Search Results for: Colite ulcerosa negli adulti: review

Why is the language and framing of health as security necessary during times of crisis? As the language and framing of ‘health security’ grow in contemporary discourse, its prominence is perhaps most consequential in public health. The concept of ‘health security’ has varying interpretations and applications, with power disparity between actors who can label health issues as such. It is crucial to understand how the concept of ‘health security’ evolved and how it operates to better understand how the framing and language impact health system prioritisation. We, therefore, aim to apply a realist approach to synthesise evidence from the literature to understand why, how and under what conditions health securitisation impacts health system priorities at the national and sub-national levels. The synthesis will include quantitative and qualitative studies from any country where data exists to assess the influence of health security on health system prioritisation. The review is being undertaken at the time of writing. We searched Ovid MEDLINE, Ovid EMBASE, SCOPUS and Ovid Global Health for articles between 2010 and 2023. With the addition of purposive article selection, up to 60 articles will be included. The synthesis will consider the actors involved, their power, autonomy and motives, including actors at the receiving end of health security practices. We seek to identify mechanisms – such as motivation, dominance and reputation – that enable and encourage health security practices, and the contextual factors that create the space for and influence such mechanisms and identify the different ways in which such contextual factors and the mechanisms they enable manifest as outcomes or priorities on the ground. The context-mechanism-outcome configurations can allow for a closer examination of the role of health security framing globally and illustrate the historical and contextual contingencies that impact prioritisation in different settings.

BackgroundImproving anti-corruption, transparency and accountability mechanisms (ACTA) in the health sector is critical for progressing towards universal health coverage. Mechanisms to foster ACTA, are rarely enforced in many LMICs and infractions and circumvention of rules are commonplace. We explored particular structures, Ward Development Committees (WDCs), in Kano, Nigeria, that are considered to be successful by different stakeholders, seeking to explore the ways in which they are able to tackle health sector corruption.MethodsWe used iterative qualitative research methodology employing Khan and Roy’s 2022 Power, Capabilities and Interest (PCI) framework involving a series of steps. The process began with a co-creation workshop that included ‘story arcs’ (participant-created narratives on the mechanisms through which the Committees act on corruption), and the political economy aspects that shape how they operate, followed by key informant interviews. Given the sensitive nature of the topic, we emphasized a close engagement and building trust with stakeholders. Our methodology included debriefing meetings, post meeting individual reflections (to ensure reflexibility on the complex set of emerging issues) and a researchers’ workshop, to review gaps in findings and identify explanatory theories.ResultsWDCs use a range of strategies for impact, interacting with stakeholders from across sectors in contextually appropriate ways to foster ACTA. Specific factors underlying success are multi-sectorality, the enabling and relatively receptive policy environment, integration with the health governance structures, longstanding and synergistic donor support, and cultural value of volunteerism. The WDCs gradually developed competencies that empowered them to serve as agents for ACTA.ConclusionIncorporating community based structured into health governance structures is essential for improving ACTA. Our study suggest that governance actors should examine how similar grassroot-led mechanisms can be strengthened elsewhere, while ensuring these are adapted to the local health systems and socio-political contexts.

BackgroundPandemic preparedness and response should incorporate transdisciplinary collaboration and recognise that social, economic and political issues are as fundamental as biological issues. This research considers how social science has become recognised and valued during the uncertainty of the changing world over the past decade. In this context there is an increasing need for transdisciplinarity, which the social science discipline can facilitate. Social science researchers need to use innovative methods to produce operationalisable research and consider changing power relations and whose knowledge is used in policy and why.AimThis research investigated how social science is integrated across epidemic preparedness and response architecture, the politics of knowledge, where power lies in research and policy implementation and the extent transdisciplinarity has been operationalised.MethodsAs part of a PhD by Published Works a literature and policy document review was conducted as well as drawing on 19 publications which the author has co-written over the past 10 years. This research draws on the examples of neglected zoonoses pre-2014, the 2014-2016 West Africa Ebola outbreak and the 2019-2023 Covid-19 pandemic to answer: ‘What is the nature of social science contributions to epidemic and pandemic response in Africa and how have these changed over the last decade? How has transdisciplinarity been implemented and developed?’.ResultsThe findings are an analysis of historical epidemics ending with Covid-19 considering how perceptions of the role of social science have changed and if there is a greater appreciation of the need for transdisciplinarity. Covid-19 has had huge impact as it has given rise to post-pandemic transformations and an impetus for rethinking pandemic preparedness more broadly.ConclusionThis research offers insights into the importance of strengthening transdisciplinary collaboration, communication, data integration, and policy to enhance preparedness and response for future pandemics by learning from experiences over the last decade.

