community setting

社区设置
  • 文章类型: Systematic Review
    背景:《世界跌倒预防和管理指南》推荐多因素跌倒风险评估和多领域干预措施。为了成功实施这些干预措施,重要的是要了解影响实施的决定因素。
    方法:在2021年12月3日对该系统综述进行了文献检索,并于2023年4月3日在五个数据库中进行了更新:PubMed(包括MEDLINE),EMBASE(通过Embase.com),Cochrane中央对照试验登记册(通过Cochrane图书馆),WebofScience核心合集和CINAHL(通过EBSCO)。如果研究报告了影响社区老年人实施多因素跌倒风险评估和/或多领域干预措施的决定因素,则包括研究。社论,意见文件,针对一个人群(如帕金森)的系统评价和研究被排除.两名研究人员独立筛选了标题上的文章,摘要和全文。基于敏感性分析评价质量。“实践决定因素综合综合清单”用于对决定因素进行分类。
    结果:纳入29项研究。决定因素分为障碍(n=40)和促进因素(n=35)。必要资源的可用性是报告最多的决定因素。其他通常报告的决定因素是知识,老年人和医疗保健专业人员的意图/信念和动机,将干预措施融入当前的实践,通信,团队和推荐流程以及财务(DIS)激励。
    结论:确定障碍和促进因素对于选择适合具体情况的实施策略至关重要,并提高多因素跌倒风险评估和/或多领域干预措施的吸收和有效性。
    BACKGROUND: Multifactorial falls risk assessment and multidomain interventions are recommended by the World guidelines for falls prevention and management. To successfully implement these interventions, it is important to understand determinants influencing the implementation.
    METHODS: A literature search was conducted for this systematic review on the 3 December 2021 and updated on the 3 April 2023 in five databases: PubMed (including MEDLINE), EMBASE (via Embase.com), Cochrane Central Register of Controlled Trials (via Cochrane Library), Web of Science Core Collection and CINAHL (via EBSCO). Studies were included if they reported on determinants influencing the implementation of a multifactorial falls risk assessment and/or multidomain interventions in community-dwelling older people. Editorials, opinion papers, systematic reviews and studies focusing on one population (e.g. Parkinson) were excluded. Two researchers independently screened the articles on title, abstract and full text. The quality was evaluated based on a sensitivity analysis. \'The Comprehensive Integrated Checklist of Determinants of practice\' was used to categorise the determinants.
    RESULTS: Twenty-nine studies were included. Determinants were classified as barriers (n = 40) and facilitators (n = 35). The availability of necessary resources is the most reported determinant. Other commonly reported determinants are knowledge, intention/beliefs and motivation at the levels of older people and healthcare professionals, fitting of the intervention into current practice, communication, team and referral processes and financial (dis)incentives.
    CONCLUSIONS: Mapping of the barriers and facilitators is essential to choose implementation strategies tailored to the context, and to enhance the uptake and effectiveness of a multifactorial falls risk assessment and/or multidomain interventions.
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  • 文章类型: Journal Article
    目的:本综述研究了在社区中预防滥用痴呆症患者的干预措施的证据。
    方法:这些文章是从2000年到2023年从六个数据库中检索的,包括通过PubMed的MEDLINE,CINAHLPlus通过EBSCO,EMBASE,ProQuest医学图书馆,WebofScience,还有Scopus.这篇综述包括了一些研究文章,这些文章专注于发现干预措施在社区环境中预防痴呆症患者滥用的有效性。该综述仅包括随机对照试验和测试前测试后试验。使用ROB2和ROBINSII对合格研究进行质量评估。将研究结果制成表格并进行叙述综合。
    结果:在1831篇文章中,这次审查只包括了三个。本疗效评价仅包括两个RCT。两项研究都表明,干预措施在减少滥用方面并不有效。这些研究利用了家庭护理人员的干预措施,如心理干预和在线支持教育。该综述通过一些证据确定了心理干预措施。另一项研究是一项准实验研究,该研究使用辩证行为疗法作为干预措施,以减少滥用的发生。该研究显示证据不足,仅侧重于报告虐待老年人的结果。
    结论:这篇综述发现的研究很少,也无法得出关于干预措施对痴呆症患者滥用的有效性的结论。鉴于研究的匮乏,显然需要确定如何克服虐待老年人研究中面临的挑战,并进一步完善减少社区痴呆症患者中虐待老年人的方法.
