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BMC Health Services Research Jan 2024Families with children who have life-limiting or life-threatening illnesses often prefer to receive care at home to maintain a sense of normalcy. However, caring for...
BACKGROUND
Families with children who have life-limiting or life-threatening illnesses often prefer to receive care at home to maintain a sense of normalcy. However, caring for children at home is different from caring for them in a hospital, and we do not know enough about the needs of healthcare personnel who provide home-based pediatric palliative care.
AIM
The aim of this review was to systematically summarize, appraise and synthesize available quantitative, qualitative, and mixed methods research to identify the needs of healthcare personnel in home-based pediatric palliative care.
METHODS
We used the Joanna Briggs Institute methodology for mixed method systematic reviews and searched systematically in Medline, Embase, PsycINFO, CINAHL, Web of Science, AMED, and the Cochrane Library. Quantitative, qualitative and mixed methods studies from 2012 to 2021 reporting on healthcare personnel's needs, experiences, perspectives, coping strategies, and/or challenges related to home-based pediatric palliative care were eligible for inclusion. The screening was conducted independently in pairs. The quantitative data were transformed into qualitative data and analyzed using thematic synthesis.
RESULTS
Overall, 9285 citations were identified, and 21 studies were eligible for review. Most of the studies were qualitative and interview-based. Few studies included healthcare personnel other than doctors and nurses. Three analytical themes were developed: (1) being connected and engaged with the child and family, (2) being part of a dedicated team, and (3) ensuring the quality of home-based pediatric palliative care services. Healthcare personnel strived to deliver high-quality, home-based pediatric palliative care. Establishing a relationship with the child and their parents, collaborating within a committed team, and having sufficient resources were identified as important needs influencing healthcare personnel when providing home-based pediatric palliative care.
CONCLUSION
The findings underscore the importance of building trusting relationships among healthcare personnel, children, and families. It also emphasizes the significance of interdisciplinary collaboration that is effective, along with the presence of enough skilled personnel to ensure high-quality home-based pediatric palliative care. Further research is necessary to include healthcare personnel beyond doctors and nurses, as palliative care requires a team of professionals from various disciplines. Addressing the needs of healthcare personnel can ensure safe and professional palliative care for children at home.
Topics: Humans; Child; Palliative Care; Health Personnel; Physicians; Academies and Institutes; Delivery of Health Care
PubMed: 38195519
DOI: 10.1186/s12913-023-10495-7 -
BMC Pregnancy and Childbirth Jan 2024Recent reviews have reported inconclusive results regarding the usefulness of consuming dates (Phoenix dactylifera L. fruit) in the peripartum period. Hence, this... (Meta-Analysis)
Meta-Analysis
Is oral consumption of dates (Phoenix dactylifera L. fruit) in the peripartum period effective and safe integrative care to facilitate childbirth and improve perinatal outcomes: a comprehensive revised systematic review and dose-response meta-analysis.
BACKGROUND
Recent reviews have reported inconclusive results regarding the usefulness of consuming dates (Phoenix dactylifera L. fruit) in the peripartum period. Hence, this updated systematic review with meta-analysis sought to investigate the efficacy and safety of this integrated intervention in facilitating childbirth and improving perinatal outcomes.
METHODS
Eight data sources were searched comprehensively from their inception until April 30, 2023. Parallel-group randomized and non-randomized controlled trials published in any language were included if conducted during peripartum (i.e., third trimester of pregnancy, late pregnancy, labor, or postpartum) to assess standard care plus oral consumption of dates versus standard care alone or combined with other alternative interventions. The Cochrane Collaboration's Risk of Bias (RoB) assessment tools and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were employed to evaluate the potential RoB and the overall quality of the evidence, respectively. Sufficient data were pooled by a random-effect approach utilizing Stata software.
RESULTS
Of 2,460 records in the initial search, 48 studies reported in 55 publications were included. Data were insufficient for meta-analysis regarding fetal, neonatal, or infant outcomes; nonetheless, most outcomes were not substantially different between dates consumer and standard care groups. However, meta-analyses revealed that dates consumption in late pregnancy significantly shortened the length of gestation and labor, except for the second labor stage; declined the need for labor induction; accelerated spontaneity of delivery; raised cervical dilatation (CD) upon admission, Bishop score, and frequency of spontaneous vaginal delivery. The dates intake in labor also significantly reduced labor duration, except for the third labor stage, and increased CD two hours post-intervention. Moreover, the intervention during postpartum significantly boosted the breast milk quantity and reduced post-delivery hemorrhage. Likewise, dates supplementation in the third trimester of pregnancy significantly increased maternal hemoglobin levels. The overall evidence quality was also unacceptable, and RoB was high in most studies. Furthermore, the intervention's safety was recorded only in four trials.
