Systematic meta-review of supported self-management for asthma: a healthcare perspective

BACKGROUND: Supported self-management has been recommended by asthma guidelines for three decades; improving current suboptimal implementation will require commitment from professionals, patients and healthcare organisations. The Practical Systematic Review of Self-Management Support (PRISMS) meta-review and Reducing Care Utilisation through Self-management Interventions (RECURSIVE) health economic review were commissioned to provide a systematic overview of supported self-management to inform implementation. We sought to investigate if supported asthma self-management reduces use of healthcare resources and improves asthma control; for which target groups it works; and which components and contextual factors contribute to effectiveness. Finally, we investigated the costs to healthcare services of providing supported self-management. METHODS: We undertook a meta-review (systematic overview) of systematic reviews updated with randomised controlled trials (RCTs) published since the review search dates, and health economic meta-analysis of RCTs. Twelve electronic databases were searched in 2012 (updated in 2015; pre-publication update January 2017) for systematic reviews reporting RCTs (and update RCTs) evaluating supported asthma self-management. We assessed the quality of included studies and undertook a meta-analysis and narrative synthesis. RESULTS: A total of 27 systematic reviews (n = 244 RCTs) and 13 update RCTs revealed that supported self-management can reduce hospitalisations, accident and emergency attendances and unscheduled consultations, and improve markers of control and quality of life for people with asthma across a range of cultural, demographic and healthcare settings. Core components are patient education, provision of an action plan and regular professional review. Self-management is most effective when delivered in the context of proactive long-term condition management. The total cost (n = 24 RCTs) of providing self-management support is offset by a reduction in hospitalisations and accident and emergency visits (standard mean difference 0.13, 95% confidence interval -0.09 to 0.34). CONCLUSIONS: Evidence from a total of 270 RCTs confirms that supported self-management for asthma can reduce unscheduled care and improve asthma control, can be delivered effectively for diverse demographic and cultural groups, is applicable in a broad range of clinical settings, and does not significantly increase total healthcare costs. Informed by this comprehensive synthesis of the literature, clinicians, patient-interest groups, policy-makers and providers of healthcare services should prioritise provision of supported self-management for people with asthma as a core component of routine care. SYSTEMATIC REVIEW REGISTRATION: RECURSIVE: PROSPERO CRD42012002694 ; PRISMS: PROSPERO does not register meta-reviews

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Longshore Sediment Transport From Northern Maine To Tampa Bay, Florida: A Comparison Of Longshore Field Studies To Relative Potential Sediment Transport Rates Derived From Wave Information Study Hindcast Data

This paper examines the regional longshore sediment transport pattern of the seaward coast of the United States and Gulf of Mexico from northern Maine to Tampa Bay, Florida. From previous studies it is known that along the coast there are variations in direction of sediment transport known as nodal zones as well as variations in sediment transport rate. Wave Information Study (WIS) hindcast data for the interval 1976 through 1995 (United States Army Corps of Engineers, 2003) provide a spatially continuous model of the regional longshore current directions in the study area. In chapter one, all available published field studies of longshore current direction and sediment transport directions and rates are compiled to create a description of the direction and, whenever possible, magnitude of longshore transport. A detailed compilation of regional and local published studies are provided in tables. An interpretation of sediment transport rates and directions is provided in eight regional maps of the study area. In chapter two the results of the literature compilations are compared with gross and net potential sediment transport directions and rates modeled using WIS hindcast data. The WIS deep-water wave characteristics are used to predict the directions and rate of longshore sediment transport at local outer coast positions using the method of Ashton et al. (2003a). The WIS-derived transport directions, including nodal zones, generally agree with the published field studies, although there are a few local inconsistencies particularly near inlets, shoals and irregular bathymetry. Trends in longshore transport rates, such as increases and decreases in gross transport rates are well represented by the WIS-derived potential transport rates. The discrepencies between the published field studies and WIS results are apparently primarily due to assumptions in the WIS model, such as assuming shore-parallel bathymetric contours

Longshore Sediment Transport Directions and Rates from Northern Maine to Tampa Bay, Florida: Literature Compilation and Interpretation

This paper examines site-specific and regional longshore sediment transport directions and rates along the U.S. seaward coast from the northern Maine border to the mouth of Tampa Bay, Florida. From previous studies, it is known that along the coast, there are nodal zones, i.e. locations of divergence or convergence in longshore current, as well as variations in current direction and sediment transport rate. Available published field-based studies of sediment transport directions and rates were compiled to create a map of the direction and rate of longshore transport. A detailed compilation of local and regional published studies is provided in tables and in a sequence of eight regional maps. Compiled studies of longshore transport reveal a dominant southward direction. On the regional scale, 12 nodal zones are identified. At the local scale, the number of nodal zones increases by approximately an order of magnitude. This work builds upon the Master\u27s thesis of van Gaalen (2004)

Longshore Sediment Transport Directions and Rates from Northern Maine to Tampa Bay, Florida: Literature Compilation and Interpretation

This paper examines site-specific and regional longshore sediment transport directions and rates along the U.S. seaward coast from the northern Maine border to the mouth of Tampa Bay, Florida. From previous studies, it is known that along the coast, there are nodal zones, i.e. locations of divergence or convergence in longshore current, as well as variations in current direction and sediment transport rate. Available published field-based studies of sediment transport directions and rates were compiled to create a map of the direction and rate of longshore transport. A detailed compilation of local and regional published studies is provided in tables and in a sequence of eight regional maps. Compiled studies of longshore transport reveal a dominant southward direction. On the regional scale, 12 nodal zones are identified. At the local scale, the number of nodal zones increases by approximately an order of magnitude. This work builds upon the Master\u27s thesis of van Gaalen (2004)

Time-Frequency Methods for Characterizing Cuspate Landforms in Lidar Data

Time-frequency techniques to characterize cuspate patterns in light detection and ranging (lidar) data are introduced using examples from the Atlantic coast of Florida, United States. These techniques permit the efficient study of beach face landforms over many kilometers of coastline at multiple spatial scales. From a lidar image, a beach-parallel spatial series is generated. Here, this series is the shore-normal position of a specific elevation (contour line). Well-established time-frequency analysis techniques, wavelet transforms, and S-Transforms, are then applied to the spatial series. These methods yield results entirely compatible with the traditional method of estimating the spacing of cuspate features. In addition, confidence intervals are readily established for the spatial extent and wavelengths of cuspate landforms simultaneously at multiple scales. Examples show this method is useful for capturing transitions in cuspate shapes. With the advent of land-based time-lapse lidar, such techniques should be particularly useful for characterizing the evolution of cuspate landforms and testing models for beach face dynamics

Observations of Beach Cusp Evolution at Melbourne Beach, Florida, USA

Morphological observations (terrestrial laser scanning) and sediment analysis are used to study beach cusp morphodynamics at Melbourne Beach (Florida, USA), a moderately sloped beach characterized by fine sand. The study couples rapid high-resolution surveying with surficial sediment sampling over multiple tidal cycles. Surveys were run ~ 500 m alongshore and sediment samples were collected intertidally over a period of 5 days. Beach cusp location within larger scale beach morphology is shown to directly influence cusp growth as either gross erosional or gross accretional. Sediment characteristics within the beach cusp morphology are reported coincident with cusp evolution. Variations in particle size distribution kurtosis are exhibited as the cusps evolve, however no significant correlation is seen between grain size and position between horn and embayment. During the end of the study, a storm resulted in beach cusp destruction and increased sediment sorting