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Psicologia, Reflexao E Critica :... Apr 2024Research has consistently shown that some children are more vulnerable at the time of school readiness. Better understanding the characteristics of these children is... (Review)
Review
BACKGROUND
Research has consistently shown that some children are more vulnerable at the time of school readiness. Better understanding the characteristics of these children is therefore important. Most studies have used a variable-based approach, which may mask the presence of small but important subgroups of children with mixed patterns of readiness strengths and weaknesses. Identifying subgroups with mixed readiness patterns using a person-centered approach matters because their developmental trajectories might differ in important ways from children with broader difficulties across all readiness domains.
OBJECTIVE
This systematic review attempts to synthesize existing profiles of school readiness conducted on preschool-aged children and to describe how these various profiles are associated with children's academic achievement and social adjustment during their school years. Specifically, we described how the school readiness profiles vary in number of profiles identified and differences in the specific domains of school readiness. We further describe the school readiness profiles and how they predict later academic and social outcomes. Furthermore, we focus on profile differences between at-risk and non-at-risk preschoolers.
METHODS
Longitudinal studies published between 2005 and 2022 on profiles of school readiness before school entry and at least one subsequent academic and/or social outcomes were extracted from five databases. Eight articles were included in this systematic review out of the 117 screened peer-reviewed articles.
RESULTS
All the studies incorporated both the cognitive and socioemotional domains of school readiness in their profiles. Fifteen profiles of school readiness at preschool age were identified based on the child level of cognitive and socioemotional skills, with 7 profiles at risk of later academic and social difficulties. Despite variation, children in these at-risk profiles of school readiness shared similar features.
CONCLUSION
This literature review provides an exhaustive summary on the number of profiles and domains of school readiness most frequently reported in studies using a person-centered approach. Yielding an in-depth description of at-risk profiles of school readiness can help designing early preventive intervention for these children.
PubMed: 38630214
DOI: 10.1186/s41155-024-00298-y -
Journal of Personalized Medicine Mar 2024(1) Background: Supraglottic airway devices (SAD) have been used in children and adolescents undergoing adenotonsillectomies under general anesthesia. This systematic... (Review)
Review
(1) Background: Supraglottic airway devices (SAD) have been used in children and adolescents undergoing adenotonsillectomies under general anesthesia. This systematic review and meta-analysis investigate the safety and efficacy of using SADs when compared to an endotracheal tube (ETT). (2) Methods: After registering with PROSPERO, databases like PubMed, Scopus, OviD, CINAHL, and Cochrane Library were searched using relevant keywords from the year 2000. We used RoB-2 for risk-of-bias assessment, GRADE for assessing the quality of evidence, RevMan 5.2 for qualitative meta-analysis, and trial sequential analysis (TSA) to corroborate the significant findings of meta-analysis. (3) Results: Out of 200 studies, 5 randomized-controlled trials fulfilled inclusion criteria. The quality of evidence was moderate for laryngospasm, low for airway device failure, and very low for recovery time. The incidence of laryngospasm was comparable between SADs and ETT (RR: 0.80, 95% CI-0.36, 1.80, = 0.59). The incidence of airway device failure was significantly higher with SADs than ETT (RR: 11.29, 95% CI: 2.73, 46.66, = 0.0008). The postoperative recovery time was significantly less with SADs than with ETT use (MD: -4.33, 95% CI: -5.28, -3.39, < 0.0001), which was confirmed by the TSA. (4) Conclusions: The results of this review suggests that use of SADs can provide a lesser postoperative recovery time and comparable incidence of laryngospasm, with a higher incidence of failure of SAD when compared to ETT. Use of SAD for pediatric and adolescent adenotonsillectomies should be individualized based on patient characteristics, and on the expertise of the anesthesiologist and the surgeons involved.
PubMed: 38541053
DOI: 10.3390/jpm14030311 -
Nursing Reports (Pavia, Italy) Feb 2024(1) Background: The ongoing COVID-19 pandemic has led to an increasing number of women giving birth while also grappling with SARS-CoV-2. The objective of this review is... (Review)
Review
(1) Background: The ongoing COVID-19 pandemic has led to an increasing number of women giving birth while also grappling with SARS-CoV-2. The objective of this review is to examine the possibility of transmission of the virus from mother to infant through breastfeeding, skin-to-skin contact, and rooming-in and to explore methods for managing COVID-19-positive mother-infant dyads. (2) Methods: A comprehensive search strategy was employed that covered pertinent studies from the Cochrane Library, PubMed Central, and Scopus databases. The Matrix Method and PRISMA guidelines were utilized by the researchers, with the search being updated until 20 December 2021, one year after the initial vaccine delivery. The inclusion criteria for the study involved articles published in English, those employing broad search terms, and those comprising full-text reviews. Additionally, the researchers required that the articles be published from December 2019 onwards. To further analyze the data, a meta-analysis was performed to estimate the rate of infant infection from mothers who engaged in breastfeeding, skin-to-skin contact, and rooming-in practices. (3) Results: Eighteen studies were analyzed in this review, with an infected infant rate of 2.8%. The maternal practices used in these studies ranged from direct separation of the infant to direct skin-to-skin contact, rooming-in, and exclusive breastfeeding. One study investigated the factors associated with positive test results in newborns and found that only the maternal social vulnerability index >90 was a significant predictor. The type of delivery, rooming-in, and the mother's symptom status were not associated with positive neonatal outcomes. (4) Conclusions: According to current data, the incidence of perinatal infection with SARS-CoV-2 is relatively low. It is advised that mothers adhere to several supportive care measures, including engaging in breastfeeding, skin-to-skin contact, and rooming-in. These measures ought to be complemented by diligent hand hygiene, the wearing of masks, and the cleansing of breasts solely when necessary.
