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  1. Article ; Online: Generating consistent longitudinal real-world data to support research: lessons from physical therapists.

    Oatis, Carol A / Konnyu, Kristin J / Franklin, Patricia D

    ACR open rheumatology

    2022  Volume 4, Issue 9, Page(s) 771–774

    Language English
    Publishing date 2022-06-16
    Publishing country United States
    Document type Journal Article
    ISSN 2578-5745
    ISSN (online) 2578-5745
    DOI 10.1002/acr2.11465
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  2. Article ; Online: Evidence Synthesis for Complex Interventions Using Meta-Regression Models.

    Konnyu, Kristin J / Grimshaw, Jeremy M / Trikalinos, Thomas A / Ivers, Noah M / Moher, David / Dahabreh, Issa J

    American journal of epidemiology

    2023  Volume 193, Issue 2, Page(s) 323–338

    Abstract: A goal of evidence synthesis for trials of complex interventions is to inform the design or implementation of novel versions of complex interventions by predicting expected outcomes with each intervention version. Conventional aggregate data meta- ... ...

    Abstract A goal of evidence synthesis for trials of complex interventions is to inform the design or implementation of novel versions of complex interventions by predicting expected outcomes with each intervention version. Conventional aggregate data meta-analyses of studies comparing complex interventions have limited ability to provide such information. We argue that evidence synthesis for trials of complex interventions should forgo aspirations of estimating causal effects and instead model the response surface of study results to 1) summarize the available evidence and 2) predict the average outcomes of future studies or in new settings. We illustrate this modeling approach using data from a systematic review of diabetes quality improvement (QI) interventions involving at least 1 of 12 QI strategy components. We specify a series of meta-regression models to assess the association of specific components with the posttreatment outcome mean and compare the results to conventional meta-analysis approaches. Compared with conventional approaches, modeling the response surface of study results can better reflect the associations between intervention components and study characteristics with the posttreatment outcome mean. Modeling study results using a response surface approach offers a useful and feasible goal for evidence synthesis of complex interventions that rely on aggregate data.
    Language English
    Publishing date 2023-09-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2937-3
    ISSN 1476-6256 ; 0002-9262
    ISSN (online) 1476-6256
    ISSN 0002-9262
    DOI 10.1093/aje/kwad184
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  3. Article ; Online: Changes to Prenatal Care Visit Frequency and Telehealth: A Systematic Review of Qualitative Evidence.

    Konnyu, Kristin J / Danilack, Valery A / Adam, Gaelen P / Friedman Peahl, Alex / Cao, Wangnan / Balk, Ethan M

    Obstetrics and gynecology

    2023  Volume 141, Issue 2, Page(s) 299–323

    Abstract: Objective: To systematically review patient, partner or family, and clinician perspectives, preferences, and experiences related to prenatal care visit schedules and televisits for routine prenatal care.: Data sources: PubMed, the Cochrane databases, ...

    Abstract Objective: To systematically review patient, partner or family, and clinician perspectives, preferences, and experiences related to prenatal care visit schedules and televisits for routine prenatal care.
    Data sources: PubMed, the Cochrane databases, EMBASE, CINAHL, ClinicalTrials.gov , PsycINFO, and SocINDEX from inception through February 12, 2022.
    Methods of study selection: This review of qualitative research is a subset of a larger review on both the qualitative experiences and quantitative benefits and harms of reduced prenatal care visit schedules and televisits for routine prenatal care that was produced by the Brown Evidence-based Practice Center for the Agency for Healthcare Research and Quality. For the qualitative review, we included qualitative research studies that examined perspectives, preferences, and experiences about the number of scheduled visits and about televisits for routine prenatal care.
    Tabulation, integration, and results: We synthesized barriers and facilitators to the implementation of reduced care visits or of televisits into 1 of 14 domains defined by the Theoretical Domains Framework (TDF) and a Best Fit Framework approach. We summarized themes within TDF domains. We assessed our confidence in the summary statements using the GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in Evidence from Reviews of Qualitative research) tool. Four studies addressed the number of scheduled routine prenatal visits, and five studies addressed televisits. Across studies, health care professionals believed fewer routine visits may be more convenient for patients and may increase clinic capacity to provide additional care for patients with high-risk pregnancies. However, both patients and clinicians had concerns about potential lesser care with fewer visits, including concerns about quality of care and challenges with implementing new delivery-of-care models.
    Conclusion: Although health care professionals and patients had some concerns about reduced visit schedules and use of televisits, several potential benefits were also noted. Our synthesis of qualitative evidence provides helpful insights into the perspectives, preferences, and experiences of important stakeholders with respect to implementing changes to prenatal care delivery that may complement findings of traditional quantitative evidence syntheses.
    Systematic review registration: PROSPERO, CRD42021272287.
    MeSH term(s) Pregnancy ; Child ; Female ; Infant, Newborn ; Humans ; Prenatal Care/methods ; Health Personnel ; Delivery of Health Care ; Telemedicine ; Perinatal Care
    Language English
    Publishing date 2023-01-04
    Publishing country United States
    Document type Systematic Review ; Journal Article
    ZDB-ID 207330-4
    ISSN 1873-233X ; 0029-7844
    ISSN (online) 1873-233X
    ISSN 0029-7844
    DOI 10.1097/AOG.0000000000005046
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  4. Article ; Online: Reduced Compared With Traditional Schedules for Routine Antenatal Visits: A Systematic Review.

