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Sports Medicine (Auckland, N.Z.) Feb 2024Many sports require maximal strength and endurance performance. Concurrent strength and endurance training can lead to suboptimal training adaptations. However, how... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Many sports require maximal strength and endurance performance. Concurrent strength and endurance training can lead to suboptimal training adaptations. However, how adaptations differ between males and females is currently unknown. Additionally, current training status may affect training adaptations.
OBJECTIVE
We aimed to assess sex-specific differences in adaptations in strength, power, muscle hypertrophy, and maximal oxygen consumption ( O) to concurrent strength and endurance training in healthy adults. Second, we investigated how training adaptations are influenced by strength and endurance training status.
METHODS
A systematic review and meta-analysis was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and a Cochrane risk of bias was evaluated. ISI Web of science, PubMed/MEDLINE, and SPORTDiscus databases were searched using the following inclusion criteria: healthy adults aged 18-50 years, intervention period of ≥ 4 weeks, and outcome measures were defined as upper- and lower-body strength, power, hypertrophy, and/or O. A meta-analysis was performed using a random-effects model and reported in standardized mean differences.
RESULTS
In total, 59 studies with 1346 participants were included. Concurrent training showed blunted lower-body strength adaptations in males, but not in females (male: - 0.43, 95% confidence interval [- 0.64 to - 0.22], female: 0.08 [- 0.34 to 0.49], group difference: P = 0.03). No sex differences were observed for changes in upper-body strength (P = 0.67), power (P = 0.37), or O (P = 0.13). Data on muscle hypertrophy were insufficient to draw any conclusions. For training status, untrained but not trained or highly trained endurance athletes displayed lower O gains with concurrent training (P = 0.04). For other outcomes, no differences were found between untrained and trained individuals, both for strength and endurance training status.
CONCLUSIONS
Concurrent training results in small interference for lower-body strength adaptations in males, but not in females. Untrained, but not trained or highly trained endurance athletes demonstrated impaired improvements in O following concurrent training. More studies on females and highly strength-trained and endurance-trained athletes are warranted.
CLINICAL TRIAL REGISTRATION
PROSPERO: CRD42022370894.
Topics: Adult; Humans; Male; Female; Endurance Training; Physical Endurance; Athletes; Sports; Hypertrophy; Muscle Strength; Resistance Training
PubMed: 37847373
DOI: 10.1007/s40279-023-01943-9 -
Systematic Reviews Nov 2023Prehabilitation programs focusing on exercise training as the main component are known as a promising alternative for improving patients' outcomes before cancer surgery....
BACKGROUND
Prehabilitation programs focusing on exercise training as the main component are known as a promising alternative for improving patients' outcomes before cancer surgery. This systematic review determined the benefits and harms of prehabilitation programs compared with usual care for individuals with cancer.
METHODS
We searched CENTRAL, MEDLINE, and EMBASE from inception to June 2022, and hand searched clinical trial registries. We included randomized-controlled trials (RCTs) in adults, survivors of any type of cancer, that compared prehabilitation programs that had exercise training as the major component with usual care or other active interventions. Outcome measures were health-related quality of life (HRQL), muscular strength, postoperative complications, average length of stay (ALOS), handgrip strength, and physical activity levels. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias and the certainty of the evidence.
RESULTS
Twenty-five RCTs (2682 participants) published between 2010 and 2022 met our inclusion criteria. Colorectal and lung cancers were the most common diagnoses. The studies had methodological concerns regarding outcome measurement, selective reporting, and attrition. Five prehabilitation programs were compared to usual care (rehabilitation): combined training, aerobic training, respiratory muscle training plus aerobic training, respiratory muscle training plus resistance training, and pelvic floor training. The studies provided no clear evidence of an effect between groups. We assessed the overall certainty of the evidence as very low, downgraded due to serious study limitations and imprecision.
CONCLUSION
Prehabilitation programs focusing on exercise training may have an effect on adults with cancer, but the evidence is very uncertain. We have very little confidence in the results and the true effect is likely to be substantially different from these. Further research is needed before we can draw a more certain conclusion.
SYSTEMATIC REVIEW REGISTRATION
CRD42019125658.
