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BMJ Health & Care Informatics Jun 2024Risk stratification tools that predict healthcare utilisation are extensively integrated into primary care systems worldwide, forming a key component of anticipatory...
OBJECTIVES
Risk stratification tools that predict healthcare utilisation are extensively integrated into primary care systems worldwide, forming a key component of anticipatory care pathways, where high-risk individuals are targeted by preventative interventions. Existing work broadly focuses on comparing model performance in retrospective cohorts with little attention paid to efficacy in reducing morbidity when deployed in different global contexts. We review the evidence supporting the use of such tools in real-world settings, from retrospective dataset performance to pathway evaluation.
METHODS
A systematic search was undertaken to identify studies reporting the development, validation and deployment of models that predict healthcare utilisation in unselected primary care cohorts, comparable to their current real-world application.
RESULTS
Among 3897 articles screened, 51 studies were identified evaluating 28 risk prediction models. Half underwent external validation yet only two were validated internationally. No association between validation context and model discrimination was observed. The majority of real-world evaluation studies reported no change, or indeed significant increases, in healthcare utilisation within targeted groups, with only one-third of reports demonstrating some benefit.
DISCUSSION
While model discrimination appears satisfactorily robust to application context there is little evidence to suggest that accurate identification of high-risk individuals can be reliably translated to improvements in service delivery or morbidity.
CONCLUSIONS
The evidence does not support further integration of care pathways with costly population-level interventions based on risk prediction in unselected primary care cohorts. There is an urgent need to independently appraise the safety, efficacy and cost-effectiveness of risk prediction systems that are already widely deployed within primary care.
Topics: Humans; Risk Assessment; Primary Health Care; Patient Acceptance of Health Care; Algorithms
PubMed: 38901863
DOI: 10.1136/bmjhci-2024-101065 -
Preventive Medicine Jun 2024This study aims to explore dentists' knowledge, attitudes, and perceptions regarding antibiotic use. (Review)
Review
OBJECTIVE
This study aims to explore dentists' knowledge, attitudes, and perceptions regarding antibiotic use.
METHODS
We conducted a systematic review of dentists' knowledge, attitudes and perceptions regarding antibiotic use, by searching the MEDLINE, EMBASE and Web of Science for all original paper published from January 1990 to July 2023, in accordance with the Preferred Reporting Items for systematic Reviews and Meta-analyses (PRISMA 2020) guidelines.
RESULTS
The review included 37 papers, (7 qualitative and 30 quantitative studies). Modifiable factors (knowledge, attitudes) were reported as being associated with antibiotic prescribing by dentists which were cited in 30 of the 37. These attitudes most frequently identified by dentists were: complacency (22/29); lack of trust (16/29); the need to postpone the dental procedure (17/29); and fear (8/29). Gaps in knowledge were also identified (15/29). Only one of the included articles quantified the influence between the reported modifiable factors and antibiotic prescribing.
CONCLUSIONS
The review emphasizes that dentists' antibiotic prescribing is predominantly influenced by modifiable factors. This insight informs the potential for targeted interventions to curtail inappropriate antibiotic use, contributing to global efforts in reducing antibiotic resistance. The protocol of this systematic review can be found in PROSPERO under registration no. CRD42021253937.
PubMed: 38901743
DOI: 10.1016/j.ypmed.2024.108043 -
PloS One 2024Depression is a very common psychiatric disorder in worldwide. Globally, Human Immunodeficiency Virus (HIV) is highly prevalent among women, and are disproportionately... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Depression is a very common psychiatric disorder in worldwide. Globally, Human Immunodeficiency Virus (HIV) is highly prevalent among women, and are disproportionately affected by depression. Antiretroviral Therapy (ART) adherence which could highly be affected by depression is yet to be explored effectively. Depression affects overall poor HIV clinical outcomes, socioeconomic and social interactions. However, it is not well understood specifically how depression affects ART adherence in women living with HIV (WLWHIV). Investigating the effects of depression on ART adherence is critical in order to develop nuanced new evidence to address non-adherence in WLWHIV.
