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Acta Obstetricia Et Gynecologica... Jul 2024To compare neonatal, obstetrical, and maternal outcomes associated with outpatient versus inpatient management of pregnancies with preterm prelabor rupture of membranes... (Review)
Review
INTRODUCTION
To compare neonatal, obstetrical, and maternal outcomes associated with outpatient versus inpatient management of pregnancies with preterm prelabor rupture of membranes (PPROM).
MATERIAL AND METHODS
A search of MEDLINE, EMBASE, the Cochrane Database and Central Register from January 1, 1990 to July 31, 2023 identified randomized controlled trials (RCTs) and cohort studies comparing outpatient with inpatient management for pregnant persons diagnosed with PPROM before 37 weeks' gestation. No language restriction was applied. We applied a random effects model for meta-analysis. Trustworthiness was assessed using recently published guidance and Risk of bias using the RoB 2.0 tool for RCTs and ROBINS-I tool for cohort studies. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to assess the certainty of evidence (COE). Outcomes of interest included perinatal mortality, neonatal morbidities, latency and gestational age at delivery, and maternal morbidities. RCTs and cohort studies were analyzed separately. This study was registered in the International Prospective Register of Systematic Reviewsr: CRD42022295275.
RESULTS
From 2825 records, two RCTs and 10 cohort studies involving 1876 patients were included in the review and meta-analysis. Outpatient management protocols varied but generally included brief initial hospitalization, strict eligibility criteria, and surveillance with laboratory and ultrasound investigations. Outpatient management showed lower rates of neonatal respiratory distress syndrome (cohort: RR 0.63 [0.52-0.77, very low COE]), longer latency to delivery (RCT: MD 7.43 days [1.14-13.72 days, moderate COE], cohort: MD 8.78 days [2.29-15.26 days, low COE]), higher gestational age at birth (cohort: MD 7.70 days [2.02-13.38 days, low COE]), lower rates of Apgar scores <7 at 5 min of life (cohort: RR 0.66 [0.50-0.89, very low COE]), and lower rates of histological chorioamnionitis (cohort: RR 0.74 [0.62-0.89, low COE]) without increased risks of adverse neonatal, obstetrical, or maternal outcomes.
CONCLUSIONS
Meta-analysis of data from RCTs and cohort studies with very low-to-moderate certainty of evidence indicates that further high-quality research is needed to evaluate the safety and potential benefits of outpatient management for selected PPROM cases, given the moderate-to-high risk of bias in the included studies.
PubMed: 38946314
DOI: 10.1111/aogs.14903 -
Journal of Trauma & Dissociation : the... Jul 2024There is little published research on dissociative experiences among transgender people, and none from an in-depth qualitative perspective. In-depth, open-ended...
There is little published research on dissociative experiences among transgender people, and none from an in-depth qualitative perspective. In-depth, open-ended interviews ( = 7, 6 trans women, 1 trans man) were conducted to explore how dissociation is experienced (particularly among trans women) and its possible relation to negative emotions. There were several similarities across the dissociative experiences described by participants: six felt themselves disconnected from their body as a whole (in contrast to feeling disconnected to a specific body part), and from the world around them and/or themselves. Four acted out different personalities, and five felt emotionally numb when they were dissociating. Six participants described that their dissociation lessened after they started hormone therapy. Respondents tended to distinguish between dysphoric and dissociative experiences: dysphoric phenomena were more clearly distressful while dissociative ones were more emotionally numb.
PubMed: 38946255
DOI: 10.1080/15299732.2024.2372563 -
Acta Dermatovenerologica Croatica : ADC Mar 2024Vulvar lichen sclerosus (VLS) is an inflammatory disease with numerous detrimental characteristics, namely its distressing symptoms, chronic course, sexual dysfunction,... (Review)
Review
Self-perceived Burden, Impairment in Quality of Life and Sexual Functioning, and Further Implications in Patients with Vulvar Lichen Sclerosus: A Narrative Review and Personal Experience.
