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European Review For Medical and... Apr 2021To evaluate the effectiveness of case-based learning (CBL) in medical students' education through meta-analysis. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the effectiveness of case-based learning (CBL) in medical students' education through meta-analysis.
MATERIALS AND METHODS
PubMed, Cochrane Library, Elsevier and other databases were searched to find randomized controlled trials (RCTs) of CBL teaching methods and other teaching methods published from January 1, 1995, to October 1, 2020. All included studies used the Cochrane risk bias assessment tool, and Review Manager software, version 5.3 (Copenhagen, Denmark), was used for the meta-analysis and systematic review.
RESULTS
A total of 8 studies were included with a total of 939 students, including 480 in the CBL group and 459 in the control group. Compared with other teaching methods, CBL teaching can improve medical students' academic performance (p=0.03) and case analysis ability (p<0.001).
CONCLUSIONS
CBL is an active teaching method that is effective for educating medical students and helps to improve their performance and case analysis ability.
Topics: Education, Medical; Humans; Learning; Students, Medical
PubMed: 33928603
DOI: 10.26355/eurrev_202104_25726 -
Journal of Medical Internet Research Feb 2022There is a lack of evidence in the literature regarding the learning outcomes of immersive technologies as educational tools for teaching university-level health care... (Review)
Review
BACKGROUND
There is a lack of evidence in the literature regarding the learning outcomes of immersive technologies as educational tools for teaching university-level health care students.
OBJECTIVE
The aim of this review is to assess the learning outcomes of immersive technologies compared with traditional learning modalities with regard to knowledge and the participants' learning experience in medical, midwifery, and nursing preclinical university education.
METHODS
A systematic review was conducted according to the Cochrane Collaboration guidelines. Randomized controlled trials comparing traditional learning methods with virtual, augmented, or mixed reality for the education of medicine, nursing, or midwifery students were evaluated. The identified studies were screened by 2 authors independently. Disagreements were discussed with a third reviewer. The quality of evidence was assessed using the Medical Education Research Study Quality Instrument (MERSQI). The review protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews) in April 2020.
RESULTS
Of 15,627 studies, 29 (0.19%) randomized controlled trials (N=2722 students) were included and evaluated using the MERSQI tool. Knowledge gain was found to be equal when immersive technologies were compared with traditional learning modalities; however, the learning experience increased with immersive technologies. The mean MERSQI score was 12.64 (SD 1.6), the median was 12.50, and the mode was 13.50. Immersive technology was predominantly used to teach clinical skills (15/29, 52%), and virtual reality (22/29, 76%) was the most commonly used form of immersive technology. Knowledge was the primary outcome in 97% (28/29) of studies. Approximately 66% (19/29) of studies used validated instruments and scales to assess secondary learning outcomes, including satisfaction, self-efficacy, engagement, and perceptions of the learning experience. Of the 29 studies, 19 (66%) included medical students (1706/2722, 62.67%), 8 (28%) included nursing students (727/2722, 26.71%), and 2 (7%) included both medical and nursing students (289/2722, 10.62%). There were no studies involving midwifery students. The studies were based on the following disciplines: anatomy, basic clinical skills and history-taking skills, neurology, respiratory medicine, acute medicine, dermatology, communication skills, internal medicine, and emergency medicine.
CONCLUSIONS
Virtual, augmented, and mixed reality play an important role in the education of preclinical medical and nursing university students. When compared with traditional educational modalities, the learning gain is equal with immersive technologies. Learning outcomes such as student satisfaction, self-efficacy, and engagement all increase with the use of immersive technology, suggesting that it is an optimal tool for education.
Topics: Humans; Delivery of Health Care; Learning; Students, Nursing; Technology
PubMed: 35103607
DOI: 10.2196/30082 -
International Journal of Environmental... Apr 2020Creatine monohydrate is a nutritional supplement often consumed by athletes in anaerobic sports. Creatine is naturally found in most meat products; therefore,...
