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JAMA Surgery Sep 2022Definitive treatment of primary hyperparathyroidism (pHPT) with curative parathyroidectomy has been shown to improve nonspecific neurocognitive symptoms and may improve...
IMPORTANCE
Definitive treatment of primary hyperparathyroidism (pHPT) with curative parathyroidectomy has been shown to improve nonspecific neurocognitive symptoms and may improve long-term quality of life (QOL). However, QOL is not currently routinely assessed preoperatively, and as a result, diminished QOL may be overlooked as an indication for surgery.
OBJECTIVE
To examine results for measures of long-term QOL after parathyroidectomy in patients with pHPT.
EVIDENCE REVIEW
A systematic, English-language literature review was performed to assess the long-term association of parathyroidectomy, defined as a minimum of 1-year postoperative follow-up, with QOL in patients with pHPT. We conducted a search of PubMed and Scopus using Medical Subject Heading (MeSH) terms for hyperparathyroidism, parathyroid hormone, parathyroidectomy, hypercalcemia, and quality of life. All relevant literature published between June 1998 and February 15, 2021, was included. Study selection was guided by the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) strategy.
FINDINGS
Thirty-one studies conducted in 14 countries with a minimum of 1 year of follow-up were included, comprising 3298 patients with pHPT (2975 underwent parathyroidectomy; 323 were observed), 5445 age- and sex-matched control participants, and 386 control patients with benign thyroid disease. To assess QOL, 21 studies (68%) used a general tool, the 36-item Short Form Survey (SF-36), and 8 (26%) used the disease-specific tool Parathyroidectomy Assessment of Symptoms (PAS). The remaining studies used a combination of 10 additional QOL tools. The median follow-up period was 1 year (range, 1-10 years). Of the 31 studies, 27 (87%) demonstrated significant score improvement in long-term QOL after parathyroidectomy, including 1 study that showed continued improvement in QOL 10 years after parathyroidectomy. The remaining 4 studies (13%) reported mixed results.
CONCLUSIONS AND RELEVANCE
This systematic review suggests that parathyroidectomy is associated with improved and sustained QOL in patients with pHPT. Patients with pHPT should be screened with a validated QOL tool such as the SF-36 or PAS at the time of diagnosis to guide discussion of these symptoms in the preoperative setting and the potential for long-term improvement after curative parathyroidectomy.
PubMed: 36103163
DOI: 10.1001/jamasurg.2022.4249 -
Journal of Personality and Social... Apr 2023holds that the intrinsic and extrinsic content of people's aspirations differentially affect their wellness. An evidence base spanning nearly 30 years indicates that... (Meta-Analysis)
Meta-Analysis
holds that the intrinsic and extrinsic content of people's aspirations differentially affect their wellness. An evidence base spanning nearly 30 years indicates that focusing on intrinsic goals (such as for growth, relationships, community giving, and health) promotes well-being, whereas a focus on extrinsic goals (such as for wealth, fame, and beauty) deters well-being. Yet, the evidence base contains exceptions, and some authors have argued that focusing on extrinsic goals may not be universally detrimental. We conducted a systematic review and used multilevel meta-analytic structural equation modeling to evaluate the links between intrinsic and extrinsic aspirations with indices of well-being and ill-being. Across 92 reports (105 studies), 1,808 effects, and a total sample of = 70,110, we found that intrinsic aspirations were linked positively with well-being, = 0.24 [95% CI 0.22, 0.27], and negatively with ill-being, = -0.11 [-0.14, -0.08]. When the variety of extrinsic aspiration scoring methods were combined, the link with well-being was not statistically significant, = 0.02 [-0.02, 0.06]. However, when extrinsic aspirations were evaluated in terms of their predominance in the overall pattern of aspiring the effect was universally detrimental, linking negatively to well-being, = -0.22 [-0.32, -0.11], and positively to ill-being, = 0.23 [0.17, 0.30]. Meta-analytic conclusions about the associations between goal types and wellness are important because they inform how individuals could shape aspirations to support their own happiness and how groups and institutions can frame goals such that their pursuit is for the common good. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Topics: Humans; United States; Goals; Motivation; Personal Autonomy
PubMed: 35951379
DOI: 10.1037/pspp0000431 -
Palliative & Supportive Care Aug 2022End-of-life dreams and visions (ELDVs) have been reported throughout history. We aimed to synthesize the research literature on ELDVs to determine the proportions of... (Review)
Review
OBJECTIVES
End-of-life dreams and visions (ELDVs) have been reported throughout history. We aimed to synthesize the research literature on ELDVs to determine the proportions of patients, bereaved families, healthcare professionals, and volunteers reporting ELDVs; ELDV content, timing, and interpretation; and any evidence-based approaches to ELDV-related care.
