B. Johnston, R. Merdad, D. Sherifali, M. Kebbe, C. Birken, A. Buchholz, L. Ge, Nicole D. Gehring, S. Hadjiyannakis, J. Hamilton, Dawn Hatanaka, Mélanie Henderson, Tracy Lebel, Sarah A. Moore, K. Morrison, X. R. Salas, M. Sebastianski, I. Zenlea, G. Ball
Background: Since the first national guideline for managing obesity in adults and children in Canada was published in 2007, new evidence has emerged and guideline standards have evolved. Our purpose is to describe the protocol used to update the Canadian clinical practice guideline for managing pediatric obesity. Methods: This guideline will update the pediatric components of the 2007 Canadian clinical practice guideline for the management of obesity. In partnership with Obesity Canada, we began preliminary work in 2019; activities are scheduled for completion in 2022. The guideline will follow standards developed by the National Academy of Medicine and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group. Guideline development will be informed by 5 complementary literature reviews: a scoping review that focuses on clinical assessment in pediatric obesity management and 4 systematic reviews to synthesize evidence regarding families’ values and preferences as well as the safety and effectiveness of interventions (psychological and behavioural; pharmacotherapeutic; and surgical). We will use standard systematic review methodology, including summarizing and assessing the certainty of evidence and determining the strength of recommendations. Competing interests will be managed proactively according to recommendations from the Guidelines International Network. Diverse stakeholders, including families and clinicians, will be engaged throughout guideline development. Interpretation: The guideline will support Canadian families and clinicians to make informed, value-sensitive and evidence-based clinical decisions related to managing pediatric obesity. The guideline and accompanying resources for end-users will be published in English and French, and we will partner with Obesity Canada to optimize dissemination using integrated and end-of-project knowledge translation.
{"title":"Updating the Canadian clinical practice guideline for managing pediatric obesity: a protocol","authors":"B. Johnston, R. Merdad, D. Sherifali, M. Kebbe, C. Birken, A. Buchholz, L. Ge, Nicole D. Gehring, S. Hadjiyannakis, J. Hamilton, Dawn Hatanaka, Mélanie Henderson, Tracy Lebel, Sarah A. Moore, K. Morrison, X. R. Salas, M. Sebastianski, I. Zenlea, G. Ball","doi":"10.9778/cmajo.20200289","DOIUrl":"https://doi.org/10.9778/cmajo.20200289","url":null,"abstract":"Background: Since the first national guideline for managing obesity in adults and children in Canada was published in 2007, new evidence has emerged and guideline standards have evolved. Our purpose is to describe the protocol used to update the Canadian clinical practice guideline for managing pediatric obesity. Methods: This guideline will update the pediatric components of the 2007 Canadian clinical practice guideline for the management of obesity. In partnership with Obesity Canada, we began preliminary work in 2019; activities are scheduled for completion in 2022. The guideline will follow standards developed by the National Academy of Medicine and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group. Guideline development will be informed by 5 complementary literature reviews: a scoping review that focuses on clinical assessment in pediatric obesity management and 4 systematic reviews to synthesize evidence regarding families’ values and preferences as well as the safety and effectiveness of interventions (psychological and behavioural; pharmacotherapeutic; and surgical). We will use standard systematic review methodology, including summarizing and assessing the certainty of evidence and determining the strength of recommendations. Competing interests will be managed proactively according to recommendations from the Guidelines International Network. Diverse stakeholders, including families and clinicians, will be engaged throughout guideline development. Interpretation: The guideline will support Canadian families and clinicians to make informed, value-sensitive and evidence-based clinical decisions related to managing pediatric obesity. The guideline and accompanying resources for end-users will be published in English and French, and we will partner with Obesity Canada to optimize dissemination using integrated and end-of-project knowledge translation.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44686061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. McClean, J. Trigg, Monica Ye, Taylor McLinden, K. Kooij, Nicanor Bacani, Christian Hui, P. Sereda, A. Burchell, S. Walmsley, D. Kelly, N. Machouf, J. Montaner, M. Loutfy, R. Hogg
Background: Socioeconomic status has been associated with higher viral loads and lower CD4 cell counts among people living with HIV. The objective of this study was to evaluate the relation between neighbourhood-level material deprivation and immunologic and virologic response to combination antiretroviral therapy (ART) among people living with HIV in Canada. Methods: The Canadian Observational Cohort (CANOC) is a longitudinal cohort of people living with HIV, containing data from 2000–2016 from 5 Canadian provinces. We defined response to combination ART as positive if the CD4 cell count increased by 50 cells/mm3 (0.05 cells × 109/L) or more (CD4+) and viral load decreased to 50 copies/mL or less (VL+) within 6 months of treatment initiation. We further categorized response to therapy as concordant positive (CD4+/VL+), concordant negative (CD4−/VL−) or discordant (CD4+/VL− or CD4−/VL+). We used adjusted multinomial logistic regression to quantify the relation between neighbourhood-level material deprivation and immunologic and virologic response. Results: This study included 8274 people living with HIV, of which 1754 (21.2%) lived in the most materially deprived neighbourhoods. Most individuals (62.2%) showed a concordant positive response to combination ART. After adjustment, living in the most materially deprived neighbourhoods was associated with a CD4−/VL+ discordant response (adjusted odds ratio [OR] 1.31, 95% confidence interval [CI] 1.06–1.62) and a concordant negative response (adjusted OR 1.45, 95% CI 1.13–1.86), using a concordant positive response as the reference. No other deprivation quartile was independently associated with a particular response. Interpretation: People living with HIV from the most materially deprived neighbourhoods had increased odds of poor immunologic or virologic response to combination ART. These results motivate further study of the specific socioeconomic factors that potentially affect response to combination ART among people living with HIV in Canada.