BACKGROUND
Creatine monohydrate is a nutritional supplement often consumed by athletes in anaerobic sports. Creatine is naturally found in most meat products; therefore, vegetarians have reduced creatine stores and may benefit from supplementation.
OBJECTIVE
to determine the effects of creatine supplementation on vegetarians.
DATA SOURCES
PubMed and SPORTDiscus. Eligibility criteria: Randomized controlled trials (parallel group, cross-over studies) or prospective studies.
PARTICIPANTS
Vegetarians.
INTERVENTION
Creatine supplementation. Study appraisal and synthesis: A total of 64 records were identified, and eleven full-text articles (covering nine studies) were included in this systematic review.
RESULTS
Creatine supplementation in vegetarians increased total creatine, creatine, and phosphocreatine concentrations in vastus lateralis and gastrocnemius muscle, plasma, and red blood cells, often to levels greater than omnivores. Creatine supplementation had no effect on brain levels of phosphocreatine. Creatine supplementation increased lean tissue mass, type II fiber area, insulin-like growth factor-1, muscular strength, muscular endurance, Wingate mean power output, and brain function (memory and intelligence) in vegetarian participants. Studies were mixed on whether creatine supplementation improved exercise performance in vegetarians to a greater extent compared to omnivores.
LIMITATIONS
Studies that were reviewed had moderate-high risk of bias.
CONCLUSIONS
Overall, it appears vegetarian athletes are likely to benefit from creatine supplementation.
Topics: Athletes; Cognition; Creatine; Diet, Vegetarian; Dietary Supplements; Humans; Memory; Physical Fitness; Prospective Studies; Vegetarians
PubMed: 32349356
DOI: 10.3390/ijerph17093041 -
Neuropsychology Review Sep 2022Mindfulness-based programs (MBPs) are increasingly utilized to improve mental health. Interest in the putative effects of MBPs on cognitive function is also growing.... (Meta-Analysis)
Meta-Analysis Review
Mindfulness-based programs (MBPs) are increasingly utilized to improve mental health. Interest in the putative effects of MBPs on cognitive function is also growing. This is the first meta-analysis of objective cognitive outcomes across multiple domains from randomized MBP studies of adults. Seven databases were systematically searched to January 2020. Fifty-six unique studies (n = 2,931) were included, of which 45 (n = 2,238) were synthesized using robust variance estimation meta-analysis. Meta-regression and subgroup analyses evaluated moderators. Pooling data across cognitive domains, the summary effect size for all studies favored MBPs over comparators and was small in magnitude (g = 0.15; [0.05, 0.24]). Across subgroup analyses of individual cognitive domains/subdomains, MBPs outperformed comparators for executive function (g = 0.15; [0.02, 0.27]) and working memory outcomes (g = 0.23; [0.11, 0.36]) only. Subgroup analyses identified significant effects for studies of non-clinical samples, as well as for adults aged over 60. Across all studies, MBPs outperformed inactive, but not active comparators. Limitations include the primarily unclear within-study risk of bias (only a minority of studies were considered low risk), and that statistical constraints rendered some p-values unreliable. Together, results partially corroborate the hypothesized link between mindfulness practices and cognitive performance. This review was registered with PROSPERO [CRD42018100904].
Topics: Adult; Aged; Cognition; Executive Function; Humans; Memory, Short-Term; Middle Aged; Mindfulness
PubMed: 34350544
DOI: 10.1007/s11065-021-09519-y -
Neural Plasticity 2020Physical exercise (PE) has been associated with increase neuroplasticity, neurotrophic factors, and improvements in brain function.
BACKGROUND
Physical exercise (PE) has been associated with increase neuroplasticity, neurotrophic factors, and improvements in brain function.
OBJECTIVE
To evaluate the effects of different PE protocols on neuroplasticity components and brain function in a human and animal model.