METHODS
A systematic review protocol was registered with PROSPERO (CRD4021282929). CINAHL, Medline, Embase, Emcare, and APA PsycInfo were searched for peer-reviewed English language articles reporting qualitative, quantitative, or mixed methods studies that explored reports of ELDVs by patients, bereaved families, healthcare professionals, or volunteers. Synthesis used both meta-analysis and a narrative approach.
RESULTS
Of 2,045 papers identified by searches, 22 were included, describing 18 studies in a variety of settings. Meta-analyses indicated that 77% (95% confidence intervals [CIs] 69-84%) of patients ( = 119) reported an ELDV compared with 32% (95% CIs 21-44%) of bereaved relatives ( = 2,444) and that 80% (95% CIs 59-94%) of healthcare professionals ( = 171) reported either witnessing or being told of an ELDV in the preceding 5 years. Studies of volunteers reported 34% (95% CIs 20-48%) ( = 45) either witnessing or being told of an ELDV over their entire period of service, with 49% of volunteers (95% CIs 33-64%) ( = 39) reporting events occurring in the preceding year. ELDVs reported by patients, bereaved families, healthcare professionals, and volunteers were perceived as being a source of comfort. Healthcare professionals and volunteers expressed a need for further education on how to support patients experiencing ELDVs and their families.
SIGNIFICANCE OF RESULTS
ELDVs are experienced by the majority of dying patients and need consideration in delivering holistic end-of-life care. Little if any research has been conducted in acute care facilities.
PubMed: 35912689
DOI: 10.1017/S1478951522000876 -
Dimensions of Critical Care Nursing :...Patients discharged from the intensive care unit (ICU) suffer from long-term symptoms affecting the physical, psychological, and cognitive well-being and cannot... (Meta-Analysis)
Meta-Analysis
The Effect of Intensive Care Unit Diaries on Posttraumatic Stress Disorder, Anxiety, and Depression: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
INTRODUCTION
Patients discharged from the intensive care unit (ICU) suffer from long-term symptoms affecting the physical, psychological, and cognitive well-being and cannot understand memories and dreams. Intensive care unit diaries describe daily events about the patient and may allow them to reconstruct their experience.
OBJECTIVE
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to investigate the effects of ICU diaries on posttraumatic stress disorder (PTSD), depression, and anxiety.
METHODS
Five electronic databases were searched up to May 6, 2022. We included RCTs comparing patients admitted to the ICU who received a diary to those who did not receive a diary. The primary outcome was the rate of PTSD. Secondary outcomes were rates of depression and anxiety.
RESULTS
We included 7 RCTs. Patients who received a diary during the ICU admission had reduced rate of PTSD (78/432 [18%] vs 106/422 [25%]; risk ratio [RR], 0.73; 95% confidence interval [CI], 0.57-0.94; P = .02; I2 = 0%; trial sequential analysis-adjusted CI, 0.55-0.97) when compared with patients who did not receive a diary. We found a non-statistically significant difference toward a reduction in the rate of depression (38/232 [16%] vs 54/224 [24%]; RR, 0.70; 95% CI, 0.49-1.01; P = .06; I2 = 0%) and anxiety (63/232 [27%] vs 70/224 [31%]; RR, 0.64; 95% CI, 0.29-1.40; P = .26; I2 = 67%).
CONCLUSIONS
Providing an ICU diary to patients admitted to the ICU reduced the rate of PTSD symptoms compared with usual care.
Topics: Anxiety; Depression; Humans; Intensive Care Units; Randomized Controlled Trials as Topic; Stress Disorders, Post-Traumatic
PubMed: 35905428
DOI: 10.1097/DCC.0000000000000539 -
Plastic and Reconstructive Surgery Aug 2022A group of experts from different disciplines was convened to develop guidelines for the management of upper visual field impairments related to eyelid ptosis and...
BACKGROUND
A group of experts from different disciplines was convened to develop guidelines for the management of upper visual field impairments related to eyelid ptosis and dermatochalasis. The goal was to provide evidence-based recommendations to improve patient care.
METHODS
A multidisciplinary group of experts representing their specialty organizations was selected. A systematic literature review was performed including topics regarding documentation of the underlying cause for visual field impairment, selection of an appropriate surgical repair, assessment of the type of anesthesia, the use of adjunctive brow procedures, and follow-up assessments. The Grading of Recommendations, Assessment, Development, and Evaluation methodology process was used to evaluate the relevant studies. Clinical practice recommendations were developed using BRIDGE-Wiz (Building Recommendations In a Developers' Guideline Editor) software.
RESULTS
Each topic area was assessed. A clinical recommendation was made, and the relevant literature was discussed.
