Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis

BACKGROUND: WHO identifies pregnant women to be at increased risk for severe outcomes from influenza virus infections and recommends that they be prioritized for influenza vaccination. The evidence supporting this, however, is inconsistent. Ecologic studies in particular suggest more severe outcomes from influenza infection during pregnancy than studies based on individual patient data. Individual studies however may be underpowered and, as reported in a previous systematic review, confounding factors could not be adjusted for. We therefore conducted an individual participant data meta-analysis to assess the risk for severe outcomes of influenza infection in pregnant women while adjusting for other prognostic factors. METHODS: We contacted authors of studies included in a recently published systematic review. We pooled the individual participant data of women of reproductive age and laboratory confirmation of influenza virus infection. We used a generalized linear mixed model and reported odds ratios (OR) and 95% confidence intervals (CI). RESULTS: A total of 33 datasets with data on 186,656 individuals were available, including 36,498 eligible women of reproductive age and known pregnancy status. In the multivariable model, pregnancy was associated with a 7 times higher risk of hospital admission (OR 6.80, 95%CI 6.02–7.68), among patients receiving medical care as in- or outpatients, pregnancy was associated with a lower risk of admission to intensive care units (ICU; OR 0.57, 95%CI 0.48–0.69), and was not significantly associated with death (OR 1.00, 95%CI 0.75–1.34). CONCLUSIONS: Our study found a higher risk of influenza associated hospitalization among pregnant women as compared to non-pregnant women. We did not find a higher mortality rate or higher likelihood of ICU admission among pregnant women who sought medical care. However, this study did not address whether a true community based cohort of pregnant women is at higher risk of influenza associated complications

Entrepreneurship in the Era of the Digital Economy. Neuroeconomic Aspect

Total technologization inherent in the present encourages economic units, and especially enterprises, to adapt to the requirements of the era of the digital economy. In order to achieve the main goal of activity, entrepreneurs need to make decisions, applying not only generally accepted economic knowledge, but also take into account the emotional state, values and ethical preferences of their consumers.   The issue of synergistic application of digital capabilities and scientific achievements in brain research and their adaptation to the economic sphere in business activities is becoming relevant. The purpose of the study is the analysis of entrepreneurial activity in the era of the digital economy in the aspect of neuroeconomic development. A high technical and intellectual level in the era of the digital economy requires entrepreneurs to be constantly up-to-date. An interdisciplinary approach is becoming more effective in training entrepreneurs, which includes not only economic and digital sciences, but also psychology and neurophysiology, which allows expanding the methodology and deepening knowledge about a person. The study of the influence of brain activity on the emotional mood and preferences of consumers has modified standard marketing approaches. The synthesis of marketing science with neurophysiology expands the opportunities of entrepreneurs to study customer preferences and improve their products. Synthesizing the economic meaning of enterprise activity and the way to achieve this meaning led to the digitalization of business activity. Innovative solutions of enterprise activity and the use of digital technologies are the key factors in the development of contemporary enterprises.</p

Analysis of commercial and marketing risks: the theoretical aspect

Проведено наукову розвідку й досліджено теоретичні питання аналізу окремої групи фінансових ризиків – комерційного та маркетингового. В рамках наукової статті використано та застосовано системний підхід як один із основних методів наукових досліджень, класичний метод гіпотез та інші загальні методи. Досліджено теоретичні й концептуальні засади ризику як однієї із складних категорій економіки, що притаманна усім фазам життєвого циклу підприємництва й загальні засади аналізу комерційних та маркетингових ризиків на підставі окремої групи показників, що найповніше їх характеризують. Представлена проблема дослідження, необхідність перевірки прийнятих у дослідженні гіпотез, потреба розроблення теоретичних засад зумовили поділ дослідницького процесу на конкретні етапи та вибір відповідних методів у кожному з них. Зазначено, що на перший план в управлінні ризиками виходять глибокі загальноосвітні та професійні знання, а відтак уміння приймати самостійні рішення, раціонально використовувати час,економічний та людський потенціал. Доведено, що для досягнення мети управління отримання знань є постійним та безперервним у часі процесом, у якому праця людини набуває рис творчої роботи. Досліджено особливості ризику як економічної категорії, класифікаційні ознаки, його оцінку, фактори, що впливають, мету контролю, ідентифікацію та перевірку в теорії прийняття рішень. Дано пропозиції щодо розрахунку окремих показників комерційного та маркетингового ризиків і сформовано матрицю прийняття рішень. Врахування ризику є важливим при прийнятті комерційних рішень. Основними результатами дослідження є обґрунтування та розробка теоретичних засад комерційного й маркетингового ризику, аналізу їх показників у процесі прийняття управлінських рішень. Практична цінність теоретичних результатів полягає у їх виробничій направленості. Реалізація у господарській діяльності зазначених пропозицій значно підвищить рівень ефективності управління комерційною та маркетинговою діяльностями й дасть можливість значно зменшити негативний вплив ризику на фінансові результати.Theoretical issues of analysis of a separate group of financial risks, such as, commercial and marketing, are investigated. The systematic approach as one of the main methods of scientific research, the classical method of hypotheses and other general methods of scientific research are used and applied in this paper The theoretical and conceptual principles of risk as one of the complex categories of the economy, which is inherent in all phases of the business life cycle and analysis of commercial and marketing risks on the basis of a separate group of indicators that most completely characterize them are investigated in this paper. The presented research problem, the need to test the hypotheses adopted in the investigation, the need to develop theoretical foundations determined the division of the research process into specific stages and the choice of appropriate methods in each of them. It is noted that profound general and professional knowledge prevail in risk management, and thus the ability to make independent decisions, rational use of time, economic and human potential. It is proved that in order to achieve the management goal, the knowledge acquisition is constant and continuous process in time, where human labor acquires the features of creative work. The peculiarities of risk as an economic category, classification features, its assessment, influencing factors, the purpose of control, identification and verification in the theory of decision making are investigated. Proposals for the calculation of its individual indicators of commercial and marketing risks and the decision-making matrix in terms of these risks are given. Risk consideration is important while making business decisions. The main results of the investigation are substantiation and development of theoretical principles of commercial and marketing risk, analysis of their indicators in the process of making management decisions. The practical value of theoretical results is in their production orientation.The implementation of these proposals in economic activity will significantly increase the level of management of commercial and marketing activities and will significantly reduce the negative impact of risk on financial results

Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis

Background: WHO identifies pregnant women to be at increased risk for severe outcomes from influenza virus infections and recommends that they be prioritized for influenza vaccination. The evidence supporting this, however, is inconsistent. Ecologic studies in particular suggest more severe outcomes from influenza infection during pregnancy than studies based on individual patient data. Individual studies however may be underpowered and, as reported in a previous systematic review, confounding factors could not be adjusted for. We therefore conducted an individual participant data meta-analysis to assess the risk for severe outcomes of influenza infection in pregnant women while adjusting for other prognostic factors. Methods: We contacted authors of studies included in a recently published systematic review. We pooled the individual participant data of women of reproductive age and laboratory confirmation of influenza virus infection. We used a generalized linear mixed model and reported odds ratios (OR) and 95% confidence intervals (CI). Results: A total of 33 datasets with data on 186,656 individuals were available, including 36,498 eligible women of reproductive age and known pregnancy status. In the multivariable model, pregnancy was associated with a 7 times higher risk of hospital admission (OR 6.80, 95%CI 6.02–7.68), among patients receiving medical care as in- or outpatients, pregnancy was associated with a lower risk of admission to intensive care units (ICU; OR 0.57, 95%CI 0.48–0.69), and was not significantly associated with death (OR 1.00, 95%CI 0.75–1.34). Conclusions: Our study found a higher risk of influenza associated hospitalization among pregnant women as compared to non-pregnant women. We did not find a higher mortality rate or higher likelihood of ICU admission among pregnant women who sought medical care. However, this study did not address whether a true community based cohort of pregnant women is at higher risk of influenza associated complications

Prevention of Clostridium difficile Infection: A Systematic Survey of Clinical Practice Guidelines

background. Clostridium difficile infection (CDI) is the most common cause of hospital-acquired infectious diarrhea. objective. To analyze themethodological quality, content, and supporting evidence among clinical practice guidelines (CPGs) on CDI prevention. design and setting. We searched medical databases and gray literature for CPGs on CDI prevention published January 2004-January 2015. Three reviewers independently screened articles and rated CPG quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, composed of 23 items, rated 1–7, within 6 domains. We reported each domain score as a percentage of its maximum possible score and standardized range. We summarized recommendations, extracted their supporting articles, and rated individually the level of evidence using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. results. Of 2,578 articles screened, 5 guidelines met inclusion criteria. Median AGREE II scores and interquartile ranges were: clarity of presentation, 75.9% (75.9%–79.6%); scope and purpose, 74.1% (68.5%–85.2%); editorial independence, 63.9% (47.2%–66.7%); applicability, 43.1% (19.4%–55.6%); stakeholder involvement, 40.7% (38.9%–44.4%); and rigor of development, 18.1% (17.4%–35.4%). CPGs addressed several common strategies for CDI prevention, including antibiotic stewardship, hypochlorite solutions, probiotic prophylaxis, and bundle strategies. Recommendations were often not consistent with evidence, and most were based on low-level studies. conclusion. CPGs did not adhere well to AGREE II reporting standards. Furthermore, there was limited transparency in moving from evidence to recommendations. CDI prevention CPGs need to better adhere to AGREE-II and be transparent in moving from evidence to recommendations, and recommendations need to be consistent with available evidence

Protocol: Conflict of interest issues when engaging stakeholders in health and healthcare guideline development: a systematic review

This is the protocol for a Campbell systematic review. The overall objective of this study is to gather and summarize the existing literature on conflict of interest issues when engaging stakeholders in guideline development

Protocol: Barriers and facilitators to stakeholder engagement in health guideline development: a qualitative evidence synthesis

