Writing and presenting a systematic review emphasizing the Cochrane Handbook for systematic reviews

BACKGROUND: The systematic review is a scientific method for identifying and presenting early research, quality assessment, and integration of their results. This study aimed to describe the principles of systematic reviews and inscribe related articles emphasizing the Cochrane Handbook, for using of medical and health students.METHODS: This study was a library review and a compilation of materials on how to conduct review studies in medical sciences and health with emphasis on the Cochrane Handbook.RESULTS: The findings of this study indicated that review studies have different types, most notably systematic reviews. The Cochrane Handbook provides valuable information collections for conducting these studies in medical sciences, and allows systematic reviews to step by step facilitate and publish relevant articles.CONCLUSION: Writing a systematic review involves defining the purpose and protocols, systematically searching for primary studies, critical assessment, selection of the studies, and then, analysis and integration of the final results

Perspective Chapter: Telehealth Technologies for the Elderly People

Home telehealth technology delivers a telemedicine tool for elder adults to take an active role in the management of their chronic diseases. This study aimed to determine the requirements and applications of home telehealth systems to monitor health parameters of the elderly. Electronic databases including PubMed, Scopus, Web of Science complemented by Google Scholar were searched. This systematic review was conducted based on preferred reporting items for systematic reviews and meta-analyses. In this study, 21 articles met the inclusion criteria and were included in the final review. There were 80 different requirements and 15 types of applications to create a home telehealth system specifically for the elderly. The highest frequency of applications element was related to the “blood pressure” (18%) and the lowest frequency related to items such as blood coagulation (1%) monitoring. Other systems` elements were “alert system” (12%), “information analysis” (12%), smartphone (20%), and internet (23%). Recognizing all used requirements and achieved capabilities may assist in designing more effective systems. They might be expanded at national level to meet the elderly’s needs at a greater scale

Writing and presenting a systematic review emphasizing the Cochrane Handbook for systematic reviews

BACKGROUND: The systematic review is a scientific method for identifying and presenting early research, quality assessment, and integration of their results. This study aimed to describe the principles of systematic reviews and inscribe related articles emphasizing the Cochrane Handbook, for using of medical and health students. METHODS: This study was a library review and a compilation of materials on how to conduct review studies in medical sciences and health with emphasis on the Cochrane Handbook. RESULTS: The findings of this study indicated that review studies have different types, most notably systematic reviews. The Cochrane Handbook provides valuable information collections for conducting these studies in medical sciences, and allows systematic reviews to step by step facilitate and publish relevant articles. CONCLUSION: Writing a systematic review involves defining the purpose and protocols, systematically searching for primary studies, critical assessment, selection of the studies, and then, analysis and integration of the final results

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Virtual clinic in pregnancy and postpartum healthcare: A systematic review

Abstract Background and Aims To monitor the health status of pregnant women moment by moment, new technologies in the field of telemedicine can be used, such as virtual visits and virtual clinics. During the COVID‐19 pandemic, by using these technologies, useful and satisfactory services have been provided to pregnant mothers. The aim of this study is to specify the applications, features, and infrastructure of a comprehensive virtual clinic in the field of gynecological and pregnancy care. Methods A systematic review search was conducted through the scientific databases from February 2013 to February 2022 using Scopus, Web of Science, and PubMed. Furthermore, manual searches in Google Scholar and the reference lists of included studies were carried out. Results In this systematic review we included 16 articles that reported experiences in virtual clinics in pregnancy and postpartum healthcare. The involved studies were experimental, cohort, and cross‐sectional studies. The target group users were pregnant or women who gave birth and families of neonatal. The application of virtual clinics was for the visit, consultation, monitoring, follow‐up, and home care virtually. Highly satisfaction scores of caregivers after virtual visits and consultation were reported. There were some challenges during virtual visits and consultation; the most important challenge was a poor internet connection. Conclusion The reviewed studies show promising outcomes according to patient and provider satisfaction. We predict that telehealth will become a growingly significant part of gynecological care in the future