CONCLUSIONS
The review of the literature revealed varied complication rates and diverse treatment modalities for the correction of upper visual field deficit. Strong recommendations could not be made in most topic areas because of a paucity of methodologically sound studies in the literature. More rigorously designed studies are needed to measure outcomes of interest, with fewer sources of potential error or bias.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, V.
Topics: Evidence-Based Medicine; Eyelids; Humans; Societies, Medical; Surgeons; United States; Visual Fields
PubMed: 35895522
DOI: 10.1097/PRS.0000000000009329 -
Surgery Sep 2022Enhanced recovery after surgery programs have improved patient outcomes following colorectal surgery. This has provided a platform for the consideration of ambulatory... (Review)
Review
BACKGROUND
Enhanced recovery after surgery programs have improved patient outcomes following colorectal surgery. This has provided a platform for the consideration of ambulatory colectomies where patients are discharged within 24 hours after surgery. Although some studies have demonstrated its feasibility, the safety profile and patient eligibility criteria for discharge within 24 hours after surgery remain relatively ill-defined. This study provided a review of the patient selection criteria and postoperative outcomes shown in patients discharged within 24 hours after surgery.
METHODS
Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were adhered to. A comprehensive search was performed on 3 electronic databases, and the relevant articles were identified. The primary outcome measures were postoperative morbidity and readmission rates. The different domains relevant to the selection of patients and perioperative care of patients discharged within 24 hours after surgery were also qualitatively assessed.
RESULTS
Eight studies were included, which involved a total of 1,229 patients. The majority of selected patients underwent elective laparoscopic colonic surgeries. The patient characteristics, such as age, comorbidities, obesity, and psychosocial environment, were important considerations. A close follow-up with home-based medical services was ideal in patients discharged within 24 hours after surgery. The readmission rates ranged from 0.0% to 9.0%. Despite morbidity rates of up to 26.7%, the majority of them were minor and classified as Clavien-Dindo Grade I to II.
CONCLUSION
The use of programs related to discharge within 24 hours after surgery in colorectal surgery is safe, feasible, and practical in a select group of patients within a well-designed clinical framework and pathway. Future studies should compare patient outcomes following discharge within 24 hours after surgery with conventional enhanced recovery after surgery protocols. In addition, patient and caregiver perceptions, quality of life, and cost-effectiveness analysis should also be performed.
Topics: Colectomy; Colon; Humans; Laparoscopy; Patient Discharge; Quality of Life
PubMed: 35840425
DOI: 10.1016/j.surg.2022.04.050 -
Rand Health Quarterly Jun 2022Posttraumatic stress disorder (PTSD) is a condition that can emerge after exposure to a traumatic event. It involves several symptoms, including distressing memories or...
Posttraumatic stress disorder (PTSD) is a condition that can emerge after exposure to a traumatic event. It involves several symptoms, including distressing memories or dreams and/or dissociative reactions; psychological distress at exposure to trauma cues; physiologic reactions to cues; avoidance of stimuli associated with the event; negative alterations in cognitions and mood associated with the trauma; and alterations in arousal and reactivity, including sleep disturbance. The purpose of this systematic review is to synthesize the evidence from randomized controlled trials on the effects that interventions for adults with PTSD have on sleep outcomes. The authors searched research databases and bibliographies of existing systematic reviews to identify pertinent trials published in English; literature was identified by the searches using predetermined eligibility criteria. The primary outcome domain included sleep quality, insomnia, and nightmares. Secondary outcomes were PTSD symptoms and adverse events. Risk of bias and the quality of evidence were assessed for each outcome. The identified interventions addressed pharmacological, psychological, behavioral, complementary, and integrative medicine treatments aimed at improving sleep or lessening other PTSD symptoms. Interventions in general showed an effect on sleep. Interventions explicitly targeting sleep-particularly psychotherapy targeting sleep-showed larger effects on sleep than did interventions not targeting sleep. Heterogeneity was considerable, but sleep effect estimates were not systematically affected by trauma type, setting, or modality. Comparative effectiveness studies are needed to support the findings.
PubMed: 35837535
DOI: No ID Found -
Frontiers in Public Health 2022Studies conducted on the practice of COVID-19 preventive methods across the world are highly inconsistent and inconclusive. Hence, this study intended to estimate the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Studies conducted on the practice of COVID-19 preventive methods across the world are highly inconsistent and inconclusive. Hence, this study intended to estimate the pooled preventive practice and its determinants among the general population.
