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Psychiatry Investigation Dec 2023To find the safety of long-acting injectable antipsychotics (LAIs) compared to each other, and/or placebo in the treatment of schizophrenia (SCZ) and/or schizoaffective...
OBJECTIVE
To find the safety of long-acting injectable antipsychotics (LAIs) compared to each other, and/or placebo in the treatment of schizophrenia (SCZ) and/or schizoaffective disorder (SZA).
METHODS
We performed a systematic review and a network meta-analysis of randomized controlled trials (RCTs) comparing the safety of LAIs versus other LAIs or placebo in adults diagnosed with SCZ or SZA. The primary outcomes were treatment emergent adverse events (TEAEs), serious treatment emergent adverse events (STEAEs), and deaths. The secondary outcomes included treatment discontinuations due to adverse events and all-cause discontinuations.
RESULTS
Seventeen RCTs were included (n=7,908). There were no significant differences between LAIs and placebo in the risk of presenting TEAEs. LAIs had a significant lower risk of presenting STEAEs except for aripiprazole. No significant differences in deaths were found. LAIs showed a significant protective effect against all-cause discontinuation, except for haloperidol. Only aripiprazole had a significantly lower risk of treatment discontinuation due to adverse events.
CONCLUSION
We found no significant differences in the risk of presenting TEAEs between LAIs and placebo. The majority of LAIs had a significantly lower risk of presenting STEAEs than placebo. Development of international guidelines for the report of safety outcomes related to antipsychotics especially for LAIs in clinical trials could minimize report and interpretation biases and improve the accuracy of posterior meta-analysis.
PubMed: 38163650
DOI: 10.30773/pi.2022.0216 -
World Journal of Pediatrics : WJP Aug 2023Advances in cancer treatments, particularly the development of radiation therapy, have led to improvements in survival outcomes in children with brain tumors. However,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Advances in cancer treatments, particularly the development of radiation therapy, have led to improvements in survival outcomes in children with brain tumors. However, radiation therapy is associated with significant long-term neurocognitive morbidity. The present systematic review and meta-analysis aimed to compare the neurocognitive outcomes of children and adolescents with brain tumors treated with photon radiation (XRT) or proton therapy (PBRT).
METHODS
A systematic search was conducted (PubMed, Embase, Cochrane, and Web of Science from inception until 02/01/2022) for studies comparing the neurocognitive outcomes of children and adolescents with brain tumors treated with XRT vs. PBRT. The pooled mean differences (expressed as Z scores) were calculated using a random effects method for those endpoints analyzed by a minimum of three studies.
RESULTS
Totally 10 studies (n = 630 patients, average age range: 1-20 years) met the inclusion criteria. Patients who had received PBRT achieved significantly higher scores (difference in Z scores ranging from 0.29-0.75, all P < 0.05 and significant in sensitivity analyses) after treatment than those who had received XRT for most analyzed neurocognitive outcomes (i.e., intelligence quotient, verbal comprehension and perceptual reasoning indices, visual motor integration, and verbal memory). No robust significant differences (P > 0.05 in main analyses or sensitivity analyses) were found for nonverbal memory, verbal working memory and working memory index, processing speed index, or focused attention.
CONCLUSIONS
Pediatric brain tumor patients who receive PBRT achieve significantly higher scores on most neurocognitive outcomes than those who receive XRT. Larger studies with long-term follow-ups are needed to confirm these results.
Topics: Child; Adolescent; Humans; Infant; Child, Preschool; Young Adult; Adult; Protons; Brain Neoplasms; Proton Therapy
PubMed: 37154861
DOI: 10.1007/s12519-023-00726-6 -
BMC Nursing Feb 2024Moral sensitivity is an essential criterion for nurses' professional competence, and it is effective in professional performance and the development of communication...
BACKGROUND
Moral sensitivity is an essential criterion for nurses' professional competence, and it is effective in professional performance and the development of communication between nurse and patient. According to several definitions of moral sensitivity in nursing texts, each of them has examined moral sensitivity from a different aspect, and there are still uncertainties in the field of moral sensitivity of nursing students. Therefore, to clarify the characteristics and dimensions of the concept of moral sensitivity of nursing students, we used the method of concept analysis.
GOAL
To clarify and define moral sensitivity of nursing students.
