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Objectives: To systematically review longitudinal studies to determine the prevalence and time-course of fatigue after stroke (post-stroke fatigue, PSF). Material(s) and Method(s): A study protocol was registered on PROSPERO. Five databases (PUBMED, MEDLINE, EMBASE, PSYCHINFO and CINAHL) were searched (10th to 13th June 2022). Citations were imported into Covidence software, s screened by one author, full texts of potentially eligible studies retrieved, and one author applied inclusion criteria (longitudinal cohort studies of patients with acute stroke). Quality assessment of included studies was performed using the Joanna Briggs institute tool for observational studies. A meta-analysis was performed for the prevalence of PSF at different time-points after stroke onset, and changes over time. Subgroup analyses were performed by type of stroke and study location. Result(s): A total of 13,991 records were returned from the searches. Nine studies were eligible and were included. Five studies were of strong and four of moderate quality. Of the studies suitable for meta-analysis, the prevalence of PSF was 42% (95% CI - 39-44%) at six months after ischaemic stroke;and 34% (95% CI - 28-40%) at one year in stroke survivors excluding subarachnoid haemorrhage. Subgroups analyses found no differences in PSF prevalence between Asian countries and others. Of those with PSF at first assessment, 66% (95% CI - 61-71%) remained fatigued at follow-up;of those without PSF initially, 15% (95% CI - 11-20%) developed PSF at follow-up. Conclusion(s): PSF is common and around two-thirds with fatigue remain fatigued. This justifies the development of new interventions for PSF treatment.Copyright © 2023 The Author(s)
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The pandemic caused by the COVID-19 has influenced peoples' lifestyles. Home-confinement scenario might impair physical activity practice, resulting in new challenges for maintaining health during the pandemic of the COVID-19. The aim of this study was to present the current context of COVID-19 pandemic, its impact on the practice of physical activity, and the strategies available to remain active during home-confinement according to international recommendations. The narrative review was conducted based on studies that analyzed themes related to physical activity and COVID-19. Virtual Health Library (VHL), CINAHL, Cochrane, PsycINFO, PubMed, ScienceDirect, Scientific Electronic Library Online (SciELO), Scopus, SPORTDiscus, and Web of Science databases were searched for relevant papers. Although an increased number of experimental studies are still necessary, people should devote more time to physical activity during social isolation. Guidelines were adjusted by international entities in order to encourage people to remain active, through practice regular physical activity, using alternative strategies such as fitness program applications, exergames, online exercise classes, and even chores. Reduction of prolonged sedentary behavior could contribute to maintain health and improve quality of life during the COVID-19 pandemic.Copyright © Universidad Peruana Cayetano Heredia, Facultad de Medicina Alberto Hurtado. All Rights Reserved.
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Background Due to climate change, the likelihood of an extreme infectious disease events-similar to the COVID-19 pandemic-is very likely to increase. Anticipating and preparing for such events Is therefore essential. A setting of high risk in such an event are long-term care facilities (LTCF), which accounted for 30-60 % of all COVID-19 related deaths in most high-income countries (HIC). To prevent, mitigate, and avoid potential adverse consequences of future outbreaks of viral respiratory pathogens with pandemic potential (e.g., SARSCoV-2, SARS, MERS, influenza) in LTCFs, a systematic review will analyze which non-pharmacological interventions (NPI) are effective in LTCFs. Methods We conducted literature searches in Medline, Embase, CINAHL, and two comprehensive specialized registries focused on COVID-19-related literature. We included experimental, quasi-experimental, and specific observational studies assessing the effect of NPIs implemented in LTCFs regarding the outcomes: infections, outbreaks, hospitalizations and deaths due to the viral pathogens of interest and adverse consequences. Screening for eligibility and risk-of-bias (RoB) assessment was done in duplicate. For RoB assessment, we used the RoB2 and ROBINS-I tool. We synthesized findings narratively, focusing on the direction of effect. The certainty of evidence was evaluated using GRADE. Results We included 16 observational studies, 14 of which focused on intervention effectiveness. All were conducted in HIC and most focused on SARSCoV-2 (n = 14). There were serious concerns regarding RoB in almost all studies. We found low/very low certainty of evidence for the effectiveness of entry regulation measures (n = 1), regular testing of residents/staff (n = 5), combined outbreak control measures (n = 2), and for combinations of multiple NPIs (n = 3) in preventing outbreaks or mitigating their consequences. The evidence on the effectiveness of hand and surface hygiene interventions showed mixed results (n = 4). We found mixed results regarding adverse mental health outcomes due to visiting restrictions. Conclusion This review indicates a number of measures which could be effective in protecting residents and staff in LTCFs in upcoming extreme infectious disease epidemics, which are expected to become more likely in the future. Furthermore, we can point out several gaps in the evidence which require further research and specific study designs to improve pandemic preparedness in LTCFs.
