Knowledge, attitude, and practice toward pre-diabetes among the public, patients with pre-diabetes and healthcare professionals: a systematic review.

The prevalence of pre-diabetes is increasing globally, affecting an estimated 552 million people by 2030. While lifestyle interventions are the first line of defense against progression toward diabetes, information on barriers toward pre-diabetes management and how to overcome these barriers are scarce. This systematic review describes the publics' and healthcare professionals' knowledge, attitude and practice (KAP) toward pre-diabetes and determines the barriers toward pre-diabetes management. A systematic search for studies examining KAP towards pre-diabetes was conducted in six databases from inception to September 2022. Studies that quantitatively assessed at least two KAP elements using questionnaires were included. The quality of studies was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Barriers and enablers were identified and mapped onto the Capability, Motivation, and Behaviour model to identify factors that influence behavior change. Twenty-one articles that surveyed 8876 participants were included in this review. Most of the reviews (n=13) were directed to healthcare professionals. Overall, positive attitudes toward diabetes prevention efforts were observed, although there were still knowledge deficits and poor behavior toward pre-diabetes management. Barriers and enablers were detected at patients (eg, goals and intention), healthcare professionals (eg, clinical judgement) and system (eg, access and resources) levels. The use of different survey instruments to assess KAP prevented a head-to-head comparison between studies. Most studies conducted among patients were from middle-income countries, while among healthcare professionals (HCPs) were from high-income countries, which may produce some biasness. Nevertheless, the development of pre-diabetes intervention should focus on: (1) increasing knowledge on pre-diabetes and its management; (2) imparting practical skills to manage pre-diabetes; (3) providing resources for lifestyle management; (4) improving the accessibility of lifestyle management programs; and (5) other HCPs and human support to pre-diabetes management.

How Willing Are Patients or Their Caregivers to Deprescribe: a Systematic Review and Meta-analysis.

BACKGROUND: Polypharmacy is associated with the increased use of potentially inappropriate medications, where the risks of medicine use outweigh its benefits. Stopping medicines (deprescribing) that are no longer needed can be beneficial to reduce the risk of adverse events. We summarized the willingness of patients and their caregivers towards deprescribing. METHODS: A systematic search was conducted in four databases from inception until April 30, 2021 as well as search of citation of included articles. Studies that reported patients' and/or their caregivers' attitude towards deprescribing quantitatively were included. All studies were independently screened, reviewed, and data extracted in duplicates. Patients and caregivers willingness to deprescribe their regular medication was pooled using random effects meta-analysis of proportions. RESULTS: Twenty-nine unique studies involving 11,049 participants were included. All studies focused on the attitude of the patients towards deprescribing, and 7 studies included caregivers' perspective. Overall, 87.6% (95% CI: 83.3 to 91.4%) patients were willing to deprescribe their medication, based upon the doctors' suggestions. This was lower among caregivers, with only 74.8% (49.8% to 93.8%) willing to deprescribe their care recipients' medications. Patients' or caregivers' willingness to deprescribe were not influenced by study location, study population, or the number of medications they took. DISCUSSION: Most patients and their caregivers were willing to deprescribe their medications, whenever possible and thus should be offered a trial of deprescribing. Nevertheless, as these tools have a poor predictive ability, patients and their caregivers should be engaged during the deprescribing process to ensure that the values and opinions are heard, which would ultimately improve patient safety. In terms of limitation, as not all studies may published the methods and results of measurement they used, this may impact the methodological quality and thus our findings. OPEN SCIENCE FRAMEWORK REGISTRATION: https:// osf.io/fhg94.

Examining the use of network meta-analysis in pharmacy services research: A systematic review.

OBJECTIVES: Pharmacists play an important role in supporting the health care needs of the public, and various studies have examined the impact of pharmacy services on patient care. This systematic review aimed to describe studies evaluating the impact of pharmacy services by means of network meta-analyses. DATA SOURCES: A systematic literature review of network meta-analyses examining pharmacy services was performed on PubMed, Embase, International Pharmaceutical Abstracts, and Cochrane Database of Systematic Reviews from database inception to November 30, 2018. STUDY SELECTION: Network meta-analyses that examined the comparative effectiveness of pharmacy services (where pharmacists provide patient care to optimize patient outcomes) in any population, country, or setting. DATA EXTRACTION: Data were independently extracted by 2 authors with the use of a standardized extraction form. The methodologic quality of articles was assessed with the use of the Cochrane Risk of Bias in Systematic Reviews tool. RESULTS: Two network meta-analysis studies were identified. The first study compared 53 randomized controlled trials evaluating the effectiveness of transitional care services among discharged patients with heart failure. The study found that pharmacist interventions such as medication reconciliation, patient education, and medication optimization had little impact on improving the all-cause mortality and readmission rate in these patients. The second report compared 43 randomized controlled trials examining the efficacy of pharmacist-based diabetes educational interventions with or without pharmaceutical care on people with type 2 diabetes. It was reported that pharmacy services were effective in reducing glycosylated hemoglobin among people with type 2 diabetes, with larger effect sizes observed when these services involved a combination of 2 or more pharmacy services. CONCLUSION: This study demonstrated a paucity of studies using network meta-analysis techniques in evaluating pharmacist-provided services. This could be due to the lack of confidence in using this method, because network meta-analysis requires several additional assumptions that require careful consideration while performing the analysis.