背景:HIV感染者的社会经济地位与较高的病毒载量和较低的CD4细胞计数有关。本研究的目的是评估社区水平的物质剥夺与加拿大艾滋病毒感染者对联合抗逆转录病毒治疗(ART)的免疫和病毒学反应之间的关系。方法:加拿大观察队列(CANOC)是一个HIV感染者的纵向队列，包含来自加拿大5个省2000-2016年的数据。如果CD4细胞计数增加50个细胞/mm3(0.05个细胞× 109个/L)或更多(CD4+)，并且病毒载量在治疗开始的6个月内下降到50拷贝/mL或更少(VL+)，我们将联合抗逆转录病毒治疗的反应定义为阳性。我们进一步将治疗反应分为协调阳性(CD4+/VL+)、协调阴性(CD4−/VL−)或不协调(CD4+/VL−或CD4−/VL+)。我们使用调整后的多项逻辑回归来量化社区水平物质剥夺与免疫和病毒学反应之间的关系。结果:本研究纳入8274例HIV感染者，其中1754例(21.2%)生活在物质最贫困的社区。大多数个体(62.2%)对联合抗逆转录病毒治疗表现出一致的阳性反应。调整后，生活在物质最贫困的社区与CD4−/VL+不一致反应(调整优势比[OR] 1.31, 95%置信区间[CI] 1.06-1.62)和一致的负面反应(调整优势比[OR] 1.45, 95% CI 1.13-1.86)相关，以一致的积极反应为参考。没有其他剥夺四分位数与特定反应独立相关。解释:来自物质最贫困社区的艾滋病毒感染者对联合抗逆转录病毒治疗的免疫或病毒学反应较差的几率增加。这些结果促使进一步研究可能影响加拿大艾滋病毒感染者对联合抗逆转录病毒治疗反应的具体社会经济因素。
{"title":"Neighbourhood-level material deprivation and response to combination antiretroviral therapy in the Canadian Observational Cohort (CANOC): a longitudinal cohort study","authors":"A. McClean, J. Trigg, Monica Ye, Taylor McLinden, K. Kooij, Nicanor Bacani, Christian Hui, P. Sereda, A. Burchell, S. Walmsley, D. Kelly, N. Machouf, J. Montaner, M. Loutfy, R. Hogg","doi":"10.9778/cmajo.20200249","DOIUrl":"https://doi.org/10.9778/cmajo.20200249","url":null,"abstract":"Background: Socioeconomic status has been associated with higher viral loads and lower CD4 cell counts among people living with HIV. The objective of this study was to evaluate the relation between neighbourhood-level material deprivation and immunologic and virologic response to combination antiretroviral therapy (ART) among people living with HIV in Canada. Methods: The Canadian Observational Cohort (CANOC) is a longitudinal cohort of people living with HIV, containing data from 2000–2016 from 5 Canadian provinces. We defined response to combination ART as positive if the CD4 cell count increased by 50 cells/mm3 (0.05 cells × 109/L) or more (CD4+) and viral load decreased to 50 copies/mL or less (VL+) within 6 months of treatment initiation. We further categorized response to therapy as concordant positive (CD4+/VL+), concordant negative (CD4−/VL−) or discordant (CD4+/VL− or CD4−/VL+). We used adjusted multinomial logistic regression to quantify the relation between neighbourhood-level material deprivation and immunologic and virologic response. Results: This study included 8274 people living with HIV, of which 1754 (21.2%) lived in the most materially deprived neighbourhoods. Most individuals (62.2%) showed a concordant positive response to combination ART. After adjustment, living in the most materially deprived neighbourhoods was associated with a CD4−/VL+ discordant response (adjusted odds ratio [OR] 1.31, 95% confidence interval [CI] 1.06–1.62) and a concordant negative response (adjusted OR 1.45, 95% CI 1.13–1.86), using a concordant positive response as the reference. No other deprivation quartile was independently associated with a particular response. Interpretation: People living with HIV from the most materially deprived neighbourhoods had increased odds of poor immunologic or virologic response to combination ART. These results motivate further study of the specific socioeconomic factors that potentially affect response to combination ART among people living with HIV in Canada.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41793697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Louise Y. Sun, H. Wijeysundera, Douglas S. Lee, S. van Diepen, M. Ruel, A. Eddeen, T. Mesana
Background: Surgical delay may result in unintended harm to patients needing cardiac surgery, who are at risk for death if their condition is left untreated. Our objective was to derive and internally validate a clinical risk score to predict death among patients awaiting major cardiac surgery. Methods: We used the CorHealth Ontario Registry and linked ICES health administrative databases with information on all Ontario residents to identify patients aged 18 years or more who were referred for isolated coronary artery bypass grafting (CABG), valvular procedures, combined CABG–valvular procedures or thoracic aorta procedures between Oct. 1, 2008, and Sept. 30, 2019. We used a hybrid modelling approach with the random forest method for initial variable selection, followed by backward stepwise logistic regression modelling for clinical interpretability and parsimony. We internally validated the logistic regression model, termed the CardiOttawa Waitlist Mortality Score, using 200 bootstraps. Results: Of the 112 266 patients referred for cardiac surgery, 269 (0.2%) died while awaiting surgery (118/72 366 [0.2%] isolated CABG, 81/24 461 [0.3%] valvular procedures, 63/12 046 [0.5%] combined CABG–valvular procedures and 7/3393 [0.2%] thoracic aorta procedures). Age, sex, surgery type, left main stenosis, Canadian Cardiovascular Society classification, left ventricular ejection fraction, heart failure, atrial fibrillation, dialysis, psychosis and operative priority were predictors of waitlist mortality. The model discriminated (C-statistic 0.76 [optimism-corrected 0.73]). It calibrated well in the overall cohort (Hosmer–Lemeshow p = 0.2) and across surgery types. Interpretation: The CardiOttawa Waitlist Mortality Score is a simple clinical risk model that predicts the likelihood of death while awaiting cardiac surgery. It has the potential to provide data-driven decision support for managing access to cardiac care and preserve system capacity during the COVID-19 pandemic, the recovery period and beyond.
