Dataset Information

Clinical preventive guidelines for school-aged children and adolescents in primary care: a protocol for a systematic review.

ABSTRACT:

Introduction

Guidelines for clinical preventive services targeting school-aged children and adolescents in primary care are limited, often inconsistent and difficult to apply in clinical contexts. This publication describes the protocol concerning a comprehensive systematic review that primarily aims to collect and synthesise available guidelines for prevention in primary care focused on school-aged children living in high-income regions. A second objective is to assess the quality of identified documents.

Methods and analysis

We will search for reports providing clinical practice guidelines or consensus or expert opinion on preventive actions in paediatric primary care. We will use the WHO definition of prevention. We will focus on children aged 6-18 years living in the European region, the USA, Canada and Australia. We will search PubMed, Embase, Web of Science and Cochrane Library and guidelines-specific databases from 1 January 2010. We will also explore the grey literature using web search engines (Google and Google Scholar). We will finally obtain unpublished information through personal contact with national paediatric societies. We will summarise all identified documents as well as their potential methodological bias. We will further use the Appraisal of Guidelines Research and Evaluation Instrument, version II tool to critically appraise their quality.

Ethics and dissemination

Our findings will contribute to the identification of clinical preventive guidelines for which implementation in routine paediatric primary care should be considered. We intend to disseminate our results through publication in peer-reviewed journals and conference proceedings.PROSPERO registration numberCRD42020163184.

SUBMITTER: Patseadou M

PROVIDER: S-EPMC7733204 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Publications

Clinical preventive guidelines for school-aged children and adolescents in primary care: a protocol for a systematic review.

Patseadou Magdalini M Pfarrwaller Eva E Haller Dagmar M DM

BMJ open 20201210 12

<h4>Introduction</h4>Guidelines for clinical preventive services targeting school-aged children and adolescents in primary care are limited, often inconsistent and difficult to apply in clinical contexts. This publication describes the protocol concerning a comprehensive systematic review that primarily aims to collect and synthesise available guidelines for prevention in primary care focused on school-aged children living in high-income regions. A second objective is to assess the quality of id ...[more]

PMID: 33303432

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Project description:BACKGROUND:Variable and poor care quality are important causes of preventable patient harm. Many patients receive less than recommended care, but the extent of the problem remains largely unknown. The CareTrack Kids (CTK) research programme sought to address this evidence gap by developing a set of indicators to measure the quality of care for common paediatric conditions. In this study, we focus on one clinical area, 'preventive care' for pre-school aged children. Our objectives were two-fold: (i) develop and validate preventive care quality indicators and (ii) apply them in general medical practice to measure adherence. METHODS:Clinical experts (n =?6) developed indicator questions (IQs) from clinical practice guideline (CPG) recommendations using a multi-stage modified Delphi process, which were pilot tested in general practice. The medical records of Australian children (n =?976) from general practices (n =?80) in Queensland, New South Wales and South Australia identified as having a consultation for one of 17 CTK conditions of interest were retrospectively reviewed by trained paediatric nurses. Statistical analyses were performed to estimate percentage compliance and its 95% confidence intervals. RESULTS:IQs (n =?43) and eight care 'bundles' were developed and validated. Care was delivered in line with the IQs in 43.3% of eligible healthcare encounters (95% CI 30.5-56.7). The bundles of care with the highest compliance were 'immunisation' (80.1%, 95% CI 65.7-90.4), 'anthropometric measurements' (52.7%, 95% CI 35.6-69.4) and 'nutrition assessments' (38.5%, 95% CI 24.3-54.3), and lowest for 'visual assessment' (17.9%, 95% CI 8.2-31.9), 'musculoskeletal examinations' (24.4%, 95% CI 13.1-39.1) and 'cardiovascular examinations' (30.9%, 95% CI 12.3-55.5). CONCLUSIONS:This study is the first known attempt to develop specific preventive care quality indicators and measure their delivery to Australian children in general practice. Our findings that preventive care is not reliably delivered to all Australian children and that there is substantial variation in adherence with the IQs provide a starting point for clinicians, researchers and policy makers when considering how the gap between recommended and actual care may be narrowed. The findings may also help inform the development of specific improvement interventions, incentives and national standards.

