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Nursing in Critical Care Jul 2024Decision aids (DAs) have been proposed to support patients and families with disease information processing and decision-making, but their effectiveness for critically... (Review)
Review
Effectiveness of decision aids on critically ill patients' outcomes and family members' knowledge, anxiety, depression and decisional conflict: A systematic review and meta-analysis.
BACKGROUND
Decision aids (DAs) have been proposed to support patients and families with disease information processing and decision-making, but their effectiveness for critically ill patients and their families is incompletely understood.
AIM
To systematically synthesize evidence on the effectiveness of the DAs on the prognosis of critically ill patients and knowledge, anxiety, depression and decisional conflict of their family members.
STUDY DESIGN
Systematic review and meta-analysis. We conducted a systematic search of literature using PubMed, Embase, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature database, Scopus, PsycNet, CNKI and Wanfang Database from the inception of the databases until May 2023 to identify randomized clinical trials (RCTs) describing DAs interventions targeted at adult intensive care unit (ICU) patients or their families. We also searched grey literature in four databases: Chinese Clinical Trials Registry, Chinese Cochrane Center, Open Grey and GreyNet International.
RESULTS
Seven RCTs were included in the review. Meta-analysis identified longer hospital length of stay (LOS) among all patients compared with usual care (mean difference [MD] = 5.64 days, 95% confidence interval, CI [0.29, 10.98], p = .04), but not in surviving patients (MD = 2.09 days, 95% CI [-3.70, 7.89], p = .48). However, there was no evidence of an effect of DAs on hospital mortality (RR = 1.25, 95% CI [0.92, 1.70], p = .15), ICU LOS (MD = 3.77 days, 95% CI [-0.17, 7.70], p = .06) and length of mechanical ventilation (MD = 0.88 days, 95% CI [-2.22, 3.97], p = .58). DAs led to a statistically significant improvement in family members' knowledge (standard mean difference = 0.84, 95% CI [0.12, 1.56], p = .02). We found no significant effect of DAs on anxiety, depression, post-traumatic stress disorder, decisional conflict and quality of communication of family members.
CONCLUSIONS
This review provides effective evidence that DAs can potentially improve the knowledge level of family members while prolonging the hospital LOS among critically ill patients.
RELEVANCE TO CLINICAL PRACTICE
Well-designed large-scale studies with DAs tailored to the individuals' preferences and existing cultural values are warranted.
PubMed: 38960705
DOI: 10.1111/nicc.13115 -
BMJ Open Jul 2024Research indicates that people with lower socioeconomic status (SES) receive inferior healthcare and experience poorer health outcomes compared with those with higher... (Review)
Review
OBJECTIVES
Research indicates that people with lower socioeconomic status (SES) receive inferior healthcare and experience poorer health outcomes compared with those with higher SES, in part due to health professional (HP) bias. We conducted a scoping review of the impact of HP bias about SES on clinical decision-making and its effect on the care of adults with lower SES.
DESIGN
JBI scoping review methods were used to perform a systematic comprehensive search for literature. The scoping review protocol has been published in .
DATA SOURCES
Medline, Embase, ASSIA, Scopus and CINAHL were searched, from the first available start date of the individual database to March 2023. Two independent reviewers filtered and screened papers.
ELIGIBILITY CRITERIA
Studies of all designs were included in this review to provide a comprehensive map of the existing evidence of the impact of HP bias of SES on clinical decision-making and its effect on the care for people with lower SES.
DATA EXTRACTION AND SYNTHESIS
Data were gathered using an adapted JBI data extraction tool for systematic scoping reviews.
RESULTS
Sixty-seven papers were included from 1975 to 2023. 35 (73%) of the included primary research studies reported an association between HP SES bias and decision-making. Thirteen (27%) of the included primary research studies did not find an association between HP SES bias and decision-making. Stereotyping and bias can adversely affect decision-making when the HP is fatigued or has a high cognitive load. There is evidence of intersectionality which can have a powerful cumulative effect on HP assessment and subsequent decision-making. HP implicit bias may be mitigated through the assertiveness of the patient with low SES.
