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Journal of Pain and Symptom Management May 2024The place where people are cared towards the end of their life and die is a complex phenomenon, requiring a deeper understanding. Honoring preferences is critical for... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
The place where people are cared towards the end of their life and die is a complex phenomenon, requiring a deeper understanding. Honoring preferences is critical for the delivery of high-quality care.
OBJECTIVES
In this umbrella review we examine and synthesize the evidence regarding preferences about place of end-of-life care and death of patients with life-threatening illnesses and their families.
METHODS
Following the Joanna Briggs Institute methodology, we conducted a comprehensive search for systematic reviews in PsycINFO, MEDLINE, EMBASE, CINAHL, Epistemonikos, and PROSPERO without language restrictions.
RESULTS
The search identified 15 reviews (10 high-quality, three with meta-analysis), covering 229 nonoverlapping primary studies. Home is the most preferred place of end-of-life care for both patients (11%-89%) and family members (23%-84%). It is also the most preferred place of death (patient estimates from two meta-analyses: 51%-55%). Hospitals and hospice/palliative care facilities are preferred by substantial minorities. Reasons and factors affecting preferences include illness-related, individual, and environmental. Differences between preferred places of care and death are underexplored and the evidence remains inconclusive about changes over time. Congruence between preferred and actual place of death ranges 21%-100%, is higher in studies since 2004 and a meta-analysis shows noncancer patients are at higher risk of incongruence than cancer patients (OR 1.23, 95% CI: 1.01-1.49, I2 = 62%).
CONCLUSION
These findings are a crucial starting point to address gaps and enhance strategies to align care with patient and family preferences. To accurately identify patient and family preferences is an important opportunity to change their lives positively.
Topics: Humans; Palliative Care; Systematic Reviews as Topic; Terminal Care; Hospice Care; Family; Patient Preference; Attitude to Death
PubMed: 38237790
DOI: 10.1016/j.jpainsymman.2024.01.014 -
Journal of Public Health (Oxford,... Aug 2023Loneliness is a growing public health concern, but little is known about how place affects loneliness, especially during adolescence. This is the first study to examine...
BACKGROUND
Loneliness is a growing public health concern, but little is known about how place affects loneliness, especially during adolescence. This is the first study to examine the influence of neighbourhoods on loneliness in early-to-mid adolescence.
METHODS
Baseline data from the #BeeWell cohort study in Greater Manchester (England), including 36 141 adolescents (aged 12-15 years) across 1590 neighbourhoods, were linked to neighbourhood characteristics using administrative data at the level of lower super output areas and analysed using multilevel regression.
RESULTS
Neighbourhood differences explained 1.18% of the variation in loneliness. Ethnic, gender and sexual orientation inequalities in loneliness varied across neighbourhoods. Several neighbourhood characteristics predicted loneliness at the individual level, including skills deprivation among children and young people, lower population density and perceptions of the local area (feeling safe; trust in local people; feeling supported by local people; seeing neighbours as helpful; the availability of good places to spend free time). Finally, a longer distance from home to school was associated with significantly higher loneliness.
CONCLUSIONS
Neighbourhoods account for a small but significant proportion of the variation in adolescent loneliness, with some neighbourhood characteristics predicting loneliness at the individual level, and loneliness disparities for some groups differing across neighbourhoods.
Topics: Child; Humans; Male; Adolescent; Female; Cohort Studies; Loneliness; Schools; England; Residence Characteristics; Neighborhood Characteristics; Socioeconomic Factors
PubMed: 37170940
DOI: 10.1093/pubmed/fdad053 -
Neuron Nov 2023Animals frequently make decisions based on expectations of future reward ("values"). Values are updated by ongoing experience: places and choices that result in reward...
Animals frequently make decisions based on expectations of future reward ("values"). Values are updated by ongoing experience: places and choices that result in reward are assigned greater value. Yet, the specific algorithms used by the brain for such credit assignment remain unclear. We monitored accumbens dopamine as rats foraged for rewards in a complex, changing environment. We observed brief dopamine pulses both at reward receipt (scaling with prediction error) and at novel path opportunities. Dopamine also ramped up as rats ran toward reward ports, in proportion to the value at each location. By examining the evolution of these dopamine place-value signals, we found evidence for two distinct update processes: progressive propagation of value along taken paths, as in temporal difference learning, and inference of value throughout the maze, using internal models. Our results demonstrate that within rich, naturalistic environments dopamine conveys place values that are updated via multiple, complementary learning algorithms.
Topics: Rats; Animals; Dopamine; Decision Making; Reward; Brain
PubMed: 37611585
DOI: 10.1016/j.neuron.2023.07.017 -
American Journal of Lifestyle Medicine 2024Despite numerous advances in basic understanding of cardiovascular disease pathophysiology, pharmacology, therapeutic procedures, and systems improvement, there hasn't... (Review)
Review
Despite numerous advances in basic understanding of cardiovascular disease pathophysiology, pharmacology, therapeutic procedures, and systems improvement, there hasn't been much decline in heart disease related mortality in the US since 2010. Hypertension and diet induced risk continue to be the leading causes of cardiovascular morbidity. Even with the excessive mortality associated with the COVID-19 pandemic, in 2020, heart disease remained the leading cause of death. Given the degree of disease burden, morbidity, and mortality, there is an urgent need to redirect medical professionals' focus towards prevention through simple and cost effective lifestyle strategies. However, current practice paradigm and financial compensation systems are mainly centered disease management and not health promotion. For example, the financial value placed on 3-10 min smoking cessation counseling (.24RVUs) is 47-fold lower than an elective PCI (11.21 RVUs). The medical community seems to be enamored with the latest and greatest technology, new devices, and surgical procedures. What if the greatest technology of all was simply the way we live every day? Perhaps when this notion is known by enough, we will switch to this lifestyle medicine technology to prevent disease in the first place.