Vulvar lichen sclerosus (VLS) is an inflammatory disease with numerous detrimental characteristics, namely its distressing symptoms, chronic course, sexual dysfunction, disfiguring anatomical changes, only partial response to treatment, and risk of evolution towards cancer. Interest in the burden of VLS on patient quality of life is fairly recent and only relatively few studies have addressed it so far. In order to focus on the impact of VLS in affected women, an electronic search was performed using the National Library of Medicine PubMed database. All the studies assessing VLS-related suffering and quality of life impairment published in the English literature were analyzed, including controlled studies, case series, and guidelines. The available literature shows that VLS can negatively affect patients' daily lives and significantly impair their physical and social activities, mental health, self-esteem, sexual functioning, and satisfaction. Health-related quality of life impairment among women with VLS is defined as moderate to severe, comparable to that of patients affected with other high-impact chronic skin disorders such as atopic dermatitis, psoriasis, and hidradenitis suppurativa. The symptoms are the main causes of the detrimental effect of VLS. By ameliorating symptoms, treatments are expected to highly improve patient quality of life, especially in case of complete clearance. Treating VLS has a beneficial impact on sexual dysfunction as well, even though dyspareunia appears less responsive than the other disease-related symptoms. In conclusion, the emotional and sexual dimensions are strongly impaired by VLS. Both in clinical practice and in clinical trials, quality of life and suffering should be taken into account and considered as strong conditioning factors in patient well-being. They should also become a measure of therapeutic response in treated patients.
Topics: Humans; Quality of Life; Female; Vulvar Lichen Sclerosus; Self Concept; Sexual Dysfunction, Physiological
PubMed: 38946189
DOI: No ID Found -
Psycho-oncology Jul 2024The study aimed to evaluate the psychometric properties and measurement invariance (MI) of the Chinese version of the cognitive emotion regulation questionnaire-short...
OBJECTIVE
The study aimed to evaluate the psychometric properties and measurement invariance (MI) of the Chinese version of the cognitive emotion regulation questionnaire-short (CERQ-short) in cancer patients.
METHODS
This cross-sectional study included 505 cancer patients from mainland China. In addition to sociodemographic and clinical characteristics, the CERQ-short and the distress thermometer were included in the study measures.
RESULTS
Item analysis indicated a promising result. And the results of CFA indicated that the CERQ-short demonstrated satisfactory factorial validity in cancer patients. Cronbach's alpha coefficients were between 0.663 and 0.910, while McDonald's omega coefficients were between 0.664 and 0.910. The CERQ-short had sufficient convergent, discriminant and concurrent validity among cancer patients. Lastly, MI supported that the CERQ-short demonstrated strong measurement equivalence across gender, residence and age.
CONCLUSIONS
This study shows that the Chinese version of the CERQ-short has convincing psychometric properties and MI, which supports its use in cancer patients.
Topics: Humans; Psychometrics; Male; Female; Neoplasms; Middle Aged; Cross-Sectional Studies; Surveys and Questionnaires; China; Reproducibility of Results; Adult; Aged; Emotional Regulation; Cognition; Factor Analysis, Statistical
PubMed: 38946040
DOI: 10.1002/pon.6373 -
Chemical & Pharmaceutical Bulletin 2024Agitation and psychosis are key behavioral and psychological symptoms of Alzheimer's disease (AD). For family and caregivers of patients, such symptoms are critical... (Review)
Review
Agitation and psychosis are key behavioral and psychological symptoms of Alzheimer's disease (AD). For family and caregivers of patients, such symptoms are critical factors of distress and increased burden, but medication to treat them is limited. In most cases, drugs for other neuropsychiatric diseases have been used to manage these symptoms in an off-label manner. Due to the complex pathological background of AD and limited clinical data, obtaining proof of concept for the treatment of these symptoms is challenging. However, in 2023, the U.S. Food and Drug Administration approved brexpiprazole as the first and only drug to treat agitation in AD. Several other compounds have been evaluated in clinical situations. This review highlights recent pipelines being developed for agitation and psychosis for patients living with AD.
Topics: Alzheimer Disease; Humans; Psychotic Disorders; Psychomotor Agitation; Antipsychotic Agents
PubMed: 38945937
DOI: 10.1248/cpb.c23-00416 -
American Journal of Critical Care : An... Jul 2024Use of noninvasive ventilation in patients with acute respiratory distress syndrome (ARDS) is debated. The COVID-19 pandemic posed challenges due to high patient volumes...
