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Journal of the International AIDS... May 2024Person-centred care (PCC) has been recognized as a critical element in delivering quality and responsive health services. The patient-provider relationship,... (Review)
Review
INTRODUCTION
Person-centred care (PCC) has been recognized as a critical element in delivering quality and responsive health services. The patient-provider relationship, conceptualized at the core of PCC in multiple models, remains largely unexamined in HIV care. We conducted a systematic review to better understand the types of PCC interventions implemented to improve patient-provider interactions and how these interventions have improved HIV care continuum outcomes and person-reported outcomes (PROs) among people living with HIV in low- and middle-income countries.
METHODS
We searched databases, conference proceedings and conducted manual targeted searches to identify randomized trials and observational studies published up to January 2023. The PCC search terms were guided by the Integrative Model of Patient-Centeredness by Scholl. We included person-centred interventions aiming to enhance the patient-provider interactions. We included HIV care continuum outcomes and PROs.
RESULTS
We included 28 unique studies: 18 (64.3%) were quantitative, eight (28.6.%) were mixed methods and two (7.1%) were qualitative. Within PCC patient-provider interventions, we inductively identified five categories of PCC interventions: (1) providing friendly and welcoming services; (2) patient empowerment and improved communication skills (e.g. supporting patient-led skills such as health literacy and approaches when communicating with a provider); (3) improved individualized counselling and patient-centred communication (e.g. supporting provider skills such as training on motivational interviewing); (4) audit and feedback; and (5) provider sensitisation to patient experiences and identities. Among the included studies with a comparison arm and effect size reported, 62.5% reported a significant positive effect of the intervention on at least one HIV care continuum outcome, and 100% reported a positive effect of the intervention on at least one of the included PROs.
DISCUSSION
Among published HIV PCC interventions, there is heterogeneity in the components of PCC addressed, the actors involved and the expected outcomes. While results are also heterogeneous across clinical and PROs, there is more evidence for significant improvement in PROs. Further research is necessary to better understand the clinical implications of PCC, with fewer studies measuring linkage or long-term retention or viral suppression.
CONCLUSIONS
Improved understanding of PCC domains, mechanisms and consistency of measurement will advance PCC research and implementation.
Topics: Humans; HIV Infections; Developing Countries; Patient-Centered Care; Continuity of Patient Care; Professional-Patient Relations
PubMed: 38740547
DOI: 10.1002/jia2.26258 -
Frontiers in Pharmacology 2024Traditional Chinese Medicine (TCM) has been used for thousands of years to treat human diseases. Recently, many databases have been devoted to studying TCM pharmacology....
Traditional Chinese Medicine (TCM) has been used for thousands of years to treat human diseases. Recently, many databases have been devoted to studying TCM pharmacology. Most of these databases include information about the active ingredients of TCM herbs and their disease indications. These databases enable researchers to interrogate the mechanisms of action of TCM systematically. However, there is a need for comparative studies of these databases, as they are derived from various resources with different data processing methods. In this review, we provide a comprehensive analysis of the existing TCM databases. We found that the information complements each other by comparing herbs, ingredients, and herb-ingredient pairs in these databases. Therefore, data harmonization is vital to use all the available information fully. Moreover, different TCM databases may contain various annotation types for herbs or ingredients, notably for the chemical structure of ingredients, making it challenging to integrate data from them. We also highlight the latest TCM databases on symptoms or gene expressions, suggesting that using multi-omics data and advanced bioinformatics approaches may provide new insights for drug discovery in TCM. In summary, such a comparative study would help improve the understanding of data complexity that may ultimately motivate more efficient and more standardized strategies towards the digitalization of TCM.
PubMed: 38738181
DOI: 10.3389/fphar.2024.1303693 -
The Journal of Emergency Medicine Jun 2024The need for a stronger evidence-base in paramedicine has precipitated a rapid development of prehospital research agendas. Paramedics are increasingly involved in... (Review)
Review
BACKGROUND
The need for a stronger evidence-base in paramedicine has precipitated a rapid development of prehospital research agendas. Paramedics are increasingly involved in research, leading to changes in their role. Yet, the integration of research responsibilities has proven to be challenging, resulting in varying attitudes and levels of engagement.
OBJECTIVE
This systematic review aimed to explore paramedics' views and experiences of research as researchers during training and within practice.
METHODS
A systematic search was performed across six databases. Qualitative empirical peer-reviewed articles that discussed paramedic perspectives on engaging with research activity were included. Of 10,594 articles identified initially, 11 were included in the final synthesis after quality appraisal. Data were extracted and subjected to narrative synthesis.
RESULTS
The following four themes were identified: motivation to engage, moral dilemmas, structural issues within the profession, and reflections on trial involvement. Attitudes toward research, understanding of related concepts, and the drive for patient benefit were interwoven core issues.