{"title":"Derivation and validation of a clinical risk score to predict death among patients awaiting cardiac surgery in Ontario, Canada: a population-based study","authors":"Louise Y. Sun, H. Wijeysundera, Douglas S. Lee, S. van Diepen, M. Ruel, A. Eddeen, T. Mesana","doi":"10.9778/cmajo.20210031","DOIUrl":"https://doi.org/10.9778/cmajo.20210031","url":null,"abstract":"Background: Surgical delay may result in unintended harm to patients needing cardiac surgery, who are at risk for death if their condition is left untreated. Our objective was to derive and internally validate a clinical risk score to predict death among patients awaiting major cardiac surgery. Methods: We used the CorHealth Ontario Registry and linked ICES health administrative databases with information on all Ontario residents to identify patients aged 18 years or more who were referred for isolated coronary artery bypass grafting (CABG), valvular procedures, combined CABG–valvular procedures or thoracic aorta procedures between Oct. 1, 2008, and Sept. 30, 2019. We used a hybrid modelling approach with the random forest method for initial variable selection, followed by backward stepwise logistic regression modelling for clinical interpretability and parsimony. We internally validated the logistic regression model, termed the CardiOttawa Waitlist Mortality Score, using 200 bootstraps. Results: Of the 112 266 patients referred for cardiac surgery, 269 (0.2%) died while awaiting surgery (118/72 366 [0.2%] isolated CABG, 81/24 461 [0.3%] valvular procedures, 63/12 046 [0.5%] combined CABG–valvular procedures and 7/3393 [0.2%] thoracic aorta procedures). Age, sex, surgery type, left main stenosis, Canadian Cardiovascular Society classification, left ventricular ejection fraction, heart failure, atrial fibrillation, dialysis, psychosis and operative priority were predictors of waitlist mortality. The model discriminated (C-statistic 0.76 [optimism-corrected 0.73]). It calibrated well in the overall cohort (Hosmer–Lemeshow p = 0.2) and across surgery types. Interpretation: The CardiOttawa Waitlist Mortality Score is a simple clinical risk model that predicts the likelihood of death while awaiting cardiac surgery. It has the potential to provide data-driven decision support for managing access to cardiac care and preserve system capacity during the COVID-19 pandemic, the recovery period and beyond.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43000737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sophy Chan-Nguyen, A. O'Riordan, A. Morin, Lisa McAvoy, Eun-Young Lee, Veronica Lloyd, R. Appireddy
Background: Since the onset of the COVID-19 pandemic, virtual care solutions have been rapidly adopted across the country to provide safe, quality care to diverse patient populations. The objective of this qualitative case study was to understand patient and caregiver experiences of virtual care to identify barriers and gather suggestions to address them. Methods: In this patient-oriented project, we sought to understand gaps in virtual care experienced by patients and caregivers, using virtual focus groups. With the assistance of a patient research liaison, we engaged 2 patient partners as full partners; they participated in study conception, data collection, data analysis and knowledge translation. Recruitment was done through email by disseminating the study poster to 30 community organizations and health units in Ontario and British Columbia. We conducted a constructivist, qualitative study guided by grounded theory methodology. One researcher employed in-vivo coding, followed by axial coding with focus group participants, followed by selective coding with the study team. The study took place from November to December 2020. Results: We conducted 6 focus groups with 13 patients and 5 caregivers. The analysis resulted in 6 major themes and 17 minor themes. Key findings showed that barriers related to access to technology and Internet, language and cultural differences were challenges to virtual care. Participants identified special considerations surrounding caregiver and family involvement; privacy, consent and confidentiality; and the patient–physician relationship. Participants suggested that technology and the Internet be universally accessible and that virtual care modalities be integrated (e.g., consolidated patient portal) to improve virtual care. Interpretation: There are multiple patient-identified barriers to accessing virtual care in Canada; patients can provide insights into ways to address these barriers. Future research should include robust patient engagement to explore ways to address these challenges and barriers to ensure that virtual care can be equitable, accessible and safe for all users. Plain language summary: Although virtual care has been rapidly adopted and scaled up in health care institutions across the country, few improvements informed by patient and caregiver experiences have been made. Driven by concerns expressed by patient partners, our study team undertook a patient-partnered qualitative study to understand the barriers of virtual care from the perspectives and experiences of patients and caregivers. Our study team created the interview guide drawing from our previous patient-oriented qualitative studies and designed an orientation package to provide resources related to the focus groups and to introduce participants to the study team. Drawing from local health teams, clinics and patient advisory groups, the study team recruited 13 patients and 5 caregivers to participate in 6 focus group interviews. An analys
{"title":"Patient and caregiver perspectives on virtual care: a patient-oriented qualitative study","authors":"Sophy Chan-Nguyen, A. O'Riordan, A. Morin, Lisa McAvoy, Eun-Young Lee, Veronica Lloyd, R. Appireddy","doi":"10.9778/cmajo.20210065","DOIUrl":"https://doi.org/10.9778/cmajo.20210065","url":null,"abstract":"Background: Since the onset of the COVID-19 pandemic, virtual care solutions have been rapidly adopted across the country to provide safe, quality care to diverse patient populations. The objective of this qualitative case study was to understand patient and caregiver experiences of virtual care to identify barriers and gather suggestions to address them. Methods: In this patient-oriented project, we sought to understand gaps in virtual care experienced by patients and caregivers, using virtual focus groups. With the assistance of a patient research liaison, we engaged 2 patient partners as full partners; they participated in study conception, data collection, data analysis and knowledge translation. Recruitment was done through email by disseminating the study poster to 30 community organizations and health units in Ontario and British Columbia. We conducted a constructivist, qualitative study guided by grounded theory methodology. One researcher employed in-vivo coding, followed by axial coding with focus group participants, followed by selective coding with the study team. The study took place from November to December 2020. Results: We conducted 6 focus groups with 13 patients and 5 caregivers. The analysis resulted in 6 major themes and 17 minor themes. Key findings showed that barriers related to access to technology and Internet, language and cultural differences were challenges to virtual care. Participants identified special considerations surrounding caregiver and family involvement; privacy, consent and confidentiality; and the patient–physician relationship. Participants suggested that technology and the Internet be universally accessible and that virtual care modalities be integrated (e.g., consolidated patient portal) to improve virtual care. Interpretation: There are multiple patient-identified barriers to accessing virtual care in Canada; patients can provide insights into ways to address these barriers. Future research should include robust patient engagement to explore ways to address these challenges and barriers to ensure that virtual care can be equitable, accessible and safe for all users. Plain language summary: Although virtual care has been rapidly adopted and scaled up in health care institutions across the country, few improvements informed by patient and caregiver experiences have been made. Driven by concerns expressed by patient partners, our study team undertook a patient-partnered qualitative study to understand the barriers of virtual care from the perspectives and experiences of patients and caregivers. Our study team created the interview guide drawing from our previous patient-oriented qualitative studies and designed an orientation package to provide resources related to the focus groups and to introduce participants to the study team. Drawing from local health teams, clinics and patient advisory groups, the study team recruited 13 patients and 5 caregivers to participate in 6 focus group interviews. An analys","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47347628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Moe, Elle Yuequiao Wang, M. McGregor, M. Schull, K. Dong, B. Holroyd, C. Hohl, E. Grafstein, F. O’Sullivan, J. Trimble, K. McGrail
