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Journal of Advanced Nursing May 2024To systematically review and synthesize primary research on experiences and needs of adult informal caregivers of adults at risk of suicide. (Review)
Review
AIM
To systematically review and synthesize primary research on experiences and needs of adult informal caregivers of adults at risk of suicide.
DESIGN
Systematic review with a data-based convergent synthesis.
DATA SOURCES
MEDLINE, PsychINFO and CINAHL were searched in April 2022 and February 2023. English language research focusing on experiences of adult carers of adults was included.
METHODS
Articles were screened by title (n = 9077) and abstract (n = 132) with additional articles (n = 6) obtained via citation and hand searching. Thirty-one included studies were quality assessed using the Mixed Methods Appraisal Tool and study data were systematically extracted prior to thematic synthesis.
RESULTS
Five interconnected themes resulted: transitions; living with fear and uncertainty; changing relationships; interface with healthcare professionals and services; what carers need and want. Caring impacts mental, physical and social wellbeing. Relationships are affected in ways which might not be evident when caring for a minor. Repeated suicidal behaviour is particularly challenging with ongoing hypervigilance contributing to burden, burnout and interpersonal strain. Poor carer support exacerbates negative effects; carers need to feel informed, educated, involved and holistically supported.
CONCLUSION
Timely support for carers is essential. Interventions should address emotional responses, relational changes and effective care recipient support. Longitudinal research is required to understand effects of ongoing caring where there are multiple suicide attempts.
IMPLICATIONS
Nurses can provide carers with early support and information and longer term psychosocial interventions. If carers are adequately equipped and supported patient safety and wellbeing will be improved.
IMPACT
Findings of this systematic review include relational changes due to carer hypervigilance reducing autonomy and living with the possibility of suicide. Clinician awareness of the potential for relational shifts will help them prepare and support carers.
PATIENT OR PUBLIC CONTRIBUTION
There was no patient or public contribution.
Topics: Adult; Humans; Caregivers; Health Personnel; Emotions; Anxiety
PubMed: 38010822
DOI: 10.1111/jan.15940 -
Sleep Medicine Reviews Jun 2024Climate change is elevating nighttime and daytime temperatures worldwide, affecting a broad continuum of behavioral and health outcomes. Disturbed sleep is a plausible...
Climate change is elevating nighttime and daytime temperatures worldwide, affecting a broad continuum of behavioral and health outcomes. Disturbed sleep is a plausible pathway linking rising ambient temperatures with several observed adverse human responses shown to increase during hot weather. This systematic review aims to provide a comprehensive overview of the literature investigating the relationship between ambient temperature and valid sleep outcomes measured in real-world settings, globally. We show that higher outdoor or indoor temperatures are generally associated with degraded sleep quality and quantity worldwide. The negative effect of heat persists across sleep measures, and is stronger during the hottest months and days, in vulnerable populations, and the warmest regions. Although we identify opportunities to strengthen the state of the science, limited evidence of fast sleep adaptation to heat suggests rising temperatures induced by climate change and urbanization pose a planetary threat to human sleep, and therefore health, performance, and wellbeing.
Topics: Humans; Climate Change; Hot Temperature; Sleep; Sleep Quality
PubMed: 38598988
DOI: 10.1016/j.smrv.2024.101915 -
Journal of Surgical Education Dec 2023Transgender and gender diverse (TGD) individuals in the U.S. face significant healthcare disparities, which can be further exacerbated by providers' unfamiliarity with...
OBJECTIVES
Transgender and gender diverse (TGD) individuals in the U.S. face significant healthcare disparities, which can be further exacerbated by providers' unfamiliarity with this population's specific needs. ACGME currently does not have requirements for gender-affirming surgery (GAS) in the residency programs of surgical specialties that are responsible for providing this care. This systematic review evaluates gender-affirming care (GAC) and GAS training in surgical residency programs in the U.S. through the analysis of survey respondent data.
METHODS
Six databases (PubMed, Embase, Web of Science and Scopus, Cochrane Library and Google Scholar) were searched in December 2022 and May 2023. The search process ultimately yielded 22 survey-based studies, published between 2015 and 2023, with responses from 3020 respondents (2582 trainees and/or attending physicians, 438 program directors).
RESULTS
Six different surgical specialties were the focus of included studies, and common questions revolved around GAS training availability, comfort in treating TGD patients, and the importance of GAS in graduate surgical education (GSE). Less than half of trainees indicated that they received some form of previous GAC or GAS training, and less than half of program directors indicated that their residency or fellowship program offered such training.
