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Pain Physician Nov 2023Remimazolam is a novel ultrashort-effect benzodiazepine. In 2020, the US Food and Drug Administration approved it for procedural sedation. Remimazolam is beneficial for... (Meta-Analysis)
Meta-Analysis
Hemodynamic Influences of Remimazolam Versus Propofol During the Induction Period of General Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
BACKGROUND
Remimazolam is a novel ultrashort-effect benzodiazepine. In 2020, the US Food and Drug Administration approved it for procedural sedation. Remimazolam is beneficial for consistent sedation and quick recovery in painless gastrointestinal endoscopy. Propofol is one of the most commonly used intravenous anesthetics in clinical practice. Recently, only a few studies have compared propofol with remimazolam for general anesthesia induction.
OBJECTIVES
The purpose of our systematic review and meta-analysis was to compare the hemodynamic effects of remimazolam and propofol during the induction of general anesthesia.
STUDY DESIGN
Systematic review and meta-analysis of randomized, controlled trials.
METHODS
The authors retrieved the PubMed, Embase, Cochrane Library, and Web of Science databases for studies published through September 30, 2022, which reported relevant prospective randomized controlled trials (RCTs) comparing remimazolam with propofol for general anesthesia. The primary outcome was hemodynamic changes, including the absolute value of fluctuation of mean arterial pressure (delta MAP) and heart rate delta HR). The secondary outcomes were the following 2 indicators: the occurrence of total adverse events and the quality of recovery from general anesthesia at 24 hours postsurgery. RevMan 5.4.1 (The Nordic Cochrane Centre for The Cochrane Collaboration) and trial sequential analysis were used to execute the statistical analyses. The different domains of bias were judged by the Cochrane risk of the bias assessment tool.
RESULTS
The authors identified 189 papers in PubMed, Embase, Cochrane Library, and Web of Science. Eight articles with 964 patients were selected. The included studies had moderate quality. For primary outcomes, the lower delta HR (mean difference [MD] = -4.99; 95% CI, -7.97 to -2.00; I² = 41.6%; P = 0.001] and delta MAP (MD = -5.91; 95% CI. -8.57 to -3.24; I² = 0%; P < 0.0001) represent more stable hemodynamic characteristics in the remimazolam group. Regarding secondary outcomes, a considerably lower incidence of total adverse events was noted in the remimazolam group than that for the propofol group (odds ratio [OR] = 0.40; 95% CI, 0.28 to 0.58; I² = 63%; P < 0.00001). In comparison to the propofol group, remimazolam achieved an advantage score of quality of recovery -15 in 24 hours postsurgery (MD = 5.31, 95% CI, 1.51 to 9.12; I² = 87%; P = 0.006).
LIMITATION
Firstly, there are only a handful of published RCTs on the administration of remimazolam in general anesthesia. In addition, due to patient privacy, we could not extract individual patient data, therefore we could not combine and assess any variations in patient characteristics.
CONCLUSION
Evidence suggests that remimazolam has a lower hemodynamic effect during general anesthesia and fewer perioperative adverse effects after general anesthesia than propofol; however, which agent is superior regarding quality benefit in postoperative recovery based on the studies included here remains inconclusive. Additional RCTs with updated meta-analyses to enlarge the sample size and properly analyze the benefit-to-risk ratio to patients are needed to determine the evidence for such a relatively new medicine.
