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Limakatso K, Lebiletsa T, Smeets RJEM, Parker R. Care Priorities for Individuals with Lower Extremity Amputations: A Patient Delphi Study. Clin Rehabil 2024:2692155241258913. [PMID: 38826022 DOI: 10.1177/02692155241258913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
OBJECTIVE To gather preliminary evidence on short- and long-term care priorities for people with lower extremity amputations. DESIGN A three-round modified Delphi study using semi-structured interviews. PARTICIPANTS A convenience sample of 20 adult participants who had undergone lower extremity amputations at a tertiary public hospital. MAIN MEASURE Consensus on each care priority was defined a priori as an agreement of more than 50%. Semi-structured interviews were conducted to understand the rationales for endorsing the care priorities. RESULTS Consensus was reached on 24 short-term care priorities and 12 long-term care priorities in the biomedical, practical and psychological and spiritual domains. The rationales for endorsing each of the care priorities generated three themes: preparedness; mental health, psychological and spiritual well-being; and participating in life, with respect and dignity. CONCLUSIONS Our results highlight the substantial need to improve patient access to education and planning support prior to undergoing limb amputation, and optimising post-amputation rehabilitation programmes, enabling people with amputations to participate in meaningful life roles that provide them with purpose, dignity, and self-respect. The knowledge of care priorities revealed in this study may promote effective patient-centred care and improve clinical outcomes.
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Affiliation(s)
- K Limakatso
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Bionics Institute, East Melbourne, Australia
- Medical Bionics Department, University of Melbourne, Fitzroy, Australia
| | - T Lebiletsa
- Department of Social Development, University of Cape Town, Cape Town, South Africa
| | - R J E M Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Faculty of Health, Life Sciences and Medicine, Maastricht University, Maastricht, The Netherlands
- CIR Revalidatie, Eindhoven, The Netherlands
- Pain in Motion International Research Group (PiM)
| | - R Parker
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Cortés-Jofré M, Madera M, Tirado-Amador L, Asenjo-Lobos C, Bonfill-Cosp X. Treatments for non-small cell lung cancer: a systematic quality assessment of clinical practice guidelines. Clin Transl Oncol 2023; 25:3541-3555. [PMID: 37254015 DOI: 10.1007/s12094-023-03223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/19/2023] [Indexed: 06/01/2023]
Abstract
AIM To evaluate the methodological quality of clinical practice guidelines (CPGs) on treatments for non-small cell lung cancer (NSCLC). METHODS We searched MEDLINE, CPG developer websites, lung cancer societies, and oncology organizations to identify CPGs providing recommendations on treatments for NSCLC. The methodological quality for each CPG was determined independently by three appraisers using the AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument. RESULTS Twenty-two CPGs met the eligibility criteria. The median scores per AGREE II domain were: scope and purpose 90.7% (64.8-100%), stakeholder involvement 76.9% (27.8-96.3%); rigor of development 80.9% (27.1-92.4%); clarity of presentation 89.8% (50-100%); applicability 46.5% (12.5-87.5%); and editorial independence 91.7% (27.8-100%). Most of the CPGs (54.5%) were rated as "recommended with modifications" for clinical use. CONCLUSIONS Overall, the methodological quality of CPGs proving recommendations on the management of NSCLC is moderate, but there is still room for improvement in their development and implementation.
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Affiliation(s)
- Marcela Cortés-Jofré
- Doctoral Program in Research Methodology and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain
- Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Meisser Madera
- Faculty of Dentistry, Department of Research, Universidad de Cartagena, Cartagena, Colombia.
