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Journal of Advanced Nursing Nov 2022To synthesize quantitative evidence on levels of dignity during acute hospital admission and identify barriers and facilitators to patients' dignity or dignified care... (Review)
Review
AIMS
To synthesize quantitative evidence on levels of dignity during acute hospital admission and identify barriers and facilitators to patients' dignity or dignified care from the perspective of hospitalized patients. The secondary aim was to examine the relationship between dignity and demographic, clinical and psychological characteristics of patients.
DESIGN
A systematic review based on the protocol of the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline for reporting systematic reviews.
DATA SOURCES
Five electronic databases (PubMed, CINAHL, Embase, PsycINFO, AgeLine) were searched in February 2021, followed by backward-forward searching using Web of Science and Scopus databases.
REVIEW METHODS
Potentially eligible articles were scrutinized by two reviewers. Articles that met the eligibility criteria were appraised for quality using the Critical Appraisal Tool for Cross-Sectional Studies. Two reviewers extracted data for the review and resolved differences by consensus.
RESULTS
Out of 3052 potentially eligible studies, 25 met the inclusion criteria. Levels of dignity for hospitalized patients vary widely across geographic locations. Patients' dignity is upheld when healthcare professionals communicate effectively, maintain their privacy, and provide dignity therapy. Patients' perceptions of dignity were, in some studies, reported to be associated with demographic (e.g. age, marital status, gender, employment, educational status), clinical (e.g. hospitalization, functional impairment, physical symptoms) and psychological (e.g. depression, anxiety, demoralization, coping mechanisms) variables whilst other studies did not observe such associations.
CONCLUSION
Patients in acute care settings experience mild to a severe loss of dignity across different geographic locations. Patients' dignity is influenced by several demographic, clinical and psychological characteristics of patients.
IMPACT
The findings of the review support impetus for improvement in dignified care for hospitalized patients, addressing factors that facilitate or impede patients' dignity. Measures aimed at alleviating suffering, fostering functional independence and addressing patients' psychosocial needs can be used to promote dignity.
Topics: Cross-Sectional Studies; Hospitalization; Hospitals; Humans; Patient Reported Outcome Measures; Respect
PubMed: 35841334
DOI: 10.1111/jan.15370 -
BMJ Open Feb 2022Urine pregnancy tests are often inaccessible in low-income settings. Expanded provision of home pregnancy testing could support self-care options for sexual and... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Urine pregnancy tests are often inaccessible in low-income settings. Expanded provision of home pregnancy testing could support self-care options for sexual and reproductive health and rights. We conducted a systematic review of pregnancy self-testing effectiveness, values and preferences and cost.
DESIGN
Systematic review and meta-analysis using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.
DATA SOURCES
PubMed, CINAHL, LILACS and EMBASE and four trial registries were searched through 2 November 2020.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
We included trials and observational studies that compared urine self-testing for pregnancy to health worker-led pregnancy testing on effectiveness outcomes; quantitative and qualitative studies describing values and preferences of end users and health workers and costs of pregnancy self-testing.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Cochrane Collaboration and Evidence Project tools. Meta-analysis was conducted using random effects models. Findings were summarised in GRADE evidence profiles and synthesised qualitatively.
RESULTS
For effectiveness, four randomised trials following 5493 individuals after medical abortion showed no difference or improvements in loss to follow-up with home pregnancy self-testing compared with return clinic visits. One additional trial of community health workers offering home pregnancy tests showed a significant increase in pregnancy knowledge and antenatal counselling among 506 clients. Eighteen diverse values and preferences studies found support for pregnancy self-testing because of quick results, convenience, confidentiality/privacy, cost and accuracy. Most individuals receiving pregnancy self-tests for postabortion home management preferred this option. No studies reported cost data.
CONCLUSION
Pregnancy self-testing is acceptable and valued by end users. Effectiveness data come mostly from articles on postabortion care, and cost data are lacking. Greater availability of pregnancy self-tests, including in postabortion care and CHW programs, may lead to improved health outcomes.
PROSPERO REGISTRATION NUMBER
CRD42021231656.
