TY - JOUR T1 - Methadone dose and neonatal abstinence syndrome-systematic review and meta-analysis JF - Addiction Y1 - 2010 A1 - Cleary, B A1 - Donnelly, Jean A1 - Strawbridge, Judith D A1 - Gallagher, Paul J A1 - Fahey, T A1 - Clarke, Mike A1 - Murphy, Deirdre J KW - Cohort Studies KW - Databases, Bibliographic KW - Dose-Response Relationship, Drug KW - Female KW - Humans KW - Infant, Newborn KW - Methadone KW - Narcotics KW - Neonatal Abstinence Syndrome KW - Opioid-Related Disorders KW - Pregnancy KW - Pregnancy Complications KW - Prenatal Exposure Delayed Effects KW - Randomized Controlled Trials as Topic KW - Severity of Illness Index AB - AIM: To determine if there is a relationship between maternal methadone dose in pregnancy and the diagnosis or medical treatment of neonatal abstinence syndrome (NAS). METHODS: PubMed, EMBASE, the Cochrane Library and PsychINFO were searched for studies reporting on methadone use in pregnancy and NAS (1966-2009). The relative risk (RR) of NAS was compared for methadone doses above versus below a range of cut-off points. Summary RRs and 95% confidence intervals (CI) were estimated using random effects meta-analysis. Sensitivity analyses explored the impact of limiting meta-analyses to prospective studies or studies using an objective scoring system to diagnose NAS. RESULTS: A total of 67 studies met inclusion criteria for the systematic review; 29 were included in the meta-analysis. Any differences in the incidence of NAS in infants of women on higher compared with lower doses were statistically non-significant in analyses restricted to prospective studies or to those using an objective scoring system to diagnose NAS. CONCLUSIONS: Severity of the neonatal abstinence syndrome does not appear to differ according to whether mothers are on high- or low-dose methadone maintenance therapy. VL - 105 UR - http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03120.x/abstract IS - 12 ER - TY - JOUR T1 - Interventions for improving outcomes in patients with multimorbidity in primary care and community settings JF - Cochrane Database Syst Rev Y1 - 2012 A1 - Smith, SM A1 - Soubhi, Hassan A1 - Fortin, M A1 - Hudon, Catherine A1 - O'Dowd, T KW - Age Factors KW - Chronic Disease KW - Community Health Services KW - Comorbidity KW - Disease Management KW - Humans KW - Patient-Centered Care KW - Primary Health Care KW - Randomized Controlled Trials as Topic KW - Risk Factors KW - Treatment Outcome AB - BACKGROUND: Many people with chronic disease have more than one chronic condition, which is referred to as multimorbidity. While this is not a new phenomenon, there is greater recognition of its impact and the importance of improving outcomes for individuals affected. Research in the area to date has focused mainly on descriptive epidemiology and impact assessment. There has been limited exploration of the effectiveness of interventions for multimorbidity. OBJECTIVES: To determine the effectiveness of interventions designed to improve outcomes in patients with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. SEARCH METHODS: We searched MEDLINE, EMBASE, CINAHL, CAB Health, AMED, HealthStar, The Cochrane Central Register of Controlled Trials (CENTRAL), the EPOC Register and the Database of Abstracts of Reviews of Effectiveness (DARE), and the EPOC Register in April 2011. SELECTION CRITERIA: We considered randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs), and interrupted time series analyses (ITS) reporting on interventions to improve outcomes for people with multimorbidity in primary care and community settings. The outcomes included any validated measure of physical or mental health, psychosocial status including quality of life outcomes, well-being, and measures of disability or functional status. We also included measures of patient and provider behaviour including measures of medication adherence, utilisation of health services, and acceptability of services and costs. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for eligibility, extracted data, and assessed study quality. Meta-analysis of results was not possible so we carried out a narrative synthesis of the results from the included studies. MAIN RESULTS: Ten studies examining a range of complex interventions for patients with multimorbidity were identified. All were RCTs and there was low risk of bias. Two of the nine studies focused on specific co-morbidities. The remaining studies focused on multimorbidity, generally in older patients. All studies involved complex interventions with multiple elements. In six of the ten studies, the predominant intervention element was a change to the organisation of care delivery, usually through case management or enhanced multidisciplinary team work. In the remaining four studies, the interventions were predominantly patient oriented. Overall the results were mixed with a trend towards improved prescribing and medication adherence. The results indicate