    Balk, Ethan M / Danilack, Valery A / Bhuma, Monika Reddy / Cao, Wangnan / Adam, Gaelen P / Konnyu, Kristin J / Peahl, Alex Friedman

    Obstetrics and gynecology

    2023  Volume 142, Issue 1, Page(s) 8–18

    Abstract: Objective: To assess differences in maternal and child outcomes in studies comparing reduced routine antenatal visit schedules with traditional schedules.: Data sources: A search was conducted of PubMed, Cochrane databases, EMBASE, CINAHL, and ... ...

    Abstract Objective: To assess differences in maternal and child outcomes in studies comparing reduced routine antenatal visit schedules with traditional schedules.
    Data sources: A search was conducted of PubMed, Cochrane databases, EMBASE, CINAHL, and ClinicalTrials.gov through February 12, 2022, searching for antenatal (prenatal) care, pregnancy, obstetrics, telemedicine, remote care, smartphones, telemonitoring, and related terms, as well as primary study designs. The search was restricted to high-income countries.
    Methods of study selection: Double independent screening was done in Abstrackr for studies comparing televisits and in-person routine antenatal care visits for maternal, child, health care utilization, and harm outcomes. Data were extracted into SRDRplus with review by a second researcher.
    Tabulation, integration, and results: Five randomized controlled trials and five nonrandomized comparative studies compared reduced routine antenatal visit schedules with traditional schedules. Studies did not find differences between schedules in gestational age at birth, likelihood of being small for gestational age, likelihood of a low Apgar score, likelihood of neonatal intensive care unit admission, maternal anxiety, likelihood of preterm birth, and likelihood of low birth weight. There was insufficient evidence for numerous prioritized outcomes of interest, including completion of the American College of Obstetricians and Gynecologists-recommended services and patient experience measures.
    Conclusion: The evidence base is limited and heterogeneous and allowed few specific conclusions. Reported outcomes included, for the most part, standard birth outcomes that do not have strong plausible biological connection to structural aspects of antenatal care. The evidence did not find negative effects of reduced routine antenatal visit schedules, which may support implementation of fewer routine antenatal visits. However, to enhance confidence in this conclusion, future research is needed, particularly research that includes outcomes of most importance and relevance to changing antenatal care visits.
    Systematic review registration: PROSPERO, CRD42021272287.
    MeSH term(s) Female ; Humans ; Infant, Newborn ; Pregnancy ; Infant, Low Birth Weight ; Obstetrics ; Parturition ; Premature Birth ; Prenatal Care/methods
    Language English
    Publishing date 2023-06-07
    Publishing country United States
    Document type Systematic Review ; Journal Article
    ZDB-ID 207330-4
    ISSN 1873-233X ; 0029-7844
    ISSN (online) 1873-233X
    ISSN 0029-7844
    DOI 10.1097/AOG.0000000000005193
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  5. Article ; Online: Televisits Compared With In-Person Visits for Routine Antenatal Care: A Systematic Review.

    Balk, Ethan M / Danilack, Valery A / Cao, Wangnan / Bhuma, Monika Reddy / Adam, Gaelen P / Konnyu, Kristin J / Peahl, Alex Friedman

    Obstetrics and gynecology

    2023  Volume 142, Issue 1, Page(s) 19–29

    Abstract: Objective: To compare benefits and harms of televisits and in-person visits in people receiving routine antenatal care.: Data sources: A search was conducted of PubMed, Cochrane databases, EMBASE, CINAHL, and ClinicalTrials.gov through February 12, ... ...

