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Journal of Tissue Viability Aug 2023To systematically synthesize research evidence on barriers and facilitators to pressure injury prevention in hospital settings. (Review)
Review
OBJECTIVE
To systematically synthesize research evidence on barriers and facilitators to pressure injury prevention in hospital settings.
METHODS
A systematic literature review of quantitative, qualitative, and mixed methods research was undertaken using PubMed, MEDLINE, Embase, CINAHL, and Cochrane Library. Studies that reported barriers or/and facilitators to pressure injury prevention in the acute care settings and published in English from 2008 to 2022 were included. Studies were excluded if they were conducted in residential care facilities and nursing homes, or other long-term community care settings. Two authors independently screened articles against the inclusion and exclusion criteria. Quality appraisal was conducted by two authors by using the Mixed Methods Appraisal Tool. Reported results were mapped to the Theoretical Domains Framework to identify the barriers and facilitators to pressure injury prevention.
RESULTS
A total of 78 studies were included. There were 65 quantitative studies, 11 qualitative studies, and two mix-methods studies. The most salient Theoretical Domains Framework domains identified in this review were "Knowledge", "Skills", "Environmental Context and Resources", "Optimism", "Social/Professional Role and Identity", and "Social influences".
CONCLUSION
The barriers and facilitators to pressure injury prevention in hospital settings identified in this systematic review were diverse, and included issues at both individual and organizational level. Healthcare organizations can address the barriers and facilitators from the influential Theoretical Domains Framework domains. Future research is required to investigate the effectiveness of behaviour change interventions that specifically target these barriers and facilitators to pressure injury prevention.
Topics: Humans; Pressure Ulcer; Nursing Homes; Hospitals; Crush Injuries; Qualitative Research
PubMed: 37150650
DOI: 10.1016/j.jtv.2023.04.009 -
Frontiers in Medicine 2023Glioblastoma is the most common and malignant primary brain tumour with median survival of 14.6 months. Personalised medicine aims to improve survival by targeting...
INTRODUCTION
Glioblastoma is the most common and malignant primary brain tumour with median survival of 14.6 months. Personalised medicine aims to improve survival by targeting individualised patient characteristics. However, a major limitation has been application of targeted therapies in a non-personalised manner without biomarker enrichment. This has risked therapies being discounted without fair and rigorous evaluation. The objective was therefore to synthesise the current evidence on survival efficacy of personalised therapies in glioblastoma.
METHODS
Studies reporting a survival outcome in human adults with supratentorial glioblastoma were eligible. PRISMA guidelines were followed. MEDLINE, Embase, Scopus, Web of Science and the Cochrane Library were searched to 5th May 2022. Clinicaltrials.gov was searched to 25th May 2022. Reference lists were hand-searched. Duplicate title/abstract screening, data extraction and risk of bias assessments were conducted. A quantitative synthesis is presented.
RESULTS
A total of 102 trials were included: 16 were randomised and 41 studied newly diagnosed patients. Of 5,527 included patients, 59.4% were male and mean age was 53.7 years. More than 20 types of personalised therapy were included: targeted molecular therapies were the most studied (33.3%, 34/102), followed by autologous dendritic cell vaccines (32.4%, 33/102) and autologous tumour vaccines (10.8%, 11/102). There was no consistent evidence for survival efficacy of any personalised therapy.
CONCLUSION
Personalised glioblastoma therapies remain of unproven survival benefit. Evidence is inconsistent with high risk of bias. Nonetheless, encouraging results in some trials provide reason for optimism. Future focus should address target-enriched trials, combination therapies, longitudinal biomarker monitoring and standardised reporting.
PubMed: 37122327
DOI: 10.3389/fmed.2023.1166104 -
Journal of Orthopaedic Surgery and... Apr 2023The use of dual mobility cups in total hip arthroplasty has gained popularity in light of the fact it enables to reduce dislocation through increased jumping distance...