Topics: Humans; Propofol; Randomized Controlled Trials as Topic; Anesthesia, General; Benzodiazepines; Hemodynamics
PubMed: 37976477
DOI: No ID Found -
International Journal of Environmental... Dec 2022Adoption of Ambient Assisted Living (AAL) technologies for geriatric healthcare is suboptimal. This study aims to present the AAL Adoption Diamond Framework,... (Review)
Review
Adoption of Ambient Assisted Living (AAL) technologies for geriatric healthcare is suboptimal. This study aims to present the AAL Adoption Diamond Framework, encompassing a set of key enablers/barriers as factors, and describe our approach to developing this framework. A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. SCOPUS, IEEE Xplore, PubMed, ProQuest, Science Direct, ACM Digital Library, SpringerLink, Wiley Online Library and grey literature were searched. Thematic analysis was performed to identify factors reported or perceived to be important for adopting AAL technologies. Of 3717 studies initially retrieved, 109 were thoroughly screened and 52 met our inclusion criteria. Nineteen unique technology adoption factors were identified. The most common factor was privacy (50%) whereas data accuracy and affordability were the least common factors (4%). The highest number of factors found per a given study was eleven whereas the average number of factors across all studies included in our sample was four (mean = 3.9). We formed an AAL technology adoption framework based on the retrieved information and named it the AAL Adoption Diamond Framework. This holistic framework was formed by organising the identified technology adoption factors into four key dimensions: Human, Technology, Business, and Organisation. To conclude, the AAL Adoption Diamond Framework is holistic in term of recognizing key factors for the adoption of AAL technologies, and novel and unmatched in term of structuring them into four overarching themes or dimensions, bringing together the individual and the systemic factors evolving around the adoption of AAL technology. This framework is useful for stakeholders (e.g., decision-makers, healthcare providers, and caregivers) to adopt and implement AAL technologies.
Topics: Humans; Aged; Ambient Intelligence; Delivery of Health Care; Assisted Living Facilities; Health Facilities; Self-Help Devices
PubMed: 36554640
DOI: 10.3390/ijerph192416760 -
Sensors (Basel, Switzerland) Jan 2023As the Internet of Things (IoT) concept materialized worldwide in complex ecosystems, the related data security and privacy issues became apparent. While the system... (Review)
Review
As the Internet of Things (IoT) concept materialized worldwide in complex ecosystems, the related data security and privacy issues became apparent. While the system elements and their communication paths could be protected individually, generic, ecosystem-wide approaches were sought after as well. On a parallel timeline to IoT, the concept of distributed ledgers and blockchains came into the technological limelight. Blockchains offer many advantageous features in relation to enhanced security, anonymity, increased capacity, and peer-to-peer capabilities. Although blockchain technology can provide IoT with effective and efficient solutions, there are many challenges related to various aspects of integrating these technologies. While security, anonymity/data privacy, and smart contract-related features are apparently advantageous for blockchain technologies (BCT), there are challenges in relation to storage capacity/scalability, resource utilization, transaction rate scalability, predictability, and legal issues. This paper provides a systematic review on state-of-the-art approaches of BCT and IoT integration, specifically in order to solve certain security- and privacy-related issues. The paper first provides a brief overview of BCT and IoT's basic principles, including their architecture, protocols and consensus algorithms, characteristics, and the challenges of integrating them. Afterwards, it describes the survey methodology, including the search strategy, eligibility criteria, selection results, and characteristics of the included articles. Later, we highlight the findings of this study which illustrates different works that addressed the integration of blockchain technology and IoT to tackle various aspects of privacy and security, which are followed by a categorization of applications that have been investigated with different characteristics, such as their primary information, objective, development level, target application, type of blockchain and platform, consensus algorithm, evaluation environment and metrics, future works or open issues (if any), and further notes for consideration. Furthermore, a detailed discussion of all articles is included from an architectural and operational perspective. Finally, we cover major gaps and future considerations that can be taken into account when integrating blockchain technology with IoT.
Topics: Blockchain; Ecosystem; Internet of Things; Privacy; Technology; Computer Security
PubMed: 36679582
DOI: 10.3390/s23020788 -
Public Health in Practice (Oxford,... Dec 2023This review summarizes women's acceptability of vaginal self-sampling for cervical cancer screening in Latin America. (Review)
Review
OBJECTIVE
This review summarizes women's acceptability of vaginal self-sampling for cervical cancer screening in Latin America.
STUDY DESIGN
Systematic review.
METHOD
A systematic literature search was performed in PubMed, Web of Science, and Embase regarding the acceptance of HPV vaginal self-sampling by women over 18 years old. Articles were selected for research that was conducted in Latin America and published between January 1st, 1993, and December 31st, 2022.