OBJECTIVE
To conduct a meta-analysis on the correlation between depression and adherence to antiretroviral therapy among women living with HIV in the globe.
METHOD
Using population, exposed and outcome approach, we searched Scopus, PubMed, EMBASE, Cochrane Library, Psych info, Web of science and google scholar for cohort and cross-sectional studies globally. The search strategy was structured comprising terms associated with antiretroviral therapy and adherence, women living with HIV and depression. We evaluated the paper quality, using the Newcastle-Ottawa Scales (NOS). The fixed effect model was used to analysis the effect of depression on ART adherence.
RESULT
A total of 8 articles comprise 6474 participants were included in this study. There were controversial findings related to the effect of depression to ART adherence. Among three cross-sectional study, one article demonstrating, depression was associated with ART adherence. Of the five cohort studies, four cohort studies reported association. The overall pooled estimated effect of depression on ART adherence was 1.02 [RR = 1.015 with 95% CI (1.004, 1.026)] with a p-value of 0.005.
CONCLUSION AND RECOMMENDATION
Depression was the risk factor for ART adherence among women living with HIV. It is therefore, necessary for clinician to note this and perform screening for ART adherence.
TRIAL REGISTRATION
The review protocol was developed with prospero registration: CRD42023415935.
Topics: Humans; HIV Infections; Female; Depression; Medication Adherence; Anti-HIV Agents
PubMed: 38900748
DOI: 10.1371/journal.pone.0300106 -
Journal of Medical Internet Research Jun 2024Despite the well-documented health benefits associated with wearable monitoring devices (WMDs), adherence among community-dwelling older adults remains low. By providing... (Review)
Review
Effects of Peer- or Professional-Led Support in Enhancing Adherence to Wearable Monitoring Devices Among Community-Dwelling Older Adults: Systematic Review of Randomized Controlled Trials.
BACKGROUND
Despite the well-documented health benefits associated with wearable monitoring devices (WMDs), adherence among community-dwelling older adults remains low. By providing guidance on the purpose and benefits of using WMDs, facilitating goal-setting aligned with the device's features, promoting comprehension of the health data captured by the device, and assisting in overcoming technological challenges, peers and health care professionals can potentially enhance older adults' adherence to WMDs. However, the effectiveness of such support mechanisms in promoting adherence to WMDs among older adults remains poorly understood.
OBJECTIVE
The aims of this systematic review were to examine the effects of peer- or professional-led intervention programs designed to improve adherence to WMDs among community-dwelling older adults and to identify the intervention components that may positively influence the effects of the intervention.
METHODS
We conducted a comprehensive search across 7 electronic databases (Cochrane Central Register of Controlled Trials [CENTRAL], PubMed, EMBASE, PsycINFO, British Nursing Index, Web of Science, and CINAHL) to identify articles published between January 1, 2010, and June 26, 2023. We specifically targeted randomized controlled trials that examined the impact of peer- or professional-led interventions on enhancing adherence to WMDs among individuals aged 60 years and older residing in the community. Two independent reviewers extracted data from the included studies and assessed the potential risk of bias in accordance with the Cochrane Risk of Bias tool for randomized trials, version 2.
RESULTS
A total of 10,511 studies were identified through the database search. Eventually, we included 3 randomized controlled trials involving 154 community-dwelling older adults. The participants had a mean age of 65 years. Our review revealed that increasing awareness of being monitored and implementing the SystemCHANGE approach, a habit change tool focusing on personal goals and feedback, were effective strategies for enhancing adherence to WMDs among older adults. All of the included studies exhibited a low risk of bias.
CONCLUSIONS
By collaboratively designing specific goals related to WMDs with health care professionals, including nurses and physicians, older adults exhibited a higher likelihood of adhering to the prescribed use of WMDs. These goal-setting tools provided a framework for structure and motivation, facilitating the seamless integration of WMDs into their daily routines. Researchers should prioritize interventions that target awareness and goal-setting as effective approaches to enhance adherence to WMDs among older adults, thereby maximizing the realization of associated health benefits.
