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The International Journal on Drug Policy Jul 2023In the past decade, a body of evidence has reported that dietary supplement use is related to prohibited performance enhancing substance use (i.e., doping). To help... (Meta-Analysis)
Meta-Analysis Review
In the past decade, a body of evidence has reported that dietary supplement use is related to prohibited performance enhancing substance use (i.e., doping). To help international and national sport organisations understand the degree to which dietary supplement use is related to doping, the objectives of this systematic review and meta-analysis were to 1) compare the prevalence of doping between dietary supplement users and non-users and 2) identify whether supplement use is related to doping social cognitive factors. We searched for studies sampling athletes and that measured both dietary supplement use and doping in EMBASE, MEDLINE, PsychINFO, CINAHL and SPORTDiscus from database creation to May 2022. Risk of bias was assessed using JBI Critical Appraisal Checklist for cross-sectional studies and the STROBE checklist. Twenty-six cross-sectional studies, involving 13,296 athletes were included. Random-effect models revealed that doping was 2.74 (95% CI=2.10 to 3.57) times more prevalent in dietary supplement users (pooled prevalence = 14.7%) than non-users (6.7%), and that users reported stronger doping intentions (r=0.26, 0.18 to 0.34) and attitudes (r=0.21, 0.13 to 0.28) compared to non-users. Preliminary evidence also suggests that dietary supplement users were less likely to dope if they were more task oriented and had a stronger sense of morality. Results of the review are limited by the cross-sectional design used in all studies and lack of consistency in measurement of dietary supplement use and doping. Data indicate that athletes using dietary supplements are more likely to self-report doping Anti-doping policy should, therefore, target dietary supplement use in anti-doping education programmes by providing alternative strategies for performance enhancement or highlighting the safest ways they can be consumed. Similarly, as a large proportion of athletes use dietary supplements without doping, further research is needed to understand the factors that protect a dietary supplement user from doping. No funding was received for the review. A study protocol can be found here: https://osf.io/xvcaq.
Topics: Humans; Cross-Sectional Studies; Dietary Supplements; Sports; Athletes; Intention; Doping in Sports
PubMed: 37267738
DOI: 10.1016/j.drugpo.2023.104077 -
International Journal of Nursing Studies Sep 2021Moral distress is a pervasive phenomenon that can negatively impact healthcare professionals and has been well studied in nursing populations. Much of the evidence... (Review)
Review
BACKGROUND
Moral distress is a pervasive phenomenon that can negatively impact healthcare professionals and has been well studied in nursing populations. Much of the evidence suggests that it is associated with intention to leave high acuity areas and the profession. Despite the increasing amounts of research to explore the causes and effects of moral distress, there is limited research on interventions that mitigate the negative effects of moral distress.
OBJECTIVES
The aims of this systematic review were to: (a) identify and examine interventions developed to address moral distress experienced by health care professionals (b) examine the quality of the research methods and (c) report on the efficacy of these interventions.
DESIGN
We conducted a systematic review of interventional studies developed to mitigate moral distress.
DATA SOURCE
Medline, Embase, PsycINFO, CINAHL and Cochrane were searched for relevant studies (July 2019- September 2019). Additional bioethics databases and reference lists were also hand-searched.
REVIEW METHODS
The first author reviewed all retrieved titles and abstracts with a low tolerance for borderline papers based on inclusion and exclusion criteria, and those papers were reviewed and discussed by all authors to determine inclusion. Quality appraisal was conducted on the included studies using narrative synthesis to compare the findings. Data were extracted and compared by all authors and then reviewed by the first author for consistency.
RESULTS
Sixteen papers were included for full text review and the following interventions identified: educational interventions of varying length and breadth; facilitated discussions ranging from 30 to 60 minutes; specialist consultation services; an intervention bundle; multidisciplinary rounds; self-reflection and narrative writing. Researchers reported statistically significant reductions in moral distress using pre and post surveys, including one mixed methods program evaluation (n=7). The qualitative program evaluation provided participant quotations to suggest their program was beneficial. There were no statistically significant findings in the other studies (n=8). All studies had limitations in design and methodology presenting significant threats to validity.
CONCLUSION
Designing rigorous research studies that measure the impact of interventions aimed at mitigating moral distress continues to be challenging. The primary reason being that moral distress is a subjective ethical phenomenon with a number of different causes and effects. This calls for interventions that are flexible and sensitive to individual's needs. To build an evidence-base, interventions should also be measurable and research methods need to be scientifically rigorous. To achieve rigor and innovation, researchers should clearly justify their methodological choices. Tweetable abstract: Interventions to mitigate moral distress: a systematic review of the literature. Educational interventions offer a promising direction but more research is needed.