CONCLUSIONS
While comfort levels around treating TGD patients ranged, the studies indicated an overall perceived importance of GAS training. These findings highlight the need to incorporate GAS training into graduate surgical education to improve access to and quality of care for TGD patients.
Topics: Humans; Transgender Persons; Internship and Residency; Curriculum; Health Personnel; Surveys and Questionnaires
PubMed: 37658003
DOI: 10.1016/j.jsurg.2023.08.007 -
Liver Transplantation : Official... Jun 2024Liver transplantation is the curative therapy of choice for patients with early-stage HCC. Locoregional therapies are often employed as a bridge to reduce the risk of... (Meta-Analysis)
Meta-Analysis
Liver transplantation is the curative therapy of choice for patients with early-stage HCC. Locoregional therapies are often employed as a bridge to reduce the risk of waitlist dropout; however, their association with posttransplant outcomes is unclear. We conducted a systematic review using Ovid MEDLINE and EMBASE to identify studies published between database inception and August 2, 2023, which reported posttransplant recurrence-free survival and overall survival among patients transplanted for HCC within Milan criteria, stratified by receipt of bridging therapy. Pooled HRs were calculated for each outcome using the DerSimonian and Laird method for a random-effects model. We identified 38 studies, including 19,671 patients who received and 20,148 patients who did not receive bridging therapy. Bridging therapy was not associated with significant differences in recurrence-free survival (pooled HR: 0.91, 95% CI: 0.77-1.08; I2 =39%) or overall survival (pooled HR: 1.09, 95% CI: 0.95-1.24; I2 =47%). Results were relatively consistent across subgroups, including geographic location and study period. Studies were discordant regarding the differential strength of association by pretreatment tumor burden and pathologic response, but potential benefits of locoregional therapy were mitigated in those who received 3 or more treatments. Adverse events were reported in a minority of studies, but when reported occurred in 6%-15% of the patients. Few studies reported loss to follow-up and most had a risk of residual confounding. Bridging therapy is not associated with improvements in posttransplant recurrence-free or overall survival among patients with HCC within Milan criteria. The risk-benefit ratio of bridging therapy likely differs based on the risk of waitlist dropout.
Topics: Humans; Liver Transplantation; Carcinoma, Hepatocellular; Liver Neoplasms; Neoplasm Recurrence, Local; Waiting Lists; Treatment Outcome; Chemoembolization, Therapeutic; Disease-Free Survival
PubMed: 38466889
DOI: 10.1097/LVT.0000000000000357 -
Frontiers in Public Health 2023Child labor can significantly impact the health, welfare, and development of children engaged in labor. The spread of child labor around the globe is predicted to...
Child labor can significantly impact the health, welfare, and development of children engaged in labor. The spread of child labor around the globe is predicted to accelerate as a consequence of the COVID-19 pandemic. To this end, a scoping review was conducted to (a) synthesize emerging themes and results from recent research on child labor during the COVID-19 pandemic, (b) identify factors that increase the risk of children falling into child labor and (c) provide recommendations that can inform the development of policies and programs to ensure that previous efforts to combat child labor are not lost. Six electronic databases (Medline, EMBASE, Scopus, CINAHL, Global health, and Web of Science) were searched on January 21, 2022. The database searches, along with the grey literature search, identified 5,244 studies, of which 45 articles were included in the final review. Several of those articles (8 of 45 articles) reviewed concluded that the pandemic could increase child labor worldwide including the worst forms of child labor. The reviewed studies identified primary risk factors for child labor during the COVID-19 pandemic including economic challenges, temporary school closure and a greater demand for child labor, mortality among parents, and limited social protection. This scoping review identified the need for more field research on child labor following the COVID-19 pandemic to detect emerging patterns of child labor and to develop effective intervention measures. There is also a need for further empirical research on the consequences of the COVID-19 pandemic on gender differences in occupational exposure and health outcomes among working children and marginalized groups such as migrants, refugees, and minority groups. Based on the conclusions drawn from this review, it is evident that addressing child labor in the wake of the pandemic necessitates a multi-sectoral response by the government, businesses, civil society, and funding/donor agencies. This response should address various areas such as education, social and child protection, and legislation to support vulnerable children and their families in order to combat child labor subsequent to the pandemic.
Topics: Child; Humans; COVID-19; Child Labor; Pandemics; Commerce; Databases, Factual
PubMed: 38361576
DOI: 10.3389/fpubh.2023.1240988 -
BMC Gastroenterology Jan 2024To evaluate the efficacy and safety of the combination of camrelizumab and apatinib in the treatment of liver cancer and to furnish clinical recommendations for... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the efficacy and safety of the combination of camrelizumab and apatinib in the treatment of liver cancer and to furnish clinical recommendations for pharmacological interventions.