RESULTS
Fifteen publications were included. Eight publications reported an acceptance of HPV self-sampling as high as 80%, six papers found an acceptance rate between 50 and 80% and only one found an acceptance rate of less than 50%. Based on non-standardized questionnaires, women considered self-sampling more comfortable, easier, and less painful than conventional cytology. The procedure was associated with less embarrassment and a greater sense of privacy.
CONCLUSION
HPV vaginal-self sampling appears to be an acceptable screening method amongst eligible Latin American women.
PubMed: 37564780
DOI: 10.1016/j.puhip.2023.100417 -
PloS One 2022Blockchain technology (BCT) has emerged in the last decade and added a lot of interest in the healthcare sector. The purpose of this systematic literature review (SLR)...
Blockchain technology (BCT) has emerged in the last decade and added a lot of interest in the healthcare sector. The purpose of this systematic literature review (SLR) is to explore the potential paradigm shift in healthcare utilizing BCT. The study is compiled by reviewing research articles published in nine well-reputed venues such as IEEE Xplore, ACM Digital Library, Springs Link, Scopus, Taylor & Francis, Science Direct, PsycINFO, Ovid Medline, and MDPI between January 2016 to August 2021. A total of 1,192 research studies were identified out of which 51 articles were selected based on inclusion criteria for this SLR that presents the modern information on the recent implications and gaps in the use of BCT for enhancing the healthcare procedures. According to the outcomes, BCT is being applied to design the novel and advanced interventions to enrich the current protocol of managing, distributing, and processing clinical records and personal medical information. BCT is enduring the conceptual development in the healthcare domain, where it has summed up the substantial elements through better and enhanced efficiency, technological innovation, access control, data privacy, and security. A framework is developed to address the probable field where future researchers can add considerable value, such as data protection, system architecture, and regulatory compliance. Finally, this SLR concludes that the upcoming research can support the pervasive implementation of BCT to address the critical dilemmas related to health diagnostics, enhancing the patient healthcare process in remote monitoring or emergencies, data integrity, and avoiding fraud.
Topics: Blockchain; Computer Security; Delivery of Health Care; Health Facilities; Humans; Technology
PubMed: 35404955
DOI: 10.1371/journal.pone.0266462 -
Midwifery Sep 2023To conduct a systematic review exploring women's experiences, views and understanding of any vaginal examinations during intrapartum care, in any care setting and by any... (Review)
Review
OBJECTIVE
To conduct a systematic review exploring women's experiences, views and understanding of any vaginal examinations during intrapartum care, in any care setting and by any healthcare professional. Intrapartum vaginal examination is deemed both an essential assessment tool and routine intervention during labour. It is an intervention that can cause significant distress, embarrassment, and pain for women, as well as reinforce outdated gender roles. In view of its widespread and frequently reported excessive use, it is important to understand women's views on vaginal examination to inform further research and current practice.
DESIGN
A systematic search and meta-ethnography synthesis informed by Noblit and Hare (1988) and the eMERGe guidance (France et al. 2019) was undertaken. Nine electronic databases were searched systematically using predefined search terms in August 2021, and again in March 2023. Studies meeting the following criteria: English language, qualitative and mixed-method studies, published from 2000 onwards, and relevant to the topic, were eligible for quality appraisal and inclusion.
FINDINGS
Six studies met the inclusion criteria. Three from Turkey, one from Palestine, one from Hong Kong and one from New Zealand. One disconfirming study was identified. Following both a reciprocal and refutational synthesis, four 3rd order constructs were formed, titled: Suffering the examination, Challenging the power dynamic, Cervical-centric labour culture embedded in societal expectations, and Context of care. Finally, a line of argument was arrived at, which brought together and summarised the 3rd order constructs.