Background: The factors that underlie persistent frequent visits to the emergency department are poorly understood. This study aimed to characterize people who visit emergency departments frequently in Ontario and Alberta, by number of years of frequent use. Methods: This was a retrospective cohort study aimed at capturing information about patients visiting emergency departments in Ontario and Alberta, Canada, from Apr. 1, 2011, to Mar. 31, 2016. We identified people 18 years or older with frequent emergency department use (top 10% of emergency department use) in fiscal year 2015/16, using the Dynamic Cohort from the Canadian Institute of Health Information. We then organized them into subgroups based on the number of years (1 to 5) in which they met the threshold for frequent use over the study period. We characterized subgroups using linked emergency department, hospitalization and mental health–related hospitalization data. Results: We identified 252 737 people in Ontario and 63 238 people in Alberta who made frequent visits to the emergency department. In Ontario and Alberta, 44.3% and 44.7%, respectively, met the threshold for frequent use in only 1 year and made 37.9% and 38.5% of visits; 6.8% and 8.2% met the threshold for frequent use over 5 years and made 11.9% and 13.2% of visits. Many characteristics followed gradients based on persistence of frequent use: as years of frequent visits increased (1 to 5 years), people had more comorbidities, homelessness, rural residence, annual emergency department visits, alcohol- and substance use–related presentations, mental health hospitalizations and instances of leaving hospital against medical advice. Interpretation: Higher levels of comorbidities, mental health issues, substance use and rural residence were seen with increasing years of frequent emergency department use. Interventions upstream and in the emergency department must address unmet needs, including services for substance use and social supports.
{"title":"People who make frequent emergency department visits based on persistence of frequent use in Ontario and Alberta: a retrospective cohort study","authors":"J. Moe, Elle Yuequiao Wang, M. McGregor, M. Schull, K. Dong, B. Holroyd, C. Hohl, E. Grafstein, F. O’Sullivan, J. Trimble, K. McGrail","doi":"10.9778/cmajo.20210131","DOIUrl":"https://doi.org/10.9778/cmajo.20210131","url":null,"abstract":"Background: The factors that underlie persistent frequent visits to the emergency department are poorly understood. This study aimed to characterize people who visit emergency departments frequently in Ontario and Alberta, by number of years of frequent use. Methods: This was a retrospective cohort study aimed at capturing information about patients visiting emergency departments in Ontario and Alberta, Canada, from Apr. 1, 2011, to Mar. 31, 2016. We identified people 18 years or older with frequent emergency department use (top 10% of emergency department use) in fiscal year 2015/16, using the Dynamic Cohort from the Canadian Institute of Health Information. We then organized them into subgroups based on the number of years (1 to 5) in which they met the threshold for frequent use over the study period. We characterized subgroups using linked emergency department, hospitalization and mental health–related hospitalization data. Results: We identified 252 737 people in Ontario and 63 238 people in Alberta who made frequent visits to the emergency department. In Ontario and Alberta, 44.3% and 44.7%, respectively, met the threshold for frequent use in only 1 year and made 37.9% and 38.5% of visits; 6.8% and 8.2% met the threshold for frequent use over 5 years and made 11.9% and 13.2% of visits. Many characteristics followed gradients based on persistence of frequent use: as years of frequent visits increased (1 to 5 years), people had more comorbidities, homelessness, rural residence, annual emergency department visits, alcohol- and substance use–related presentations, mental health hospitalizations and instances of leaving hospital against medical advice. Interpretation: Higher levels of comorbidities, mental health issues, substance use and rural residence were seen with increasing years of frequent emergency department use. Interventions upstream and in the emergency department must address unmet needs, including services for substance use and social supports.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48796212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Cuthbert, N. Nixon, M. Vickers, S. Samimi, K. Rawson, R. Ramjeesingh, S. Karim, B. Stein, Garry Laxdal, Lorilee Dundas, Diane Huband, Emily Dazé, C. Farrer, W. Cheung
Background: Colorectal cancer, one of the most commonly diagnosed cancers, is now being detected earlier and treatments are improving, which means that patients are living longer. Partnering with Canadian clinicians, patients and researchers, we aimed to determine research priorities for those living with early-stage colorectal cancer in Canada. Methods: We followed the well-established priority-setting partnership outlined by the James Lind Alliance to identify and prioritize unanswered questions about early-stage (i.e., stages I–III) colorectal cancer. The study was conducted from September 2018 to September 2020. We surveyed patients, caregivers and clinicians from across Canada between June 2019 and December 2019. We categorized the responses using thematic analysis to generate a list of unique questions. We conducted an interim prioritization survey from April 2020 to July 2020, with patients, caregivers and clinicians, to determine a shorter list of questions, which was then reviewed at a final meeting (involving patients, caregivers and clinicians) in September 2020. At that meeting, we used a consensus-based process to determine the top 10 priorities. Results: For the initial survey, 370 responses were submitted by 185 individuals; of the 98 individuals who provided demographic information, 44 (45%) were patients, 16 (16%) were caregivers, 7 (7%) were members of an advocacy group, 26 (27%) were health care professionals and 5 (5%) were categorized as “other.” The responses were refined to create a list of 66 unique unanswered questions. Twenty-five respondents answered the interim prioritization survey: 13 patients (52%), 2 caregivers (8%), 3 advocacy group members (12%) and 7 health care professionals (28%). This led to a list of the top 30 questions. The final consensus meeting involved 20 individuals (10 patients [50%], 3 caregivers [15%] and 7 health care professionals [35%]), who agreed to the top 10 research priorities. The priorities covered a range of topics, including screening, treatment, recurrence, management of adverse effects and decision-making. Interpretation: We determined the top research priorities for early-stage colorectal cancer using a collaborative partnership of stake-holders from across Canada. The priorities covered a broad range of topics that could be addressed by future research, including improved screening practices, the role of personalized medicine, the management of adverse effects of treatment, decision-making and prevention of recurrence.