PubMed: 38535712
DOI: 10.3390/nursrep14010040 -
Radiation Oncology (London, England) Mar 2024Intensity-modulated radiation therapy (IMRT) is considered standard of care for head and neck squamous cell carcinoma (HNSCC). Improved conformity of IMRT and smaller... (Review)
Review
BACKGROUND
Intensity-modulated radiation therapy (IMRT) is considered standard of care for head and neck squamous cell carcinoma (HNSCC). Improved conformity of IMRT and smaller margins, however, have led to concerns of increased rates of marginal failures. We hypothesize that while patterns of failure (PoF) after IMRT for HNSCC have been published before, the quality of patient positioning and image guided radiotherapy (IGRT) have rarely been taken into account, and their importance remains unclear. This work provides a systematic review of the consideration of IGRT in PoF studies after IMRT for HNSCC.
MATERIALS AND METHODS
A systematic literature search according to PRISMA guidelines was performed on PubMed for HNSCC, IMRT and PoF terms and conference abstracts from ESTRO and ASTRO 2020 and 2021 were screened. Studies were included if they related PoF of HNSCC after IMRT to the treated volumes. Data on patient and treatment characteristics, IGRT, treatment adaptation, PoF and correlation of PoF to IGRT was extracted, categorized and analyzed.
RESULTS
One-hundred ten studies were included. The majority (70) did not report any information on IGRT. The remainder reported daily IGRT (18), daily on day 1-3 or 1-5, then weekly (7), at least weekly (12), or other schemes (3). Immobilization was performed with masks (78), non-invasive frames (4), or not reported (28). The most common PoF classification was "in-field/marginal/out-of-field", reported by 76 studies. Only one study correlated PoF in nasopharyngeal cancer patients to IGRT.
CONCLUSION
The impact of IGRT on PoF in HNSCC is severely underreported in existing literature. Only one study correlated PoF to IGRT measures and setup uncertainty. Further, most PoF studies relied on outdated terminology ("in/out-of-field"). A clearly defined and up-to-date PoF terminology is necessary to evaluate PoFs properly, as is systematic and preferably prospective data generation. PoF studies should consistently and comprehensively consider and report on IGRT.
Topics: Humans; Squamous Cell Carcinoma of Head and Neck; Radiotherapy, Intensity-Modulated; Nasopharyngeal Neoplasms; Prospective Studies; Head and Neck Neoplasms
PubMed: 38444011
DOI: 10.1186/s13014-024-02421-w -
The Journal of Hospital Infection May 2024Healthcare-associated infections (HAIs) burden healthcare globally. Amid the SARS-CoV-2 pandemic, intensified infection control measures, such as mask usage and hand... (Review)
Review
BACKGROUND
Healthcare-associated infections (HAIs) burden healthcare globally. Amid the SARS-CoV-2 pandemic, intensified infection control measures, such as mask usage and hand hygiene, were implemented.
AIM
To assess the efficacy of these measures in preventing HAIs among hospitalized patients.
METHODS
Using the PICO framework (Population, Intervention, Comparison, Outcome), the study focused on hospitalized patients and the effectiveness of anti-COVID-19 measures in preventing HAIs. A systematic review of literature published in 2020-2022 was conducted, examining interventions such as mask usage, hand hygiene, and environmental cleaning.
FINDINGS
This systematic review analysed 42 studies: two in 2020, 21 in 2021, and 19 in 2022. Most studies were from high-income countries (28). Most studies (30 out of 42) reported a reduction in HAIs after implementing anti-COVID-19 measures. Gastrointestinal infections and respiratory tract infections showed significant reduction, unlike bloodstream infections and urinary tract infections. Some wards, like cardiology and neurology, experienced reduced HAIs, unlike intensive care units and coronary care units. There was an increase in studies reporting no effect of hygiene measures on HAIs in 2022, eventually indicating a shift in effectiveness over time.