Topics: Abortion, Induced; Female; Health Personnel; Humans; Pregnancy; Qualitative Research; Self-Testing
PubMed: 35228285
DOI: 10.1136/bmjopen-2021-054120 -
Contraception Jul 2022We sought to systematically review the literature on values and preferences for contraception among adolescents and young adults globally.
OBJECTIVE
We sought to systematically review the literature on values and preferences for contraception among adolescents and young adults globally.
STUDY DESIGN
We searched ten electronic databases for articles from January 1, 2005 through July 27, 2020 regarding end-users' values and preferences for contraception. We included studies that report specifically on people up to 25 years old.
RESULTS
Fifty-five studies out of 7,846 met our inclusion criteria. These studies included participants aged 10-25 years and were conducted in 16 countries. Through open coding, we identified 18 content areas. The five most commonly discussed content areas were: (1) general preferences regarding contraception, (2) contraceptive method benefits, (3) contraceptive method drawbacks, (4) the influence of the social context, and (5) the influence of myths and misconceptions, including safety and side effects, on contraceptive choice. Privacy and autonomy were important overarching themes, along with safety of the method. These considerations affected participants' access to and use of contraception.
CONCLUSION
Various social, cultural, and method-specific factors influence a young person's values and preferences around contraceptive methods. Understanding their values and preferences can help providers and programs improve contraceptive care for young people.
Topics: Adolescent; Contraception; Contraception Behavior; Contraceptive Agents; Contraceptive Devices; Family Planning Services; Humans; Young Adult
PubMed: 34077748
DOI: 10.1016/j.contraception.2021.05.018 -
Journal of the International AIDS... Jul 2023Pre-exposure prophylaxis (PrEP) is an important HIV prevention option. Two randomized trials have provided efficacy evidence for long-acting injectable cabotegravir... (Review)
Review
INTRODUCTION
Pre-exposure prophylaxis (PrEP) is an important HIV prevention option. Two randomized trials have provided efficacy evidence for long-acting injectable cabotegravir (CAB-LA) as PrEP. In considering CAB-LA as an additional PrEP modality for people at substantial risk of HIV, it is important to understand community response to injectable PrEP. We conducted a systematic review of values, preferences and perceptions of acceptability for injectable PrEP to inform global guidance.
METHODS
We searched nine databases and conference websites for peer-reviewed and grey literature (January 2010-September 2021). There were no restrictions on location. A two-stage review process assessed references against eligibility criteria. Data from included studies were organized by constructs from the Theoretical Framework of Acceptability.
RESULTS
We included 62 unique references. Most studies were observational, cross-sectional and qualitative. Over half of the studies were conducted in North America. Men who have sex with men were the most researched group. Most studies (57/62) examined injectable PrEP, including hypothetical injectables (55/57) or placebo products (2/57). Six studies examined CAB-LA specifically. There was overall interest in and often a preference for injectable PrEP, though there was variation within and across groups and regions. Many stakeholders indicated that injectable PrEP could help address adherence challenges associated with daily or on-demand dosing for oral PrEP and may be a better lifestyle fit for individuals seeking privacy, discretion and infrequent dosing. End-users reported concerns, including fear of needles, injection site pain and body location, logistical challenges and waning or incomplete protection.
DISCUSSION
Despite an overall preference for injectable PrEP, heterogeneity across groups and regions highlights the importance of enabling end-users to choose a PrEP modality that supports effective use. Like other products, preference for injectable PrEP may change over time and end-users may switch between prevention options. There will be a greater understanding of enacted preference as more end-users are offered anti-retroviral (ARV)-containing injectables. Future research should focus on equitable implementation, including real-time decision-making and how trained healthcare providers can support choice.
CONCLUSIONS
Given overall acceptability, injectable PrEP should be included as part of a menu of prevention options, allowing end-users to select the modality that suits their preferences, needs and lifestyle.