CONCLUSION
More well-designed investigations are required to robustly support consuming dates during peripartum as effective and safe integrated care.
TRIAL REGISTRATION
PROSPERO Registration No: CRD42023399626.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Fruit; Labor, Obstetric; Parturition; Peripartum Period; Phoeniceae; Infant
PubMed: 38166785
DOI: 10.1186/s12884-023-06196-y -
JAMA Pediatrics Mar 2024Problem-solving skills training (PSST) has a demonstrated potential to improve psychosocial well-being for parents of children with chronic health conditions (CHCs), but... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Problem-solving skills training (PSST) has a demonstrated potential to improve psychosocial well-being for parents of children with chronic health conditions (CHCs), but such evidence has not been fully systematically synthesized.
OBJECTIVE
To evaluate the associations of PSST with parental, pediatric, and family psychosocial outcomes.
DATA SOURCES
Six English-language databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Cochrane Library), 3 Chinese-language databases (China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang), gray literature, and references were searched from inception to April 30, 2023.
STUDY SELECTION
Randomized clinical trials (RCTs) that performed PSST for parents of children with CHCs and reported at least 1 parental, pediatric, or family psychosocial outcome were included.
DATA EXTRACTION AND SYNTHESIS
Study selection, data extraction, and quality assessment were conducted independently by 2 reviewers. Data were pooled for meta-analysis using the standardized mean difference (SMD) by the inverse variance method or a random-effects model. Subgroup analyses of children- and intervention-level characteristics were conducted.
MAIN OUTCOMES AND MEASURES
The psychosocial outcomes of the parents, their children, and their families, such as problem-solving skills, negative affectivity, quality of life (QOL), and family adaptation.
RESULTS
The systematic review included 23 RCTs involving 3141 parents, and 21 of these trials were eligible for meta-analysis. There was a significant association between PSST and improvements in parental outcomes, including problem-solving skills (SMD, 0.43; 95% CI, 0.27-0.58), depression (SMD, -0.45; 95% CI, -0.66 to -0.23), distress (SMD, -0.61; 95% CI, -0.81 to -0.40), posttraumatic stress (SMD -0.39; 95% CI, -0.48 to -0.31), parenting stress (SMD, -0.62; 95% CI, -1.05 to -0.19), and QOL (SMD, 0.45; 95% CI, 0.15-0.74). For children, PSST was associated with better QOL (SMD, 0.76; 95% CI, 0.04-1.47) and fewer mental problems (SMD, -0.51; 95% CI, -0.68 to -0.34), as well as with less parent-child conflict (SMD, -0.38; 95% CI, -0.60 to -0.16). Subgroup analysis showed that PSST was more efficient for parents of children aged 10 years or younger or who were newly diagnosed with a CHC. Significant improvements in most outcomes were associated with PSST delivered online.
CONCLUSIONS AND RELEVANCE
These findings suggest that PSST for parents of children with CHCs may improve the psychosocial well-being of the parents, their children, and their families. Further high-quality RCTs with longer follow-up times and that explore physical and clinical outcomes are encouraged to generate adequate evidence.
Topics: Child; Humans; Chronic Disease; Parenting; Parents; Quality of Life; Problem Solving
PubMed: 38165710
DOI: 10.1001/jamapediatrics.2023.5753 -
Nature and Science of Sleep 2023Sleep disturbances are commonly reported by parents of children and adolescents with epilepsy. However, evidence synthesis including quality and quantity of sleep in... (Review)
Review
Sleep disturbances are commonly reported by parents of children and adolescents with epilepsy. However, evidence synthesis including quality and quantity of sleep in parents of children and adolescents with epilepsy is lacking. This systematic review and meta-analysis was conducted to quantify pooled mean estimates of parental sleep variables and to determine the prevalence of sleep disturbances in parents of children and adolescents with epilepsy. Five electronic databases, PubMed, Medline, Embase, PsychINFO, and CINAHL, were systematically searched from inception to September 2021. Eleven observational studies examining parents of pediatric patients aged <18 years with epilepsy using a quantitative measure of sleep duration, sleep quality, or sleep disturbance were reviewed. Our results showed that the pooled nocturnal sleep duration was 5.93 hours (95% CI: 4.64 to 7.21 hours). Overall sleep quality as estimated by the bias-adjusted pooled Pittsburgh Sleep Quality Index total score was 6.65 (95% CI: 5.98 to 7.33). Parents of children with epilepsy had significantly higher Pittsburgh Sleep Quality Index total scores compared to parents of healthy children (differences in means 1.84, 95% CI: 1.29 to 2.39). The pooled estimated prevalence of parental sleep disturbances was 58.1% (95% CI: 45.7% to 69.6%). Our findings demonstrate a high prevalence of sleep disturbances with poor sleep quality and substantial reductions in sleep time in parents of children and adolescents with epilepsy. Healthcare professionals in pediatric neurology clinics should proactively initiate screening for sleep disturbances in parents of children and adolescents with epilepsy and refer parents to a sleep specialist when necessary.