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Introduction: Due to lockdown measures associated with the COVID 19 pandemic (1), there were substantial changes to healthcare delivery, including the suspension of face-to-face medical appointments, expansion of telehealth and changes to medication protocols.(2) It is important to learn from the successes and challenges of this period to ensure we adapt and improve how we support people to take medicines in the future. Aim(s): We sought to conduct a systematic review to explore the different approaches used to deliver medicines management services for people living with long term conditions (LTCs) during the pandemic and identify strategies that could be integrated into standard care. Method(s): We conducted a systematic review across 3 large databases: MEDLINE (OVID), EMBASE (OVID) and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Our research question and search strategy was developed using the PICO framework (Population: adults with LTCs, Intervention: medicines management during the COVID 19 pandemic;no comparison group. Outcome(s): any aspect relating to medicines management. Search terms relating to 'long term conditions', 'medication management' and 'COVID-19' were used. One reviewer (LM) screened all titles, s, and full texts. We included studies discussing medication management of LTCs, in patients of all ages and healthcare settings, throughout the pandemic. Primary literature sources, feasibility studies and case studies, were included. We excluded studies solely focusing on disease monitoring, or the treatment of COVID/ 'long Covid'. One reviewer performed a thematic analysis, synthesising the findings into themes and sub-themes, which were discussed with a further reviewer (CT). A critical appraisal was performed using the Critical Appraisal Skills Programme checklists. Result(s): The search returned 2365 results. After deduplication, articles were removed at the title (n=1070) (n=813) and full text (n=232) stages. 31 studies were included. Studies were conducted in India (n=6), US (n=5), international (n=4), France (n=2), Italy (n=2), and one each from China, Japan, Jordan, Mexico, Morocco, Nigeria, Romania, Saudi Arabia, Spain, UK, UK and US, and location not specified. Most studies (n=17) employed subjective methods of data collection (surveys/ questionnaires). We identified 6 themes. These were: changes in consultation type, for instance using teleconsultations and smartphone apps to monitor glucose control and diabetic management. Studies described temporary changes to treatment protocols e.g., using oral chemotherapy to reduce the need for in-person appointments and reduce the infection risk associated with intravenous administration. Control of certain conditions for example epilepsy was reduced in some studies. Patients missed doses due to drug shortages associated with disruptions in the medication supply chain, particularly in low-income countries. Finally, we identified prescribing trend changes in certain classes of medicines (e.g. reduced biologic usage due to immunosuppression risk) and an increase in patients self-medicating conditions including anxiety and depression, with associated safety risks. Conclusion(s): This review suggested that certain medical conditions such as diabetes and hypertension were more suited to remote monitoring with technological interventions such as smartphone apps. While other conditions e.g., cancer and epilepsy, demonstrated a greater need for in-person care. Countries of lower socioeconomic status were disproportionately affected by the pandemic.
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Introduction/Aim: Although there remains insufficient evidence regarding singing programs as effective strategies for achieving clinically significant health outcomes, this non-pharmacological intervention appears to be subjectively low-risk and well-tolerated by people with advanced chronic respiratory diseases (CRD). Method(s): A meta-synthesis was undertaken to examine the current qualitative evidence regarding the experiences of singing for lung health programs in adults with advanced CRD and their careers. Electronic databases (Medline, CINAHL, PsycINFO, and EMBASE) were searched for qualitative studies published in English. Qualitative data was extracted and analysed, which generated descriptive and analytical themes. Result(s): Themes identified from seven included studies consisted of anticipation and reluctance to participate;physical and psychological benefits;new sense of purpose and enjoyment;social connection and achievement;and broad views regarding program structure and content. The themes were categorised into three time points to explore participants' perspectives before, during and after engaging in the singing program. Over time participants transitioned from anxiety to mastery of their chronic condition as the singing program progressed. Participants, however, raised concerns regarding several singing technicalities, the lack of ongoing support after the singing programs' conclusion and the social impacts of transitioning the sessions online during the COVID-19 pandemic. Conclusion(s): The increasing body of qualitative literature suggests that participants enjoyed the singing program and derived psychological, social and health benefits, not necessarily captured in quantitative studies. Future work should explore participants' experiences through qualitative, longitudinal methods to gain further insight into the acceptability and feasibility of singing programs and inform broader implementation of the intervention.
