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showed good agreement with radiologists, highlighting the potential for AI diagnostic support to improve clinical practice.
There are 50 million dementia sufferers worldwide. Decisions about healthcare often need to be made when the person with dementia lacks capacity to do so.Understanding the support needs of carers acting as proxy healthcare decision-makers will be vital in improving the decision-making process for people with dementia and addressing the holistic needs of carers.
The objective of this study was to review the existing literature on the support needs of carers acting as proxy healthcare decision-makers for people with dementia.
A qualitative systematic review protocol was published on PROSPERO. The Critical Appraisal Skills Programme checklist was used to appraise study quality. A meta-ethnographic synthesis was performed to develop third-order constructs.
A search was conducted using three online databases (MEDLINE, CINAHL and PsycINFO).
Fifteen studies met the inclusion criteria primary qualitative research involving carers of people with dementia who had been involved in making proxy healthcare decisions.
Two independent researchers conducted validity assessments for each paper selected for inclusion, and discrepancies were resolved by discussions with a third reviewer. Nvivo software was used and conceptual findings from study papers lead to interpretations of findings by the team.
From the 15 papers included in the study, three main domains arose from the meta-ethnography; informational, practical and emotional. Informational support needs included information about dementia itself and the anticipated disease trajectory. Practical needs included continuity of care, person-centred care and the use of legal frameworks.Emotional support included recognising the guilt that healthcare decisions can provoke and the importance of providing guidance in an empathic manner.
This meta-ethnography highlights opportunities for healthcare professionals and policymakers to improve experiences of carers making proxy healthcare decisions for people with dementia.
CRD42020124485.
CRD42020124485.
Assess whether impactibility modelling is being used to refine risk stratification for preventive health interventions.
Systematic review.
Primary and secondary healthcare populations.
Articles published from 2010 to 2020 on the use or implementation of impactibility modelling in population health management, reported with the terms 'intervenability', 'amenability', and 'propensity to succeed' (PTS) and associated with the themes 'care sensitivity', 'characteristic responders', 'needs gap', 'case finding', 'patient selection' and 'risk stratification'.
Qualitative synthesis to identify themes for approaches to impactibility modelling.
Of 1244 records identified, 20 were eligible for inclusion. Identified themes were 'health conditions amenable to care' (n=6), 'PTS modelling' (n=8) and 'comparison or combination with clinical judgement' (n=6). For the theme 'health conditions amenable to care', changes in practice did not reduce admissions, particularly for ambulatory care sensitive conditions, andood of treatment impact, suggesting that complementary use of models might be optimum.
The efficiency and equity of targeted preventive care guided by risk stratification could be augmented and personalised by impactibility modelling.
The efficiency and equity of targeted preventive care guided by risk stratification could be augmented and personalised by impactibility modelling.
This study investigated the risk factors associated with the coexistence of stunting, underweight, and wasting among children under age 5 in sub-Saharan Africa (SSA).
Data of 127, 487 under-5 children from 31 countries in SSA were pooled from the Demographic and Health Surveys collected between 2010 and 2019. We examined the risk of coexistence of stunting, underweight, and wasting using multinomial logistic regression models. The results were presented using relative risk ratios (RRR) with corresponding confidence intervals (CIs).
Thirty-one sub-Saharan African countries.
Children under age 5.
The outcome variables were three child anthropometrics stunting (height-for-age z-scores); underweight (weight-for-age z-scores) and wasting (weight-for-height z-scores).
The prevalence of coexistence of stunting, underweight, and wasting varied across countries, with the highest (12.14%) and lowest (0.58%) prevalences of coexistence of stunting, underweight and wasting in Benin and Gambia respectively. Thentions to eradicate child malnutrition in SSA. In the short-term, national-level policies and interventions need to be well tailored considering the compositional characteristics.
Findings suggest the urgent need for consideration of the coexistence of stunting, wasting and underweight among under-5 children in policy design and programming of interventions to eradicate child malnutrition in SSA. In the short-term, national-level policies and interventions need to be well tailored considering the compositional characteristics.
Thoracoscopic surgery is performed for refractory or recurrent primary spontaneous pneumothorax (PSP). To reduce postoperative recurrence, additional treatment is occasionally adopted during surgery after bulla resection. However, the most effective method has not been fully elucidated. Furthermore, the preference for additional treatment varies among countries, and its efficacy in preventing recurrence must be evaluated based on settings tailored for the conditions of a specific country. The number of registries collecting detailed data about PSP surgery is limited. Therefore, to address this issue, a prospective multicentre observational study was performed.
