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Advances in Health Sciences Education :... Aug 2022The purpose of this scoping review was to explore how errors are conceptualized in medical education contexts by examining different error perspectives and practices.... (Review)
Review
The purpose of this scoping review was to explore how errors are conceptualized in medical education contexts by examining different error perspectives and practices. This review used a scoping methodology with a systematic search strategy to identify relevant studies, written in English, and published before January 2021. Four medical education journals (Medical Education, Advances in Health Science Education, Medical Teacher, and Academic Medicine) and four clinical journals (Journal of the American Medical Association, Journal of General Internal Medicine, Annals of Surgery, and British Medical Journal) were purposively selected. Data extraction was charted according to a data collection form. Of 1505 screened studies, 79 studies were included. Three overarching perspectives were identified: 'understanding errors') (n = 31), 'avoiding errors' (n = 25), 'learning from errors' (n = 23). Studies that aimed at'understanding errors' used qualitative methods (19/31, 61.3%) and took place in the clinical setting (19/31, 61.3%), whereas studies that aimed at 'avoiding errors' and 'learning from errors' used quantitative methods ('avoiding errors': 20/25, 80%, and 'learning from errors': 16/23, 69.6%, p = 0.007) and took place in pre-clinical (14/25, 56%) and simulated settings (10/23, 43.5%), respectively (p < 0.001). The three perspectives differed significantly in terms of inclusion of educational theory: 'Understanding errors' studies 16.1% (5/31),'avoiding errors' studies 48% (12/25), and 'learning from errors' studies 73.9% (17/23), p < 0.001. Errors in medical education and clinical practice are defined differently, which makes comparisons difficult. A uniform understanding is not necessarily a goal but improving transparency and clarity of how errors are currently conceptualized may improve our understanding of when, why, and how to use and learn from errors in the future.
Topics: Delivery of Health Care; Education, Medical; Humans; United States
PubMed: 35190892
DOI: 10.1007/s10459-022-10091-0 -
MedRxiv : the Preprint Server For... Apr 2023Heterogeneity in type 2 diabetes presentation, progression and treatment has the potential for precision medicine interventions that can enhance care and outcomes for...
Heterogeneity in type 2 diabetes presentation, progression and treatment has the potential for precision medicine interventions that can enhance care and outcomes for affected individuals. We undertook a systematic review to ascertain whether strategies to subclassify type 2 diabetes are associated with improved clinical outcomes, show reproducibility and have high quality evidence. We reviewed publications that deployed 'simple subclassification' using clinical features, biomarkers, imaging or other routinely available parameters or 'complex subclassification' approaches that used machine learning and/or genomic data. We found that simple stratification approaches, for example, stratification based on age, body mass index or lipid profiles, had been widely used, but no strategy had been replicated and many lacked association with meaningful outcomes. Complex stratification using clustering of simple clinical data with and without genetic data did show reproducible subtypes of diabetes that had been associated with outcomes such as cardiovascular disease and/or mortality. Both approaches require a higher grade of evidence but support the premise that type 2 diabetes can be subclassified into meaningful groups. More studies are needed to test these subclassifications in more diverse ancestries and prove that they are amenable to interventions.
PubMed: 37131632
DOI: 10.1101/2023.04.19.23288577 -
Current Pharmaceutical Design 2023Cognitive dysfunction, such as dementia, is the most common neurological disorder that affects memory, perception, learning, and problem-solving. Emerging evidence...
BACKGROUND
Cognitive dysfunction, such as dementia, is the most common neurological disorder that affects memory, perception, learning, and problem-solving. Emerging evidence suggests that nutritional factors may prevent or accelerate the incidence of neurodegenerative diseases.
OBJECTIVE
This systematic review was designed to evaluate the association between pomegranate treatment and cognitive function.
METHODS
PubMed, Embase, Google Scholar, and Scopus databases were searched to extract original animal and human studies published until July 2021 without date restrictions. Firstly, 215 studies were retrieved via the search strategy. Irrelevant and duplicated studies were screened out, and critical analysis was used to obtain data. The articles' quality and bias risks were assessed by OHAT and Cochrane Collaboration's quality assessment tools.