    OBJECTIVE: This review examined the evidence for interventions to prevent the abuse of people living with dementia in the community.
    METHODS: The articles were retrieved from 2000 to 2023 from six databases, including MEDLINE via PubMed, CINAHL Plus via EBSCO, EMBASE, ProQuest Medical Library, Web of Science, and Scopus. The research articles that focused on finding the effectiveness of interventions for preventing abuse of people living with dementia in community settings were included in this review. The review included randomized controlled trials and pre-test post-test trials only. The quality appraisal of the eligible studies was done using ROB 2 and ROBINS II. The findings were tabulated and narratively synthesised.
    RESULTS: Out of 1831 articles, only three were included in this review. Only two RCTs were included in this efficacy review. Both the studies showed that the interventions were not effective in reducing abuse. The studies utilised family caregiver interventions like psychological interventions and online supportive education. The review identified psychological interventions with some evidence. Another study was a quasi-experimental study that used dialectical behaviour therapy as an intervention to reduce abuse occurrence. The study showed low evidence and focused only on reporting of elder abuse as an outcome.
    CONCLUSIONS: This review found very few studies and was not able to draw a conclusion on the effectiveness of interventions for abuse in people living with dementia. Given the paucity of research, there is a clear need to identify how to overcome the challenges faced in elder abuse research and further refine the development of approaches to reduce elder abuse among people living with dementia in community settings.
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  • 文章类型: Journal Article
    目的:探讨健康沟通在社区环境中护理人员与老年人之间的共享决策(SDM)中的作用。
    背景:社会和医疗服务的特点是人口呈指数级老龄化,导致相当大比例的患者是具有高要求护理需求的老年人。科学文献支持将共享决策作为一个让患者参与护理的过程。然而,越来越多的技术使用和COVID-19大流行的后果影响了护士与老年患者的沟通方式.因此,了解如何发展健康沟通以达到有效,共享决策过程。
    方法:Whittemore和Knafl的综合审查方法,文献检索包括五个数据库:PubMed,CINALH,WebofScience,Scopus和PsycINFO。
    结果:纳入的12项研究被合成为三种研究模式:(1)护士与老年患者的健康沟通关系,(2)老年患者的观点和(3)临终关怀中的非治疗性沟通。
    结论:这篇综述强调了有效的健康沟通在塑造社区护理人员和老年人之间的SDM动态方面的关键作用。关键要素包括透明的信息交流,与非正式护理网络建立信任并保持沟通渠道。SDM行动与保护老年人的自主权保持一致,但沟通挑战依然存在,特别是在生命终结的情况下。建议进行高级护理计划,以解决这些缺点并改善老年人之间的沟通,医疗保健专业人员和家庭。
    结论:在护理培训中实施基于言语和非言语健康交流的教育措施可能是有益的。护理研究可以继续开发和完善适应健康的社会决定因素的特定沟通策略,以适应社区环境中老年人的各种临床情况。
    作者通过PRISMA2020清单遵守了相关的EQUATOR指南。没有患者或公共贡献。
    OBJECTIVE: To explore the role of health communication in Shared Decision-Making (SDM) between nursing staff and older people in the community setting.
    BACKGROUND: Society and healthcare services are marked by an exponentially ageing population, leading to a significant proportion of patients being older adults with highly demanding care needs. Scientific literature supports shared decision-making as a process that engages patients in their care. However, the increasing use of technology and the consequences of the COVID-19 pandemic have influenced how nurses communicate with older patients. Therefore, it is crucial to understand how to develop health communication to reach effective, shared decision-making processes.
    METHODS: Whittemore and Knafl\'s integrative review method, the literature search comprised five databases: PubMed, CINALH, Web of Science, Scopus and PsycINFO.