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Introduction/Aim: Self-management is considered important in people with pulmonary fibrosis (PF);however, components of self-management that are relevant to PF are not well defined. This study aimed to identify the common self-management components used in PF. Method(s): A scoping review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. The protocol was registered with Open Science Framework database (doi: https://doi.org/10.17605/OSF.IO/EUZ6S). A systematic search was conducted on August 16, 2022, using five electronic databases (Medline, Embase, PsychInfo, CINAHL and the Cochrane central register of controlled trials). Search results were screened and studies were included if they (i) described any educational, behavioural and support components that aimed at facilitating self-management;(ii) involved adults with PF;and (iii) employed quantitative, qualitative or mixed methods. Two researchers performed record screening and data extraction independently followed by discussions of discrepancies. Result(s): Of the 27081 records screened, 87 studies were included (39% observational studies, 26% randomised controlled trials). The most common self-management components were patient education (78%), information or support for managing physical symptoms (66%) and enhancing psychosocial wellbeing (54%). Majority of the included studies (71%) were rehabilitation programs with evidence of self-management training such as home exercise program and breathing training. Other studies included palliative care programs consisting of components such as patient education and care goal setting (12%), support programs for managing medication (4%), home-based self-monitoring training (4%), disease management programs (4%), mindfulness-focused stress reduction program (1%), telemedicine service delivered during the COVID-19 outbreak that included strategies to prevent infections and self-monitoring of clinical parameters (1%) and PF-specific educational and support website (1%). Over half of the interventions were provided by a multidisciplinary team. Conclusion(s): This review identified the common components used to promote self-management in PF. These findings help to guide the development of optimal interventions to support self-management in PF.
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Introduction: The rapid spread of antimicrobial resistance (AMR), which causes a serious threat to both human health and the global economy, is primarily linked to the overuse and misuse of antibacterial drugs. The AMR crisis is significantly impacted by the use of antibacterial drugs in primary care (1). Within these settings, oral antibacterial drugs are considered one of the most frequently prescribed group of medicines. It has been claimed that within primary care, the proportion of antibacterial drug prescribing is higher outside the regular working hours (out-of-hours (OOH) services) compared to in-hours (IH) services (2). Aim(s): To identify the existing body of literature around oral antibacterial drug prescribing within primary care OOH services. Method(s): The scoping review was guided by the Joanna Briggs Institute manual and reported in accordance with the PRISMA-ScR. Seven electronic databases (Medline, Embase, Emcare, CINAHL, Scopus, Web of Science, and Cochrane Library) were systematically searched, and the results were screened against pre-defined eligibility criteria. Original and secondary analysis studies that addressed oral antibacterial prescribing in OOH primary care and were published in English were included. Titles and s were independently screened by three reviewers. A pre-piloted extraction form was used to extract relevant data. A narrative synthesis approach was used to summarise the results. Result(s): The initial search yielded 834 records. Upon screening, 28 publications fulfilled the eligibility criteria. Included studies originated from nine high-income countries, with the most frequent being the United Kingdom (six studies, 21.4%) followed by Belgium (five studies, 17.9%). Literature on antibacterial prescribing in OOH services was mostly from quantitative studies (23 studies, 82.14%), with only a few employing a qualitative design (five studies, 17.86%). Different themes and sub-themes were identified across these studies. The majority discussed antibacterial prescribing data in terms of the commonly prescribed medications and/or associated conditions. Eleven studies provided a comparison between IH and OOH settings. Seven studies reported the trends of prescribing over time;of these, three explored prescribing trends before and during COVID-19. The impact of intervention implementation on prescribing was investigated in two studies, an educational intervention in one study and the use of an interactive booklet in the other study. Four studies assessed the quality/appropriateness of prescribing either by adherence to guidelines or antibiotic prescribing quality indicators. Limited studies explored prescribing predictors and patients' expectations and satisfaction with OOH services. In contrast, qualitative studies focussed more on exploring prescribers' experiences, perspectives, behaviours, and the challenges they face during consultations within OOH settings which may influence their decision-making process. Of these, one study explored why patients consult OOH services and how they communicate their problems. Conclusion(s): This review shows the key areas around oral antibacterial prescribing in primary care OOH services. While there is a satisfactory number of published articles covering various areas within OOH, the use of different approaches to OOH across countries may confound the comparison of practice. A strength of this work is using three reviewers to screen identified records independently. Further research is needed to provide a better understanding of current practice in these settings and how it may be contributing to AMR.