CONCLUSION
Anti-COVID-19 measures have shown selective efficacy in preventing HAIs. The study emphasizes the need for context-specific strategies and increased focus on regions with limited resources. Continued research is essential to refine infection control practices, especially in high-risk settings.
Topics: Humans; COVID-19; Cross Infection; Infection Control; SARS-CoV-2; Hand Hygiene; Masks
PubMed: 38423132
DOI: 10.1016/j.jhin.2024.02.008 -
Journal of Clinical Medicine Feb 2024: Oral midazolam is the most commonly used sedative premedication agent in pediatric patients. While effective, oral midazolam cannot reduce the incidence of emergence... (Review)
Review
Oral Dexmedetomidine Achieves Superior Effects in Mitigating Emergence Agitation and Demonstrates Comparable Sedative Effects to Oral Midazolam for Pediatric Premedication: A Systematic Review and Meta-Analysis of Randomized Controlled Studies.
: Oral midazolam is the most commonly used sedative premedication agent in pediatric patients. While effective, oral midazolam cannot reduce the incidence of emergence agitation. Oral dexmedetomidine may be effective in providing satisfactory sedation and reduce the incidence of emergence agitation, although the results of different randomized controlled trials are conflicting. : This study enrolled randomized controlled trials (RCTs) examining premedication with oral dexmedetomidine versus oral midazolam in pediatric patients undergoing general anesthesia. PubMed, the Cochrane Library, Embase, and the Web of Science database were searched from their inception until June 2023. The outcomes were the incidence of satisfactory preoperative sedation, satisfactory sedation during separation from parents, satisfactory sedation during anesthesia induction using an anesthesia mask, and the incidence of emergence agitation. : A total of 9 RCTs comprising 885 patients were analyzed. Our data revealed comparable effects of dexmedetomidine and midazolam with respect to satisfactory preoperative sedation and a satisfactory incidence of sedation during parental separation and mask acceptance before anesthesia induction. Notably, our data revealed that the rate of emergence agitation was significantly lower in pediatric patients receiving dexmedetomidine ( = 162) than in those receiving midazolam ( = 159) (odds ratio = 0.16; 95% confidence interval: 0.06 to 0.44; < 0.001; = 35%). : Data from this meta-analysis revealed comparable effects for premedication with oral dexmedetomidine or oral midazolam with respect to satisfactory sedation; furthermore, premedication with oral dexmedetomidine more effectively mitigated emergence agitation in pediatric patients receiving general anesthesia compared with oral midazolam.
PubMed: 38398486
DOI: 10.3390/jcm13041174 -
Nature Communications Jan 2024A key goal of pertussis control is to protect infants too young to be vaccinated, the age group most vulnerable to this highly contagious respiratory infection. In the... (Meta-Analysis)
Meta-Analysis
A key goal of pertussis control is to protect infants too young to be vaccinated, the age group most vulnerable to this highly contagious respiratory infection. In the last decade, maternal immunization has been deployed in many countries, successfully reducing pertussis in this age group. Because of immunological blunting, however, this strategy may erode the effectiveness of primary vaccination at later ages. Here, we systematically reviewed the literature on the relative risk (RR) of pertussis after primary immunization of infants born to vaccinated vs. unvaccinated mothers. The four studies identified had ≤6 years of follow-up and large statistical uncertainty (meta-analysis weighted mean RR: 0.71, 95% CI: 0.38-1.32). To interpret this evidence, we designed a new mathematical model with explicit blunting mechanisms and evaluated maternal immunization's short- and long-term impact on pertussis transmission dynamics. We show that transient dynamics can mask blunting for at least a decade after rolling out maternal immunization. Hence, the current epidemiological evidence may be insufficient to rule out modest reductions in the effectiveness of primary vaccination. Irrespective of this potential collateral cost, we predict that maternal immunization will remain effective at protecting unvaccinated newborns, supporting current public health recommendations.
Topics: Infant; Pregnancy; Female; Infant, Newborn; Humans; Whooping Cough; Vaccination; Parturition; Respiratory Tract Infections; Vaccines; Immunization
PubMed: 38297003
DOI: 10.1038/s41467-024-44943-7 -
PLOS Global Public Health 2024To make inferences regarding the effectiveness of respiratory interventions and case isolation measures in reducing or preventing the transmission of mpox based on...
OBJECTIVES
To make inferences regarding the effectiveness of respiratory interventions and case isolation measures in reducing or preventing the transmission of mpox based on synthesis of available literature.
METHODS
The WHO Clinical Management and Infection Prevention and Control 2022 guideline and droplet precautions in healthcare facilities and home isolation infection prevention control measures for patients with mpox. We conducted a systematic review that included a broad search of five electronic databases. In a two-stage process, we initially sought only randomized controlled trials and observational comparative studies; when the search failed to yield eligible studies, the subsequent search included all study designs including clinical and environmental sampling studies.