BACKGROUND
Use of noninvasive ventilation in patients with acute respiratory distress syndrome (ARDS) is debated. The COVID-19 pandemic posed challenges due to high patient volumes and worldwide resource strain.
OBJECTIVES
To determine associations between use of noninvasive ventilation in adult patients with moderate to severe ARDS due to SARS-CoV-2 pneumonia, progression to intubation, and hospital mortality.
METHODS
This retrospective cohort study included patients in an institutional COVID-19 registry. Adult patients were included if they were admitted for COVID-19 between March 1, 2020, and March 31, 2022, and developed moderate to severe ARDS. Primary outcomes were progression to intubation and hospital mortality in patients who received noninvasive ventilation or mechanical ventilation. A secondary outcome was successful treatment with noninvasive ventilation without intubation.
RESULTS
Of 823 patients who met inclusion criteria, 454 (55.2%) did not receive noninvasive ventilation and 369 (44.8%) received noninvasive ventilation. Patients receiving noninvasive ventilation were more likely to require mechanical ventilation than were patients not receiving noninvasive ventilation. Among patients requiring endotracheal intubation, those receiving noninvasive ventilation had a higher likelihood of mortality. Patients receiving noninvasive ventilation had lower severity-adjusted odds of survival to discharge without intubation than did patients not receiving noninvasive ventilation.
CONCLUSION
Patients with moderate to severe ARDS due to SARS-CoV-2 pneumonia treated with noninvasive ventilation had increased likelihood of progression to endotracheal intubation and hospital mortality.
Topics: Humans; COVID-19; Male; Female; Retrospective Studies; Middle Aged; Noninvasive Ventilation; Respiratory Distress Syndrome; Hospital Mortality; Aged; Intubation, Intratracheal; SARS-CoV-2; Severity of Illness Index; Respiration, Artificial; Adult
PubMed: 38945818
DOI: 10.4037/ajcc2024663 -
Journal of Pediatric Nursing Jun 2024Despite advances in diabetes technology, many adolescents with type 1 diabetes (T1D) cannot achieve target metabolic control. Resilience is associated with better... (Review)
Review
PROBLEM
Despite advances in diabetes technology, many adolescents with type 1 diabetes (T1D) cannot achieve target metabolic control. Resilience is associated with better outcomes in diabetes care. The aim of this review is to synthesize studies on resilience in adolescents with T1D, particularly how the concept of resilience has been explored.
METHODS
This integrative review was carried out according to Whittemore and Knafl's framework. A systematic search was conducted in the CINAHL, PubMed/Medline and PsycInfo databases. Eligibility criteria included studies on resilience in adolescents with T1D, aged 13 to 18 years, that were published in English in peer-reviewed scientific journals. The Mixed Methods Appraisal Tool was used to assess study quality.
RESULTS
The review included twenty-four studies. Resilience was defined as the ability or capacity, or the process, to maintain physical and psychological well-being despite exposure to significant stressors or distress events. Diabetes resilience was defined as achieving positive psychosocial and health outcomes despite the challenges of living with T1D. Studies were quantitative (n = 21), qualitative (n = 1) and mixed methods (n = 2). Six resilience instruments were found. The DSTAR-Teen was the most used and the only instrument for adolescents with T1D.
CONCLUSIONS
This review highlighted the need for an explicit definition of the concept of resilience because previous studies used different definitions or lacked a definition. In the future, a more precise concept analysis of resilience in adolescents with T1D is warranted.
IMPLICATIONS
The DSTAR-Teen is a promising resilience measure with good psychometric properties for further studies in adolescents with T1D.
PubMed: 38945756
DOI: 10.1016/j.pedn.2024.06.007 -
Revista Clinica Espanola Jun 2024To describe the predictors of mortality in hospitalized patients with severe acute respiratory syndrome (SARS) due to COVID-19 presenting with silent hypoxemia.
OBJECTIVE
To describe the predictors of mortality in hospitalized patients with severe acute respiratory syndrome (SARS) due to COVID-19 presenting with silent hypoxemia.
