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Age and Ageing Sep 2022older adults living in long-term care (LTC) commonly suffer from anxiety symptoms and disorders. We completed a systematic review and meta-analysis to identify... (Meta-Analysis)
Meta-Analysis
BACKGROUND
older adults living in long-term care (LTC) commonly suffer from anxiety symptoms and disorders. We completed a systematic review and meta-analysis to identify efficacious treatments for anxiety symptoms for older adults living in LTC.
METHODS
we searched five electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials) to identify treatments for anxiety that have been trialled in LTC. Included studies had to be randomised trials, include residents of LTC, and measure anxiety symptoms as an outcome.
RESULTS
the electronic search returned 6,617 articles, 519 were reviewed in full text, and 80 were included in the descriptive synthesis. Limited studies were meta-analysed (n = 10) due to differences in described treatment and comparator conditions. Limited clinically relevant evidence supporting the use of pharmacologic treatments for symptoms of anxiety in LTC was identified. Of the treatments trialled, music compared with usual care (standardised mean difference, SMD: -0.82; 95% confidence interval (CI): -1.31, -0.34), music compared with social interaction (SMD: -0.41; 95% CI: -0.72, -0.10) and massage compared with usual care (SMD: -4.32; 95% CI: -7.44, -1.19) were found to improve anxiety symptoms, however, significant heterogeneity was detected in two comparisons.
CONCLUSIONS
a range of non-pharmacologic treatments that improved anxiety symptoms were identified for use in LTC. Although limited evidence exists to support the use of particular treatments, most non-pharmacologic treatments were low-risk interventions that may be readily implemented. Further research is required to assess the treatment effect on residents of LTC with anxiety disorders or clinically relevant symptoms at baseline.
Topics: Aged; Anxiety; Anxiety Disorders; Humans; Long-Term Care; Treatment Outcome
PubMed: 36057989
DOI: 10.1093/ageing/afac195 -
The Journal of Sports Medicine and... Jun 2017Understanding kinematic and kinetic changes with fatigue during running is important to assess changes that may influence performance and injury. The aim of this... (Review)
Review
INTRODUCTION
Understanding kinematic and kinetic changes with fatigue during running is important to assess changes that may influence performance and injury. The aim of this systematic review was to identify, critique and summarize literature about the effects of fatigue on kinematics and kinetics during a fatiguing overground run and present the reported influence on performance and injury.
EVIDENCE ACQUISITION
An electronic search was conducted of MEDLINE, SPORTDiscus, CINAHL and PubMed databases. Two reviewers assessed articles for inclusion, and evaluated the quality of articles included using a modified version of the Downs and Black Quality Index.
EVIDENCE SYNTHESIS
A total of twelve articles were identified for review. The mean quality assessment score was seven out of a possible 12. Kinematic and kinetic changes reported to affect performance included decreased speed, step or stride frequency and length, increased trunk flexion, lower leg position at heel strike, mediolateral acceleration, changes in hip and knee ranges, and decreased stride regularity, heel lift, maximum knee rotation and backward ankle velocity. Alterations reported to increase risk of injury included decreased step frequency, increased upper body rotation and lower leg position at heel strike, and decreased knee flexion during stance. Reduced risk of injury has been linked to decreased step length and hip ranges, and increased trunk flexion.
CONCLUSIONS
This review found limited evidence regarding changes in kinematic and kinetic during a fatiguing run in relation to performance and injury. Higher quality studies are warranted, with a larger sample of homogenous runners, and type of run carefully selected to provide quality information for runners, coaches and clinicians.
Topics: Acceleration; Ankle Joint; Biomechanical Phenomena; Fatigue; Gait; Humans; Kinetics; Knee Joint; Running; Torso
PubMed: 27074435
DOI: 10.23736/S0022-4707.16.06339-8 -
PLoS Neglected Tropical Diseases Apr 2024Snakebite envenoming represents a significant and often neglected public health challenge, particularly in rural communities across tropical and subtropical regions. An... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Snakebite envenoming represents a significant and often neglected public health challenge, particularly in rural communities across tropical and subtropical regions. An estimated 1.2-5.5 million people are envenomed by snakebites annually. More than 125,000 of these bites are fatal, and 3-4 times as many results in disability/disfigurement. Despite its prevalence, collecting accurate epidemiological data on snakebite is challenging. This systematic review and meta-analysis collates global epidemiology data on snakebite morbidity and mortality.