    Abstract Objective: To compare benefits and harms of televisits and in-person visits in people receiving routine antenatal care.
    Data sources: A search was conducted of PubMed, Cochrane databases, EMBASE, CINAHL, and ClinicalTrials.gov through February 12, 2022, for antenatal (prenatal) care, pregnancy, obstetrics, telemedicine, remote care, smartphones, telemonitoring, and related terms, as well as primary study designs. The search was restricted to high-income countries.
    Methods of study selection: Double independent screening was done in Abstrackr for studies comparing televisits and in-person routine antenatal care visits for maternal, child, health care utilization, and harm outcomes. Data were extracted into SRDRplus with review by a second researcher.
    Tabulation, integration, and results: Two randomized controlled trials, four nonrandomized comparative studies, and one survey compared visit types between 2004 and 2020, three of which were conducted during the coronavirus disease 2019 (COVID-19) pandemic. Number, timing, and mode of televisits and who provided care varied across studies. Low-strength evidence from studies comparing hybrid (televisits and in-person visits) and all in-person visits did not indicate differences in rates of neonatal intensive care unit admission of the newborn (summary odds ratio [OR] 1.02, 95% CI 0.82-1.28) or preterm births (summary OR 0.93, 95% CI 0.84-1.03). However, the studies with stronger, although still statistically nonsignificant, associations between use of hybrid visits and preterm birth compared the COVID-19 pandemic and prepandemic eras, confounding the association. There is low-strength evidence that satisfaction with overall antenatal care was greater in people who were pregnant and receiving hybrid visits. Other outcomes were sparsely reported.
    Conclusion: People who are pregnant may prefer hybrid televisits and in-person visits. Although there is no evidence of differences in clinical outcomes between hybrid visits and in-person visits, the evidence is insufficient to evaluate most outcomes.
    Systematic review registration: PROSPERO, CRD42021272287.
    MeSH term(s) Female ; Humans ; Infant, Newborn ; Pregnancy ; COVID-19 ; Obstetrics ; Pandemics ; Premature Birth ; Prenatal Care/methods
    Language English
    Publishing date 2023-06-07
    Publishing country United States
    Document type Systematic Review ; Journal Article
    ZDB-ID 207330-4
    ISSN 1873-233X ; 0029-7844
    ISSN (online) 1873-233X
    ISSN 0029-7844
    DOI 10.1097/AOG.0000000000005194
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  6. Article ; Online: Imputing intracluster correlation coefficients from a posterior predictive distribution is a feasible method of dealing with unit of analysis errors in a meta-analysis of cluster RCTs.

    Konnyu, Kristin J / Taljaard, Monica / Ivers, Noah M / Moher, David / Grimshaw, Jeremy M

    Journal of clinical epidemiology

    2021  Volume 139, Page(s) 307–318

    Abstract: Background: Incorporating cluster randomized trials (CRTs) into meta-analyses is challenging because appropriate standard errors of study estimates accounting for clustering are not always reported. Systematic reviews of CRTs often use a single constant ...

    Abstract Background: Incorporating cluster randomized trials (CRTs) into meta-analyses is challenging because appropriate standard errors of study estimates accounting for clustering are not always reported. Systematic reviews of CRTs often use a single constant external estimate of the intraclass correlation coefficient (ICC) to adjust study estimate standard errors and facilitate meta-analyses; an approach that fails to account for possible variation of ICCs among studies and the imprecision with which they are estimated. Using a large systematic review of the effects of diabetes quality improvement interventions, we investigated whether we could better account for ICC variation and uncertainty in meta-analyzed effect estimates by imputing missing ICCs from a posterior predictive distribution constructed from a database of relevant ICCs.
    Methods: We constructed a dataset of ICC estimates from applicable studies. For outcomes with two or more available ICC estimates, we constructed posterior predictive ICC distributions in a Bayesian framework. For a selected continuous outcome, glycosylated hemoglobin (HbA1c), we compared the impact of incorporating a single constant ICC versus imputing ICCs drawn from the posterior predictive distribution when estimating the effect of intervention components on post treatment mean in a case study of diabetes quality improvement trials.
    Results: Using internal and external ICC estimates, we were able to construct a database of 59 ICCs for 12 of the 13 review outcomes (range 1-10 per outcome) and estimate the posterior predictive ICC distribution for 11 review outcomes. Synthesized results were not markedly changed by our approach for HbA1c.
    Conclusion: Building posterior predictive distributions to impute missing ICCs is a feasible approach to facilitate principled meta-analyses of cluster randomized trials using prior data. Further work is needed to establish whether the application of these methods leads to improved review inferences for different reviews based on different factors (e.g., proportion of CRTs and CRTs with missing ICCs, different outcomes, variation and precision of ICCs).
    MeSH term(s) Cluster Analysis ; Data Collection/methods ; Data Collection/statistics & numerical data ; Diabetes Mellitus/therapy ; Humans ; Meta-Analysis as Topic ; Randomized Controlled Trials as Topic/statistics & numerical data ; Research Design/statistics & numerical data ; Scientific Experimental Error
    Language English
    Publishing date 2021-06-22
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639306-8
    ISSN 1878-5921 ; 0895-4356
    ISSN (online) 1878-5921
    ISSN 0895-4356
    DOI 10.1016/j.jclinepi.2021.06.011
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  7. Article ; Online: Diagnostic Imaging and Medical Management of Acute Left-Sided Colonic Diverticulitis : A Systematic Review.