METHOD
For this systematic review, ten databases (PubMed, Scopus, Science Direct, Emerald, Springer, Proquest (open access), ERIC, SID, Irandoc, Magiran) were searched. They were published between 1990 and 2020. Inclusion criteria were having access to the full text of the article, types of studies (quantitative, qualitative, concept analysis, systematic review, and meta-analysis) related to the attributes, antecedents, and consequences of nursing students' moral sensitivity, medical students' moral sensitivity and Ethics education, articles being published in scientific journals in English or Persian language, texts published in non-peer-reviewed journals and letters to the editor were excluded from the data analysis. The methodological quality of the studies was assessed using the Mixed Methods Appraisal Tool 2018 and Prisma ScR Checklist 2020. Rodger's evolutionary concept analysis was used to conduct this study.
RESULTS
From 361 articles, 38 were included. The results showed moral sensitivity in nursing students improves through specialized ethical knowledge and presence in educational and professional settings. The attributes consist of honest and benevolent communication, compassionate professional practice, intuitive perceiving moral challenges, awareness of the responsibilities and moral consequences of decisions. The moral sensitivity of nursing students improves the quality of nursing care and the effective management of ethical challenges.
CONCLUSION
Results can help develop nursing education theories and programs, design appropriate tools to evaluate this concept, and increase the quality of care and management of moral challenges in society and health systems.
LIMITATION
This research has only examined Persian and English texts; also, accessing all the international databases was impossible, and more investigation in this field is required.
PubMed: 38321462
DOI: 10.1186/s12912-024-01713-6 -
Systematic Reviews Nov 2023International guidelines promote preoperative education for patients undergoing orthopedic surgery. However, the evidence sustaining these recommendations comes mainly... (Review)
Review
BACKGROUND
International guidelines promote preoperative education for patients undergoing orthopedic surgery. However, the evidence sustaining these recommendations comes mainly from studies for hip and knee replacement surgery. Little is known about patients undergoing foot and ankle surgery. We aimed to map and characterize all the available evidence on preoperative education for patients undergoing foot and ankle surgery.
METHODS
This study complies with the PRISMA-ScR guidelines. We searched eight databases, including MEDLINE, Embase, and CENTRAL. We performed cross-citations and revised the references of included studies. We included studies addressing preoperative education in patients undergoing foot and ankle surgery. We did not exclude studies because of the way of delivering education, the agent that provided it, or the content of the preoperative education addressed in the study. Two independent authors screened the articles and extracted the data. The aggregated data are presented in descriptive tables.
RESULTS
Of 1596 retrieved records, only 15 fulfilled the inclusion criteria. Four addressed preoperative education on patients undergoing foot and ankle surgery and the remaining 11 addressed a broader population, including patients undergoing foot and ankle surgery but did not provide separate data of them. Two studies reported that preoperative education decreases the length of stay of these patients, another reported that education increased the knowledge of the participants, and the other leaflets were well received by patients.
CONCLUSION
This scoping review demonstrates that evidence on preoperative education in foot and ankle surgery is scarce. The available evidence supports the implementation of preoperative education in patients undergoing foot and ankle surgery for now. The best method of education and the real impact of this education remain to be determined.
Topics: Humans; Ankle; Preoperative Care; Orthopedics; Orthopedic Procedures; Arthroplasty, Replacement, Knee
PubMed: 37957710
DOI: 10.1186/s13643-023-02375-2 -
Clinical Oral Investigations Mar 2024To investigate the oral manifestations in women of reproductive age using hormonal contraceptive methods. (Review)
Review
OBJECTIVES
To investigate the oral manifestations in women of reproductive age using hormonal contraceptive methods.
MATERIALS AND METHODS
This review is based on the PRISMA statement. A literature search incorporated observational studies from the last 21 years. An investigative question was formulated using the PICO model, studies were selected, and a quality analysis was performed using the modified STROBE guidelines. A bibliometric analysis was performed, and the data were examined.
RESULTS
Thirteen articles were included, with the majority evaluating periodontal status. Others analyzed factors such as the presence of alveolar osteitis, oral candidiasis, and salivary microbiome dysbiosis. Ten articles were deemed to have a low risk of bias.
CONCLUSIONS
Hormonal contraceptives may increase the risk of alveolar osteitis following tooth extraction and increase the presence of the Candida species in the oral cavity. They also affect the periodontium, such as the frequent development of gingivitis, but do not lead to changes in the salivary microbiome.
CLINICAL RELEVANCE
The increasing number of women using hormonal contraceptives and the knowledge that these contraceptives can produce oral cavity alterations underscore the need to evaluate the oral manifestations found in these women.
