Experiences of long-term life-limiting conditions among patients and carers: what can we learn from a meta-review of systematic reviews of qualitative studies of chronic heart failure, chronic obstructive pulmonary disease and chronic kidney disease?

Objectives: To summarise and synthesise published qualitative studies to characterise factors that shape patient and caregiver experiences of chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD).Design: Meta-review of qualitative systematic reviews and metasyntheses. Papers analysed using content analysis.Data sources: CINAHL, EMBASE, MEDLINE, PsychINFO, Scopus and Web of Science were searched from January 2000 to April 2015.Eligibility criteria for selecting studies: Systematic reviews and qualitative metasyntheses where the participants were patients, caregivers and which described experiences of care for CHF, COPD and CKD in primary and secondary care who were aged ?18?years.Results: Searches identified 5420 articles, 53 of which met inclusion criteria. Reviews showed that patients' and caregivers' help seeking and decision-making were shaped by their degree of structural advantage (socioeconomic status, spatial location, health service quality); their degree of interactional advantage (cognitive advantage, affective state and interaction quality) and their degree of structural resilience (adaptation to adversity, competence in managing care and caregiver response to demands).Conclusions: To the best of our knowledge, this is the first synthesis of qualitative systematic reviews in the field. An important outcome of this overview is an emphasis on what patients and caregivers value and on attributes of healthcare systems, relationships and practices that affect the distressing effects and consequences of pathophysiological deterioration in CHF, COPD and CKD. Interventions that seek to empower individual patients may have limited effectiveness for those who are most affected by the combined weight of structural, relational and practical disadvantage identified in this overview. We identify potential targets for interventions that could address these disadvantages.Systematic review registration number: PROSPERO CRD42014014547.<br/

A systematic review of cost-utility analyses of screening methods in latent tuberculosis infection in high-risk populations.

BackgroundThe World Health Organisation (WHO) recommends that testing and treatment for latent tuberculosis infection (LTBI) should be undertaken in high-risk groups using either interferon gamma release assays (IGRAs) or a tuberculin skin test (TST). As IGRAs are more expensive than TST, an assessment of the cost-effectiveness of IGRAs can guide decision makers on the most appropriate choice of test for different high-risk populations. This current review aimed to provide the most up to date evidence on the cost-effectiveness evidence on LTBI testing in high-risk groups-specifically evidence reporting the costs per QALY of different testing strategies.MethodsA comprehensive search of databases including MEDLINE, EMBASE and NHS-EED was undertaken from 2011 up to March 2021. Studies were screened and extracted by two independent reviewers. The study quality was assessed using the Bias in Economic Evaluation Checklist (ECOBIAS). A narrative synthesis of the included studies was undertaken.ResultsThirty-two studies reported in thirty-three documents were included in this review. Quality of included studies was generally high, although there was a weakness across all studies referencing sources correctly and/or justifying choices of parameter values chosen or assumptions where parameter values were not available. Inclusions of IGRAs in testing strategies was consistently found across studies to be cost-effective but this result was sensitive to underlying LTBI prevalence rates.ConclusionWhile some concerns remain about uncertainty in parameter values used across included studies, the evidence base since 2010 has grown with modelling approaches addressing the weakness pointed out in previous reviews but still reaching the same conclusion that IGRAs are likely to be cost-effective in high-income countries for high-risk populations. Evidence is also required on the cost-effectiveness of different strategies in low to middle income countries and countries with high TB burden

Systematic review of 3D mammography for breast cancer screening.

AbstractThis review investigated the relative performance of digital breast tomosynthesis (DBT) (alone or with full field digital mammography (FFDM) or synthetic digital mammography) compared with FFDM alone for detecting breast cancer lesions in asymptomatic women. A systematic review was carried out according to systematic reviewing principles provided in the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. A protocol was developed a priori. The review was registered with PROSPERO (number CRD42014013949). Searches were undertaken in October 2014. Following selection, five studies were eligible. Higher cancer detection rates were observed when comparing DBT + FFDM with FFDM in two European studies: the summary difference per 1000 screens was 2.43 (95% CI: 1.8 to 3.1). Both European studies found lower false positive rates for individual readers. One found a lower recall rate based on conditional recall. The second study was not designed to compare post-arbitration recall rates between FFDM and DBT + FFDM. One European study presented data on interval cancer rates; sensitivity and specificity for DBT + FFDM were both higher compared to FFDM. One large multicentre US study showed a higher cancer detection rate for DBT + FFDM, while two smaller US studies did not find statistically significant differences. Reductions in recall and false positive rates were observed in the US studies in favour of DBT + FFDM. In comparison to FFDM, DBT, as an adjunct to FFDM, has a higher cancer detection rate, increasing the effectiveness of breast cancer screening. Additional benefits of DBT may also include reduced recalls and, consequently, reduced costs and distress caused to women who would have been recalled

The Comparative Clinical Effects and Safety of Immunoglobulin Replacement Therapy for the Treatment of Primary Immunodeficiency Disorders – A pragmatic review protocol.

People with primary immunodeficiency disorders (PIDDs) require regular infusions with immunoglobulin (Ig) treatments to replenish their naturally low or absent Ig levels, acting as prophylaxis against infection. Ig preparations are produced by numerous manufacturers, who claim differences between the preparations in terms of efficacy and safety. However, to date, these preparations have not been compared with each other. Therefore, we will conduct a pragmatic review of the comparative efficacy and safety of Ig replacement therapies used to treat PIDD. Results of the pragmatic review will be used to inform statistical analyses of named Ig preparations, and if feasible an indirect treatment comparison (ITC) will be conducted. The primary objectives of this project are: 1. To identify and map the evidence-base for the clinical effectiveness and safety of Ig replacement therapies to treat patients with PIDDs. 2. To review and report the clinical effectiveness and safety of different brands of Ig replacement therapies

Death and dying in prehospital care: what are the experiences and issues for prehospital practitioners, families and bystanders? A scoping review

To identify the factors that shape and characterise experiences of prehospital practitioners (PHPs), families and bystanders in the context of death and dying outside of the hospital environment where PHPs respond. https://bmjopen.bmj.com/content/10/9/e036925 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/bmjopen-2020-03692

Additional file 1 of The burden of mitochondrial disease with associated seizures: systematic literature reviews of health-related quality of life, utilities, costs and healthcare resource use data

Additional file 1. Detailed search methods, supplementary tables, and PRISMA checklist