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To assess all published studies which describe what happens to the delivery of pressure ulcer/injury (PI/PU) care pathways as a result of detecting raised sub‐epidermal moisture (SEM) delta (∆ ≥ 0.6). We undertook a systematic review of the literature, and included original research studies using either a prospective or retrospective study design that report the impact that assessment using SEM assessments have on healthcare practitioners' delivery of PI/PU care pathways in adults at risk of developing PI/PUs. The review protocol was registered on PROSPERO (CRD42023416975). A literature search was conducted in May 2023, using PubMed, CINAHL, Scopus, Cochrane, EMBASE, Web of Science and Science Direct databases. Data were extracted using a data extraction tool including elements such as country, setting, sample size, intervention, control and quality appraisal was undertaken using the Evidence‐based Librarianship. We identified nine papers published between 2017 and 2022. The majority of these studies were conducted in England (n = 6; 67%). The systematic review included studies conducted across multiple care settings including acute care, medical‐surgical units, and palliative care, highlighting the importance of PI/PU prevention and management across diverse patient populations. The PI/PU care pathways implemented in the studies varied, but commonly included elements such as the application or increased use of pressure‐redistributing mattresses/cushions, implementation of repositioning plans, management of incontinence and moisture, regular skin inspection, and assessment of patient mobility. Out of the nine studies identified, seven reported PI/PU incidence. A meta‐analysis of seven studies (N = 18 451) demonstrated a statistically significant reduction in visual PI/PU development in favour of SEM‐guided care pathways compared to usual care (the odds ratio = 0.36 [95% confidence interval: 0.24–0.53, p < 0.00001]). This systematic review provides evidence that implementing SEM assessments in patients at risk of developing PI/PUs prompts anatomy‐specific clinical actions. The subsequent implementation of enhanced and targeted skin care interventions leads to consistent and sustained reductions in hospital‐acquired PU incidence. The findings emphasise the importance of incorporating SEM assessments as part of comprehensive PI/PU prevention strategies in all care settings and patient populations. This systematic review is limited by the predominance of observational studies and variable study quality. Future research should focus on randomised trials in different care settings that monitor the efficacy of preventive interventions and their impact in reducing PI/PU incidence when implemented based on SEM assessments. [ABSTRACT FROM AUTHOR]

Background: Postpartum depression (PPD) is a condition that can affect any woman regardless of ethnicity, age, party, marital status, income, and type of delivery. This condition is highly prevalent worldwide. PPD, if not treated timely, can affect the maternal‐child bond and can have a detrimental impact on the future cognitive, emotional, and behavioral development of the child. Interpersonal psychotherapy (IPT) has been reported as an effective treatment of PPD in previous studies as this focuses on relationship and social support issues. Previous reviews conducted in developed nations have reported the superior efficacy of IPT in comparison to other treatment options. There is no systematic review conducted in low to middle‐income countries on the efficacy of IPT on PPD. Therefore it was necessary to undertake a systematic review to assess the effectiveness of IPT in reducing the depression among postpartum women in low and middle‐income countries (LMICs). Objectives: The main aim of this systematic review was to assess the effectiveness of IPT alone or in conjunction with pharmacological therapy and/or other psychological and psychosocial interventions, in reducing depressive symptoms among women diagnosed with PPD residing in LMICs. Search Methods: The systematic search encompassed several prominent databases and grey literature. Furthermore, experts specializing in the field of IPT were consulted to identify any relevant studies conducted in LMICs that fulfilled the predetermined eligibility criteria. The most recent search update was performed in July 2022. Selection Criteria: The PICOS criteria were meticulously defined for this review as described. Participants: Postpartum women diagnosed with PPD in LMICs were included. Intervention: IPT either as a standalone treatment or in conjunction with pharmacological therapy was included. Comparison: any form of psychological therapy or pharmacological therapy, whether administered individually or in combination, was considered for comparison. Study designs: experimental and quasi‐experimental, factorial designs, and quantitative components (experimental, quasi‐experimental, factorial designs) of mixed methods designs were eligible to be included. Studies with single‐group study designs and qualitative studies were excluded from the review. Data Collection and Analysis: Two reviewers from our team conducted a rigorous screening process to determine the eligibility of articles for inclusion. This involved an initial evaluation of titles and abstracts, followed by a comprehensive assessment of the full text of selected articles. In instances where discrepancies arose between the two reviewers, resolution was achieved through discussion or consultation with a third author to establish a consensus. Following the screening process, two team members independently extracted pertinent information and data from the studies that met the inclusion criteria. The treatment effect of the intervention, in comparison to the control group, was subsequently analyzed utilizing the fixed effects model taking into account the small number of studies. Main Results: A total of 17,588 studies were identified from various databases, and 6493 duplicate studies were removed. Subsequently, 9380 studies underwent independent title and abstract screening resulting in the exclusion of 9040 studies. 