| | - Lesbia Tirado-Amador
- Programa de Odontología, Grupo GINOUS, Universidad del Sinú, Cartagena, Colombia
| | - Claudia Asenjo-Lobos
- Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana, Universidad de Desarrollo, Santiago, Chile
| | - Xavier Bonfill-Cosp
- Iberoamerican Cochrane Center, Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona, Spain
- Public Health and Clinical Epidemiology Service, Hospital de la Santa Creu i Sant Pau, CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Laursen SH, Rasmussen HL, Seidelin D, Pedersen PH, Chræmmer TM. Psychosocial patient perspectives following major lower-limb amputation due to vascular aetiology: a protocol for a systematic meta-aggregation study. BMJ Open 2023; 13:e076794. [PMID: 37734884 PMCID: PMC10514670 DOI: 10.1136/bmjopen-2023-076794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION Persistent psychosocial problems in people with lower-limb amputation due to vascular aetiology indicate a great need for long-lasting holistic rehabilitation. An in-depth understanding of the psychosocial problems is essential for the guidance of health professionals in meeting and normalising patients' experiences and emotions. Furthermore, identifying the psychological problems may help develop effective rehabilitation and counselling programmes. This meta-aggregation study aims to explore the psychosocial perspectives of individuals who have undergone a major lower-limb amputation due to vascular aetiology during the post-discharge rehabilitation phase. METHODS AND ANALYSIS A systematic meta-aggregation study will be performed to identify full-text, peer-reviewed journal articles reporting on patients' psychosocial perspectives on major lower-limb amputation due to vascular aetiology from post-discharge to several years afterward. The databases Embase, CINAHL Ultimate, APA PsycInfo, PubMed and Scopus will be searched with no limitations regarding the publication year. Studies that satisfy the eligibility criteria will be critically appraised using an acknowledged checklist and synthesised using the Joanna Briggs Institute three-phase approach for the synthesis of meta-aggregation studies. The GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation- Confidence in Evidence from Reviews of Qualitative research) tool will be used to determine the level of confidence in the qualitative evidence, and the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) reporting guidelines will be followed throughout the review process. ETHICS AND DISSEMINATION Ethical approval is not required for the study, as the review is built on pre-existing available data in the literature. Findings from the review will be disseminated through publication in a peer-review journal. PROSPERO REGISTRATION NUMBER CRD42022377114.
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Affiliation(s)
- Sisse Heiden Laursen
- Department of Nursing, University College of Northern Denmark, Aalborg, Denmark
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | | | - Dinnie Seidelin
- Department of Nursing, University College of Northern Denmark, Aalborg, Denmark
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Crunkhorn A, Andrews E, Fantini C, Highsmith MJ, Loftsgaarden M, Randolph B, Sall J, Webster J. Management of Upper Limb Amputation Rehabilitation: Synopsis of the 2022 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline for Acquired Amputation. Am J Phys Med Rehabil 2023; 102:245-253. [PMID: 36480336 DOI: 10.1097/phm.0000000000002164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT Upper limb amputation can result in significant functional impairment necessitating a comprehensive rehabilitation approach throughout the continuum of care. In 2022, the Departments of Veteran Affairs and Defense completed an updated clinical practice guideline for the management of upper limb amputation rehabilitation. This practice guideline was developed by a workgroup of subject-matter experts from a variety of disciplines. Twelve key questions were developed by the workgroup using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) format to establish the scope of the literature review. Eighteen recommendations were developed through extensive review of the available literature and use of the Grading of Recommendations, Assessment, Development and Evaluation criteria. The strength of each recommendation was determined based on the quality of the research evidence and the additional domains of the Grading of Recommendations, Assessment, Development and Evaluation criteria. Of the 18 recommendations, 4 were found to have sufficient evidence to suggest for use of a particular rehabilitation management strategy. Thus, the 2022 Department of Veteran Affairs and Department of Defense clinical practice guideline provides updated, evidence-based information on the care and rehabilitation of persons with upper limb amputation. However, a significant lack of high-quality evidence in upper limb amputation rehabilitation limited evidence-based clinical guidance to assist healthcare providers in managing this population.
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Affiliation(s)
- Andrea Crunkhorn
- From the Extremity Trauma and Amputation Center of Excellence, Department of the Army, Office of the Surgeon General, Falls Church, Virginia (AC); Department of Veterans Affairs Texas Valley Coastal Bend Health Care System, Harlington, Texas (EA); Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, Texas (EA); Department of Veterans Affairs Orthotic, Prosthetic and Pedorthic Clinical Services, Rehabilitation and Prosthetics Service, Washington, DC (CF, MJH); University of South Florida, Morsani College of Medicine, School of Physical Therapy and Rehabilitation Sciences, Tampa, Florida (MJH); Physical Medicine and Rehabilitation Service, Center for the Intrepid, Brooke Army Medical Center, San Antonio, Texas (ML); Extremity Trauma and Amputation Center of Excellence, Department of Veterans Affairs Rehabilitation and Prosthetic Services, Washington, DC (BR); Evidence Based Practice, Quality and Patient Safety, Veterans Administration Central Office, Washington, DC (JS); Department of Physical Medicine and Rehabilitation, School of Medicine at Virginia Commonwealth University, Richmond, Virginia (JW); and Physical Medicine and Rehabilitation, Central Virginia Veterans Affairs Healthcare System, Richmond, Virginia (JW)
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Madsen UR, Biesbjerg CB, Mikkelsen TB, Marsaa K, Olsen Zwisler AD, Vedste Aagaard T. Considerable gaps and differences in rehabilitation after major lower extremity amputations across regions and municipalities in Denmark - A national survey. Scand J Caring Sci 2023; 37:595-607. [PMID: 36727432 DOI: 10.1111/scs.13144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 11/14/2022] [Accepted: 01/05/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Equal access to healthcare is a fundamental principle in the fully tax-financed Danish healthcare system. This study reveals whether this system lives up to the principle of equal access when it comes to the rehabilitation of patients who have major lower extremity amputations. METHODS With the aim of exploring possible inequality in rehabilitation for patients having major lower extremity amputation in Denmark, a nationwide electronic survey was conducted in the autumn of 2020, which included all hospitals and municipalities in Denmark. RESULTS Eighty six percent of hospitals (n = 19) and 97% (n = 95) of municipalities responded. Of the 32% (n = 6) of hospitals and 78% (n = 74) of municipalities that provided prosthesis rehabilitation, the majority (hospitals 50% /municipalities 91%) provided prostheses for <10 patients in 2019, and 36% reported having competencies at only a general level among physiotherapists performing prosthetic training. Psychosocial rehabilitation modalities were lacking overall. CONCLUSIONS This national study documents pronounced geographic inequality in access to qualified rehabilitation services for the relatively few patients undergoing lower extremity amputations in Denmark. The decentralised organisation of amputation rehabilitation makes it difficult to build and maintain specialist competencies among healthcare professionals. Inconsistent availability of psychosocial rehabilitation modalities of all kinds found in this study points to a need for action particularly among patients not in prosthetic rehabilitation where palliative needs should also be considered.
