INTRODUCTION: Healthcare workforces are currently facing multiple challenges, including aging populations; increasing prevalence of long-term conditions; and shortfall of registered nurses. Employing non-registered support workers is common across many countries to expand service capacity of nursing teams. One task delegated to non-registered support workers is medication administration, which is considered a complex task, with associated risks. This is an important topic given the predicted global increase in patients requiring assistance with medication in community settings. This review explores the evidence on delegation of medication administration from registered nurse to non-registered support workers within community settings, to better understand factors that influence the process of delegation and its impact on service delivery and patient care. METHODS: The review followed key principles of Critical Interpretative Synthesis and was structured around Preferred Reporting Items for Systematic Reviews and Meta‐analysis guidelines. Literature searches were conducted in MEDLINE, CINAHL, Embase, and ProQuest-British Nursing Index databases. Twenty studies were included. RESULTS: Findings are reported under four themes: 1, Regulatory and contextual factors; 2, Individual and team level factors; 3, Outcomes of delegation; and 4, Process of implementation and evaluation. Delegation was found to be a complex phenomenon, influenced by a myriad of interconnecting factors at the macro, meso, micro level. At the macro level, the consistency and clarity of government and state level regulations was found to facilitate or impede delegation of medication administration. Lack of clarity at the macro level, impacted at meso and micro levels, resulting in confusion around what medication administration could be delegated and who held responsibility. At the micro level, central to the interpretation of success was the relationship between the delegator and delegatee. This relationship was influenced by personal views, ...
Objectives: Depression symptom questionnaires are not for diagnostic classification. Patient Health Questionnaire-9 (PHQ-9) scores >= 10 are nonetheless often used to estimate depression prevalence. We compared PHQ-9 >= 10 prevalence to Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) major depression prevalence and assessed whether an alternative PHQ-9 cutoff could more accurately estimate prevalence. Study Design and Setting: Individual participant data meta-analysis of datasets comparing PHQ-9 scores to SCID major depression status. Results: A total of 9,242 participants (1,389 SCID major depression cases) from 44 primary studies were included. Pooled PHQ-9 >= 10 prevalence was 24.6% (95% confidence interval [CI]: 20.8%, 28.9%); pooled SCID major depression prevalence was 12.1% (95% CI: 9.6%, 15.2%); and pooled difference was 11.9% (95% CI: 9.3%, 14.6%). The mean study-level PHQ-9 >= 10 to SCID-based prevalence ratio was 2.5 times. PHQ-9 >= 14 and the PHQ-9 diagnostic algorithm provided prevalence closest to SCID major depression prevalence, but study-level prevalence differed from SCID-based prevalence by an average absolute difference of 4.8% for PHQ-9 >= 14 (95% prediction interval: -13.6%, 14.5%) and 5.6% for the PHQ-9 diagnostic algorithm (95% prediction interval: -16.4%, 15.0%). Conclusion: PHQ-9 >= 10 substantially overestimates depression prevalence. There is too much heterogeneity to correct statistically in individual studies. ; Canadian Institutes of Health Research (CIHR) KRS-134297 PCG155468 PJT-162206 Fonds de recherche du Quebec -Sante (FRQS) Postdoctoral Training Fellowships FRQS Research Institute of the McGill University Health Centre G.R. Caverhill Fellowship from the Faculty of Medicine, McGill University Vanier Canada Graduate Scholarship Canadian Institutes of Health Research (CIHR) Cumming School of Medicine, University of Calgary Alberta Health Services through the Calgary Health Trust Hotchkiss Brain Institute Alberta Innovates Health Solutions Canada Research Chair in Neurological Health Services Research AIHS Population Health Investigator Award Department of Education (NIDRR) H133B080025 National Multiple Sclerosis Society MB 0008 Lundbeck International Tehran University of Medical Sciences M-288 Canadian Institutes of Health Research (CIHR) THC-135234 Crohn's and Colitis Canada Bingham Chair in Gastroenterology Waugh Family Chair in Multiple Sclerosis UK Department for International Development 201446 Department of Education, National Institute on Disability and Rehabilitation Research, Spinal Cord Injury Model Systems: University of Washington H133N060033 Baylor College of Medicine H133N060003 