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The Patient Feb 2017Benzodiazepines and Z-drugs are used to treat complaints like insomnia, anxiety and pain. These drugs are recommended for short-term use only, but many studies report... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Benzodiazepines and Z-drugs are used to treat complaints like insomnia, anxiety and pain. These drugs are recommended for short-term use only, but many studies report long-term use, particularly in older people.
OBJECTIVE
The aim of this study was to identify and synthesise qualitative studies exploring patients' experiences and perceptions of receiving benzodiazepines and Z-drugs, and through this identify factors which perpetuate use of these drugs, and strategies for achieving safer prescribing.
METHODS
A systematic search of six databases for qualitative studies exploring patients' experiences and perceptions of primary care benzodiazepine and z-drug prescribing published between January 2000 and April 2014 in a European language, and conducted in Europe, the United States, Australia or New Zealand. Reference lists of included papers were also searched. Study quality was assessed using the Critical Appraisal Skills Programme qualitative checklist. Findings were synthesised using thematic synthesis.
RESULTS
Nine papers were included and seven analytical themes were identified relating to patients' experiences and perceptions and, within that, strategies for safer prescribing of benzodiazepines and Z-drugs: (1) patients' negative perceptions of insomnia and its impact, (2) failed self-care strategies, (3) triggers to medical help-seeking, (4) attitudes towards treatment options and service provision, (5) varying patterns of use, (6) withdrawal, (7) reasons for initial or ongoing use.
CONCLUSIONS
Inappropriate use and prescribing of benzodiazepines and Z-drugs is perpetuated by psychological dependence, absence of support and patients' denial/lack of knowledge of side effects. Education strategies, increased availability of alternatives, and targeted extended dialogue with patients could support safer prescribing.
Topics: Adult; Aged; Aged, 80 and over; Anxiety Disorders; Australia; Benzodiazepines; Drug-Related Side Effects and Adverse Reactions; Europe; Female; Humans; Inappropriate Prescribing; Male; Middle Aged; Pain; Qualitative Research; Self Care; Sleep Initiation and Maintenance Disorders
PubMed: 27282559
DOI: 10.1007/s40271-016-0182-z -
BMC Geriatrics May 2016There has been a substantial number of systematic reviews of stress, coping and interventions for people with dementia and their caregivers. This paper provides a... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There has been a substantial number of systematic reviews of stress, coping and interventions for people with dementia and their caregivers. This paper provides a meta-review of this literature 1988-2014.
METHOD
A meta-review was carried out of systematic reviews of stress, coping and interventions for people with dementia and their caregivers, using SCOPUS, Google Scholar and CINAHL Plus databases and manual searches.
RESULTS
The meta-review identified 45 systematic reviews, of which 15 were meta-analyses. Thirty one reviews addressed the effects of interventions and 14 addressed the results of correlational studies of factors associated with stress and coping. Of the 31 systematic reviews dealing with intervention studies, 22 focused on caregivers, 6 focused on people with dementia and 3 addressed both groups. Overall, benefits in terms of psychological measures of mental health and depression were generally found for the use of problem focused coping strategies and acceptance and social-emotional support coping strategies. Poor outcomes were associated with wishful thinking, denial, and avoidance coping strategies. The interventions addressed in the systematic reviews were extremely varied and encompassed Psychosocial, Psychoeducational, Technical, Therapy, Support Groups and Multicomponent interventions. Specific outcome measures used in the primary sources covered by the systematic reviews were also extremely varied but could be grouped into three dimensions, viz., a broad dimension of "Psychological Well-Being v. Psychological Morbidity" and two narrower dimensions of "Knowledge and Coping" and of "Institutionalisation Delay".
CONCLUSIONS
This meta-review supports the conclusion that being a caregiver for people with dementia is associated with psychological stress and physical ill-health. Benefits in terms of mental health and depression were generally found for caregiver coping strategies involving problem focus, acceptance and social-emotional support. Negative outcomes for caregivers were associated with wishful thinking, denial and avoidance coping strategies. Psychosocial and Psychoeducational interventions were beneficial for caregivers and for people with dementia. Support groups, Multicomponent interventions and Joint Engagements by both caregivers and people with dementia were generally found to be beneficial. It was notable that virtually all reviews addressed very general coping strategies for stress broadly considered, rather than in terms of specific remedies for specific sources of stress. Investigation of specific stressors and remedies would seem to be a useful area for future research.