    RESULTS: The 12 included studies were synthesised into three study patterns: (1) nurse-older patient health communication relationship, (2) older patients\' perspectives and (3) nontherapeutic communication in end-of-life care.
    CONCLUSIONS: This review underscored the crucial role of effective health communication in shaping SDM dynamics between nursing staff and older people in the community setting. Key elements included transparent information exchange, establishing trust and maintaining communication channels with informal caregiving networks. SDM actions were aligned with preserving older people\'s autonomy, but communication challenges persisted, particularly in end-of-life situations. Advanced care planning was recommended to address these shortcomings and improve communication among older people, healthcare professionals and families.
    CONCLUSIONS: Implementing educational measures based on verbal and nonverbal health communication in nursing training could be beneficial. Nursing research could continue to develop and refine specific communication strategies adapted to the social determinants of health for diverse clinical situations regarding older adults in the community setting.
    UNASSIGNED: The authors have adhered to relevant EQUATOR guidelines through the PRISMA 2020 checklist. No Patient or Public Contribution.
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  • 文章类型: Journal Article
    本范围审查审查了社区环境中抗菌药物处方适当性的概念和范围,以及如何对其进行测量。
    利用乔安娜·布里格斯研究所的方法,我们评估了同行评审的文章和未发表的研究,专注于美国,英国,加拿大,澳大利亚,没有限制日期。
    确定了在社区环境中评估抗菌药物适用性期间要评估的抗菌药物处方的四个基本组成部分:感染诊断或抗菌治疗指征,抗菌治疗的选择,给药,和治疗的持续时间。适当性定义的基准对于评估抗菌药物处方的适当性至关重要。使用推荐的指南作为基准是适当的抗菌治疗的标准,必要时,应该探索敏感性测试。
    评估抗菌药物处方适当性的研究应评估抗菌药物处方的这些组成部分,这应该在研究的目的和目标中明确规定。
    UNASSIGNED: This scoping review examined the concept and scope of appropriateness of antimicrobial prescribing in the community setting and how it has been measured.
    UNASSIGNED: Utilizing the Joanna Briggs Institute\'s methodology, we appraised peer-reviewed articles and unpublished studies, focusing on the US, UK, Canada, and Australia, with no limit to date.
    UNASSIGNED: Four basic components of antimicrobial prescribing to be evaluated during assessment of antimicrobial appropriateness in the community setting were identified: diagnosis for infection or indication for antimicrobial therapy, choice of antimicrobial therapy, dosing, and duration of therapy. The benchmark for definition of appropriateness is crucial in assessing antimicrobial prescribing appropriateness. The use of recommended guidelines as a benchmark is the standard for appropriate antimicrobial therapy, and when necessary, susceptibility testing should be explored.
    UNASSIGNED: Studies evaluating the appropriateness of antimicrobial prescribing should assess these components of antimicrobial prescribing, and this should be clearly stated in the aim and objectives of the study.
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  • 文章类型: Journal Article
    前列腺癌,英国男性最常见的癌症原因,也是迄今为止世界上最常见的癌症之一,对筛查没有共识。来自世界各地的多项大规模试验在癌症特异性和总死亡率方面产生了相互矛盾的结果。问题的主要部分是PSA测试,具有高度的可变性,设定PSA阈值具有挑战性,以及有限的特异性。前列腺癌有黑人背景的男性倾向,社会经济地位较低的男性的结果更差。移动目标案件调查,重点关注高危人群,可能是一个解决方案,以帮助那些最需要它。本系统综述的目的是回顾前列腺癌移动检测的证据。根据Cochrane指南和PRISMA声明,对所有前列腺癌的移动筛查研究进行了回顾。在筛选的629项独特研究中,发现6人符合审查条件。这些研究始于1973年至2017年,来自四个不同的大陆,大约有30,275名男性接受前列腺癌筛查。检出率从最早研究的0.6%到最新研究的8.2%不等。对于发达国家和低收入和中等收入国家来说,早期诊断潜在致命性前列腺癌的挑战仍然是一个问题。虽然还需要进一步的研究,通过简化调查和转诊途径对目标人群进行流动筛查,并提高这些社区的意识,可能有助于为前列腺癌筛查提供依据.
