Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units : a systematic review

Funding The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.Peer reviewedPublisher PD

What is the impact of long term COVID-19 on workers in healthcare settings? A rapid review of current evidence. [Protocol]

The objective of this systematic rapid review is to assess the effects of long COVID among healthcare workers and its impact on their self-reported health status, professional working lives, personal circumstances and use of health services. A range of clinical and social science databases will be searched, including MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, and ASSIA. Eligible studies will be those assessing i) the experiences and views of healthcare workers with symptoms of long COVID as well as ii) the impact of long COVID symptoms on health status, working performance, personal circumstances and use of healthcare resources. The eligible population will be healthcare workers with symptoms of long COVID. All clinical and non-clinical staff will be eligible for inclusion, for example, cleaners, domestic staff, receptionists, estate workers

Randomised controlled trials in pre-hospital trauma : a systematic mapping review

Acknowledgements The authors thank Paul Manson (HSRU Information Scientist) for help with the database searches, Professor Graeme MacLennan for advice on categorising adaptive design trials, and Professor Marion Campbell for commenting on a draft version of the manuscript. Funding statement RL held an NHS Research Scotland Fellowship during the delivery of this project. The Health Services Research Unit, Institute of Applied Health Sciences (University of Aberdeen), is core-funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The funders had no involvement in study design, collection, analysis and interpretation of data, reporting or the decision to publish.Peer reviewedPublisher PD

Child food insecurity in the UK: a rapid review

The National Institute for Health Research Public Health Research programme. The Health Services Research Unit is core-funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.Peer reviewedPublisher PD

Does weight management research for adults with severe obesity represent them? Analysis of systematic review data

Acknowledgments We thank the members of the REBALANCE Project and Advisory Groups for their contributions to the REBALANCE Project. We thank Shaun Treweek and Heidi Gardner, Health Services Research Unit, University of Aberdeen, for helpful discussions on trial generalisability and inclusion of underserved groups. Funding National Institute for Health Research Health Technology Assessment Programme (project number: 15/09/04).Peer reviewedPublisher PD

Cost-effectiveness and value of information analysis of multiple frequency bioimpedance devices for fluid management in people with chronic kidney disease having dialysis

Acknowledgements The authors would like to thank the Thomas Walker and Rebecca Albrow (National Institute for Health and Care Excellence) for comments on earlier versions of the model. We also wish to thank the NICE expert committee members who provided information and data to support the development of the model: Dr Andrew Davenport (Royal Free Hospital, London), Dr Simon Roe (Nottingham University Hospitals NHS Trust), Dr Elizabeth Lindley (St James’s University Hospital), Dr Wesley Hayes (Great Ormond Street Hospital), Ms Joanne Prince (Central Manchester University Hospitals NHS Foundation Trust), Mr Nick McAleer (Royal Devon & Exeter NHS Foundation Trust), Dr Kay Tyerman (Leeds General Infirmary), Dr Graham Woodrow (St James’s University Hospital) and Mr Paul Taylor (lay specialist committee member). Funding This paper presents independent research funded by the National Institute for Health Research (NIHR), commissioned through the NICE Diagnostic Assessment Programme (Project no 15/17/07). The views expressed are those of the authors and not necessarily those of NICE, the NHS, the NIHR or the Department of Health. The Health Economics Research Unit and the Health Services Research Unit, University of Aberdeen, are funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.Peer reviewedPublisher PD

Pre-hospital and emergency department treatment of convulsive status epilepticus in adults : an evidence synthesis

Acknowledgements The authors are grateful to Robert Silbergleit, Department of Emergency Medicine, University of Michigan, MI, USA, for providing the individual participant data set of RAMPART. Patient and public involvement The Plain English summary was shared with the Health Services Research Unit (HSRU) Public Partnership Group at the University of Aberdeen, which consists of 11 patient and public involvement partners (seven men, four women; three working age, eight retired). Communication with the Public Partnership Group was facilitated by the HSRU patient and public involvement co-ordinator. The Group consists of members of the public, who meet regularly to discuss aspects of HSRU research and provide a public perspective. Six members of the group provided comments on the language and general meaning of the summary Funding This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 26, No. 20. See the NIHR Journals Library website for further project information.Peer reviewedPublisher PD