{"title":"Top 10 research priorities for early-stage colorectal cancer: a Canadian patient-oriented priority-setting partnership","authors":"C. Cuthbert, N. Nixon, M. Vickers, S. Samimi, K. Rawson, R. Ramjeesingh, S. Karim, B. Stein, Garry Laxdal, Lorilee Dundas, Diane Huband, Emily Dazé, C. Farrer, W. Cheung","doi":"10.9778/cmajo.20210046","DOIUrl":"https://doi.org/10.9778/cmajo.20210046","url":null,"abstract":"Background: Colorectal cancer, one of the most commonly diagnosed cancers, is now being detected earlier and treatments are improving, which means that patients are living longer. Partnering with Canadian clinicians, patients and researchers, we aimed to determine research priorities for those living with early-stage colorectal cancer in Canada. Methods: We followed the well-established priority-setting partnership outlined by the James Lind Alliance to identify and prioritize unanswered questions about early-stage (i.e., stages I–III) colorectal cancer. The study was conducted from September 2018 to September 2020. We surveyed patients, caregivers and clinicians from across Canada between June 2019 and December 2019. We categorized the responses using thematic analysis to generate a list of unique questions. We conducted an interim prioritization survey from April 2020 to July 2020, with patients, caregivers and clinicians, to determine a shorter list of questions, which was then reviewed at a final meeting (involving patients, caregivers and clinicians) in September 2020. At that meeting, we used a consensus-based process to determine the top 10 priorities. Results: For the initial survey, 370 responses were submitted by 185 individuals; of the 98 individuals who provided demographic information, 44 (45%) were patients, 16 (16%) were caregivers, 7 (7%) were members of an advocacy group, 26 (27%) were health care professionals and 5 (5%) were categorized as “other.” The responses were refined to create a list of 66 unique unanswered questions. Twenty-five respondents answered the interim prioritization survey: 13 patients (52%), 2 caregivers (8%), 3 advocacy group members (12%) and 7 health care professionals (28%). This led to a list of the top 30 questions. The final consensus meeting involved 20 individuals (10 patients [50%], 3 caregivers [15%] and 7 health care professionals [35%]), who agreed to the top 10 research priorities. The priorities covered a range of topics, including screening, treatment, recurrence, management of adverse effects and decision-making. Interpretation: We determined the top research priorities for early-stage colorectal cancer using a collaborative partnership of stake-holders from across Canada. The priorities covered a broad range of topics that could be addressed by future research, including improved screening practices, the role of personalized medicine, the management of adverse effects of treatment, decision-making and prevention of recurrence.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43276222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Moe, Elle Yuequiao Wang, M. McGregor, M. Schull, K. Dong, B. Holroyd, C. Hohl, E. Grafstein, F. O’Sullivan, J. Trimble, K. McGrail
Background: The population that visits emergency departments frequently is heterogeneous and at high risk for mortality. This study aimed to characterize these patients in Ontario and Alberta, compare them with controls who do not visit emergency departments frequently, and identify subgroups. Methods: This was a retrospective cohort study that captured patients in Ontario or Alberta from fiscal years 2011/12 to 2015/16 in the Dynamic Cohort from the Canadian Institute for Health Information, which defined people with frequent visits to the emergency department in the top 10% of annual visits and randomly selected controls from the bottom 90%. We included patients 18 years of age or older and linked to emergency department, hospitalization, continuing care, home care and mental health–related hospitalization data. We characterized people who made frequent visits to the emergency department over time, compared them with controls and identified subgroups using cluster analysis. We examined emergency department visit acuity using the Canadian Triage and Acuity Scale. Results: The number of patients who made frequent visits to the emergency department ranged from 435 334 to 477 647 each year in Ontario (≥ 4 visits per year), and from 98 840 to 105 047 in Alberta (≥ 5 visits per year). The acuity of these visits increased over time. Those who made frequent visits to the emergency department were older and used more health care services than controls. We identified 4 subgroups of those who made frequent visits: “short duration” (frequent, regularly spaced visits), “older patients” (median ages 69 and 64 years in Ontario and Alberta, respectively; more comorbidities; and more admissions), “young mental health” (median ages 45 and 40 years in Ontario and Alberta, respectively; and common mental health–related and alcohol-related visits) and “injury” (increased prevalence of injury-related visits). Interpretation: From 2011/12 to 2015/16, people who visited emergency departments frequently had increasing visit acuity, had higher health care use than controls, and comprised distinct subgroups. Emergency departments should codevelop interventions with the identified subgroups to address patient needs.