RESULTS
Finally, 24 articles (20 animal and 4 randomized controlled trial studies) were included in this review. All included animal and human studies indicated that pomegranate treatment was positively associated with improving specific domains of cognitive function.
CONCLUSION
Our findings demonstrated that pomegranate treatment could improve cognitive function. Therefore, including pomegranate intake during daily life may lower the risk of cognitive impairment at the population level.
Topics: Animals; Humans; Pomegranate; Cognitive Dysfunction; Cognition; Randomized Controlled Trials as Topic
PubMed: 37005403
DOI: 10.2174/1381612829666230330163645 -
Vaccines Feb 2022The coronavirus disease 2019 (COVID-19) pandemic has threatened global health and prompted the need for mass vaccination. We aimed to assess the efficacy and... (Review)
Review
The coronavirus disease 2019 (COVID-19) pandemic has threatened global health and prompted the need for mass vaccination. We aimed to assess the efficacy and effectiveness of COVID-19 vaccines to prevent mortality and reduce the risk of developing severe disease after the 1st and 2nd doses. From conception to 28 June 2021, we searched PubMed, Cochrane, EBSCO, Scopus, ProQuest, Web of Science, WHO-ICTRP, and Google Scholar. We included both observational and randomized controlled trials. The pooled vaccine efficacy and effectiveness following vaccination, as well as their 95 percent confidence intervals (CI), were estimated using the random-effects model. In total, 22 of the 21,567 screened articles were eligible for quantitative analysis. Mortality 7 and 14 days after full vaccination decreased significantly among the vaccinated group compared to the unvaccinated group (OR = 0.10, ([95% CI, 0.04-0.27], I = 54%) and (OR = 0.46, [95% CI, 0.35-0.61], I = 0%), respectively. The probability of having severe disease one or two weeks after 2nd dose decreased significantly (OR = 0.29 [95% CI, 0.19-0.46], I = 25%) and (OR = 0.08 [95% CI, 0.03-0.25], I = 74%), respectively. The incidence of infection any time after the 1st and 2nd doses diminished significantly (OR = 0.14 [95% CI, 0.07-0.4], I = 100%) and (OR = 0.179 [95% CI, 0.15-0.19], I = 98%), respectively. Also, incidence of infection one week after 2nd dose decreased significantly, (OR = 0.04, [95% CI (0.01-0.2], I = 100%). After meta-regression, the type of vaccine and country were the main predictors of outcome [non-mRNA type, ß = 2.99, = 0.0001; country UK, ß = -0.75, = 0.038; country USA, ß = 0.8, = 0.02]. This study showed that most vaccines have comparable effectiveness, and it is purported that mass vaccination may help to end this pandemic.
PubMed: 35334982
DOI: 10.3390/vaccines10030350 -
Cortex; a Journal Devoted To the Study... Sep 2022Severe acute respiratory syndrome coronavirus 2 is a worldwide public health issue. Almost 2 years into the pandemic, the persistence of symptoms after the acute phase... (Review)
Review
Severe acute respiratory syndrome coronavirus 2 is a worldwide public health issue. Almost 2 years into the pandemic, the persistence of symptoms after the acute phase is a well-recognized phenomenon. We conducted a scoping review to map cognitive domain impairments, their frequency, and associated psycho-affective disorders in people with a previous COVID-19 infection. We searched PubMed/MEDLINE, Scopus, and PsycInfo to identify relevant reports published between December 1, 2019 and February 21, 2022. We followed the PRISMA (Preferred-Reporting-Items-for-Systematic-Reviews-and-Meta-Analyses) extension for scoping review guidelines. Three independent reviewers selected and charted 25 records out of 922. Memory, attention, and executive functions appeared to be the most affected domains. Delayed recall and learning were the most impaired domains of memory. Among the executive functions, abstraction, inhibition, set shifting, and sustained and selective attention were most commonly impaired. Language and visuo-spatial abilities were rarely affected, although this finding might be biased by the scarcity of reports. Neurological and respiratory conditions were often reported in association with cognitive deficits. Results on psycho-affective conditions were inconclusive due to the low frequency of reported data. Admission to an intensive care unit is not related to cognitive deficits. This review highlighted a potential effect of a previous post-COVID-19 infection on a pattern of memory, attention, and executive functions impairments. These findings need to be confirmed on larger cohorts with comprehensive neuropsychological batteries and correlated to neurophysiological and neurobiological substrates.