    Prostate cancer, the most common cause of cancer in men in the UK and one of the most common around the world to date, has no consensus on screening. Multiple large-scale trials from around the world have produced conflicting outcomes in cancer-specific and overall mortality. A main part of the issue is the PSA test, which has a high degree of variability, making it challenging to set PSA thresholds, as well as limited specificity. Prostate cancer has a predisposition in men from black backgrounds, and outcomes are worse in men of lower socioeconomic groups. Mobile targeted case finding, focusing on high-risk groups, may be a solution to help those that most need it. The aim of this systematic review was to review the evidence for mobile testing for prostate cancer. A review of all mobile screening studies for prostate cancer was performed in accordance with the Cochrane guidelines and the PRISMA statement. Of the 629 unique studies screened, 6 were found to be eligible for the review. The studies dated from 1973 to 2017 and came from four different continents, with around 30,275 men being screened for prostate cancer. Detection rates varied from 0.6% in the earliest study to 8.2% in the latest study. The challenge of early diagnosis of potentially lethal prostate cancer remains an issue for developed and low- and middle-income countries alike. Although further studies are needed, mobile screening of a targeted population with streamlined investigation and referral pathways combined with raising awareness in those communities may help make the case for screening for prostate cancer.
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  • 文章类型: Systematic Review
    背景:每年有三分之一的社区老年人跌倒。指南建议使用多因素跌倒预防干预措施。然而,这些干预措施很难在社区中实施。本系统综述旨在探索用于在社区中实施多因素跌倒预防干预措施的策略。
    方法:在PubMed(包括MEDLINE)中进行系统搜索,CINAHL(EBSCO),Embase,WebofScience(核心收藏),Cochrane图书馆于8月25日进行了演出和更新,2022年。包括报告评估社区环境中多因素跌倒预防干预措施实施策略的研究。两名审阅者独立进行了搜索,筛选,数据提取,和合成过程(PRISMA流程图)。通过敏感性分析对纳入报告的质量进行了评估,评估与研究问题和方法论质量的相关性(混合方法评估工具)。根据Proctor等人的报告,实施策略。(2013)Kok等人指定和报告实施策略和行为改变方法分类的指南。(2016)。
    结果:23份报告(18项研究)符合纳入标准,其中14份报告在敏感性分析中得分高,9份得分中等。所有研究都结合了实施策略,解决不同的决定因素。个人层面最常用的实施策略是“剪裁”,\"\"主动学习,\"\"个性化风险,\"\"个性化,“\”意识的提高,“和”参与。“在环境层面,最常描述的策略是“技术援助,使用非专业卫生工作者,同伴教育,“\”增加利益相关者的影响力,“和”组成联盟。“纳入的研究没有详细描述实施策略,并使用了各种实施策略的标签。十二项研究使用了实施理论,模型,和框架;没有研究既没有描述决定性框架的使用,也没有描述实施策略如何针对影响因素。
    结论:本综述强调了在详细说明实施策略和有效使用实施框架方面的差距,模型,和理论。审查发现,研究主要集中在老年人和医疗保健专业人员层面的实施策略上,强调“剪裁”的重要性,“\”意识的提高,执行过程中的\"和\"参与\"。描述组织层面实施战略的研究,社区,和政策/社会表明,“技术援助,“”积极参与利益相关者,“”和“组建联盟”是重要的策略。
    背景:PROSPEROCRD42020187450.
    One-third of the community-dwelling older persons fall annually. Guidelines recommend the use of multifactorial falls prevention interventions. However, these interventions are difficult to implement into the community. This systematic review aimed to explore strategies used to implement multifactorial falls prevention interventions into the community.
    A systematic search in PubMed (including MEDLINE), CINAHL (EBSCO), Embase, Web of Science (core collection), and Cochrane Library was performed and updated on the 25th of August, 2022. Studies reporting on the evaluation of implementation strategies for multifactorial falls prevention interventions in the community setting were included. Two reviewers independently performed the search, screening, data extraction, and synthesis process (PRISMA flow diagram). The quality of the included reports was appraised by means of a sensitivity analysis, assessing the relevance to the research question and the methodological quality (Mixed Method Appraisal Tool). Implementation strategies were reported according to Proctor et al.\'s (2013) guideline for specifying and reporting implementation strategies and the Taxonomy of Behavioral Change Methods of Kok et al. (2016).