{"title":"Subgroups of people who make frequent emergency department visits in Ontario and Alberta: a retrospective cohort study","authors":"J. Moe, Elle Yuequiao Wang, M. McGregor, M. Schull, K. Dong, B. Holroyd, C. Hohl, E. Grafstein, F. O’Sullivan, J. Trimble, K. McGrail","doi":"10.9778/cmajo.20210132","DOIUrl":"https://doi.org/10.9778/cmajo.20210132","url":null,"abstract":"Background: The population that visits emergency departments frequently is heterogeneous and at high risk for mortality. This study aimed to characterize these patients in Ontario and Alberta, compare them with controls who do not visit emergency departments frequently, and identify subgroups. Methods: This was a retrospective cohort study that captured patients in Ontario or Alberta from fiscal years 2011/12 to 2015/16 in the Dynamic Cohort from the Canadian Institute for Health Information, which defined people with frequent visits to the emergency department in the top 10% of annual visits and randomly selected controls from the bottom 90%. We included patients 18 years of age or older and linked to emergency department, hospitalization, continuing care, home care and mental health–related hospitalization data. We characterized people who made frequent visits to the emergency department over time, compared them with controls and identified subgroups using cluster analysis. We examined emergency department visit acuity using the Canadian Triage and Acuity Scale. Results: The number of patients who made frequent visits to the emergency department ranged from 435 334 to 477 647 each year in Ontario (≥ 4 visits per year), and from 98 840 to 105 047 in Alberta (≥ 5 visits per year). The acuity of these visits increased over time. Those who made frequent visits to the emergency department were older and used more health care services than controls. We identified 4 subgroups of those who made frequent visits: “short duration” (frequent, regularly spaced visits), “older patients” (median ages 69 and 64 years in Ontario and Alberta, respectively; more comorbidities; and more admissions), “young mental health” (median ages 45 and 40 years in Ontario and Alberta, respectively; and common mental health–related and alcohol-related visits) and “injury” (increased prevalence of injury-related visits). Interpretation: From 2011/12 to 2015/16, people who visited emergency departments frequently had increasing visit acuity, had higher health care use than controls, and comprised distinct subgroups. Emergency departments should codevelop interventions with the identified subgroups to address patient needs.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41338491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Redwood-campbell, N. Arora, M. Hunt, L. Schwartz, M. Vanstone, Alexandra Hildebrand, Simran Sharma, S. Sohani
Background: Individuals with prior experience in international disaster response represent an essential source of expertise to support disaster response in their home countries. Our objective was to explore the experiences of personnel involved in international emergency health response regarding their perceptions of essential disaster response attributes and capacities and determine how these competencies apply to the Canadian context. Methods: For this qualitative study, we conducted semistructured interviews with key informants in person or over the telephone from May to December 2018. Participants were delegates deployed as part of the Canadian Red Cross medical response team in a clinical or technical, or administrative role within the last 5 years. Interviews were audio-recorded and transcribed. Conventional content analysis was performed on the transcripts, and themes were developed. Results: Eighteen key informants from 4 Canadian provinces provided perspectives on individual attributes acquired during international deployments, such as agility and stress management, and team capacities developed, including collaboration and conflict management. Key informants, including administrators (n = 5), technicians (n = 4), nurses (n = 4), physicians (n = 3) and psychosocial support workers (n = 2), described these experiences as highly relevant to the Canadian domestic context. Interpretation: Canadian physicians and health care workers involved with international disaster response have already acquired essential capacities, and this experience can be vital to building efficient disaster response teams in Canada. These findings complement the Canadian Medical Education Directives for Specialists (CanMEDS) roles and can inform course design, competency and curriculum development for physician and professional training programs related to disaster response and preparedness.
{"title":"Domestic application of lessons learned by Canadian health care professionals working in international disaster settings: a qualitative research study","authors":"L. Redwood-campbell, N. Arora, M. Hunt, L. Schwartz, M. Vanstone, Alexandra Hildebrand, Simran Sharma, S. Sohani","doi":"10.9778/cmajo.20210127","DOIUrl":"https://doi.org/10.9778/cmajo.20210127","url":null,"abstract":"Background: Individuals with prior experience in international disaster response represent an essential source of expertise to support disaster response in their home countries. Our objective was to explore the experiences of personnel involved in international emergency health response regarding their perceptions of essential disaster response attributes and capacities and determine how these competencies apply to the Canadian context. Methods: For this qualitative study, we conducted semistructured interviews with key informants in person or over the telephone from May to December 2018. Participants were delegates deployed as part of the Canadian Red Cross