بررسی استفاده از سیستمI-PASS در بهبود فرآیند تحویل بیماران در زمان تغییر شیفت بین دستیاران طب اورژانس دانشگاه علوم پزشکی مازندران

Introduction: The emergency department is one of the most important departments of educational and medical centers that despite the crowds of patients must provide immediate and vital services in the shortest possible time with high efficiency to different patients. Therefore, it is necessary to use the standard method in transmitting this information between emergency medicine assistants. Methods: This research is a quasi-experimental interventional study that was conducted and completed by survey-analytical method during the years (1398-99) during three phases. In the first phase, information on the current status of the patient delivery process was collected among emergency medicine assistants. In the second phase, a workshop based on the I-PASS method was held. In the final phase, the process of patient delivery by I-PASS method was practically implemented and the obtained information was collected through a researcher-made questionnaire and analyzed using statistical methods. Results: First, the average and qualitative value of all research variables are high and very high. Second, there is a significant relationship between I-PASS indicators and patient delivery process improvement indicators. In other words, there is a direct relationship between all I-PASS indicators and all indicators of patient delivery process improvement between emergency medical assistants Inter-Shift Handoffs. Third, the main purpose of the research has been met. Therefore, this study has an innovative and new aspect for the effectiveness of the I-PASS system. Conclusion: The use of I-PASS system has a high impact on improving the patient delivery process between emergency medicine assistants Inter-Shift Handoffs in Imam Khomeini Educational and Medical Center of Mazandaran University of Medical Sciences. As this effect is in most cases, above 70%.مقدمه:بخش اورژانس یکی از مهمترین بخش های مراکزآموزشی و درمانی می باشد كه علیرغم ازدحام بیماران باید خدمات فوری و حیاتی را در کوتاه ترین زمان ممکن با بهره وری بالا به بیماران مختلف ارائه نماید. بنابراین استفاده از روش استاندارد در انتقال این اطلاعات بین دستیاران طب اورژانس ضروری است. روش کار: این مطالعه، از نوع مطالعه مداخله ای نیمه تجربی (Quasi-Experimental) است که به روش پیمایشی- تحلیلی در طی سال های (99 – 1398) در طی سه فازکلی اجراء و تکمیل گردید. بطوریکه در فاز نخست، اطلاعات وضعیت مرسوم فرآیند تحویل بیماران بین دستیاران طب اورژانس گردآوری شد. در فاز دوم کارگاه آموزشی مبتنی بر روش I-PASS برگزار گردید. در فاز نهائی نحوه فرآیند تحویل بیماران به روش I-PASS عملا اجراء و اطلاعات حاصله از طریق پرسشنامه محقق ساخته جمع آوری و با استفاده از روش های آماری مورد تجزیه و تحلیل قرارگرفت. &nbsp;یافته ها: میانگین و میانه ارزش کیفی همه متغیرهای مطالعه درحد زیاد و خیلی زیاد می باشد و یک رابطه معنادار بین شاخص های I-PASS و شاخص های بهبود فرآیند تحویل بیماران وجود دارد. به بیان دیگر، بین همه شاخص های I-PASS و همه شاخص های بهبود فرآیند تحویل بیماران بین دستیاران طب اورژانس در زمان تغییر شیفت ارتباط مستقیم وجود دارد. هدف اصلی مطالعه برآورده شده است و این مطالعه به جهت اثربخشی سیستم I-PASS جنبه نوآوری و جدید دارد. &nbsp;نتیجه گیری: استفاده از سیستم I-PASS دارای تاثیرگذاری بالا در بهبود فرآیند تحویل بیماران بین دستیاران طب اورژانس در زمان تغییر شیفت در مرکز آموزشی درمانی امام خمینی(ره) دانشگاه علوم پزشکی مازندران می باشد. بطوریکه این میزان تاثیرگذاری در بیشتر حالت ها، بالای 70درصد است. &nbsp