Topics: Adaptation, Psychological; Caregivers; Dementia; Depression; Emotions; Humans; Mental Health; Social Support; Stress, Psychological
PubMed: 27193287
DOI: 10.1186/s12877-016-0280-8 -
Diabetic Medicine : a Journal of the... Jan 2017To identify the reasons why those offered a place on diabetes education programmes declined the opportunity. (Meta-Analysis)
Meta-Analysis Review
AIMS
To identify the reasons why those offered a place on diabetes education programmes declined the opportunity.
BACKGROUND
It is well established that diabetes education is critical to optimum diabetes care; it improves metabolic control, prevents complications, improves quality of life and empowers people to make informed choices to manage their condition. Despite the significant clinical and personal rewards offered by diabetes education, programmes are underused, with a significant proportion of patients choosing not to attend.
METHODS
A systematic search of the following databases was conducted for the period from 2005-2015: Medline; EMBASE; Scopus; CINAHL; and PsycINFO. Studies that met the inclusion criteria focusing on patient-reported reasons for non-attendance at structured diabetes education were selected.
RESULTS
A total of 12 studies spanning quantitative and qualitative methodologies were included. The selected studies were published in Europe, USA, Pakistan, Canada and India, with a total sample size of 2260 people. Two broad categories of non-attender were identified: 1) those who could not attend for logistical, medical or financial reasons (e.g. timing, costs or existing comorbidities) and 2) those who would not attend because they perceived no benefit from doing so, felt they had sufficient knowledge already or had emotional and cultural reasons (e.g. no perceived problem, denial or negative feelings towards education). Diabetes education was declined for many reasons, and the range of expressed reasons was more diverse and complex than anticipated.
CONCLUSION
New and innovative methods of delivering diabetes education are required which address the needs of people with diabetes whilst maintaining quality and efficiency.
Topics: Activities of Daily Living; Adult; Appointments and Schedules; Child; Combined Modality Therapy; Cost of Illness; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Health Care Costs; Health Knowledge, Attitudes, Practice; Humans; Insurance, Health, Reimbursement; Patient Acceptance of Health Care; Patient Education as Topic; Referral and Consultation
PubMed: 26996982
DOI: 10.1111/dme.13120 -
Technology and Health Care : Official... 2016Recent legislation empowering providers to embrace the electronic exchange of health information leaves the healthcare industry increasingly vulnerable to cybercrime.... (Review)
Review
BACKGROUND
Recent legislation empowering providers to embrace the electronic exchange of health information leaves the healthcare industry increasingly vulnerable to cybercrime. The objective of this systematic review is to identify the biggest threats to healthcare via cybercrime.
OBJECTIVE
The rationale behind this systematic review is to provide a framework for future research by identifying themes and trends of cybercrime in the healthcare industry.
METHODS
The authors conducted a systematic search through the CINAHL, Academic Search Complete, PubMed, and ScienceDirect databases to gather literature relative to cyber threats in healthcare. All authors reviewed the articles collected and excluded literature that did not focus on the objective.
RESULTS
Researchers selected and examined 19 articles for common themes. The most prevalent cyber-criminal activity in healthcare is identity theft through data breach. Other concepts identified are internal threats, external threats, cyber-squatting, and cyberterrorism.
CONCLUSIONS
The industry has now come to rely heavily on digital technologies, which increase risks such as denial of service and data breaches. Current healthcare cyber-security systems do not rival the capabilities of cyber criminals. Security of information is a costly resource and therefore many HCOs may hesitate to invest what is required to protect sensitive information.