METHODS
We conducted a systematic review process from November 2019 to January 2020 of the following databases: PubMed, ScienceDirect, SciELO, LILACS, and Scopus. A keyword combination referring to PE and neuroplasticity was included as part of a more thorough search process. From an initial number of 20,782 original articles, after reading the titles and abstracts, twenty-one original articles were included. Two investigators evaluated the abstract, the data of the study, the design, the sample size, the participant characteristics, and the PE protocol.
RESULTS
PE increases neuroplasticity via neurotrophic factors (BDNF, GDNF, and NGF) and receptor (TrkB and P75NTR) production providing improvements in neuroplasticity, and cognitive function (learning and memory) in human and animal models.
CONCLUSION
PE was effective for increasing the production of neurotrophic factors, cell growth, and proliferation, as well as for improving brain functionality.
Topics: Animals; Brain; Cognition; Exercise; Humans; Learning; Memory; Neuronal Plasticity
PubMed: 33414823
DOI: 10.1155/2020/8856621 -
Trials Jan 2021Informed consent is a basic concept of contemporary, autonomy-based medical practice and facilitates a shared decision-making model for relations between physicians and... (Review)
Review
BACKGROUND
Informed consent is a basic concept of contemporary, autonomy-based medical practice and facilitates a shared decision-making model for relations between physicians and patients. Thus, the extent to which patients can comprehend the consent they grant is essential to the ethical viability of medicine as it is pursued today. However, research on patients' comprehension of an informed consent's basic components shows that their level of understanding is limited.
METHODS
Systemic searches of the PubMed and Web of Science databases were performed to identify the literature on informed consent, specifically patients' comprehension of specific informed consent components.
RESULTS
In total, 14 relevant articles were retrieved. In most studies, few clinical trial participants correctly responded to items that examined their awareness of what they consented to. Participants demonstrated the highest level of understanding (over 50%) regarding voluntary participation, blinding (excluding knowledge about investigators' blinding), and freedom to withdraw at any time. Only a small minority of patients demonstrated comprehension of placebo concepts, randomisation, safety issues, risks, and side effects.
CONCLUSIONS
We found that participants' comprehension of fundamental informed consent components was low, which is worrisome because this lack of understanding undermines an ethical pillar of contemporary clinical trial practice and questions the viability of patients' full and genuine involvement in a shared medical decision-making process.
Topics: Comprehension; Humans; Informed Consent
PubMed: 33446265
DOI: 10.1186/s13063-020-04969-w -
Ageing Research Reviews Dec 2023Chronic exercise intervention is a non-pharmacological therapy suggested to improve cognitive function in various populations. However, few meta-analyses have assessed... (Meta-Analysis)
Meta-Analysis Review
Chronic exercise intervention is a non-pharmacological therapy suggested to improve cognitive function in various populations. However, few meta-analyses have assessed the cognitive benefits associated with all FITT-VP variables (exercise frequency, intensity, bout duration time, type, volume or total intervention length, and progression) in healthy populations by age. Thus, this meta-analysis assessed the effects of each FITT-VP variable on cognitive function in healthy children, adults, and older adults. This study followed PRISMA guidelines. After searching PubMed and the Web of Science, we included 54 randomized controlled trials to examined the effects of FITT-VP variables on five cognitive domains: global cognition, executive function, memory, attention, and information processing. Moderation analyses assessed the effects by age and by each exercise variables. Exercise benefitted overall cognition and all subcognitive domains. Aerobic and resistance exercise showed the greatest benefits on global cognition and executive function respectively, whereas mind-body exercise benefitted memory. Among all populations, older adults showed the greatest benefits of exercise on global cognition, executive function, and memory compared with controls. Additional studies are needed to assess the effects of exercise on attention and information processing. This meta-analysis offers new insights on the relationships between cognition and FITT-VP exercise variables in healthy populations.