Identification and categorisation of relevant outcomes for symptomatic uncomplicated gallstone disease : in depth analysis to inform the development of a core outcome set

Moira Cruickshank and Rumana Newlands are joint-first authors. Funding Information: Funding This work was supported by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme grant (14/192/71). The work was also supported by an NHS Grampian Endowment grant (16/11/006). KG held a Medical Research Council UK Methodology Fellowship during the delivery of this project (MR/L01193X/1). The Health Services Research Unit, Institute of Applied Health Sciences (University of Aberdeen), is core funded by the chief scientist office of the Scottish Government Health and Social Care Directorates. Disclaimer The funders had no involvement in study design, collection, analysis and interpretation of data, reporting or the decision to publish.Peer reviewedPublisher PD

Interventions to Reduce Anticholinergic Burden in Adults Aged 65 and Older: A Systematic Review

INTRODUCTION: Older age is associated with multimorbidity and polypharmacy with high anticholinergic burden (ACB). High ACB is linked to adverse events such as poor physical functioning, dementia, cardiovascular disease, and falls. Interventions are needed to reduce this burden. AIMS/OBJECTIVES: The aim was to systematically review the literature to identify and describe studies of clinical and cost-effectiveness of interventions designed to reduce ACB in adults (≥65 years) on polypharmacy regimes, compared with usual care. The objective was to answer the following questions: What are the contents of the interventions? Were these interventions clinically effective? Were these interventions cost effective?. DESIGN, SETTING, AND PARTICIPANTS: Systematic review of interventions to reduce anticholinergic burden in adults aged 65 and older in any clinical setting. METHODS: Eligible papers reported primary or secondary research describing any type of intervention including systematic reviews, randomized controlled trials (RCTs), controlled clinical trials, or nonrandomized pre-post intervention studies (PPIs) published in English from January 2010 to February 2019. Databases searched included CINAHL, Ovid MEDLINE, EMBASE, and The Cochrane Central Register of Controlled Trials (CENTRAL). RESULTS: The search yielded 5862 records. Eight studies (4 RCTs, 4 PPIs) conducted in hospital (4), community (2), nursing homes (1), and retirement villages (1) met the inclusion criteria. Pharmacists, either individually or as part of a team, provided the intervention in the majority of studies (6/8). Most (7/8) involved individual patient medication review followed by feedback to the prescriber. Two of the 4 RCTs and all non-RCTs reported a decrease in ACB following the intervention. No study reported cost outcome. CONCLUSIONS/IMPLICATIONS: Pharmacists may be well placed to implement an ACB reduction intervention. This is the first systematic review of interventions to reduce ACB in older adults, and it highlights the need for development and testing of high-quality pragmatic clinical and cost-effectiveness trials in community and specific patient populations at high risk of harm from ACB. [PROSPERO registration: CRD42018089764]

Barriers and facilitators to reducing anticholinergic burden: a qualitative systematic review

Background: Despite common use, anticholinergic medications have been associated with serious health risks. Interventions to reduce their use are being developed and there is a need to understand their implementation into clinical care. Aim of review: This systematic review aims to identify and analyse qualitative research studies exploring the barriers and facilitators to reducing anticholinergic burden. Methods: Medline (OVID), EMBASE (OVID), CINAHL (EMBSCO) and PsycINFO (OVID) were searched using comprehensive search terms. Peer reviewed studies published in English presenting qualitative research in relation to the barriers and facilitators of deprescribing anticholinergic medications, involving patients, carers or health professionals were eligible. Normalization Process Theory was used to explore and explain the data. Results: Of 1764 identified studies, two were eligible and both involved healthcare professionals (23 general practitioners, 13 specialist clinicians and 12 pharmacists). No studies were identified that involved patients or carers. Barriers to collaborative working often resulted in poor motivation to reduce anticholinergic use. Low confidence, system resources and organisation of care also hindered anticholinergic burden reduction. Good communication and relationships with patients, carers and other healthcare professionals were reported as important for successful anticholinergic burden reduction. Having a named person for prescribing decisions, and clear role boundaries, were also important facilitators. Conclusions: This review identified important barriers and facilitators to anticholinergic burden reduction from healthcare provider perspectives which can inform implementation of such deprescribing interventions. Studies exploring patient and carer perspectives are presently absent but are required to ensure person-centeredness and feasibility of future interventions