PURPOSE
The use of dual mobility cups in total hip arthroplasty has gained popularity in light of the fact it enables to reduce dislocation through increased jumping distance (JD) and impingement-free arc of movement. Modular Dual Mobility Cup (modular DMC) systems have been recently introduced to enable the use of dual mobility cups with standard metal-backed shells. The objective of this study was twofold: calculate the JD for each modular DMC system and conduct a systematic literature review to report clinical outcomes and reasons for failure of this construct.
METHODS
The JD was calculated using the Sariali formula: JD = 2Rsin [(π/2 - Ψ - arcsin (offset/R))/2]. A qualitative systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search for English and French articles between January 2000 and July 2020 was run on PubMed, EMBASE, Google Scholar, and Scopus with the primary objective of finding articles about modular DMC systems.
RESULTS
We identified eight 8 different manufacturers of modular DMC systems and 327 publications on the subject. After screening for duplicates and eligibility, we identified 229 publications: 206 articles were excluded because they contained no reports on modular DMC systems, whereas other three were not included because they focused on biomechanical aspects. Among the 11 included articles, 2 were prospective case series, 9 were retrospective case series. True dislocation occurred in 25 cases (0.9%), and six of them were solved by closed reduction without necessity of revision, while all 5 intraprosthetic dislocations were operated.
CONCLUSIONS
Modular DMCs are a valid method to deal with complex THA instability, with good clinical and patient-reported outcomes, low complication rates, and low revision rates at early follow-up. We would advise cautious optimism on the role of modular DMC implants, as it seems safer to use ceramic instead of metallic heads whenever possible to avoid the increase cobalt and chromium trace ion serum levels.
Topics: Humans; Arthroplasty, Replacement, Hip; Hip Prosthesis; Retrospective Studies; Prosthesis Failure; Prosthesis Design; Reoperation; Hip Dislocation; Joint Dislocations
PubMed: 37020227
DOI: 10.1186/s13018-023-03730-8 -
Drug and Alcohol Review Jul 2023Organisational factors have been found to be associated with health outcomes in a number of health-care settings. Despite likely being an important influence on the... (Review)
Review
INTRODUCTION
Organisational factors have been found to be associated with health outcomes in a number of health-care settings. Despite likely being an important influence on the quality of care provided within alcohol and other drug (AOD) treatment centres, the impact of organisational factors on AOD treatment outcomes have not been extensively explored. This systematic literature review examines the characteristics, methodological quality and findings of published studies exploring the association between organisational factors and client AOD treatment outcomes.
METHODS
Medline, Embase, PsycINFO and the Cochrane database were searched from 2010 to March 2022 for relevant papers. Studies meeting the inclusion criteria underwent quality assessment using the Joanna Brigg's Institute critical appraisal tool for cross-sectional studies, followed by data extraction of key variables pertaining to the aims. A narrative summary was used to synthesise the data.
RESULTS
Nine studies met the inclusion criteria. Organisational factors examined included cultural competency, organisational readiness for change, directorial leadership, continuity of care practices, service access, service to needs ratios, dual diagnosis training, therapeutic optimism and the funding model/health-care system that treatment was delivered in. Outcome measures included duration, completion or continuation of treatment; AOD use; and patient perceptions of treatment outcomes. Seven out of nine papers found a significant interaction between at least one organisational variable and AOD treatment outcomes.
DISCUSSION AND CONCLUSIONS
Organisational factors are likely to impact treatment outcomes for patients seeking treatment for AOD. Further examination of the organisational factors that influence AOD outcomes is needed to inform systemic improvements to AOD treatment.
Topics: Humans; Cross-Sectional Studies; Substance-Related Disorders; Treatment Outcome
PubMed: 37005012
DOI: 10.1111/dar.13653 -
Journal of General Internal Medicine May 2023Physicians treating similar patients in similar care-delivery contexts vary in the intensity of life-extending care provided to their patients at the end-of-life.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Physicians treating similar patients in similar care-delivery contexts vary in the intensity of life-extending care provided to their patients at the end-of-life. Physician psychological propensities are an important potential determinant of this variability, but the pertinent literature has yet to be synthesized.
OBJECTIVE
Conduct a review of qualitative studies to explicate whether and how psychological propensities could result in some physicians providing more intensive treatment than others.