RESULTS
No studies were identified that directly addressed airborne and droplet precautions and home isolation infection prevention control measures. To inform the review questions the review team synthesized route of transmission data in mpox. There were 2366/4309 (54.9%) cases in which investigators identified mpox infection occurring following transmission through direct physical sexual contact. There were no reported mpox cases in which investigators identified inhalation as a single route of transmission. There were 2/4309 cases in which investigators identified fomite as a single route of transmission. Clinical and environmental sampling studies isolated mpox virus in a minority of saliva, oropharangeal swabs, mpox skin lesions, and hospital room air.
CONCLUSIONS
Current findings provide compelling evidence that transmission of mpox occurs through direct physical contact. Because investigators have not reported any cases of transmission via inhalation alone, the impact of airborne and droplet infection prevention control measures in reducing transmission will be minimal. Avoiding physical contact with others, covering mpox lesions and wearing a medical mask is likely to reduce onward mpox transmission; there may be minimal reduction in transmission from additionally physically isolating patients with mild disease at home.
PubMed: 38236835
DOI: 10.1371/journal.pgph.0002731 -
Medicine Dec 2023Critically ill patients in intensive care often struggle with disrupted sleep, a prevalent issue in this population. However, the question of which non-pharmacological... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Critically ill patients in intensive care often struggle with disrupted sleep, a prevalent issue in this population. However, the question of which non-pharmacological intervention is most effective in enhancing sleep quality remains unanswered. This study was conducted to comprehensively evaluate and compare the efficacy of various non-pharmacological interventions aimed at improving sleep quality among critically ill individuals.
METHODS
We conducted a search of PubMed, Embase, and the Cochrane Library (Cochrane Central Register of Controlled Trials) without language restrictions to identify articles published until July 15, 2023. Randomized controlled trials (RCTs) that investigated various nursing interventions designed to improve sleep quality in critically ill patients were included in this network meta-analysis. All analyses were performed using R software (version 3.4.3) with the "gemtc" package.
RESULTS
A total of 2036 patients from 31 RCTs were included in the network meta-analysis, involving 11 different nursing interventions (routine care, relaxation combined with imagery (RI), nursel, music + earplugs + eye masks, music, eye masks, earplugs + eye masks, earplugs, aromatherapy, Warm footbath combined with acupoint exercise (WFA), Virtual reality meditation (VR)). Eye masks and earplugs + eye masks were associated with improved sleep quality compared to routine care intervention (P < .05).
CONCLUSIONS
In summary, eye masks and earplugs + eye masks stand out as the most effective interventions for enhancing sleep quality in critically ill patients. Therefore, critical care nurses should consider incorporating the use of eye masks alone or combining music with eye masks into the sleep care regimen for critically ill patients.
Topics: Humans; Critical Care; Critical Illness; Intensive Care Units; Network Meta-Analysis; Randomized Controlled Trials as Topic; Sleep; Sleep Quality
PubMed: 38206715
DOI: 10.1097/MD.0000000000036298 -
Jornal Brasileiro de Pneumologia :... 2024To evaluate the efficacy of wearing a mask to prevent COVID-19 infection. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the efficacy of wearing a mask to prevent COVID-19 infection.
METHODS
This was a systematic review and meta-analysis of cohort and case-control studies, considering the best level of evidence available. Electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Clinical Trials.gov) were searched to identify studies that evaluated the effectiveness of wearing masks compared with that of not wearing them during the COVID-19 pandemic. Risk of bias and quality of evidence were assessed using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation.
RESULTS
Of the 1,028 studies identified, 9 met the inclusion criteria (2 cohort studies and 7 case-control studies) and were included in the analysis. The meta-analysis using cohort studies alone showed statistically significant differences, wearing a cloth mask decreased by 21% [RD = -0.21 (95% CI, -0.34 to -0.07); I2 = 0%; p = 0,002] the risk of COVID-19 infection, but the quality of evidence was low. Regarding case-control studies, wearing a surgical mask reduced the chance of COVID-19 infection [OR = 0.51 (95% CI, 0.37-0.70); I2 = 47%; p = 0.0001], as did wearing an N95 respirator mask [OR = 0.31 (95% CI, 0.20-0.49); I2 = 0%; p = 0.00001], both with low quality of evidence.
CONCLUSIONS
In this systematic review with meta-analysis, we showed the effectiveness of wearing masks in the prevention of SARS-CoV-2 infection regardless of the type of mask (disposable surgical mask, common masks, including cloth masks, or N95 respirators), although the studies evaluated presented with low quality of evidence and important biases.
Topics: Humans; COVID-19; Pandemics; SARS-CoV-2; Case-Control Studies; Disease Outbreaks
PubMed: 38198343
DOI: 10.36416/1806-3756/e20230003