Topics: Female; Humans; Dry Socket; Contraceptives, Oral, Hormonal; Periodontium; Gingivitis; Contraception
PubMed: 38427087
DOI: 10.1007/s00784-024-05573-x -
Trauma, Violence & Abuse Apr 2024The current research examines potentially morally injurious events (PMIEs) faced by healthcare professionals working in forensic and psychiatric environments. A... (Review)
Review
The current research examines potentially morally injurious events (PMIEs) faced by healthcare professionals working in forensic and psychiatric environments. A systematic literature review was conducted to identify peer-reviewed articles reporting on sources of moral injury or similar concepts (e.g., moral distress) for healthcare workers in such settings. Thirty articles were included and analyzed using a meta-ethnographic approach. Synthesis yielded three third-order factors, each reflecting a moral dichotomy: (a) "between profession and system," (b) "between relations with patients and relations with others," and (c) "between principles and practices." Findings illustrated the hierarchical relationships between dichotomies, with discordance between values of the healthcare profession and features of the healthcare system providing the conditions for PMIEs to occur. The review advances conceptual understandings of PMIEs in forensic and psychiatric settings, illustrating the multilayered dimensions within which morally injurious events are experienced. Theoretical and practical implications are offered that may support the early detection and prevention of moral injury in healthcare professionals.
Topics: Humans; Stress Disorders, Post-Traumatic; Health Personnel
PubMed: 37083056
DOI: 10.1177/15248380231167390 -
Frontiers in Public Health 2023The aim of this review was to assess the possible risk factors arising from working conditions, that could have an impact on the stress, fear, and anxiety of...
OBJECTIVES
The aim of this review was to assess the possible risk factors arising from working conditions, that could have an impact on the stress, fear, and anxiety of construction workers.
METHODS
A systematic review was conducted following the PRISMA format in the Pubmed, Cochrane, Web of Science, Scopus, and PsycInfo electronic databases on February 3, 2023, using the following key words: anxiety, stress, fear, and construction workers. Methodological quality was assessed using the critical appraisal tools of the Joanna Briggs Institute.
RESULTS
A total of 35 studies were included. The results showed a number of conditioning factors for stress, anxiety, and fear among construction workers such as age, inappropriate safety equipment, safety culture, high workload and long working hours, physical pain, low social support from direct supervisor or co-workers, lack of organizational justice and lack of reward, financial situation, maladaptive coping strategies, and characteristics of the pandemic.
CONCLUSIONS
There are a number of risk factors related to working conditions, organizations, and individuals that can affect the levels of stress, anxiety, and fear among construction workers, such as age, work hardship, safety culture and, especially, the long hours that construction professionals work. This may lead to an increase in the number of occupational accidents and higher associated fatality rates.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022367724, identifier: CRD42022367724.
Topics: Humans; Construction Industry; Organizational Culture; Social Justice; Anxiety; Fear
PubMed: 37521990
DOI: 10.3389/fpubh.2023.1226914 -
The American Journal of Tropical... May 2024Snakebites still constitute a significant public health problem in developing countries and are considered a neglected tropical condition by the WHO. Snake accidents are... (Meta-Analysis)
Meta-Analysis
Snakebites still constitute a significant public health problem in developing countries and are considered a neglected tropical condition by the WHO. Snake accidents are associated with substantial morbidity and mortality and may produce secondary complications, such as severe infections. The objective of this systematic review was to determine the prevalence of snakebite infections and characterize the bacteria isolated from these infections. A systematic literature review in five databases was carried out to assess the prevalence of snakebite infection. A meta-analysis was performed using a random-effects model to calculate the pooled prevalence and 95% CIs. Cochran's Q test and the I2 statistic were used to assess between-study heterogeneity. The pooled prevalence of infection due to snakebite was 27.0% (95% CI: 22.0-32.0%), with high heterogeneity among studies (I2 = 99.7%). The prevalence was higher in Asia (32%) than in the Americas (21%). Snakebite infections required surgical interventions in 68% (95% CI: 37.0-98.0%). The leading group of pathogens identified corresponded to Gram-negative bacteria (63%), particularly Morganella morganii (32%), but also, Gram-positive cocci (40%), especially Enterococcus spp. (23%) and Staphylococcus aureus (15%). However, multiple other pathogens, including anaerobes, were found. A high prevalence of snakebite-associated infection has been described, primarily due to M. morganii, with the corresponding implications for empirical therapy. Rational use of antimicrobials is recommended, and this should guide initial empirical treatment. Moreover, isolation and identification of the possible bacteria present in snakebite wounds is recommended in all cases to confirm or rule out associated infection.