CONCLUSION
HP decision-making is at times influenced by non-medical factors for people of low SES, and assumptions are made based on implicit bias and stereotyping, which compound or exacerbate health inequalities. Research that focuses on decision-making when the HP has a high cognitive load, would help the health community to better understand this potential influence.
Topics: Humans; Clinical Decision-Making; Social Class; Healthcare Disparities; Health Personnel; Attitude of Health Personnel; Low Socioeconomic Status
PubMed: 38960454
DOI: 10.1136/bmjopen-2023-081723 -
International Journal of Antimicrobial... Jul 2024Outpatient parenteral antimicrobial therapy (OPAT) offers an alternative to inpatient (hospital bed-based) treatment of infections that require intravenous... (Review)
Review
BACKGROUND
Outpatient parenteral antimicrobial therapy (OPAT) offers an alternative to inpatient (hospital bed-based) treatment of infections that require intravenous administration of antimicrobials. This meta-analysis aimed to summarise the evidence available from randomised controlled trials (RCTs) regarding the efficacy and safety of OPAT compared to inpatient parenteral antimicrobial therapy.
METHODS
We searched the Cochrane Library, MEDLINE, Embase, PubMed, and Web of Sciences databases for RCTs comparing outpatient versus inpatient parenteral antimicrobial therapy. We included studies without restrictions on language or publication year. Eligibility was reviewed independently by two assessors, and data extraction was cross validated. We evaluated bias risk via the Cochrane tool and determined the evidence certainty using GRADE. Meta-analysis was conducted using a random effects model. The protocol of this review was registered on PROSPERO (CRD42023460389).
RESULT
Thirteen RCTs, involving 1,310 participants were included. We found no difference in mortality (Risk Ratio (RR) 0.54, 95% Confidence Interval (CI) 0.23 to 1.26; p = 0.93), treatment failure (RR 1.0, CI 0.59 to 1.72; p = 0.99), adverse reaction related to antimicrobials (RR 0.89, CI 0.69 to 1.15; p = 0.38), and administration device (RR 0.58, CI 0.17 to 1.98; p = 0.87) between outpatient and inpatient parenteral antimicrobial therapy. The overall body of evidence had a low level of certainty.
CONCLUSION
Existing evidence suggests OPAT is a safe and effective alternative to inpatient treatment. Further RCTs are warranted for a thorough comparison of inpatient and outpatient parenteral antimicrobial therapy with a high level of certainty.
PubMed: 38960209
DOI: 10.1016/j.ijantimicag.2024.107263 -
Annals of Vascular Surgery Jul 2024The unibody bifurcated aortic endograft (AFX/AFX2) has emerged as a treatment option for abdominal aortic aneurysms (AAAs). This systematic review and meta-analysis... (Review)
Review
BACKGROUND
The unibody bifurcated aortic endograft (AFX/AFX2) has emerged as a treatment option for abdominal aortic aneurysms (AAAs). This systematic review and meta-analysis aimed to evaluate the safety of the unibody endograft.
METHODS
A literature search was conducted in Cochrane Library, Scopus, Web of Science, and PubMed. Studies assessing the unibody endograft for abdominal aortic aneurysm repair between 2014 and 2023 were included. The defined primary outcomes were the incidences of type I, II, and III endoleaks. The secondary outcomes were access site problems, aneurysm-related mortality, aneurysm rupture, all-cause mortality, aneurysm sac growth, limb occlusion, stent graft migration, and technical success rate.
RESULTS
14 studies including 12 observational studies and two randomized controlled trials (RCTs) were included in the systematic review. The meta-analysis included 10 studies with 12,690 patients that reported the measured outcomes, and excluded four studies that did not. Type II endoleaks had the highest incidence of 12% (95% CI: 4-20%), followed by type III endoleaks with an incidence of 3% (95% CI: 1-5). The incidence of type I endoleaks was 1% (95% CI: 0-2%). A subgroup analysis by follow-up duration showed that type II endoleak incidence was higher after one to two years of follow-up than three to four years of follow-up. The incidence of aneurysmal mortality was 2% (95% CI: 0-7%); limb occlusion was 1% (95% CI: 0-1%); stent graft migration was 1% (95% CI: 0-2%); aneurysmal rupture was 6% (95% CI: 2-11%); access site problems were 7% (95% CI: 2-13%); aneurysm sac growth was 2% (95% CI: 0-4%);, all-cause mortality was 21% (95% CI: 4-38%), and technical success rate was 100% (95% CI: 98-100%).