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Shift workers are known to have poorer metabolic health outcomes compared to day workers,(1) whilst those who work in rotating shift work roles have the highest risk.(2) To date, overall energy intake in shift workers has been found to be similar to day workers,(3) but it is unknown whether energy intake in workers on rotating shift schedules may be a contributing factor to the observed higher chronic disease risk. A systematic review and meta-analysis were conducted to explore how rotating shift work schedules impact total energy intake compared to fixed day/morning work schedules. Intra-person differences in energy intake amongst rotating shift workers on day/morning versus night shifts was also examined. Searches were conducted on CINAHL, Cochrane, Embase, MEDLINE PsycINFO and Scopus databases to identify articles reporting energy intake for rotating shift workers and fixed day workers. Articles were screened in duplicate against inclusion criteria using Covidence software. Data were extracted by one reviewer and checked independently by one of three reviewers. Quality assessment of included studies was assessed in duplicate using the American Dietetic Association (ADA) Quality Criteria Checklist for Primary Research. Meta-analyses were performed in RevMan using a random effects model, to compare mean difference in 24-hour energy intake with 95% confidence intervals. Heterogeneity was assessed with the I-squared test (I2). Thirty-one studies (n = 18196 participants) met the inclusion criteria and were included in the review with data for the two meta-analyses comprising 18 studies and seven studies, respectively. Overall, rotating shift workers had significantly higher average 24-hour energy intake compared to fixed day or morning work schedules (weighted mean difference [WMD] = 264 kJ;95% CI [70, 458], p < 0.008;I2 = 63%). Within rotating shift workers, the mean difference in 24-hour energy intake across morning/day shifts compared to night shifts was not statistically significant (WMD = 101 kJ;95% CI [-651, 852];p = 0.79;I2 = 77%). Results indicate workers on rotating shift schedules had a higher average 24-hour energy intake compared to their fixed day schedule counterparts. However, energy intake across shift schedules did not differ for individuals working this pattern. A higher 24-hour energy intake in rotating shift workers can contribute to gradual weight gain and higher metabolic risk in rotating shift work populations.
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Introduction: The COVID-19 pandemic has created a chronically stressful work environment for healthcare workers, increasing the negative psychological effects experienced. Aim(s): The authors of this systematic review and meta-analysis aimed to assess the impact of COVID-19 on frontline healthcare workers' mental health, using various psychological outcomes. Method(s): A systematic literature search was conducted up until June 30th, 2022 on MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Science, ClinicalTrials.gov, and Dissertations and Theses. Result(s): This meta-analysis includes 22 cross-sectional studies with a total of 32,690 participants. Anxiety (ES = 0.23, CI: [0.18, 0.28]), depression (ES = 0.17, CI: [0.10, 0.24]), PTSD (ES = 0.28, CI: [0.08, 0.48]), and stress (ES = 0.35, CI: [0.17, 0.53]) was significantly prevalent among frontline healthcare workers. Conclusion(s): Our results suggested that European healthcare workers were experiencing high psychological symptoms associated with the COVID-19 pandemic. The monitoring of their psychological symptoms, preventative interventions, and treatments should be implemented to prevent, reduce, and treat the worsening of their mental health.Copyright © 2023 The Authors. Published by Semmelweis University, Institute of Mental Health, Budapest.