CONCLUSIONS
Research was highly valued when links to patient benefit were obvious, however, this review highlights some cultural resistance to research, particularly regarding informed consent and changes to standard practice. Paramedic research methods training should provide structured opportunities to explore concerns and emphasize the role of research in developing a high-quality evidence base to underpin safe practice. Currently, there is inadequate organizational support for paramedics to engage effectively in research activity, with minimal allocations of time, training, and remuneration. Without properly integrating research activity into the paramedic role, their capacity to engage with research activity is limited.
Topics: Humans; Allied Health Personnel; Attitude of Health Personnel; Emergency Medical Technicians; Motivation; Paramedics
PubMed: 38734546
DOI: 10.1016/j.jemermed.2024.01.008 -
Iranian Journal of Nursing and... 2024Due to the dramatic rise in overweight and obesity, adolescent weight management interventions are required. Therefore, this study aimed to study the components and the... (Review)
Review
BACKGROUND
Due to the dramatic rise in overweight and obesity, adolescent weight management interventions are required. Therefore, this study aimed to study the components and the effect size of weight control programs for adolescents with overweight and obese.
MATERIALS AND METHODS
Following the PRISMA 2020 guidelines, we systematically searched electronic databases (PubMed, Google Scholar, ThaiJo, ThaiLis, and Embase) through December 2021 published in English and Thai, samples aged 15-22 years, and presenting the mean, SD a sample size of both experimental and control groups. However, we excluded articles other than full-text articles. In addition, a risk of bias assessment was performed according to the Cochrane Collaboration's quality assessment tool. Finally, this meta-analysis included six studies that met the criteria. The meta-analysis used a fixed-effects model with a forest plot to compute effect sizes and Cochran's Q and I statistics as measures of heterogeneity.
RESULTS
We found six primary studies which included 721 overweight adolescents. The analysis of the effectiveness of weight control programs for overweight adolescents revealed that 360 adolescents with overweight and obese (49.93%) who underwent the weight control programs changed body weight and body mass index values with the effect size of -0.80 (-1.03, -0.56) and I was 56.00%.
CONCLUSIONS
The results indicate further studies should focus on constructing programs that consider adolescents' changes in technology and lifestyles. Additionally, social and mobile tools should motivate and educate adolescents about body weight control to help them adapt to a healthy lifestyle and maintain weight control over time.
PubMed: 38721238
DOI: 10.4103/ijnmr.ijnmr_383_22 -
Systematic Reviews May 2024Psychosocial approaches are the first-line treatments for cocaine dependence, although they still present high dropout and relapse rates. Thus, there is a pressing need...
BACKGROUND
Psychosocial approaches are the first-line treatments for cocaine dependence, although they still present high dropout and relapse rates. Thus, there is a pressing need to understand which variables influence treatment outcomes to improve current treatments and prevent dropout and relapse rates. The aim of this study is to explore predictors of treatment retention and abstinence in CUD.
METHODS
This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched three databases-PubMed, PsychINFO and Web of Science-for randomized clinical trials (RCTs) published in English and Spanish from database inception through April 1, 2023. We selected all studies that met the inclusion criteria (adults aged ≥ 18, outpatient treatment, CUD as main addiction, and no severe mental illness) to obtain data for the narrative synthesis addressing cocaine abstinence and treatment retention as main outcome variables. After data extraction was completed, risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB-2).
RESULTS
A total of 566 studies were screened, and, of those, 32 RCTs were included in the synthesis. Younger age, more years of cocaine use, and craving levels were significant predictors of relapse and treatment dropout. Fewer withdrawal symptoms, greater baseline abstinence, greater treatment engagement, and more self-efficacy were all predictors of longer duration of abstinence. The role of impulsivity as a predictor of CUD is unclear due to conflicting data, although the evidence generally suggests that higher impulsivity scores can predict more severe addiction and withdrawal symptoms, and earlier discontinuation of treatment.
CONCLUSION
Current evidence indicates which variables have a direct influence on treatment outcomes, including well-studied cocaine use-related variables. However, additional variables, such as genetic markers, appear to have a high impact on treatment outcomes and need further study.
SYSTEMATIC REVIEW REGISTRATION
This systematic review is registered at PROSPERO (ID: CRD42021271847). This study was funded by the Spanish Ministry of Science, Innovation and Universities, Instituto Carlos III (ISCIII) (FIS PI20/00929) and FEDER funds and Fundació Privada Hospital de la Santa Creu i Sant Pau (Pla d'acció social 2020).