CONCLUSION
The unibody endograft is a safe and minimally invasive approach for AAA repair. However, potential complications necessitate close patient follow-up after the intervention.
PubMed: 38960091
DOI: 10.1016/j.avsg.2024.04.027 -
Dermatology Online Journal Apr 2024A rare neuroendocrine skin cancer called Merkel cell carcinoma (MCC) primarily affects elderly people. The objective of this study is to comprehensively review the...
UNLABELLED
A rare neuroendocrine skin cancer called Merkel cell carcinoma (MCC) primarily affects elderly people. The objective of this study is to comprehensively review the impact of immunosuppressive medications, particularly TNF inhibitors, on the emergence of MCC.
METHODS
PubMed, Web of Science, Science Direct, and Cochrane Library were searched. Study articles were screened by title and abstract at Rayyan Qatar Computing Research Institute, then a full-text assessment was implemented.
RESULTS
A total of eight case reports with 9 patients were included. Of the total population, seven were women and only two were men. Their age ranged from 31 to 73 years. More than half the population (5 cases) were being treated for rheumatoid arthritis. All received TNF inhibitors that were associated with the induction of MCC.
CONCLUSION
We found that it is essential for physicians to explain potential cancer risks to patients before starting long-term immunosuppressive therapy and to conduct routine checks for MCC and other side effects. TNF inhibitors (infliximab, adalimumab, etanercept, and golimumab) were all associated with MCC development. Women constituted the majority of cases and most were elderly.
Topics: Humans; Carcinoma, Merkel Cell; Skin Neoplasms; Middle Aged; Tumor Necrosis Factor Inhibitors; Etanercept; Aged; Female; Male; Infliximab; Antibodies, Monoclonal; Adalimumab; Adult; Immunosuppressive Agents; Arthritis, Rheumatoid; Tumor Necrosis Factor-alpha
PubMed: 38959915
DOI: 10.5070/D330263575 -
Journal of Radiological Protection :... Jul 2024Anecdotal reports are appearing in the scientific literature about cases of brain tumors in interventional physicians who are exposed to ionizing radiation. In response...
BACKGROUND
Anecdotal reports are appearing in the scientific literature about cases of brain tumors in interventional physicians who are exposed to ionizing radiation. In response to this alarm, several designs of leaded caps have been made commercially available. However, the results reported on their efficacy are discordant.
OBJECTIVE
To synthesise, by means of a systematic review of the literature, the capacity of decreasing radiation levels conferred by radiation attenuating devices (RAD) at the cerebral level of interventional physicians.
METHODOLOGY
A systematic review were performed including the following databases: MEDLINE, SCOPUS, EBSCO, Science Direct, Cochrane Controlled Trials Register (CENTRAL), WOS, WHO International Clinical Trials Register, Scielo and Google Scholar, considering original studies that evaluated the efficacy of RAD in experimental or clinical contexts from January 1990 to May 2022. Data selection and extraction were performed in triplicate, with a fourth author resolving discrepancies.
RESULTS
Twenty articles were included in the review from a total of 373 studies initially selected from the databases. From these, twelve studies were performed under clinical conditions encompassing 3801 fluoroscopically guided procedures, ten studies were performed under experimental conditions with phantoms, with a total of 88 procedures, four studies were performed using numerical calculations with a total of 63 procedures. The attenuation and effectiveness of provided by the caps analysed in the present review varying from 12.3% to 99.9%, y 4.9% to 91% respectively.
CONCLUSION
RAD were found to potentially provide radiation protection, but a high heterogeneity in the shielding afforded was found. This indicates the need for local assessment of cap efficiency according to the practice.