Topics: Health Personnel; Humans; Morals; Surveys and Questionnaires
PubMed: 34214894
DOI: 10.1016/j.ijnurstu.2021.103984 -
The association between low calf circumference and mortality: a systematic review and meta-analysis.European Geriatric Medicine Jun 2022Low calf circumference is an important indicator of malnutrition and has been widely studied, especially among older adults. However, data on the association between low... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Low calf circumference is an important indicator of malnutrition and has been widely studied, especially among older adults. However, data on the association between low calf circumference and mortality have been inconsistent. This systematic review was aimed to quantify this association.
METHODS
The internet databases (PubMed, Embase, ScienceDirect and Cochrane Library databases) were systematically searched from inception to November 01, 2021 for studies investigating the association between low calf circumference and mortality. A random effects model was adopted to pool the relevant data.
RESULTS
Low calf circumference was associated with a higher risk of mortality than normal calf circumference, with a pooled HR of 2.42 (95% CI 1.97-2.97, I = 74.3%). In addition, this association between low calf circumference and morality was still statistically significant in the subgroup analysis across different settings, including hospitals (pooled HR = 2.63, 95% CI 1.93-3.58), nursing homes (pooled HR = 2.49, 95% CI 1.76-3.54), and communities (pooled HR = 2.22, 95% CI 1.60-3.07). Other subgroup analyses based on different cutoffs of calf circumference showed that, compared to individual with normal calf circumference, participants with low calf circumference had an increased risk of mortality (pooled HR = 2.66, 95% CI 2.06-3.43) when using the Asian Working Group for Sarcopenia (AWGS) criterion (≤ 34 cm for males and ≤ 33 cm for females). Similar results were found when the Mini Nutritional Assessment (MNA) criterion (≤ 31 cm) was used, with a pooled HR of 2.11 (95% CI 1.59-2.81).
CONCLUSION
Calf circumference, which is simple and convenient to measure, could be used to stratify the high-risk group, as low calf circumference was significantly associated with mortality among patients. Interventions, including exercise and nutrition programs, could be conducted promptly once low calf circumference is detected.
Topics: Aged; Female; Humans; Male; Malnutrition; Nursing Homes; Nutrition Assessment; Nutritional Status; Sarcopenia
PubMed: 35006574
DOI: 10.1007/s41999-021-00603-3 -
Philosophy, Ethics, and Humanities in... Sep 2021The acceptance or practical application of the do-not-resuscitate order is substantially dependent on internal or personal factors; in a way that decision-making about... (Review)
Review
BACKGROUND
The acceptance or practical application of the do-not-resuscitate order is substantially dependent on internal or personal factors; in a way that decision-making about this issue can be specific to each person. Moreover, most nurses feel morally and emotionally stressed and confused during the process decision-making regarding DNR order. Therefore, the purpose of the present study was to evaluate nurses' attitudes towards DNR order in a systematic review.
METHODS
This critical survey was conducted using a systematic review protocol. To this end, the most relevant articles published in domestic and foreign databases with no time limits until October 2018 were searched. The inclusion and exclusion criteria were articles on DNR order, studies about nurses' attitudes, descriptive and analytical research papers, as well as those with download links and full texts. The given articles were also assessed in terms of their quality and their main results were extracted.
RESULTS
Of the total number of 1663 articles searched in the process of systematic review to investigate nurses' attitudes towards DNR order, 88 articles were included in the full-text review step and finally 10 articles, meeting the inclusion criteria, were found. Assessing the quality of articles included in this review showed that 8 articles, in general, were of good quality and 2 studies were characterized with moderate quality. The main factors associated with nurses' attitudes towards DNR order were grouped into three categories of (1) nurses' attitudes towards DNR order, (2) guidelines for DNR order, and (3) decision-making by patients and their families about DNR order. In most of the studies examined, nurses' attitudes towards DNR order were reported positive.
CONCLUSION
It seemed that nurses were willing to get involved in DNR order and each hospital was recommended to develop a written DNR policy directing individuals and avoiding their confusion in this respect.
Topics: Attitude of Health Personnel; Health Knowledge, Attitudes, Practice; Humans; Nurses; Nursing Staff, Hospital; Resuscitation Orders
PubMed: 34488819
DOI: 10.1186/s13010-021-00103-z -
Medicine, Health Care, and Philosophy Sep 2022To present the ethical issues, moral arguments, and reasons found in the ethical literature on organoid models. (Review)
Review
OBJECTIVE
To present the ethical issues, moral arguments, and reasons found in the ethical literature on organoid models.