Topics: Male; Humans; Cross-Sectional Studies; Homosexuality, Male; Pre-Exposure Prophylaxis; Sexual and Gender Minorities; HIV Infections
PubMed: 37439057
DOI: 10.1002/jia2.26107 -
Public Health Sep 2022To systematically appraise the existing published literature on cervical cancer screening utilization, and associated barriers and facilitators, in Nepal. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To systematically appraise the existing published literature on cervical cancer screening utilization, and associated barriers and facilitators, in Nepal.
STUDY DESIGN
Systematic literature review and meta-analysis.
METHODS
PubMed/MEDLINE, CINAHL, Scopus, Embase, and, Google Scholar were systematically searched using Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. All quantitative and qualitative studies reporting cervical cancer screening (using the Pap smear test or visual inspection with acetic acid or human papillomavirus test) utilization, barriers, and facilitators for screening were identified. A meta-analysis was performed to estimate Nepal's pooled cervical cancer screening utilization proportion.
RESULTS
The search yielded 97 records, of which 17 studies were included. Fifteen studies were quantitative and two were qualitative. Of the 17 studies, six were hospital-based and six were community-based. The pooled cervical cancer screening utilization proportion (using Pap smear test) among Nepalese women was 17% from the studies in the hospital settings, and 16% in the community. Six studies reported barriers to cervical cancer screening, of which four reported embarrassments related to the gynecological examination and a low level of knowledge on cervical cancer. Three (of four) studies reported health personnel, and two studies reported screening services-related facilitators for cervical cancer screening.
CONCLUSION
Our review reported that cervical cancer screening utilization (16%) is more than four times lower than the national target (70%) in Nepal. Multiple barriers such as low levels of knowledge and embarrassment are associated with cervical cancer screening utilization. Health personnel's gender, counseling, and privacy of screening services were commonly reported facilitators. These findings could help to inform future research, and policy efforts to increase cervical cancer screening utilization in Nepal.
Topics: Early Detection of Cancer; Female; Humans; Mass Screening; Nepal; Papanicolaou Test; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 35863158
DOI: 10.1016/j.puhe.2022.06.007 -
Journal of Medical Internet Research Mar 2022Mental health apps (MHAs) provide opportunities for accessible, immediate, and innovative approaches to better understand and support the treatment of mental health... (Review)
Review
BACKGROUND
Mental health apps (MHAs) provide opportunities for accessible, immediate, and innovative approaches to better understand and support the treatment of mental health disorders, especially those with a high burden, such as bipolar disorder (BD). Many MHAs have been developed, but few have had their effectiveness evaluated.
OBJECTIVE
This systematic scoping review explores current process and outcome measures of MHAs for BD with the aim to provide a comprehensive overview of current research. This will identify the best practice for evaluating MHAs for BD and inform future studies.
METHODS
A systematic literature search of the health science databases PsycINFO, MEDLINE, Embase, EBSCO, Scopus, and Web of Science was undertaken up to January 2021 (with no start date) to narratively assess how studies had evaluated MHAs for BD.
RESULTS
Of 4051 original search results, 12 articles were included. These 12 studies included 435 participants, and of these, 343 had BD type I or II. Moreover, 11 of the 12 studies provided the ages (mean 37 years) of the participants. One study did not report age data. The male to female ratio of the 343 participants was 137:206. The most widely employed validated outcome measure was the Young Mania Rating Scale, being used 8 times. The Hamilton Depression Rating Scale-17/Hamilton Depression Rating Scale was used thrice; the Altman Self-Rating Mania Scale, Quick Inventory of Depressive Symptomatology, and Functional Assessment Staging Test were used twice; and the Coping Inventory for Stressful Situations, EuroQoL 5-Dimension Health Questionnaire, Generalized Anxiety Disorder Scale-7, Inventory of Depressive Symptomatology, Mindfulness Attention Awareness Scale, Major Depression Index, Morisky-Green 8-item, Perceived Stress Scale, and World Health Organization Quality of Life-BREF were used once. Self-report measures were captured in 9 different studies, 6 of which used MONARCA. Mood and energy levels were the most commonly used self-report measures, being used 4 times each. Furthermore, 11 of the 12 studies discussed the various confounding factors and barriers to the use of MHAs for BD.