    Balk, Ethan M / Adam, Gaelen P / Bhuma, Monika Reddy / Konnyu, Kristin J / Saldanha, Ian J / Beland, Michael D / Shah, Nishit

    Annals of internal medicine

    2022  Volume 175, Issue 3, Page(s) 379–387

    Abstract: Background: Clinicians need to better understand the value of computed tomography (CT) imaging and nonsurgical treatment options to manage acute left-sided colonic diverticulitis.: Purpose: To evaluate CT imaging, outpatient treatment of ... ...

    Abstract Background: Clinicians need to better understand the value of computed tomography (CT) imaging and nonsurgical treatment options to manage acute left-sided colonic diverticulitis.
    Purpose: To evaluate CT imaging, outpatient treatment of uncomplicated diverticulitis, antibiotic treatment, and interventional radiology for patients with complicated diverticulitis.
    Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, CINAHL, and ClinicalTrials.gov from 1 January 1990 through 16 November 2020.
    Study selection: Existing systematic reviews of CT imaging accuracy, as well as randomized trials and adjusted nonrandomized comparative studies reporting clinical or patient-centered outcomes.
    Data extraction: 6 researchers extracted study data and risk of bias, which were verified by an independent researcher. The team assessed strength of evidence across studies.
    Data synthesis: Based on moderate-strength evidence, CT imaging is highly accurate for diagnosing acute diverticulitis. For patients with uncomplicated acute diverticulitis, 6 studies provide low-strength evidence that initial outpatient and inpatient management have similar risks for recurrence or elective surgery, but they provide insufficient evidence regarding other outcomes. Also, for patients with uncomplicated acute diverticulitis, 5 studies comparing antibiotics versus no antibiotics provide low-strength evidence that does not support differences in risks for treatment failure, elective surgery, recurrence, posttreatment complications, and other outcomes. Evidence is insufficient to determine choice of antibiotic regimen (7 studies) or effect of percutaneous drainage (2 studies).
    Limitations: The evidence base is mostly of low strength. Studies did not adequately assess heterogeneity of treatment effect.
    Conclusion: Computed tomography imaging is accurate for diagnosing acute diverticulitis. For patients with uncomplicated diverticulitis, no differences in outcomes were found between outpatient and inpatient care. Avoidance of antibiotics for uncomplicated acute diverticulitis may be safe for most patients. The evidence is too sparse for other evaluated questions.
    Primary funding source: Agency for Healthcare Research and Quality and American College of Physicians. (PROSPERO: CRD42020151246).
    MeSH term(s) Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Diagnostic Imaging ; Diverticulitis/drug therapy ; Diverticulitis, Colonic/complications ; Diverticulitis, Colonic/diagnostic imaging ; Diverticulitis, Colonic/therapy ; Humans
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2022-01-18
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S. ; Systematic Review
    ZDB-ID 336-0
    ISSN 1539-3704 ; 0003-4819
    ISSN (online) 1539-3704
    ISSN 0003-4819
    DOI 10.7326/M21-1645
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  8. Article ; Online: Behavior Change Techniques in Continuing Professional Development.

    Konnyu, Kristin J / McCleary, Nicola / Presseau, Justin / Ivers, Noah M / Grimshaw, Jeremy M

    The Journal of continuing education in the health professions

    2020  Volume 40, Issue 4, Page(s) 268–273

    Abstract: Continuing professional development (CPD) is a widely used and evolving set of complex interventions that seeks to update and improve the knowledge, skills, and performance of health care professionals to ultimately improve patient care and outcomes. ... ...