PubMed: 38164242
DOI: 10.2147/NSS.S437349 -
SAGE Open Medicine 2023In spite of, the need for evidence-based intervention on the potential harmful effects of self-medication practices during pregnancy, there is no systematic review and... (Review)
Review
BACKGROUND
In spite of, the need for evidence-based intervention on the potential harmful effects of self-medication practices during pregnancy, there is no systematic review and meta-analysis study regarding self-medication practices in Ethiopia. Therefore, the aim of this study is to determine prevalence of self-medication practice and associated factors among pregnant women in Ethiopia.
METHOD
We used PubMed, the Cochrane Library, Google Scholar, the Wiley Online Library, and African Journals Online to choose important studies. The -squared statistic method was used to check for heterogeneity between studies. Random effect model was used to estimate the pool prevalence of self-medication among pregnant women. Publication bias was determined by the funnel plot and Egger's test.
RESULT
A total of 11 studies with 4643 study participants were included in this review. The finding from the current meta-analysis showed that the overall prevalence of self-medication practice among pregnant women is 33.92% (95% CI: 23.15-44.70, ² value = 80.9%). First trimester of pregnancy (OR: 2.24, 95% CI: 1.44-3.47), women who faced health problems during pregnancies at the moment (OR: 5.7, 95% CI: 3.92-8.29), previous self-medication practice (OR: 13.07, 95% CI: 5.14-33.25) and previous pregnancy-related problems (OR: 2.065, 95% CI: 1.44-2.96) were positively associated with self-medication practice among pregnant women.
CONCLUSION
The prevalence of self-medication practices among pregnant women is found to be high. Self-medication practices of the pregnant women were significantly higher among women who were in first-trimester pregnancy, encountered illness during pregnancy, previous self-medication history, and previous pregnancy-related problems.Prospero registration number: CRD42023394907.
PubMed: 38146496
DOI: 10.1177/20503121231194429 -
JMIR Mental Health Dec 2023During the COVID-19 pandemic, the Oxford Precision Psychiatry Lab (OxPPL) developed open-access web-based summaries of mental health care guidelines (OxPPL guidance) in... (Review)
Review
BACKGROUND
During the COVID-19 pandemic, the Oxford Precision Psychiatry Lab (OxPPL) developed open-access web-based summaries of mental health care guidelines (OxPPL guidance) in key areas such as digital approaches and telepsychiatry, suicide and self-harm, domestic violence and abuse, perinatal care, and vaccine hesitancy and prioritization in the context of mental illness, to inform timely clinical decision-making.
OBJECTIVE
This study aimed to evaluate the practice of creating evidence-based health guidelines during health emergencies using the OxPPL guidance as an example. An international network of clinical sites and colleagues (in Australia, New Zealand, and the United Kingdom) including clinicians, researchers, and experts by experience aimed to (1) evaluate the clinical impact of the OxPPL guidance, as an example of an evidence-based summary of guidelines; (2) review the literature for other evidence-based summaries of COVID-19 guidelines regarding mental health care; and (3) produce a framework for response to future global health emergencies.
METHODS
The impact and clinical utility of the OxPPL guidance were assessed using clinicians' feedback via an international survey and focus groups. A systematic review (protocol registered on Open Science Framework) identified summaries or syntheses of guidelines for mental health care during and after the COVID-19 pandemic and assessed the accuracy of the methods used in the OxPPL guidance by identifying any resources that the guidance had not included.
