ObjectiveWe investigated the use of systematic review automation tools by systematic reviewers, health technology assessors and clinical guideline developers.Study design and settingsAn online, 16-question survey was distributed across several evidence synthesis, health technology assessment and guideline development organisations internationally. We asked the respondents what tools they use and abandon, how often and when they use the tools, their perceived time savings and accuracy, and desired new tools. Descriptive statistics were used to report the results.Results253 respondents completed the survey; 89% have used systematic review automation tools – most frequently whilst screening (79%). Respondents’ ‘top 3’ tools include: Covidence (45%), RevMan (35%), Rayyan and GRADEPro (both 22%); most commonly abandoned were Rayyan (19%), Covidence (15%), DistillerSR (14%) and RevMan (13%). Majority thought tools saved time (80%) and increased accuracy (54%). Respondents taught themselves to how to use the tools (72%), and were most often prevented by lack of knowledge from their adoption (51%). Most new tool development was suggested for the searching and data extraction stages.ConclusionAutomation tools are likely to take on an increasingly important role in high quality and timely reviews. Further work is required in training and dissemination of automation tools and ensuring they meet the desirable features of those conducting systematic reviews.
Background: Asymptomatic bacteriuria (ASB) is common amongst residents of residential aged care facilities (RACFs). However, differentiating between an established urinary tract infection and ASB in older adults is difficult. As a result, the overuse of dipstick urinalysis, as well as the subsequent initiation of antibiotics, is common in RACFs. Aim: To find, appraise and synthesize studies that reported the effectiveness, harms and adverse events associated with antibiotics treatment for elderly patients with ASB residing in RACFs. Design and setting: A systematic review, using standard Cochrane methods of RACF residents with asymptomatic bacteriuria using antibiotics against placebo, or no treatment. Method: We searched three electronic databases (PubMed, Embase, CENTRAL), clinical trial registries and citing-cited references of included studies. Results: Nine randomised controlled trials, comprising 1,391 participants were included; 2 of which used a placebo comparator, and the remaining 7 used no therapy control groups. There was a relatively small number of studies assessed per outcome and an overall moderate risk of bias. Outcomes related to mortality, development of ASB, and complications were comparable between the two groups. Antibiotic therapy was associated with a higher number of adverse effects (4 studies; 317 participants; Relative Risk (RR)=5.62, 95% CI: 1.07-29.55, p=0.04) and bacteriological cure (9 studies; 888 participants; RR=1.89, 95% CI: 1.08-3.32, p<0.001). Conclusion: Overall, whilst the antibiotic treatment was associated with bacteriological cure, it was also associated with significantly more adverse effects. The harms and lack of clinical benefit of antibiotic use for older patients in RACFs may outweigh its benefits.
Background
To develop an electronic resource, called Communicating Health Alternatives Tool (CHAT) that was compatible with hospital medical records software to facilitate preliminary patient-centered decision-making across health settings for frail older adults with progressive chronic disease.
Methods
Mixed methods including literature review; user-directed specifications; web-based interface development with authentication, authorisation, and secure cloud services; clinician and consumer co-design, iterative user testing; and developer integration of feedback.
Results
An internet-based conversation guide to facilitate clinician-led advance care planning was co-developed covering screening for short-term risk of death, patient values and preferences, and treatment choices for chronic kidney disease and dementia. Printed summary of such discussion could be used to begin the process in hospital or community health services. Clinicians, patients, and caregivers were generally accepting of its contents and format and supported its use in routine clinical practice.
Conclusion
CHAT is anticipated to enhance clinicians’ confidence in initiating these sensitive but important discussions with their older patients near end of life. CHAT is available to health services for implementation in effectiveness trials of patient-centered care to determine whether the interaction and documentation leads to formal decision-making, goal-concordant care, and subsequent reduction of unwanted treatments at the end of life.
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