345 full texts were thoroughly assessed leading to the exclusion of 341 studies, finally including 4 studies for review. The four included trials were randomized trials and comprised a total sample size of 188 women diagnosed with PPD residing in LMICs. Among these studies, three compared IPT with usual treatment, while one study compared IPT with antidepressant medications (ADMs). In terms of the providers of IPT, in one study, IPT was administered by nurses, while psychologists delivered IPT in another study. In one study, community health workers were responsible for providing IPT. However, in one study, information regarding the specific providers of IPT was not available or reported. The primary outcome measure reported in all four studies was depression, assessed using the Edinburgh Postnatal Depression Scale (EPDS). The geographical distribution of the studies included; one conducted in Zambia, one in Kenya, one in Pakistan, and one in Iran. Out of the four studies, three were included in the meta‐analysis, as missing data from one study could not be obtained. Based on the overall treatment effect, it was found that depression scores decreased significantly more in the IPT group compared to other interventions (usual treatment or ADMs) (standardized mean difference [SMD] −0.62, 95% confidence interval [CI] (−1.01, −0.23), Z = 3.13 (p = 0.002), χ2 = 49.49; df = 2; p < 0.00001; I2 = 96%; 3 studies, n = 136). Out of the three studies, two studies compared the effectiveness of IPT in reducing depression scores specifically when compared to the usual treatment, and in both studies, depression scores were reduced significantly in the IPT group as compared to the usual treatment group. Only one study directly compared the effectiveness of IPT with ADM, reporting that IPT was more effective than ADM in reducing depression scores among postpartum women. Regarding adverse outcomes, only one study reported suicidal ideation with one participant in the IPT group and two in the ADM group (RR 0.50, 95% CI (0.05, 5.30), p = 0.56, n = 78). The same study reported seven participants in the ADM group had adverse drug reactions as compared to none in the IPT group (RR 15.0, 95% CI (0.89, 254), p = 0.06, n = 78). Authors' Conclusions: Our comprehensive search yielded a limited number of four studies conducted in such settings. Despite the scarcity of available evidence, the findings collectively suggest that IPT is indeed an effective treatment for reducing PPD when compared to usual treatment and pharmacological therapy. However given the low certainty of evidence, there is a need for further research in the form of well‐designed randomized controlled trials with larger sample sizes and a reduced risk of bias. Such studies would greatly contribute to enhancing the strength and reliability of the evidence base regarding the effectiveness of IPT in the context of PPD in LMICs. The knowledge generated from future research endeavors would be highly valuable in guiding the development of more affordable and cost‐effective treatment approaches for PPD in resource‐limited settings. [ABSTRACT FROM AUTHOR]

The risk factors for childhood overweight and obesity are known and can be identified antenatally or during infancy, however, the majority of effective interventions are designed for older children. This review identified interventions designed to reduce the risk of overweight/obesity that were delivered antenatally or during the first 2 years of life, with outcomes reported from birth to 7 years of age. Six electronic databases were searched for papers reporting randomised controlled trials of interventions published from January 1990 to September 2013. A total of 35 eligible studies were identified, describing 27 unique trials of which 24 were behavioural and three were non‐behavioural. The 24 behavioural trials were categorised by type of intervention: (1) nutritional and/or responsive feeding interventions targeted at parents of infants, which improved feeding practices and had some impact on child weight (n = 12); (2) breastfeeding promotion and lactation support for mothers, which had a positive effect on breastfeeding but not child weight (n = 5); (3) parenting and family lifestyle (n = 4); and (4) maternal health (n = 3) interventions that had some impact on feeding practices but not child weight. The non‐behavioural trials comprised interventions manipulating formula milk composition (n = 3). Of these, lower/hydrolysed protein formula milk had a positive effect on weight outcomes. Interventions that aim to improve diet and parental responsiveness to infant cues showed most promise in terms of self‐reported behavioural change. Despite the known risk factors, there were very few intervention studies for pregnant women that continue during infancy which should be a priority for future research. [ABSTRACT FROM AUTHOR]