PubMed: 38559785
DOI: 10.1177/15598276221130684 -
ELife Jul 2023Aversive stimuli can cause hippocampal place cells to remap their firing fields, but it is not known whether remapping plays a role in storing memories of aversive...
Aversive stimuli can cause hippocampal place cells to remap their firing fields, but it is not known whether remapping plays a role in storing memories of aversive experiences. Here, we addressed this question by performing in vivo calcium imaging of CA1 place cells in freely behaving rats (n = 14). Rats were first trained to prefer a short path over a long path for obtaining food reward, then trained to avoid the short path by delivering a mild footshock. Remapping was assessed by comparing place cell population vector similarity before acquisition versus after extinction of avoidance. Some rats received shock after systemic injections of the amnestic drug scopolamine at a dose (1 mg/kg) that impaired avoidance learning but spared spatial tuning and shock-evoked responses of CA1 neurons. Place cells remapped significantly more following remembered than forgotten shocks (drug-free versus scopolamine conditions); shock-induced remapping did not cause place fields to migrate toward or away from the shocked location and was similarly prevalent in cells that were responsive versus non-responsive to shocks. When rats were exposed to a neutral barrier rather than aversive shock, place cells remapped significantly less in response to the barrier. We conclude that place cell remapping occurs in response to events that are remembered rather than merely perceived and forgotten, suggesting that reorganization of hippocampal population codes may play a role in storing memories for aversive events.
Topics: Rats; Animals; Place Cells; Hippocampus; Neurons; Scopolamine Derivatives; CA1 Region, Hippocampal
PubMed: 37466236
DOI: 10.7554/eLife.80661 -
Frontiers in Neural Circuits 2023If a full visual percept can be said to be a 'hypothesis', so too can a neural 'prediction' - although the latter addresses one particular component of image content... (Review)
Review
If a full visual percept can be said to be a 'hypothesis', so too can a neural 'prediction' - although the latter addresses one particular component of image content (such as 3-dimensional organisation, the interplay between lighting and surface colour, the future trajectory of moving objects, and so on). And, because processing is hierarchical, predictions generated at one level are conveyed in a backward direction to a lower level, seeking to predict, in fact, the neural activity at that prior stage of processing, and learning from errors signalled in the opposite direction. This is the essence of 'predictive coding', at once an algorithm for information processing and a theoretical basis for the nature of operations performed by the cerebral cortex. Neural models for the implementation of predictive coding invoke specific functional classes of neuron for generating, transmitting and receiving predictions, and for producing reciprocal error signals. Also a third general class, 'precision' neurons, tasked with regulating the magnitude of error signals contingent upon the confidence placed upon the prediction, i.e., the reliability and behavioural utility of the sensory data that it predicts. So, what is the ultimate source of a 'prediction'? The answer is multifactorial: knowledge of the current environmental context and the immediate past, allied to memory and lifetime experience of the way of the world, doubtless fine-tuned by evolutionary history too. There are, in consequence, numerous potential avenues for experimenters seeking to manipulate subjects' expectation, and examine the neural signals elicited by surprising, and less surprising visual stimuli. This review focuses upon the predictive physiology of mouse and monkey visual cortex, summarising and commenting on evidence to date, and placing it in the context of the broader field. It is concluded that predictive coding has a firm grounding in basic neuroscience and that, unsurprisingly, there remains much to learn.
Topics: Humans; Reproducibility of Results; Neurons; Algorithms; Biological Evolution; Cerebral Cortex
PubMed: 38259953
DOI: 10.3389/fncir.2023.1254009 -
Journal of Clinical Medicine Mar 2024Stress urinary incontinence is a financially burdensome and socially isolating problem and can be experienced by men as a result of radical prostatectomy, radiation... (Review)
Review
Stress urinary incontinence is a financially burdensome and socially isolating problem and can be experienced by men as a result of radical prostatectomy, radiation therapy, or other urologic surgery. Artificial urinary sphincter (AUS) placement for stress urinary incontinence is considered the 'gold standard' for male stress urinary incontinence. While initially only placed by specialized prosthetic surgeons, changes in urologic training have made implantation of the device by general urologists more widespread. Additionally, even though a minority of urologists place the majority of implants, many urologists may find themselves caring for patients with these devices even if they have never placed them themselves. For this reason, it is paramount that the urologic surgeon implanting the device and those caring for patients with prostheses are familiar with the various perioperative and postoperative complications of AUS implantation. This review discusses the most commonly reported complications of AUS implantation as well as those that are rarely described. Knowledge of these potential complications is necessary in order to care for patients with urologic implants.
PubMed: 38610677
DOI: 10.3390/jcm13071913