Efectividad de las intervenciones para la transferencia y apropiación social del conocimiento de las Guías de práctica clínica y salud pública basadas en la evidencia (Revisión Sistemática)

OBJETIVO: Evaluar la efectividad de las intervenciones para realizar apropiación social y transferencia del conocimiento (KT) de las guías de práctica clínica (GPC) y salud pública basadas en la evidencia (GSP) para mejorar la adherencia de los pacientes y/o comunidad. METODOLOGÍA: Revisión sistemática de las intervenciones de KT comparadas con el desarrollo clásico de las guías y estrategias para los pacientes y/o comunidad. Se realizó una búsqueda hasta abril de 2017 en MEDLINE (Ovid), EMBASE, SCOPUS, CENTRAL (Ovid), Web of Science, LILACS, Academic Search y Scielo. Dos evaluadores independientes calificaron el riesgo de sesgo y la calidad de la evidencia de los estudios incluidos. RESULTADOS: Ocho estudios fueron incluidos relacionados con GPC y 3 con GSP. El desenlace de adherencia de las recomendaciones se observó en tres estudios. Se presentó alta heterogeneidad en los estudios debido a la variabilidad en la población, tipo de guía y de las herramientas de medición. El riesgo de sesgo fue alto debido principalmente al sesgo de desempeño, degaste, selección y reporte. Los estudios de GSP presentaron un mayor riesgo de sesgo que los GPC. La mayoría de los desenlaces presentaron una calidad de la evidencia muy baja y baja, solamente del desenlace de adherencia y de mortalidad en algunos estudios fueron evaluados con calidad moderada. A pesar que no se pudo realizar un efecto global de la intervención, se detalla que la intervención mejora los desenlaces de adherencia, conocimiento de las recomendaciones y algunos desenlaces clínicos cuando se realiza una combinación de estrategias de KT como educación combinadas con la modificación del entorno o con el grupo de profesionales de la salud. CONCLUSIÓN: Las intervenciones a corto plazo presentan un leve efecto a favor en el desenlace de adherencia, y las mixtas (pacientes y profesionales) en algunos desenlaces clínicos. Sin embargo, se requieren nuevos estudios con menos heterogeneidad que permitan confirmar estos resultados.Abstract. OBJECTIVE: To assess the effectiveness of knowledge translation (KT) and knowledge appropriation social interventions to improve patients and/or community adherence to clinical practice guidelines (CPG) and Evidence-Based Public health guidelines (PHG). METHODS: We performed a systematic review of KT interventions compared with classical interventions for patients and/or communities. We searched the following electronic databases up to April 2017: MEDLINE (Ovid), EMBASE, SCOPUS, CENTRAL (Ovid), Web of Science, LILACS, Academic Search, and Scielo. Two independent raters qualified the relevance, risk of bias, and quality of included studies. RESULTS: Eight studies were finally included relation CPG and three for PHG. Patients adherence was observed in 3 studies. There was high heterogeneity due to the variability of the population, types of guidelines, and types of measurement tools. The risk of bias was high by performance bias, attrition bias, selection and report bias. The studies of PHG had a greater risk of bias than CPG. The quality of evidence of the outcomes majority was classified as very low and low evidence, only the outcomes of adherence and mortality had a moderate evidence. Although an overall effect of the intervention could not be realized, it is detailed that the intervention improves the outcomes of adherence, knowledge of the recommendations and some clinical outcomes when a combination of strategies of KT is realized as education combined with the modification of the environment or with the group of health professionals. CONCLUSION: KT interventions might have a slight positive effect on patient adherence and some short-term clinical outcomes, particularly within mixed interventions (patients and health professionals). However, future studies with less heterogeneity are necessary to confirm these results.Maestrí

Effectiveness of knowledge translation and knowledge appropriation of clinical practice guidelines for patients and communities, a systematic review