Topics: Adult; Humans; Preoperative Exercise; Exercise; Exercise Therapy; Neoplasms; Resistance Training; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 37978411
DOI: 10.1186/s13643-023-02373-4 -
Journal of Pain and Symptom Management Aug 2023With the expansion of palliative care services in clinical settings, clinical decision support systems (CDSSs) have become increasingly crucial for assisting bedside... (Review)
Review
CONTEXT
With the expansion of palliative care services in clinical settings, clinical decision support systems (CDSSs) have become increasingly crucial for assisting bedside nurses and other clinicians in improving the quality of care to patients with life-limiting health conditions.
OBJECTIVES
To characterize palliative care CDSSs and explore end-users' actions taken, adherence recommendations, and clinical decision time.
METHODS
The CINAHL, Embase, and PubMed databases were searched from inception to September 2022. The review was developed following the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews guidelines. Qualified studies were described in tables and assessed the level of evidence.
RESULTS
A total of 284 abstracts were screened, and 12 studies comprised the final sample. The CDSSs selected focused on identifying patients who could benefit from palliative care based on their health status, making referrals to palliative care services, and managing medications and symptom control. Despite the variability of palliative CDSSs, all studies reported that CDSSs assisted clinicians in becoming more informed about palliative care options leading to better decisions and improved patient outcomes. Seven studies explored the impact of CDSSs on end-user adherence. Three studies revealed high adherence to recommendations while four had low adherence. Lack of feature customization and trust in guideline-based in the initial stages of feasibility and usability testing were evident, limiting the usefulness for nurses and other clinicians.
CONCLUSION
This study demonstrated that implementing palliative care CDSSs can assist nurses and other clinicians in improving the quality of care for palliative patients. The studies' different methodological approaches and variations in palliative CDSSs made it challenging to compare and validate the applicability under which CDSSs are effective. Further research utilizing rigorous methods to evaluate the impact of clinical decision support features and guideline-based actions on clinicians' adherence and efficiency is recommended.
Topics: Humans; Palliative Care; Decision Support Systems, Clinical; Hospice and Palliative Care Nursing; Referral and Consultation
PubMed: 36933748
DOI: 10.1016/j.jpainsymman.2023.03.006 -
European Journal of Public Health Aug 2023The higher disease burden and related costs due to an increasing aging population have placed tremendous pressure on the healthcare systems worldwide. Given that music,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The higher disease burden and related costs due to an increasing aging population have placed tremendous pressure on the healthcare systems worldwide. Given that music, both listened and actively performed, promotes and maintains good health and wellbeing among the population, we sought to perform a systematic review that would assess its biopsychosocial effects on a population over 40 years of age.
METHODS
A comprehensive search of peer-reviewed articles up to April 2021 was conducted on six electronic databases (i.e. Cochrane, MEDLINE, PubMed, PsycINFO, Web of Science and Scopus). Our study population only included healthy adults of 40 years and older. A total of 11 randomized controlled trials (RCTs) matched the inclusion criteria and were therefore analyzed.
RESULTS
Despite the heterogeneity of the methodologies used in the selected studies, our findings suggest that active musical participation can lead to beneficial effects on both cognitive and psychosocial functioning, whereas the positive impact of listening to music seems to be predominantly restricted to the cognitive domain.
CONCLUSIONS
Although our results are consistent with both active and passive music activities favouring health and wellbeing in individuals 40 years old and over, future prospective RCTs, employing more uniformed and sensitive measurements, should allow us to better gauge the role of music participation in healthy aging and longevity, especially in countries with a high population density of elderly people.
Topics: Adult; Humans; Middle Aged; Aged; Music; Music Therapy
PubMed: 37322515
DOI: 10.1093/eurpub/ckad063 -
Nurse Education Today Sep 2023The objective was to conduct a systematic review describing the competencies required from nurses working in neonatal intensive care settings. (Review)
Review
OBJECTIVE
The objective was to conduct a systematic review describing the competencies required from nurses working in neonatal intensive care settings.
DESIGN
Systematic review.
DATA SOURCES
A total of eight databases, including PubMed, Scopus, CINAHL, MEDLINE, Mednar, Web of Science, ProQuest and Medic, were screened for relevant literature during February and September 2022.