    Abstract Continuing professional development (CPD) is a widely used and evolving set of complex interventions that seeks to update and improve the knowledge, skills, and performance of health care professionals to ultimately improve patient care and outcomes. While synthesized evidence shows CPD in general to be effective, effects vary, in part due to variation in CPD interventions and limited understanding of CPD mechanisms of action. We introduce two behavioral science tools-the Behavior Change Technique Taxonomy version 1 and the Theoretical Domains Framework-that can be used to characterize the content of CPD interventions and the determinants of behaviour potentially targeted by the interventions, respectively. We provide a worked example of the use of these tools in coding the educational content of 43 diabetes quality improvement trials containing clinician education as part of their multicomponent intervention. Fourteen (of a possible 93; 15%) behavior change techniques were identified in the clinician education content of the quality improvement trials, suggesting a focus of addressing the behavioral determinants beliefs about consequences, knowledge, skills, and social influences, of diabetes care providers' behavior. We believe that the Behavior Change Technique Taxonomy version 1 and Theoretical Domains Framework offer a novel lens to analyze the CPD content of existing evidence and inform the design and evaluation of future CPD interventions.
    MeSH term(s) Behavior Therapy/methods ; Behavior Therapy/trends ; Education, Continuing/methods ; Education, Continuing/trends ; Humans ; Quality Improvement ; Staff Development/methods ; Staff Development/trends ; Surveys and Questionnaires
    Language English
    Publishing date 2020-12-07
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639445-0
    ISSN 1554-558X ; 0894-1912
    ISSN (online) 1554-558X
    ISSN 0894-1912
    DOI 10.1097/CEH.0000000000000319
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  9. Article ; Online: Systematic reviews can guide clinical practice and new research on primary headaches in pregnancy: An editorial on the 2022 American Headache Society Members' Choice Award paper.

    Saldanha, Ian J / Cao, Wangnan / Bhuma, Monika R / Konnyu, Kristin J / Adam, Gaelen P / Zullo, Andrew R / Chen, Kenneth K / Roth, Julie L / Balk, Ethan M

    Headache

    2022  Volume 62, Issue 7, Page(s) 774–776

    MeSH term(s) Awards and Prizes ; Female ; Headache/diagnosis ; Headache/therapy ; Humans ; Pregnancy ; United States
    Language English
    Publishing date 2022-05-31
    Publishing country United States
    Document type Editorial
    ZDB-ID 410130-3
    ISSN 1526-4610 ; 0017-8748
    ISSN (online) 1526-4610
    ISSN 0017-8748
    DOI 10.1111/head.14332
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  10. Article ; Online: Pharmacotherapy interventions for adolescent co-occurring substance use and mental health disorders: a systematic review.

    Scott, Kelli / Becker, Sara J / Helseth, Sarah A / Saldanha, Ian J / Balk, Ethan M / Adam, Gaelen P / Konnyu, Kristin J / Steele, Dale W

    Family practice

    2021  Volume 39, Issue 2, Page(s) 301–310

    Abstract: Background: Co-occurring mental health and substance use (SU) disorders among adolescents are common, with two-thirds of adolescents who seek SU treatment also requiring support for mental health. Primary care physicians play a key role in the ... ...

    Abstract Background: Co-occurring mental health and substance use (SU) disorders among adolescents are common, with two-thirds of adolescents who seek SU treatment also requiring support for mental health. Primary care physicians play a key role in the pharmacological treatment of mental health disorders among adolescents, however, little is known about the impact of these treatments on SU outcomes.
    Objectives: This systematic review summarizes the evidence regarding commonly used pharmacotherapy interventions for mental health and their impact on adolescent SU.
    Methods: Literature searches were conducted across five databases as part of a larger systematic review of adolescent SU interventions. Studies were screened for eligibility by two researchers, and study data were extracted regarding study design, patient and treatment characteristics and results. Risk of bias analyses and qualitative syntheses were completed to evaluate the strength of the evidence and the impact of pharmacotherapy on SU outcomes.
    Results: Ten randomized controlled trials exploring seven pharmacotherapies met criteria for inclusion. All studies had low to moderate risk of bias. Four studies evaluated pharmacotherapy for co-occurring depression and SU, three evaluated attention deficit hyperactivity disorder and SU, and three evaluated bipolar disorder and SU. Five of the 10 studies also included a behavioural intervention. We found no evidence that pharmacotherapy for co-occurring mental health diagnoses impacted SU.
    Conclusion: Family medicine clinicians prescribing pharmacotherapy for mental health should be aware that additional interventions will likely be needed to address co-occurring SU.
    MeSH term(s) Adolescent ; Attention Deficit Disorder with Hyperactivity ; Behavior Therapy ; Bipolar Disorder ; Humans ; Mental Disorders/complications ; Mental Disorders/drug therapy ; Mental Health ; Substance-Related Disorders/drug therapy
    Language English
    Publishing date 2021-08-27
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S. ; Systematic Review
    ZDB-ID 605939-9
    ISSN 1460-2229 ; 0263-2136
    ISSN (online) 1460-2229
    ISSN 0263-2136
    DOI 10.1093/fampra/cmab096
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