METHODS
Systematic searches were conducted in five major electronic databases-MEDLINE ALL (Ovid), Embase (Elsevier), CINAHL (EBSCO), PsycINFO (Ovid), and Cochrane CENTRAL (Wiley)-to identify eligible studies (earliest available date to August 2021). Eligibility criteria included examination of a physician psychological factor as relating to end-of-life care intensity in advanced life-limiting illness. Findings from individual studies were pooled and synthesized using thematic analysis, which identified common, prevalent themes across findings.
RESULTS
The search identified 5623 references, of which 28 were included in the final synthesis. Seven psychological propensities were identified as influencing physician judgments regarding whether and when to withhold or de-escalate life-extending treatments resulting in higher treatment intensity: (1) professional identity as someone who extends lifespan, (2) mortality aversion, (3) communication avoidance, (4) conflict avoidance, (5) personal values favoring life extension, (6) decisional avoidance, and (7) over-optimism.
CONCLUSIONS
Psychological propensities could influence physician judgments regarding whether and when to de-escalate life-extending treatments. Future work should examine how individual and environmental factors combine to create such propensities, and how addressing these propensities could reduce physician-attributed variation in end-of-life care intensity.
Topics: Humans; Communication; Death; Pharmaceutical Preparations; Physicians; Terminal Care
PubMed: 36732436
DOI: 10.1007/s11606-022-08011-4 -
Annals of Physical and Rehabilitation... Jun 2023After total hip arthroplasty (THA), over 30% of individuals report activity limitations and participation restrictions. This systematic review aimed to determine the... (Review)
Review
OBJECTIVES
After total hip arthroplasty (THA), over 30% of individuals report activity limitations and participation restrictions. This systematic review aimed to determine the association between contextual factors and outcomes in the activity and participation domain after THA for hip osteoarthritis (OA).
METHODS
This systematic review was developed according to the PRISMA guidelines for systematic reviews. PubMed, Web of Science, Embase and Scopus were searched until August 2022. Risk of bias was assessed with the Quality in Prognosis Studies tool (QUIPS).
RESULTS
Twenty-nine articles were included. Eighteen had a high risk of bias, 3 had a low risk of bias, and 8 had a moderate risk of bias. Anxiety was only investigated in studies with high risk of bias but showed a consistent negative association with activities and participation after THA across multiple studies. Evidence was inconsistent regarding the associations between depression, trait anxiety, sense of coherence, big 5 personality traits, educational level, marital status, employment status, job position, expectations and social support, and the activity and participation domain. Optimism, general self-efficacy, cognitive appraisal processes, illness perception, ethnicity, and positive life events were associated with activities and participation but were only investigated in 1 study. No associations were identified across multiple studies for living or smoking status. Control beliefs, kinesiophobia, race, discharge location, level of poverty in neighbourhood, negative life events and occupational factors, were not associated with the activity and participation domain but were only investigated in 1 study.
CONCLUSION
Methodological quality of the included studies was low. Anxiety was the only factor consistently associated with worse outcomes in the activity and participation domain after THA but was only investigated in studies with high risk of bias. Further research is needed to confirm relationships between other contextual factors and activities and participation after THA.
REGISTRATION
PROSPERO CRD42020199070.
Topics: Humans; Arthroplasty, Replacement, Hip; Prognosis; Osteoarthritis, Hip; Anxiety
PubMed: 36680879
DOI: 10.1016/j.rehab.2022.101712 -
International Journal of Environmental... Dec 2022This study aimed to explore parents' perspectives regarding the use of digital health technologies in paediatric overweight and obesity weight support. A systematic... (Review)
Review
This study aimed to explore parents' perspectives regarding the use of digital health technologies in paediatric overweight and obesity weight support. A systematic search in 'Academic Search Premier', 'British Nursing Index', 'Cumulative Index to Nursing and Allied Health', and 'Health Research Premium Collection' was conducted in November 2021. Inclusion criteria were English or Nordic peer-reviewed articles published after 2010, overweight and obese children aged 2-10, weight support using digital health technologies, and parental experiences examined. An integrative review was conducted using Joanna Briggs Institute quality appraisal checklists and a constant comparison analysis method. In total, 14 articles were analysed that included SMS, telephone, apps, websites, and social media as the main technology groups. A limitation of this review was the heterogenicity of the studies. The results indicate that parents, mostly mothers, had a positive experience, finding technologies helpful and easy to use, and expressed optimism toward future use. An option for interacting with others and the possibility of personalising support were enjoyed or requested. In conclusion, digital health technologies can be a suitable tool to empower the parents of children with overweight and obesity concerns, whose perspective should be considered during the design and support phases.