Topics: Snake Bites; Humans; Prevalence; Animals; Anti-Bacterial Agents; Asia
PubMed: 38507793
DOI: 10.4269/ajtmh.23-0278 -
International Journal of Nursing... Jun 2024There is a global shortfall of nurses. Despite national targets to increase nurse training and retention, the numbers leaving the profession continue to rise. Emergency... (Review)
Review
BACKGROUND
There is a global shortfall of nurses. Despite national targets to increase nurse training and retention, the numbers leaving the profession continue to rise. Emergency departments (EDs) consistently record above average staff-turnover. Meanwhile descriptions of moral distress amongst emergency nurses are increasing. It is vital to consider the long-term emotional and psychological impact of moral distress on the emergency nursing workforce. However, the events which trigger moral distress in the emergency department may differ from those described in other clinical areas. A clearer understanding of the effects of moral distress on intention to leave could help identify those at risk and inform decisions on interventions designed to mitigate moral distress, aiding nurse retention and the organisational stability of health services.
AIM
This systematic review aims to synthesise the available evidence on the association between moral distress and intention to leave in emergency nurses.
METHODS
A systematic search of studies was performed on MEDLINE, CINAHL, PsychINFO, Web of Science and Cochrane databases (8th -10th June 2022). Results were screened and quality-assessed with cross-checks. The heterogeneity of samples and insufficient data precluded statistical pooling and meta-analysis. Consequently, narrative synthesis was performed.
RESULTS
Five studies reported quantitative results eligible for synthesis. Low to moderate levels of moral distress were reported in emergency nurses; contrasting starkly with the significant proportion who reported having left or considered leaving due to moral distress (up to 51%). Sparse, mostly low-quality evidence was identified, highlighting a need for more robust research. Current tools for measuring moral distress appear not to capture the unique pressures which contribute to moral distress in emergency nurses.
CONCLUSIONS
Emergency nurses cite moral distress as a reason for leaving. Further study is required to determine the levels of moral distress associated with intentions to leave and the strength of that association. This is fundamental to the design of effective retention policies. Future research should also explore the applicability of current moral distress measures to the emergency department, with consideration given to developing emergency department specific tools.
PROSPERO REGISTRATION NUMBER
CRD42022336241 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=336241.
PubMed: 38746824
DOI: 10.1016/j.ijnsa.2023.100164 -
Environmental Research May 2024Exposure to environmental chemicals has been associated with an elevated risk of heart failure (HF). However, the impact on early markers of HF, such as left ventricular... (Meta-Analysis)
Meta-Analysis Review
A systematic review and meta-analysis of human population studies on the association between exposure to toxic environmental chemicals and left ventricular dysfunction (LVD).
BACKGROUND
Exposure to environmental chemicals has been associated with an elevated risk of heart failure (HF). However, the impact on early markers of HF, such as left ventricular dysfunction (LVD), remains limited.
OBJECTIVE
To establish a foundation of evidence regarding early HF markers and their association with environmental pollutants, a systematic review and meta-analysis was conducted.
METHODS
The search, conducted on October 13th, 2023, encompassed PubMed, Embase, and Web of Science without filters, focusing on observational studies reporting myocardial geometrical, structural, or functional alterations in individuals without a history of heart disease. This included the general adult population, workers, young people, and the elderly. The risk of bias was assessed using the ROBINS-I tool at both study and item levels.
RESULTS
The systematic review included 17 studies involving 43.358 individuals exposed to air pollution and 2038 exposed to heavy metals. Approximately 41% of the effect measures of associations reported significant abnormalities in myocardial structure or function. The metanalyses by pollutants categories indicated positive associations between LV systolic and diastolic abnormalities and exposure to PM2.5 [-0.069 (-0.104, -0.033); -0.044 (-0.062, -0.025)] and PM10 [-0.055 (-0.087, -0.022); -0.030 (-0.050, -0.010)] and NO2 [-0.042 (-0.071, -0.013); -0.021 (-0.037, -0.004)], as well as positive associations between lead exposure and LV systolic abnormalities [-0.033 (-0.051, -0.016)].
CONCLUSIONS
Existing evidence shows that specific early markers of HF may be associated with exposure to chemical pollutants. It is recommended to include such endpoints in new longitudinal and case-control studies to confirm further risk associations. These studies should consider co-exposures, account for vulnerable groups, and identify cardiotoxic compounds that may require regulation. When examining the link between myocardial abnormalities and environmental exposure, it is also advisable to explore the supportive use of Adverse Outcome Pathway (AOP) approaches to confirm a causal relationship.
Topics: Humans; Ventricular Dysfunction, Left; Environmental Exposure; Environmental Pollutants
PubMed: 38354889
DOI: 10.1016/j.envres.2024.118429