Topics: Computer Security; Electronic Health Records; Health Information Systems; Humans; Identity Theft; Terrorism; United States
PubMed: 26578272
DOI: 10.3233/THC-151102 -
Clinical Psychology & Psychotherapy Nov 2016Posttraumatic growth (PTG) and Posttraumatic Stress Disorder (PTSD) are possible consequences of trauma. PTG is supposed to emerge from cognitive processes and can have... (Review)
Review
UNLABELLED
Posttraumatic growth (PTG) and Posttraumatic Stress Disorder (PTSD) are possible consequences of trauma. PTG is supposed to emerge from cognitive processes and can have functional and dysfunctional aspects. This systematic review aims to identify and evaluate publications assessing PTG in adults diagnosed with PTSD in order to analyse the relationship between both constructs, how PTG is related to specific psychological variables and if there are biological variables linked to PTG. This extended review evaluates the quality of measures applied and is the first to study PTG only in populations meeting full PTSD criteria. In addition, the relationship between PTG and other relevant constructs, such as openness, optimism and social support, is explored. Our systematic literature search identified 140 studies of which 19 fulfilled our inclusion criteria; most of them used the Post-Traumatic Growth Inventory. Results indicate that trauma survivors with PTSD exhibit more PTG than those without PTSD and that PTG can be intensified during the therapeutic process whereat it is unclear whether PTG is a desirable outcome of PTSD therapy. Positive correlations between PTG and PTSD are reported. For diagnosed populations, we could not find strong evidence of a quadratic relationship between PTG and PTSD, although some studies support this hypothesis. Findings regarding the association of PTG with psychological variables are heterogeneous. Only one study focused on PTG as well as on biological variables (salivary cortisol) but did not discuss possible links between these two so far unconnected research fields in PTSD. Copyright © 2015 John Wiley & Sons, Ltd.
KEY PRACTITIONER MESSAGE
Trauma survivors with PTSD develop more PTG than those without PTSD, it remains unclear whether PTSD and PTG are curvilinearly related. PTG can be enhanced through PTSD therapy, nevertheless one must not assume that PTG is a favorable treatment outcome since we do not know if the development of PTG during therapy promotes the reduction of PTSD symptoms. It is unclear whether PTG in PTSD sufferers is a constructive outcome of cognitive processes or a positive illusion in favor of avoidance and denial. Results regarding the association of personality factors, social support and PTG are inconsistent, studies on biological aspects of PTG are lacking.
Topics: Adaptation, Psychological; Adult; Humans; Psychotherapy; Social Support; Stress Disorders, Post-Traumatic; Survivors
PubMed: 26514236
DOI: 10.1002/cpp.1985 -
American Journal of Kidney Diseases :... Mar 2016Kidney transplantation offers better outcomes compared to dialysis, but requires patients to adhere to an ongoing and complex self-management regimen. Medication... (Review)
Review
BACKGROUND
Kidney transplantation offers better outcomes compared to dialysis, but requires patients to adhere to an ongoing and complex self-management regimen. Medication nonadherence remains a leading cause of transplant loss, and inadequate self-management undermines transplantation and other health outcomes. We aimed to describe kidney transplant recipients' motivations, challenges, and attitudes toward self-management.
STUDY DESIGN
Systematic review and thematic synthesis of qualitative studies.
SETTING & POPULATION
Kidney transplant recipients.
SEARCH STRATEGY & SOURCES
MEDLINE, EMBASE, PsycINFO, and CINAHL were searched to October 2014.
ANALYTICAL APPROACH
Thematic synthesis.
RESULTS
50 studies involving 1,238 recipients aged 18 to 82 years across 19 countries were included. We identified 5 themes: empowerment through autonomy (achieving mastery, tracking against tangible targets, developing bodily intuition, routinizing and problem solving, and adaptive coping), prevailing fear of consequences (inescapable rejection anxiety, aversion to dialysis, minimizing future morbidity, trivialization and denial, and defining acceptable risks), burdensome treatment and responsibilities (frustrating ambiguities, inadvertent forgetfulness, intrusive side effects, reversing ingrained behaviors, and financial hardship), overmedicalizing life (dominating focus, evading patienthood, and succumbing to burnout), and social accountability and motivation (demonstrating gratitude toward medical team, indebtedness to donor, and peer learning).
