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International Journal of Surgery... Nov 2023Surgery induces high rates of cognitive disorders, persisting for up to 12 months in elderly adults. This review aimed to assess the currently debated preventive effect... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Surgery induces high rates of cognitive disorders, persisting for up to 12 months in elderly adults. This review aimed to assess the currently debated preventive effect of perioperative ketamine on postoperative delirium and postoperative neurocognitive disorders (POND).
MATERIALS AND METHODS
Systematic review and meta-analysis including all randomized controlled trials investigating the effects of perioperative ketamine administration in adult patients compared to placebo or no intervention on postoperative delirium and/or POND between January 2007 and April 2022. Database searches were conducted in PubMed, Medline, Embase, Scopus, and Central. Random effects models were used to pool overall estimates. The GRADE approach was used to assess the quality of the evidence.
RESULTS
From 1379 records screened, 14 randomized controlled trials with 1618 patients randomized met our inclusion criteria with a high level of consensus among reviewers, amongst whom 50% were at low-moderate risk of bias. There was no between-group difference in postoperative delirium [8 trials, 1265 patients, odds ratio (OR) 0.93, 95% CI (0.51-1.70), I2 =28%] and POND [5 trials, 494 patients, OR 0.52, 95% CI (0.15-1.80); I2 =78%]. There was no significant between-group difference in postoperative psychological adverse effects, level of pain, hospital length of stay, or mortality. Between-group subgroup analyses showed no difference in delirium or POND incidence according to surgical setting, ketamine dose, mode of administration, combination or not with other drug(s), and assessment timing or definition of cognitive disorders.
CONCLUSION
Perioperative ketamine does not prevent postoperative delirium or POND. Significant study heterogeneity suggests that standardized measures for POND assessment and a specific focus on patients at high risk for POND should be used to improve the comparability of future studies.
Topics: Adult; Humans; Aged; Ketamine; Emergence Delirium; Cognition Disorders; Cognitive Dysfunction; Randomized Controlled Trials as Topic
PubMed: 37526094
DOI: 10.1097/JS9.0000000000000619 -
Sleep Nov 2023This scoping review explores the use of extended reality (virtual, augmented, and mixed reality) within sleep health, sleep medicine, and sleep research. It aims to...
STUDY OBJECTIVES
This scoping review explores the use of extended reality (virtual, augmented, and mixed reality) within sleep health, sleep medicine, and sleep research. It aims to provide insight into current uses and implementation considerations whilst highlighting directions for future research.
METHODS
A systematic scoping review was undertaken informed by the preferred reporting items for systematic reviews and meta-analyses for scoping reviews and Johanna Briggs Institute.
RESULTS
The use of virtual reality (VR) as a research tool in the investigation of areas such as dreaming and memory reactivation is growing. Thirty-one articles were identified in total with 20 utilizing VR to improve sleep as a clinical intervention.
CONCLUSIONS
Research exploring the utility of VR as a clinical intervention in various patient populations and clinical settings is therefore warranted. Researchers and clinicians should ensure that extended reality interventions are developed based on clinical reasoning and informed by evidence of both sleep medicine and the effects of virtual and augmented reality. Where possible future research should utilize up-to-date technology and reporting frameworks to assist in the translation of research into clinical practice.
Topics: Humans; Virtual Reality; Sleep; Biomedical Research
PubMed: 37498981
DOI: 10.1093/sleep/zsad201 -
BMJ Supportive & Palliative Care Jan 2024To identify the current state of understanding about end-of-life experiences (ELEs) and examine evidence concerning prevalence, the impact on the process of dying and...
OBJECTIVES
To identify the current state of understanding about end-of-life experiences (ELEs) and examine evidence concerning prevalence, the impact on the process of dying and the perceptions/explanations of patients, relatives and healthcare professionals (HCPs) with regard to ELEs.
METHODS
Scoping review and mixed-methods systematic review (ScR and MMSR). Nine academic databases were searched for a screening of the available scientific literature (ScR). Articles reporting qualitative, quantitative or mixed-methods studies were selected (MMSR), the quality of which was assessed using the Joanna Briggs Institute (JBI) standardised critical appraisal tools. The quantitative data were synthesised in narrative form while a meta-aggregation approach was adopted for the qualitative results.
