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Brain Injury Jun 2024To identify and describe differences in demographics, injury characteristics, and outcomes between rural and urban patients suffering brain injury. (Review)
Review
OBJECTIVE
To identify and describe differences in demographics, injury characteristics, and outcomes between rural and urban patients suffering brain injury.
DATA SOURCES
CINAHL, Emcare, MEDLINE, and Scopus.
REVIEW METHODS
A systematic review and meta-analysis of studies comparing epidemiology and outcomes of rural and urban brain trauma was conducted in accordance with PRISMA and MOOSE guidelines.
RESULTS
36 studies with ~ 2.5-million patients were included. Incidence of brain injury was higher in males, regardless of location. Rates of transport-related brain injuries, particularly involving motorized vehicles other than cars, were significantly higher in rural populations (OR:3.63, 95% CI[1.58,8.35], = 0.002), whereas urban residents had more fall-induced brain trauma (OR:0.73, 95% CI[0.66,0.81], < 0.00001). Rural patients were 28% more likely to suffer severe injury, indicated by Glasgow Coma Scale (GCS)≤8 (OR:1.28, 95% CI[1.04,1.58], = 0.02). There was no difference in mortality (OR:1.09, 95% CI[0.73,1.61], = 0.067), however, urban patients were twice as likely to be discharged with a good outcome (OR:0.52, 95% CI[0.41,0.67], < 0.00001).
CONCLUSIONS
Rurality is associated with greater severity and poorer outcomes of traumatic brain injury. Transport accidents disproportionally affect those traveling on rural roads. Future research recommendations include addition of prehospital data, adequate follow-up, standardized measures, and sub-group analyses of high-risk groups, e.g. Indigenous populations.
PubMed: 38836355
DOI: 10.1080/02699052.2024.2361641 -
Psychiatry Research Aug 2024An association between psychiatric medications and falls and fractures in people taking them has been demonstrated, but which class or medication leads to the greatest... (Meta-Analysis)
Meta-Analysis Comparative Study Review
An association between psychiatric medications and falls and fractures in people taking them has been demonstrated, but which class or medication leads to the greatest risk of falls or fractures should be further investigated. The aim of this study was to compare and rank the magnitude of risk of falls and fractures due to different psychiatric medications. Eight databases were searched for this meta-analysis and evaluated using a frequency-based network meta-analysis. The results included a total of 28 papers with 14 medications from 5 major classes, involving 3,467,314 patients. The results showed that atypical antipsychotics were the class of medications with the highest risk of falls, and typical antipsychotics were the class of medications with the highest risk of resulting in fractures. Quetiapine ranked first in the category of 13 medications associated with risk of falls, and class Z drugs ranked first in the category of 6 medications associated with risk of fractures. The available evidence suggests that atypical antipsychotics and typical antipsychotics may be the drugs with the highest risk of falls and fractures, respectively. Quetiapine may be the medication with the highest risk of falls, and class Z drugs may be the medication with the highest risk of fractures.
Topics: Humans; Accidental Falls; Antipsychotic Agents; Fractures, Bone; Network Meta-Analysis
PubMed: 38833938
DOI: 10.1016/j.psychres.2024.115974 -
JAMA Jul 2024Falls are the most common cause of injury-related morbidity and mortality in older adults. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Falls are the most common cause of injury-related morbidity and mortality in older adults.
OBJECTIVE
To systematically review evidence on the effectiveness and harms of fall prevention interventions in community-dwelling older adults.
DATA SOURCES
MEDLINE, Cumulative Index for Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Clinical Trials for relevant English-language literature published between January 1, 2016, and May 8, 2023, with ongoing surveillance through March 22, 2024.
STUDY SELECTION
Randomized clinical trials of interventions to prevent falls in community-dwelling adults 65 years or older.
DATA EXTRACTION AND SYNTHESIS
Critical appraisal and data abstraction by 2 independent reviewers. Random-effects meta-analyses with Knapp-Hartung adjustment.