Topics: Humans; Aged; Independent Living; Wearable Electronic Devices; Randomized Controlled Trials as Topic; Patient Compliance; Peer Group; Middle Aged; Female; Male; Aged, 80 and over
PubMed: 38900546
DOI: 10.2196/53607 -
Acta Psychologica Jun 2024This systematic review and meta-analysis investigates the relationship between successful aging (SA) and resilience in older adults, focusing on individuals aged 60 and...
BACKGROUND
This systematic review and meta-analysis investigates the relationship between successful aging (SA) and resilience in older adults, focusing on individuals aged 60 and above, to address a significant gap in understanding how resilience contributes to SA.
METHODS
Following the Cochrane review guidelines, we conducted searches in databases such as Web of Science, PsycNet, and PubMed up to December 2021 and used PRISMA as a tool for reporting the results. Our inclusion criteria were studies on psychological resilience and SA in older adults aged 60 and above. Exclusion criteria included studies on physical resilience, medical outcomes of SA, other indicators not used in screened studies (e.g., prevalence, means), populations with suicidal ideation or chronic/palliative illnesses, studies considering resilience as an indicator of SA, and qualitative studies on the association between resilience and SA.
RESULTS
A total of 21 studies were included and assessed for risk of bias using funnel plot and trim-and-fill methods. The meta-analysis revealed a medium effect size indicating a positive relationship between resilience and SA. However, high heterogeneity warrants a cautious interpretation of these results. No significant differences were found between older adults in the general population and those in retirement communities, nor were geographical variations (Asia, Europe, America) found to moderate this relationship.
DISCUSSION
The findings highlight the intrinsic link between older adults' attitudes towards aging, their subjective evaluations, and their level of psychological resilience. Resilience acts as a protective factor against psychological and physical adversities, underscoring the importance of resilience-enhancing strategies in interventions aimed at promoting SA. The conclusions drawn from this analysis should be approached with caution due to the heterogeneity of the included studies.
PubMed: 38897094
DOI: 10.1016/j.actpsy.2024.104357 -
BMC Medical Ethics Jun 2024The nursing profession considers conscience as the foundation and cornerstone of clinical practice, which significantly influences professional decision-making and...
BACKGROUND
The nursing profession considers conscience as the foundation and cornerstone of clinical practice, which significantly influences professional decision-making and elevates the level of patient care. However, a precise definition of conscience in the nursing field is lacking, making it challenging to measure. To address this issue, this study employed the hybrid approach of Schwartz Barcott and Kim to analyze the concept of conscience-based nursing care.
METHODS
This approach involves a three-phase process; theoretical, fieldwork, and analytical. A systematic literature review was conducted using electronic databases during the first phase to find relevant papers. The content of 42 articles that met the inclusion criteria was extracted to determine the attributes, antecedents, and consequences of consciousness care using thematic analysis. Based on the working definition as a product of this phase, the plan of doing the fieldwork phase was designed. During this phase, data were collected through interviews with nurses all of whom were responsible for patient care in hospitals. In this phase, 5 participants were chosen for in-depth interviewing by purposeful sampling. Data were analyzed using directed content analysis. The findings of the theoretical and fieldwork phases were integrated and the final definition was derived.
RESULTS
The integration of the theoretical and fieldwork phases resulted in identifying four key characteristics of conscience-based nursing care. Firstly, it involves providing professional care with a conscientious approach. Secondly, ethics is at the core of conscience-based care. Thirdly, external spirituality plays a significant role in shaping one's conscience in this context. Finally, conscience-based nursing care is both endogenous and exogenous, with professional commitment being the central focus of care.
CONCLUSION
Conscience-based nursing care is an essential component of ethical care, which elevates clinical practice to professional care. It requires the integration of individual and social values, influenced by personal beliefs and cultural backgrounds, and supported by professional competence, resources, and a conducive organizational atmosphere in the healthcare field. This approach leads to the provision of responsive care, moral integrity, and individual excellence, ultimately culminating in the development of professionalism in nursing.