METHODS
PubMed, Embase, Web of Science and the Cochrane Library were scrutinized for research publications from their inception to 22 December 2023. Bibliographic perusal and data procurement were executed. The quality of the included studies was evaluated employing the MINORS tool. Meta-analysis was conducted utilizing Stata 15.0 software.
RESULTS
A total of 10 studies involving 849 patients were included in the meta-analysis. The study revealed that the objective response rate (ORR) of the combined therapy was 28% (95% CI: 23%-34%), the disease control rate (DCR) was 69% (95% CI: 64%-73%), the median progression-free survival (mPFS) was 5.87 months (95% CI: 4.96-6.78), the median overall survival (mOS) was 19.35 months (95% CI: 17.53-21.17), the incidence of any grade adverse events was 90% (95% CI: 85%-95%), and the occurrence of grade 3 or higher adverse events was 49% (95% CI: 27%-71%).
CONCLUSION
The combination of camrelizumab and apatinib exhibits commendable effectiveness in the management of liver cancer; nevertheless, vigilance should be exercised concerning potential adverse reactions in clinical applications to enhance the safety of pharmacological interventions.
Topics: Humans; Antibodies, Monoclonal, Humanized; Pyridines; Liver Neoplasms
PubMed: 38297195
DOI: 10.1186/s12876-024-03144-8 -
Telemedicine Journal and E-health : the... Mar 2024Telemedicine systems were rapidly implemented in response to COVID-19. However, little is known about their effectiveness, acceptability, and sustainability for safety...
Telemedicine systems were rapidly implemented in response to COVID-19. However, little is known about their effectiveness, acceptability, and sustainability for safety net populations. This study systematically reviewed primary care telemedicine implementation and effectiveness in safety net settings. We searched PubMed for peer-reviewed articles on telemedicine implementation from 2013 to 2021. The search was done between June and December 2021. Included articles focused on health care organizations that primarily serve low-income and/or rural populations in the United States. We screened 244 articles from an initial search of 343 articles and extracted and analyzed data from = 45 articles. Nine (20%) of 45 articles were randomized controlled trials. = 22 reported findings for at least one marginalized group (i.e., racial/ethnic minority, 65 years+, limited English proficiency). Only = 19 (42%) included African American/Black patients in demographics descriptions, = 14 (31%) LatinX/Hispanic patients, = 4 (9%) Asian patients, = 4 (9%) patients aged 65+ years, and = 4 (9%) patients with limited English proficiency. Results show telemedicine can provide high-quality primary care that is more accessible and affordable. Fifteen studies assessed barriers and facilitators to telemedicine implementation. Common barriers were billing/administrative workflow disruption ( = 9, 20%), broadband access/quality ( = 5, 11%), and patient preference for in-person care ( = 4, 9%). Facilitators included efficiency gains ( = 6, 13%), patient acceptance ( = 3, 7%), and enhanced access ( = 3, 7%). Telemedicine is an acceptable care modality to deliver primary care in safety net settings. Future studies should compare telemedicine and in-person care quality and test strategies to improve telemedicine implementation in safety net settings.
Topics: Humans; Ethnicity; Minority Groups; Poverty; Telemedicine; United States; Safety-net Providers
PubMed: 37707997
DOI: 10.1089/tmj.2023.0260 -
Children (Basel, Switzerland) Jan 2024Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) manifest in individuals facing attachment system challenges, particularly observed... (Review)
Review
A Systematic Review on Assessing Assessments: Unveiling Psychometric Properties of Instruments for Reactive Attachment Disorder and Disinhibited Social Engagement Disorder in Minors under Protective Measures.
BACKGROUND
Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) manifest in individuals facing attachment system challenges, particularly observed in minors under protective measures. The lack of standardized tools for assessing these difficulties and uncertainty about the most effective instruments from a psychometric perspective prompted this study.
AIM
Using the COSMIN checklist, we systematically reviewed instruments assessing RAD, adhering to PRISMA.
METHODOLOGY
Examined tools included the Disturbance Attachment Interview, Preschool Age Psychiatric Assessment, Relationship Patterns Questionnaire, Assessment of RAD and DSED, Development and Well-Being Assessment, and Reactive Attachment Disorder Questionnaire.
RESULTS
Of the 10 articles analyzed, the results highlight a research emphasis on internal consistency and structural and construct validity, sidelining other properties.
CONCLUSION
Most articles review structural validity and internal consistency. These measures are satisfactory but insufficiently evaluated. It is necessary to evaluate these tools using other indicators such as cross-cultural validity, measurement error, or responsiveness in adolescents under protective measures.