METHODS
This study was conducted using online databases (PubMed, HINARI, Scopus, EMBASE, Science Direct, and Cochrane library database), African Journals online, Google Scholar, open gray and online repository accessed studies. The quality of the included studies was assessed using Newcastle-Ottawa Quality Assessment Scale (NOS). STATA 14.0 software for analysis. The existence of heterogeneity between studies was checked using Cochran Q test and I2 test statistics and then, the presence of publication bias was detected using both funnel plot and Egger's test.
RESULTS
51 studies were included and the pooled level of practice toward the preventive measures of COVID-19 was 74.4% (95% CI: 70.2-78.6%, 2 = 99.7%, < 0.001] using a random effects model. Being female [OR = 1.97: 95% CI 1.75, 2.23; 2 = 0.0%, < 0.698], rural residence [OR = 0.53: 95% CI 0.44, 0.65; 2 = 73.5%, < 0.013], attending higher education level [OR = 1.47: 95% CI 1.18, 1.83; 2 = 75.4%, < 0.001], being employed [OR = 2.12: 95% CI 1.44, 3.12; 2 = 91.8%, < 0.001], age < 30 [OR = 0.73: 95% CI 0.60, 0.89; 2 = 73.9%, < 0.001], and knowledgeable [OR = 1.22: 95% CI 1.09, 1.36; 2 = 47.3%, < 0.077] were the independent predictors of adequate practice level.
CONCLUSIONS
nearly three-fourths of the general population has an adequate preventive practice level toward COVID-19. Thus, the global, regional, national, and local governments need to establish policies and strategies to address the identified factors.
Topics: Black People; COVID-19; Databases, Factual; Female; Humans; Local Government; Male; Policy
PubMed: 35784216
DOI: 10.3389/fpubh.2022.844692 -
Computational Intelligence and... 2022Cloud computing is a long-standing dream of computing as a utility, where users can store their data remotely in the cloud to enjoy on-demand services and high-quality... (Review)
Review
Cloud computing is a long-standing dream of computing as a utility, where users can store their data remotely in the cloud to enjoy on-demand services and high-quality applications from a shared pool of configurable computing resources. Thus, the privacy and security of data are of utmost importance to all of its users regardless of the nature of the data being stored. In cloud computing environments, it is especially critical because data is stored in various locations, even around the world, and users do not have any physical access to their sensitive data. Therefore, we need certain data protection techniques to protect the sensitive data that is outsourced over the cloud. In this paper, we conduct a systematic literature review (SLR) to illustrate all the data protection techniques that protect sensitive data outsourced over cloud storage. Therefore, the main objective of this research is to synthesize, classify, and identify important studies in the field of study. Accordingly, an evidence-based approach is used in this study. Preliminary results are based on answers to four research questions. Out of 493 research articles, 52 studies were selected. 52 papers use different data protection techniques, which can be divided into two main categories, namely noncryptographic techniques and cryptographic techniques. Noncryptographic techniques consist of data splitting, data anonymization, and steganographic techniques, whereas cryptographic techniques consist of encryption, searchable encryption, homomorphic encryption, and signcryption. In this work, we compare all of these techniques in terms of data protection accuracy, overhead, and operations on masked data. Finally, we discuss the future research challenges facing the implementation of these techniques.
Topics: Cloud Computing; Computer Security; Confidentiality; Delivery of Health Care; Privacy
PubMed: 35712069
DOI: 10.1155/2022/8303504 -
Neuroscience and Biobehavioral Reviews Aug 2022This network meta-analysis compares the efficacy and acceptability of all published psychotherapeutic and pharmacological interventions for trauma-related nightmares... (Meta-Analysis)
Meta-Analysis Review
This network meta-analysis compares the efficacy and acceptability of all published psychotherapeutic and pharmacological interventions for trauma-related nightmares (TRN) in adults. The analysis included data from 29 randomized clinical trials involving 14 psychotherapeutic and pharmacological interventions and involved 2214 trauma survivors. Prazosin and image rehearsal therapy (IRT) were found to be the two effective interventions for TRN. Other interventions such as risperidone, paroxetine, cognitive behavioral therapy for insomnia (CBT-I), CBT-I+IRT, prolonged exposure (PE), and IRT+PE, did not show significantly greater efficacy compared with control conditions. The rates of all-cause discontinuations were comparable among majority of the interventions and did not show significant differences compared with control conditions. Prazosin and IRT should be considered as the initial choice of pharmacological and psychotherapeutic interventions for TRN. The efficacy of other pharmacological and psychotherapeutic interventions remains to be demonstrated. Future guidelines and daily clinical decision making on the choice of interventions for TRN should consider these findings.
Topics: Adult; Dreams; Humans; Implosive Therapy; Network Meta-Analysis; Prazosin; Psychotropic Drugs; Stress Disorders, Post-Traumatic
PubMed: 35661755
DOI: 10.1016/j.neubiorev.2022.104717