Topics: Humans; Aged; Cognition; Executive Function; Exercise; Exercise Therapy; Health Status; Cognitive Dysfunction
PubMed: 37924980
DOI: 10.1016/j.arr.2023.102116 -
CNS Drugs Sep 2020Interest in the use of psychedelic substances for the treatment of mental disorders is increasing. Processes that may affect therapeutic change are not yet fully...
INTRODUCTION
Interest in the use of psychedelic substances for the treatment of mental disorders is increasing. Processes that may affect therapeutic change are not yet fully understood. Qualitative research methods are increasingly used to examine patient accounts; however, currently, no systematic review exists that synthesizes these findings in relation to the use of psychedelics for the treatment of mental disorders.
OBJECTIVE
To provide an overview of salient themes in patient experiences of psychedelic treatments for mental disorders, presenting both common and diverging elements in patients' accounts, and elucidating how these affect the treatment process.
METHODS
We systematically searched the PubMed, MEDLINE, PsycINFO, and Embase databases for English-language qualitative literature without time limitations. Inclusion criteria were qualitative research design; peer-reviewed studies; based on verbalized patient utterances; and a level of abstraction or analysis of the results. Thematic synthesis was used to analyze and synthesize results across studies. A critical appraisal of study quality and methodological rigor was conducted using the Critical Appraisal Skills Programme (CASP).
RESULTS
Fifteen research articles, comprising 178 patient experiences, were included. Studies exhibited a broad heterogeneity in terms of substance, mental disorder, treatment context, and qualitative methodology. Substances included psilocybin, lysergic acid diethylamide (LSD), ibogaine, ayahuasca, ketamine and 3,4-methylenedioxymethamphetamine (MDMA). Disorders included anxiety, depression, eating disorders, post-traumatic stress disorder, and substance use disorders. While the included compounds were heterogeneous in pharmacology and treatment contexts, patients reported largely comparable experiences across disorders, which included phenomenological analogous effects, perspectives on the intervention, therapeutic processes and treatment outcomes. Comparable therapeutic processes included insights, altered self-perception, increased connectedness, transcendental experiences, and an expanded emotional spectrum, which patients reported contributed to clinically and personally relevant responses.
CONCLUSIONS
This review demonstrates how qualitative research of psychedelic treatments can contribute to distinguishing specific features of specific substances, and carry otherwise undiscovered implications for the treatment of specific psychiatric disorders.
Topics: Hallucinogens; Humans; Mental Disorders; Patient Outcome Assessment; Substance-Related Disorders
PubMed: 32803732
DOI: 10.1007/s40263-020-00748-y -
East Asian Archives of Psychiatry :... Jun 2020Generalised anxiety disorder (GAD) has harmful effects on physical and mental health and quality of life. Mindfulness-based cognitive therapy (MBCT) is a treatment... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Generalised anxiety disorder (GAD) has harmful effects on physical and mental health and quality of life. Mindfulness-based cognitive therapy (MBCT) is a treatment option for GAD. This meta-analysis was conducted to determine the effectiveness of MBCT on GAD.
METHODS
Two authors independently performed the eligibility, quality assessment, and data extraction processes, and consensus was reached in case of discrepancies. Electronic databases were searched for eligible studies (randomised controlled trials, randomised trials, cluster randomised controlled trials, and clinical trials) up to November 2018 using keywords: mindfulness-based cognitive therapy OR mindfulness based cognitive therapy OR MBCT AND general anxiety disorder OR GAD*. The methodological quality of studies was assessed using the revised Jadad scale. Cohen's formula was used to determine the effect size based on the mean and standard deviation of the changes in the study groups before and after the intervention.
RESULTS
Six studies that compared the effectiveness between MBCT and controls were included for analysis. The mean revised Jadad score of the six studies was 4.3 (range, 3-6). The overall mean effect size was -0.65. The funnel plot of effect sizes in relation to the effect size standard error showed a symmetrical distribution. Compared with controls, MBCT significantly improved the treatment outcome of GAD in all studies, except one.
CONCLUSION
MBCT was effective for treating GAD.
