-
JBI Database of Systematic Reviews and... Sep 2019The objective of this review was to evaluate the effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults 18 years and over.
OBJECTIVE
The objective of this review was to evaluate the effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults 18 years and over.
INTRODUCTION
Stress has reached epidemic proportions globally. Unidentified sequela of physiological and psychological stress can result in anxiety, depression, heart disease, cancer, immunologic conditions and death. There is a high cost associated with the treatment of stress related health conditions in the United States and worldwide. Many treatments are pharmacologic and cannot be self-initiated. Therefore, it is critical to identify evidence-based, low-cost, non-pharmacologic, self-administered interventions that can mitigate physiological and psychological stress.
INCLUSION CRITERIA
This review considered adults 18 years and over engaged in diaphragmatic breathing as an isolated intervention to reduce physiological and psychological stress. There were no exclusions based on physical or psychological conditions. The comparator was no treatment or usual treatment, which may constitute ordinary breathing.
METHODS
The comprehensive literature search included published and unpublished studies in English from the beginning of the databases through January 2018. The databases searched included: PubMed, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, ProQuest Nursing and Allied Health and Health Source: Nursing/Academic Edition. The recommended JBI approach to critical appraisal, study selection, data extraction and data synthesis was used.
RESULTS
Three studies met the criteria for review: one randomized controlled trial and two quasi-experimental studies. Statistical pooling was not possible due to clinical and methodological heterogeneity of interventions and outcome measures of the included studies. All three studies demonstrated the effectiveness of diaphragmatic breathing on reducing stress. One study showed improvement in the biomarkers of respiratory rate and salivary cortisol levels, one showed improvement in systolic and diastolic blood pressure, and one study showed an improvement in the stress subscale of the Depression Anxiety Stress Scales-21 (DASS-21) after implementation of a diaphragmatic breathing intervention. Although there were limitations across the studies, such as sample size, and length and duration of the intervention over time, ranging from one 20-minute intervention to nine months, the studies demonstrated that diaphragmatic breathing had a positive effect on lowering physiological and psychological stress.
CONCLUSIONS
The evidence suggests that diaphragmatic breathing may decrease stress as measured by physiologic biomarkers, as well psychological self-report tools. Given the benefits of diaphragmatic breathing on stress reduction, ongoing research is needed to continue to establish the evidence-base for this self-administered, low-cost, non-pharmacologic intervention.
Topics: Adult; Breathing Exercises; Clinical Trials as Topic; Diaphragm; Female; Humans; Male; Stress, Physiological; Stress, Psychological; Treatment Outcome
PubMed: 31436595
DOI: 10.11124/JBISRIR-2017-003848 -
Arthritis Care & Research Oct 2015Management of systemic lupus erythematosus (SLE) is complex and variability in practices exists. Guidelines have been developed to help improve the management of SLE... (Review)
Review
OBJECTIVE
Management of systemic lupus erythematosus (SLE) is complex and variability in practices exists. Guidelines have been developed to help improve the management of SLE patients, but there has been no formal evaluation of these guidelines. This study aims to compare the scope, quality, and consistency of clinical practice guidelines on the diagnosis, monitoring, and treatment of patients with SLE.
METHODS
Electronic databases were searched up to April 2014. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument and textual synthesis was used to appraise and compare recommendations.
RESULTS
Nine clinical practice guidelines and 5 consensus statements were identified, which covered 7 topics: diagnosis, monitoring, treatment, neuropsychiatric SLE, lupus nephritis, antiphospholipid syndrome, and other manifestations of lupus. The methodological quality of the guidelines was variable, with the overall mean AGREE II scores ranging from 31% to 75%, out of a maximum 100%. Scores were consistently low for applicability, with only 1 guideline scoring above 50%. There was substantial variability in the treatments recommended for class II and V lupus nephritis, the recommended duration of maintenance therapy for class III/IV lupus nephritis (from 1 to 4 years), and timing of ophthalmologic examination for patients taking corticosteroids.