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Alcohol use disorder (AUD) is highly prevalent in Australia.(1) However, best practice management of AUD in the community post discharge from hospital is not well articulated in the literature. In particular, given the harmful effects excessive alcohol consumption has on nutritional status there is a need to identify what approaches are being utilised in managing this vulnerable group.(2) Hence the aim of this scoping review was to identify the current approaches and outcomes with respect to nutritional care as identified by the Nutrition Care Process Model (NCPM) for patients discharged from hospital post alcohol withdrawal. This scoping review was registered with OpenScience Framework (words: PubMed, CINAHL, Web of Science and Scopus. Articles included were published between January 1995 and April 2022 Eligible articles were screened independently by pairs of reviewers, and consensus was reached across pairs to provide inter-rater and inter-consensus reliability. Screening and data extraction was conducted using Covidence by reviewers HM, ATM, CM, SG Fourteen articles were eligible for inclusion. Approaches to nutritional care was identified based on the intervention utilised and in comparison to the NCPM.(3) Key findings were screening for nutrition related problems and anthropometry measures were the most evaluated (n = 10), whereas practices of referral providing continuum of care were highlighted in only a minority of studies (n = 3). Education interventions included Motivational Interviewing and cognitive behavioural therapy sessions (4) (n = 7). Few studies (n = 4) which combined harm-reduction counselling with nutritional approaches and education interventions showed significant improvement (p < 0.05) in outcome measures of nutritional care. This was measured through the improvement in nutritional status (positive eating habits, decrease in nutrition-related impact symptoms, and WHO Quality of Life (QoL) health and physical domains) Limitations include varying aims of analysis and a paucity of information in this area. There is a need for further studies to be completed in this area to understand the nature of this complex issue and recommend effective strategies to improve health outcomes for individuals and populations.
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Background: Inflammatory bowel diseases (IBDs) are chronic diseases that require routine hospital visits and long-term medical treatment for control of disease activity. Factors such as gender may impact the use and need for healthcare. This systematic review aimed to summarize what is known about sex differences in the risk of bowel surgery in patients with IBD Methods: Embase, Medline, CINAHL, and Web of Science abstracts (January 2012 to January 2022) were searched systematically for observational studies examining associations between sex and risk of bowel surgery. Screening and data extraction were performed independently by two reviewers using Covidence. Study data were analysed and reported in accordance with the PRISMA guidelines. Quality assessment of included studies was conducted using the Newcastle- Ottawa Scale for cohort studies. Pooled hazard ratios (HRs) were calculated using random effects model meta-analysis for the risk of surgery In addition, meta-analysis was undertaken to assess the risk of surgery by IBD subtype. The between-study heterogeneity was assessed by calculating the tau-squared and the I-squared statistics Results: Of 9,902 screened articles, 36 studies were included in the review Most studies were retrospective by design (74.6%). In total, 21 of 36 studies found statistically significant sex-based differences in the risk of bowel surgery for IBD patients. A pooled estimate of HRs for the 13 studies eligible for meta-analysis showed a statistically significant increased risk of bowel surgery among male patients (HR: 1.43 [95% confidence interval (CI): 1.09;1.86]) compared to female patients. The between-study heterogeneity was high (I2=88.60 [60.60;96.33] and tau2=0.17 [0.03;0.58]) indicating that the pooled estimate should be interpreted with caution. These findings were consistent with the subgroup analysis for ulcerative colitis (HR: 1.78 [1.16;2.72]), but no statistically significant sex difference in the risk of surgery in Crohn's disease patients was found (HR: 1.26 [0.82;1.93]) Conclusion(s): Sex differences exist in the risk of bowel surgery in IBD patients, and further research is needed to address the underlying causes and consequences of these disparities. It is unclear whether differences are due to underlying biologic mechanisms or are associated with healthcare system related factors such as differential access to care. Surgical procedures or the lack or delay thereof, will have consequences for the further disease trajectory.