RESULTS
The ScR identified 115 reports, with 70.4% published after 2010, 55.6% from the USA and the most common terminology for ELE was deathbed visions (29%). The MMSR included 36 papers, describing 35 studies in various settings. The combination of quantitative and qualitative evidence indicated a greater prevalence of ELEs in samples of patients and HCPs compared with relatives. The most common ELEs were visions and dreams of the presence of deceased relatives/friends with references to making ready for a journey. The impact of ELEs was mainly positive, and there was a tendency to interpret them as spiritual experiences inherent to the process of dying.
CONCLUSIONS
ELEs are often reported by patients, relatives and HCPs and have a significant, generally positive impact on the process of dying. Guidelines for the furtherance of studies and clinical applications are discussed.
Topics: Humans; Death; Qualitative Research
PubMed: 37311603
DOI: 10.1136/spcare-2022-004055 -
Trauma, Violence & Abuse Jan 2024Trauma exposure places refugees at serious risk of developing mental health difficulties. However, research also recognizes that refugees can respond to trauma with... (Review)
Review
Trauma exposure places refugees at serious risk of developing mental health difficulties. However, research also recognizes that refugees can respond to trauma with psychological development and growth, commonly referred to as post-traumatic growth (PTG). An updated systematic review was conducted to investigate PTG across different refugee populations, including the processes that mediate this phenomenon, and the use of therapy in promoting PTG. A systematic search of CINAHL Complete, Proquest 5000, PsychINFO, Scopus, and Web of Science was performed to identify studies exploring PTG in refugee populations, published between June 2013 and November 2021. In all, 26 studies met the inclusion criteria for this review. Quantitative results reveal a positive correlation between PTG and religious commitment and coping, and the effectiveness of narrative and community-based interventions in facilitating PTG. Qualitative results facilitate insight into the complex ways refugees find meaning and strength after trauma through religion, comparison-based thinking, helping others, and storytelling. Findings highlight the need for future research and interventions to recognize the distinct PTG experiences of different refugee populations.
Topics: Humans; Posttraumatic Growth, Psychological; Refugees; Dreams; Stress Disorders, Post-Traumatic; Mental Health
PubMed: 37097092
DOI: 10.1177/15248380231163641 -
The American Journal of Hospice &... Jan 2024When conscious, about 50% to 60% of hospice patients report a "visitation" by someone who is not there while they dream or are awake: a phenomenon known as End-of-Life...
When conscious, about 50% to 60% of hospice patients report a "visitation" by someone who is not there while they dream or are awake: a phenomenon known as End-of-Life Dreams and Visions (ELDVs). Since the dying process is frequently complicated by delirium, ELDVs risk being misidentified as such by professionals and caregivers. To observe these phenomena from patients' perspectives, we conducted a systematic review to aggregate and synthesize the findings from the qualitative studies about ELDVs of patients assisted in hospices to indicate future directions for research and care. MEDLINE/PubMed, Embase, CINAHL, PsycINFO, Scopus, and Web of Science databases were searched, yielding 293 documents after duplicates were removed. Six qualitative articles reporting on five unique studies conducted in hospice settings were included in the meta-synthesis. We generated three main categories: i) typologies of ELDVs reported, ii) emotional consequences, and iii) intersubjective meaning-making. The ELDVs reported were experiences that remained intimate and unsocialized and thus preventing participants from defining a shared sense in their relationships. Training healthcare professionals to recognize ELDVs and take advantage of them in the care relationship is desirable. We also encourage the patient's family members to listen and understand ELDVs when they occur actively. For caregivers to know how to interpret these phenomena may provide them with additional strategies for supporting, reassuring, and strengthening their relationships with their loved ones. The review allowed us to inform healthcare professionals and caregivers about how to help patients share their emotional and identity-related experiences and meaning-making in end-of-life.
Topics: Humans; Hospices; Hospice Care; Death; Qualitative Research; Family
PubMed: 36947427
DOI: 10.1177/10499091231163571