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Frontiers in Endocrinology 2023The aim of the study was to identify available polycystic ovary syndrome (PCOS) models of care (MoCs) and describe their characteristics and alignment with the...
INTRODUCTION
The aim of the study was to identify available polycystic ovary syndrome (PCOS) models of care (MoCs) and describe their characteristics and alignment with the international PCOS guideline.
METHODS
Ovid MEDLINE, All EBM, PsycINFO, Embase, and CINAHL were searched from inception until 11 July 2022. Any study with a description of a PCOS MoC was included. Non-evidence-based guidelines, abstracts, study protocols, and clinical trial registrations were excluded. We also excluded MoCs delivered in research settings to minimize care bias. Meta-analysis was not performed due to heterogeneity across MoCs. We describe and evaluate each MoC based on the recommendations made by the international evidence-based guideline for assessing and managing PCOS.
RESULTS
Of 3,671 articles, six articles describing five MoCs were included in our systematic review. All MoCs described a multidisciplinary approach, including an endocrinologist, dietitian, gynecologist, psychologist, dermatologist, etc. Three MoCs described all aspects of PCOS care aligned with the international guideline recommendations. These include providing education on long-term risks, lifestyle interventions, screening and management of emotional well-being, cardiometabolic diseases, and the dermatological and reproductive elements of PCOS. Three MoCs evaluated patients' and healthcare professionals' satisfaction, with generally positive findings. Only one MoC explored the impact of their service on patients' health outcomes and showed improvement in BMI.
CONCLUSION
There is limited literature describing PCOS MoCs in routine practice. Future research should explore developing cost-effective co-created multidisciplinary PCOS MoCs globally. This may be facilitated by the exchange of best practices between institutions with an established MoC and those who are interested in setting one up.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346539, identifier CRD42022346539.
Topics: Female; Humans; Developing Countries; Educational Status; Emotions; Endocrinologists; Polycystic Ovary Syndrome
PubMed: 37614710
DOI: 10.3389/fendo.2023.1217468 -
Respiratory Medicine 2024Chronic obstructive pulmonary disease (COPD) is a leading public health concern globally. Interdisciplinary pulmonary rehabilitation programs exist and should ideally... (Review)
Review
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is a leading public health concern globally. Interdisciplinary pulmonary rehabilitation programs exist and should ideally consider nutritional health impacts since the nutritional status of COPD patients is often compromised. However, little is known about the role of dietary counseling in COPD management.
RESEARCH QUESTION
Does providing tailored dietary advice to adult patients with COPD improve outcomes?
STUDY DESIGN AND METHODS
We conducted a systematic review. The following electronic databases and registrars were used: MEDLINE, EMBASE, Web of Science, CINAHL, Cochrane Library, and ClinicalTrials.gov. The original search was conducted in June 2021 with an updated search conducted on February 21, 2024. Validity and bias assessments were completed.
RESULTS
We selected 14 articles for inclusion. Multiple outcomes were considered including functional, body composition, nutritional intake, cost analyses, quality of life, and others. The most common measured outcomes were quality of life and the 6 min walk test. A number of interventions were used with most interventions being interdisciplinary pulmonary rehabilitation packages where nutrition counseling was one component. A number of interventions showed positive results but there tended to be inconsistency.
INTERPRETATION
Evidence shows that various interventions appear to improve outcomes, but it is difficult to determine if improvements are due to nutritional intervention specifically or a rehabilitation program as a whole. More specific randomized controlled trials should be completed regarding tailored nutritional counseling and therapy in adults with COPD to determine the benefits attributable to nutritional interventions.
Topics: Adult; Humans; Quality of Life; Nutritionists; Pulmonary Disease, Chronic Obstructive; Counseling; Nutritional Status
PubMed: 38467310
DOI: 10.1016/j.rmed.2024.107584 -
Canadian Journal of Gastroenterology &... 2020In recent years, more and more emphasis has been placed on early diagnosis and adequate treatment of malnutrition in the course of chronic diseases (CP). One of these... (Review)
Review
PURPOSE
In recent years, more and more emphasis has been placed on early diagnosis and adequate treatment of malnutrition in the course of chronic diseases (CP). One of these diseases is chronic pancreatitis in which malnutrition may develop as a consequence of abdominal pain, vomiting, diarrhea, and alcohol abuse. The aim of this review paper is recognized if we can improve the nutritional status of patients with CP.
METHODS
This paper is based on systematic literature review according to the PubMed.