DESIGN
In this systematic review of reasons in ethical literature, we selected sources based on predefined criteria: (1) The publication mentions moral reasons or arguments directly relating to the creation and/or use of organoid models in biomedical research; (2) These moral reasons and arguments are significantly addressed, not as mere passing mentions, or comprise a large portion of the body of work; (3) The publication is peer-reviewed and published in an academic article, book, national-level report, working paper, or Ph.D. thesis; (4) The publications collected are in English.
ANALYSIS
Each article was read in-depth for identifiable moral reasons, arguments, and concerns. These were then inductively classified and synthesized to create broader categories of reasons, and eventually an overarching conceptual scheme was created.
RESULTS
A total of twenty-three sources were included and analyzed out of an initial 266 collected sources. Five themes of ethical issues and arguments were found: Animal Experimentation; Clinical Applications and Experiments; Commercialization and Consent; Organoid Ontology and Moral Status; and Research Ethics and Research Integrity. These themes are then further broken down into sub-themes and topics. Given the extensive nature of the topics found, we will focus on describing the topics that comprised of more in-depth reasons and arguments rather than few, passing mentions or concerns.
CONCLUSIONS
The ethics of organoids requires further deliberation in multiple areas, as much of the discussions are not presented as in-depth arguments. Such sentiments are also echoed throughout the organoid ethics literature.
Topics: Animal Experimentation; Animals; Dissent and Disputes; Ethics, Research; Humans; Organoids
PubMed: 35532849
DOI: 10.1007/s11019-022-10082-3 -
Nursing Ethics Sep 2023During a disaster, nurses face complex ethical challenges because of risky situations. It is necessary to identify trends and ethical issues of nurses in disasters to... (Review)
Review
BACKGROUND
During a disaster, nurses face complex ethical challenges because of risky situations. It is necessary to identify trends and ethical issues of nurses in disasters to improve the quality of care and impact for nurses.
METHOD
This systematic review enrolled in the international registration with PROSPERO: CRD42022350765. We searched the following databases: PubMed, EBSCO MEDLINE, SCOPUS, ProQuest, ScienceDirect, and Sage Pub. The inclusion criteria were developed according to PICO and D; are Population (F): involving nurses; intervention/Exposure (I): disaster, Comparison (C): none; outcome (O): ethical practice. And Design (D): qualitative, quantitative, and mixed methods. Years of publication were 2012-2022, with full text in English. The quality of study assessment used was The Joanna Briggs Institute (JBI) Critical Appraisal tool and Mixed Methods Appraisal Tool (MMAT) version 2018. Analysis used PICO synthesis.
RESULTS
There were 15 studies reviewed from 2093 results, including cross-sectional (4/15, 26.6%), qualitative (9/15, 60%), and mixed methods (2/15, 13.3%) studies. The types of disasters were: COVID-19 (7/15, 46.6%), infectious (4/15, 26.6%), and all disaster events (4/15, 26.6%). The main themes were: (1) ethical issues in disasters have the potential to address ethical dilemmas, (2) factors applying nursing ethics to support ethical decision-making in disasters, (3) strategies for applying ethics and dealing with ethical issues in disasters, and (4) the impact of applying ethics in disasters.
CONCLUSION
Applying ethics nursing in a disaster is influenced by various factors. This framework for ethical nursing in disasters aims to help nurses, educational institutions, and policymakers develop schemes or scenarios to enhance responsible ethical decisions in disasters.
Topics: Humans; Cross-Sectional Studies; Disasters; Ethics, Nursing
PubMed: 36974633
DOI: 10.1177/09697330231155602 -
The Journal of Nervous and Mental... Apr 2023Demoralization as cancer-related mental health needs to be understood and addressed by clinical staff. This review systematically examined the characteristics and... (Review)
Review
Demoralization as cancer-related mental health needs to be understood and addressed by clinical staff. This review systematically examined the characteristics and outcomes of interventions for demoralization in patients with cancer. Seven databases-PubMed, PsycINFO, Cinahl, Embase, Web of Science, Medline, and Cochrane Library Databases of Systematic Reviews-were systematically searched for relevant literature. We included intervention studies focusing on interventions for demoralization in patients with cancer. We ultimately included 14 studies. Overall, 10 studies had a positive effect on improving demoralization in patients with cancer, including two main types of interventions: psilocybin-assisted psychotherapy and psychological interventions. This review summarizes information on interventions for demoralization in patients with cancer. To provide precise care for demoralization in patients with cancer, future studies should use more rigorous methods to test interventions that may affect demoralization.
Topics: Humans; Demoralization; Psychotherapy; Mental Health; Neoplasms
PubMed: 36975545
DOI: 10.1097/NMD.0000000000001615 -
Philosophy, Ethics, and Humanities in... Apr 2022Human brain organoids are a valuable research tool for studying brain development, physiology, and pathology. Yet, a host of potential ethical concerns are inherent in...