RESULTS
Overall, 80.2% (146/182) of the clinicians agreed or strongly agreed that the OxPPL guidance answered important clinical questions, 73.1% (133/182) stated that the guidance was relevant to their service, 59.3% (108/182) said that the guidelines had or would have a positive impact on their clinical practice, 42.9% (78/182) that they had shared or would share the guidance, and 80.2% (146/182) stated that the methodology could be used during future health crises. The focus groups found that the combination of evidence-based knowledge, clinical viewpoint, and visibility was crucial for clinical implementation. The systematic review identified 2543 records, of which 2 syntheses of guidelines met all the inclusion criteria, but only 1 (the OxPPL guidance) used evidence-based methodology. The review showed that the OxPPL guidance had included the majority of eligible guidelines, but 6 were identified that had not been included.
CONCLUSIONS
The study identified an unmet need for web-based, evidence-based mental health care guidance during the COVID-19 pandemic. The OxPPL guidance was evaluated by clinicians as having a real-world clinical impact. Robust evidence-based methodology and expertise in mental health are necessary, but easy accessibility is also needed, and digital technology can materially help. Further health emergencies are inevitable and now is the ideal time to prepare, including addressing the training needs of clinicians, patients, and carers, especially in areas such as telepsychiatry and digital mental health. For future planning, guidance should be widely disseminated on an international platform, with allocated resources to support adaptive updates.
Topics: Humans; COVID-19; Mental Health; Pandemics; Psychiatry; Emergencies; Telemedicine
PubMed: 38133912
DOI: 10.2196/52901 -
Journal of Multidisciplinary Healthcare 2023Cancer has an impact not only on children but also on parents. Parents play the most crucial role in cancer's symptom control and management. However, as the primary... (Review)
Review
BACKGROUND
Cancer has an impact not only on children but also on parents. Parents play the most crucial role in cancer's symptom control and management. However, as the primary caretakers, parents are frequently unprepared or engage in inappropriate behavior when caring for their children. Increasing parents' role through empowerment is critical in pediatric cancer care.
PURPOSE
This systematic review aimed to identify the effect of empowerment interventions on parent and child outcomes in pediatric oncology.
METHODS
In this review, studies published between 2013 and 2023 in The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, Medline, and Scopus databases were identified using a search strategy to identify relevant studies that determined empowerment-based intervention for parents in the pediatric oncology. This study used the Joanna Briggs Institute (JBI) critical appraisal tools to assess the quality of the studies. This systematic review followed the recommended reporting items for systematic reviews and meta-analysis (PRISMA) standards.
RESULTS
Seven studies met the inclusion criteria: four randomized and three non-randomized experimental studies. Children range in age from 1-14 years. The intervention is mostly delivered through face-to-face learning using booklets or modules as a learning tool. The intervention is delivered in 2-6 sessions over 1-8 weeks, lasting 20-45 minutes each. In most studies, the interventions positively affect parents' outcomes (knowledge, caring behavior, distress, care burden, quality of life) and children's outcomes (oral mucositis, gastrointestinal complications, quality of life). The intervention, however, has no significant effect on the coping style. Barriers to implementation include parent-nurse commitment, the retention of parent-nurse participation, and more time spent to provide interventions.
CONCLUSION
Our study highlights that empowerment-based interventions positively impact parents and children. These findings suggest that an empowerment-based intervention should be developed to provide better cancer care for a parent and their children.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration number was CRD42023422834.
PubMed: 38058460
DOI: 10.2147/JMDH.S436394 -
Seminars in Reproductive Medicine Mar 2023Polycystic ovary syndrome (PCOS) is a complex endocrinopathy with wide-ranging implications for affected individuals. Literature has shown that patients with PCOS are... (Review)
Review
Polycystic ovary syndrome (PCOS) is a complex endocrinopathy with wide-ranging implications for affected individuals. Literature has shown that patients with PCOS are dissatisfied with the health information provided to them and that healthcare professionals lack adequate knowledge. In this narrative review with systematic approach, we explored the unmet information needs in PCOS care for both patients and healthcare professionals. A comprehensive search of databases yielded 41 relevant studies, predominantly of observational and qualitative design. Adults and adolescents with PCOS desire wide ranging health information and express a keen desire for weight management guidance. Importantly, discussions surrounding weight should be addressed knowledgeably and without weight bias. Therefore, healthcare professionals should facilitate access to comprehensive evidence-based resources. Lack of information drives PCOS-related online searches. Referral to support groups that promote individual agency in the self-management aspects of PCOS can furthermore guide patient resource acquisition. Patients prefer guidance from professionals that understand the psychosocial complexity of PCOS and can empathize with experiences of stigmatization or even marginalization depending on the cultural context of the individual. The findings informed the 2023 International Evidence-Based PCOS Guideline, recommending patient-centered communication, evidence-based information resources, and culturally sensitive approaches to optimize PCOS care.