Topics: Anxiety Disorders; Cognitive Behavioral Therapy; Humans; Mindfulness
PubMed: 32611828
DOI: 10.12809/eaap1885 -
Cochlear Implantation in Children With Single-Sided Deafness: A Systematic Review and Meta-analysis.JAMA Otolaryngology-- Head & Neck... Jan 2021In 2019, the US Food and Drug Administration approved cochlear implantation for children with single-sided deafness (SSD). The absence of robust clinical data specific... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
In 2019, the US Food and Drug Administration approved cochlear implantation for children with single-sided deafness (SSD). The absence of robust clinical data specific to pediatric patients to guide shared decision-making and to identify potential advantages is a challenge in family counseling.
OBJECTIVE
To evaluate the audiological and patient-reported outcomes in children who underwent cochlear implantation for SSD and to assess the association between time of implantation, subjective outcomes, and cochlear implant device use rates.
DATA SOURCE
MEDLINE, Embase, Scopus, Cochrane, and PubMed were searched for English-language articles that were published in a peer-reviewed journal from database inception to February 18, 2020.
STUDY SELECTION
Inclusion criteria were designed to capture studies that evaluated pediatric patients (1) younger than 18 years, (2) with a diagnosis of SSD for which they underwent a cochlear implantation, and (3) with at least 1 outcome of interest measured numerically: speech perception, sound localization, device use, and patient-reported outcomes. Of the 526 articles reviewed, 12 (2.3%) met the selection criteria.
DATA EXTRACTION AND SYNTHESIS
The Meta-analyses Of Observational Studies in Epidemiology (MOOSE) reporting guidelines were followed. Data were pooled using fixed-effect and random-effect models. The following information was obtained from each article: study characteristics, patient characteristics, hearing loss and intervention characteristics, and outcomes.
MAIN OUTCOMES AND MEASURES
Outcomes were (1) postoperative changes in speech perception (in quiet was measured as a proportion of correct responses, and in noise was measured as decibel signal to noise ratio for speech reception threshold) and sound localization (measured in degree of localization error), (2) patient-reported audiological outcomes (measured by the speech, spatial, and qualities of hearing scale), and (3) device use rates among children who received cochlear implantation for SSD.
RESULTS
Twelve observational studies that evaluated 119 children (mean [SD] age, 6.6 [4.0] years) with SSD who received a cochlear implant were included. Most children showed clinically meaningful improvement in speech perception in noise (39 of 49 children [79.6%]) and in quiet (34 of 42 children [81.0%]). Long duration of deafness (>4 years in congenital SSD and >7 years in perilingual SSD) was the most commonly proposed reason for lack of improvement. Sound localization as measured by degrees of error from true location (mean difference [MD], -24.78°; 95% CI, -34.16° to -15.40°; I2 = 10%) improved statistically significantly after cochlear implantation. Patients with acquired SSD and shorter duration of deafness compared with those with congenital SSD reported greater improvements in speech (MD, 2.27; 95% CI, 1.89-2.65 vs 1.58; 95% CI, 1.00-2.16) and spatial (MD, 2.95; 95% CI, 2.66-3.24 vs 1.68; 95% CI, 0.96-2.39) hearing qualities. The duration of deafness among device nonusers was statistically significantly longer than the duration of deafness among regular device users (median difference, 6.84; 95% CI, 4.02-9.58).
CONCLUSIONS AND RELEVANCE
This systematic review and meta-analysis found that cochlear implantation for children with SSD was associated with clinically meaningful improvements in audiological and patient-reported outcomes; shorter duration of deafness may lead to better outcomes. These findings can guide future research efforts, refine cochlear implantation candidacy criteria, and aid in family counseling and shared decision-making.
Topics: Child; Cochlear Implantation; Hearing Loss, Unilateral; Humans; Patient Reported Outcome Measures; Sound Localization; Speech Perception
PubMed: 33151295
DOI: 10.1001/jamaoto.2020.3852