RESULTS
One of the most important problems is lack of "gold standard" in screening of nutritional status in patients with CP, especially in outpatient clinics. Another problem is preventing malnutrition in these patients and beginning treatment already at significant stages of disease. To prevent malnutrition you must first recognize the causes of malnutrition in CP, adequately assess its severity using one of available questionnaires and then apply the appropriate therapeutic management. At each visit, remember to assess the nutritional status of the patient, including laboratory markers and anthropometric measurements. Patients should be advised to stop smoking and drinking alcohol and to use adequate enzyme supplementation.
CONCLUSION
Patients with CP should be led by a team of gastroenterologist, diabetologist, and psychologist and consulted by a dietitian, specialist of pain treatment, and surgeon.
Topics: Alcoholism; Humans; Malnutrition; Nutritional Status; Pancreatitis, Chronic; Surveys and Questionnaires
PubMed: 32832490
DOI: 10.1155/2020/8875487 -
Nutrition (Burbank, Los Angeles County,... 2020Obesity has been identified as an important risk factor for cardiovascular disease and other chronic diseases. However, dietary treatment of obesity is far from being a... (Review)
Review
OBJECTIVES
Obesity has been identified as an important risk factor for cardiovascular disease and other chronic diseases. However, dietary treatment of obesity is far from being a closed issue. Therefore, it is critical to identify the most appropriate obesity management approaches. The aim of this review was to summarize the effects, potentialities, and limitations of nutritional interventions aimed at managing obesity in primary and secondary health care settings, highlighting the most effective strategies and theories.
METHODS
This systematic review of randomized controlled trials evaluated nutritional interventions aimed at achieving weight loss in primary and secondary health care patients. All screening and extraction processes were conducted according to PRISMA.
RESULTS
From an initial 7816 studies that were identified, 28 met the criteria and were included in the review. Most studies were conducted in a developed country in primary care, with a higher proportion of women. Most of the nutrition interventions maintained continuous contacts during follow-up, and telephone calls were the most commonly used technology. A physical activity component was included in most studies, and the most common dietary approaches used were energy restrictions, changes in macronutrient distribution, and diet self-monitoring. Regarding theories, interventions mainly incorporated Social Cognitive Theory and Motivational Interviewing. Most trials presented significant and moderate weight loss (~5%), in which the key contributors were behavioral theories, the dietary approach of calorie restriction, and interventions delivered by dietitians and psychologists.
CONCLUSIONS
Most trials presented better weight loss results with the association of calorie restrictions and theory-based interventions delivered by dietitians or psychologists. We identified the need to develop interventions in other contexts, such as low- and middle-income countries; further trials comparing a theory- versus not-theory-driven intervention; group-based versus individually based intervention; and intervention using or not using technology.
Topics: Delivery of Health Care; Diet; Exercise; Female; Humans; Obesity; Weight Loss
PubMed: 32259716
DOI: 10.1016/j.nut.2020.110784 -
PloS One 2017Different metabolic profiles as well as comorbidities are common in people with Down Syndrome (DS). Therefore it is relevant to know whether micronutrient levels in... (Meta-Analysis)
Meta-Analysis Review
Systematic review and meta-analysis shows a specific micronutrient profile in people with Down Syndrome: Lower blood calcium, selenium and zinc, higher red blood cell copper and zinc, and higher salivary calcium and sodium.
Different metabolic profiles as well as comorbidities are common in people with Down Syndrome (DS). Therefore it is relevant to know whether micronutrient levels in people with DS are also different. This systematic review was designed to review the literature on micronutrient levels in people with DS compared to age and sex-matched controls without DS. We identified sixty nine studies from January 1967 to April 2016 through main electronic medical databases PubMed, Scopus, and Web of knowledge. We carried out meta-analysis of the data on four essential trace elements (Cu, Fe, Se, and Zn), six minerals (Ca, Cl, K, Mg, Na, and P), and five vitamins (vitamin A, B9, B12, D, and E). People with DS showed lower blood levels of Ca (standard mean difference (SMD) = -0.63; 95% confidence interval (CI): -1.16 to -0.09), Se (SMD = -0.99; 95% CI: -1.55 to -0.43), and Zn (SMD = -1.30; 95% CI: -1.75 to -0.84), while red cell levels of Zn (SMD = 1.88; 95% CI: 0.48 to 3.28) and Cu (SMD = 2.77; 95% CI: 1.96 to 3.57) were higher. They had also higher salivary levels of Ca (SMD = 0.85; 95% CI: 0.38 to 1.33) and Na (SMD = 1.04; 95% CI: 0.39 to 1.69). Our findings that micronutrient levels are different in people with DS raise the question whether these differences are related to the different metabolic profiles, the common comorbidities or merely reflect DS.