Aim: To critically assess the effects of white noise on the pain level, weight gain and vital signs (heart rate, respiratory rate and oxygen saturation) of preterm infants in neonatal intensive care units (NICUs). Design: A systematic review and meta‐analysis of randomised controlled trials (RCTs). Methods: Ten databases (PubMed, Cochrane Library, Embase, Web of Science, CINAHL, PsycINFO, SinoMed, China National Knowledge Infrastructure, VIP and Wanfang Data) were systematically reviewed from inception to July 2022. Two reviewers evaluated the risk of bias separately using the Cochrane Collaboration criteria and extracted data using a predesigned information form. Results: The meta‐analysis included eight eligible RCTs. According to statistical analysis, white noise significantly affected the pain level, weight gain, heart rate, respiratory rate and oxygen saturation in preterm infants. Regardless of the outcome measurement timing, gestational age and birth weight of preterm infants, subgroup analysis demonstrated that white noise reduced the pain level, heart rate and respiratory rate and promoted weight gain in preterm infants in NICUs. Conclusion: White noise is a practical and potentially useful therapy for premature neonates in NICUs. No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aim: This systematic review examined recent studies on fragmented care of patients with chronic illnesses in the United States to examine the association between fragmented care and patient outcomes. Design: Systematic review. Methods: Studies published from January 1, 2012, to June 1, 2022, were selected from four electronic databases (PubMed, CINAHL, PsycINFO, and Web of Science), following the Cochrane protocols and PRISMA statements. Based on inclusion and exclusion criteria, ten studies that examined associations published between 2015 and 2021 were selected. A methodological assessment was conducted with the Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies. The studies selected for this systematic review were rated as having fair methodological rigor. The protocol of this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42021285379). Because of the heterogeneity of the selected studies' data, a systematic narrative synthesis of the extracted data was conducted. Results: Three common measures for fragmented care and outcomes were synthesized. A synthesis of the studies found significant association between fragmented care and adverse outcomes of chronic illnesses (emergency department visits, utilization of diagnostic tests, and healthcare costs). Despite the heterogeneity of significant findings between fragmented care and patient outcomes, the relationship between these outcomes and fragmented care was significant. This systematic review provides clear evidence of the association between care fragmentation and its adverse effects on individuals with chronic illnesses. However, mixed relationship findings were also reported. Conclusion: Given the demands of overcoming fragmented care in healthcare settings in the United States, nurse managers, healthcare leaders, and policymakers should utilize this evidence to reduce fragmented care strategies. It is recommended that nurse researchers and other healthcare practitioners conduct further studies to understand the contexts and mechanisms of fragmented care and develop theoretical frameworks for care fragmentation and chronic illness outcomes. [ABSTRACT FROM AUTHOR]

Background: The consequences for children born with birth defects and developmental disabilities encompassed by foetal alcohol spectrum disorder (FASD) are profound, affecting all areas of social, behavioural and cognitive functioning. Given the strong evidence for a core deficit in executive functioning, underpinned by impaired self‐regulation skills, there has been a growing focus on the development of interventions that enhance or support the development of executive functions (EFs). Objectives: The primary objective of this review is to synthesise the evidence for structured psychological interventions that explicitly aim to improve EF in children. The review also sought to ascertain if the effectiveness of interventions were influenced by characteristics of the intervention, participants or type of EF targeted by the intervention. Search Methods: Sixteen databases, 18 grey literature search locations and 9 trial registries were systematically searched to locate eligible studies (up to December 2020). These searches were supplemented with reference harvesting, forward citation searching, hand searches of topic‐relevant journals and contact with experts. Selection Criteria: Studies were included in the review if they reported on an impact evaluation of a psychological intervention aiming to improve EF in children 3–16 years who either had confirmed prenatal alcohol exposure or a formal diagnosis falling under the umbrella term of FASDs. Eligible study designs included randomised controlled trials (RCTs) and quasi‐experimental designs with either no treatment, wait list control or an alternative treatment as a comparison condition. Single‐group pre‐post designs were also included. Data Collection and Analysis: Standard methodological procedures expected by the Campbell Collaboration were used at all stages of this review. Standardised mean differences (SMDs) were used to estimate intervention effects, which were combined with random effects meta‐analysis (data permitting). Risk of bias was assessed using the Cochrane Risk of Bias Tool (RoB2) and Cochrane Risk of Bias in Non‐Randomised Studies‐Interventions