Topics: Humans; Cocaine-Related Disorders; Treatment Outcome; Recurrence; Craving; Self Efficacy; Patient Dropouts; Randomized Controlled Trials as Topic; Age Factors; Substance Withdrawal Syndrome
PubMed: 38720357
DOI: 10.1186/s13643-024-02550-z -
Midwifery Jul 2024Freebirth is currently defined as the deliberate decision to give birth without a regulated healthcare professional. Previous reviews have identified factors influencing... (Review)
Review
BACKGROUND
Freebirth is currently defined as the deliberate decision to give birth without a regulated healthcare professional. Previous reviews have identified factors influencing women's decision to freebirth, yet there is limited evidence on what is the care experience for women who opt to freebirth.
AIM
To synthesise the qualitative evidence on women's motivations to freebirth and their experience of maternity care when deciding to freebirth.
METHODS
We conducted a qualitative evidence synthesis using a sensitive search strategy in May 2022 and August 2023. Twenty-two publications between 2008 and 2023 and from ten different high-income countries were included. Thematic synthesis, underpinned by a feminist standpoint, was used to analyse the data.
FINDINGS
Three main analytical themes were developed in response to each of the review questions. 'A quest for a safer birth' describes the factors influencing women's decision to freebirth. 'Powerful and powerless midwives' describes women's perceptions of their care providers (mostly midwives) and how these perceptions influenced their decision to freebirth. 'Rites of self-protection' describes women's care experiences and self-care practices in the pregnancy leading to freebirth DISCUSSION: Freebirth was rarely women's primary choice but the result of structural and relational barriers to access wanted care. Self-care in the form of freebirth helped women to achieve a positive birth experience and to protect their reproductive self-determination.
CONCLUSION
A new woman-centred definition of freebirth is proposed as the practice to self-care during birth in contexts where emergency maternity care is readily available.
Topics: Humans; Female; Pregnancy; Motivation; Qualitative Research; Adult; Maternal Health Services; Decision Making
PubMed: 38718432
DOI: 10.1016/j.midw.2024.104022 -
Preventive Medicine Jul 2024The menstrual cycle often presents barriers to participation in daily life activities, including physical activity (PA), which is a cornerstone of health and well-being.... (Review)
Review
OBJECTIVE
The menstrual cycle often presents barriers to participation in daily life activities, including physical activity (PA), which is a cornerstone of health and well-being. The purpose of this systematic review was to explore and summarize the impact of symptoms, experiences, and perceptions of the menstrual cycle on recreational PA (RPA), including sports, exercise and active recreation, in the general population.
METHODS
Six databases were searched for studies that investigated the impact of the menstrual cycle on PA among individuals who were cyclically menstruating, healthy, and not involved in professional sports training.
RESULTS
The search yielded 3025 studies that were screened for relevance and eligibility, resulting in 25 eligible studies, which were found to be of moderate-to-high quality following a quality and risk-of-bias assessment. Thematic synthesis of qualitative and quantitative data from the selected studies, constituting 16,557 adults and 3715 adolescents, identified the impact of menstrual symptoms on the physical and psychological capability to participate in RPA, social opportunity barriers to RPA (e.g., social pressure due to the sociocultural taboo against menstruation), as well reflective (knowledge) and automatic (habit) motivation on RPA behaviours.
CONCLUSION
The variability in menstrual symptoms and corresponding experiences suggested the need for an individualized approach to RPA promotion. Furthermore, this review highlighted the need to address the sociocultural taboo against menstruation, as well as improve the provision of knowledge and resources related to the menstrual cycle and RPA, in order to promote and facilitate RPA for cyclically menstruating individuals throughout the menstrual cycle.
Topics: Humans; Female; Menstrual Cycle; Exercise; Recreation; Adult; Adolescent; Menstruation; Sports; Motivation; Health Knowledge, Attitudes, Practice
PubMed: 38704099
DOI: 10.1016/j.ypmed.2024.107980 -
Accident; Analysis and Prevention Jul 2024Despite the implementation of legal countermeasures, distracted driving remains a prevalent concern for road safety. This systematic review (following the Preferred...
Despite the implementation of legal countermeasures, distracted driving remains a prevalent concern for road safety. This systematic review (following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) summarised the literature on the impact of interventions targeting attitudes/intentions towards, and self-reported engagement in, distracted driving. Studies were eligible for this review if they examined self-reported behaviour/attitudes/intentions pertaining to distracted driving at baseline and post-intervention. Databases searched included PubMed, ProQuest, Scopus, and TRID. The review identified 19 articles/interventions, which were categorised into three intervention types. First, all program-based interventions (n = 6) reduced engagement in distracted driving. However, there were notable limitations to these studies, including a lack of control groups and difficulties implementing this intervention in a real-world setting. Second, active interventions (n = 9) were commonly utilised, yet a number of studies did not find any improvements in outcomes. Finally, four studies used a message-based intervention, with three studies reporting reduced intention and/or engagement in distracted driving. There is opportunity for message-based interventions to be communicated effortlessly online and target high-risk driving populations. However, further research is necessary to address limitations highlighted in the review, including follow-up testing and control groups. Implications are discussed with particular emphasis on areas where further research is needed.
