Ina Wallace

Bio: Ina Wallace is an academic researcher from Research Triangle Park. The author has contributed to research in topics: Psychological intervention & Otitis. The author has an hindex of 9, co-authored 13 publications receiving 1302 citations.

Health literacy interventions and outcomes: an updated systematic review.

Abstract: Objectives To update a 2004 systematic review of health care service use and health outcomes related to differences in health literacy level and interventions designed to improve these outcomes for individuals with low health literacy. Disparities in health outcomes and effectiveness of interventions among different sociodemographic groups were also examined. Data sources We searched MEDLINE®, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, PsychINFO, and the Educational Resources Information Center. For health literacy, we searched using a variety of terms, limited to English and studies published from 2003 to May 25, 2010. For numeracy, we searched from 1966 to May 25, 2010. Review methods We used standard Evidence-based Practice Center methods of dual review of abstracts, full-text articles, abstractions, quality ratings, and strength of evidence grading. We resolved disagreements by consensus. We evaluated whether newer literature was available for answering key questions, so we broadened our definition of health literacy to include numeracy and oral (spoken) health literacy. We excluded intervention studies that did not measure health literacy directly and updated our approach to evaluate individual study risk of bias and to grade strength of evidence. Results We included good- and fair-quality studies: 81 studies addressing health outcomes (reported in 95 articles including 86 measuring health literacy and 16 measuring numeracy, of which 7 measure both) and 42 studies (reported in 45 articles) addressing interventions. Differences in health literacy level were consistently associated with increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and, among seniors, poorer overall health status and higher mortality. Health literacy level potentially mediates disparities between blacks and whites. The strength of evidence of numeracy studies was insufficient to low, limiting conclusions about the influence of numeracy on health care service use or health outcomes. Two studies suggested numeracy may mediate the effect of disparities on health outcomes. We found no evidence concerning oral health literacy and outcomes. Among intervention studies (27 randomized controlled trials [RCTs], 2 cluster RCTs, and 13 quasi-experimental designs), the strength of evidence for specific design features was low or insufficient. However, several specific features seemed to improve comprehension in one or a few studies. The strength of evidence was moderate for the effect of mixed interventions on health care service use; the effect of intensive self-management inventions on behavior; and the effect of disease-management interventions on disease prevalence/severity. The effects of other mixed interventions on other health outcomes, including knowledge, self-efficacy, adherence, and quality of life, and costs were mixed; thus, the strength of evidence was insufficient. Conclusions The field of health literacy has advanced since the 2004 report. Future research priorities include justifying appropriate cutoffs for health literacy levels prior to conducting studies; developing tools that measure additional related skills, particularly oral (spoken) health literacy; and examining mediators and moderators of the effect of health literacy. Priorities in advancing the design features of interventions include testing novel approaches to increase motivation, techniques for delivering information orally or numerically, "work around" interventions such as patient advocates; determining the effective components of already-tested interventions; determining the cost-effectiveness of programs; and determining the effect of policy and practice interventions.

Screening for Speech and Language Delay in Children 5 Years Old and Younger: A Systematic Review

Abstract: BACKGROUND AND OBJECTIVES: No recommendation exists for or against routine use of brief, formal screening instruments in primary care to detect speech and language delay in children through 5 years of age. This review aimed to update the evidence on screening and treating children for speech and language since the 2006 US Preventive Services Task Force systematic review. METHODS: Medline, the Cochrane Library, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, and reference lists. We included studies reporting diagnostic accuracy of screening tools and randomized controlled trials reporting benefits and harms of treatment of speech and language. Two independent reviewers extracted data, checked accuracy, and assigned quality ratings using predefined criteria. RESULTS: We found no evidence for the impact of screening on speech and language outcomes. In 23 studies evaluating the accuracy of screening tools, sensitivity ranged between 50% and 94%, and specificity ranged between 45% and 96%. Twelve treatment studies improved various outcomes in language, articulation, and stuttering; little evidence emerged for interventions improving other outcomes or for adverse effects of treatment. Risk factors associated with speech and language delay were male gender, family history, and low parental education. A limitation of this review is the lack of well-designed, well-conducted studies addressing whether screening for speech and language delay or disorders improves outcomes. CONCLUSIONS: Several screening tools can accurately identify children for diagnostic evaluations and interventions, but evidence is inadequate regarding applicability in primary care settings. Some treatments for young children identified with speech and language delays and disorders may be effective.