This multicentre, prospective, observational study will enrol 450 participants aged between 16 and 40 years who initially underwent PSP surgery. Data about demographic characteristics, disease and family history, surgical details, and CT scan findings will be collected. Follow-up must be conducted until 3 years after surgery or in the event of recurrence, whichever came first. KRpep-2d order Patients without recurrence will undergo annual follow-up until 3 years after surgery. The primary outcome is the rate of recurrence within 2 years after surgery. A multivariate analysis will be performed to compare the efficacy of different surgical options. Then, adverse outcomes correlated with various treatments and the feasibility of treatment methods will be compared.
This study was approved by the local ethics committee of all participating centres. The findings will be available in 2025, and they can be used as a basis for clinical decision-making regarding appropriate options for the initial PSP surgery.
NCT04758143.
NCT04758143.
COVID-19 disease has affected more than a hundred countries worldwide and has exposed the population to an increase in mental health problems. The objective of this study was to assess the emotional impact of the pandemic from a gender perspective, as well as to study the modulating variables of that impact.
A descriptive and cross-sectional study through the General Health Questionnaire scale and the Sense of Coherence (SOC) scale is developed.
General population of Spain was the target of this study PARTICIPANTS The sample consisted of 3801 adult subjects living in Spain, without diagnosis for Sars-Cov-2 virus infection during confinement.
Data collection was carried out using an online questionnaire, from 26 March 2020 to 26 April 2020.
A sample profile description was obtained, regarding to the study variables. Later, a regression model was implemented in order to test the relationship between these variables, and to achieve a predictive model of psychological discomfort controlling the gender variable.
The results showed that women, as compared with men, had increased psychological discomfort during confinement (t=-12.877; p<0.001; d=0.470). In contrast, significantly higher scores were observed on the SOC scale (t=6.336; p<0.001; d=0.231) in men, as compared with those obtained by women.
Women have higher levels of psychological discomfort, increased concern about getting infected with COVID-19 and infecting others, as well as a lower level of SOC and perceived health. In addition, low levels of SOC predict greater concern about contagion and increased psychological discomfort.
Women have higher levels of psychological discomfort, increased concern about getting infected with COVID-19 and infecting others, as well as a lower level of SOC and perceived health. In addition, low levels of SOC predict greater concern about contagion and increased psychological discomfort.
Exploration of the factors that influence hospital doctors' antibiotic prescribing decisions when treating children with respiratory symptoms in UK emergency departments.
A qualitative study using semistructured interviews based on a critical incident technique with 21 physicians of different grades and specialties that treat children in the UK. Interviews were audio-recorded then transcribed verbatim and analysed using thematic analysis.
Four themes were identified. These themes illustrate factors which influence clinician prescribing. The three principal themes were authorities, pressures and risk. The fourth transcending theme that ran through all themes was clinician awareness and complicity ('knowing but still doing').
Hospital doctors prescribe antibiotics even when they know they should not. This appears to be due to the influence of those in charge or external pressures experienced while weighing up the immediate and longer term risks but clinicians do this with full insight into their actions. These findings have implications for invested parties seeking to develop future antimicrobial stewardship programmes. It is recommended that stewardship interventions acknowledge and target these themes which may in turn facilitate behaviour change and antimicrobial prescribing practice in emergency departments.
Hospital doctors prescribe antibiotics even when they know they should not. This appears to be due to the influence of those in charge or external pressures experienced while weighing up the immediate and longer term risks but clinicians do this with full insight into their actions. These findings have implications for invested parties seeking to develop future antimicrobial stewardship programmes. It is recommended that stewardship interventions acknowledge and target these themes which may in turn facilitate behaviour change and antimicrobial prescribing practice in emergency departments.
Psychosocial problems (PSPs) are common issues associated with negative health outcomes. Since general practitioners are the first point of contact for any health-related concern, understanding their options to recognise patients with PSPs plays an important role as it is essential for early intervention and can prevent serious conditions. The objective of our scoping review is to map published evidence on the usage of instruments to identify patients with PSPs in general practice.
We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist and the Joanna Briggs Institute Reviewer's Manual on scoping reviews. A systematic search of four electronic databases (Medline (Ovid), Web of Science Core Collection, PsycInfo, Cochrane Library) will be conducted for quantitative and qualitative studies published in English, Spanish, French and German. Main study characteristics as well as information on identification instruments will be extracted and visualised in structured tables to map the available evidence.