medical response team in a clinical or technical, or administrative role within the last 5 years. Interviews were audio-recorded and transcribed. Conventional content analysis was performed on the transcripts, and themes were developed. Results: Eighteen key informants from 4 Canadian provinces provided perspectives on individual attributes acquired during international deployments, such as agility and stress management, and team capacities developed, including collaboration and conflict management. Key informants, including administrators (n = 5), technicians (n = 4), nurses (n = 4), physicians (n = 3) and psychosocial support workers (n = 2), described these experiences as highly relevant to the Canadian domestic context. Interpretation: Canadian physicians and health care workers involved with international disaster response have already acquired essential capacities, and this experience can be vital to building efficient disaster response teams in Canada. These findings complement the Canadian Medical Education Directives for Specialists (CanMEDS) roles and can inform course design, competency and curriculum development for physician and professional training programs related to disaster response and preparedness.","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46287061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Racey, M. Ali, D. Sherifali, D. Fitzpatrick-Lewis, R. Lewis, Milos Jovkovic, D. Bouchard, A. Giguere, J. Holroyd-Leduc, A. Tang, L. Gramlich, H. Keller, J. Prorok, P. Kim, A. Lorbergs, J. Muscedere
Background: Physical activity is known to prevent frailty and reduce its consequences; however, it remains unclear which interventions are optimal for older adults with frailty. We conducted a systematic review and meta-analysis to identify effective physical activity interventions in improving outcomes related to frailty. Methods: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and CINAHL (inception to July 2019) for English-language randomized controlled trials (RCTs) of physical activity interventions in adults aged 65 years or more who were prefrail or frail; we included observational and cohort studies when there were no RCT data. Outcomes of interest were frailty, mobility, physical function, cognitive function, use of health care services and quality of life. After data extraction, we assessed the risk of bias using the Cochrane Collaboration risk of bias tool for RCTs and the Newcastle–Ottawa Scale for observational studies, rated the certainty of evidence with the Grading of Recommendation, Assessment, Development and Evaluations (GRADE) approach, and assessed statistical and methodologic heterogeneity. Results: We identified 26 studies (24 RCTs [1 of which did not have any relevant outcomes for extraction] and 2 observational studies) involving 8022 prefrail or frail older adults. Nine studies had low risk of bias, 2 had high risk of bias, and for 13 the risk of bias was unclear. The trials included mixed (aerobic and muscle-strengthening) (n = 13), muscle-strengthening (n = 8), mobilization and rehabilitation (n = 4) or aerobic (n = 1) activities. Significant effects were found for mobility (standardized mean difference [SMD] 0.60, 95% confidence interval [CI] 0.37 to 0.83), activities of daily living (SMD 0.50, 95% CI 0.15 to 0.84), cognitive function (SMD 0.35, 95% CI 0.09 to 0.61), quality of life (SMD 0.60, 95% CI 0.13 to 1.07) and frailty (SMD −1.29, 95% CI −2.22 to −0.36; risk ratio 0.58, 95% CI 0.36 to 0.93), with moderate certainty of evidence. Interpretation: There is low-to moderate-level evidence that various physical activity interventions are beneficial for prefrail and frail older adults. Studies need to better define frailty to ensure the identification and implementation of such interventions into clinical practice. PROSPERO registration: CRD42020144556
背景：众所周知，体育活动可以预防虚弱并减少其后果；然而，目前尚不清楚哪些干预措施最适合患有虚弱的老年人。我们进行了一项系统综述和荟萃分析，以确定有效的体育活动干预措施来改善与虚弱相关的结果。方法：我们在MEDLINE、Embase、Cochrane Central Register of Controlled Trials和CINAHL（开始至2019年7月）中搜索了针对65岁或65岁以上运动前或虚弱成年人的体育活动干预的英语随机对照试验（RCT）；在没有随机对照试验数据的情况下，我们纳入了观察性和队列研究。感兴趣的结果是虚弱、行动能力、身体功能、认知功能、医疗服务的使用和生活质量。数据提取后，我们使用随机对照试验的Cochrane协作偏倚风险工具和观察性研究的Newcastle–Ottawa量表评估偏倚风险，使用推荐、评估、发展和评估分级（GRADE）方法对证据的确定性进行评级，并评估统计学和方法学的异质性。结果：我们确定了26项研究（24项随机对照试验[其中1项没有任何相关的提取结果]和2项观察性研究），涉及8022名轨前或体弱的老年人。9项研究存在低偏倚风险，2项研究存在高偏倚风险。13项研究的偏倚风险尚不清楚。试验包括混合（有氧和肌肉强化）（n=13）、肌肉强化（n=8）、动员和康复（n=4）或有氧（n=1）活动。流动性（标准化平均差[SMD]0.60，95%置信区间[CI]0.37至0.83）、日常生活活动（SMD 0.50，95%CI 0.15至0.84）、认知功能（SMD 0.35，95%CI 0.09至0.61）、生活质量（SMD 0.60，95%CI 0.13至1.07）和虚弱（SMD−1.29，95%CI−2.22至−0.36；风险比0.58，95%CI 0.36至0.93）受到显著影响，证据的确定性适中。解释：有中低水平的证据表明，各种体育活动干预措施对飞行前和体弱的老年人有益。研究需要更好地定义虚弱，以确保在临床实践中识别和实施此类干预措施。PROSPERO注册号：CRD42020144556
{"title":"Effectiveness of physical activity interventions in older adults with frailty or prefrailty: a systematic review and meta-analysis","authors":"M. Racey, M. Ali, D. Sherifali, D. Fitzpatrick-Lewis, R. Lewis, Milos Jovkovic, D. Bouchard, A. Giguere, J. Holroyd-Leduc, A. Tang, L. Gramlich, H. Keller, J. Prorok, P. Kim, A. Lorbergs, J. Muscedere","doi":"10.9778/cmajo.20200222","DOIUrl":"https://doi.org/10.9778/cmajo.20200222","url":null,"abstract":"Background: Physical activity is known to prevent frailty and reduce its consequences; however, it remains unclear which interventions are optimal for older adults with frailty. We conducted a systematic review and meta-analysis to identify effective physical activity interventions in improving outcomes related to frailty. Methods: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and CINAHL (inception to July 2019) for English-language randomized controlled trials (RCTs) of physical activity interventions in adults aged 65 years or more who were prefrail or frail; we included