Topics: Humans; Conscience; Nursing Care; Attitude of Health Personnel; Ethics, Nursing; Concept Formation
PubMed: 38890687
DOI: 10.1186/s12910-024-01070-8 -
Cureus May 2024Globally, mental disorders have become a significant burden, affecting a substantial number of individuals. Accessing mental health services is crucial for effective... (Review)
Review
Globally, mental disorders have become a significant burden, affecting a substantial number of individuals. Accessing mental health services is crucial for effective treatment and improving outcomes. However, significant barriers to seeking health services can impede access and contribute to the treatment gap. This systematic review aims to identify and analyze the perceived barriers to seeking mental health services in Saudi Arabia. A comprehensive search was conducted among four databases (PubMed, Web of Science, ProQuest, and Science Direct) to identify relevant studies published between 2018 and 2023. Studies that investigated barriers that could prevent psychiatric patients from seeking mental health services in Saudi Arabia were included. Data extraction and synthesis were performed to identify common themes and barriers. The review included a total of six studies that examined barriers to seeking mental health services in Saudi Arabia. The identified barriers encompassed a range of factors, including stigma, lack of awareness, concerns about confidentiality, limited availability of services, negative attitudes toward professional help, and cultural and religious beliefs. The lack of knowledge, as well as the negative attitude toward mental health care, was a perceived barrier to help-seeking in most studies. Furthermore, stigma was consistently reported as a predominant barrier, preventing individuals from seeking mental health care. This systematic review highlights the barriers to seeking mental health services in Saudi Arabia. Addressing these barriers is essential for improving access to mental healthcare and reducing the treatment gap. Strategies should focus on destigmatization efforts, increasing awareness, ensuring confidentiality and privacy, providing culturally appropriate care, and addressing structural limitations. By implementing these strategies, healthcare systems can improve access to mental health care and the overall well-being of individuals experiencing mental disorders in Saudi Arabia.
PubMed: 38883041
DOI: 10.7759/cureus.60363 -
Heliyon Jun 2024Pregnant women and recent mothers face a higher risk of severe illness from Coronavirus disease 2019 due to physiological and immunological shifts during pregnancy,...
BACKGROUND
Pregnant women and recent mothers face a higher risk of severe illness from Coronavirus disease 2019 due to physiological and immunological shifts during pregnancy, rendering them more vulnerable to inflammatory lung conditions. This susceptibility poses serious threats to both maternal and newborn health. Therefore, it is imperative for pregnant women to be fully informed about Coronavirus disease 2019 and to implement preventive measures. This study aimed to evaluate the collective knowledge, attitudes, and practices related to Coronavirus disease 2019 among pregnant women across Africa.
METHODS
The researchers collected studies from multiple databases, including Pub Med/MEDLINE, EMBASE, CINAHL, Science Direct, Scopus, Web of Science, Cochran library, and Google Scholar. A combination of search terms and Boolean operators were utilized to gather relevant literature. Each study underwent quality assessment by five authors independently, using the modified Newcastle Ottawa Scale tailored for cross-sectional research. Statistical analysis was conducted using STATA™ Version 11 software, and meta-analysis was performed using the random-effects (Der Simonian and Laird) method. Heterogeneity was evaluated using I-squared (I) statistics, and a one-out sensitivity analysis was carried out.
RESULTS
This systematic review and meta-analysis included 19 articles, involving a total of 7852 participants. It revealed that the combined estimated prevalence of good knowledge about Coronavirus disease 2019, positive attitudes, and good practices among pregnant women was found to be 61.8 % (95 % CI: 53.0%-70.65 %; I = 98.7 %), 51.7 % (95 % CI: 30.34%-73.6 %; I = 99.3 %), and 52.31 % (95 % CI: 41.48%-63.15 %; I = 98.8 %) respectively.
CONCLUSION
This study emphasizes a significant concern: pregnant women exhibit a notable lack of knowledge, positive attitudes, and preventive practices regarding Coronavirus disease 2019. Considering their heightened vulnerability, urgent action is required to improve their understanding, attitudes, and behaviours related to the virus. Healthcare professionals should take proactive measures to educate pregnant women, addressing this crucial gap through various strategies.