METHODS
Medline, Embase, Cochrane and CINAHL Plus databases were searched for articles published between 2001-2022. Pooled incidence and mortality were obtained using random effects modelling, heterogeneity (I2) was tested, and sensitivity analyses performed. Newcastle-Ottawa Scale assessed study quality.
RESULTS
Out of the four databases, 5,312 articles were found. After removing duplicates, 3,953 articles were screened by title and abstract and 65 articles containing information on snakebite epidemiology, encompassing 663,460 snakebites, were selected for analysis. The people most at risk for snakebite were men (59%), engaged in agricultural labour (27.5%), and residing in rural areas (66.7%). More than half (57%) of the reported bites resulted in envenoming. Incidents occurred frequently in the summer season (38.5%), during daytime (56.7%), and bites were most often to the lower limb (56.4%). Envenoming severity was frequently mild (46.7%), treated in hospital (68.3%), and was treated with anti-venom (64.7%). The pooled global incidence and mortality was 69.4 /100,000 population (95%CI: 36.8 to 101.9) and 0.33/100,000 population (95%CI, 0.14 to 0.52) per year, respectively. Stratified by continents, Asia had the highest incidence of 130.7/100,000 population (95%CI: 48.3 to 213.1) while Europe has the lowest with 0.7/100,000 population (95%CI: -0.2 to 1.5). The highest mortality was reported in Asia at 0.96/100,000 population (95% CI: 0.22 to 1.70), and Africa 0.44/100,000 population (95%CI: -0.03 to 0.84). Incidence was highest among inhabitants of lower-middle-income countries 132.7/100,000 population (95%CI: 55.4 to 209.9) while mortality was highest in low-income countries at 0.85/100,000 population (95% CI: -0.06 to 2.31).
CONCLUSION
Incidence and mortality rates noted here highlight the global impact of snakebite and underscore the critical need to address the burden of snakebite envenoming. It also reveals that while reported snakebite incidence was higher in lower-middle-income countries, the burden of mortality was greatest among inhabitants of low-income countries, again emphasising the need for greater efforts to tackle this neglected tropical disease.
Topics: Male; Humans; Female; Snake Bites; Antivenins; Incidence; Asia; Prevalence
PubMed: 38574167
DOI: 10.1371/journal.pntd.0012080 -
British Journal of Anaesthesia Jan 2018The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. (Observational Study)
Observational Study
BACKGROUND
The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool.
METHODS
Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals.
RESULTS
We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32-0.77); P<0.01], but no difference in complication rates [OR 1.02 (0.88-1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62-0.92); P<0.01; I=87%] and reduced complication rates [OR 0.73 (0.61-0.88); P<0.01; I=89%).
CONCLUSIONS
Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.
Topics: Adult; Aged; Checklist; Cohort Studies; Elective Surgical Procedures; Evidence-Based Medicine; Female; Hospital Mortality; Humans; Male; Middle Aged; Patient Safety; Postoperative Complications; Postoperative Period; Surgical Procedures, Operative; Treatment Outcome
PubMed: 29397122
DOI: 10.1016/j.bja.2017.08.002 -
British Journal of Community Nursing May 2022This systematic review and meta-analysis estimates the prevalence of common comorbid health disorders in adults with rheumatoid arthritis (RA). A multi-database search... (Meta-Analysis)
Meta-Analysis
This systematic review and meta-analysis estimates the prevalence of common comorbid health disorders in adults with rheumatoid arthritis (RA). A multi-database search strategy was undertaken. Screening, data extraction and quality assessment were carried out by two independent reviewers. A meta-analysis and meta-regression were used to generate a pooled prevalence estimate and identify relevant moderators. After study selection, 33 studies (74633 participants) were included in the meta-analysis. Some 31 studies were judged to be of low risk of bias, and two studies were judged to be at moderate risk of bias. The three most common comorbidities in RA were anxiety disorders (62.1%, 95% Cl: 43.6%; 80.6%), hypertension (37.7%, 95% Cl: 29.2%; 46.2%) and depression (32.1%, 95% Cl: 21.6%; 42.7%). There was substantial statistically significant heterogeneity for all comorbidities (I2 ≥77%). Meta-regression identified that the covariate of mean age (unit increase) had a statistically significant effect on the prevalence of hypertension (+2.3%, 95% Cl: 0.4%; 4.2%), depression (-0.5%, 95% Cl: -0.6%; -0.4%) and cancer (0.5%, 95% Cl: 0.2%; 0.8%) in adults with RA. A country's income was identified to have a statistically significant effect on the prevalence of depression, with low-to moderate-income countries having 40% (95% Cl: 14.0%; 66.6%) higher prevalence than high-income countries. No studies consider health inequalities. It is concluded that comorbidities are prevalent among people with RA, particularly those associated with mental health and circulatory conditions. Provision of health services should reflect the importance of such multimorbidity and the consequences for quality and length of life.