Project description:BackgroundThe burden of malaria infection in sub-Saharan Africa among school-aged children aged 5-15 years is underappreciated and represents an important source of human-to-mosquito transmission of Plasmodium falciparum. Additional interventions are needed to control and eliminate malaria. We aimed to assess whether preventive treatment of malaria might be an effective means of reducing P falciparum infection and anaemia in school-aged children and lowering parasite transmission.MethodsIn this systematic review and two meta-analyses, we searched the online databases PubMed, Embase, Cochrane CENTRAL, and Clinicaltrials.gov for intervention studies published between Jan 1, 1990, and Dec 14, 2018. We included randomised studies that assessed the effect of antimalarial treatment among asymptomatic school-aged children aged 5-15 years in sub-Saharan Africa on prevalence of P falciparum infection and anaemia, clinical malaria, and cognitive function. We first extracted data for a study-level meta-analysis, then contacted research groups to request data for an individual participant data meta-analysis. Outcomes of interest included prevalence of P falciparum infection detected by microscopy, anaemia (study defined values or haemoglobin less than age-adjusted and sex-adjusted values), clinical malaria (infection and symptoms on the basis of study-specific definitions) during follow-up, and code transmission test scores. We assessed effects by treatment type and duration of time protected, and explored effect modification by transmission setting. For study-level meta-analysis, we calculated risk ratios for binary outcomes and standardised mean differences for continuous outcomes and pooled outcomes using fixed-effect and random-effects models. We used a hierarchical generalised linear model for meta-analysis of individual participant data. This study is registered with PROSPERO, CRD42016030197.FindingsOf 628 studies identified, 13 were eligible for the study-level meta-analysis (n=16 309). Researchers from 11 studies contributed data on at least one outcome (n=15 658) for an individual participant data meta-analysis. Interventions and study designs were highly heterogeneous; overall risk of bias was low. In the study-level meta-analysis, treatment was associated with reductions in P falciparum prevalence (risk ratio [RR] 0·27, 95% CI 0·17-0·44), anaemia (0·77, 0·65-0·91), and clinical malaria (0·40, 0·28-0·56); results for cognitive outcomes are not presented because data were only available for three trials. In our individual participant data meta-analysis, we found treatment significantly decreased P falciparum prevalence (adjusted RR [ARR] 0·46, 95% CI 0·40-0·53; p<0·0001; 15 648 individuals; 11 studies), anaemia (ARR 0·85, 0·77-0·92; p<0·0001; 15 026 individuals; 11 studies), and subsequent clinical malaria (ARR 0·50, 0·39-0·60; p<0·0001; 1815 individuals; four studies) across transmission settings. We detected a marginal effect on cognitive function in children older than 10 years (adjusted mean difference in standardised test scores 0·36, 0·01-0·71; p=0·044; 3962 individuals; five studies) although we found no significant effect when combined across all ages.InterpretationPreventive treatment of malaria among school-aged children significantly decreases P falciparum prevalence, anaemia, and risk of subsequent clinical malaria across transmission settings. Policy makers and programme managers should consider preventive treatment of malaria to protect this age group and advance the goal of malaria elimination, while weighing these benefits against potential risks of chemoprevention.FundingUS National Institutes of Health and Burroughs Wellcome Fund/ASTMH Fellowship.

Project description:BACKGROUND:Recent studies have observed low levels of physical activity in children and adolescents worldwide. Physical activity interventions are increasingly carried out to counteract this development. The school environment is an ideal setting for such interventions to take place as large numbers of children and adolescents can be addressed. With the assumption that motivation is the key to initiate and sustain beneficial health behaviors, theory-based intervention studies apply motivational strategies to increase students' participation in physical activity. The main objective of this systematic review will be to analyze the effects of school-based physical activity interventions on a variety of motivational outcomes towards physical activity in school-aged children and adolescents. METHODS:Comprehensive literature searches will be conducted in multiple electronic databases, including MEDLINE, Scopus, PsycINFO, ERIC, PSYNDEX, Physical Education Index, and SPORTDiscus. We will include randomized controlled trials (RCTs) and quasi-experimental studies examining the effects of school-based physical activity interventions (e.g., physical activity components during school lessons including physical education, or during morning, lunch and afternoon breaks). Primarily extracurricular physical activity interventions will not be considered. The primary outcomes will be students' motivation, basic psychological needs, goal orientation, enjoyment, and motivational teaching climate in physical education. Secondary outcomes will be the students' physical activity behaviors in-class, during school, and in leisure time. Only peer-reviewed articles published in English will be considered. Three reviewers will independently screen all citations and full-text articles, and two reviewers will abstract data. The quality of the included studies will be assessed with the Cochrane Collaboration's tool for assessing risk of bias for RCTs and the GRADE methodology will be used to assess the certainty of the body of retreived evidence. DISCUSSION:In order to increase and maintain physical activity levels in children and adolescents, motivation towards physical activity should be sustained. It is anticipated that the results of this systematic review will provide information as to which strategies implemented in the school setting are effective in increasing students' motivation towards physical activity, and hence increase their physical activity during school and after-school hours. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42018110306.

Dataset Information

Clinical preventive guidelines for school-aged children and adolescents in primary care: a protocol for a systematic review.

Introduction

Methods and analysis

Ethics and dissemination

Publications

Clinical preventive guidelines for school-aged children and adolescents in primary care: a protocol for a systematic review.

Similar Datasets

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