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A scoping review of evaluation frameworks and their applicability to real-world physical activity and dietary change programme evaluation.
Fynn, JF, Hardeman, W, Milton, K, Jones, AP
BMC public health. 2020;(1):1000
Abstract
BACKGROUND Physical activity and dietary change programmes play a central role in addressing public health priorities. Programme evaluation contributes to the evidence-base about these programmes; and helps justify and inform policy, programme and funding decisions. A range of evaluation frameworks have been published, but there is uncertainty about their usability and applicability to different programmes and evaluation objectives, and the extent to which they are appropriate for practitioner-led or researcher-led evaluation. This review appraises the frameworks that may be applicable to evaluation of physical activity and/or dietary change programmes, and develops a typology of the frameworks to help guide decision making by practitioners, commissioners and evaluators. METHODS A scoping review approach was used. This included a systematic search and consultation with evaluation experts to identify evaluation frameworks and to develop a set of evaluation components to appraise them. Data related to each framework's general characteristics and components were extracted. This was used to construct a typology of the frameworks based on their intended programme type, evaluation objective and format. Each framework was then mapped against the evaluation components to generate an overview of the guidance included within each framework. RESULTS The review identified 71 frameworks. These were described variously in terms of purpose, content, or applicability to different programme contexts. The mapping of frameworks highlighted areas of overlap and strengths and limitations in the available guidance. Gaps within the frameworks which may warrant further development included guidance on participatory approaches, non-health and unanticipated outcomes, wider contextual and implementation factors, and sustainability. CONCLUSIONS Our typology and mapping signpost to frameworks where guidance on specific components can be found, where there is overlap, and where there are gaps in the guidance. Practitioners and evaluators can use these to identify, agree upon and apply appropriate frameworks. Researchers can use them to identify evaluation components where there is already guidance available and where further development may be useful. This should help focus research efforts where it is most needed and promote the uptake and use of evaluation frameworks in practice to improve the quality of evaluation and reporting.
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2.
Complementary and Alternative Medicine in the School-Age Child With Autism.
Nath, D
Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners. 2017;(3):393-397
Abstract
This case study examines some common complementary and alternative treatments used in the management of behavioral and gastrointestinal symptoms associated with autism including food selectivity, abdominal pain, nausea, gastroesophageal reflux, constipation, and diarrhea. The current literature on the safety and efficacy of these treatments for pediatric patients is reviewed. This study examines therapies including gluten-free and casein-free diet, probiotics, vitamin B12, omega-3 fatty acid supplementation, chelation therapy, acupuncture, and chiropractic manipulations used in treating these core symptoms of autism.
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3.
Weighing as a stand-alone intervention does not reduce excessive gestational weight gain compared to routine antenatal care: a systematic review and meta-analysis of randomised controlled trials.
Fealy, SM, Taylor, RM, Foureur, M, Attia, J, Ebert, L, Bisquera, A, Hure, AJ
BMC pregnancy and childbirth. 2017;(1):36
Abstract
BACKGROUND Excessive gestational weight gain is associated with short and long-term adverse maternal and infant health outcomes, independent of pre-pregnancy body mass index. Weighing pregnant women as a stand-alone intervention during antenatal visits is suggested to reduce pregnancy weight gain. In the absence of effective interventions to reduce excessive gestational gain within the real world setting, this study aims to test if routine weighing as a stand-alone intervention can reduce total pregnancy weight gain and, in particular, excessive gestational weight gain. METHODS A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted between November 2014 and January 2016, and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Seven databases were searched. A priori eligibility criteria were applied to published literature by at least two independent reviewers. Studies considered methodologically rigorous, as per the Academy of Nutrition and Dietetics Quality Criteria Checklist for Primary Research, were included. Meta-analysis was conducted using fixed-effects models. RESULTS A total of 5223 (non-duplicated) records were screened, resulting in two RCTs that were pooled for meta-analysis (n = 1068 randomised participants; n = 538 intervention, n = 534 control). No difference in total weight gain per week was observed between intervention and control groups (weighted mean difference (WMD) -0.00 kg/week, 95% confidence interval (CI) -0.03 to 0.02). There was also no reduction in excessive gestational weight gain between intervention and control, according to pre-pregnancy body mass index (BMI). However, total weight gain was lower in underweight women (n = 23, BMI <18.5 kg/m2) in the intervention compared to control group (-0.12 kg/week, 95% CI -0.23 to -0.01). No significant differences were observed for other pregnancy, birth and infant outcomes. CONCLUSION Weighing as a stand-alone intervention is not worse nor better at reducing excessive gestational weight gain than routine antenatal care.