Introduction: Knowledge translation and knowledge appropriation social interventions apply knowledge to improve health services and outcomes. These interventions can be implemented routinely to improve patient adherence to clinical practice guidelines. Objective: To assess the effectiveness of knowledge translation interventions to improve patient and community adherence to clinical practice guidelines. Materials and methods: We performed a systematic review of these interventions compared with classical interventions for patients and/or communities. We searched the following electronic databases up to April 2017: Medline (Ovid), Embase, Scopus, Central (Ovid), Web of Science, LILACS, Academic Search, and Scielo. Two independent raters qualified the relevance, risk of bias, and quality of included studies. Results: Eight studies were included. Patient adherence to recommendations was observed in two studies. There was high heterogeneity due to the variability of the population, types of guidelines, and types of measurement tools. The risk of bias was high: a 60% risk of performance bias, 50% risk of attrition bias, 25% risk of selection and reporting bias, and 15% risk of detection bias. The quality of evidence was moderate for the outcomes of adherence and mortality. The interventions that used a combination of strategies, such as with the group of health professionals, could improve some clinical outcomes in the patients (Average deviation: -3.00; 95% IC: -6.08-0.08). Conclusions: Knowledge translation interventions might have a slight positive effect on patient adherence and some short-term clinical outcomes, particularly within mixed interventions (patients and health professionals). However, future studies with less heterogeneity are necessary to confirm these results

Food Insecurity Experience Scale (FIES) in Colombia, Guatemala, and México

Objetive. To compare the psychometric characteristics of the Food Insecurity Experience Scale (FIES) and the grade of similitude or difference among Colombia, Guatemala, and Mexico during three years. Materials and methods. Psychometric comparison using the Rasch model to calculate the relative severity of each item in FIES, INFIT and contrast in the Differential Functioning of Items (c-DIF). Results. The majority of items showed a relative severity corresponding to the theoretical construct and acceptably fit the model (INFIT=0.7-1.3). No c-DIF above 1.0 logit was observed in the comparison men vs women. In the comparison among countries by year 87% of the items showed c-DIF below 0.5 logit. Conclusion. The FIES presents psychometric characteristics corresponding to the theoretical construct of the tool. Future studies with the inclusion of more countries and more time points are essential to evaluate the relative severity, behavior and distribution of items

Quality of life in refractory generalized myasthenia gravis : a rapid review of the literature

Generalized myasthenia gravis (GMG) is a neuromuscular transmission disorder that creates a fluctuating weakness of the voluntary muscles. This study is aimed at understanding the effect that refractory GMG has on the quality of life of patients who suffer from it, and the effect of eculizumab on it. A systematic literature search was conducted in MEDLINE (Ovid), EMBASE and the Cochrane Database of Systematic Reviews (Ovid). Eligibility criteria were verified via the title and summary and afterward through the full text. The risk of bias of the included randomized clinical trials was evaluated and the data were synthesized in a descriptive manner. Nine studies were identified that evaluated the quality of life of patients with GMG. Regarding the effect of eculizumab, two studies were identified. The quality of life in patients with GMG is lower compared to ocular myasthenia gravis (MG) and MG in remission, especially in the domains of physical function, physical role, bodily pain, vitality, and social function. Patients treated with eculizumab had a better perception of their quality of life compared to those who received placebo. GMG affects the quality of life more than other types of MG. This outcome is of great importance for the choice of therapeutic options in patients with refractory GMG. Eculizumab generates improvements in the perception of patients' quality of life compared to placebo, making it a relevant therapeutic option in the management of refractory GMG.N/

Consecuencias de los conflictos armados en la salud mental de niños y adolescentes: revisión de revisiones de la literatura