Topics: Adult; Calcium; Case-Control Studies; Cations, Divalent; Cations, Monovalent; Child; Copper; Down Syndrome; Female; Humans; Male; Micronutrients; Saliva; Selenium; Sodium; Zinc
PubMed: 28422987
DOI: 10.1371/journal.pone.0175437 -
International Journal of Qualitative... Dec 2023This systematic review and meta-synthesis of qualitative studies provides an overview of barriers and facilitators that breast cancer patients experience in weight... (Review)
Review
INTRODUCTION
This systematic review and meta-synthesis of qualitative studies provides an overview of barriers and facilitators that breast cancer patients experience in weight management interventions.
METHODS
We included qualitative studies describing barriers and facilitators for weight management interventions as experienced by adult breast cancer patients after the completion of initial treatment . The data was extracted and using thematic analysis.
RESULTS
After analysis, eleven themes were determined. Six of those themes could be linked to the Attitude, Social Influence and self Efficacy (ASE)-model. Physical and mental benefits, anticipated regret and a lack of motivation were linked to attitude. Integrating a weight management programme in daily life, stigma and fears were linked to self-efficacy. With regard to the social influence determinant, encouragement and discouragement by family members were developed as a theme. Four additional themes were conducted related to weight management behaviour; external barriers, economic barriers, cultural barriers and physical barriers. In addition, integrating weight management in cancer care was described as a separate theme.
CONCLUSIONS
Several disease specific issues, including feeling stigmatized after cancer treatment and treatment-related side effects and peer-support should be given specific attention to maximize adherence of weight management programmes.
Topics: Adult; Humans; Female; Breast Neoplasms; Health Behavior; Attitude; Motivation; Social Stigma; Qualitative Research
PubMed: 37840321
DOI: 10.1080/17482631.2023.2259290 -
Human Resources For Health Apr 2023Health systems worldwide are faced with the challenge of adequately staffing their hospital services. Much of the current research and subsequent policy has been... (Review)
Review
OBJECTIVES
Health systems worldwide are faced with the challenge of adequately staffing their hospital services. Much of the current research and subsequent policy has been focusing on nurse staffing and minimum ratios to ensure quality and safety of patient care. Nonetheless, nurses are not the only profession who interact with patients, and, therefore, not the only professional group who has the potential to influence the outcomes of patients while in hospital. We aimed to synthesise the evidence on the relationship between multi-disciplinary staffing levels in hospital including nursing, medical and allied health professionals and the risk of death.
METHODS
Systematic review. We searched Embase, Medline, CINAHL, and the Cochrane Library for quantitative or mixed methods studies with a quantitative component exploring the association between multi-disciplinary hospital staffing levels and mortality.
RESULTS
We included 12 studies. Hospitals with more physicians and registered nurses had lower mortality rates. Higher levels of nursing assistants were associated with higher patient mortality. Only two studies included other health professionals, providing scant evidence about their effect.
CONCLUSIONS
Pathways for allied health professionals such as physiotherapists, occupational therapists, dietitians, pharmacists, to impact safety and other patient outcomes are plausible and should be explored in future studies.
Topics: Humans; Nursing Staff, Hospital; Workforce; Hospitals; Allied Health Personnel; Personnel, Hospital; Personnel Staffing and Scheduling
PubMed: 37081525
DOI: 10.1186/s12960-023-00817-5 -
Eating and Weight Disorders : EWD Oct 2023This systematic review aimed to compare the weight change in people with or without binge eating who underwent various weight loss treatments. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This systematic review aimed to compare the weight change in people with or without binge eating who underwent various weight loss treatments.
METHODS
We searched for studies in PubMed, American Psychological Association, and Embase from inception to January 2022. The studies selected included assessment of binge eating and body weight before and after weight loss treatment in people of any age. The meta-analyses were conducted using Comprehensive Meta-Analysis (CMA). We used Egger's regression test, the funnel plot, and the Trim and Fill test to assess the risk of publication bias.
RESULTS
Thirty-four studies were included in the systematic review, with a total of 10.184 participants. The included studies were divided into three categories according to types of weight loss treatments, namely, (1) bariatric surgery; (2) pharmacotherapy isolated or combined with behavioral interventions; and (3) behavioral and/or nutritional interventions. The meta-analyses showed no significant difference in weight loss between people with or without binge eating engaged in weight loss treatments, with an overall effect size of - 0.117 (95% CI - 0.405 to 0.171; P = 0.426).