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4.
Preeclampsia and future cardiovascular disease in women: How good are the data and how can we manage our patients?
Seely, EW, Tsigas, E, Rich-Edwards, JW
Seminars in perinatology. 2015;(4):276-83
Abstract
Women with a history of preeclampsia have double the risk of future heart disease and stroke, and elevated risks of hypertension and diabetes. The American Heart Association (AHA) and the American College of Obstetrics and Gynecology now include preeclampsia as a risk factor for future cardiovascular disease (CVD) with the recommendation of obtaining a history of preeclampsia and improving lifestyle behaviors for women with such a history. Research has progressed from asking whether preeclampsia is associated with CVD to how preeclampsia is associated with CVD, and the implications for prevention of CVD among women with a history of preeclampsia. A history of preeclampsia "unmasks" future CVD risk; research is inconclusive whether it also causes vascular damage that leads to CVD. For women with prior preeclampsia, the AHA recommends CVD risk reduction actions similar to those for other "at risk" groups: cessation of cigarette smoking, physical activity, weight reduction if overweight or obese and counseling to follow a "DASH" like diet. The efficacy of these lifestyle modifications to lower risk of CVD in women with prior preeclampsia remains to be determined. Barriers exist to implementing lifestyle improvement measures in this population, including lack of awareness of both patients and clinicians of this link between preeclampsia and CVD. We review patient, provider, and systems level barriers and solutions to leverage this information to prevent CVD among women with a history of preeclampsia.
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5.
What we do not know about ADHD… yet.
Kiely, B, Adesman, A
Current opinion in pediatrics. 2015;(3):395-404
Abstract
PURPOSE OF REVIEW This article provides an overview of current controversies in attention-deficit/hyperactivity disorder (ADHD) research, with an emphasis on recent findings that are directly relevant to clinical practice. RECENT FINDINGS Over the past few years, a number of studies have added key evidence to ongoing debates about the epidemiology, nosology, and treatment of ADHD. Although the causes of the rising prevalence of ADHD in the USA are still not fully understood, recent research suggests that environmental factors and changes to the diagnostic criteria may have played a role. In addition, there continues to be controversy surrounding the clinical diagnosis of ADHD and newly recognized, related conditions such as sluggish cognitive tempo. Recent studies have also challenged previous assumptions about the long-term effects of stimulant treatment on growth, academic achievement, and substance use. Moreover, although most complementary and alternative therapies for ADHD appear to be ineffective, there is emerging evidence supporting the value of fatty acid supplementation. Although these findings are promising, more research is needed on all fronts. SUMMARY Although research has shed light on unanswered questions about the epidemiology, nosology, and treatment of ADHD, much is still not known. An understanding of the most important current controversies in ADHD research may aid pediatricians in clinical decision making and allow them to counsel patients more effectively.
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6.
A moving line in the sand: a review of obstetric management surrounding periviability.
Arora, KS, Miller, ES
Obstetrical & gynecological survey. 2014;(6):359-68
Abstract
Periviable birth poses numerous clinical and ethical challenges for the practicing clinician. We review the data surrounding the administration of corticosteroids for fetal lung maturity, antibiotics in the case of preterm premature rupture of membranes, magnesium sulfate for cerebral palsy prophylaxis, fetal monitoring, and cesarean delivery. The ethical complexities of patient counseling are also reviewed with a recommendation toward shared decision making between patient and physician.
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7.
[Dietary counseling in obesity].