PubMed: 38882307
DOI: 10.1016/j.heliyon.2024.e31926 -
Cureus May 2024Human Papillomavirus (HPV) infection is the most common sexually transmitted infection, affecting both men and women globally. Men and women are at risk of type HPV16... (Review)
Review
A Systematic Review of Knowledge, Attitudes, and Factors Influencing HPV Vaccine Acceptance Among Adolescents, Parents, Teachers, and Healthcare Professionals in the Middle East and North Africa (MENA) Region.
Human Papillomavirus (HPV) infection is the most common sexually transmitted infection, affecting both men and women globally. Men and women are at risk of type HPV16 and HPV18 viruses leading to cervical, anal, vulvar, and oropharyngeal cancers. The HPV vaccines are highly effective in preventing various strains of HPV infection, and effective vaccines are available only in the Middle East and North Africa (MENA) region. Hence, this systematic review explored knowledge and attitudes toward HPV infection and HPV vaccination and factors influencing HPV vaccination uptake among the MENA populations. Various databases, such as Medline, Science Direct, CINHAL, EBSCO, PsycINFO, and PubMed, were systematically searched to include English studies assessing knowledge, attitudes toward HPV infection, and factors influencing HPV vaccination acceptance in the MENA region. Twenty-two papers met the inclusion criteria. The number of participants ranged from 99 to 7223. While knowledge, attitude, and vaccine hesitancy association factors were generally reported in cross-sectional studies, the HPV vaccine acceptancy over time from longitudinal studies was mixed and inconclusive due to inadequate information on HPV infection and vaccination, the cost of the vaccine, cultural beliefs, and safety concerns. Results demonstrated that low HPV vaccine acceptance is due to a lack of HPV understanding among the MENA population, coupled with access issues. Factors such as awareness, confidence in vaccination, and involvement in decision-making positively influence vaccine uptake. Therefore, tailored programs addressing vaccine hesitancy in the MENA communities are necessary.
PubMed: 38872638
DOI: 10.7759/cureus.60293 -
Australian Critical Care : Official... Jun 2024Patients in the intensive care unit (ICU) are commonly on mechanical ventilation, either through endotracheal intubation or tracheostomy, which usually leaves them... (Review)
Review
BACKGROUND
Patients in the intensive care unit (ICU) are commonly on mechanical ventilation, either through endotracheal intubation or tracheostomy, which usually leaves them nonverbal. Low-technology augmentative and alternative communication (AAC) strategies are simple and effective ways to enhance communication between patients and their communication partners but are underutilised.
AIM
The aim of this study was to systematically review current evidence regarding the effectiveness, experience of use, and usability of low-technology AAC with nonverbal patients and their communication partners in the ICU.
METHODS
This review included quantitative, qualitative, and mixed-methods studies of adult ICU patients aged 18 or older who were nonverbal due to mechanical ventilation and their communication partners. Studies using low-technology AAC, such as communication boards and pen and paper, were included. Six databases were searched, and the review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A convergent segregated approach was used for data synthesis.
RESULTS
Thirty-two studies were included. Low-technology AAC improved patient satisfaction, facilitated communication, and met patients' physical and psychological needs. Communication boards with mixed content (e.g., pictures, words, and letters) were preferred but were used less frequently than unaided strategies due to patients' medical status, tool availability, and staff attitudes. Boards should be user-friendly, tailored, include pen/paper, and introduced preoperation to increase patient's comfort when using them postoperatively.
CONCLUSION
Existing evidence support low-technology AAC's efficacy in meeting patients' needs. Better usability hinges on proper implementation and addressing challenges. Further research is crucial for refining communication-board design, ensuring both user-friendliness and sophistication to cater to ICU patients' diverse needs.
REGISTRATION
The review protocol was registered in the International Prospective Register of Systematic Reviews, with registration number CRD42022331566.
PubMed: 38866691
DOI: 10.1016/j.aucc.2024.04.006