Improving integration in care requires many components. However, local barriers and facilitators need to be considered. Changes are expected to occur slowly and are more likely to be successful where elements of integrated care are well incorporated into local settings.
Quality EOL care for older populations requires many core components but the local context and implementation issues may ultimately determine if these elements can be incorporated into the system to improve care. Changes at the macro-level (system/national), meso-level (organizational), and micro-level (individual) will be required to successfully implement service changes to provide holistic and person-centered EOL care for elderly populations.
Background:Pharmacotherapy, including prokinetics and proton pump inhibitors for
functional dyspepsia (FD) have limited effectiveness, and their safety has
been recently questioned. Chinese herbal medicine (CHM) could be considered
as an alternative. A systematic review (SR) of SRs was performed to evaluate
the potential effectiveness and safety of CHM.Method:We conducted a comprehensive literature search for SRs with meta-analyses in
eight international and Chinese databases. Pooled effect estimation from
each meta-analysis was extracted. The AMSTAR instrument was used to assess
the methodological quality of the included SRs.Results:A total of 14 SRs of mediocre quality assessing various CHMs, alone or in
combination with conventional pharmacotherapy, were included. Meta-analyses
showed that CHM was more effective than prokinetic agents for the
alleviation of global dyspeptic symptoms. Three specific CHM formulae
appeared to show superior results in the alleviation of global dyspeptic
symptoms, including Si Ni San, modified Xiao Yao San and Xiang Sha Liu Jun
Zi decoction. No significant difference in the occurrence of adverse events
in using CHM or pharmacotherapy was reported.Conclusion:CHM can be considered as an alternative for the treatment of FD symptoms when
prokinetic agents and proton pump inhibitors are contraindicated. Future
trial design should focus on measuring changes in individual dyspeptic
symptoms and differentiate the effectiveness of different CHM for
postprandial distress syndrome and epigastric pain syndrome. A network
meta-analysis approach should be used to explore the most promising CHM
formula for FD treatment in the future.
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