Introduction: Armed conflicts affect the mental health of children and adolescents. Their outcomes in these populations have been documented identifying vulnerability and significant biopsychosocial damage as the most common factors.Objective: To identify and synthesize the mental health consequences of armed conflicts in children and adolescents.Materials and methods: We carried out a comprehensive and systematic search of reviews published until July 2019 in the MEDLINE (Ovid), EMBASE, Cochrane Central Register of Controlled Trials, and LILACS databases, as well as in additional sources. The information was retrieved and analyzed narratively by describing the characteristics and objectives of the studies and the mental health consequences of armed conflicts in three periods of time: pre-armed conflict, during the armed conflict, and post-conflict.Results. Out of 587 potentially relevant studies, we finally selected 72. In the pre-armed conflict period, we described in detail the psychological experiences and the anticipatory somatic symptoms. During the conflict, we identified regressive, behavioral, and cognitive symptoms such as enuresis, fear, sadness, aggression, hyperactivity, and inattention, among others. Direct mental health consequences such as adjustment disorders, depression, anxiety, and post-traumatic stress were also identified. Finally, in the postconflict period, we referred to the transmission of mental health consequences and resilience processes. On the other hand, we reviewed in depth the potential consequences of armed conflicts on biopsychosocial development, morality, identity, culture, education, and society.Conclusion. The development of mental health consequences due to the exposure to armed conflicts in these populations is a complex process that depends on the stage of the exposure, the length of the conflict, and contextual factors.Introducción. Los conflictos armados dejan consecuencias evidentes en la salud mental de la población infantil y adolescente. En ese marco, se ha documentado una serie de situaciones que tienen como factor común la vulnerabilidad de esta población y las afectaciones biopsicosociales significativas.Objetivo. Determinar y sintetizar las diferentes consecuencias de los conflictos armados en la salud mental de la población infantil y adolescente.Materiales y métodos. Se realizó una búsqueda sistemática exhaustiva de revisiones bibliográficas hasta julio de 2019 en las bases de datos MEDLINE (Ovid), EMBASE, Cochrane Central Register of Controlled Trials, LILACS y otras. Se seleccionaron los artículos y se analizaron de forma narrativa sus características, objetivos y consecuencias en salud mental en tres momentos: antes del conflicto, durante el conflicto y en el posconflicto.Resultados. De un total de 587 artículos potencialmente relevantes, se seleccionaron 72. En los estudios sobre el periodo anterior al conflicto, se detallaron experiencias psicológicas y síntomas somáticos anticipatorios. Durante el conflicto, se evidenciaron síntomas regresivos, conductuales y cognitivos, como enuresis, miedo, tristeza, agresión, hiperactividad e inatención, entre otros. Además, se establecieron consecuencias directas, como trastornos de adaptación, depresión, ansiedad y, en mayor medida, estrés postraumático. Por último, en el posconflicto, se recopiló la información sobre los procesos de transmisión de las consecuencias y la resiliencia. Por otro lado, se profundizó en las consecuencias potenciales en el desarrollo biopsicosocial, la moralidad, la identidad, el contexto, la cultura, la educación y la sociedad.Conclusiones. Las consecuencias de los conflictos armados en la salud mental se inscriben en un proceso complejo que se expresa en función de la etapa evolutiva de la exposición, del tiempo del conflicto armado y de los factores contextuales

Violence due to Armed Conflict and Prevalence of Mood Disorders, Anxiety and Mental Problems in the Colombian Adult Population

Antecedentes La violencia en Colombia tiene una historia de más de 50 años. se calcula que entre 1985 y 2012 han fallecido 220.000 colombianos y cerca de 6.000.000 han sido desplazados por la violencia. Objetivo Describir y comparar las prevalencias de algunos problemas y trastornos mentales en la población adulta colombiana teniendo en cuenta las características del municipio respecto a su historia de violencia o conflicto armado. Métodos Se utilizaron los resultados de los adultos (mayores de 18 años) sobre algunos problemas y trastornos mentales de la ENSM de 2015, y se clasificaron los municipios según la presencia y la intensidad del conflicto utilizando la clasificación propuesta por la CERAC. Se realizó la medición de trastorno (con el CIDI-CAPI), problemas (con AUDIT, PCL modificado) y consumo de sustancias psicoactivas. Resultados Se entrevistó a 10.870 personas, de las que 5.429 no habían cambiado de residencia. El 21,8% de los municipios sufrían conflicto permanente; el 65,5%, interrumpido, y solamente el 12,7% había sido pacificado o no tenía conflicto. La intensidad del conflicto se reportó alta en el 31,8%. Los municipios violentos presentaban prevalencias más altas de trastornos de ansiedad, depresivos, posible trastorno de estrés postraumático y consumo de cigarrillo. El consumo de alcohol era más frecuente en municipios con menor intensidad del conflicto. Conclusiones Los municipios clasificados como con altos niveles de violencia presentaban mayor prevalencia de trastornos mentales y de la mayoría de los problemas mentales.Q4Artículo original147-153Background Violence in Colombia has a history of over 50 years. Between 1985 and 2012 an estimated of 220,000 Colombians have died and about 6,000,000 have been displaced by violence. Objective To describe and compare the prevalence of some problems and mental disorders in the adult population in Colombia, taking into account the characteristics of the municipality, as regards its history of violence or armed conflict. Methods The results for adults (over 18 years) of some problems and mental disorders were taken from the ENSM-2015. The municipalities were classified according to the presence and intensity of the conflict using the classification proposed by the CERAC. Disorders were measured using CIDI-CAPI, and problems with AUDIT, modified PCL (Post-Traumatic Stress Disorder Checklist). An estimate was also made of psychoactive substances consumption. Results A total of 10,870 people were interviewed, of whom 5,429 had not changed residence. There was had permanent conflict in 21.8% of the municipalities, 65.5% had a discontinued conflict, and only 12.7% had been pacified or had no conflict. The intensity of the conflict was reported as high by 31.8% of the people. Violent municipalities have a higher prevalence of anxiety disorders, depression, possible Post-Traumatic Stress Disorder, and smoking. Alcohol consumption was more common in municipalities with less intense conflict. Conclusions The municipalities classified as having high levels of violence have a higher prevalence of mental disorders and the majority of the mental problems