MATERIAL AND METHODS
Retrospective cohort study of hospitalized patients with SARS due to COVID-19 and silent hypoxemia at admission, in Brazil, from January to June 2021. The primary outcome of interest was in-hospital death. Multivariable logistic regression analysis was performed.
RESULTS
Of 46,102 patients, the mean age was 59 ± 16 years, and 41.6% were female. During hospitalization, 13,149 patients died. Compared to survivors, non-survivors were older (mean age, 66 vs. 56 years; P < 0.001), less frequently female (43.6% vs. 40.9%; P < 0.001), and more likely to have comorbidities (74.3% vs. 56.8%; P < 0.001). Non-survivors had higher needs for invasive mechanical ventilation (42.4% vs 6.6%; P < 0.001) and intensive care unit admission (56.9% vs 20%; P < 0.001) compared to survivors. In the multivariable regression analysis, advanced age (OR 1.04; 95%CI 1.037-1.04), presence of comorbidities (OR 1.54; 95%CI 1.47-1.62), cough (OR 0.74; 95%CI 0.71-0.79), respiratory distress (OR 1.32; 95%CI 1.26-1.38), and need for non-invasive respiratory support (OR 0.37; 95%CI 0.35-0.40) remained independently associated with death.
CONCLUSIONS
Advanced age, presence of comorbidities, and respiratory distress were independent risk factors for mortality, while cough and requirement for non-invasive respiratory support were independent protective factors against mortality in hospitalized patients due to SARS due to COVID-19 with silent hypoxemia at presentation.
PubMed: 38945525
DOI: 10.1016/j.rceng.2024.06.010 -
The Journal of Biological Chemistry Jun 2024Acute respiratory distress syndrome (ARDS) is a deadly clinical presentation in sepsis, COVID, and other lung disorders where vascular fluid leakage is a severe problem....
Acute respiratory distress syndrome (ARDS) is a deadly clinical presentation in sepsis, COVID, and other lung disorders where vascular fluid leakage is a severe problem. Recent findings by Shadab et al in the JBC show that a well-known player in immune function, Syk, also regulates vascular leakage in response to sepsis. An existing FDA-approved inhibitor of Syk, fostamatinib, prevents the vascular leakage and improves survival in a mouse sepsis model, providing promise for ARDS treatment in the clinic.
PubMed: 38945448
DOI: 10.1016/j.jbc.2024.107517 -
Journal of Affective Disorders Jun 2024The COVID-19 pandemic has had situational impacts and induced various psychological responses among residents. The present study aims to analyze the network structure of...
BACKGROUND
The COVID-19 pandemic has had situational impacts and induced various psychological responses among residents. The present study aims to analyze the network structure of psychological responses to the pandemic and their relationships with situational impact, resilience, and well-being through a network approach.
METHODS
An online survey recruited 1122 residents (mean age = 32.5 years, 65.4 % female) in Hong Kong from October 2020 to October 2021. The participants completed the Mental Impact and Distress Scale: Psychological Response (MIDc-PR) and other validated measures. Gaussian graphical modeling was conducted in R to identify the central MIDc-PR symptoms and their bridge linkages with situational impact, resilience, and well-being.
RESULTS
In the MIDc-PR network, the central symptoms were 'Routine' and 'Images' for Anticipation and 'Tense' and 'Lonely' for Modulation, with 12 bridge edges between the two clusters. In the combined network, the MIDc-PR nodes showed 12 bridge edges with situational impact, particularly in the health domain. 'Concerned', 'Sleep', and 'Lonely' showed negative linkages with resilience; 'Unmotivated' and 'Trapped' showed negative linkages with well-being. The network models showed good levels of stability and did not differ significantly in network structure and global strength across gender and age groups.
LIMITATIONS
The cross-sectional study design only allowed undirected associations in the network and could not model the within-subject effects.
CONCLUSIONS
The study findings contributed to the literature by elucidating the network structure of psychological responses to the pandemic. The central and bridge symptoms have clinical implications as potential targets for future interventions.
PubMed: 38945403
DOI: 10.1016/j.jad.2024.06.105