University of Michigan System H133N060032 Grand Challenges Canada 0087-04 United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Mental Health (NIMH) R24MH071604 R34 MH072925 K02 MH65919 P30 DK50456 R24 MH56858 RO1-MH069666 R24 MH071604 MH014592-38 MH103210 United States Department of Health & Human Services Centers for Disease Control & Prevention - USA R49 CE002093 Spanish Ministry of Health's Health Research Fund (Fondo de Investigaciones Sanitarias) 97/1184 US National Center for Medical Rehabilitation Research RO1 HD39415 Federal Ministry of Education & Research (BMBF) 01GY1150 University of Technology Sydney Duke Global Health Institute 453-0751 Macao (SAR) Government, through the University of Macau RSKTO grants MYRG-2014-111 United States Agency for International Development (USAID) AID-DFD A-00-08-00308 UK National Institute for Health Research under its Programme Grants for Applied Research Programme RP-PG0606-1142 Consejo Nacional de Ciencia y Tecnologia (CONACyT) CB-2009133923-H National Health Research Institutes - Taiwan NHRI-EX97-9706PI Reitoria de Pesquisa da Universidade de Sao Paulo 09.1.01689.17.7 Banco Santander 10.1.01232.17.9 Pfizer medical faculty of the University of Heidelberg, Germany 121/2000 Research Manitoba Chair in Multiple Sclerosis Canadian Institutes of Health Research (CIHR) Niigata Seiryo University Productivity Grants (PQ-CNPq-2) 301321/2016-7 Ministry of Health, Italy United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Cancer Institute (NCI) U10CA21661 U10CA180868 U10CA180822 U10CA37422 Pennsylvania Department of Health United Kingdom National Health Service Lothian Neuro-Oncology Endowment Fund United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Cancer Institute (NCI) K07 CA 093512 Lance Armstrong Foundation United States Department of Health & Human Services United States Health Resources & Service Administration (HRSA) R40MC07840 United States Department of Health & Human Services National Institutes of Health (NIH) - USA T32 GM07356 United States Department of Health & Human Services Agency for Healthcare Research & Quality R36 HS018246 United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Center for Research Resources (NCRR) TL1 RR024135 medical faculty, University of Leipzig Hunter Medical Research Institute Netherlands Organization for Health Research and Development (ZonMw) Mental Health Program 100.003.005 100.002.021 Academic Medical Center/University of Amsterdam Fund for Innovation and Competitiveness of the Chilean Ministry of Economy, Development and Tourism, through the Millennium Scientific Initiative IS130005 Research Manitoba Chair
Researchers increasingly use meta-analysis to synthesize the results of several studies in order to estimate a common effect. When the outcome variable is continuous, standard meta-analytic approaches assume that the primary studies report the sample mean and standard deviation of the outcome. However, when the outcome is skewed, authors sometimes summarize the data by reporting the sample median and one or both of (i) the minimum and maximum values and (ii) the first and third quartiles, but do not report the mean or standard deviation. To include these studies in meta-analysis, several methods have been developed to estimate the sample mean and standard deviation from the reported summary data. A major limitation of these widely used methods is that they assume that the outcome distribution is normal, which is unlikely to be tenable for studies reporting medians. We propose two novel approaches to estimate the sample mean and standard deviation when data are suspected to be non-normal. Our simulation results and empirical assessments show that the proposed methods often perform better than the existing methods when applied to non-normal data. ; anadian Institutes of Health Research (CIHR) KRS-134297 Fonds de recherche du Quebec -Sante (FRQS) Canadian Institutes of Health Research (CIHR) Canadian Institutes of Health Research (CIHR) FRQS Masters Training Awards Vanier Canada Graduate Scholarship FRQS Postdoctoral Training Fellowship Research Institute of the McGill University Health Centre G.R. Caverhill Fellowship from the Faculty of Medicine, McGill University Cumming School of Medicine, University of Calgary Alberta Health Services through the Calgary Health Trust Hotchkiss Brain Institute Senior Health Scholar award from Alberta Innovates Health Solutions Health Research Council of New Zealand Lundbeck International Tehran University of Medical Sciences M-288 Department of Education, National Institute on Disability and Rehabilitation Research, Spinal Cord Injury Model Systems: University of Washington H133N060033 Baylor College of Medicine