MAIN OUTCOMES AND MEASURES
Falls, injurious falls, fall-related fractures, hospitalizations or emergency department visits, people with 1 or more falls, people with injurious falls, people with fall-related fractures, and harms.
RESULTS
Eighty-three fair- to good-quality randomized clinical trials (n = 48 839) examined the effectiveness of 6 fall prevention interventions in older adults. This article focuses on the 2 most studied intervention types: multifactorial (28 studies; n = 27 784) and exercise (37 studies; n = 16 117) interventions. Multifactorial interventions were associated with a statistically significant reduction in falls (incidence rate ratio [IRR], 0.84 [95% CI, 0.74-0.95]) but not a statistically significant reduction in individual risk of 1 or more falls (relative risk [RR], 0.96 [95% CI, 0.91-1.02]), injurious falls (IRR, 0.92 [95% CI, 0.84-1.01]), fall-related fractures (IRR, 1.01 [95% CI, 0.81-1.26]), individual risk of injurious falls (RR, 0.92 [95% CI, 0.83-1.02]), or individual risk of fall-related fractures (RR, 0.86 [95% CI, 0.60-1.24]). Exercise interventions were associated with statistically significant reductions in falls (IRR, 0.85 [95% CI, 0.75-0.96]), individual risk of 1 or more falls (RR, 0.92 [95% CI, 0.87-0.98]), and injurious falls (IRR, 0.84 [95% CI, 0.74-0.95]) but not individual risk of injurious falls (RR, 0.90 [95% CI, 0.79-1.02]). Harms associated with multifactorial and exercise interventions were not well reported and were generally rare, minor musculoskeletal symptoms associated with exercise.
CONCLUSIONS AND RELEVANCE
Multifactorial and exercise interventions were associated with reduced falls in multiple good-quality trials. Exercise demonstrated the most consistent statistically significant benefit across multiple fall-related outcomes.
Topics: Accidental Falls; Humans; Aged; Independent Living; Randomized Controlled Trials as Topic; Fractures, Bone; Exercise; Hospitalization; Wounds and Injuries; Aged, 80 and over
PubMed: 38833257
DOI: 10.1001/jama.2024.4166 -
Health Informatics Journal 2024: This systematic review and meta-analysis aimed to investigate the effect of fall prevention interventions using information and communication technology (ICT). : A... (Meta-Analysis)
Meta-Analysis
: This systematic review and meta-analysis aimed to investigate the effect of fall prevention interventions using information and communication technology (ICT). : A comprehensive search across four databases was performed. The inclusion criteria were fall prevention interventions including telehealth, computerized balance training, exergaming, mobile application education, virtual reality exercise, and cognitive-behavioral training for community-dwelling adults aged ≥60 years. : Thirty-four studies were selected. Telehealth, smart home systems, and exergames reduced the risk of falls (RR = 0.63, 95% CI [0.54, 0.75]). Telehealth and exergame improved balance (MD = 3.30, 95% CI [1.91, 4.68]; MD = 4.40, 95% CI [3.09, 5.71]). Telehealth improved physical function (SMD = 0.69, 95% CI [0.23, 1.16]). Overall, ICT fall interventions improved fall efficacy but not cognitive function. For quality of life (QOL), mixed results were found depending on the assessment tools. : Future investigations on telehealth, smart home systems, or exergames are needed to motivate older adults to exercise and prevent falls.
Topics: Humans; Accidental Falls; Aged; Telemedicine; Independent Living; Quality of Life; Information Technology
PubMed: 38825745
DOI: 10.1177/14604582241259324 -
The Journal of Evidence-based Dental... Jun 2024da Trindade RQ, Vieira MG, Vieira RB, Vicentin-Junior CA, Damascena NP, Santiago BM, Martins-Filho PR, Machado CE. The role of paranasal sinus fluid in determining... (Meta-Analysis)
Meta-Analysis
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION
da Trindade RQ, Vieira MG, Vieira RB, Vicentin-Junior CA, Damascena NP, Santiago BM, Martins-Filho PR, Machado CE. The role of paranasal sinus fluid in determining drowning as the cause of death: a systematic review and meta-analysis. J forensic Leg Med. 2023;12:102591.