Surgical Treatments for Otitis Media With Effusion: A Systematic Review

Abstract: BACKGROUND AND OBJECTIVE: The near universality of otitis media with effusion (OME) in children makes a comparative review of treatment modalities important. This study9s objective was to compare the effectiveness of surgical strategies currently used for managing OME. METHODS: We identified 3 recent systematic reviews and searched 4 major electronic databases. Eligible studies included randomized controlled trials, nonrandomized trials, and cohort studies that compared myringotomy, adenoidectomy, tympanostomy tubes (tubes), and watchful waiting. Using established criteria, pairs of reviewers independently selected, extracted data, rated risk of bias, and graded strength of evidence of relevant studies. We incorporated meta-analyses from the earlier reviews and synthesized additional evidence qualitatively. RESULTS: We identified 41 unique studies through the earlier reviews and our independent searches. In comparison with watchful waiting or myringotomy (or both), tubes decreased time with OME and improved hearing; no specific tube type was superior. Adenoidectomy alone, as an adjunct to myringotomy, or combined with tubes, reduced OME and improved hearing in comparison with either myringotomy or watchful waiting. Tubes and watchful waiting did not differ in language, cognitive, or academic outcomes. Otorrhea and tympanosclerosis were more common in ears with tubes. Adenoidectomy increased the risk of postsurgical hemorrhage. CONCLUSIONS: Tubes and adenoidectomy reduce time with OME and improve hearing in the short-term. Both treatments have associated harms. Large, well-controlled studies could help resolve the risk-benefit ratio by measuring acute otitis media recurrence, functional outcomes, quality of life, and long-term outcomes. Research is needed to support treatment decisions in subpopulations, particularly in patients with comorbidities.

Screening for Speech and Language Delays and Disorders in Children Age 5 Years or Younger: A Systematic Review for the U.S. Preventive Services Task Force

Abstract: Purpose To evaluate the evidence on screening and treating children for speech and language delays or disorders for the U.S. Preventive Services Task Force (USPSTF). Data Sources PubMed/MEDLINE®, the Cochrane Library, PsycInfo®, ClinicalTrials.gov, HSRProj, the World Health Organization International Clinical Trials Registry Platform, and reference lists of published literature (through July 2014). Study Selection Two investigators independently selected studies reporting on benefits and harms of screening; accuracy of screening tools compared with diagnostic evaluations; and benefits or harms of treatment of speech and language delays or disorders compared with placebo, watchful waiting, or wait-list interventions. To provide context for evaluating our Key Questions, we also included studies describing screening instruments and risk factors for speech and language delays or disorder. Data Extraction One reviewer extracted data and a second checked accuracy. Two independent reviewers assigned quality ratings using predefined criteria. Data Synthesis No included studies examined the effects of screening on speech and language or other functional outcomes. We included 23 studies evaluating the accuracy of speech and language screening in primary care settings to identify children for diagnostic evaluations and interventions. Among instruments in 13 studies in which parents rated their children’s skills, sensitivity ranged from 50 to 94 percent and specificity ranged from 45 to 96 percent. Of the three instruments widely used in the United States, the MacArthur Bates Communication Development Inventory (CDI) and the Language Development Survey (LDS) outperformed the Ages and Stages Questionnaire (ASQ) Communication Domain, especially in terms of their specificity, correctly identifying, on average, 82 percent (CDI) and 91 percent (LDS) compared with 58 percent (ASQ) of children without a language disorder. The ASQ and CDI have versions for infants, toddlers, and preschool-age children, with the CDI being more robust across age groups. The accuracy of professionally or paraprofessionally administered instruments was more variable across studies, and many did not perform as well as parent-rated instruments. Because few studies examined the same instrument in different populations or in different ages, it is unclear how professionally or paraprofessionally administered instruments for multiple ages fare more broadly or whether there is an optimal age for screening. We found no studies addressing adverse effects of screening, such as deleterious consequences of false conclusions from screening. We also found no studies concerning the role of enhanced surveillance by a primary care provider. We included 13 studies examining treatment for speech and language delays or disorders. Although the treatment approaches sometimes overlap, we organized our findings by outcome: language (including expressive and receptive language and more specific aspects of language, such as vocabulary, syntax/morphology, and narratives), speech sounds (including articulation, phonology, and speech intelligibility), and fluency (stuttering). Although results were mixed, the majority of studies found treatment to be effective. Characteristics of effective studies include higher intensity, treating children with more severe delays, and individualizing treatment to the child. We found little evidence concerning other functional outcomes or adverse effects of treatment. Risk factors that were generally associated with speech and language delays or disorders in multivariate analyses of cohort populations included being male, a family history of speech and language concerns, and lower levels of parental educational achievement. Limitations As in the earlier review, we did not find any well-conducted trials that could address our overarching question of whether screening leads to improved outcomes. Many screening studies do not include unselected samples from the population but rather participants with and without language delays. Intervention studies did not consistently control for additional community services that children may have been receiving and varied greatly in treatment approach and outcome measurement. Also, because young children with disabilities are entitled to treatment, it may not be possible for future studies in the United States to examine treatment versus no treatment. Conclusion Our review yields evidence that two parent-rated screening instruments, the CDI and LDS, can accurately identify children for diagnostic evaluations and interventions and likely can be interpreted with little difficulty in the primary care setting. Some treatments for young children identified with speech and language delays and disorders may be effective.

