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The aim of this study is to identify the types of community paramedicine programs and the training for each.
A systematic review of MEDLINE, Embase, grey literature, and bibliographies followed a search strategy using common community paramedicine terms. All studies published in English up to January 22, 2018, were captured. Screening and extraction were completed in duplicate by two independent reviewers. The Mixed Methods Appraisal Tool (MMAT) was used to assess studies’ methodological quality (full methodology on PROSPERO: CRD42017051774).
From 3,004 papers, there were 64 papers identified (58 unique community paramedicine programs). Of the papers with an appraisable study design (40.6%), the median MMAT score was 3 of 4 criteria met, suggesting moderate quality. Programs most often served frequent 911 callers (48.3%) and individuals at risk for emergency department admission, readmission, or hospitalization (41.4%); and 70.7% of programs were preventive home visits. Common services provided were home assessment (29.5%), medication management (39.7%), and referral and/or transport to community services (37.9%); and 77.6% of programs involved interprofessional collaboration. Community paramedicine training was described by 57% of programs and expanded upon traditional paramedicine training and emphasized technical skills. Study heterogeneity prevented meta-analysis.
Community paramedicine programs and training were diverse and allowed community paramedics to address a spectrum of population health and social needs. Training was poorly described. Enabling more programs to assess and report on program and training outcomes would support community paramedicine growth and the development of formalized training or education frameworks.
Screening for depression in older adults is recommended.
To evaluate the diagnostic accuracy of the Two-Question Screen for older adults and compare it with other screening instruments for depression.
We undertook a literature search for studies assessing the diagnostic performance of depression screening instruments in older adults. Combined diagnostic accuracy including sensitivity and specificity were the primary outcomes. Potential risks of bias and the quality of studies were also assessed.
A total of 46506 participants from 132 studies were identified evaluating 16 screening instruments. The majority of studies (63/132) used various versions of the Geriatric Depression Scale (GDS) and 6 used the Two-Question Screen. The combined sensitivity and specificity for the Two-Question Screen were 91.8% (95% CI 85.2–95.6) and 67.7% (95% CI 58.1–76.0), respectively; the diagnostic performance area under the curve (AUC) was 90%. The Two-Question Screen showed comparable performance with other instruments, including clinician-rated scales. The One-Question Screen showed the lowest diagnostic performance with an AUC of 78%. In subgroup analysis, the Two-Question Screen also had good diagnostic performance in screening for major depressive disorder.
The Two-Question Screen is a simple and short instrument for depression screening. Its diagnostic performance is comparable with other instruments and, therefore, it would be favourable to use it for older adult screening programmes.
To examine potential clinical outcomes and cost of active methicillin-resistant Staphylococcus aureus (MRSA) surveillance with and without decolonization in neonatal intensive care units (NICUs) from the perspective of healthcare providers in Hong Kong.
Decision analysis modeling.
Hypothetical cohort of patients admitted to an NICU.
We designed a decision tree to simulate potential outcomes of active MRSA surveillance with and without decolonization in patients admitted to an NICU. Outcome measures included total direct medical cost per patient, MRSA infection rate, and MRSA-associated mortality rate. Model inputs were derived from the literature. Sensitivity analyses evaluated the impact of uncertainty in all model variables.
In the base-case analysis, active surveillance plus decolonization showed a lower expected MRSA infection rate (0.911% vs 1.759%), MRSA-associated mortality rate (0.223% vs 0.431%), and total cost per patient (USD 47,294 vs USD 48,031) compared with active surveillance alone. Sensitivity analyses showed that active surveillance plus decolonization cost less and had lower event rates if the incidence risk ratio of acquiring MRSA infections in carriers after decolonization was less than 0.997. In 10,000 Monte Carlo simulations, active surveillance plus decolonization was significantly less costly than active surveillance alone 99.9% of the time, and both the MRSA infection rate and the MRSA-associated mortality rate were significantly lower 99.9% of the time.
Active surveillance plus decolonization for patients admitted to NICUs appears to be cost saving and effective in reducing the MRSA infection rate and the MRSA-associated mortality rate if addition of decolonization to active surveillance reduces the risk of MRSA infection.
Infect Control Hosp Epidemiol 2012;33(10):1024-1030
The child was 2 years, 8 months old and weighed 25 pounds, one-fifth
the weight of her mother, for whom she was to be the bone marrow donor.
The mother had suffered a relapse of acute myelogenous leukemia; her
physicians recommended a bone marrow transplant. The child was the
closest human leukocyte antigen (HLA) match and thus the best donor
candidate for her mother's transplant.
There is increasing evidence suggesting that the cut-off values for defining obesity used in the Western countries cannot be readily applied to Asians, who often have smaller body frames than Caucasians. We examined the BMI and body fat (BF) as measured by bioelectrical impedance in 5153 Hong Kong Chinese subjects. We aimed to assess the optimal BMI reflecting obesity as defined by abnormal BF in Hong Kong Chinese. Receiver operating characteristic curve (ROC) analysis was used to assess the optimal BMI predicting BF at different levels. The mean age and SD OF THE 5153 SUBJECTS (3734 WOMEN AND 1419 MEN) WAS 51.5 (sd 16.3) years (range: 18.0–89.5 years, median: 50.7 years). Age-adjusted partial correlation (r) between BMI and BF in women and men were 0.899 (P<0.001) and 0.818 (P<0.001) respectively. Using ROC analysis, the BMI corresponding to the conventional upper limit of normal BF was 22.5–23.1 kg/m2, and the BMI corresponding to the 90 percentiles of BF was 25.4–26.1 kg/m2. Despite similar body fat contents, the BMI cut-off value used to define obesity in Hong Kong Chinese should be lower as compared to Caucasians. We suggest a BMI of 23 kg/m2 and 26 kg/m2 as the cut-off values to define overweight and obesity respectively in Hong Kong Chinese.
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