an explanatory coding framework.FINDINGS: Inclusion criteria were met by 37 papers; 20 had been published between 1995 and 2007 and 17 between 2008 and 2009. Methodological quality was poor: 19 papers did not specify the inclusion and exclusion criteria and 13 did not indicate the precise number of articles screened. The use of normalization process theory as a conceptual framework revealed that relatively little attention was paid to: (i) work directed at making sense of e-health systems, specifying their purposes and benefits, establishing their value to users and planning their implementation; (ii) factors promoting or inhibiting engagement and participation; (iii) effects on roles and responsibilities; (iv) risk management, and (v) ways in which implementation processes might be reconfigured by user-produced knowledge.CONCLUSION: The published literature focused on organizational issues, neglecting the wider social framework that must be considered when introducing new technologies.<br/

EMDR therapy for PTSD after motor vehicle accidents: meta-analytic evidence for specific treatment

Motor vehicle accident (MVA) victims may suffer both acute and post-traumatic stress disorders (PTSD). With PTSD affecting social, interpersonal and occupational functioning, clinicians as well as the National Institute of Health are very interested in identifying the most effective psychological treatment to reduce PTSD. From research findings, eye movement desensitization and reprocessing (EMDR) therapy is considered as one of the effective treatment of PTSD. In this paper, we present the results of a meta-analysis of fMRI studies on PTSD after MVA through activation likelihood estimation. We found that PTSD following MVA is characterized by neural modifications in the anterior cingulate cortex (ACC), a cerebral structure involved in fear-conditioning mechanisms. Basing on previous findings in both humans and animals, which demonstrate that desensitization techniques and extinction protocols act on the limbic system, the effectiveness of EMDR and of cognitive behavioral therapies (CBT) may be related to the fact that during these therapies the ACC is stimulated by desensitization

Helping young people with psychosis

Background: Psychotic disorders are associated with a high degree of impairment making early intervention crucial for youth. We therefore set out to identify effective psychosis interventions for young people. Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating treatment interventions. After applying our rigorous inclusion criteria, we accepted eight RCTs – evaluating five different medications and three psychosocial interventions. Results: Aripiprazole and olanzapine showed benefits in two trials each, although both led to adverse events that require close monitoring. Cognitive Remediation Therapy, Computer-Assisted Cognitive Remediation and the Think Program showed secondary benefits of improved cognitive skills and reduced emergency room visits which can be helpful when used along with antipsychotic medications. Conclusions: Antipsychotics should be used prudently, after careful assessment and diagnosis, and psychosocial interventions should be offered as well. Further research is needed on early interventions to help young people with psychosis

Untapped Potential of Clinical Text for Opioid Surveillance

Accurate surveillance is needed to combat the growing opioid epidemic. To investigate the potential volume of missed opioid overdoses, we compare overdose encounters identified by ICD-10-CM codes and an NLP pipeline from two different medical systems. Our results show that the NLP pipeline identified a larger percentage of OOD encounters than ICD-10-CM codes. Thus, incorporating sophisticated NLP techniques into current diagnostic methods has the potential to improve surveillance on the incidence of opioid overdoses

Effectiveness and Content Analysis of Interventions to Enhance Oral Antidiabetic Drug Adherence in Adults with Type 2 Diabetes : Systematic Review and Meta-Analysis

We thank Frederic Bergeron, information scientist, for assistance in search strategies. We thank American Journal Experts for editing the text. Source of financial support: This study was funded by the Laval University Chair on Adherence to Treatments. This Chair is supported by nonrestricted grants from AstraZeneca Canada, Merck Canada, Sanofi Canada, and Pfizer Canada and from the Prends soin de toi program (a Quebec provincial program for the improvement of public health).Peer reviewedPostprin

Exploring psychosocial interventions for people with dementia that enhance personhood and relate to legacy- an integrative review

Background: Epidemiological predictions suggest that dementia will continue to rise and that this will have social and economic ramifications. Effective interventions, beyond pharmacological management are needed. Psychosocial interventions have largely been investigated in relation to carers of people with dementia, or with regards to their ability to manage dementia symptoms, improve cognition, and reduce challenging behaviour. However, since dementia is a life-limiting illness and people with dementia are at risk of having their personhood compromised, psychosocial interventions should seek to enhance personhood, and offer the potential for the person to leave a legacy. Methods: An integrative review was carried out to identify, assess, appraise and synthesise studies featuring interventions, which relate to both personhood and legacy. Search strategies were developed in key databases: MEDLINE; PsycINFO; Embase; Joanna Briggs Institute; CINAHL; Cochrane Database of Systematic Reviews; ASSIA. Grey literature was also identified through free-text searches. Results: Thirty six articles were included in the final review, these were tabulated and were assessed based on how the intervention related to personhood and legacy. Classification resulted in three themes being identified: Offering aspects of legacy; Acknowledging the person behind the patient; Facilitating meaningful engagement. Generally, personhood aspects of interventions were well reported, but further research is required to explore legacy potential of psychosocial interventions for people with dementia. Conclusion: The integrative review provides an overview and exploration of an under-researched area, and provides directions for future research, which will help expand the evidence base and ultimately help improve patient care for people with dementia and their families