PubMed: 38959875
DOI: 10.1088/1361-6498/ad5e8e -
Clinical Neurology and Neurosurgery Jun 2024To date, no biomarkers have been validated in acute ischemic stroke, and its diagnosis currently relies on clinical judgement and radiographic findings. The presence of... (Review)
Review
BACKGROUND
To date, no biomarkers have been validated in acute ischemic stroke, and its diagnosis currently relies on clinical judgement and radiographic findings. The presence of circulating microRNAs in the setting AIS has grown significant attention in recent years. This study aims to summarize the evidence of microRNAs as super-early biomarkers (within 12 hours from last known well) and determine their temporal expression in AIS.
METHODS
This review was conducted in accordance with the PRISMA statement recommendations. Three databases were searched (Pubmed, Scopus, and Cochrane) for case-control studies comparing the expression of microRNAs in AIS patients and healthy controls. Risk of bias was computed using the QUADAS-2 Scale tool. The review protocol was registered in PROSPERO (CRD42023454012).
RESULTS
A total of 186 articles were screened and 6 full-text articles were included in this review, involving 441 AIS and 307 controls. Samples were obtained from blood in three studies, plasma in two studies, and serum in one study. All studies utilized RT-qPCR as quantification method. One study included only patients with large artery atherosclerosis. Eleven microRNAs were found to be overexpressed and seven underexpressed in AIS. No single microRNA was validated in two separate studies. The misexpressed microRNAs were associated with inflammation, platelet activation, angiogenesis, and apoptosis. Two studies followed the temporal expression of microRNAs. miR-125b-5p and miR-143-3p (inflammation, angiogenesis, and apoptosis) normalized at 90 days. miR-125a-5p (angiogenesis) remained elevated. The heterogeneity in temporal sampling and microRNAs detected did not allow to perform a quantitative analysis. Qualitative analysis of each study revealed an overall moderate risk of bias.
CONCLUSIONS
This review suggests the promising potential role of microRNAs as adjuvant tool in the early diagnosis of AIS. Further larger studies are needed to corroborate these findings and discover a reliable and reproducible biomarker.
PubMed: 38959787
DOI: 10.1016/j.clineuro.2024.108416 -
Nurse Education Today Jun 2024This review aimed to assess the quality and nature of the literature related to digital simulation-based pharmacology education. Specifically, we sought to understand... (Review)
Review
OBJECTIVE
This review aimed to assess the quality and nature of the literature related to digital simulation-based pharmacology education. Specifically, we sought to understand the influence of simulations on the knowledge, satisfaction, and confidence of pre-registration nurses and other healthcare students participating in such educational programs.
DESIGN
Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. This study was registered in the Prospective Register of Systematic Reviews (PROSPERO, reg no: CRD42023437570).
DATA SOURCES
PubMed, MEDLINE, APA PsycInfo, ProQuest, Web of Science, ScienceDirect, and CINHAL databases were searched.
REVIEW METHODS
The review focused on the quantitative findings from the studies published from 2016 to 2023. Only the studies that assessed the impact of digital simulation-based pharmacology education on pre-registration healthcare students' knowledge, satisfaction, and confidence were selected for review. Data were synthesized using a narrative approach. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the included articles. This was followed by a narrative synthesis to consolidate the themes.
RESULT
Out of 1587 articles,16 met the inclusion criteria. A wide variety of digital technologies have been utilised, such as virtual simulation, computer simulation (2D/3D), mixed reality, and augmented reality, with the majority using virtual simulation. All studies implemented single-user simulations. The themes emerging from the narrative synthesis suggest that a digital simulation-based pharmacology course is an effective tool for enhancing students' knowledge, confidence, and satisfaction in learning pharmacological concepts. Furthermore, simulation-based teaching with a blended approach was found to be beneficial. However, the integration of the polypharmacy concept and the intra and interprofessional approach to teaching and learning was not evident in these studies.
CONCLUSION
This systematic literature review provides evidence of the potential of digital simulation-based education in pharmacology teaching among healthcare pre-registration students. In future studies, the integration of polypharmacy content with an intra and interprofessional teaching-learning approach is recommended.