Meyer, N, Haslebacher, Y, Teuscher-Sick, P, Fischer, B
Therapeutische Umschau. Revue therapeutique. 2013;(2):109-11
Abstract
Information on weight management and a healthy eating is accessible to anyone. However, recommendations are inconsistent. This often leads to confusion rather than to real changes in eating behavior. The principle of a long-term weight reduction is based on the idea of achieving negative energy balance with a healthy, balanced and slightly hypocaloric diet. The regimen is neither supposed to be rigid nor should it ban any food products or food products. Changes in eating patterns come about step by step and the counseling approach should be based on the patient's habits and capabilities. The basic requirement to successfully treat obese patients is their own motivation Therefore, the timing of launching the therapy needs to be well chosen. Apart from goals directly concerning weight loss, goals related to well-being, general health and exercise should be set and pursued. However, the main focus should be on changes of dietary behavior. Dietary counseling is preferably embedded in a multidisciplinary treatment concept.
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8.
The challenge of integrating self-management support into clinical settings.
McGowan, P
Canadian journal of diabetes. 2013;(1):45-50
Abstract
Best practice diabetes mellitus clinical treatment and education takes place in the medical clinic, however, patient outcomes are largely mediated through their own behaviour and lifestyle that occurs after they leave the clinical setting. Once they return home, people usually continue to engage in the social, cultural and lifestyle behaviours that had contributed to having diabetes in the first place. Although a host of factors (e.g. economic, health care team and system, condition and client-related) can impact a client's capacity to self-manage, there are client, organizational and community level strategies that may partially mitigate these difficulties. To address client behaviour, clinicians are increasingly becoming skilled to incorporate self-management support including behavioural counselling interventions into routine practice. At the organizational level, the operation and structure of the clinical setting may create difficulty for staff to provide self-management support. Sustaining benefits on a day-to-day basis presents an additional challenge. This article will review several common implementation barriers to self-management support and describe strategies and techniques used elsewhere to successfully integrate self-management support as a core care component for persons with diabetes.
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9.
A systematic review of motivational interviewing within musculoskeletal health.
Chilton, R, Pires-Yfantouda, R, Wylie, M
Psychology, health & medicine. 2012;(4):392-407
Abstract
Motivational interviewing (MI) has been investigated within a range of healthcare environments though to date no studies have systematically assessed its application and effectiveness within musculoskeletal health. The aim of this study is to identify interventions that have utilised MI to create change within musculoskeletal healthcare, evaluate quality and effectiveness, as well as identify the level of training received by those utilising the approach. The search strategy identified both published and unpublished or grey literature through electronic resources, reference list and content searches. Five studies were identified for quality assessment. Due to variations in delivery modality, musculoskeletal condition and type of MI application it was not possible to provide direct comparative interpretations for these factors. A data synthesis was used to provide a summary of study characteristics, a narrative overview and conduct a quality assessment as well as considering authors comments on study limitations. The results of the quality assessment highlighted a number of methodological issues which supported and expanded upon those expressed by the studies authors. None of the studies contained children or young people and in terms of training there were variations in training provider, duration and competency, as well as variation in the fidelity of MI. The findings have highlighted the need for well designed randomised controlled trials that are suitability powered to measure the effectiveness of MI within musculoskeletal health. Future studies may consider the application of MI within musculoskeletal conditions in terms of self-management and its application to creating lifestyle changes (e.g., diet, exercise) for adults, as well as children and young people. Research currently being conducted may expand upon the evidence, feasibility and validity of MI within areas such as fibromyalgia, osteoporosis, arthritis, understanding of knee replacement and rehabilitation.
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10.
Update on gestational diabetes mellitus.
Evensen, AE
Primary care. 2012;(1):83-94
Abstract
The incidence of gestational diabetes mellitus (GDM) is increasing in the United States. Universal GDM screening is recommended, although evidence of benefit is lacking. Treatment of GDM reduces the risk of shoulder dystocia, preeclampsia, and macrosomia. Intensive treatment is more effective than less-intensive treatment. Traditional management includes diet, exercise, and short- and intermediate-acting insulin regimens. Use of metformin and glyburide is controversial, but evidence supporting safety and efficacy is accumulating. Postpartum screening with a glucose tolerance test rather than a fasting blood glucose level should be performed 6 weeks after delivery.