KEY CONCLUSIONS AND IMPLICATIONS OF PRACTICE
The dominant biomedical discourse of vaginal examination and cervical dilatation as central to the birthing process does not align with midwifery philosophy or women's embodied experience. Women experience examinations as painful and distressing but tolerate them as they view them as necessary and unavoidable. Factors such as context of care setting, environment, privacy, midwifery care, particularly in a continuity of carer model, have considerable positive affect on women's experience of examinations. Further research into women's experiences of vaginal examination in different care models as well as research into less invasive intrapartum assessment tools that promote physiological processes is urgently required.
Topics: Pregnancy; Female; Humans; Gynecological Examination; Anthropology, Cultural; Parturition; Labor, Obstetric; Midwifery; Qualitative Research
PubMed: 37315454
DOI: 10.1016/j.midw.2023.103746 -
Current Nutrition Reports Sep 2022Globally, too few children are breastfed as recommended. Commercial promotion of breast-milk substitutes (BMS) is one factor undermining breastfeeding globally. Although... (Review)
Review
PURPOSE OF REVIEW
Globally, too few children are breastfed as recommended. Commercial promotion of breast-milk substitutes (BMS) is one factor undermining breastfeeding globally. Although the International Code of Marketing of BMS prohibits all forms of marketing, promotion has been observed in digital environments. We aimed to understand the scope and impact of digital marketing for the promotion of BMS.
RECENT FINDINGS
BMS are promoted strategically and in an integrated fashion across multiple digital channels (social media, manufacturer websites, online retailers, blogs, mobile apps and digital streaming services). Traditional marketing strategies like gifts, discounts and coupons are also disseminated digitally. Data mining, real-time direct-to-consumer advertising and partnering with peer-group social media influencers are additional avenues. Exposure to digital marketing is common. Research on the impact of digital marketing is scarce, but its negative impact on breastfeeding intention and initiation has been documented. Case reports from marketing industry press corroborate academic evidence by highlighting the benefits of digital marketing to BMS companies in recruiting new users and increasing sales. To protect and promote breastfeeding, coordinated global action and strengthened national measures will be needed to implement, monitor and enforce the International Code in a digital context. Further action could include voluntary restrictions on BMS marketing by social media platforms and greater use of government-led data and health privacy regulation.
Topics: Breast Feeding; Child; Female; Humans; Marketing; Milk Substitutes
PubMed: 35507274
DOI: 10.1007/s13668-022-00414-3 -
Journal of Medical Internet Research Oct 2021As a distributed technology, blockchain has attracted increasing attention from stakeholders in the medical industry. Although previous studies have analyzed blockchain... (Review)
Review
BACKGROUND
As a distributed technology, blockchain has attracted increasing attention from stakeholders in the medical industry. Although previous studies have analyzed blockchain applications from the perspectives of technology, business, or patient care, few studies have focused on actual use-case scenarios of blockchain in health care. In particular, the outbreak of COVID-19 has led to some new ideas for the application of blockchain in medical practice.
OBJECTIVE
This paper aims to provide a systematic review of the current and projected uses of blockchain technology in health care, as well as directions for future research. In addition to the framework structure of blockchain and application scenarios, its integration with other emerging technologies in health care is discussed.
METHODS
We searched databases such as PubMed, EMBASE, Scopus, IEEE, and Springer using a combination of terms related to blockchain and health care. Potentially relevant papers were then compared to determine their relevance and reviewed independently for inclusion. Through a literature review, we summarize the key medical scenarios using blockchain technology.
RESULTS
We found a total of 1647 relevant studies, 60 of which were unique studies that were included in this review. These studies report a variety of uses for blockchain and their emphasis differs. According to the different technical characteristics and application scenarios of blockchain, we summarize some medical scenarios closely related to blockchain from the perspective of technical classification. Moreover, potential challenges are mentioned, including the confidentiality of privacy, the efficiency of the system, security issues, and regulatory policy.