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Background: Correct use of personal protective equipment is vital to minimise the risk of patients acquiring healthcare-associated infections. These measures are also important in preventing exposure to occupational infection. During the COVID-19 pandemic, the use of personal protective equipment was associated with anxiety, uncertainty and additional training requirements. This study investigated midwives' experiences using personal protective equipment during the pandemic. Methods: This systematic scoping review searched seven academic databases and grey literature. Data analysis was conducted using a thematic analysis framework. Results: A total of 16 studies were included. Four themes were found: 'fear and anxiety', 'personal protective equipment/resources', 'education and training needs' and 'communication'. Conclusions: Management and administration inconsistences, logistical issues and lack of training on personal protective equipment led to midwives' negative feedback. A gap has been identified in the exploration of midwives' experiences as personal protective equipment end-users during the COVID-19 pandemic.
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Objectives: To determine how the addition of health literacy interventions may generate additional benefits and impact quality of life and health outcomes for those with atrial fibrillation (AF). Material(s) and Method(s): Searches were carried out according to six databases (MEDLINE, EMBASE, Web of Science, CINAHL, Emcare, Cochrane library) alongside gray literature (Google Scholar). Studies were included if their evaluated interventions improved any dimension, typology, or aspect of health literacy. Citations were exported into Covidence for duplicate removal, and article screening. Extraction will occur using a standardized extraction tool and studies will be synthesized using best evidence synthesis. The Downs and Black's checklist will be used for the risk of bias and the assessment of the overall quality of evidence will utilize the Grading of Recommendations, Assessment, Development, and Evaluation approach (GRADE). Result(s): A total of 2851 articles were identified for screening, with 59 included for quality assessment according to the Downs and Black checklist. The majority of articles involved randomized controlled trials or pre-post studies. Health literacy interventions included brochures (n = 3), web-( n = 12), visual-( n = 10), and smartphone-based (n = 14), to group sessions (n = 8) and specific integrated AF clinics (n = 12). General themes from these articles involved mostly improvements in AF knowledge, adherence/activation, and quality of life/clinical outcomes. Conclusion(s): This review extends the concept of precision health to also include health literacy interventions. Further research with aims to clarify the impact of specific modes of interventions will greatly assist in the application of health literacy interventions in conjunction with precision health in those with AF.
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Introduction: Research into patients' perception of empathy has revealed that patients with stomas feel unsupported by healthcare professionals, who can lack an understanding of how it feels to live life with a stoma. A literature review was undertaken to explore what is the evidence for best practice for teaching empathy skills to healthcare professionals and how this can be applied to caring for people with a stoma. Search strategy: Included studies were required to explore teaching empathy or measuring levels of empathy in pre- and post-graduate nurses and in healthcare professionals caring for patients with a stoma. Excluded studies were those involving paediatric and mental health nursing, as these domains of nursing were considered to differ in clinical specialism and any other healthcare professional discipline outside the nursing profession such as doctors or allied healthcare professionals. Results: Given the number of articles reporting that empathy is lacking in stoma care, it is remarkable that so little original research has been carried out in this area, specifically the lack of qualitative research. A variety of interventions were used to assess empathy in pre- and post-graduate nurses, from multiple nations with diverse cultures. Conclusions: Results from the data revealed several themes for the best practice of teaching empathy skills to healthcare professionals, including essential nurse attributes, innate nurse characteristics, nurse experience and the contribution of experiential learning.
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Introduction Post-diagnostic support is key to ensuring the well-being of people with dementia and unpaid carers. The COVID-19 pandemic has caused a shift from in-person to remote service delivery, often with the use of information communication technologies (ICT) formats. This systematic review examined how ICT has been used to access remote post-diagnostic support services that address the needs people with dementia, or those of dyad, and explored care recipients' views on accessing dementia-related support remotely. Method Concepts relating to dementia and ICT were searched across six databases (PsychInfo, PubMed, Cochrane Library, CINAHL, Social Care Online, and Web of Science) in March 2021 and updated in March 2022. Studies published from 1990 and written in English, German or French were considered for inclusion. Methodological quality was appraised using the Hawker quality assessment tool and reporting structured according to PRISMA guidelines. Results The search yielded 8,485 citations. Following the removal of duplicates and two screening processes, 18 papers were included. Papers described a range of post-diagnostic support, including exercise classes and therapeutic sessions, which were largely delivered remotely on a one-to-one basis. Videoconferencing software was the most employed ICT format, and people with dementia were directly engaging with ICT to access post-diagnostic support in 13 studies. Whilst studies demonstrated the feasibility of accessing post-diagnostic service remotely, overall, care recipients' views were mixed. Conclusions Following the increased reliance on ICT during the pandemic, it is likely that service delivery will continue with a hybrid approach. Accessing post-diagnostic support remotely is likely to benefit some care recipients. However, to prevent widening inequalities in access, service provision is required to accommodate to people with dementia and unpaid carers who are digitally excluded. Future research should capture the support provided by unpaid carers facilitating the engagement of the person with dementia when accessing remote post-diagnostic support.