BACKGROUND
Human brain organoids are a valuable research tool for studying brain development, physiology, and pathology. Yet, a host of potential ethical concerns are inherent in their creation. There is a growing group of bioethicists who acknowledge the moral imperative to develop brain organoid technologies and call for caution in this research. Although a relatively new technology, brain organoids and their uses are already being discussed in media literature. Media literature informs the public and policymakers but has the potential for utopian or dystopian distortions. Thus, it is important to understand how this technology is portrayed to the public.
METHODS
To investigate how brain organoids are displayed to the public, we conducted a systematic review of media literature indexed in the Nexis Uni database from 2013-2019. News and media source articles passing exclusion criteria (n = 93) were scored to evaluate tone and relevant themes. Themes were validated with a pilot sample before being applied to the dataset. Thematic analysis assessed article tone, reported potential for the technology, and the scientific, social, and ethical contexts surrounding brain organoids research.
RESULTS
Brain organoid publications became more frequent from 2013 to 2019. We observed increases in positively and negatively toned articles, suggesting growing polarization. While many sources discuss realistic applications of brain organoids, others suggest treatment and cures beyond the scope of the current technology. This could work to overhype the technology and disillusion patients and families by offering false hope. In the ethical narrative we observe a preoccupation with issues such as development of artificial consciousness and "humanization" of organoid-animal chimeras. Issues of regulation, ownership, and accuracy of the organoid models are rarely discussed.
CONCLUSIONS
Given the power that media have to inform or misinform the public, it is important this literature provides an accurate and balanced reflection of the therapeutic potential and associated ethical issues regarding brain organoid research. Our study suggests increasing polarization, coupled with misplaced and unfounded ethical concern. Given the inhibitory effects of public fear or disillusion on research funding, it is important media literature provides an accurate reflection of brain organoids.
Topics: Animals; Brain; Chimera; Consciousness; Ethics, Research; Humans; Organoids
PubMed: 35414094
DOI: 10.1186/s13010-022-00119-z -
American Journal of Audiology Sep 2022This systematic review aimed to update and explore the extant literature (2011-2020) regarding ethics knowledge in audiology and to compare the findings to an earlier...
PURPOSE
This systematic review aimed to update and explore the extant literature (2011-2020) regarding ethics knowledge in audiology and to compare the findings to an earlier study (2001-2010).
METHOD
This systematic review employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
RESULTS
MEDLINE, CINAHL, ERIC, MasterFILE Premier, E-Journals, Africa-Wide information and Academic Search Premier electronic databases, and non-peer-reviewed papers in Seminars in Hearing yielded a total of 63 papers. Following systematic screening using inclusion and exclusion criteria, a total of 12 full-text papers were included in this review. Pertinent data and findings from the review were tabulated and analyzed using a qualitative, deductive approach. Results showed that the 12 papers were published in nine peer-reviewed journals with a predominantly social scientific approach. This differs from the earlier review that reported only five papers with a predominantly philosophical approach. However, both the current and earlier studies focused on the rehabilitation/management role of the audiologist. In the earlier study, the focus was on moral judgment (as one of the components of moral behavior), whereas this was the focus of only half of the papers identified in this study, with the remaining papers focusing on moral sensitivity and moral motivation.
CONCLUSIONS
The focus of papers had evolved and continued to include more elements related to the multiple perspectives used to analyze and describe ethics research. The body of knowledge of ethics in audiology specifically expanded in the area of social scientific research, focusing on beneficence and nonmaleficence, including moral motivation and basing research on moral judgment with the emphasis on the rehabilitation/management and education/research/administration role of audiologists.
Topics: Audiology; Follow-Up Studies; Humans
PubMed: 35944019
DOI: 10.1044/2022_AJA-22-00043 -
Journal of Empirical Research on Human... Jul 2023Informed consent and debriefing of research participants in studies that use deception are ethical safeguards for which existing scholarly work on their implementation... (Review)
Review
Informed consent and debriefing of research participants in studies that use deception are ethical safeguards for which existing scholarly work on their implementation remains variable and insufficiently clear. A systematic review of research ethics guidelines was conducted to sketch a picture of whether, why and how informed consent and debriefing are recommended when using deception. Documents roughly agreed on several general principles, but varied significantly in the specifics of why and whether these safeguards are necessary, in which conditions and how they should be implemented. Various aspects that appear in the literature could not be found in the guidelines. In our review, guidance was integrated and showed a variation of implementation strategies that could help in contextualizing these safeguards.
Topics: Humans; Informed Consent; Ethics, Research
PubMed: 37186795
DOI: 10.1177/15562646231173477