Topics: COVID-19; Cognitive Dysfunction; Humans; Pandemics; SARS-CoV-2
PubMed: 35780756
DOI: 10.1016/j.cortex.2022.06.002 -
Advances in Nutrition (Bethesda, Md.) Dec 2022We studied associations between prenatal and early postnatal choline intake, brain development, and neurocognitive function of children. We conducted a systematic review... (Meta-Analysis)
Meta-Analysis
We studied associations between prenatal and early postnatal choline intake, brain development, and neurocognitive function of children. We conducted a systematic review followed by a meta-analysis and critical appraisal of human studies published from 1997 to 2021. Thirty publications were identified. The meta-analysis included 5 of 7 case-control studies studying neural tube defects (NTDs) in relation to maternal choline intakes/circulating concentrations. Low maternal choline intake/circulating concentrations were associated with a higher OR for NTDs among 1131 mothers of newborns with NTDs and 4439 control mothers (pooled estimate = 1.36; 95% CI: 1.11, 1.67). The 95% prediction intervals were 0.78, 2.36. Findings and critical evaluation of 10 publications with interventional designs showed that higher maternal choline intakes during the second half of pregnancy and early postnatal period (550 mg up to 1 g/d on top of the diet) or a child intake of 513 to 625 mg/d from supplements were safe and likely to demonstrate favorable effects on several domains of child neurocognition, such as memory, attention, and visuospatial learning versus the comparators. Findings from observational studies (n = 13) partly supported the association between maternal choline intake/serum concentrations and child neurocognition, but there was low confidence in the use of plasma choline concentrations as a choline intake marker. In conclusion, low maternal choline intakes were associated with a higher OR for NTDs. The risk could be up to 2.36-fold in some populations. Despite limitations of available trials and observational studies, higher maternal choline intake was likely to be associated with better child neurocognition/neurodevelopment. The results should be used to guide choline intake recommendations in pregnancy and lactation, especially because most young women are not achieving the reference intake of choline. This meta-analysis is registered at PROSPERO as CRD42021233790.
Topics: Pregnancy; Humans; Child; Infant, Newborn; Female; Choline; Dietary Supplements; Vitamins; Diet; Neural Tube Defects; Brain; Child Development
PubMed: 36041182
DOI: 10.1093/advances/nmac082 -
NPJ Digital Medicine Sep 2023Skin diseases affect one-third of the global population, posing a major healthcare burden. Deep learning may optimise healthcare workflows through processing skin images... (Review)
Review
Skin diseases affect one-third of the global population, posing a major healthcare burden. Deep learning may optimise healthcare workflows through processing skin images via neural networks to make predictions. A focus of deep learning research is skin lesion triage to detect cancer, but this may not translate to the wider scope of >2000 other skin diseases. We searched for studies applying deep learning to skin images, excluding benign/malignant lesions (1/1/2000-23/6/2022, PROSPERO CRD42022309935). The primary outcome was accuracy of deep learning algorithms in disease diagnosis or severity assessment. We modified QUADAS-2 for quality assessment. Of 13,857 references identified, 64 were included. The most studied diseases were acne, psoriasis, eczema, rosacea, vitiligo, urticaria. Deep learning algorithms had high specificity and variable sensitivity in diagnosing these conditions. Accuracy of algorithms in diagnosing acne (median 94%, IQR 86-98; n = 11), rosacea (94%, 90-97; n = 4), eczema (93%, 90-99; n = 9) and psoriasis (89%, 78-92; n = 8) was high. Accuracy for grading severity was highest for psoriasis (range 93-100%, n = 2), eczema (88%, n = 1), and acne (67-86%, n = 4). However, 59 (92%) studies had high risk-of-bias judgements and 62 (97%) had high-level applicability concerns. Only 12 (19%) reported participant ethnicity/skin type. Twenty-four (37.5%) evaluated the algorithm in an independent dataset, clinical setting or prospectively. These data indicate potential of deep learning image analysis in diagnosing and monitoring common skin diseases. Current research has important methodological/reporting limitations. Real-world, prospectively-acquired image datasets with external validation/testing will advance deep learning beyond the current experimental phase towards clinically-useful tools to mitigate rising health and cost impacts of skin disease.