    Twenty-three reports (eighteen studies) met the inclusion criteria, of which fourteen reports scored high and nine moderate on the sensitivity analysis. All studies combined implementation strategies, addressing different determinants. The most frequently used implementation strategies at individual level were \"tailoring,\" \"active learning,\" \"personalize risk,\" \"individualization,\" \"consciousness raising,\" and \"participation.\" At environmental level, the most often described strategies were \"technical assistance,\" \"use of lay health workers, peer education,\" \"increasing stakeholder influence,\" and \"forming coalitions.\" The included studies did not describe the implementation strategies in detail, and a variety of labels for implementation strategies were used. Twelve studies used implementation theories, models, and frameworks; no studies described neither the use of a determinant framework nor how the implementation strategy targeted influencing factors.
    This review highlights gaps in the detailed description of implementation strategies and the effective use of implementation frameworks, models, and theories. The review found that studies mainly focused on implementation strategies at the level of the older person and healthcare professional, emphasizing the importance of \"tailoring,\" \"consciousness raising,\" and \"participation\" in the implementation process. Studies describing implementation strategies at the level of the organization, community, and policy/society show that \"technical assistance,\" \"actively involving stakeholders,\" and \"forming coalitions\" are important strategies.
    PROSPERO CRD42020187450.
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  • 文章类型: Journal Article
    目标:需要有效的公共政策来防止独立社区居住的老年人跌倒,以解决这一全球公共卫生问题。本文旨在找出改进未来政策的差距和机会,以增加其成功的可能性。方法:进行了系统的范围审查,以确定2005-2020年间发布的政策。使用根据世界卫生组织制定预防伤害和暴力政策的指南和新西兰政府的政策质量框架改编的新框架和内容标准来评估政策质量。结果:共有来自14个国家的107篇文章被确认。对25项政策的内容评估显示,只有54%的政策符合世卫组织的标准,只有59%的政策符合新西兰标准。需要改进的领域包括量化目标,优先干预措施,预算,部长批准,监测和评估。结论:研究结果表明,大量政策的不足可能导致政策意图与实施之间的脱节。有必要制定一个明确的、以证据为基础的模式的跌倒预防政策,以加强未来政府减轻全球跌倒负担的努力。
    Objectives: Effective public policy to prevent falls among independent community-dwelling older adults is needed to address this global public health issue. This paper aimed to identify gaps and opportunities for improvement of future policies to increase their likelihood of success. Methods: A systematic scoping review was conducted to identify policies published between 2005-2020. Policy quality was assessed using a novel framework and content criteria adapted from the World Health Organization\'s guideline for Developing policies to prevent injuries and violence and the New Zealand Government\'s Policy Quality Framework. Results: A total of 107 articles were identified from 14 countries. Content evaluation of 25 policies revealed that only 54% of policies met the WHO criteria, and only 59% of policies met the NZ criteria. Areas for improvement included quantified objectives, prioritised interventions, budget, ministerial approval, and monitoring and evaluation. Conclusion: The findings suggest deficiencies in a substantial number of policies may contribute to a disconnect between policy intent and implementation. A clear and evidence-based model falls prevention policy is warranted to enhance future government efforts to reduce the global burden of falls.