Topics: Adolescent; Adult; Female; Humans; Communication; Health Personnel; Polycystic Ovary Syndrome
PubMed: 38052244
DOI: 10.1055/s-0043-1777086 -
Revista Espanola de Quimioterapia :... Feb 2024Children are at a higher risk of influenza infection compared to the general population. The World Organization Health and recommendations of the Vaccine Advisory...
OBJECTIVE
Children are at a higher risk of influenza infection compared to the general population. The World Organization Health and recommendations of the Vaccine Advisory Committee of the Spanish Association of Pediatrics contemplate annual vaccination as the most effective way to prevent the disease. Therefore, the purpose of this review was to update information on efficacy and safety in the anti -shed vaccine in children and adolescents.
METHODS
A search in four electronic databases (Scopus, Cumulative Index to Nursing and Allied Health Literature, Medline / Pubmed, Google Scholar and Cochrane), as well as a manual search to identify original research published between 2012 and 2022. The guidelines of ANALYSIS (PRISMACR) as a preferred report element for systematic reviews.
RESULTS
Seven original research articles were included where two issues of antigripal vaccination were identified in healthy children/adolescents and with pathologies. The efficacy (between approximately 30% and 80%) varied depending on the vaccine used and circulating subtypes. Most adverse reactions were mild intensity, and the most common local adverse event was pain in the injection site.
CONCLUSIONS
We positively highlight the safety of pediatric flu vaccination in analyzed studies, on the contrary, with respect to the efficacy of flu vaccination, we observe a wide variability of results. There is a clear need to continue conducting efficacy and safety studies in the child.
Topics: Adolescent; Child; Humans; Influenza Vaccines; Influenza, Human; Vaccination
PubMed: 38050694
DOI: 10.37201/req/101.2023 -
Journal of Medical Internet Research Dec 2023Persons diagnosed with serious chronic illnesses and their caretakers experience multiple types of financial costs that strain their income and generate financial... (Review)
Review
BACKGROUND
Persons diagnosed with serious chronic illnesses and their caretakers experience multiple types of financial costs that strain their income and generate financial distress. Many turn to medical crowdfunding (MCF) to mitigate the harms of these costs on their health and quality of life.
OBJECTIVE
This scoping review aims to summarize the research on MCF for persons diagnosed with serious chronic illness regarding study designs and methods; the responsible conduct of research practices; and study foci as they relate to stress, stress appraisals, and the coping processes.
METHODS
This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Eligible studies were conducted in countries designated as high income by the World Bank and focused on beneficiaries diagnosed with serious chronic illness. The findings of the included studies were summarized as they related to the key concepts in a conceptual framework derived from an established stress, appraisal, and coping framework and a conceptual model of financial toxicity in pediatric oncology.
RESULTS
Overall, 26 studies were eligible for inclusion in the review. The main findings included a lack of integration of qualitative and quantitative approaches and the inconsistent reporting of the responsible conduct of research practices. The included studies focused on financial stressors that contributed to financial burden, such as out-of-pocket payments of medical bills, basic living expenses, medical travel expenses, and lost income owing to illness-related work disruptions. Few studies addressed stress appraisals as threatening or the adequacy of available financial resources. When mentioned, appraisals related to the global financial struggle during the COVID-19 pandemic or the capacity of social network members to donate funds. The consequences of MCF included the receipt of 3 forms of social support (tangible, informational, and emotional), privacy loss, embarrassment, and the propagation of scientifically unsupported information. Studies found that friends and family tended to manage MCF campaigns. Although most of the studies (21/26, 81%) focused on monetary outcomes, a few (5/26, 19%) concentrated on peoples' experiences with MCF.
CONCLUSIONS
The identified methodological gaps highlight the need for more robust and reproducible approaches to using the copious data available on public MCF platforms. The integration of quantitative and qualitative methods will allow for nuanced explorations of the MCF experience. A more consistent elaboration of strategies to promote the responsible conduct of research is warranted to minimize risk to populations that are vulnerable and express concerns regarding the loss of privacy. Finally, an examination of the unanticipated consequences of MCF is critical for the development of future interventions to optimize existing supports while providing needed supports, financial and nonfinancial, that are lacking.
Topics: Child; Humans; Medical Tourism; Pandemics; Quality of Life; Health Expenditures; Chronic Disease
PubMed: 38048149
DOI: 10.2196/44530