PubMed: 37758829
DOI: 10.1038/s41746-023-00914-8 -
Frontiers in Aging Neuroscience 2023The development of mild cognitive impairment (MCI) and Alzheimer's disease (AD) may be associated with an inflammatory process. Inflammatory cytokines may be a surrogate...
BACKGROUND
The development of mild cognitive impairment (MCI) and Alzheimer's disease (AD) may be associated with an inflammatory process. Inflammatory cytokines may be a surrogate for systemic inflammation leading to worsening neurological function. We aim to investigate the association between cognitive impairment and inflammation by pooling and analyzing the data from previously published studies.
METHODS
We performed a systematic literature search on MEDLINE, PubMed, Embase, Web of Science, and Scopus for prospective longitudinal and cross-sectional studies evaluating the relationship between inflammation and cognitive functions.
RESULTS
A total of 79 articles were included in our systematic review and meta-analysis. Pooled estimates from cross-sectional studies have demonstrated an increased level of C-reactive protein (CRP) [Hedges's g 0.35, 95% CI (0.16, 0.55), < 0.05], IL-1β [0.94, 95% CI (-0.04, 1.92), < 0.05], interleukin-6 (IL-6) [0.46, 95% CI (0.05, 0.88), < 0.005], TNF alpha [0.22, 95% CI (-0.24, 0.68), < 0.05], sTNFR-1 [0.74, 95% CI (0.46, 1.02), < 0.05] in AD compared to controls. Similarly, higher levels of IL-1β [0.17, 95% CI (0.05, 0.28), < 0.05], IL-6 [0.13, 95% CI (0.08, 0.18), < 0.005], TNF alpha [0.28, 95% CI (0.07, 0.49), < 0.05], sTNFR-1 [0.21, 95% CI (0.05, 0.48), < 0.05] was also observed in MCI vs. control samples. The data from longitudinal studies suggested that levels of IL-6 significantly increased the risk of cognitive decline [OR = 1.34, 95% CI (1.13, 1.56)]. However, intermediate levels of IL-6 had no significant effect on the final clinical endpoint [OR = 1.06, 95% CI (0.8, 1.32)].
CONCLUSION
The data from cross-sectional studies suggest a higher level of inflammatory cytokines in AD and MCI as compared to controls. Moreover, data from longitudinal studies suggest that the risk of cognitive deterioration may increase by high IL-6 levels. According to our analysis, CRP, antichymotrypsin (ACT), Albumin, and tumor necrosis factor (TNF) alpha may not be good surrogates for neurological degeneration over time.
PubMed: 36815174
DOI: 10.3389/fnagi.2023.1069439 -
Nurse Education in Practice Nov 2023The aim of this scoping review is to summarize and critically evaluate research focused on nursing bridging education programs internationally. Specifically, this review... (Review)
Review
AIM
The aim of this scoping review is to summarize and critically evaluate research focused on nursing bridging education programs internationally. Specifically, this review addresses bridging from a: (1) Personal Support Worker (or similar) to a Registered Practical Nurse (or similar); and (2) Registered Practical Nurse (or similar) to a Registered Nurse.