Disease-Specific Quality Indicators for Outpatient Antibiotic Prescribing for Respiratory Infections (ESAC Quality Indicators) Applied to Point Prevalence Audit Surveys in General Practices in 13 European Countries

Up to 80% of antibiotics are prescribed in the community. An assessment of prescribing by indication will help to identify areas where improvement can be made. A point prevalence audit study (PPAS) of consecutive respiratory tract infection (RTI) consultations in general practices in 13 European countries was conducted in January-February 2020 (PPAS-1) and again in 2022 (PPAS-4). The European Surveillance of Antibiotic Consumption quality indicators (ESAC-QI) were calculated to identify where improvements can be made. A total of 3618 consultations were recorded for PPAS-1 and 2655 in PPAS-4. Bacterial aetiology was suspected in 26% (PPAS-1) and 12% (PPAS-4), and an antibiotic was prescribed in 30% (PPAS-1) and 16% (PPAS-4) of consultations. The percentage of adult patients with bronchitis who receive an antibiotic should, according to the ESAC-QI, not exceed 30%, which was not met by participating practices in any country except Denmark and Spain. For patients (≥1) with acute upper RTI, less than 20% should be prescribed an antibiotic, which was achieved by general practices in most countries, except Ireland (both PPAS), Croatia (PPAS-1), and Greece (PPAS-4) where prescribing for acute or chronic sinusitis (0-20%) was also exceeded. For pneumonia in adults, prescribing is acceptable for 90-100%, and this is lower in most countries. Prescribing for tonsillitis (≥1) exceeded the ESAC-QI (0-20%) in all countries and was 69% (PPAS-1) and 75% (PPAS-4). In conclusion, ESAC-QI applied to PPAS outcomes allows us to evaluate appropriate antibiotic prescribing by indication and benchmark general practices and countries

Evaluation of different landing pages on behavioural engagement with the CARA dashboard: A user research protocol

Abstract Background CARA set out to develop a data-visualisation platform to facilitate general practitioners to develop a deeper understanding of their patient population, disease management and prescribing through dashboards. To support the continued use and sustainability of the CARA dashboards, dashboard performance and user engagement have to be optimised. User research places people at the centre of the design process and aims to evaluate the needs, behaviours and attitudes of users to inform the design, development and impact of a product. Objective To explore how different initial key messages impact the level of behavioural engagement with a CARA dashboard. Methods Participating general practices can upload their practice data for analysis and visualisation in CARA dashboards. Practices will be randomised to one of three different initial landing pages: the full dashboard or one of two key messages: a between comparison (their practice prescribing with the average of all other practices) or within comparison (with practice data of the same month the previous year) with subsequent continuation to the full dashboard. Analysis will determine which of the three landing pages encourages user interaction, as measured by the number of ‘clicks’, ‘viewings’ and ‘sessions’. Dashboard usage data will be collected through Google analytics. Discussion This study will provide evidence of behavioural engagement and its metrics during the implementation of the CARA dashboards to optimise and sustain interaction. Trial registration ISRCTN32783644 (Registration date: 02/01/2024)

Quality indicators for chronic disease management in Europe: a scoping review protocol

Background: Chronic disease management systems aim to collect, analyse, interpret and disseminate information on the prevalence of and risk factors for chronic conditions in a population. Quality indicators (QIs) could provide a set of metrics to consistently measure the burden and allow planning at national and international level. This scoping review explores existing literature to identify quality indicators for chronic disease management in the EU and UK. Methods: The scoping review will describe quality indicators used in selected European countries to monitor chronic diseases. This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. A systematic search strategy will be carried out in MEDLINE (OVID), EMBASE and SCOPUS along with manual searches of relevant websites, national action plans and other grey literature. The results will be collated into a narrative. Conclusion: This scoping review will identify current literature on quality indicators for chronic disease management