PubMed: 38959780
DOI: 10.1016/j.nedt.2024.106295 -
Epilepsy & Behavior : E&B Jul 2024Temporal encephaloceles (TE) are an under-identified, potentially intervenable cause of epilepsy. This systematic review consolidates the current data to identify the... (Review)
Review
Temporal encephaloceles (TE) are an under-identified, potentially intervenable cause of epilepsy. This systematic review consolidates the current data to identify the major clinical, neuroimaging, and EEG features and surgical outcomes of epilepsy associated with TE. Literature searches were carried out using MEDLINE, Embase, PsycINFO, Scopus, and Cochrane Library databases from inception to December 7, 2023. Studies were included if they described clinical, neuroimaging, EEG, or surgical data in ≥5 patients with TE and epilepsy. Of 562 studies identified in the search, 24 met the eligibility criteria, reporting 423 unique patients with both epilepsy and TE. Compared to epilepsy patients without TE, those with TE had a higher mean age of seizure onset and were less likely to have a history of febrile seizures. Seizure semiologies were variable, but primarily mirrored temporal lobe onset patterns. Epilepsy patients with TE had a higher likelihood of having clinical or radiographic features of idiopathic intracranial hypertension (IIH) than those without. Brain MRI may show ipsilateral mesial temporal sclerosis (16 %). CT scans of the skull base usually revealed bony defects near the TE (90 %). Brain PET scans primarily showed ipsilateral temporal lobe hypometabolism (80 %), mostly in the anterior temporal lobe (67 %). Scalp EEG mostly lateralized ipsilateral to the implicated TE (92 % seizure onset) and localized to the temporal lobe (96 %). Intracranial EEG revealed seizure onset near the TE (11 of 12 cases including TE-adjacent electrodes) with variable timing of spread to the ipsilateral hippocampus. After surgical treatment of the TE, the rate of Engel I or ILAE 1 outcomes at one year was 75 % for lesionectomy, 85 % for anterior temporal lobectomy (ATL), and 80 % for ATL with amygdalohippocampectomy. Further studies are needed to better elucidate the relationship between IIH, TE, and epilepsy, improve the identification of TE, and optimize surgical interventions.
PubMed: 38959747
DOI: 10.1016/j.yebeh.2024.109928 -
Pediatric Critical Care Medicine : a... Jul 2024To identify and prioritize research questions for anticoagulation and hemostasis management of neonates and children supported with extracorporeal membrane oxygenation...
Priorities for Clinical Research in Pediatric Extracorporeal Membrane Oxygenation Anticoagulation From the Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference.
OBJECTIVES
To identify and prioritize research questions for anticoagulation and hemostasis management of neonates and children supported with extracorporeal membrane oxygenation (ECMO) from the Pediatric ECMO Anticoagulation CollaborativE (PEACE) consensus.
DATA SOURCES
Systematic review was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021, followed by serial consensus conferences of international, interprofessional experts in the management of ECMO for critically ill neonates and children.
STUDY SELECTION
The management of ECMO anticoagulation for critically ill neonates and children.
DATA EXTRACTION
Within each of the eight subgroups, two authors reviewed all citations independently, with a third independent reviewer resolving any conflicts.
DATA SYNTHESIS
Following the systematic review of MEDLINE, EMBASE, and Cochrane Library databases from January 1988 to May 2021, and the consensus process for clinical recommendations and consensus statements, PEACE panel experts constructed research priorities using the Child Health and Nutrition Research Initiative methodology. Twenty research topics were prioritized, falling within five domains (definitions and outcomes, therapeutics, anticoagulant monitoring, protocolized management, and impact of the ECMO circuit and its components on hemostasis).
CONCLUSIONS
We present the research priorities identified by the PEACE expert panel after a systematic review of existing evidence informing clinical care of neonates and children managed with ECMO. More research is required within the five identified domains to ultimately inform and improve the care of this vulnerable population.
Topics: Extracorporeal Membrane Oxygenation; Humans; Anticoagulants; Child; Infant, Newborn; Critical Illness; Biomedical Research; Infant; Child, Preschool
PubMed: 38959362
DOI: 10.1097/PCC.0000000000003488