This systematic review aimed to evaluate the effect of eHealth-delivered interventions for adults who undergo bariatric surgery on postoperative weight loss, weight loss maintenance, eating psychopathology, quality of life, depression screening, and self-efficacy. Six electronic databases were searched, with 14 studies (across 17 reports) included, involving 1633 participants. With substantial heterogeneity, qualitative descriptions have been provided. Interventions were delivered via an online program or internet modules (n 5 2), telephone (n 5 2), text messages (n 5 2), videoconferencing (n 5 3), mobile application (n 5 1), and audiovisual media (n 5 1). Three studies included a combination, including internet modules and telephone (n 5 1), wireless fidelity scales, emails, and telephone (n 5 1), and a combination of online treatment, weekly emails, and access to a private Facebook group (n 5 1). All the eHealth interventions, except for one, implemented behavior change techniques, including self-monitoring, problem solving, social support, goal setting, and shaping knowledge. Both eHealth intervention and control groups lost weight across the included studies, and eHealth was found to be as effective as or more effective than the control for weight loss. Two studies measured weight loss maintenance; both eHealth and control groups regained weight in the longer term. The interventions showed significant improvement on assessment measures for eating psychopathology. In conclusion, when bariatric surgery patients have limited or no access to healthcare teams or require additional support, eHealth may be a suitable option. Future studies implementing eHealth interventions would benefit from reporting intervention components as per the behavior change techniques taxonomy and further consideration of delivering eHealth in a stepped care approach would be beneficial.
Objectives: To identify outcome measures used to evaluate performance of healthcare professional role substitution against usual medical doctor or specialist medical doctor care to facilitate our understanding of the adequacy of these measures in assessing quality of healthcare delivery. Methods: Using a systematic approach, we searched Medline, Cochrane Central Register of Controlled Trials, Embase, CINAHL, and Web of Science from database inception until May 2020. Studies that presented original comparative data on at least one outcome measure were included following screening by two authors. Findings were synthesized, and outcome measures classified into six domains which included: effectiveness, safety, appropriateness, access, continuity of care, efficiency, and sustainability which were informed by the Institute of Medicine dimensions of healthcare quality, the Australian health performance framework, and Levesque and Sutherland's integrated performance measurement framework.Results: One thirty five articles met the inclusion criteria, describing 58 separate outcome measures. Safety of role substitution models of care was assessed in 80 studies, effectiveness (n = 60), appropriateness (n = 40), access (n = 36), continuity of care (n = 6), efficiency and productivity (n = 45). Two-thirds of the studies that assessed productivity and efficiency performed an economic analysis (n = 27). The quality and rigour of evaluations varied substantially across studies, with two-thirds of all studies measuring and reporting outcomes from only one or two of these domains.Conclusions: There are a growing number of studies measuring the performance of non-medical healthcare professional substitution roles. Few have been subject to robust evaluations, and there is limited evidence on the scientific rigour and
Aim Current literature regarding the prevalence and consequences of poor dietary intake and risk of malnutrition in older adults is limited to wealthier regions including the United States, Europe and Australasia. With a rapidly ageing population in India, this prospective observational study aimed to evaluate hospital food intake and malnutrition risk and their impact on hospital length of stay, readmission rates and in‐hospital mortality of older adults in Indian hospitals. Methods Data collected during nutritionDay worldwide audits (2014‐2016), in five urban, private hospitals in India included baseline demographic and clinical data on patients aged ≥60 years. Proportion of food consumed at one main meal was recorded and data on length of stay, readmissions and in‐hospital mortality were collected 30 days post‐baseline. Results A total of 262 participants (mean age: 69 ± 8 years; 65% males) were recruited. Mapped malnutrition risk (mapped Malnutrition Screening Tool [mMST] score ≥ 2) on admission was 31% and increased to 44% during the course of hospitalisation. Over one quarter of participants consumed ≤50% of their meal (28%). Over half the participants were found to be eating poorly (59%) and those identified as at risk of malnutrition were not offered additional nutrition support. The median LOS was 8 days (range: 1‐92), 30‐day readmission rates were 7% and in‐hospital mortality was 0.4%. Malnutrition risk and poor food intake were not associated with health‐related outcomes. Conclusion Older adults in Indian acute care hospitals have a noticeable prevalence of malnutrition risk and poor food intake. There is an opportunity for future research to focus on identifying and managing nutritional issues.
Home Observation for Measurement of the Environment (HOME) was designed to reflect parental support of early cognitive and socioemotional development. 12-month HOME scores were correlated with elementary school achievement, 5--9 years later. 50 low-income children were rank ordered by a weighted average of centile estimates of achievement test scores, letter grades, and curriculum levels in reading and math. 24 children were classified as having significant school achievement problems. The HOME total score correlated significantly, r = .37, with school centile scores among the low-income families. The statistically more appropriate contingency table analysis revealed a 68% correct classification rate and a significantly reduced error rate over random or blanket prediction. The results supported the predictive value of the 12-month HOME for school achievement among low-income families. In an additional sample of 21 middle-income families, there was insufficient variability among HOME scores to allow prediction. The HOME total scores were highly correlated, r = .86, among siblings tested at least 10 months apart.
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