CONCLUSION
Published guidelines on SLE cover a complex area of clinical care, but the methodological quality, scope, and recommendations varied substantially. Collaborative and multidisciplinary efforts to develop comprehensive, high-quality evidence-based guidelines are needed to promote best treatment and health outcomes for patients with SLE.
Topics: Combined Modality Therapy; Disease Progression; Female; Humans; Lupus Erythematosus, Systemic; Lupus Nephritis; Lupus Vasculitis, Central Nervous System; Male; Monitoring, Physiologic; Practice Guidelines as Topic; Prognosis; Risk Assessment; Severity of Illness Index; Survival Rate
PubMed: 25778500
DOI: 10.1002/acr.22591 -
International Journal of Environmental... Nov 2020In conditions of intensive therapy, where the patients treated are in a critical condition, alarms are omnipresent. Nurses, as they spend most of their time with...
BACKGROUND
In conditions of intensive therapy, where the patients treated are in a critical condition, alarms are omnipresent. Nurses, as they spend most of their time with patients, monitoring their condition 24 h, are particularly exposed to so-called alarm fatigue. The purpose of this study is to review the literature available on the perception of clinical alarms by nursing personnel and its impact on work in the ICU environment.
METHODS
A systematic review of the literature was carried out according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol. The content of electronic databases was searched through, i.e., PubMed, OVID, EBSCO, ProQuest Nursery, and Cochrane Library. The keywords used in the search included: "intensive care unit," "nurse," "alarm fatigue," "workload," and "clinical alarm." The review also covered studies carried out among nurses employed at an adult intensive care unit. Finally, seven publications were taken into consideration. Data were analyzed both descriptively and quantitatively, calculating a weighted average for specific synthetized data.
RESULTS
In the analyzed studies, 389 nurses were tested, working in different intensive care units. Two studies were based on a quality model, while the other five described the problem of alarms in terms of quantity, based on the HTF (Healthcare Technology Foundation) questionnaire. Intensive care nurses think that alarms are burdensome and too frequent, interfering with caring for patients and causing reduced trust in alarm systems. They feel overburdened with an excessive amount of duties and a continuous wave of alarms. Having to operate modern equipment, which is becoming more and more advanced, takes time that nurses would prefer to dedicate to their patients. There is no clear system for managing the alarms of monitoring devices.
CONCLUSION
Alarm fatigue may have serious consequences, both for patients and for nursing personnel. It is necessary to introduce a strategy of alarm management and for measuring the alarm fatigue level.
Topics: Adult; Clinical Alarms; Cross-Sectional Studies; Fatigue; Female; Humans; Intensive Care Units; Monitoring, Physiologic; Stress, Psychological
PubMed: 33202907
DOI: 10.3390/ijerph17228409 -
Sensors (Basel, Switzerland) May 2021Recently, there has been an increase in the production of devices to monitor mental health and stress as means for expediting detection, and subsequent management of... (Review)
Review
Recently, there has been an increase in the production of devices to monitor mental health and stress as means for expediting detection, and subsequent management of these conditions. The objective of this review is to identify and critically appraise the most recent smart devices and wearable technologies used to identify depression, anxiety, and stress, and the physiological process(es) linked to their detection. The MEDLINE, CINAHL, Cochrane Central, and PsycINFO databases were used to identify studies which utilised smart devices and wearable technologies to detect or monitor anxiety, depression, or stress. The included articles that assessed stress and anxiety unanimously used heart rate variability (HRV) parameters for detection of anxiety and stress, with the latter better detected by HRV and electroencephalogram (EGG) together. Electrodermal activity was used in recent studies, with high accuracy for stress detection; however, with questionable reliability. Depression was found to be largely detected using specific EEG signatures; however, devices detecting depression using EEG are not currently available on the market. This systematic review highlights that average heart rate used by many commercially available smart devices is not as accurate in the detection of stress and anxiety compared with heart rate variability, electrodermal activity, and possibly respiratory rate.