CONCLUSIONS
Reported low adherence rates, usability challenges, and privacy concerns act as barriers to the use of MHAs for BD. Moreover, as MHA evaluation is itself developing, guidance for clinicians in how to aid patient choices in mobile health needs to develop. These obstacles could be ameliorated by incorporating co-production and co-design using participatory patient approaches during the development and evaluation stages of MHAs for BD. Further, including qualitative aspects in trials that examine patient experience of both mental ill health and the MHA itself could result in a more patient-friendly fit-for-purpose MHA for BD.
Topics: Adult; Bipolar Disorder; Female; Humans; Male; Mobile Applications; Outcome Assessment, Health Care; Quality of Life; Surveys and Questionnaires
PubMed: 35319470
DOI: 10.2196/29114 -
Schizophrenia Research Apr 2023Schizophrenia spectrum disorders (SSD) have heterogeneous outcomes. If we could predict individual outcome and identify predictors of outcome, we could personalize and... (Meta-Analysis)
Meta-Analysis Review
Systematic review and meta-analysis on predictors of prognosis in patients with schizophrenia spectrum disorders: An overview of current evidence and a call for prospective research and open access to datasets.
BACKGROUND
Schizophrenia spectrum disorders (SSD) have heterogeneous outcomes. If we could predict individual outcome and identify predictors of outcome, we could personalize and optimize treatment and care. Recent research showed that recovery rates tend to stabilize early in the course of disease. Short- to medium- term treatment goals are most relevant for clinical practice.
METHODS
We performed a systematic review and meta-analysis to identify predictors of outcome ≤1 year in prospective studies of patients with SSD. For our meta-analysis risk of bias was assessed with the QUIPS tool.
RESULTS
178 studies were included for analysis. Our systematic review and meta-analysis showed that the chance of symptomatic remission was lower in males, and in patients with longer duration of untreated psychosis, more symptoms, worse global functioning, more previous hospital admissions and worse treatment adherence. The chance of readmission was higher for patients with more previous admissions. The chance of functional improvement was lower in patients with worse functioning at baseline. For other proposed predictors of outcome, like age at onset and depressive symptoms, limited to no evidence was found.
DISCUSSION
This study illuminates predictors of outcome of SSD. Level of functioning at baseline was the best predictor of all investigated outcomes. Furthermore, we found no evidence for many predictors proposed in original research. Possible reasons for this include the lack of prospective research, between-study heterogeneity and incomplete reporting. We therefore recommend open access to datasets and analysis scripts, enabling other researchers to reanalyze and pool the data.
Topics: Humans; Access to Information; Prognosis; Prospective Studies; Psychotic Disorders; Schizophrenia
PubMed: 36863229
DOI: 10.1016/j.schres.2023.02.024 -
Sensors (Basel, Switzerland) Nov 2022Recently, the number of vehicles equipped with wireless connections has increased considerably. The impact of that growth in areas such as telecommunications,... (Review)
Review
Recently, the number of vehicles equipped with wireless connections has increased considerably. The impact of that growth in areas such as telecommunications, infotainment, and automatic driving is enormous. More and more drivers want to be part of a vehicular network, despite the implications or risks that, for instance, the openness of wireless communications, its dynamic topology, and its considerable size may bring. Undoubtedly, this trend is because of the benefits the vehicular network can offer. Generally, a vehicular network has two modes of communication (V2I and V2V). The advantage of V2I over V2V is roadside units' high computational and transmission power, which assures the functioning of early warning and driving guidance services. This paper aims to discover the principal vulnerabilities and challenges in V2I communications, the tools and methods to mitigate those vulnerabilities, the evaluation metrics to measure the effectiveness of those tools and methods, and based on those metrics, the methods or tools that provide the best results. Researchers have identified the non-resistance to attacks, the regular updating and exposure of keys, and the high dependence on certification authorities as main vulnerabilities. Thus, the authors found schemes resistant to attacks, authentication schemes, privacy protection models, and intrusion detection and prevention systems. Of the solutions for providing security analyzed in this review, the authors determined that most of them use metrics such as computational cost and communication overhead to measure their performance. Additionally, they determined that the solutions that use emerging technologies such as fog/edge/cloud computing present better results than the rest. Finally, they established that the principal challenge in V2I communication is to protect and dispose of a safe and reliable communication channel to avoid adversaries taking control of the medium.