BackgroundBig qualitative data analysis is an emerging discipline in qualitative health research and has been used with online posts, open-ended survey responses, and patient health records. Traditional methods of qualitative data analysis can be time-consuming and biased by small sample sizes. The combined strengths of collaborative and participatory methods from rapid research approaches and the efficiency of digital software analyses can mitigate these issues.AimWe developed the LISTEN method (Collaborative and Digital Analysis of Big Qualitative Data in Time Sensitive Contexts), combining interdisciplinary expertise in collaborative, participatory, and digital methods for big qualitative data analysis.MethodsThe LISTEN project iteratively combines findings from a systematic review of peer-reviewed literature and world-wide-web data as well as consultation with stakeholders, collaborative team discussions and text network analysis using digital software. Text and thematic analysis software was used to conduct sentiment analysis and text network analysis of data from academic literature on digital software usage, types of qualitative data, qualitative analysis methods, analysis steps, and citations of notable publications in the field of big qualitative analysis methods.Results520 peer-reviewed studies and 37,129 internet posts were systematically reviewed. Web and social media posts referencing large qualitative data sets presented negative sentiments and many posts expressed ambiguity surrounding the categorization of digital and computational methods within the qualitative data analysis discipline. Over 50 types of digital software, and several collaborative qualitative data analysis methods and steps were identified. A LISTEN method manual has been developed to train and support the implementation of the method at three different sites, as well as the development of an interactive living systematic review.ConclusionsThe newly developed LISTEN method will provide research teams with the flexibility to triangulate different types of data and combine the strengths of rapid research designs and digital methods.

BackgroundThere is a requirement for health and care systems and services to work on an equitable basis with people who use and provide integrated care. In response, co-production has become popular in the design and transformation of services. An array of approaches have been implemented to achieve this. This presentation explores how an exceptional combination of methods were used to systematically review global publications of co-production within integrated care.MethodsThis systematic review used meta-ethnography with input from a patient and public involvement (PPI) advisory group comprising six members representing service users, family carers and the workforce. Meta-ethnography can generate theories by interpreting patterns between studies set in different contexts. Nine academic and four grey literature databases were searched for publications between 2012–2022. Data were extracted, analysed, translated and interpreted using the seven phases of meta-ethnography, with involvement of the advisory group throughout.ResultsA total of 2,097 studies were identified. 10 met the inclusion criteria. Studies demonstrated a variety of integrated care provisions for diverse populations. The methods applied organically drew out new interpretations, namely an additional step on the ‘ladder of co-production’ is proposed; a cyclic co-delivery framework for application within integrated care.ConclusionsThe use of meta-ethnography with input from an advisory group was successful in ensuring perceptions from lived experience and operational viewpoints were integral to the systematic review decisions and findings. Co-production was most effective through person-centred design, innovative planning, and collaboration. Key impacts on service transformation were structural changes, accessibility, and acceptability of service delivery. The cyclic co-delivery framework has the potential to enable better-sustained person-centred integrated care services.

BackgroundMyanmar has a high maternal mortality rate. Evidence about pregnancy and antenatal care experiences of women in more remote areas, where Covid and conflict have increased poverty and restricted travel, is limited. Understanding how women in a camp for internally displaced persons (IDP) navigate pregnancy and antenatal care may inform strategies to improve pregnancy outcomes in remote and fragile contexts.AimTo explore how women living as IDPs experience pregnancy and antenatal care in a remote setting.MethodsA case study approach with an exploratory and descriptive design will be employed using qualitative data collection methods with women in one settled IDP camp. Thematic interviews will be undertaken with internally displaced women, members of a local women’s support network and local data collectors who have been working in women’s health and development. Due to travel restrictions, a pragmatic decision was taken to work online with local data collectors experienced in qualitative research. This arrangement should increase richness of data, strengthen research capacity and reduce the impact of cross-cultural communication in the interview setting. Transcripts will be translated to English and data will be analysed thematically.Expected ResultsPandemic restrictions and disruption to services have increased challenges for displaced women in relation to pregnancy and antenatal care. The study is likely to develop themes related to access difficulties, traditional beliefs and practices, the role of cultural factors in pregnancy and the value of social support networks in women’s experiences of pregnancy in displacement.Current Stage of WorkEthical approval has been granted by Ulster University. A systematic review of qualitative evidence on pregnancy experiences of displaced women is underway. Interview guides have been translated, local language data collectors have been engaged, a site identified and local permissions secured.

BackgroundHealthcare ethnography requires a conscious effort at objectivity because the method is inherently subjective. Qualitative research in newborn care in low-resource-settings, such as Zimbabwe, can present significant challenges and ethical dilemmas. This abstract presents an ethnographic study conducted in a low-resource setting in Zimbabwe, of the implementation of a newborn digital intervention (Neotree) designed to improve newborn care, comparing a period of crisis to normality.AimThe aim is to discuss the methodological implications of observational research and positionality during crisis within the newborn healthcare context, using Zimbabwe as a case-study.MethodsThe ethnographic observations focused on two main Neotree functions: data capture and emergency management/stabilisation. Two separate periods of observation took place at the hospital-intervention sites during a period of crisis (political instability) and normality. Clinicians using the Neotree were observed over a period of three weeks in each time-period. The observations were performed by a UK paediatric doctor (lead researcher) both alone and alongside a Shona speaking social scientist. The lead researcher held both an emic perspective; with detailed experience of the neonatal unit, having lived in Zimbabwe for the preceding three years, and an etic perspective as a non-Shona speaking observer.ResultsThree main factors influenced positionality: lead observer’s role as a doctor, with challenges around seniority and judgement, being a white female and the language. The lead researcher’s unique perspective holding both detailed knowledge of Neotree function and delivery of newborn-care offered constructive actionable insights which may not have been elicited by a social scientist alone. The importance of co-observers was essential in a challenging healthcare setting.ConclusionThe emic vs etic perspective is a key component when interpreting and understanding findings, particularly during crises. The benefits of healthcare professionals as lead observers can provide vital insights, particularly when related to implementation of healthcare interventions.

Introduction
Early eye screening and treatment can reduce the incidence of blindness by detecting and addressing eye diseases at an early stage. The Ophthalmologist Robot is an automated device that can simultaneously capture ocular surface and fundus images without the need for ophthalmologists, making it highly suitable for primary application. However, the accuracy of the device’s screening capabilities requires further validation. This study aims to evaluate and compare the screening accuracies of ophthalmologists and deep learning models using images captured by the Ophthalmologist Robot, in order to identify a screening method that is both highly accurate and cost-effective. Our findings may provide valuable insights into the potential applications of remote eye screening.

Methods and analysis
This is a multicentre, prospective study that will recruit approximately 1578 participants from 3 hospitals. All participants will undergo ocular surface and fundus images taken by the Ophthalmologist Robot. Additionally, 695 participants will have their ocular surface imaged with a slit lamp. Relevant information from outpatient medical records will be collected. The primary objective is to evaluate the accuracy of ophthalmologists’ screening for multiple blindness-causing eye diseases using device images through receiver operating characteristic curve analysis. The targeted diseases include keratitis, corneal scar, cataract, diabetic retinopathy, age-related macular degeneration, glaucomatous optic neuropathy and pathological myopia. The secondary objective is to assess the accuracy of deep learning models in disease screening. Furthermore, the study aims to compare the consistency between the Ophthalmologist Robot and the slit lamp in screening for keratitis and corneal scar using the Kappa test. Additionally, the cost-effectiveness of three eye screening methods, based on non-telemedicine screening, ophthalmologist-telemedicine screening and artificial intelligence-telemedicine screening, will be assessed by constructing Markov models.

Ethics and dissemination
The study has obtained approval from the ethics committee of the Ophthalmology and Optometry Hospital of Wenzhou Medical University (reference: 2023-026 K-21-01). This work will be disseminated by peer-review publications, abstract presentations at national and international conferences and data sharing with other researchers.

Trial registration number
ChiCTR2300070082.

Introduction
Migraine headache is a significant health problem affecting patients’ psychological well-being and quality of life. Several network meta-analyses (NMAs) have compared the efficacy of migraine prophylaxis medications. However, some have focused exclusively on oral medications, while others were limited to injectable medications. Moreover, none of these NMAs conducted a stratified analysis between treatment-naïve patients and those with prior treatment failure. Therefore, this systematic review and NMA will compare the efficacy among all treatments for migraine prophylaxis, stratified by the treatment status of patients (ie, treatment-naïve and previous treatment failure).

Methods and analysis
Randomised-controlled trials that included patients with chronic or episodic migraine, assessed the efficacy of oral or injectable treatments for migraine prophylaxis and measured the outcomes as monthly migraine day, monthly headache day, migraine-related disability, health-related quality of life or adverse drug events will be eligible for inclusion in this review. Relevant studies will be searched from Medline, Scopus, the US National Institutes of Health Register, and the World Health Organization International Clinical Trials Registry Platform (WHO-ICTRP) databases since inception through 15 August 2023. Risk of bias assessment will be performed using a revised tool for assessing the risk of bias in randomised trials. Two-stage NMA will be applied to compare relative treatment effects among all treatments of migraine prophylaxis. Surface under the cumulative ranking curve will be applied to estimate and rank the probability to be the best treatment. Consistency assumption will be assessed using a design-by-treatment interaction model. Publication bias will be assessed by comparison-adjusted funnel plot. All analyses will be stratified according to patients’ status (ie, treatment-naïve and prior treatment failure).

Ethics and dissemination
This study is a systematic review protocol collecting data from published literature and does not require approval from an institutional review board. Results from this systematic review will be published in a peer-reviewed journal.

PROSPERO registration number
CRD42020171843.

Introduction
Many rural communities bear a disproportionate share of drug-related harms. Innovative harm reduction service models, such as vending machines or kiosks, can expand access to services that reduce drug-related harms. However, few kiosks operate in the USA, and their implementation, impact and cost-effectiveness have not been adequately evaluated in rural settings. This paper describes the Kentucky Outreach Service Kiosk (KyOSK) Study protocol to test the effectiveness, implementation outcomes and cost-effectiveness of a community-tailored, harm reduction kiosk in reducing HIV, hepatitis C and overdose risk in rural Appalachia.

Methods and analysis
KyOSK is a community-level, controlled quasi-experimental, non-randomised trial. KyOSK involves two cohorts of people who use drugs, one in an intervention county (n=425) and one in a control county (n=325). People who are 18 years or older, are community-dwelling residents in the target counties and have used drugs to get high in the past 6 months are eligible. The trial compares the effectiveness of a fixed-site, staffed syringe service programme (standard of care) with the standard of care supplemented with a kiosk. The kiosk will contain various harm reduction supplies accessible to participants upon valid code entry, allowing dispensing data to be linked to participant survey data. The kiosk will include a call-back feature that allows participants to select needed services and receive linkage-to-care services from a peer recovery coach. The cohorts complete follow-up surveys every 6 months for 36 months (three preceding kiosk implementation and four post-implementation). The study will test the effectiveness of the kiosk on reducing risk behaviours associated with overdose, HIV and hepatitis C, as well as implementation outcomes and cost-effectiveness.

Ethics and dissemination
The University of Kentucky Institutional Review Board approved the protocol. Results will be disseminated in academic conferences and peer-reviewed journals, online and print media, and community meetings.

Trial registration number
NCT05657106.

In the Original Investigation titled “Critical Appraisal of Guideline Recommendations on Systemic Therapies for Advanced Hepatocellular Carcinoma: A Review” published online August 3, 2023, there were errors in the Observation section of the Abstract. The third and fourth sentences should be as follows: “Thus far, the first-line immune-based regimen of tremelimumab plus durvalumab has been integrated only in the American Association for the Study of Liver Diseases guidance document and the latest National Comprehensive Cancer Network guidelines and has particular utility for patients with a high risk of gastrointestinal bleeding. Overall, in the first-line setting, both atezolizumab plus bevacizumab and sintilimab plus IBI305 (a bevacizumab biosimilar) and durvalumab plus tremelimumab received the highest ESMO-MCBS score of 5, indicating a substantial magnitude of clinical benefit.” In Table 1, the correct objective response rate was 30.0 for atezolizumab plus bevacizumab and 11.0 for sorafenib. Median progression-free survival for single tremelimumab regular interval durvalumab was 3.8 and the European Society for Medical Oncology–Magnitude of Clinical Benefit Scale (ESMO-MCBS) score was 5 (Substantial). In the ESMO-MCBS Score for First-Line and Second-Line Therapies section, the third sentence of the last paragraph should be as follows: “Thus, the ESMO-MCBS scores were 5 for sintilimab plus IBI305 and tremelimumab plus durvalumab, 4 for camrelizumab plus rivoceranib, and 3 for tremelimumab plus durvalumab.” Reference 26 in the reference list should be Kelley RK, Sangro B, Harris W, et al. Safety, efficacy, and pharmacodynamics of tremelimumab plus durvalumab for patients with unresectable hepatocellular carcinoma: randomized expansion of a phase I/II study. J Clin Oncol. 2021;39(27):2991-3001. The article was corrected online.

In Reply We thank Abou-Alfa and Sangro for their comments on our review of systemic therapies for hepatocellular carcinoma (HCC). They raise valid concerns that we would like to address.

In the Original Investigation titled “Psychotherapies for Generalized Anxiety Disorder in Adults: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials,” published online October 18, 2023, the authors had erroneously included a secondary analysis of a primary trial already included in the network, thus counting the same cohort of patients twice. Additionally, a standard error had been misinterpreted as a standard deviation during data extraction. All analyses have been rerun, and the article was corrected to fix errors in the Abstract, Key Points, text, References, Table 2, Figures 1-3, and eAppendixes D-N in Supplement 1. The 95% CI for behavior therapy vs waiting list no longer crosses the line of no effect in the primary efficacy analysis, but overall, the corrections do not affect the clinical interpretations or conclusions. The article was corrected online.

This narrative review compares the clinical benefit and safety profile of the recommended first-line and second-line drug regimens for advanced hepatocellular carcinoma.

This review examines the race and ethnicity of participants enrolled in pediatric studies conducted in response to written requests from the US Food and Drug Administration (FDA) for which pediatric exclusivity was granted between 2001 and 2021.

In the Original Investigation titled “Rapid Advances in Resectable Non–Small Cell Lung Cancer: A Narrative Review,” published online December 28, 2023, there was an error in the Figure. Where it previously read “pembrolizumab” in the bottom right bubble it now correctly reads “atezolizumab.” This article was corrected online.