LIMITATIONS
Non-English articles were excluded.
CONCLUSIONS
Self-efficacy and social accountability are motivators for self-management, although adherence can be mentally and physically taxing. Multicomponent interventions incorporating personalized care planning, education, psychosocial support, decision aids, and self-monitoring tools may foster self-management capacity and improve transplantation outcomes.
Topics: Adaptation, Psychological; Attitude to Health; Graft Rejection; Graft Survival; Humans; Kidney Failure, Chronic; Kidney Transplantation; Medication Adherence; Motivation; Qualitative Research; Self Care
PubMed: 26372087
DOI: 10.1053/j.ajkd.2015.07.030 -
Journal of Medical Systems Nov 2014Wireless Body Area Networks (WBANs) have emerged as a promising technology that has shown enormous potential in improving the quality of healthcare, and has thus found a... (Review)
Review
Wireless Body Area Networks (WBANs) have emerged as a promising technology that has shown enormous potential in improving the quality of healthcare, and has thus found a broad range of medical applications from ubiquitous health monitoring to emergency medical response systems. The huge amount of highly sensitive data collected and generated by WBAN nodes requires an ascendable and secure storage and processing infrastructure. Given the limited resources of WBAN nodes for storage and processing, the integration of WBANs and cloud computing may provide a powerful solution. However, despite the benefits of cloud-assisted WBAN, several security issues and challenges remain. Among these, data availability is the most nagging security issue. The most serious threat to data availability is a distributed denial of service (DDoS) attack that directly affects the all-time availability of a patient's data. The existing solutions for standalone WBANs and sensor networks are not applicable in the cloud. The purpose of this review paper is to identify the most threatening types of DDoS attacks affecting the availability of a cloud-assisted WBAN and review the state-of-the-art detection mechanisms for the identified DDoS attacks.
Topics: Computer Communication Networks; Humans; Information Systems; Wireless Technology
PubMed: 25218122
DOI: 10.1007/s10916-014-0128-8 -
BMC Public Health Apr 2014South Asian children with asthma are less likely to receive prescriptions and more likely to suffer uncontrolled symptoms and acute asthma admissions compared with White... (Review)
Review
BACKGROUND
South Asian children with asthma are less likely to receive prescriptions and more likely to suffer uncontrolled symptoms and acute asthma admissions compared with White British children. Understanding barriers are therefore vital in addressing health inequalities. We undertook a systematic review identifying explanatory factors for barriers and facilitators to asthma management in South Asian children. South Asians were defined as individuals of Indian, Pakistani or Bangladeshi descent.
METHODS
Data Sources - Medline, HMIC, EMBASE, ASSIA, Web of Science, BNI, CINAHL, PsycINFO, OpenSIGLE, CRD, Scopus, NHS Evidence, Cochrane Library, Campbell Collaboration, RCPCH, ATS, ERS, Asthma UK, Google Scholar & Asthma Guidelines (BTS, GINA, ATS, Monash, NAEPP, Singapore & New Zealand) to August 2013.Inclusion Criteria - Qualitative, quantitative or mixed methods research with primary focus on identifying explanations for barriers and/or facilitators to asthma management in South Asian children aged 0-18 years with diagnosed/suspected asthma and/or carers and/or healthcare professionals.Data Extraction - Three authors independently reviewed, selected & extracted eligible articles with disagreements resolved by research team discussion.
RESULTS
15 studies encompassing 25,755 children, 18,483 parents/carers and 239 healthcare professionals were included. Barriers and explanatory factors identified were:1. Lack of asthma knowledge in families and healthcare professionals.2. Under-use of preventer medications.3. Non-acceptance/denial of asthma.4. Over-reliance on Emergency Department management.5. Communication problems.6. Non-adherence to medication.7. Use of complementary therapies.Little facilitators regarding asthma management were identified.