Topics: Computer Security; Confidentiality; Cloud Computing; Computer Communication Networks; Communication
PubMed: 36501828
DOI: 10.3390/s22239123 -
JMIR Medical Informatics Feb 2023Over the past 2 decades, various desktop and mobile telemedicine systems have been developed to support communication and care coordination among distributed medical... (Review)
Review
BACKGROUND
Over the past 2 decades, various desktop and mobile telemedicine systems have been developed to support communication and care coordination among distributed medical teams. However, in the hands-busy care environment, such technologies could become cumbersome because they require medical professionals to manually operate them. Smart glasses have been gaining momentum because of their advantages in enabling hands-free operation and see-what-I-see video-based consultation. Previous research has tested this novel technology in different health care settings.
OBJECTIVE
The aim of this study was to review how smart glasses were designed, used, and evaluated as a telemedicine tool to support distributed care coordination and communication, as well as highlight the potential benefits and limitations regarding medical professionals' use of smart glasses in practice.
METHODS
We conducted a literature search in 6 databases that cover research within both health care and computer science domains. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology to review articles. A total of 5865 articles were retrieved and screened by 3 researchers, with 21 (0.36%) articles included for in-depth analysis.
RESULTS
All of the reviewed articles (21/21, 100%) used off-the-shelf smart glass device and videoconferencing software, which had a high level of technology readiness for real-world use and deployment in care settings. The common system features used and evaluated in these studies included video and audio streaming, annotation, augmented reality, and hands-free interactions. These studies focused on evaluating the technical feasibility, effectiveness, and user experience of smart glasses. Although the smart glass technology has demonstrated numerous benefits and high levels of user acceptance, the reviewed studies noted a variety of barriers to successful adoption of this novel technology in actual care settings, including technical limitations, human factors and ergonomics, privacy and security issues, and organizational challenges.
CONCLUSIONS
User-centered system design, improved hardware performance, and software reliability are needed to realize the potential of smart glasses. More research is needed to examine and evaluate medical professionals' needs, preferences, and perceptions, as well as elucidate how smart glasses affect the clinical workflow in complex care environments. Our findings inform the design, implementation, and evaluation of smart glasses that will improve organizational and patient outcomes.
PubMed: 36853760
DOI: 10.2196/44161 -
Frontiers in Digital Health 2021The analysis of clinical free text from patient records for research has potential to contribute to the medical evidence base but access to clinical free text is...
The analysis of clinical free text from patient records for research has potential to contribute to the medical evidence base but access to clinical free text is frequently denied by data custodians who perceive that the privacy risks of data-sharing are too high. Engagement activities with patients and regulators, where views on the sharing of clinical free text data for research have been discussed, have identified that stakeholders would like to understand the potential clinical benefits that could be achieved if access to free text for clinical research were improved. We aimed to systematically review all UK research studies which used clinical free text and report direct or potential benefits to patients, synthesizing possible benefits into an easy to communicate taxonomy for public engagement and policy discussions. We conducted a systematic search for articles which reported primary research using clinical free text, drawn from UK health record databases, which reported a benefit or potential benefit for patients, actionable in a clinical environment or health service, and not solely methods development or data quality improvement. We screened eligible papers and thematically analyzed information about clinical benefits reported in the paper to create a taxonomy of benefits. We identified 43 papers and derived five themes of benefits: health-care quality or services improvement, observational risk factor-outcome research, drug prescribing safety, case-finding for clinical trials, and development of clinical decision support. Five papers compared study quality with and without free text and found an improvement of accuracy when free text was included in analytical models. Findings will help stakeholders weigh the potential benefits of free text research against perceived risks to patient privacy. The taxonomy can be used to aid public and policy discussions, and identified studies could form a public-facing repository which will help the health-care text analysis research community better communicate the impact of their work.
PubMed: 34713089
DOI: 10.3389/fdgth.2021.606599