Background There is a need for the development of comprehensive, global, evidence-based guidance for stakeholder engagement in guideline development. Stakeholders are any individual or group who is responsible for or affected by health- and healthcare-related decisions. This includes patients, the public, providers of health care and policymakers for example. As part of the guidance development process, Multi-Stakeholder Engagement (MuSE) Consortium set out to conduct four concurrent systematic reviews to summarise the evidence on: (1) existing guidance for stakeholder engagement in guideline development, (2) barriers and facilitators to stakeholder engagement in guideline development, (3) managing conflicts of interest in stakeholder engagement in guideline development and (4) measuring the impact of stakeholder engagement in guideline development. This protocol addresses the second systematic review in the series. Objectives The objective of this review is to identify and synthesise the existing evidence on barriers and facilitators to stakeholder engagement in health guideline development. We will address this objective through two research questions: (1) What are the barriers to multi-stakeholder engagement in health guideline development across any of the 18 steps of the GIN-McMaster checklist? (2) What are the facilitators to multi-stakeholder engagement in health guideline development across any of the 18 steps of the GIN-McMaster checklist? Search Methods A comprehensive search strategy will be developed and peer-reviewed in consultation with a medical librarian. We will search the following databases: MEDLINE, Cumulative Index to Nursing & Allied Health Literature (CINAHL), EMBASE, PsycInfo, Scopus, and Sociological Abstracts. To identify grey literature, we will search the websites of agencies who actively engage stakeholder groups such as the AHRQ, Canadian Institutes of Health Research (CIHR) Strategy for Patient-Oriented Research (SPOR), INVOLVE, the National Institute for Health and Care Excellence (NICE) and the PCORI. We will also search the websites of guideline-producing agencies, such as the American Academy of Pediatrics, Australia's National Health Medical Research Council (NHMRC) and the WHO. We will invite members of the team to suggest grey literature sources and we plan to broaden the search by soliciting suggestions via social media, such as Twitter. Selection Criteria We will include empirical qualitative and mixed-method primary research studies which qualitatively report on the barriers or facilitators to stakeholder engagement in health guideline development. The population of interest is stakeholders in health guideline development. Building on previous work, we have identified 13 types of stakeholders whose input can enhance the relevance and uptake of guidelines: Patients, caregivers and patient advocates; Public; Providers of health care; Payers of health services; Payers of research; Policy makers; Program managers; Product makers; Purchasers; Principal investigators and their research teams; and Peer-review editors/publishers. Eligible studies must describe stakeholder engagement at any of the following steps of the GIN-McMaster Checklist for Guideline Development. Data Collection and Analysis All identified citations from electronic databases will be imported into Covidence software for screening and selection. Documents identified through our grey literature search will be managed and screened using an Excel spreadsheet. A two-part study selection process will be used for all identified citations: (1) a title and abstract review and (2) full-text review. At each stage, teams of two review authors will independently assess all potential studies in duplicate using a priori inclusion and exclusion criteria. Data will be extracted by two review authors independently and in duplicate according to a standardised data extraction form. Main Results The results of this review will be used to inform the development of guidance for multi-stakeholder engagement in guideline development and implementation. This guidance will be official GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group guidance. The GRADE system is internationally recognised as a standard for guideline development. The findings of this review will assist organisations who develop healthcare, public health and health policy guidelines, such as the World Health Organization, to involve multiple stakeholders in the guideline development process to ensure the development of relevant, high quality and transparent guidelines

Protocol for the development of guidance for stakeholder engagement in health and healthcare guideline development and implementation

Stakeholder engagement has become widely accepted as a necessary component of guideline development and implementation. While frameworks for developing guidelines express the need for those potentially affected by guideline recommendations to be involved in their development, there is a lack of consensus on how this should be done in practice. Further, there is a lack of guidance on how to equitably and meaningfully engage multiple stakeholders. We aim to develop guidance for the meaningful and equitable engagement of multiple stakeholders in guideline development and implementation. METHODS: This will be a multi-stage project. The first stage is to conduct a series of four systematic reviews. These will (1) describe existing guidance and methods for stakeholder engagement in guideline development and implementation, (2) characterize barriers and facilitators to stakeholder engagement in guideline development and implementation, (3) explore the impact of stakeholder engagement on guideline development and implementation, and (4) identify issues related to conflicts of interest when engaging multiple stakeholders in guideline development and implementation. DISCUSSION: We will collaborate with our multiple and diverse stakeholders to develop guidance for multi-stakeholder engagement in guideline development and implementation. We will use the results of the systematic reviews to develop a candidate list of draft guidance recommendations and will seek broad feedback on the draft guidance via an online survey of guideline developers and external stakeholders. An invited group of representatives from all stakeholder groups will discuss the results of the survey at a consensus meeting which will inform the development of the final guidance papers. Our overall goal is to improve the development of guidelines through meaningful and equitable multi-stakeholder engagement, and subsequently to improve health outcomes and reduce inequities in health