SOURCE OF FUNDING
No funding was received for this review.
TYPE OF STUDY/DESIGN
Systematic review (SR) with meta-analysis (MA) of data.
Topics: Humans; Drowning; Paranasal Sinuses; Cause of Death; Autopsy
PubMed: 38821654
DOI: 10.1016/j.jebdp.2023.101966 -
Journal of Medical Internet Research May 2024Health care organizations worldwide are faced with an increasing number of cyberattacks and threats to their critical infrastructure. These cyberattacks cause... (Review)
Review
BACKGROUND
Health care organizations worldwide are faced with an increasing number of cyberattacks and threats to their critical infrastructure. These cyberattacks cause significant data breaches in digital health information systems, which threaten patient safety and privacy.
OBJECTIVE
From a sociotechnical perspective, this paper explores why digital health care systems are vulnerable to cyberattacks and provides sociotechnical solutions through a systematic literature review (SLR).
METHODS
An SLR using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was conducted by searching 6 databases (PubMed, Web of Science, ScienceDirect, Scopus, Institute of Electrical and Electronics Engineers, and Springer) and a journal (Management Information Systems Quarterly) for articles published between 2012 and 2022 and indexed using the following keywords: "(cybersecurity OR cybercrime OR ransomware) AND (healthcare) OR (cybersecurity in healthcare)." Reports, review articles, and industry white papers that focused on cybersecurity and health care challenges and solutions were included. Only articles published in English were selected for the review.
RESULTS
In total, 5 themes were identified: human error, lack of investment, complex network-connected end-point devices, old legacy systems, and technology advancement (digitalization). We also found that knowledge applications for solving vulnerabilities in health care systems between 2012 to 2022 were inconsistent.
CONCLUSIONS
This SLR provides a clear understanding of why health care systems are vulnerable to cyberattacks and proposes interventions from a new sociotechnical perspective. These solutions can serve as a guide for health care organizations in their efforts to prevent breaches and address vulnerabilities. To bridge the gap, we recommend that health care organizations, in partnership with educational institutions, develop and implement a cybersecurity curriculum for health care and intelligence information sharing through collaborations; training; awareness campaigns; and knowledge application areas such as secure design processes, phase-out of legacy systems, and improved investment. Additional studies are needed to create a sociotechnical framework that will support cybersecurity in health care systems and connect technology, people, and processes in an integrated manner.
Topics: Computer Security; Humans; Delivery of Health Care; Patient Safety
PubMed: 38820579
DOI: 10.2196/46904 -
Work (Reading, Mass.) May 2024Human error and violation of rules are perceived as deviations from some desired behavior, appearing variably in literature as either similar or opposing concepts....
BACKGROUND
Human error and violation of rules are perceived as deviations from some desired behavior, appearing variably in literature as either similar or opposing concepts. Behavioral deviations may be linked to accidents or considered a protective factor against them.
OBJECTIVE
This article aims to explore definitions, characteristics, classifications, and management approaches for behavioral deviations, specifically human error and violation of rules.
METHODS
A systematic literature review was conducted.
RESULTS
The authors differ in defining and classifying error and violation, associating them with generation of accidents or their prevention. The management proposals for deviations highlighted by the authors were emphasized.
CONCLUSION
The findings of this article reinforce the prominence of authors Jens Rasmussen and James Reason in the field. They assert that deviations are a natural aspect of the work process and even serve as a preventive factor against accidents, although their frequent association with accidents remains common in organizations. This study contributes to theoretical understanding by systematizing prevalent perspectives on deviation, human error, and violation of rules. It proposes a taxonomy and emphasizing the need for managing deviations, rather than combating them, especially in an organizational context.