REVIEW METHODS
The systematic review process followed Joanna Briggs Institute guidelines. The inclusion criteria were: 1) (P = population) registered nurses; 2) (C = concept) the competence; 3) (C = context) nursing in neonatal intensive care units; and 4) cross-sectional study as study method. A critical appraisal tool for cross-sectional studies from Joanna Briggs Institute was used by two independent reviewers. After data extraction, thematic analysis was performed.
RESULTS
The database searches yielded a total of 8887 studies and after two independent evaluations, a total of 50 eligible studies were identified comprising of 7536 registered nurses working in neonatal intensive care units across 19 countries. The studies described four main competence themes: 1) neonatal care interventions; 2) caring for a dying infant; 3) family-centered care; and 4) neonatal intensive care interventions.
CONCLUSION
Previous research has focused on evaluating specific competencies that are necessary in the neonatal intensive care setting. There is a need for research concerning the overall competence of nurses working in neonatal intensive care units. There was a lot of variety within the quality of the eligible studies and within the used instruments.
PROTOCOL REGISTRATION
This systematic review was registered in Prospero (PROSPERO 2022 CRD42022308028).
Topics: Infant, Newborn; Infant; Humans; Intensive Care, Neonatal; Cross-Sectional Studies; Nursing Care; Nurses
PubMed: 37393653
DOI: 10.1016/j.nedt.2023.105892 -
International Journal of Surgery... Dec 2023Surgeons have historically used age as a preoperative predictor of postoperative outcomes. Sarcopenia, the loss of skeletal muscle mass due to disease or biological age,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Surgeons have historically used age as a preoperative predictor of postoperative outcomes. Sarcopenia, the loss of skeletal muscle mass due to disease or biological age, has been proposed as a more accurate risk predictor. The prognostic value of sarcopenia assessment in surgical patients remains poorly understood. Therefore, the authors aimed to synthesize the available literature and investigate the impact of sarcopenia on perioperative and postoperative outcomes across all surgical specialties.
METHODS
The authors systematically assessed the prognostic value of sarcopenia on postoperative outcomes by conducting a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching the PubMed/MEDLINE and EMBASE databases from inception to 1st October 2022. Their primary outcomes were complication occurrence, mortality, length of operation and hospital stay, discharge to home, and postdischarge survival rate at 1, 3, and 5 years. Subgroup analysis was performed by stratifying complications according to the Clavien-Dindo classification system. Sensitivity analysis was performed by focusing on studies with an oncological, cardiovascular, emergency, or transplant surgery population and on those of higher quality or prospective study design.
RESULTS
A total of 294 studies comprising 97 643 patients, of which 33 070 had sarcopenia, were included in our analysis. Sarcopenia was associated with significantly poorer postoperative outcomes, including greater mortality, complication occurrence, length of hospital stay, and lower rates of discharge to home (all P <0.00001). A significantly lower survival rate in patients with sarcopenia was noted at 1, 3, and 5 years (all P <0.00001) after surgery. Subgroup analysis confirmed higher rates of complications and mortality in oncological (both P <0.00001), cardiovascular (both P <0.00001), and emergency ( P =0.03 and P =0.04, respectively) patients with sarcopenia. In the transplant surgery cohort, mortality was significantly higher in patients with sarcopenia ( P <0.00001). Among all patients undergoing surgery for inflammatory bowel disease, the frequency of complications was significantly increased among sarcopenic patients ( P =0.007). Sensitivity analysis based on higher quality studies and prospective studies showed that sarcopenia remained a significant predictor of mortality and complication occurrence (all P <0.00001).
CONCLUSION
Sarcopenia is a significant predictor of poorer outcomes in surgical patients. Preoperative assessment of sarcopenia can help surgeons identify patients at risk, critically balance eligibility, and refine perioperative management. Large-scale studies are required to further validate the importance of sarcopenia as a prognostic indicator of perioperative risk, especially in surgical subspecialties.
Topics: Humans; Aftercare; Patient Discharge; Postoperative Complications; Prospective Studies; Sarcopenia
PubMed: 37696253
DOI: 10.1097/JS9.0000000000000688 -
Transplantation Reviews (Orlando, Fla.) Apr 2024Frailty, malnutrition and sarcopenia lead to a significant increase in morbidity and mortality before and after liver transplantation (LT). Prehabilitation attempts to... (Review)
Review
BACKGROUND
Frailty, malnutrition and sarcopenia lead to a significant increase in morbidity and mortality before and after liver transplantation (LT). Prehabilitation attempts to optimize physical fitness of individuals before major surgeries. To date, little is known about its impact on patients awaiting LT.