Topics: Heart Rate; Mental Health; Monitoring, Physiologic; Reproducibility of Results; Wearable Electronic Devices
PubMed: 34065620
DOI: 10.3390/s21103461 -
Drug Metabolism and Disposition: the... Nov 2015Modeling and simulation of drug disposition has emerged as an important tool in drug development, clinical study design and regulatory review, and the number of... (Review)
Review
Modeling and simulation of drug disposition has emerged as an important tool in drug development, clinical study design and regulatory review, and the number of physiologically based pharmacokinetic (PBPK) modeling related publications and regulatory submissions have risen dramatically in recent years. However, the extent of use of PBPK modeling by researchers, and the public availability of models has not been systematically evaluated. This review evaluates PBPK-related publications to 1) identify the common applications of PBPK modeling; 2) determine ways in which models are developed; 3) establish how model quality is assessed; and 4) provide a list of publically available PBPK models for sensitive P450 and transporter substrates as well as selective inhibitors and inducers. PubMed searches were conducted using the terms "PBPK" and "physiologically based pharmacokinetic model" to collect published models. Only papers on PBPK modeling of pharmaceutical agents in humans published in English between 2008 and May 2015 were reviewed. A total of 366 PBPK-related articles met the search criteria, with the number of articles published per year rising steadily. Published models were most commonly used for drug-drug interaction predictions (28%), followed by interindividual variability and general clinical pharmacokinetic predictions (23%), formulation or absorption modeling (12%), and predicting age-related changes in pharmacokinetics and disposition (10%). In total, 106 models of sensitive substrates, inhibitors, and inducers were identified. An in-depth analysis of the model development and verification revealed a lack of consistency in model development and quality assessment practices, demonstrating a need for development of best-practice guidelines.
Topics: Animals; Computer Simulation; Drug Interactions; Humans; Models, Biological; Pharmaceutical Preparations; Pharmacokinetics
PubMed: 26296709
DOI: 10.1124/dmd.115.065920 -
Telemedicine Journal and E-health : the... May 2020Remote patient monitoring or telemonitoring aims at improving patient care through digitally transmitted health-related data. That allows early detection of disease...
Remote patient monitoring or telemonitoring aims at improving patient care through digitally transmitted health-related data. That allows early detection of disease decompensation and intervention, patient education and improves patientphysician relationship. Despite its relevance, there are no comprehensive reviews evaluating the variables discussed by clinical studies on telemonitoring. A systematic literature search of PubMed was performed to identify studies about telemonitoring published between 2000 and 2018. These had to be case reports with >5 cases, comparative or clinical studies/trials. The following variables were evaluated: year of publication, author's country, discussed topic, objective of study, follow-up time, number of telemonitoring patients, primary outcome, use of teleconsultation and tele-education, presence of a control group, effectiveness of telemonitoring, telemonitoring strategies, and level of evidence. After screening 947 records, 272 articles were included. The review showed a growing number of publications over the years, with 43.0% being published between 2015 and 2018, providing generally positive results (76.8%). The United States was responsible for 38.2% of articles. Cardiovascular disease was the topic of 47.8% of studies, whereas surgical pathologies and postoperative care represented only 2.6%. Wireless devices or smartphone apps were the most popular strategy (75.7%), with 17.6% of studies employing tele-education and 24.6% employing teleconsultation measures. Most publications were OCEBM Level of Evidence 2 (73.5%). Telemonitoring appears to maximize patient care and effectiveness of treatment. The number of publications illustrates the growing interest in the matter. Telemonitoring has yet to be evaluated in the setting of postoperative care and surgical pathologies.
Topics: Humans; Monitoring, Physiologic; Randomized Controlled Trials as Topic; Remote Consultation; Telemedicine
PubMed: 31314689
DOI: 10.1089/tmj.2019.0066 -
Intensive Care Medicine Dec 2016We performed a systematic review and meta-analysis of studies investigating the passive leg raising (PLR)-induced changes in cardiac output (CO) and in arterial pulse... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
We performed a systematic review and meta-analysis of studies investigating the passive leg raising (PLR)-induced changes in cardiac output (CO) and in arterial pulse pressure (PP) as predictors of fluid responsiveness in adults.