Topics: Adult; Arthritis, Rheumatoid; Comorbidity; Humans; Hypertension; Mental Health; Prevalence
PubMed: 35522453
DOI: 10.12968/bjcn.2022.27.5.232 -
Health Policy and Planning Nov 2017Integration of services for patients with more than one diagnosed condition has intuitive appeal but it has been argued that the empirical evidence to support it is... (Review)
Review
Integration of services for patients with more than one diagnosed condition has intuitive appeal but it has been argued that the empirical evidence to support it is limited. We report the findings of a systematic review that sought to identify health system factors, extrinsic to the integration process, which either facilitated or hindered the integration of services for two common disorders, HIV and chronic non-communicable diseases. Findings were initially extracted and organized around a health system framework, followed by a thematic cross-cutting analysis and validation steps. Of the 150 articles included, 67% (n = 102) were from high-income countries. The articles explored integration with services for one or several chronic disorders, the most studied being alcohol or substance use disorders (47.7%), and mental health issues (29.5%). Four cross-cutting themes related to the health system were identified. The first and most common theme was the requirement for effective collaboration and coordination: formal and informal productive relationships throughout the system between providers and within teams, and between staff and patients. The second was the need for adequate and appropriately skilled and incentivized health workers-with the right expertise, training and operational support for the programme. The third was the need for supportive institutional structures and dedicated resources. The fourth was leadership in terms of political will, effective managerial oversight and organizational culture, indicating that actual implementation is as important as programme design. A fifth theme, outside the health system, but underpinning all aspects of the system operation, was that placing the patient at the centre of service delivery and responding holistically to their diverse needs. This was an important facilitator of integration. These findings confirm that integration processes in service delivery depend substantially for their success on characteristics of the health systems in which they are embedded.
Topics: Chronic Disease; Cooperative Behavior; Delivery of Health Care, Integrated; HIV Infections; Humans; Systems Integration
PubMed: 28666336
DOI: 10.1093/heapol/czw149 -
Palliative Medicine Sep 2019Delirium is a common and distressing neurocognitive condition that frequently affects patients in palliative care settings and is often underdiagnosed.
BACKGROUND
Delirium is a common and distressing neurocognitive condition that frequently affects patients in palliative care settings and is often underdiagnosed.
AIM
Expanding on a 2013 review, this systematic review examines the incidence and prevalence of delirium across all palliative care settings.
DESIGN
This systematic review and meta-analyses were prospectively registered with PROSPERO and included a risk of bias assessment.
DATA SOURCES
Five electronic databases were examined for primary research studies published between 1980 and 2018. Studies on adult, non-intensive care and non-postoperative populations, either receiving or eligible to receive palliative care, underwent dual reviewer screening and data extraction. Studies using standardized delirium diagnostic criteria or valid assessment tools were included.
RESULTS
Following initial screening of 2596 records, and full-text screening of 153 papers, 42 studies were included. Patient populations diagnosed with predominantly cancer ( = 34) and mixed diagnoses ( = 8) were represented. Delirium point prevalence estimates were 4%-12% in the community, 9%-57% across hospital palliative care consultative services, and 6%-74% in inpatient palliative care units. The prevalence of delirium prior to death across all palliative care settings ( = 8) was 42%-88%. Pooled point prevalence on admission to inpatient palliative care units was 35% (confidence interval = 0.29-0.40, = 14). Only one study had an overall low risk of bias. Varying delirium screening and diagnostic practices were used.
CONCLUSION
Delirium is prevalent across all palliative care settings, with one-third of patients delirious at the time of admission to inpatient palliative care. Study heterogeneity limits meta-analyses and highlights the future need for rigorous studies.
Topics: Adult; Delirium; Female; Hospice and Palliative Care Nursing; Humans; Internationality; Male; Prevalence
PubMed: 31184538
DOI: 10.1177/0269216319854944 -
Clinical and Translational Radiation... Jan 2023To assess the literature on men's preferences and perceptions regarding prostate cancer radiation therapy. (Review)
Review
PURPOSE
To assess the literature on men's preferences and perceptions regarding prostate cancer radiation therapy.