AIMS
The aim of our scoping review was to describe whether prehabilitation in patients awaiting LT is feasible and safe, and whether it leads to a change in clinical parameters before or after transplantation.
METHODS
We performed a systematic review of the literature from 1946 to November 2023 to identify prospective studies and randomized controlled trials of adult LT candidates who participated in an exercise training program.
RESULTS
Out of 3262 citations initially identified, six studies were included. Studies were heterogeneous in design, patient selection, intervention, duration, and outcomes assessed. All studies were self-described as pilot or feasibility studies and had a sample size ranging from 13 to 33. Two studies were randomized controlled trials. Two study restricted to patients with cirrhosis who were eligible for liver transplantation or on the transplant list. Exercise programs lasted between 6 and 12 weeks. In terms of feasibility, proportion of eligible patients that were recruited was between 54 and 100%. Program completion ranged between 38 and 90%. Interventions appeared safe with 9 (9.2%) adverse events noted. In the intervention group, improvements were generally noted in peak oxygen consumption and workload, 6-min walking distance, and muscle strength. One study suggested a decrease in post-transplant hospital length of stay.
CONCLUSIONS
Overall, it appears that prehabilitation with exercise training is feasible, and safe in patients awaiting LT. Higher quality and larger studies are needed to confirm its impact on pre- and post-transplantation-related outcomes.
Topics: Adult; Humans; Liver Transplantation; Preoperative Exercise; Prospective Studies; Exercise; Exercise Therapy; Quality of Life; Preoperative Care; Postoperative Complications
PubMed: 38367398
DOI: 10.1016/j.trre.2024.100835 -
Value in Health : the Journal of the... Apr 2024Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an increasing incidence and prevalence because of progressively aging populations. Costs related to... (Review)
Review
OBJECTIVES
Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an increasing incidence and prevalence because of progressively aging populations. Costs related to AF are both direct and indirect. This systematic review aims to identify the main cost drivers of the illness, assess the potential economic impact resulting from changes in care strategies, and propose interventions where they are most needed.
METHODS
A systematic literature search of the PubMed and Scopus databases was performed to identify analytical observational studies defining the cost of illness in cases of AF. The search strategy was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 recommendations.
RESULTS
Of the 944 articles retrieved, 24 met the inclusion criteria. These studies were conducted in several countries. All studies calculated the direct medical costs, whereas 8 of 24 studies assessed indirect costs. The median annual direct medical cost per patient, considering all studies, was €9409 (13 333 US dollars in purchasing power parities), with a very large variability due to the heterogeneity of different analyses. Hospitalization costs are generally the main cost drivers. Comorbidities and complications, such as stroke, considerably increase the average annual direct medical cost of AF.
CONCLUSIONS
In most of the analyzed studies, inpatient care cost represents the main component of the mean direct medical cost per patient. Stroke and heart failure are responsible for a large share of the total costs; therefore, implementing guidelines to manage comorbidities in AF is a necessary step to improve health and mitigate healthcare costs.
Topics: Humans; Atrial Fibrillation; Health Care Costs; Hospitalization; Stroke; Cost of Illness
PubMed: 38296049
DOI: 10.1016/j.jval.2023.12.015 -
BMC Public Health Jun 2024Preconception health has the potential to improve parental, pregnancy and infant outcomes. This scoping review aims to (1) provide an overview of the strategies,... (Review)
Review
BACKGROUND
Preconception health has the potential to improve parental, pregnancy and infant outcomes. This scoping review aims to (1) provide an overview of the strategies, policies, guidelines, frameworks, and recommendations available in the UK and Ireland that address preconception health and care, identifying common approaches and health-influencing factors that are targeted; and (2) conduct an audit to explore the awareness and use of resources found in the scoping review amongst healthcare professionals, to validate and contextualise findings relevant to Northern Ireland.
METHODS
Grey literature resources were identified through Google Advanced Search, NICE, OpenAire, ProQuest and relevant public health and government websites. Resources were included if published, reviewed, or updated between January 2011 and May 2022. Data were extracted into Excel and coded using NVivo. The review design included the involvement of the "Healthy Reproductive Years" Patient and Public Involvement and Engagement advisory panel.