Clinical Practice Guideline Otitis Media with Effusion (Update)

Abstract: ObjectiveThis update of a 2004 guideline codeveloped by the American Academy of Otolaryngology—Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians, provides evidence-based recommendations to manage otitis media with effusion (OME), defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection. Changes from the prior guideline include consumer advocates added to the update group, evidence from 4 new clinical practice guidelines, 20 new systematic reviews, and 49 randomized control trials, enhanced emphasis on patient education and shared decision making, a new algorithm to clarify action statement relationships, and new and expanded recommendations for the diagnosis and management of OME.PurposeThe purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing OME and to create explicit and actionable recommendations to implement these opportunities in clinical pra...

Relieving pain in america: a blueprint for transforming prevention, care, education, and research

Abstract: The National Academy of Sciences through its Institute of Medicine (IOM) has produced a major scholarly assessment of pain in America. This document is a tremendous contribution to the evolving nec...

Best Care at Lower Cost: The Path to Continuously Learning Health Care in America

Abstract: America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost.The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009--roughly $750 billion--was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances.About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care.This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.

Mental health need and access to mental health services by youths involved with child welfare: a national survey.

Abstract: Objective This study assessed the relationship between the need for and use of mental health services among a nationally representative sample of children who were investigated by child welfare agencies after reported maltreatment. Method Data were collected at study entry into the National Survey of Child and Adolescent Well-Being and were weighted to provide population estimates. Results Nearly half (47.9%) of the youths aged 2 to 14 years ( N = 3,803) with completed child welfare investigations had clinically significant emotional or behavioral problems. Youths with mental health need (defined by a clinical range score on the Child Behavior Checklist) were much more likely to receive mental health services than lower scoring youth; still, only one fourth of such youths received any specialty mental health care during the previous 12 months. Clinical need was related to receipt of mental health care across all age groups (odds ratio=2.7–3.5). In addition, for young children (2–5 years), sexual abuse (versus neglect) increased access to mental health services. For latency-age youths, African-American race and living at home significantly reduced the likelihood of care. Adolescents living at home were also less likely to receive services, whereas having a parent with severe mental illness increased (odds ratio=2.4) the likelihood of service use. Conclusions Routine screening for mental health need and increasing access to mental health professionals for further evaluation and treatment should be a priority for children early in their contact with the child welfare system.