METHODS
MEDLINE, EMBASE and Cochrane Database were screened for relevant original and review articles. The meta-analysis determined the pooled area under the ROC curve, the sensitivity, specificity and threshold for the PLR test when assessed with CO and PP.
RESULTS
Twenty-one studies (991 adult patients, 995 fluid challenges) were included. CO was measured by echocardiography in six studies, calibrated pulse contour analysis in six studies, bioreactance in four studies, oesophageal Doppler in three studies, transpulmonary thermodilution or pulmonary artery catheter in one study and suprasternal Doppler in one study. The pooled correlation between the PLR-induced and the fluid-induced changes in CO was 0.76 (0.73-0.80). For the PLR-induced changes in CO, the pooled sensitivity was 0.85 (0.81-0.88) and the pooled specificity was 0.91 (0.88-0.93). The area under the ROC curve was 0.95 ± 0.01. The best threshold was a PLR-induced increase in CO ≥10 ± 2 %. For the PLR-induced changes in PP (8 studies, 432 fluid challenges), the pooled sensitivity was 0.56 (0.49-0.53), the pooled specificity was 0.83 (0.77-0.88) and the pooled area under the ROC curve was 0.77 ± 0.05. Sensitivity and subgroup analysis were consistent with the primary analysis.
CONCLUSIONS
PLR-induced changes in CO very reliably predict the response of CO to volume expansion in adults with acute circulatory failure. When PLR effects are assessed by changes in PP, the specificity of the PLR test remains acceptable but its sensitivity is poor.
Topics: Cardiac Output; Chi-Square Distribution; Critical Illness; Fluid Therapy; Humans; Intensive Care Units; Leg; Monitoring, Physiologic; Patient Positioning; ROC Curve; Sensitivity and Specificity
PubMed: 26825952
DOI: 10.1007/s00134-015-4134-1 -
Critical Care (London, England) Nov 2021Extubation failure is an important issue in ventilated patients and its risk factors remain a matter of research. We conducted a systematic review and meta-analysis to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Extubation failure is an important issue in ventilated patients and its risk factors remain a matter of research. We conducted a systematic review and meta-analysis to explore factors associated with extubation failure in ventilated patients who passed a spontaneous breathing trial and underwent planned extubation. This systematic review was registered in PROPERO with the Registration ID CRD42019137003.
METHODS
We searched the PubMed, Web of Science and Cochrane Controlled Register of Trials for studies published from January 1998 to December 2018. We included observational studies involving risk factors associated with extubation failure in adult intensive care unit patients who underwent invasive mechanical ventilation. Two authors independently extracted data and assessed the validity of included studies.
RESULTS
Sixty-seven studies (involving 26,847 participants) met the inclusion criteria and were included in our meta-analysis. We analyzed 49 variables and, among them, we identified 26 factors significantly associated with extubation failure. Risk factors were distributed into three domains (comorbidities, acute disease severity and characteristics at time of extubation) involving mainly three functions (circulatory, respiratory and neurological). Among these, the physiological respiratory characteristics at time of extubation were the most represented. The individual topic of secretion management was the one with the largest number of variables. By Bayesian multivariable meta-analysis, twelve factors were significantly associated with extubation failure: age, history of cardiac disease, history of respiratory disease, Simplified Acute Physiologic Score II score, pneumonia, duration of mechanical ventilation, heart rate, Rapid Shallow Breathing Index, negative inspiratory force, lower PaO/FiO ratio, lower hemoglobin level and lower Glasgow Coma Scale before extubation, with the latest factor having the strongest association with extubation outcome.
CONCLUSIONS
Numerous factors are associated with extubation failure in critically ill patients who have passed a spontaneous breathing trial. Robust multiparametric clinical scores and/or artificial intelligence algorithms should be tested based on the selected independent variables in order to improve the prediction of extubation outcome in the clinical scenario.
