ObjectiveThis systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients.SettingGeneral practice and other primary care facilities.ParticipantsAdults (>18 years) with a subacute (≤3-month) non-malignant pain condition. Eligibility criteria were cohort studies investigating the prediction of disability or long-term sick leave in adults with a subacute pain condition in a primary care setting. 19 studies were included, referring to a total of 6266 patients suffering from pain in the head, neck, back and shoulders.Primary and secondary outcome measuresThe primary outcome was long-term disability (>3 months) due to a pain condition. The secondary outcome was sick leave, defined as ‘absence from work’ or ‘return-to-work’.ResultsPubMed, EMBASE, CINAHL and PEDro databases were searched from 16 January 2003 to 16 January 2014. The quality of evidence was presented according to the GRADE WG recommendations. Several factors were found to be associated with disability at follow-up for at least two different pain symptoms. However, owing to insufficient studies, no generic risk factors for sick leave were identified.ConclusionsMultiple site pain, high pain severity, older age, baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites. There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain, indicating that these factors may not play as large a role as expected in developing disability due to a pain condition. Quality of evidence was moderate, low or very low, implying that confidence in the results is limited. Large prospective prognostic factor studies are needed with sufficient study populations and transparent reporting of all factors examined.Trial registration numberCRD42014008914.
Even though long-term QoL does not seem to be impaired, the patients are struggling with fear of recurrence, and the way of coping with this fear is a possible predictor for long-term QoL after cancer. However, there is a lack of evidence on QoL, needs, and preferences regarding follow-up of the survivors after gynecologic cancer. The quality of the follow-up regimen is questionable, and it is not evidence based. Thus, it is extremely important to optimize the follow-up program and move focus to life quality. There is a need for an evidence-based strategy regarding follow-up for low-risk gynecologic cancer patients.
Co-production involves knowledge and skills based on both lived experiences of citizens and professionally training of staff. In Europe, co-production is viewed as an essential tool for meeting the demographic, political and economic challenges of welfare states. However, co-production is facing challenges because public services and civil society are rooted in two very different logics. These challenges are typically encountered by provider organisations and their staff who must convert policies and strategies into practice. Denmark is a welfare state with a strong public services sector and a relatively low involvement of volunteers. The aim of this study was to investigate how provider organisations and their staff navigate between the two logics. The present analysis is a critical case study of two municipalities selected from seven participating municipalities, for their maximum diversity. The study setting was the Community Families programme, which aim to support the social network of mental health users by offering regular contact with selected private families/individuals. The task of the municipalities was to initiate and support Community Families. The analysis built on qualitative data generated at the organisational level in the seven participating municipalities. Within the two "case study" municipalities, qualitative interviews were conducted with front-line co-ordinators (six) and line managers (two). The interviews were recorded, transcribed verbatim and coded using the software program NVivo.The results confirm the central role played by staff and identify a close interplay between public services and civil society logics as essential for the organisation of coproduction. Corresponding objectives, activities and collaborative relations of provider organisations are keys for facilitating the co-productive practice of individual staff.Organised in this way, co-production can succeed even in a mental health setting associated with social stigma and in a welfare state dominated by public services. K E Y W O R D Scivil society logic, community mental health services, co-production, organisational level, public service logic, qualitative study | 123 VAEGGEMOSE Et al. | INTRODUCTIONAcross Europe, countries make efforts to involve civil society in the co-production of healthcare services to meet the demographic, political and economic challenges of the contemporary welfare state (Pestoff, 2009). The basic idea is to combine the professional knowledge of healthcare providers with knowledge and skills based on the lived experiences of citizens. Citizens can be involved individually as volunteers or collectively within civil society organisations. The concept of co-production was developed in the 1980s in response to a greater awareness of the limitations of the "provider-centric" model of the welfare state (Nimegeer, Farmer, Munoz, & Currie, 2016;Ostrom, 1996;Parks et al., 1981;Pestoff, 2014;Pestoff, Brandsen, & Verschuere, 2013). In practice, the organisation of co-production has several challen...
BACKGROUND: Users of home mechanical ventilation encounter major psychological and physiologic challenges. To ensure well-functioning home mechanical ventilation, users' experiences of care and treatment are important knowledge to supplement clinical perspectives. This systematic review aimed to summarize current qualitative evidence regarding experiences of home mechanical ventilation users. METHODS: By following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, 9 databases were systematically searched. Seven studies met the inclusion criteria after title and/or abstract screening and full-text assessment. These were appraised by using the Relevance, Appropriateness, Transparency, Soundness checklist. Thematic analysis guided data extraction and identification of the findings. The Confidence in the Evidence for Reviews of Qualitative Research tool was applied to assess the confidence of the findings. RESULTS: The review showed high confidence in 4 findings: an increase in quality of life, feeling forced to accept home mechanical ventilation, collaboration between home-care assistants and users of home mechanical ventilation is challenging, and information about the technology from a user's perspective. The review showed moderate confidence in 2 findings: living at home is pivotal for a normalized everyday life, and home mechanical ventilation causes a life with continued worries and uncertainty. CONCLUSIONS: According to the users, treatment by home mechanical ventilation resulted in increased well-being and facilitated a community-and home-based lifestyle compared with institutional-based treatment. However, the users also expressed difficulties in coming to terms with the necessary extensive surveillance, which gave rise to a sense of undermined autonomy and self-determinism as well as continued worries and uncertainty. The users called this situation dependent independency. As a result of the review we call for an increased focus on a patientcentered treatment and care.
BackgroundNonattendance at scheduled appointments in public hospitals presents a challenge for efficient resource use and may ultimately affect health outcomes due to longer waiting times. Seven percent of all scheduled outpatient appointments in the United Kingdom are estimated to be nonattended. Various reminder systems have been shown to moderately reduce nonattendance, although the effect of issuing fines for nonattendance has not yet been tested in a randomized context. However, such use of financial incentives could impact access to care differently across the different socioeconomic groups. The aim of this study is to assess the effect of fines on hospital outpatient nonattendance.Methods/designA 1:1 randomized controlled trial of scheduled outpatient appointments was used, with follow-ups until the date of appointment. The setting is an orthopedic clinic at a regional hospital in Denmark. Appointments for users who are scheduled for diagnostics, treatment, surgery, or follow-ups were included from May 2015 to November 2015. Appointments assigned to the intervention arm include an attachment of the appointment letter explaining that a fine will be issued in the case of nonattendance without prior notice. Appointments assigned to the control arm follow usual practice (same system but no letter attachment). The primary outcome is the proportion of nonattendance. Secondary outcomes are proportions of cancellations, sociodemographics, and health-problem characteristics. Furthermore, the intervention costs and production value of nonattended appointments will be measured. An analysis of effect and cost-effectiveness will be conducted based on a 5 % significance level.DiscussionThe study is initiated and funded by the Danish Regions, which have the responsibility for the Danish public healthcare sector. The results are expected to inform future decisions about the introduction of fines for nonattendance at public hospitals.Trial registrationCurrent Controlled Trials, ISRCTN61925912. Registered on 6 July 2015.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.