observational and cohort studies when there were no RCT data. Outcomes of interest were frailty, mobility, physical function, cognitive function, use of health care services and quality of life. After data extraction, we assessed the risk of bias using the Cochrane Collaboration risk of bias tool for RCTs and the Newcastle–Ottawa Scale for observational studies, rated the certainty of evidence with the Grading of Recommendation, Assessment, Development and Evaluations (GRADE) approach, and assessed statistical and methodologic heterogeneity. Results: We identified 26 studies (24 RCTs [1 of which did not have any relevant outcomes for extraction] and 2 observational studies) involving 8022 prefrail or frail older adults. Nine studies had low risk of bias, 2 had high risk of bias, and for 13 the risk of bias was unclear. The trials included mixed (aerobic and muscle-strengthening) (n = 13), muscle-strengthening (n = 8), mobilization and rehabilitation (n = 4) or aerobic (n = 1) activities. Significant effects were found for mobility (standardized mean difference [SMD] 0.60, 95% confidence interval [CI] 0.37 to 0.83), activities of daily living (SMD 0.50, 95% CI 0.15 to 0.84), cognitive function (SMD 0.35, 95% CI 0.09 to 0.61), quality of life (SMD 0.60, 95% CI 0.13 to 1.07) and frailty (SMD −1.29, 95% CI −2.22 to −0.36; risk ratio 0.58, 95% CI 0.36 to 0.93), with moderate certainty of evidence. Interpretation: There is low-to moderate-level evidence that various physical activity interventions are beneficial for prefrail and frail older adults. Studies need to better define frailty to ensure the identification and implementation of such interventions into clinical practice. PROSPERO registration: CRD42020144556","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46327010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Racey, M. Ali, D. Sherifali, D. Fitzpatrick-Lewis, Ruth A. Lewis, Milos Jovkovic, L. Gramlich, H. Keller, J. Holroyd-Leduc, A. Giguere, A. Tang, D. Bouchard, J. Prorok, P. Kim, A. Lorbergs, J. Muscedere
Background: Although nutrition interventions may reverse frailty, it is unclear which interventions are optimal. We conducted a systematic review and meta-analysis to identify effective nutrition interventions that improve outcomes related to frailty. Methods: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and CINAHL (inception to July 2019) for English-language trials of nutrition and combined-approach (nutrition and exercise) interventions (with a control group) involving prefrail or frail adults aged 65 years or more. Outcomes of interest were frailty, mobility, health (body weight, body mass index), physical function (e.g., activities of daily living, muscle strength, appendicular lean mass), use of health care services (e.g., hospital admissions), quality of life, diet quality, mortality, and caregiver and social support. After data extraction, we assessed the risk of bias using the Cochrane Collaboration risk of bias tool for randomized controlled trials, rated the certainty of evidence with the Grading of Recommendation, Assessment, Development and Evaluations (GRADE) approach, and assessed statistical and methodologic heterogeneity. In addition, we conducted subgroup analyses of studies based on the primary intervention of protein supplementation. Results: We identified 15 studies involving 1825 prefrail or frail older participants: 7 were nutrition trials, 7 were combined-approach trials, and 1 trial had both a nutrition arm and a combined-approach arm. Seven studies had low risk of bias, 2 studies had high risk of bias, and for 6 studies the risk of bias was unclear. Nutrition interventions had small but significant effects on measures of physical function (standardized mean difference [SMD] 0.16, 95% confidence interval [CI] 0.02 to 0.29), mobility (SMD 0.15, 95% CI 0.00 to 0.30) and frailty (SMD −0.22, 95% CI −0.44 to −0.01) outcomes. Nutrition interventions combined with physical activity also had small but significant effects on physical function (SMD 0.19, 95% CI 0.06 to 0.32), mobility (SMD 0.25, 95% CI 0.02 to 0.48) and frailty (SMD −0.41, 95% CI −0.68 to −0.14; risk ratio 0.72, 95% CI 0.52 to 1.00) measures. Protein supplementation (5 studies) had small but significant effects on physical function measures (SMD 0.16, 95% CI 0.01 to 0.31) and mobility measures (SMD 0.20, 95% CI 0.02 to 0.39), with moderate certainty of evidence. Interpretation: There is moderate evidence that nutrition (including protein supplementation) and combined interventions are beneficial for prefrail or frail older adults. Trials with clear definitions of frailty and outcomes that reflect frailty identification and diagnosis are needed. PROSPERO registration: CRD42020144819
背景:虽然营养干预可以逆转虚弱，但目前尚不清楚哪种干预是最佳的。我们进行了系统回顾和荟萃分析，以确定有效的营养干预措施，改善与虚弱相关的结果。方法:我们检索了MEDLINE、Embase、Cochrane中央对照试验登记处和CINAHL(成立至2019年7月)，检索了涉及65岁及以上体弱或体弱成年人的营养和联合方法(营养和运动)干预(对照组)的英语试验。感兴趣的结局是虚弱、活动能力、健康(体重、体重指数)、身体功能(如日常生活活动、肌肉力量、阑尾瘦质量)、医疗保健服务的使用(如住院)、生活质量、饮食质量、死亡率以及护理者和社会支持。数据提取后，我们使用Cochrane协作随机对照试验偏倚风险评估工具评估偏倚风险，使用推荐、评估、发展和评价分级(GRADE)方法评估证据的确定性，并评估统计和方法学异质性。此外，我们对以补充蛋白质为主要干预措施的研究进行了亚组分析。结果:我们确定了15项研究，涉及1825名体弱或体弱的老年人参与者:7项是营养试验，7项是联合入路试验，1项试验既有营养组又有联合入路组。7项研究有低偏倚风险，2项研究有高偏倚风险，6项研究的偏倚风险尚不清楚。营养干预对身体功能(标准化平均差[SMD] 0.16, 95%可信区间[CI] 0.02至0.29)、活动能力(SMD为0.15,95% CI为0.00至0.30)和虚弱(SMD为- 0.22,95% CI为- 0.44至- 0.01)结果的测量有微小但显著的影响。营养干预与体育活动相结合对身体功能(SMD 0.19, 95% CI 0.06至0.32)、活动能力(SMD 0.25, 95% CI 0.02至0.48)和虚弱(SMD - 0.41, 95% CI - 0.68至- 0.14;风险比0.72,95% CI 0.52 ~ 1.00)。蛋白质补充(5项研究)对身体功能测量(SMD 0.16, 95% CI 0.01至0.31)和运动能力测量(SMD 0.20, 95% CI 0.02至0.39)有较小但显著的影响，证据确定性中等。解释:有适度证据表明，营养(包括蛋白质补充)和联合干预措施对体弱或体弱的老年人有益。需要对虚弱有明确定义的试验和反映虚弱识别和诊断结果的试验。普洛斯彼罗注册号:CRD42020144819
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