METHODS
A scoping review was undertaken as per JBI guidelines. Searches were conducted in PubMed, CINAHL, Scopus and Science Direct with search terms including "prostate cancer," "radiotherapy," "radiation therapy," "radiation oncology," "patient preferences," "patient perceptions" and "patient experience." The resultant studies were mapped and grouped according to the emergent themes and pathway stages.
RESULTS
A total of 779 titles and abstracts were screened by two independent reviewers. Fifty-two full-text studies were reviewed, with 27 eligible for inclusion. There were 4 pre-treatment, 13 during treatment and 10 post-treatment studies covering broad themes of information needs (n = 3), preferences and decisions (n = 6), general experiences (n = 8), side effects (n = 6), and support (n = 4). There were a mix of methodologies, including 11 qualitative, 14 quantitative (including four preference studies), one mixed methods and one narrative review.
CONCLUSION
There were only four preference studies, with the remaining 23 reporting on perceptions. Overall, there is a paucity of literature regarding patient preferences and perceptions of prostate cancer radiation therapy, particularly when considering how many clinical and technical studies are published in the area. This highlights opportunities for future research.
PubMed: 36345391
DOI: 10.1016/j.ctro.2022.10.007 -
Accident; Analysis and Prevention Jan 2015Strategies to contend with driver distraction may no longer be sufficient for the emerging variety of contemporary driver distractions. A more systematic and systemic... (Review)
Review
Strategies to contend with driver distraction may no longer be sufficient for the emerging variety of contemporary driver distractions. A more systematic and systemic approach holds promise for improved road safety but is not currently being developed. This systematic review of multiple driver distractions aims to address this gap and presents two key findings. Systematic classification of distracting tasks with respect to driving is challenging, and engagement with Multiple-Additional-to-Driving (MAD) tasks is almost universally detrimental to driving performance. A model is presented to assist in systematically characterising multiple driver demands. Identified literature is placed into context using the model and shortfalls are identified.
Topics: Attention; Automobile Driving; Humans; Safety; Systems Analysis; Task Performance and Analysis
PubMed: 25073420
DOI: 10.1016/j.aap.2014.07.006 -
Maternal & Child Nutrition Oct 2015The beneficial effect of balanced protein energy supplementation during pregnancy on subsequent child growth is unclear and may depend upon the mother entering pregnancy... (Meta-Analysis)
Meta-Analysis Review
The effect of balanced protein energy supplementation in undernourished pregnant women and child physical growth in low- and middle-income countries: a systematic review and meta-analysis.
The beneficial effect of balanced protein energy supplementation during pregnancy on subsequent child growth is unclear and may depend upon the mother entering pregnancy adequately nourished or undernourished. Systematic reviews to-date have included studies from high-, middle- and low-income countries. However, the effect of balanced protein energy supplementation should not be generalised. This review assesses the effect of balanced protein energy supplementation in undernourished pregnant women from low- and middle-income countries on child growth. A systematic review of articles published in English (1970-2015) was conducted via MEDLINE, Scopus, the Cochrane Register and hand searching. Only peer-reviewed experimental studies analysing the effects of balanced protein energy supplementation in undernourished pregnant women from low- and middle-income countries with measures of physical growth as the primary outcome were included. Two reviewers independently assessed full-text articles against inclusion criteria. Validity of eligible studies was ascertained using the Quality Assessment Tool for Quantitative Studies (EPHPP QAT). In total, seven studies met the inclusion criteria. All studies reported on birthweight, five on birth length, three on birth head circumference, and one on longer-term growth. Standardised mean differences were calculated using a random-effects meta-analysis. Balanced protein energy supplementation significantly improved birthweight (seven randomised controlled trials, n = 2367; d = 0.20, 95% confidence interval, 0.03-0.38, P = 0.02). No significant benefit was observed on birth length or birth head circumference. Impact of intervention could not be determined for longer-term physical growth due to limited evidence. Additional research is required in low- and middle-income countries to identify impacts on longer-term infant growth.
Topics: Birth Weight; Child Development; Developing Countries; Dietary Proteins; Dietary Supplements; Energy Intake; Female; Humans; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; Maternal Nutritional Physiological Phenomena; Poverty; Pregnancy
PubMed: 25857334
DOI: 10.1111/mcn.12183