Topics: Child; Female; Humans; Mothers; Overweight; Pediatric Obesity; Social Media
PubMed: 36612733
DOI: 10.3390/ijerph20010410 -
Journal of Medical Internet Research Dec 2022Digital technologies facilitate everyday life, social connectedness, aging at home, well-being, and dignified care. However, older adults are disproportionately excluded... (Review)
Review
BACKGROUND
Digital technologies facilitate everyday life, social connectedness, aging at home, well-being, and dignified care. However, older adults are disproportionately excluded from these benefits. Equal digital opportunities, access, and meaningful engagement require an understanding of older adults' experience across different stages of the technological engagement life cycle from nonuse and initial adoption to sustained use, factors influencing their decisions, and how the experience changes over time.
OBJECTIVE
Our objectives were to identify the extent and breadth of existing literature on older adults' perspective on digital engagement and summarize the barriers to and facilitators for technological nonuse, initial adoption, and sustained digital technology engagement.
METHODS
We used the Arksey and O'Malley framework for the scoping review process. We searched MEDLINE, PsycINFO, CINAHL, Web of Science, and ACM digital library for primary studies published between 2005 and 2021. The inclusion and exclusion criteria were developed based on the Joanna Briggs Institute (participants, content, and context) framework. Studies that investigated the digital engagement experience as well as barriers to and facilitators of older adults' digital technology engagement were included. The characteristics of the study, types of digital technology, and digital engagement levels were analyzed descriptively. Content analysis was used to generate tentative elements using a congruent theme, and barriers and facilitators were mapped over the capability, opportunity, and motivation behavior change model (COM-B) and the theoretical domain framework. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews).
RESULTS
In total, 96 publications were eligible for the final charting and synthesis. Most of the studies were published over the past 5 years, investigated the initial adoption stage of digital engagement, and focused on everyday technologies. The most cited barriers and facilitators across the engagement stages from each COM-B component were capability (eg, physical and psychological changes and lack of skill), opportunity (eg, technological features, environmental context, and resources), and motivation (eg, optimism from perceived usefulness and beliefs about capability).
CONCLUSIONS
The COM-B model and theoretical domain framework provide a guide for identifying multiple and intertwined barriers and facilitators at each stage of digital engagement. There are limited studies looking into the whole spectrum of older adults' digital technology experience; in particular, studies on technological nonuse and sustained use stages are rare. Future research and practice should focus on tailored interventions accounting for the barriers to older adults' digital engagement and addressing capabilities, motivation, and opportunities; affordable, usable, and useful digital technologies, which address the changes and capability requirements of older adults and are cocreated with a value framework; and lifelong learning and empowerment to develop older adults' knowledge and skills to cope with digital technology development.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
RR2-10.2196/25616.
Topics: Humans; Aged; Digital Technology; Education, Continuing
PubMed: 36477006
DOI: 10.2196/40192 -
Clinical Nutrition (Edinburgh, Scotland) Dec 2022Probiotics and synbiotics have been increasingly investigated for the management of chronic constipation. We aimed to investigate the effect of probiotics and synbiotics... (Meta-Analysis)
Meta-Analysis
BACKGROUND & AIMS
Probiotics and synbiotics have been increasingly investigated for the management of chronic constipation. We aimed to investigate the effect of probiotics and synbiotics on stool output, gut transit time, symptoms and quality of life in adults with chronic constipation via a systematic review and meta-analysis of randomized controlled trials (RCTs).
