ABSTRACT
Provide a critical analysis of measurement properties of mHealth technologies (wearable sensors and smartphone applications) currently used to capture the amount and intensity of functional skills (locomotion and object-interaction) in stroke survivors. The search was performed in four databases from inception to January 8, 2020 using key words and variations of 'stroke,' 'mHealth technology,' and 'functional movement behaviors' [1-2]. Publication language was restricted to English, Portuguese, and French. Inclusion criteria: original research assessing step count, arm/hand activity and/or intensity, and measurement properties of mHealth technologies in adults post-stroke. Titles, abstracts and full texts were screened for eligibility by two reviewers using COVIDENCE software [3]. Of 1,380 publications, 64 met inclusion criteria. We extracted reliability, validity, responsiveness, and interpretability [4-5]. Measurement properties were reported in 32 studies of locomotor behaviors, 17 of arm/hand behaviors, and 22 studies reported intensity metrics. Remarkably, no studies reported simultaneous measurement of arm/hand and locomotor behaviors. Reliability and validity were the most frequently reported measurement properties, with large variability between devices and smartphone applications. Most studies were conducted in laboratory settings with chronic stroke. Few to none were longitudinal in design across stroke chronicity. Findings underscore the need for further development and use of mHealth technologies to better understand activity of stroke survivors in the natural environment and throughout recovery and reintegration. This review provides a foundation for a field experiencing rapid growth and new opportunities within research and clinical practice to help shape a more active and healthier future for stroke survivors. The authors do not have any conflict of interest.
ABSTRACT
OBJECTIVE: In pandemics like COVID-19, the need for medical resources quickly outpaces available supply. policymakers need strategies to inform decisions about allocating scarce resources. STUDY DESIGN AND SETTING: We updated a systematic review on evidence-based approaches and searched databases through May 2020 for evaluation of strategies for policymakers. RESULTS: The 201 identified studies evaluated reducing demand for healthcare, optimizing existing resources, augmenting resources, and adopting crisis standards of care. Most research exists to reduce demand (n = 149); 39 higher quality studies reported benefits of contact tracing, school closures, travel restrictions, and mass vaccination. Of 28 strategies to augment resources, 6 higher quality studies reported effectiveness of establishing temporary facilities, use of volunteers, and decision support software. Of 23 strategies to optimize existing resources, 12 higher quality studies reported successful scope of work expansions and building on existing interagency agreements. Of 15 COVID-19 studies, 5 higher quality studies reported on combinations of policies and benefits of community-wide mask policies. CONCLUSION: Despite the volume, the evidence base is limited; few strategies were empirically tested in robust study designs. The review provides a comprehensive overview of the effects of strategies to allocate resources and provides critical appraisal to identify the best available evidence.
Subject(s)
Administrative Personnel , Health Care Rationing/methods , Pandemics , COVID-19/epidemiology , HumansABSTRACT
BACKGROUND: Understanding the safety of vaccines is critical to inform decisions about vaccination. Our objective was to conduct a systematic review of the safety of vaccines recommended for children, adults, and pregnant women in the United States. METHODS: We searched the literature in November 2020 to update a 2014 Agency for Healthcare Research and Quality review by integrating newly available data. Studies of vaccines that used a comparator and reported the presence or absence of key adverse events were eligible. Adhering to Evidence-based Practice Center methodology, we assessed the strength of evidence (SoE) for all evidence statements. The systematic review is registered in PROSPERO (CRD42020180089). RESULTS: Of 56,603 reviewed citations, 338 studies reported in 518 publications met inclusion criteria. For children, SoE was high for no increased risk of autism following measles, mumps, and rubella (MMR) vaccine. SoE was high for increased risk of febrile seizures with MMR. There was no evidence of increased risk of intussusception with rotavirus vaccine at the latest follow-up (moderate SoE), nor of diabetes (high SoE). There was no evidence of increased risk or insufficient evidence for key adverse events for newer vaccines such as 9-valent human papillomavirus and meningococcal B vaccines. For adults, there was no evidence of increased risk (varied SoE) or insufficient evidence for key adverse events for the new adjuvanted inactivated influenza vaccine and recombinant adjuvanted zoster vaccine. We found no evidence of increased risk (varied SoE) for key adverse events among pregnant women following tetanus, diphtheria, and acellular pertussis vaccine, including stillbirth (moderate SoE). CONCLUSIONS: Across a large body of research we found few associations of vaccines and serious key adverse events; however, rare events are challenging to study. Any adverse events should be weighed against the protective benefits that vaccines provide.