CONCLUSIONS
Blockchain technology can improve health care services in a decentralized, tamper-proof, transparent, and secure manner. With the development of this technology and its integration with other emerging technologies, blockchain has the potential to offer long-term benefits. Not only can it be a mechanism to secure electronic health records, but blockchain also provides a powerful tool that can empower users to control their own health data, enabling a foolproof health data history and establishing medical responsibility.
Topics: Blockchain; COVID-19; Confidentiality; Data Management; Electronic Health Records; Humans; SARS-CoV-2
PubMed: 34533470
DOI: 10.2196/28613 -
Depression Research and Treatment 2020Prison populations tend to be marginalized and disadvantaged of the rights and freedoms that other people in the community benefit from. Their separation from families,... (Review)
Review
BACKGROUND
Prison populations tend to be marginalized and disadvantaged of the rights and freedoms that other people in the community benefit from. Their separation from families, a narrow room and lack of privacy in the prison, violence between prisoners, and the uncertainty about the future result in psychological distress, for example, depression. The review has synthesized previous studies conducted on the topic and summarized to formulate recommendations for future prison health care services.
METHODS
We systematically searched the databases: PubMed, Psych Info, and SCOPUS, as well as manual Google Scholar searches, were conducted to retrieve published literature globally. We have included observational studies, written in English language. Estimates were pooled using a random-effects model. The study protocol was registered in PROSPERO with protocol number CRD42020156108. Subgroup and sensitivity analysis was conducted, and heterogeneity across the studies was evaluated using Q and the -test. Publication bias was assessed by inspection of the funnel plot and Egger's regression test.
RESULT
A total of 1313 studies were initially identified through the electronic database; among these, a total of 73 full-text articles were retrieved for further appraisal. Further, 32 full-text articles were included in the final systematic review and meta-analysis. In this meta-analysis, the pooled prevalence of depression among prisoners was 36.9% (95% CI; 27.3-47.6). The pooled prevalence of depression among prisoners in the developing and developed countries was 39.2% and 33.1%, respectively. Moreover, the prevalence of depression was 19.1% and 54% for the studies that used diagnostic and screen tools to diagnose or screen depression, respectively. A leave-one-out analysis revealed that the pooled prevalence of depression among prisoners was not dependent on a single study removal or addition. Thus, the pooled prevalence of depression ranges between 35.3 and 38.0%.
CONCLUSION
The prevalence of depression among prisoners was high. Therefore, regular and continuous screening of depressive symptoms for prisoners along with its appropriate management is highly recommended.
PubMed: 33294222
DOI: 10.1155/2020/3695209 -
Cadernos de Saude Publica Jul 2017Cyber culture with its related e-commerce, expanded since the 2000s through the advent of social network platforms, incites participants to engage in hyper-exposure and... (Review)
Review
Cyber culture with its related e-commerce, expanded since the 2000s through the advent of social network platforms, incites participants to engage in hyper-exposure and spectacularization of their private lives, with inherent consequences for personal image and privacy, publicizing private matters (especially those pertaining to sexuality and corporality) in the digital media. This raises the need to understand how the phenomenon of cyber dating abuse in affective and sexual relationships is conceptualized and characterized in scientific studies, which health problems are associated with it, and which social technologies are suggested for intervention. This form of abuse is a new expression of intimate partner violence that involves, among other practices, posting embarrassing photos and videos and intimate messages without prior consent, with the purpose of humiliating and defaming the person. The current study is an integrative systematic review, including 35 articles, with a predominance of studies in the United States (22). Types of cyber dating abuse range from direct aggression to stalking. Despite the high prevalence, especially among adolescents and youth, the literature highlights that this type of cyber abuse is often taken for granted. The suggested interventions are mostly for prevention and awareness-raising concerning relationship abuse, action by school counselors, and family orientation. The high reciprocity of cyber dating abuse between males and females indicates that future studies should attempt to elucidate how the dynamics of gender violence are reproduced or subverted by it.
Topics: Age Factors; Bullying; Humans; Intimate Partner Violence; Privacy; Sex Offenses; Sexual Partners; Social Media
PubMed: 28767962
DOI: 10.15090/0102-311X00138516