RESULTS
The searches identified 273 resources, and a subsequent audit with healthcare professionals in Northern Ireland revealed five additional preconception health-related resources. A wide range of resource types were identified, and preconception health was often not the only focus of the resources reviewed. Resources proposed approaches to improve preconception health and care, such as the need for improved awareness and access to care, preconceptual counselling, multidisciplinary collaborations, and the adoption of a life-course approach. Many behavioural (e.g., folic acid intake, smoking), biomedical (e.g., mental and physical health conditions), and environmental and social (e.g., deprivation) factors were identified and addressed in the resources reviewed. In particular, pre-existing physical health conditions were frequently mentioned, with fewer resources addressing psychological factors and mental health. Overall, there was a greater focus on women's, rather than men's, behaviours.
CONCLUSIONS
This scoping review synthesised existing resources available in the UK and Ireland to identify a wide range of common approaches and factors that influence preconception health and care. Efforts are needed to implement the identified resources (e.g., strategies, guidelines) to support people of childbearing age to access preconception care and optimise their preconception health.
Topics: Humans; Preconception Care; Ireland; Female; United Kingdom; Health Policy; Practice Guidelines as Topic; Pregnancy
PubMed: 38909211
DOI: 10.1186/s12889-024-19188-0 -
JAMA Network Open Jul 2023English language proficiency has been reported to correlate with disparities in health outcomes. Therefore, it is important to identify and describe the association of...
IMPORTANCE
English language proficiency has been reported to correlate with disparities in health outcomes. Therefore, it is important to identify and describe the association of language barriers with perioperative care and surgical outcomes to inform efforts aimed at reducing health care disparities.
OBJECTIVE
To examine whether limited English proficiency compared with English proficiency in adult patients is associated with differences in perioperative care and surgical outcomes.
EVIDENCE REVIEW
A systematic review was conducted in MEDLINE, Embase, Web of Science, Sociological Abstracts, and CINAHL of all English-language publications from database inception to December 7, 2022. Searches included Medical Subject Headings terms related to language barriers, perioperative or surgical care, and perioperative outcomes. Studies that investigated adults in perioperative settings and involved quantitative data comparing cohorts with limited English proficiency and English proficiency were included. The quality of studies was evaluated using the Newcastle-Ottawa Scale. Because of heterogeneity in analysis and reported outcomes, data were not pooled for quantitative analysis. Results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline.
FINDINGS
Of 2230 unique records identified, 29 were eligible for inclusion (281 266 total patients; mean [SD] age, 57.2 [10.0] years; 121 772 [43.3%] male and 159 240 [56.6%] female). Included studies were observational cohort studies, except for a single cross-sectional study. Median cohort size was 1763 (IQR, 266-7402), with a median limited English proficiency cohort size of 179 (IQR, 51-671). Six studies explored access to surgery, 4 assessed delays in surgical care, 14 assessed surgical admission length of stay, 4 assessed discharge disposition, 10 assessed mortality, 5 assessed postoperative complications, 9 assessed unplanned readmissions, 2 assessed pain management, and 3 assessed functional outcomes. Surgical patients with limited English proficiency were more likely to experience reduced access in 4 of 6 studies, delays in obtaining care in 3 of 4 studies, longer surgical admission length of stay in 6 of 14 studies, and more likely discharge to a skilled facility than patients with English proficiency in 3 of 4 studies. Some additional differences in associations were found between patients with limited English proficiency who spoke Spanish vs other languages. Mortality, postoperative complications, and unplanned readmissions had fewer significant associations with English proficiency status.
CONCLUSIONS AND RELEVANCE
In this systematic review, most of the included studies found associations between English proficiency and multiple perioperative process-of-care outcomes, but fewer associations were seen between English proficiency and clinical outcomes. Because of limitations of the existing research, including study heterogeneity and residual confounding, mediators of the observed associations remain unclear. Standardized reporting and higher-quality studies are needed to understand the impact of language barriers on perioperative health disparities and identify opportunities to reduce related perioperative health care disparities.
Topics: Adult; Humans; Female; Male; Middle Aged; Cross-Sectional Studies; Limited English Proficiency; Hospitalization; Databases, Factual; Postoperative Complications
PubMed: 37432686
DOI: 10.1001/jamanetworkopen.2023.22743