PubMed: 38397256
DOI: 10.3390/children11020144 -
Blood Purification 2024Therapeutic apheresis (TA) is commonly used for cryoglobulinemic vasculitis (CV) patients, but its efficacy remains uncertain. This systematic review aimed to assess the...
INTRODUCTION
Therapeutic apheresis (TA) is commonly used for cryoglobulinemic vasculitis (CV) patients, but its efficacy remains uncertain. This systematic review aimed to assess the efficacy of different TA modalities, such as plasma exchange (PE), plasmapheresis (PP), and cryofiltration (CF), in treating CV patients with renal involvement.
METHODS
Literature search of MEDLINE, EMBASE, and Cochrane Databases was conducted up to December 2022. Studies that reported the outcomes of TA in adult CV patients with renal involvement were assessed. The protocol for this systematic review has been registered with PROSPERO (No. CRD42023417727). The quality of each study was evaluated by the investigators using the validated methodological index for non-randomized studies (minors) quality score.
RESULTS
154 patients who encountered 170 episodes of serious events necessitating TA were evaluated across 76 studies. Among them, 51% were males, with a mean age ranging from 49 to 58 years. The CV types included 15 type I, 97 type II, and 13 type III, while the remaining patients exhibited mixed (n = 17) or undetermined CV types (n = 12). Among the treatment modalities, PE, PP, and CF were performed in 85 (56%), 52 (34%), and 17 patients (11%), respectively, with no identical protocol for TA treatment. The overall response rate for TA was 78%, with response rates of 84%, 77%, and 75% observed in type I, II, and III patients respectively. Most patients received steroids, immunosuppressants, and treatment targeting the underlying causative disease. The overall long-term renal outcome rate was 77%, with type I, II, and III patients experiencing response rates of 89%, 76%, and 90%, respectively. The renal outcomes in patients receiving PE, PP, and CF were comparable, with rates of 78%, 76%, and 81%, respectively.
CONCLUSIONS
This study presents compelling evidence that combination of TA with other treatments, especially immunosuppressive therapy, is a successful strategy for effectively managing severe renal involvement in CV patients. Among the TA modalities studied, including PE, PP, and CF, all demonstrated efficacy, with PE being the most frequently employed approach.
Topics: Adult; Female; Humans; Male; Middle Aged; Blood Component Removal; Cryoglobulinemia; Immunosuppressive Agents; Plasma Exchange; Plasmapheresis; Vasculitis
PubMed: 37852193
DOI: 10.1159/000534102 -
International Journal For Equity in... Feb 2024Sepsis is a serious and life-threatening condition caused by a dysregulated immune response to an infection. Recent guidance issued in the UK gave recommendations around...
BACKGROUND AND AIMS
Sepsis is a serious and life-threatening condition caused by a dysregulated immune response to an infection. Recent guidance issued in the UK gave recommendations around recognition and antibiotic treatment of sepsis, but did not consider factors relating to health inequalities. The aim of this study was to summarise the literature investigating associations between health inequalities and sepsis.
METHODS
Searches were conducted in Embase for peer-reviewed articles published since 2010 that included sepsis in combination with one of the following five areas: socioeconomic status, race/ethnicity, community factors, medical needs and pregnancy/maternity.
RESULTS
Five searches identified 1,402 studies, with 50 unique studies included in the review after screening (13 sociodemographic, 14 race/ethnicity, 3 community, 3 care/medical needs and 20 pregnancy/maternity; 3 papers examined multiple health inequalities). Most of the studies were conducted in the USA (31/50), with only four studies using UK data (all pregnancy related). Socioeconomic factors associated with increased sepsis incidence included lower socioeconomic status, unemployment and lower education level, although findings were not consistent across studies. For ethnicity, mixed results were reported. Living in a medically underserved area or being resident in a nursing home increased risk of sepsis. Mortality rates after sepsis were found to be higher in people living in rural areas or in those discharged to skilled nursing facilities while associations with ethnicity were mixed. Complications during delivery, caesarean-section delivery, increased deprivation and black and other ethnic minority race were associated with post-partum sepsis.
CONCLUSION
There are clear correlations between sepsis morbidity and mortality and the presence of factors associated with health inequalities. To inform local guidance and drive public health measures, there is a need for studies conducted across more diverse setting and countries.
Topics: Humans; Female; Pregnancy; Ethnicity; Minority Groups; Socioeconomic Factors; Risk Factors; Health Inequities; Sepsis
PubMed: 38383380
DOI: 10.1186/s12939-024-02114-6