BACKGROUND
Nursing bridging education programs support learners to move from one level of educational preparation or practice to another. These programs can therefore increase nursing workforce capacity. Global healthcare systems have faced nursing shortages for decades. Moreover, the presently insufficient nursing workforce is confronting an ever-increasing volume of needed healthcare that is rising with the global ageing demographic shift.
DESIGN
The Joanna Briggs Institute methods for scoping reviews, combined with Arksey and O'Malley's (2005) guidelines, were used with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR).
METHODS
MEDLINE (Ovid), CINAHL, EMBASE and SCOPUS databases were searched. Articles published in English that included Personal Support Workers, Registered Practical Nurses, Registered Nurses and/or nurses in similar categories who were studied through the process of a nursing bridging education program were included in the review. The study search was limited to papers published after 2005 (i.e., the beginning of nurse workload "overload" according to the Canadian Nurses Association). Braun and Clarke's (2006) thematic analysis was used in a content analysis of the included studies.
RESULTS
A total of 15 articles published between 2005 and 2022 were included. Four themes were generated: (1) participating in bridging education programs fuels both professional and personal development; (2) nursing bridging education programs enhance diversity in the nursing workforce; (3) student nurses do not anticipate the challenges associated with participating in a bridging program; and (4) mentor-mentee connection promotes academic learning and successful completion of nursing bridging education programs.
CONCLUSIONS
Despite experiencing challenges, participation in/completion of nursing bridging education programs leads to successful role transitioning and self-reported fulfillment of personal and professional aspirations. This review revealed the need for bridging programs to accommodate the unique needs of student nurses. Incorporation of support services, mentorship and faculty familiarity with varying nursing educational backgrounds facilitates role transitions by reducing the perceived challenges of bridging and promoting connection to foster learning. Nursing bridging education programs allow greater numbers of nurses to be trained to build workforce capacity and enable care for the world's rapidly ageing population.
Topics: Humans; Canada; Education, Nursing; Learning; Nursing Staff; Delivery of Health Care
PubMed: 37952474
DOI: 10.1016/j.nepr.2023.103833 -
Steroids Oct 2021In recent years the expanding misuse of Nandrolone among non-athletes, particularly adolescent males is a prevalent global concern due to its adverse effects. This...
BACKGROUND AND AIM
In recent years the expanding misuse of Nandrolone among non-athletes, particularly adolescent males is a prevalent global concern due to its adverse effects. This article provides a summary of the experimental studies to clarify the relationship between Nandrolone exposure and behavioral and cognitive performances.
MATERIALS AND METHODS
The present systematic review was conducted using PubMed, Embase and ScienceDirect databases, from 2000 to 2020, using the following key terms: Nandrolone AND Cognition, Nandrolone AND Learning, Nandrolone AND Memory, Nandrolone AND (Synaptic plasticity or Hippocampal synaptic plasticity), Nandrolone AND (Aggression or Aggressive-like behavior), Nandrolone AND (Anxiety or Anxiety-like behavior), Nandrolone AND (Depression or Depressive-like behavior).
RESULTS
33 qualified papers were selected from the 2498 sources found. Of the 33 cases, 32 (96.97%) were males while only 1 (3.03%) was female and male. From 33 selected articles 8 reported studies were related to spatial memory, 2 reported studies were related to avoidance memory, 11 studies reported information on synaptic plasticity, 11 reported studies were related to aggressive behavior, 8 reported studies were related to aggressive behavior and 6 reported studies were related to depression.
CONCLUSION
Nandrolone can change spatial ability, avoidance memory and hippocampal synaptic plasticity. Also, Nandrolone exposure produces variable effects on behavioral function such as aggression, depression and anxiety. This despite the fact that the results are contradictory. These discrepancies might be due to the differences in sex, age, dosage and treatment duration, and administration route. However, the negative results are more common than the published positive ones.
Topics: Nandrolone
PubMed: 34407462
DOI: 10.1016/j.steroids.2021.108901