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  • 文章类型: Journal Article
    背景:在社区环境中,普通公众使用医疗和布罩的有效性的现有证据综合起来,需要为未来的呼吸道流行病/大流行吸取教训。
    方法:与口罩相关的搜索术语,感染和社区设置用于PubMed,科克伦图书馆数据库和谷歌学者。使用随机效应模型进行荟萃分析。
    结果:该综述包括12项关于使用医用口罩预防流感的有效性的初步研究,流感样疾病,SARS-CoV,和SARS-CoV-2传播。荟萃分析表明,使用面罩可以显着降低传播这些呼吸道感染的风险(汇总OR=0.66,95%CI0.54-0.81)。在12项研究中,10项临床试验表明,在医用面罩依从性高的情况下,呼吸道感染发病率较低,早期使用和使用结合密集的手部卫生。在SARS-CoV-2大流行期间进行的一项队列研究表明,在感染者出现症状之前使用口罩可有效减少SARS-CoV-2的传播。一项病例对照研究报告说,与感染SARS-CoV的病例相比,对照组使用医疗口罩的频率更高(p<0.05)。没有发现有关布面罩预防呼吸道感染传播的有效性的主要研究。
    结论:根据现有证据,建议健康和患病的人使用医疗面罩,以防止社区环境中的呼吸道感染传播。医用面罩的有效性取决于依从性和利用以及预防措施,例如强化手部卫生。目前在人类中没有直接证据支持使用布面罩预防呼吸道感染传播的建议。
    BACKGROUND: Synthesis of the available evidence on the effectiveness of medical and cloth facemask use by the general public in community settings is required to learn lessons for future respiratory epidemics/pandemics.
    METHODS: Search terms relating to facemasks, infection and community settings were used for PubMed, the Cochrane Library Database and Google Scholar. A meta-analysis was conducted using a random-effects model.
    RESULTS: The review included 12 primary studies on the effectiveness of medical facemask use to prevent influenza, influenza-like illness, SARS-CoV, and SARS-CoV-2 transmission. The meta-analysis demonstrated that facemask use significantly reduces the risk of transmitting these respiratory infections (pooled OR = 0.66, 95% CI 0.54-0.81). Of the 12 studies, 10 clinical trials suggested that respiratory infection incidence is lower with high medical facemask compliance, early use and use in combination with intensive hand hygiene. One cohort study conducted during the SARS-CoV-2 pandemic demonstrated that facemasks are effective in reducing SARS-CoV-2 transmission when used before those who are infected develop symptoms. One case-control study reported that controls used medical facemasks more often than cases infected with SARS-CoV (p <  0.05). No primary study on cloth facemask effectiveness to prevent respiratory infection transmission was found.
    CONCLUSIONS: Based on the available evidence, medical facemask use by healthy and sick individuals is recommended for preventing respiratory infection transmission in community settings. Medical facemask effectiveness is dependent on compliance and utilization in combination with preventive measures such as intensive hand hygiene. No direct evidence is currently available in humans supporting the recommendation of cloth facemask use to prevent respiratory infection transmission.
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  • 文章类型: Journal Article
    Targeted screening interventions for chronic kidney disease (CKD) are increasingly being implemented in various community settings. However, the overall success of these programs is uncertain. Therefore, the aim of this review is to determine whether targeted screening is effective in detecting people with undiagnosed CKD.
    We performed a systematic literature review, and included studies of targeted screening intervention implemented in any community-based setting. Studies were required to have targeted people aged ≥18 years, and multiple CKD risk factors from the following: diabetes, hypertension, cardiovascular disease and family history of kidney disease. The outcome measures were percentages of participants with positive screening test results and diagnosed with CKD at follow-up.
    Nine studies met the inclusion criteria. Eight studies reported the percentage of participants with positive screening test results, which ranged from 7 to 60.3%. Only two studies repeated the diagnostic tests to detect CKD, and confirmed the chronicity of CKD in 20.5 and 17.1% of screened participants. The most commonly used screening tests were albumin creatinine ratio (≥3.4 mg/mmol), and estimated glomerular filtration rate (eGFR) (<60 ml/min/1.73 m2). All studies classified CKD stage 3 and above based on eGFR alone. Characteristics of the interventions responsible for inconsistencies in the outcome measures included CKD risk factors targeted, and screening tests used to detect CKD.
    This systematic review found significant variation in the methods that were used to detect CKD, with the majority of studies reporting results based on only single albuminuria or eGFR values. Future targeted screening programs should appropriately use the 2012 KDIGO guidelines in order to detect CKD, which is necessary to determine the benefit of these programs when implemented in community-settings.
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