Topics: Humans; Distracted Driving; Self Report; Intention; Accidents, Traffic; Attitude; Automobile Driving
PubMed: 38703591
DOI: 10.1016/j.aap.2024.107608 -
Einstein (Sao Paulo, Brazil) 2024To identify, synthesize, and analyze the scientific knowledge produced regarding the implications of using clinical simulation for undergraduate nursing or medical... (Review)
Review
OBJECTIVE
To identify, synthesize, and analyze the scientific knowledge produced regarding the implications of using clinical simulation for undergraduate nursing or medical students' motivation for learning.
METHODS
The search for articles was conducted between July 28 and August 3, 2022, on the PubMed/MEDLINE, Scopus, Web of Science, and SciELO databases. The following was used for the search: P - undergraduate students attending Nursing or Medicine courses; C - motivation for learning, and C - skills and clinical simulation laboratory. The following research question guided the study: "What are the implications of clinical simulation on the motivation for learning of undergraduate students of nursing and medicine?" Of the 1,783 articles found, 13 were included in the sample for analysis. All stages of the selection process were carried out by two independent evaluators. The results were presented as charts and a discursive report.
RESULTS
The studies analyzed indicated the beneficial effects of clinical simulation on students' motivation, in addition to other gains such as competencies, technical and non-technical skills, knowledge, belonging, autonomy, clinical judgment, critical and reflective thinking, self-efficacy and decreased anxiety, self-management, and improvements in learning and learning climate.
CONCLUSION
Clinical simulation provides a positive learning environment favorable to the development of technical and interpersonal skills and competencies, and raising the level of motivational qualities.
Topics: Humans; Clinical Competence; Education, Medical, Undergraduate; Learning; Motivation; Simulation Training; Students, Medical; Students, Nursing
PubMed: 38695476
DOI: 10.31744/einstein_journal/2024RW0792 -
Frontiers in Public Health 2024The use of Information and Communication Technology (ICT) for assessing and treating cognitive and motor disorders is promoting home-based telerehabilitation. This...
INTRODUCTION
The use of Information and Communication Technology (ICT) for assessing and treating cognitive and motor disorders is promoting home-based telerehabilitation. This approach involves ongoing monitoring within a motivating context to help patients generalize their skills. It can also reduce healthcare costs and geographic barriers by minimizing hospitalization. This systematic review focuses on investigating key aspects of telerehabilitation protocols for children with neurodevelopmental or neurological disorders, including technology used, outcomes, caregiver involvement, and dosage, to guide clinical practice and future research.
METHOD
This systematic review adhered to PRISMA guidelines and was registered in PROSPERO. The PICO framework was followed to define the search strategy for technology-based telerehabilitation interventions targeting the pediatric population (aged 0-18) with neurological or neurodevelopmental disorders. The search encompassed Medline/PubMed, EMBASE, and Web of Science databases. Independent reviewers were responsible for selecting relevant papers and extracting data, while data harmonization and analysis were conducted centrally.
RESULTS
A heterogeneous and evolving situation emerged from our data. Our findings reported that most of the technologies adopted for telerehabilitation are commercial devices; however, research prototypes and clinical software were also employed with a high potential for personalization and treatment efficacy. The efficacy of these protocols on health or health-related domains was also explored by categorizing the outcome measures according to the International Classification of Functioning, Disability, and Health (ICF). Most studies targeted motor and neuropsychological functions, while only a minority of papers explored language or multi-domain protocols. Finally, although caregivers were rarely the direct target of intervention, their role was diffusely highlighted as a critical element of the home-based rehabilitation setting.
DISCUSSION
This systematic review offers insights into the integration of technological devices into telerehabilitation programs for pediatric neurologic and neurodevelopmental disorders. It highlights factors contributing to the effectiveness of these interventions and suggests the need for further development, particularly in creating dynamic and multi-domain rehabilitation protocols. Additionally, it emphasizes the importance of promoting home-based and family-centered care, which could involve caregivers more actively in the treatment, potentially leading to improved clinical outcomes for children with neurological or neurodevelopmental conditions.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (CRD42020210663).
Topics: Humans; Neurodevelopmental Disorders; Telerehabilitation; Child; Nervous System Diseases; Child, Preschool; Adolescent; Infant
PubMed: 38694988
DOI: 10.3389/fpubh.2024.1295273