Topics: Airway Extubation; Artificial Intelligence; Bayes Theorem; Critical Illness; Humans; Treatment Failure
PubMed: 34782003
DOI: 10.1186/s13054-021-03802-3 -
Journal of Musculoskeletal & Neuronal... Jun 2015We performed a meta-analysis to evaluate the effects of whole-body vibration on physiologic and functional measurements in children with cerebral palsy. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
We performed a meta-analysis to evaluate the effects of whole-body vibration on physiologic and functional measurements in children with cerebral palsy.
DESIGN AND METHODS
We searched MEDLINE, Cochrane Controlled Trials Register, EMBASE, Scielo, CINAHL (from the earliest date available to November 2014) for randomized controlled trials, that aimed to investigate the effects of whole-body vibration versus exercise and/or versus control on physiologic and functional measurements in children with cerebral palsy. Two reviewers independently selected the studies. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated.
RESULTS
Six studies with 176 patients comparing whole-body vibration to exercise and/or control were included. Whole-body vibration resulted in improvement in: gait speed WMDs (0.13 95% CI: 0.05 to 0.20); gross motor function dimension E WMDs (2.97 95% CI: 0.07 to 5.86) and femur bone density (1.32 95% CI: 0.28 to 2.36). The meta-analysis also showed a nonsignificant difference in muscle strength and gross motor function dimension D for participants in the whole-body vibration compared with control group. No serious adverse events were reported.
CONCLUSIONS
Whole-body vibration may improve gait speed and standing function in children with cerebral palsy and could be considered for inclusion in rehabilitation programs.
Topics: Adolescent; Cerebral Palsy; Child; Exercise Therapy; Female; Humans; Male; Mobility Limitation; Physical Therapy Modalities; Postural Balance; Vibration
PubMed: 26032205
DOI: No ID Found -
PloS One 2019Vital signs, i.e. respiratory rate, oxygen saturation, pulse, blood pressure and temperature, are regarded as an essential part of monitoring hospitalized patients....
BACKGROUND
Vital signs, i.e. respiratory rate, oxygen saturation, pulse, blood pressure and temperature, are regarded as an essential part of monitoring hospitalized patients. Changes in vital signs prior to clinical deterioration are well documented and early detection of preventable outcomes is key to timely intervention. Despite their role in clinical practice, how to best monitor and interpret them is still unclear.
OBJECTIVE
To evaluate the ability of vital sign trends to predict clinical deterioration in patients hospitalized with acute illness.
DATA SOURCES
PubMed, Embase, Cochrane Library and CINAHL were searched in December 2017.
STUDY SELECTION
Studies examining intermittently monitored vital sign trends in acutely ill adult patients on hospital wards and in emergency departments. Outcomes representing clinical deterioration were of interest.
DATA EXTRACTION
Performed separately by two authors using a preformed extraction sheet.
RESULTS
Of 7,366 references screened, only two were eligible for inclusion. Both were retrospective cohort studies without controls. One examined the accuracy of different vital sign trend models using discrete-time survival analysis in 269,999 admissions. One included 44,531 medical admissions examining trend in Vitalpac Early Warning Score weighted vital signs. They stated that vital sign trends increased detection of clinical deterioration. Critical appraisal was performed using evaluation tools. The studies had moderate risk of bias, and a low certainty of evidence. Additionally, four studies examining trends in early warning scores, otherwise eligible for inclusion, were evaluated.
CONCLUSIONS
This review illustrates a lack of research in intermittently monitored vital sign trends. The included studies, although heterogeneous and imprecise, indicates an added value of trend analysis. This highlights the need for well-controlled trials to thoroughly assess the research question.
Topics: Bias; Clinical Deterioration; Early Diagnosis; Female; Hospitalization; Humans; Male; Models, Statistical; Monitoring, Physiologic; Prognosis; Vital Signs
PubMed: 30645637
DOI: 10.1371/journal.pone.0210875