METHODS
Studies were identified using electronic databases, backward citation and hand-searching abstracts. The search date was 10 July 2022. RCTs reporting administration of probiotics or synbiotics in adults with chronic constipation were included. Risk of bias (RoB) was assessed with the Cochrane RoB 2.0 tool. Meta-analysis was conducted separately for probiotics and synbiotics. Results were synthesized using risk ratios (RRs), mean differences or standardized mean differences (SMDs) and 95% confidence intervals (CIs) using a random-effects model.
RESULTS
Thirty RCTs investigating probiotics and four RCTs investigating synbiotics were included. Overall, 369/647 (57%) responded to probiotic treatment and 252/567 (44%) to control (RR 1.28, 95% CI 1.07, 1.52, p = 0.007). Probiotics increased stool frequency (SMD 0.71, 95% CI 0.37, 1.04, p < 0.00001), with Bifidobacterium lactis having a significant effect, but not mixtures of probiotics, Bacillus coagulans Unique IS2 or Lactobacillus casei Shirota. Probiotics did not impact stool consistency (SMD 0.26, 95% CI -0.03, 0.54, p = 0.08). Probiotics improved integrative symptom scores compared to control (SMD -0.46, 95% CI -0.89, -0.04). Synbiotics did not impact stool output or integrative symptom scores compared to control.
CONCLUSIONS
Certain probiotics may improve response to treatment, stool frequency and integrative constipation symptoms, providing cautious optimism for their use as a dietary management option. There is currently insufficient evidence to recommend synbiotics in the management of chronic constipation. Caution is needed when interpreting these results due to high heterogeneity and risk of bias amongst the studies.
Topics: Adult; Humans; Synbiotics; Randomized Controlled Trials as Topic; Probiotics; Constipation; Bifidobacterium animalis
PubMed: 36372047
DOI: 10.1016/j.clnu.2022.10.015 -
Annals of Medicine Dec 2022Although the Japanese chronic total occlusion (J-CTO) score is widely used to assess the complexity of revascularization for CTO lesions, ambiguous and conflicting... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although the Japanese chronic total occlusion (J-CTO) score is widely used to assess the complexity of revascularization for CTO lesions, ambiguous and conflicting results are reported in validation studies. Therefore, we aimed to quantitatively evaluate the effectiveness of the J-CTO score and explore the heterogeneity of its comparison with other CTO scores.
METHODS
PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov databases were systematically searched from January 1st, 2011 to December 23rd, 2021. Studies that examined the accuracy of the J-CTO score were eligible. Where feasible, estimates of discrimination and calibration were pooled with a random-effects model. The Prediction model Risk Of Bias ASsessment Tool (PROBAST) was used for risk-of-bias assessment. This study was reported according to PRISMA guidelines and prospectively registered with PROSPERO (CRD42019126161).
RESULTS
Of 28 included studies ( = 34,944 lesions), 24 were eligible for meta-analysis. The J-CTO score demonstrated significant discrimination for 30-min wire crossing (summary C-statistic 0.76; 95% CI 0.68-0.84) and technical success (0.68; 95% CI 0.61-0.74) despite significant heterogeneity. Only 19 (33%) of the 58 pairwise comparisons with 14 competing scores that were based on discrimination reported a statistical result. The J-CTO score performed worse (relative difference of C-statistics >5%) in eight out of 33 independent comparisons but better in another 13. Methodological shortcomings resulted from only one study evaluating model calibration appropriately.
CONCLUSION
The discrimination power of the J-CTO score was useful for time-efficient wire crossing and moderate for angiographic success. Head-to-head comparisons of CTO scores would benefit from standardized reporting and appropriate statistical methods.Key messagesThe J-CTO score has useful discrimination in predicting 30-min wire crossing while performing moderately for technical success.After excluding optimism bias, there is insufficient independent evidence supporting the superiority of newly introduced models over the J-CTO score.Standardized methodology and assessment are needed to achieve a better understanding of CTO scores, especially for their calibration.
Topics: Humans; Coronary Occlusion; Coronary Angiography; Percutaneous Coronary Intervention; Registries; Predictive Value of Tests; Treatment Outcome; Risk Factors; Chronic Disease
PubMed: 36322535
DOI: 10.1080/07853890.2022.2141466