PubMed: 38820041
DOI: 10.3233/WOR-230186 -
Cureus Apr 2024Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal cancer often diagnosed at advanced stages, highlighting the urgent need for early detection strategies. This... (Review)
Review
Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal cancer often diagnosed at advanced stages, highlighting the urgent need for early detection strategies. This systematic review explores the potential of fecal and urinary biomarkers for early PDAC detection. A comprehensive search identified eight relevant studies investigating various biomarkers, including proteins, metabolites, microbial profiles, DNA mutations, and non-coding RNAs. Promising findings suggest that urinary biomarkers related to metabolic alterations, inflammatory processes, fecal microbiome profiles, and fecal miRNAs hold diagnostic potential even at early stages of PDAC. Combining biomarkers into panels may enhance diagnostic accuracy. Challenges such as validation in larger cohorts, standardization of protocols, and regulatory approval must be addressed for clinical translation. Despite these hurdles, non-invasive urinary and fecal biomarkers represent a promising avenue for improving PDAC outcomes through early detection.
PubMed: 38813271
DOI: 10.7759/cureus.59248 -
Rehabilitacion 2024The objective was to perform a systematic review of those performance outcomes (HRD) tools that assess sensitivity in post-stroke subjects, as well as to know which of... (Review)
Review
The objective was to perform a systematic review of those performance outcomes (HRD) tools that assess sensitivity in post-stroke subjects, as well as to know which of all is the most reliable and viable. The design was a systematic review. The following were included: HRD, developed in post-stroke subjects, of any etiology and period of evolution; 18 years of age or older and testing for sensitivity; results on psychometric properties. Excluded: self-reported results, the report of cross-cultural adaptation, designed through computerized means. 19 HRD were acquired. The psychometric properties analyzed were reliability, internal consistency, measurement error, construct validity, content validity, and sensitivity to change, the first being the most studied. Psychometric properties were identified, assessed, compared, and summarized. Of all of them, we recommend the use of the modified Erasmus Nottingham Sensory Assessment, as it presents the best degree of confidence in the evidence.
Topics: Humans; Psychometrics; Stroke; Stroke Rehabilitation; Reproducibility of Results; Outcome Assessment, Health Care; Sensitivity and Specificity
PubMed: 38795503
DOI: 10.1016/j.rh.2024.100855 -
Children (Basel, Switzerland) May 2024Pediatric basilar skull fractures (BSFs) are a rare type of traumatic head injury that can cause debilitating complications without prompt treatment. Here, we sought to... (Review)
Review
Pediatric basilar skull fractures (BSFs) are a rare type of traumatic head injury that can cause debilitating complications without prompt treatment. Here, we sought to review the literature and characterize the clinical features, management, and outcomes of pediatric BSFs. We identified 21 relevant studies, excluding reviews, meta-analyses, and non-English articles. The incidence of pediatric BSFs ranged from 0.0001% to 7.3%, with falls from multi-level heights and traffic accidents being the primary causes (9/21). The median presentation age ranged from 3.2 to 12.8 years, and the mean age of patients across all studies was 8.68 years. Up to 55% of pediatric BSFs presented with intracranial hematoma/hemorrhage, along with pneumocephalus and edema. Cranial nerve palsies were a common complication (9/21), with the facial nerve injured most frequently (7/21). While delayed cranial nerve palsy was reported in a few studies (4/21), most resolved within three months post-admission. Other complications included CSF leaks (10/21) and meningitis (4/21). Management included IV fluids, antiemetics, and surgery (8/21) to treat the fracture directly, address a CSF leak, or achieve cranial nerve compression. Despite their rarity, pediatric skull base fractures are associated with clinical complications, including CSF leaks and cranial nerve palsies. Given that some of these complications may be delayed, patient education is critical.
PubMed: 38790559
DOI: 10.3390/children11050564