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Background: Clinical trials involving patients who are unable to provide consent rely on proxies to make a decision on the patient's behalf. The proxy's decision should be based on the patient's wishes and preferences. However, patients rarely discuss their preferences about research, and proxies find it challenging to determine what their wishes would be. While improving consent in trials has been the focus of much research in recent decades, the more conceptually complex area of proxy consent has remained largely unexplored. A global increase in conditions such as dementia has led to an urgent need for trials involving populations who require proxy consent, and the necessity to conduct trials with large numbers of critically ill patients during the COVID-19 pandemic has made this need even more pressing. However, interventions to improve and support proxy decision-making for research are hampered by a lack of understanding about what constitutes decision quality in this context. This presentation reports a concept synthesis that was conducted to develop the first conceptualization of what constitutes ''good'' proxy consent decisions. A concept synthesis enables a greater understanding of a concept through identifying the existing theoretical strands that define that concept, with the conceptual knots then re-tied to form a stronger, more coherent ''tapestry of theory.'' Methods: Literature was identified through conducting iterative searches of databases including MEDLINE and CINAHL. Literature which captured domains of both proxy decision-making (the process) and decision quality (the decision itself) were reviewed. Concepts of interest were identified and assessed according to established principle-based criteria used in concept syntheses. Data were then extracted and synthesized to generate a concept matrix. This was then used to create a concept map, with quality descriptors developed for each stage. Result(s): Elements of decision quality were identified across three stages of decision-making: (1) the preparation stage requires the proxy to have knowledge and understanding about the trial and any associated risks and benefits, as well as about their role, and involves values clarification and preference elicitation;(2) the decision-making stage includes both deliberation and determination processes, with the proxy seeking to make a decision about participation that is congruent with the patient's values;and (3) the outcome of the decision-either the proxy agreeing or declining participation-is in accordance with the patient's preferences as determined by the proxy. These stages of proxy decision-making may be influenced by affective factors experienced by the proxy such as decisional uncertainty, decisional conflict, satisfaction, and regret. Quality descriptors have been developed that map against the three stages of decision-making, such that a ''good'' proxy consent decision can be said to occur where the proxy is adequately prepared, supported, and satisfied, and when a preference-linked outcome is achieved. Conclusion(s): Proxy decisions about trial participation are ethically complex, and interventions are needed to address the challenges of providing proxy consent. This conceptualization provides an essential first step toward the future development of interventions to enhance the quality of proxy decision-making and ensuring that proxy consent represents patients' values and preferences.
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To examine current literature on the role of physical therapy (PT) in management of post COVID-19 related conditions and common symptomatology in adults, as well as potential guidelines for rehabilitation in the outpatient setting. PubMed, CINAHL, Medline, Cochrane. Searches were conducted to examine current data related to PT interventions and their effectiveness for treating post COVID-19 conditions. Articles were evaluated for relevance based on the following criteria: articles in English, original peer reviewed articles, adult population (over 18), relevant PT interventions for rehabilitation, post-acute infection of COVID-19. Consensus agreement confirmed approximately 25% of reviewed articles. Articles were analyzed for relevance to implications regarding post COVID-19 and potential PT rehabilitation interventions. Interventions were assessed in feasibility and applicability to an outpatient clinic setting. Independent Data Extraction followed by consensus discussion was applied. Articles were examined for content regarding the latest updates on disease criteria, manifestations, new classifications, and cohorts emerging as the pandemic progresses as well as management strategies applicable to PT practice. After article analysis, the findings include a key theme that PT services helped improve overall functional mobility and symptom management in patients after an acute infection of COVID-19. An essential consideration is keeping the interventions specific to the patient and their goals while preventing exacerbations of symptoms that could lead to further setbacks. PT has a growing role in the management of post COVID-19 deficits as well as implications related to long COVID sequelae. By choosing the appropriate parameters and having awareness of the varying symptomology amongst patients, physical therapists can improve patients' functional mobility and post COVID-19 disease management. The focus of future studies should include more specific interventions related to managing conditions and finding the most effective treatment strategies. No conflicts to disclose.