that it is difficult to improve outcomes in this population but that interventions focusing on particular risk factors or functional difficulties in patients with co-morbid conditions or multimorbidity may be more effective. Cost data were limited with no economic analyses included, though the improvements in prescribing and risk factor management in some studies provided potentially significant cost savings. AUTHORS' CONCLUSIONS: This review highlights the paucity of research into interventions to improve outcomes for multimorbidity with the focus to date being on co-morbid conditions or multimorbidity in older patients. The limited results suggest that interventions to date have had mixed effects but have shown a tendency to improve prescribing and medication adherence, particularly if interventions can be targeted at risk factors or specific functional difficulties in people with co-morbid conditions or multimorbidity. There is a need for clear definitions of participants, consideration of appropriate outcomes, and further pragmatic studies based in primary care settings. VL - 4 UR - http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006560.pub2/abstract;jsessionid=D2206ED1424E7EEAA91B88C4BA4F8E11.f03t01 ER - TY - JOUR T1 - Interventions for improving outcomes in patients with multimorbidity in primary care and community settings JF - Cochrane Database of Systematic Reviews Y1 - 2016 A1 - Smith, SM A1 - Wallace, E A1 - O'Dowd, T A1 - Fortin, M KW - Age Factors KW - Chronic Disease [therapy] KW - Community Health Services KW - Comorbidity KW - Disease Management KW - Humans[checkword] KW - Patient-Centered Care [methods] KW - Primary Health Care KW - Randomized Controlled Trials as Topic KW - Risk Factors KW - Treatment Outcome SN - 1465-1858 UR - http://dx.doi.org/10.1002/14651858.CD006560.pub3 IS - 3 ER - TY - JOUR T1 - Injection of botulinum toxin for treatment of chronic lateral epicondylitis: systematic review and meta-analysis JF - Semin Arthritis Rheum Y1 - 2011 A1 - Galvin, R A1 - Callaghan, Claire A1 - Chan, Wai-Sun A1 - Dimitrov, B A1 - Fahey, T KW - Botulinum Toxins, Type A KW - Chronic Disease KW - Databases, Bibliographic KW - Finger Injuries KW - Humans KW - Injections, Intramuscular KW - Movement KW - Neuromuscular Agents KW - Outpatients KW - Pain KW - Randomized Controlled Trials as Topic KW - Tennis Elbow KW - Treatment Outcome AB - In this article in Seminars in Arthritis and Rheumatism, Kalichman and coworkers examine the impact of the botulinum toxin injections in the management of lateral epicondylitis ( 1). We would like to add to the findings of this systematic review in 2 ways: first, we use a different method of pooling the data that allows us to present the findings in a clinically meaningful manner. Second, we also examine 2 randomized controlled trials (RCTs) that compare an active comparator to BoNT-A injections ( 2 and 3). We have summarized the 6 trials in Table 1 VL - 40 UR - http://www.sciencedirect.com/science/article/pii/S0049017211000151 IS - 6 ER - TY - JOUR T1 - Electronic prescribing and other forms of technology to reduce inappropriate medication use and polypharmacy in older people: a review of current evidence JF - Clin Geriatr Med Y1 - 2012 A1 - Clyne, B A1 - Bradley, MC A1 - Hughes, CM A1 - Fahey, T A1 - Lapane, Kate L KW - Aged KW - Aged, 80 and over KW - Clinical Pharmacy Information Systems KW - Decision Support Systems, Clinical KW - Drug Prescriptions KW - Drug Utilization Review KW - Electronic Prescribing KW - Evidence-Based Medicine KW - Female KW - Humans KW - Inappropriate Prescribing KW - Male KW - Medication Errors KW - Physician's Practice Patterns KW - Polypharmacy KW - Randomized Controlled Trials as Topic AB - This review provided an overview of the current evidence in relation to the use of e-prescribing and other forms of technology, such as CDSS, to reduce inappropriate prescribing in older people. The evidence indicates that various types of e-prescribing and CDSS interventions have the potential to reduce inappropriate prescribing and polypharmacy in older people, but the magnitude of their effect varies according to study design and setting. There was significant heterogeneity in the studies reported in terms of study designs, intervention design, patient settings, and outcome measures with patient outcomes seldom reported. Widespread diffusion of these interventions has not occurred in any of the health care settings examined. Overall, health care providers report being satisfied with e-prescribing systems and see the systems as having a positive impact on the safety of their prescribing practices, yet the problem of overriding or ignoring alerts persists. The problem of large numbers of inaccurate and insignificant alerts and this issue, along with the other barriers that have been identified, warrant further investigation. VL - 28 UR - http://www.sciencedirect.com/science/article/pii/S0749069012000109 IS - 2 ER -