CONCLUSIONS
Several key issues were identified as likely to be ethnic-specific to South Asian families, rather than a reflection of minority status: impact of parental and professional knowledge and beliefs, health service utilisation pattern explanations and the impact of prejudice and stigmatisation. Other explanations such as language barriers are not strictly ethnic specific but instead reflect a minority position.Further research is required to identify why barriers exist, the mechanisms by which they impact on asthma management and how they can be overcome. Furthermore, understanding the difference between barriers and explanations that are ethnic-specific and those that are related to being a minority will enable the application of generic system-wide interventions where ethnicity is not the issue and ethnically-tailored interventions where needed.
Topics: Adolescent; Asthma; Bangladesh; Child; Child Welfare; Child, Preschool; Communication Barriers; Female; Health Knowledge, Attitudes, Practice; Healthcare Disparities; Humans; India; Infant; Infant, Newborn; Male; Pakistan; Patient Education as Topic
PubMed: 24767303
DOI: 10.1186/1471-2458-14-403 -
Journal of Health Organization and... 2013This paper explores the reasons for the sometimes seemingly irrational and dysfunctional organisational behaviour within the NHS. It seeks to provide possible answers to... (Review)
Review
PURPOSE
This paper explores the reasons for the sometimes seemingly irrational and dysfunctional organisational behaviour within the NHS. It seeks to provide possible answers to the persistent historical problem of intimidating and negative behaviour between staff, and the sometimes inadequate organisational responses. The aim is to develop a model to explain and increase understanding of such behaviour in the NHS.
DESIGN/METHODOLOGY/APPROACH
This paper is conceptual in nature based upon a systematic literature review. The concepts of organisational silence, normalised organisational corruption, and protection of image, provide some possible answers for these dysfunctional responses, as does the theory of selective moral disengagement.
FINDINGS
The NHS exhibits too high a level of collective ego defences and protection of its image and self-esteem, which distorts its ability to address problems and to learn. Organisations and the individuals within them can hide and retreat from reality and exhibit denial; there is a resistance to voice and to "knowing". The persistence and tolerance of negative behaviour is a corruption and is not healthy or desirable. Organisations need to embrace the identity of a listening and learning organisation; a "wise" organisation. The "Elephant in the room" of persistent negative behaviour has to be acknowledged; the silence must be broken. There is a need for cultures of "respect", exhibiting "intelligent kindness".
ORIGINALITY/VALUE
A model has been developed to increase understanding of dysfunctional organisational behaviour in the NHS primarily for leaders/managers of health services, health service regulators and health researchers/academics. Research, with ethical approval, is currently being undertaken to test and develop the conceptual model to further reflect the complexities of the NHS culture.
Topics: Aggression; Antisocial Personality Disorder; Humans; Interprofessional Relations; Medical Staff; Models, Theoretical; Organizational Culture; State Medicine
PubMed: 24422253
DOI: 10.1108/JHOM-10-2012-0207 -
Journal of Oral Rehabilitation Nov 2013The objective of this systematic review was to find sufficient evidence to deny or accept the association between the head and cervical posture and temporomandibular... (Review)
Review
The objective of this systematic review was to find sufficient evidence to deny or accept the association between the head and cervical posture and temporomandibular disorders (TMDs), and thus assist health professionals in the evaluation and treatment of patients with TMDs. A search was conducted through all publications written in English about this topic using the databases from Medline, ISI Web of Science, EMBASE, PubMed and Lilacs. The abstracts that fulfilled the initial guideline were retrieved and evaluated to ensure they met the inclusion criteria. To assess the methodological quality of the studies, we developed a questionnaire considering the following criteria: participant's eligibility, control group, diagnosis of TMDs, posture diagnosis and randomisation. Twenty-two studies were selected as potential studies based on their abstracts. Only seventeen studies actually fulfilled the inclusion criteria. The search provided information about the methodological quality of the studies, in which several methodological defects were found. The evidence presented in this systematic review shows that the relation between TMDs and the head and neck posture is still controversial and unclear. The insufficient number of articles considered of excellent methodological quality is a factor that hinders the acceptance or denial of this association.
Topics: Cervical Vertebrae; Head; Humans; Neck; Posture; Randomized Controlled Trials as Topic; Temporomandibular Joint Dysfunction Syndrome
PubMed: 24118029
DOI: 10.1111/joor.12104