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Burnout in hospice and palliative care nurses is a growing issue, especially in light of the COVID-19 pandemic. However, few studies have focused specifically on burnout in this population. A scoping review was undertaken to identify what is known about burnout among hospice and palliative care nurses, and to unify disparate findings. Analysis of eight articles revealed three overarching categories: personal factors, organizational/workplace factors, and nursing professional development factors. Each category was then divided into three cross-cutting subcategories: contributory and noncontributory factors, mitigating factors, and workplace issues. Recommendations for individuals include self-care as well as self-awareness of intrinsic characteristics that can predispose one to burnout. Within the workplace, leaders are challenged to support evidence-based practice and ongoing education. Role modeling positive communication skills, effective conflict mitigation, responsiveness, promotion of equity, and workplace commitment also help to create a culture of wellness. Nursing professional development may aid in resilience-building, and promotion of self-efficacy, self-confidence, and assertiveness. Although all identified recommendations were derived from the literature, no interventional studies have been conducted to test the effects of suggested interventions. Future research should include interventional studies as well as qualitative research to capture nuanced experiences of burnout in hospice and palliative care nurses.
ABSTRACT
PURPOSE/HYPOTHESIS: Coronavirus disease 2019 (COVID-19) may result in hypoxemic respiratory failure and death similar to acute respiratory distress syndrome (ARDS). Based on its known efficacy in ARDS, prone positioning (PP) was used to manage intubated patients with severe COVID-19 lung disease. Though less supported by evidence, awake prone positioning (APP) was also trialed in non-intubated patients with COVID-19 to preserve resources and optimize outcomes. The primary available evidence included in recent reviews on APP in COVID-19 were the resultant retrospective single group studies that showed mixed findings. While such designs expedite results, a risk of bias weakens their application. With emerging research, this focused review evaluated APP in COVID-19 based on prospective trials that included a comparison group. NUMBER OF SUBJECTS: Not applicable. MATERIALS AND METHODS: PubMed and CINAHL databases were searched through June 10, 2022 with the following strategy: [(SARS-COV-2) OR (COVID-19) OR (coronavirus)] AND [(prone) OR (proning) OR (prone positioning)]. Prospective studies investigating APP in non-intubated adults with COVID-19 compared to usual care were included. Quality of evidence was determined by the Cochrane Risk of Bias tool with recommendations made using the GRADE approach. RESULT(S): Seven articles evaluating APP in a combined total of 2604 participants (66% male, mean age: 59.8 yrs, BMI: 29.0) with mild to moderate hypoxemic respiratory failure were included. Participant characteristics were heterogeneous and the duration of proning ranged from 4 to 16 hrs/d. APP was associated with improved oxygenation;however, only one study reported a lower incidence of intubation. No effect was noted on mortality or length of stay (LOS). Adverse events were rare but APP was associated an initial worsening outcome in one instance. Lack of blinding and protocol heterogeneity were identified risks of bias. CONCLUSION(S): APP may improve oxygenation in non-intubated individuals with mild to moderate COVID-19 lung disease as compared to usual care;however, prospective controlled trials do not support a positive effect on intubation, LOS, or mortality. The lack of transference in contrast to PP in intubated patients suggests that the primary benefit of PP may be minimizing ventilator-induced lung injury. Alternatively, benefits of APP may be reserved in select individuals as patient characteristics and proning protocols may influence the response. Though serious adverse events were not reported, the potential for skin breakdown and brachial plexus injuries are noted in ventilated patients with the proning times necessary for benefit. Given these findings, the value of immobilizing awake patients in prone should be questioned and alternate active interventions investigated. CLINICAL RELEVANCE: The routine application of APP in COVID-19 lung disease to improve clinical outcomes is not supported by current literature. Based on the GRADE approach, a weak recommendation against using APP was determined. Future studies should investigate if optimal protocols matched to potential responders improve the value of APP in COVID-19.