H133N060003 University of Michigan System H133N060032 National Health and Medical Research Council of Australia 1002160 Safe Work Australia Australian Research Council FT130101444 European Foundation for Study of Diabetes Chinese Diabetes Society Lilly Foundation Asia Diabetes Foundation Liao Wun Yuk Diabetes Memorial Fund United States National Institute of Mental Health (NIMH) grant 5F30MH096664 United States Department of Health & Human Services National Institutes of Health (NIH) - USA United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH Fogarty International Center (FIC) United States Department of Health & Human Services National Institutes of Health (NIH) - USA National Cancer Center United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Heart Lung & Blood Institute (NHLBI) NIH Office of Research for Women's Health through the Fogarty Global Health Fellows Program Consortium 1R25TW00934001 American Recovery and Reinvestment Act United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Mental Health (NIMH) R24MH071604 / R34 MH072925/ K02 MH65919 / P30 DK50456 / R24 MH56858 / RO1 MH073687 /RO1-MH069666 / R34MH084673 /R24 MH071604 United States Department of Health & Human Services Centers for Disease Control & Prevention - USA R49 CE002093 St Anne's Community Services, Leeds, UK US National Center for Medical Rehabilitation Research RO1 HD39415 Federal Ministry of Education & Research (BMBF) 01GY1150 United States Department of Health & Human Services National Institutes of Health (NIH) - USA T37 MD001449 / T32 GM07356 Ohio Board of Regents Research and Development Administration Office, University of Macau MYRG2015-00109-FSS Federal Ministry of Education & Research (BMBF) 01 GD 9802/4 ; 01 GD 0101 Federation of German Pension Insurance Institute Federal Ministry of Education & Research (BMBF) Perpetual Trustees Flora and Frank Leith Charitable Trust Jack Brockhoff Foundation Grosvenor Settlement Sunshine Foundation Danks Trust Canadian Institutes of Health Research (CIHR) FRN 83518 Scleroderma Society of Canada Scleroderma Society of Ontario Scleroderma Society of Saskatchewan Sclerodermie Quebec Cure Scleroderma Foundation Inova Diagnostics Inc Euroimmun FRQS Canadian Arthritis Network Lady Davis Institute of Medical Research of the Jewish General Hospital, Montreal, QC FRQS Senior Investigator Award National Strategic Reference Framework European Union (EU) Greek Ministry of Education, Lifelong Learning and Religious Affairs (ARISTEIA-ABREVIATE) 1259 Ministry of Health, Labour and Welfare, Japan UK National Institute for Health Research under its Programme Grants for Applied Research Programme RP-PG-0606-1142 Canada Research Chair in Neurological Health Services Research AIHS Population Health Investigator Award National Health and Medical Research Council of Australia 1088313 Netherlands Organization for Health Research and Development 945-03-047 National Health Research Institutes - Taiwan NHRI-EX97-9706PI Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand 49086 Reitoria de Pesquisa da Universidade de Sao Paulo 09.1.01689.17.7 Banco Santander 10.1.01232.17.9 Pfizer medical faculty of the University of Heidelberg, Germany 121/2000 Research University Grant Scheme from Universiti Putra Malaysia, Malaysia Postgraduate Research Student Support Accounts of the University of Auckland, New Zealand National Program for Centers of Excellence (PRONEX/FAPERGS/CNPq, Brazil) Pfizer US Pharmaceutical Inc. PQ-CNPq-2 301321/2016-7 Belgian Ministry of Public Health and Social Affairs Pfizer Ministry of Health, Italy UK National Health Service Lothian Neuro-Oncology Endowment Fund Universiti Sains Malaysia United States Department of Health & Human Services United States Health Resources & Service Administration (HRSA) R40MC07840 United States Department of Health & Human Services Agency for Healthcare Research & Quality R36 HS018246 United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Center for Research Resources (NCRR) TL1 RR024135 University of Melbourne Hunter Medical Research Institute Innovatiefonds Zorgverzekeraars Netherlands Organization for Health Research and Development (ZonMw) Mental Health Program 100.003.005 100.002.021 Academic Medical Center/University of Amsterdam Fund for Innovation and Competitiveness of the Chilean Ministry of Economy, Development and Tourism, through the Millennium Scientific Initiative IS130005 US Department of Veteran Affairs US Department of Veteran Affairs United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Heart Lung & Blood Institute (NHLBI) R01 HL079235 American Federation for Ageing Research Robert Wood Johnson Foundation (RWJF) Ischemia Research and Education Foundation