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Affiliation(s)
- Ulla Riis Madsen
- Department of Orthopedic Surgery, Holbaek Hospital, Holbaek, Denmark.,REHPA, Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Holbaek, Denmark
| | | | - Tina Broby Mikkelsen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Ann-Dorthe Olsen Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Thomas Vedste Aagaard
- Department of Orthopedic Surgery, Holbaek Hospital, Holbaek, Denmark.,Department of Physiotherapy and Occupational Therapy, Holbaek Hospital, Holbaek, Denmark.,Department of Orthopaedic Surgery, Zealand University Hospital, Koege, Denmark
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Schober TL, Abrahamsen C. Patient perspectives on major lower limb amputation – A qualitative systematic review. Int J Orthop Trauma Nurs 2022; 46:100958. [DOI: 10.1016/j.ijotn.2022.100958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
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Wang Y, Guo J, Xiong T, Wang F, Kou G, Ning H. The quality assessment of intraabdominal infection guidelines/consensuses in 2 decades - which are better and any changes? Medicine (Baltimore) 2020; 99:e23643. [PMID: 33327344 PMCID: PMC7738084 DOI: 10.1097/md.0000000000023643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/12/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND AIM Intraabdominal infection (IAI) is a common and important disease worldwide. An increasing number of related guidelines/consensuses have been published in recent years, the quality evaluation for these guidelines/consensuses is necessary to identify lower-quality documents and explore the quality distribution in different time range and areas in this field. METHODS The Appraisal of Guidelines for Research & Evaluation Instrument tool was adopted to assess the quality of IAI guidelines/consensuses by 3 researchers independently. Intraclass correlation coefficients (ICCs) among the researchers were retrieved to reflect reliability. The quality differences of these guidelines/consensuses issued before and after May 2009, both international and non-international, were compared by a Mann-Whitney U test. RESULTS Fourteen IAI guidelines/consensuses published in English were obtained following a literature search. The ICCs among the researchers were all above 0.75, indicating satisfactory reliability. This outcome showed that the overall quality of these guidelines/consensuses was mediocre and considered acceptable in all items. A few guidelines/consensuses were better in their scientific and methodological characteristics than the others. Moreover, there were no significant differences in the scores between the guidelines/consensuses issued before and after May 2009 or between international vs regional guidelines/consensuses. CONCLUSIONS Overall, the quality of the IAI guidelines/consensuses was generally acceptable and applicable, with a few deficiencies. Therefore, continuous improvement is essential. The guideline assessment tools should be applied in guideline/consensus development both widely and strictly to improve the methodological quality.
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Affiliation(s)
- Yu Wang
- Department of Pharmacy
- Northwestern SiChuan Regional Medical Center, MianYang, China
| | - Jun Guo
- Department of Pediatrics, MianYang Center Hospital, MianYang
- Northwestern SiChuan Regional Medical Center, MianYang, China
| | - Tingting Xiong
- Department of Pharmacy, sichuan provincial hospital for women and children, Chengdu
| | - Fangfang Wang
- Department of Pharmacy, Yibin hospital for women and children, Yibin
| | - Guoxian Kou
- Department of Infectious Diseases
- Northwestern SiChuan Regional Medical Center, MianYang, China
| | - Hong Ning
- Department of Pharmacy, MianYang Center Hospital
- Northwestern SiChuan Regional Medical Center, MianYang, China
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