29 research outputs found
Systematic review of communication technologies to promote access and engagement of young people with diabetes into healthcare
Background: Research has investigated whether communication technologies (e.g. mobile telephony, forums,
email) can be used to transfer digital information between healthcare professionals and young people who live
with diabetes. The systematic review evaluates the effectiveness and impact of these technologies on
communication.
Methods: Nine electronic databases were searched. Technologies were described and a narrative synthesis of all
studies was undertaken.
Results: Of 20,925 publications identified, 19 met the inclusion criteria, with 18 technologies assessed. Five
categories of communication technologies were identified: video-and tele-conferencing (n = 2); mobile telephony
(n = 3); telephone support (n = 3); novel electronic communication devices for transferring clinical information (n =
10); and web-based discussion boards (n = 1). Ten studies showed a positive improvement in HbA1c following the
intervention with four studies reporting detrimental increases in HbA1c levels. In fifteen studies communication
technologies increased the frequency of contact between patient and healthcare professional. Findings were
inconsistent of an association between improvements in HbA1c and increased contact. Limited evidence was
available concerning behavioural and care coordination outcomes, although improvement in quality of life, patientcaregiver
interaction, self-care and metabolic transmission were reported for some communication technologies.
Conclusions: The breadth of study design and types of technologies reported make the magnitude of benefit and
their effects on health difficult to determine. While communication technologies may increase the frequency of
contact between patient and health care professional, it remains unclear whether this results in improved
outcomes and is often the basis of the intervention itself. Further research is needed to explore the effectiveness
and cost effectiveness of increasing the use of communication technologies between young people and
healthcare professionals
Meta-analysis of variation suggests that embracing variability improves both replicability and generalizability in preclinical research
The replicability of research results has been a cause of increasing concern to the scientific community. The long-held belief that experimental standardization begets replicability has also been recently challenged, with the observation that the reduction of variability within studies can lead to idiosyncratic, lab-specific results that cannot be replicated. An alternative approach is to, instead, deliberately introduce heterogeneity, known as "heterogenization" of experimental design. Here, we explore a novel perspective in the heterogenization program in a meta-analysis of variability in observed phenotypic outcomes in both control and experimental animal models of ischemic stroke. First, by quantifying interindividual variability across control groups, we illustrate that the amount of heterogeneity in disease state (infarct volume) differs according to methodological approach, for example, in disease induction methods and disease models. We argue that such methods may improve replicability by creating diverse and representative distribution of baseline disease state in the reference group, against which treatment efficacy is assessed. Second, we illustrate how meta-analysis can be used to simultaneously assess efficacy and stability (i.e., mean effect and among-individual variability). We identify treatments that have efficacy and are generalizable to the population level (i.e., low interindividual variability), as well as those where there is high interindividual variability in response; for these, latter treatments translation to a clinical setting may require nuance. We argue that by embracing rather than seeking to minimize variability in phenotypic outcomes, we can motivate the shift toward heterogenization and improve both the replicability and generalizability of preclinical research
Indole-3-carbinol-induced death in cancer cells involves EGFR downregulation and is exacerbated in a 3D environment
Indole-3-carbinol-induced death in cancer cells involves EGFR downregulation and is exacerbated in a 3D environmen
Accelerating the Evolution of Nonhuman Primate Neuroimaging
Nonhuman primate neuroimaging is on the cusp of a transformation, much in the same way its human counterpart was in 2010, when the Human Connectome Project was launched to accelerate progress. Inspired by an open data-sharing initiative, the global community recently met and, in this article, breaks through obstacles to define its ambitions
Global variation in anastomosis and end colostomy formation following left-sided colorectal resection
Background
End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection.
Methods
This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model.
Results
In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001).
Conclusion
Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone