Publications
180 results found
Semwal M, Whiting P, Bajpai R, et al., 2018, Digital Education for Health Professions on Smoking Cessation Management: Systematic Review by the Digital Health Education Collaboration (Preprint)
<sec> <title>BACKGROUND</title> <p>Tobacco smoking, one of the leading causes of preventable death and disease, is associated with 7 million deaths every year. This is estimated to rise to more than 8 million deaths per year by 2030, with 80% occurring in low- and middle-income countries. Digital education, teaching, and learning using digital technologies have the potential to increase educational opportunities, supplement teaching activities, and decrease distance barriers in health professions education.</p> </sec> <sec> <title>OBJECTIVE</title> <p>The primary objective of this systematic review was to evaluate the effectiveness of digital education compared with various controls in improving learners’ knowledge, skills, attitudes, and satisfaction to deliver smoking cessation therapy. The secondary objectives were to assess patient-related outcomes, change in health professionals’ practice or behavior, self-efficacy or self-rated competence of health professionals in delivering smoking cessation therapy, and cost-effectiveness of the interventions.</p> </sec> <sec> <title>METHODS</title> <p>We searched 7 electronic databases and 2 trial registers for randomized controlled trials published between January 1990 and August 2017. We used gold standard Cochrane methods to select and extract data and appraise eligible studies.</p> </sec> <sec> <title>RESULTS</title> <p>A total of 11 studies (number of participants, n=2684) were included in the review. All studies found that digital education was at least as effective as tradit
Gentry SV, Gauthier A, L'Estrade Ehrstrom B, et al., 2018, Serious Gaming and Gamification Education in Health Professions: Systematic Review (Preprint)
<sec> <title>BACKGROUND</title> <p>There is a worldwide shortage of health workers, and this issue requires innovative education solutions. Serious gaming and gamification education have the potential to provide a quality, cost-effective, novel approach that is flexible, portable, and enjoyable and allow interaction with tutors and peers.</p> </sec> <sec> <title>OBJECTIVE</title> <p>The aim of this systematic review was to evaluate the effectiveness of serious gaming/gamification for health professions education compared with traditional learning, other types of digital education, or other serious gaming/gamification interventions in terms of patient outcomes, knowledge, skills, professional attitudes, and satisfaction (primary outcomes) as well as economic outcomes of education and adverse events (secondary outcomes).</p> </sec> <sec> <title>METHODS</title> <p>A comprehensive search of MEDLINE, EMBASE, Web of Knowledge, Educational Resources Information Centre, Cochrane Central Register of Controlled Trials, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature was conducted from 1990 to August 2017. Randomized controlled trials (RCTs) and cluster RCTs were eligible for inclusion. Two reviewers independently searched, screened, and assessed the study quality and extracted data. A meta-analysis was not deemed appropriate due to the heterogeneity of populations, interventions, comparisons, and outcomes. Therefore, a narrative synthesis is presented.</p> </sec> <sec> <title>RESULTS</title> <p>A total of 27 RCTs and 3 clus
Tudor Car L, Kyaw BM, Dunleavy G, et al., 2018, Digital Problem-Based Learning in Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration (Preprint)
<sec> <title>BACKGROUND</title> <p>The use of digital education in problem-based learning, or digital problem-based learning (DPBL), is increasingly employed in health professions education. DPBL includes purely digitally delivered as well as blended problem-based learning, wherein digital and face-to-face learning are combined.</p> </sec> <sec> <title>OBJECTIVE</title> <p>The aim of this review is to evaluate the effectiveness of DPBL in improving health professionals’ knowledge, skills, attitudes, and satisfaction.</p> </sec> <sec> <title>METHODS</title> <p>We used the gold-standard Cochrane methods to conduct a systematic review of randomized controlled trials (RCTs). We included studies that compared the effectiveness of DPBL with traditional learning methods or other forms of digital education in improving health professionals’ knowledge, skills, attitudes, and satisfaction. Two authors independently screened studies, extracted data, and assessed the risk of bias. We contacted study authors for additional information, if necessary. We used the random-effects model in the meta-analyses.</p> </sec> <sec> <title>RESULTS</title> <p>Nine RCTs involving 890 preregistration health professionals were included. Digital technology was mostly employed for presentation of problems. In three studies, PBL was delivered fully online. Digital technology modalities spanned online learning, offline learning, virtual reality, and virtual patients. The control groups consisted of traditional PBL and traditional learning. The pooled analysi
Dunleavy G, Nikolaou CK, Nifakos S, et al., 2018, Mobile Digital Education for Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration (Preprint)
<sec> <title>BACKGROUND</title> <p>There is a pressing need to implement efficient and cost-effective training to address the worldwide shortage of health professionals. Mobile digital education (mLearning) has been mooted as a potential solution to increase the delivery of health professions education as it offers the opportunity for wide access at low cost and flexibility with the portability of mobile devices. To better inform policy making, we need to determine the effectiveness of mLearning.</p> </sec> <sec> <title>OBJECTIVE</title> <p>The primary objective of this review was to evaluate the effectiveness of mLearning interventions for delivering health professions education in terms of learners’ knowledge, skills, attitudes, and satisfaction.</p> </sec> <sec> <title>METHODS</title> <p>We performed a systematic review of the effectiveness of mLearning in health professions education using standard Cochrane methodology. We searched 7 major bibliographic databases from January 1990 to August 2017 and included randomized controlled trials (RCTs) or cluster RCTs.</p> </sec> <sec> <title>RESULTS</title> <p>A total of 29 studies, including 3175 learners, met the inclusion criteria. A total of 25 studies were RCTs and 4 were cluster RCTs. Interventions comprised tablet or smartphone apps, personal digital assistants, basic mobile phones, iPods, and Moving Picture Experts Group-1 audio layer 3 player devices to deliver learning content. A total of 20 studies assessed knowledge (n=2469) and compared mLearning or blended learning to tr
Car J, Carlstedt-Duke J, Tudor Car L, et al., 2018, Digital education in health professions: the need for overarching rvidence synthesis (Preprint), Publisher: JMIR Publications Inc.
Synthesizing evidence from randomized controlled trials of digital health education poses some challenges. These include a lack of clear categorization of digital health education in the literature; constantly evolving concepts, pedagogies, or theories; and a multitude of methods, features, technologies, or delivery settings. The Digital Health Education Collaboration was established to evaluate the evidence on digital education in health professions; inform policymakers, educators, and students; and ultimately, change the way in which these professionals learn and are taught. The aim of this paper is to present the overarching methodology that we use to synthesize evidence across our digital health education reviews and to discuss challenges related to the process. For our research, we followed Cochrane recommendations for the conduct of systematic reviews; all reviews are reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidance. This included assembling experts in various digital health education fields; identifying gaps in the evidence base; formulating focused research questions, aims, and outcome measures; choosing appropriate search terms and databases; defining inclusion and exclusion criteria; running the searches jointly with librarians and information specialists; managing abstracts; retrieving full-text versions of papers; extracting and storing large datasets, critically appraising the quality of studies; analyzing data; discussing findings; drawing meaningful conclusions; and drafting research papers. The approach used for synthesizing evidence from digital health education trials is commonly regarded as the most rigorous benchmark for conducting systematic reviews. Although we acknowledge the presence of certain biases ingrained in the process, we have clearly highlighted and minimized those biases by strictly adhering to scientific rigor, methodological integrity, and standard operating procedures.
Majeed A, 2018, GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in;195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017 (vol 392, pg 1736, 2018), LANCET, Vol: 392, Pages: 2170-2170, ISSN: 0140-6736
Stanaway JD, Afshin A, Gakidou E, et al., 2018, Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017, LANCET, Vol: 392, Pages: 1923-1994, ISSN: 0140-6736
BackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations.MethodsWe used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risk
Kyu HH, Abate D, Abate KH, et al., 2018, Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 1859-1922, ISSN: 0140-6736
BackgroundHow long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years.MethodsWe used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males.FindingsGlobally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1–7·8), from 65·6 years (65·3–65·8) in 1990 to 73·0 years (72·7–73·3) in 2017. The increase in years of life varied from 5·1 years (5·0–5·3) in high SDI countries to 12·0 years (11·3–12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1&ndash
James SL, Abate D, Abate KH, et al., 2018, Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 1789-1858, ISSN: 0140-6736
BackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data.MethodsWe estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calcula
Roth GA, Abate D, Abate KH, et al., 2018, Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 1736-1788, ISSN: 0140-6736
BackgroundGlobal development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017.MethodsThe causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries—Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised.FindingsAt the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest f
Dicker D, Nguyen G, Abate D, et al., 2018, Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 1684-1735, ISSN: 0140-6736
BackgroundAssessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally.MethodsThe GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different compone
Murray CJL, Callender CSKH, Kulikoff XR, et al., 2018, Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 1995-2051, ISSN: 0140-6736
BackgroundPopulation estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods.MethodsWe estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migrat
Lozano R, Fullman N, Abate D, et al., 2018, Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 2091-2138, ISSN: 0140-6736
BackgroundEfforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment.MethodsWe measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected fo
Martinengo L, Yeo NJY, Tang ZQ, et al., 2018, Digital Education for the Management of Chronic Wounds in Health Care Professionals: Protocol for a Systematic Review by the Digital Health Education Collaboration (Preprint)
<sec> <title>BACKGROUND</title> <p>Digital education is “the act of teaching and learning by means of digital technologies.” Digital education comprises a wide range of interventions that can be broadly divided into offline digital education, online digital education, digital game-based learning, massive open online courses (MOOCs), psychomotor skills trainers, virtual reality environments, virtual patient simulations, and m-learning. Chronic wounds pose an immense economic and psychosocial burden to patients and the health care system, as caring for them require highly specialized personnel. Current training strategies face significant barriers, such as lack of time due to work commitments, distance from provider centers, and costs. Therefore, there is an increased need to synthesize evidence on the effectiveness of digital education interventions on chronic wounds management in health care professionals.</p> </sec> <sec> <title>OBJECTIVE</title> <p>Our main objective is to assess the effectiveness of digital education as a stand-alone approach or as part of a blended-learning approach in improving pre- and postregistration health care professionals’ knowledge, attitudes, practical skills, and behavior in the management of chronic wounds, as well as their satisfaction with the intervention. Secondary objectives are to evaluate patient-related outcomes, cost-effectiveness of the interventions, and any unfavorable or undesirable outcomes that may arise.</p> </sec> <sec> <title>METHODS</title> <p>This systematic review will follow the methodology as described in the Cochrane Handbook for Systematic Reviews of Interventions. As our systematic
Saxena N, Kyaw BM, Vseteckova J, et al., 2018, Virtual reality environments for health professional education, Cochrane Database of Systematic Reviews, Vol: 2018
© 2018 The Cochrane Collaboration. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of virtual reality environment (VRE)-based educational interventions for health professionals on knowledge, skills, and participants' attitude towards and satisfaction with the interventions. Additionally, this review will assess the interventions' economic impact (cost and cost effectiveness), patient-related outcomes and unintended adverse effects of VRE-based educational interventions for post-registration healthcare providers.
Hervatis V, Kyaw BM, Semwal M, et al., 2018, Offline and computer-based eLearning interventions for medical students' education, Cochrane Database of Systematic Reviews, Vol: 2018
© 2018 The Cochrane Collaboration. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective of this review is to assess the effects of offline, computer-based eLearning compared with 'traditional' learning and other types of eLearning interventions for medical students' knowledge as well as changes in skills and attitude towards the intervention. Additionally, as secondary objectives, this review will assess the economic impact (cost-benefit, cost-utility or cost-effectiveness), unintended adverse effects, and medical students' satisfaction with using offline and computer-based educational interventions.
Semwal M, Wahabi HA, Posadzki P, et al., 2018, Offline and computer-based eLearning interventions for medical doctors' education, Cochrane Database of Systematic Reviews, Vol: 2018
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective of this systematic review is to evaluate the effectiveness of offline computer-based eLearning educational interventions compared to traditional classroom learning and/or other types of eLearning or no intervention, for improving medical doctors' knowledge, skills, attitudes, satisfaction and patient-related outcomes. We will assess the cost and cost-effectiveness of offline computer-based eLearning, and adverse, unintended, or undesirable effects of the interventions as secondary objectives.
Paul P, Toon E, Hadadgar A, et al., 2018, Online- and local area network (LAN)-based eLearning interventions for medical doctors' education, Cochrane Database of Systematic Reviews, Vol: 2018
© 2018 The Cochrane Collaboration. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: This review will evaluate the effectiveness of internet- and LAN-based eLearning for ongoing training of medical doctors, specifically looking at the impact of the learning on the learners' knowledge, skills, attitude, and satisfaction. This review will also assess any change in clinical practices or behaviours in response to these interventions, and the economic impact (cost and cost-effectiveness) of internet- and LAN-based educational interventions.
Tudor Car L, Kyaw BM, Atun R, 2018, The role of eLearning in health management and leadership capacity building in health system: a systematic review, Human Resources for Health, Vol: 16, ISSN: 1478-4491
BackgroundHealth leadership and management are essential for ensuring resilient health systems. Relevant training opportunities are often scarce, and the use of digital education could help address this gap. Our aim was to assess the effectiveness of eLearning for healthcare leadership and management capacity building.MethodsWe performed a systematic review on the effectiveness of eLearning for health leadership and management training. We also reviewed literature on relevant competencies and training programmes. We conceptualise the role of health leadership and management capacity building in health system strengthening and explore the use of eLearning in this area.ResultsNo evidence was found on the effectiveness of eLearning for health leadership and management capacity guiding. Evidence on health leadership and management education effectiveness in general is scarce and descriptive and reports learning outcomes. We explore how various forms of eLearning can help meet specific requirements of health leadership and management training.ConclusionsLiterature on the effectiveness of health leadership and management education is scarce. The use of eLearning could support this type of training by making it more accessible and tailored. Future research should be carried out in diverse settings, assume experimental designs, evaluate the use of information technology and report health system outcomes.
Tudor Car L, Riboli-Sasco EF, Marcano Belisario JS, et al., 2018, Mobile learning for delivering health professional education, Cochrane Database of Systematic Reviews, ISSN: 1469-493X
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The objective of this review is to evaluate the effectiveness of mLearning educational interventions for delivering pre-registration and post-registration healthcare professional education. We will primarily assess the impact of these interventions on students' knowledge, skills, professional attitudes and satisfaction.
Gentry S, L'Estrade Ehrstrom B, Gauthier A, et al., 2018, Serious Gaming and Gamification interventions for health professional education, Cochrane Database of Systematic Reviews, Vol: 2018
© 2018 The Cochrane Collaboration. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the effectiveness of Serious Gaming and Gamification interventions for delivering pre- and post-registration health professional education compared with traditional learning, other types of eLearning, or other Serious Gaming and Gamification interventions. We will primarily assess the impact of these interventions on students' knowledge, skills, professional attitudes and satisfaction.
Kononowicz AA, Woodham L, Georg C, et al., 2018, Virtual patient simulations for health professional education, Cochrane Database of Systematic Reviews, Vol: 2018
© 2018 The Cochrane Collaboration. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The objective of this review is to evaluate the effectiveness of virtual patient simulation as an educational intervention versus traditional learning, other types of e-Learning interventions and other forms of virtual patient simulation interventions for delivering pre-registration and post-registration healthcare professional education. We will primarily assess the impact of these interventions on learners' knowledge, skills and attitudes. Our secondary objective is to assess the cost-effectiveness of these interventions.
GBD 2016 Healthcare Access and Quality Collaborators, 2018, Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016, Lancet, Vol: 391, Pages: 2236-2271, ISSN: 0140-6736
BACKGROUND: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. METHODS: Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derive
Law GC, Apfelbacher C, Posadzki PP, et al., 2018, Choice of outcomes and measurement instruments in randomised trials on eLearning in medical education: a systematic mapping review protocol, Systematic Reviews, Vol: 7, ISSN: 2046-4053
BackgroundThere will be a lack of 18 million healthcare workers by 2030. Multiplying the number of well-trained healthcare workers through innovative ways such as eLearning is highly recommended in solving this shortage. However, high heterogeneity of learning outcomes in eLearning systematic reviews reveals a lack of consistency and agreement on core learning outcomes in eLearning for medical education. In addition, there seems to be a lack of validity evidence for measurement instruments used in these trials. This undermines the credibility of these outcome measures and affects the ability to draw accurate and meaningful conclusions. The aim of this research is to address this issue by determining the choice of outcomes, measurement instruments and the prevalence of measurement instruments with validity evidence in randomised trials on eLearning for pre-registration medical education.MethodsWe will conduct a systematic mapping and review to identify the types of outcomes, the kinds of measurement instruments and the prevalence of validity evidence among measurement instruments in eLearning randomised controlled trials (RCTs) in pre-registration medical education. The search period will be from January 1990 until August 2017. We will consider studies on eLearning for health professionals’ education. Two reviewers will extract and manage data independently from the included studies. Data will be analysed and synthesised according to the aim of the review.DiscussionAppropriate choice of outcomes and measurement tools is essential for ensuring high-quality research in the field of eLearning and eHealth. The results of this study could have positive implications for other eHealth interventions, including (1) improving quality and credibility of eLearning research, (2) enhancing the quality of digital medical education and (3) informing researchers, academics and curriculum developers about the types of outcomes and validity evidence for measurement instruments us
Tudor Car L, Atun R, 2017, eLearning for health system leadership and management capacity building: a protocol for a systematic review, BMJ Open, Vol: 7, ISSN: 2044-6055
Introduction: Health leadership and management capacity are essential for health system strengthening and for attaining universal health coverage by optimizing the existing human, technological, and financial resources. However, in health systems health leadership and management training is not widely available. The use of information technology for education (i.e. eLearning) could help address this training gap by enabling flexible, efficient, and scalable health leadership and management training. We present a protocol for a systematic review on the effectiveness of eLearning for health leadership and management capacity building in improving health system outcomes.Methodology and analysis: We will follow the Cochrane Collaboration methodology. We will search for experimental studies focused on the use of any type of eLearning modality for health management and leadership capacity building in all types of health workforce cadres. The primary outcomes of interest will be health outcomes, financial risk protection and user satisfaction. In addition, secondary outcomes of interest the attainment of health system objectives of improved equity, efficiency, effectiveness and responsiveness. We will search relevant databases of published and grey literature as well as clinical trials registries from 1990 onwards without language restrictions. Two review authors will screen references, extract data and perform risk of bias assessment independently. Contingent on the heterogeneity of the collated literature, we will either perform a meta-analysis or a narrative synthesis of the collated data.Ethics and dissemination: The systematic review will aim to inform policy makers, investors, health professionals, technologists and educators about the existing evidence, potential gaps in literature and the impact of eLearning for health leadership and management capacity building on health system outcomes. We will disseminate the review findings by publishing it as a peer-review jou
Tudor Car L, Papachristou N, Urch C, et al., 2017, Prioritizing medication safety in care of people with cancer: clinicians’ views on main problems and solutions, Journal of Global Health, Vol: 7, ISSN: 2047-2986
Background: Cancer care is liable to medication errors due to the complex nature of cancer treatment, the common presence of comorbidities and the involvement of a number of clinicians in cancer care. While the frequency of medication errors in cancer care has been reported, little is known about their causal factors and effective prevention strategies. With a unique insight into the main safety issues in cancer treatment, frontline staff can help close this gap. In this study, we aimed to identify medication safety priorities in cancer patient care according to clinicians in North West London using PRIORITIZE, a novel priority-setting approach.Methods:The project steering group determined the scope, the context and the criteria for prioritization. We then invited North West London cancer care clinicians to identify and prioritize main causes for, and solutions to, medication errors in cancer care. Forty cancer care providers submitted their suggestions which were thematically synthesized into a composite list of 20 distinct problems and 22 solutions. A group of 26 clinicians from the initial cohort ranked the composite list of suggestions using predetermined criteria. Results: The top ranked problems focused on patients’ poor understanding of treatments due to language or education difficulties, clinicians’ insufficient attention to patients’ psychological distress, and inadequate information sharing among healthcare providers. The top ranked solutions were provision of guidance to patients and their carers on what to do when unwell, pre-chemotherapy work-up for all patients and better staff training. Overall, clinicians considered improved communication between healthcare providers, quality assurance procedures (during prescription and monitoring stages) and patient education as key strategies for improving cancer medication safety. Prescribing stage was identified as the most vulnerable to medication safety threats. The highest ranked suggesti
Tudor Car L, El-Khatib M, Perneczky N, et al., 2017, Prioritizing problems in and solutions to homecare safety of people with dementia: supporting carers, streamlining care, BMC Geriatrics, Vol: 17, ISSN: 1471-2318
BackgroundDementia care is predominantly provided by carers in home settings. We aimed to identify the priorities for homecare safety of people with dementia according to dementia health and social care professionals using a novel priority-setting method.MethodsThe project steering group determined the scope, the context and the criteria for prioritization. We then invited 185 North-West London clinicians via an open-ended questionnaire to identify three main problems and solutions relating to homecare safety of people with dementia. 76 clinicians submitted their suggestions which were thematically synthesized into a composite list of 27 distinct problems and 30 solutions. A group of 49 clinicians arbitrarily selected from the initial cohort ranked the composite list of suggestions using predetermined criteria.ResultsInadequate education of carers of people with dementia (both family and professional) is seen as a key problem that needs addressing in addition to challenges of self-neglect, social isolation, medication nonadherence. Seven out of top 10 problems related to patients and/or carers signalling clearly where help and support are needed. The top ranked solutions focused on involvement and education of family carers, their supervision and continuing support. Several suggestions highlighted a need for improvement of recruitment, oversight and working conditions of professional carers and for different home safety-proofing strategies.ConclusionsClinicians identified a range of suggestions for improving homecare safety of people with dementia. Better equipping carers was seen as fundamental for ensuring homecare safety. Many of the identified suggestions are highly challenging and not easily changeable, yet there are also many that are feasible, affordable and could contribute to substantial improvements to dementia homecare safety.
Semwal M, Wahabi HA, Posadzki P, et al., 2016, Offline and computer-based eLearning interventions for medical doctors' education, Cochrane Database of Systematic Reviews, Vol: 2016, ISSN: 1469-493X
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective of this systematic review is to evaluate the effectiveness of offline computer-based eLearning educational interventions compared to traditional classroom learning and/or other types of eLearning or no intervention, for improving medical doctors knowledge, skills, attitudes, satisfaction and patient-related outcomes. We will assess the cost and cost-effectiveness of offline computer-based eLearning, and adverse, unintended, or undesirable effects of the interventions as secondary objectives.
Tudor Car L, Papachristou N, Urch C, et al., 2016, Preventing delayed diagnosis of cancer: clinicians’ views on main problems and solutions, Journal of Global Health, Vol: 6, ISSN: 2047-2986
BackgroundDelayed diagnosis is a major contributing factor to the UK’s lower cancer survival compared to many European countries. In the UK, there is a significant national variation in early cancer diagnosis. Healthcare providers can offer an insight into local priorities for timely cancer diagnosis. In this study, we aimed to identify the main problems and solutions relating to delay cancer diagnosis according to cancer care clinicians.MethodsWe developed and implemented a new priority–setting approach called PRIORITIZE and invited North West London cancer care clinicians to identify and prioritize main causes for and solutions to delayed diagnosis of cancer care.ResultsClinicians identified a number of concrete problems and solutions relating to delayed diagnosis of cancer. Raising public awareness, patient education as well as better access to specialist care and diagnostic testing were seen as the highest priorities. The identified suggestions focused mostly on the delays during referrals from primary to secondary care.ConclusionsMany identified priorities were feasible, affordable and converged around common themes such as public awareness, care continuity and length of consultation. As a timely, proactive and scalable priority–setting approach, PRIORITZE could be implemented as a routine preventative system for determining patient safety issues by frontline staff.
Tudor Car L, Papachristou N, Gallagher J, et al., 2016, Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study, BMC Family Practice, Vol: 17, ISSN: 1471-2296
Background: Medication error is a frequent, harmful and costly patient safety incident. Research to date has mostly focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to, medication error in primary care.Methods: We used a novel priority-setting method for identifying and ranking patient safety problems and solutions called PRIORITIZE. We invited 500 North West London primary care clinicians to complete an open-ended questionnaire to identify three main problems and solutions relating to medication error in primary care. 113 clinicians submitted responses, which we thematically synthesized into a composite list of ¬48 distinct problems and 45 solutions. A group of 57 clinicians randomly selected from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians’ scores was presented using the average expert agreement (AEA). The study was conducted between September 2013 and November 2014.Results: The top three problems were incomplete reconciliation of medication during patient ‘hand-overs’, inadequate patient education about their medication use and poor discharge summaries. The highest ranked solutions included development of a standardized discharge summary template, reduction of unnecessary prescribing, and minimisation of polypharmacy. Overall, better communication between the healthcare provider and patient, quality assurance approaches during medication prescribing and monitoring, and patient education on how to use their medication were considered the top priorities. The highest ranked suggestions received the strongest agreement among the clinicians, i.e. the highest AEA score.Conclusions: Clinicians identified a range of suggestions for better medication management, quality assurance procedures and patient education. According to clinicians, medication errors can be largely prevented with feasible and affordable interventions. PRIO
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