CONCLUSIONS
Our findings showed no difference in weight loss in people with or without pre-treatment binge eating who received various weight loss treatments. Weight loss treatments should not be withheld on the basis that they will not be effective in people with pre-treatment binge eating, albeit their safety and longer term impacts are unclear.
LEVEL OF EVIDENCE
Level I, at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies.
Topics: Humans; Binge-Eating Disorder; Overweight; Bulimia; Weight Loss; Body Weight
PubMed: 37889364
DOI: 10.1007/s40519-023-01613-9 -
Public Health Nutrition Aug 2015Non-pharmacological approaches to the treatment of depression and anxiety are of increasing importance, with emerging evidence supporting a role for lifestyle factors in... (Review)
Review
OBJECTIVE
Non-pharmacological approaches to the treatment of depression and anxiety are of increasing importance, with emerging evidence supporting a role for lifestyle factors in the development of these disorders. Observational evidence supports a relationship between habitual diet quality and depression. Less is known about the causative effects of diet on mental health outcomes. Therefore a systematic review was undertaken of randomised controlled trials of dietary interventions that used depression and/or anxiety outcomes and sought to identify characteristics of programme success.
DESIGN
A systematic search of the Cochrane, MEDLINE, EMBASE, CINAHL, PubMed and PyscInfo databases was conducted for articles published between April 1971 and May 2014.
RESULTS
Of the 1274 articles identified, seventeen met eligibility criteria and were included. All reported depression outcomes and ten reported anxiety or total mood disturbance. Compared with a control condition, almost half (47%) of the studies observed significant effects on depression scores in favour of the treatment group. The remaining studies reported a null effect. Effective dietary interventions were based on a single delivery mode, employed a dietitian and were less likely to recommend reducing red meat intake, select leaner meat products or follow a low-cholesterol diet.
CONCLUSIONS
Although there was a high level of heterogeneity, we found some evidence for dietary interventions improving depression outcomes. However, as only one trial specifically investigated the impact of a dietary intervention in individuals with clinical depression, appropriately powered trials that examine the effects of dietary improvement on mental health outcomes in those with clinical disorders are required.
Topics: Anxiety; Anxiety Disorders; Depression; Depressive Disorder; Humans
PubMed: 25465596
DOI: 10.1017/S1368980014002614 -
Behavioral Sciences (Basel, Switzerland) Dec 2019Severely energy-restricted diets are used in obesity management, but their efficacy in people with class III obesity (body mass index ≥40 kg/m) is uncertain. The aims... (Review)
Review
Severely energy-restricted diets are used in obesity management, but their efficacy in people with class III obesity (body mass index ≥40 kg/m) is uncertain. The aims of this systematic review and meta-analysis were to determine the effectiveness and characteristics of severely energy-restricted diets in people with class III obesity. As there was a lack of publications reporting long-term dietary interventions and randomised controlled trial designs, our original publication inclusion criteria were broadened to include uncontrolled study designs and a higher upper limit of energy intake. Eligible publications reported studies including adults with class III obesity and that assessed a diet with daily energy intake ≤5000 kJ for ≥4 weeks. Among 572 unique publications from 4 databases, 11 were eligible and 10 were suitable for meta-analysis. Our original intention was to classify comparison arms into short-term (<6 months) and long-term (>1 year) interventions. Due to the lack of long-term data found, comparison arms were classified according to the commonalities in dietary intervention length among the included publications, namely dietary interventions of 4 weeks' duration and those of ≥6 weeks' duration. After a 4-week severely energy-restricted diet intervention, the pooled average weight loss was 9.81 (95% confidence interval 10.80, 8.83) kg, with a 95% prediction interval of 6.38 to 13.25 kg, representing a loss of approximately 4.1 to 8.6% of initial body weight. Diets ≥6 weeks' duration produced 25.78 (29.42, 22.15) kg pooled average weight loss, with a 95% prediction interval of 13.77 to 37.80 kg, representing approximately 10.2 to 28.0% weight loss. Daily dietary prescriptions ranged from 330 to 5000 kJ (mean ± standard deviation 2260 ± 1400 kJ), and had wide variations in macronutrient composition. The diets were administered mostly via liquid meal replacement products. While the included publications had a moderate risk of bias score, which may inflate reported weight loss outcomes, the published data to date suggest that severely energy-restricted diets, delivered via diets of varying composition, effectively produce clinically relevant weight loss (≥10% of initial body weight) when used for 6 weeks or more in people with class III obesity.
PubMed: 31817943
DOI: 10.3390/bs9120144