tool (ROBINS‐I). Main Results: The systematic search identified 3820 unique records. After title/abstract and full‐text screening, 11 eligible studies (reported in 21 eligible documents) were deemed eligible, with a combined 253 participants. Of the 11 studies, 6 were RCTs, 1 was a quasi‐experiment and 4 were single‐group pre‐post intervention designs. All studies were rated as having an overall high or serious risk of bias, with some variation across domains for RCTs. For RCT and quasi‐experimental studies, the overall effect of EF interventions on direct and indirect measures of EF generally favoured the experimental condition, but was not statistically significant. There was no difference between intervention and comparison groups on direct measures of auditory attention (k = 3; SMD = 0.06, 95% confidence interval [CI] = −1.06, 1.18), visual attention (k = 2; SMD = 0.90, 95% CI = −1.41, 3.21), cognitive flexibility (k = 2; SMD = 0.23, 95% CI = −0.40, 0.86), attentional inhibition (k = 2; SMD = 0.04, 95% CI = −0.58, 0.65), response inhibition (k = 3; SMD = 0.47, 95% CI = −0.04, 0.99), or verbal working memory (k = 1; d = 0.6827; 95% CI = −0.0196, 1.385). Significant heterogeneity was found across studies on measures of auditory attention and visual attention, but not for measures of cognitive flexibility, attentional inhibition or response inhibition. Available data prohibited further exploration of heterogeneity. There was no statistical difference between intervention and comparison groups on indirect measures of global executive functioning (k = 2; SMD = 0.21, 95% CI = −0.40, 0.82), behavioural regulation (k = 2; SMD = 0.18, 95% CI = −0.43, 0.79), or emotional control (k = 3; SMD = 0.01, 95% CI = −0.33, 0.36). Effect sizes were positive and not significant for meta‐cognition (k = 1; SMD = 0.23, 95% CI = −0.72, 1.19), shifting (k = 2; SMD = 0.04, 95% CI = −0.35, 0.43), initiation (k = 1; SMD = 0.04, 95% CI = −0.40, 0.49), monitoring (k = 1; SMD = 0.25, 95% CI = −0.20, 0.70) and organisation of materials (k = 1; SMD = 0.25, 95% CI = −0.19, 0.70). Effect sizes were negative and not statistically different for effortful control (k = 1; SMD = −0.53, 95% CI = −1.50, 0.45), inhibition (k = 2; SMD = −0.08, 95% CI = −0.47, 0.31), working memory (k = 1; SMD = 0.00, 95% CI = −0.45, 0.44), and planning and organisation (k = 1; SMD = −0.10, 95% CI = −0.55, 0.34). No statistically significant heterogeneity was found for any of the syntheses of indirect measures of EF. Based on pre‐post single‐group designs, there was evidence for small to medium sized improvements in EF based on direct measures (cognitive flexibility, verbal working memory and visual working memory) and indirect measures (behavioural regulation, shifting, inhibition and meta‐cognition). However, these results must be interpreted with caution due to high risk of bias. Authors' Conclusions: This review found limited and uncertain evidence for the effectiveness of interventions for improving executive functioning in children with FASD across 8 direct and 13 indirect measures of EF. The findings are limited by the small number of high‐quality studies that could be synthesised by meta‐analysis and the very small sample sizes for the included studies. [ABSTRACT FROM AUTHOR]

Virtual reality (VR) technology has been widely used in clinical nursing care in recent years. We aimed to systematically evaluate the effect and safety of VR technology on pain control in wound care, to provide evidence and support for clinical wound care. We searched PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, China Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and Chinese Science and Technology Journal databases for randomised controlled trials (RCTs) on the application of VR technology in wound care up to December 20, 2021. Two researchers independently assessed the quality of the included RCTs and extracted associated data. RevMan5.3 statistical software was used for data analysis. 13 RCTs involving 1258 adult patients were included, of whom 588 patients underwent VR intervention. VR technology intervention could reduce the VAS score(MD = −1.13, 95%CI:−2.01~−0.26, P <.001), pain cognition score(MD = −3.94, 95%CI:−4.59 ~ −3.30, P <.001), pain emotion score(MD = ‐5.21, 95%CI: −10.46 ~ −0.04, P <.001), pain sensation score (MD = −4.94, 95%CI: −9.46 ~ −0.42, P =.03) and blood pressure(MD = −4.66, 95%CI: −8.63 ~ −0.69, P =.02) during would care. There were no significant differences on the heart rate (MD = −1.85, 95%CI: −5.71 ~ −2.01, P =.45) and VR interestingness (MD = 28.96, 95%CI: −22.10 ~ 80.02, P =.27) of the VR group and control group. No publication biases among the synthesised outcomes were found (all P >.001). VR technology can effectively reduce the pain degree and sensation of patients during wound care, which may be an effective auxiliary non‐drug method used for pain relief during wound care. [ABSTRACT FROM AUTHOR]

Background: Shoulder dislocations are a common injury prompting presentation to the emergency department. Point‐of‐care ultrasound (POCUS) is a diagnostic tool for shoulder dislocations, which has the potential to reduce time to diagnosis and reduction, radiation exposure, and health care costs. This systematic review sought to evaluate the diagnostic accuracy of POCUS for diagnosing shoulder dislocations. Methods: We searched PubMed, Scopus, CINAHL, LILACS, the Cochrane databases, Google Scholar, and bibliographies of selected articles for all prospective and randomized controlled trials evaluating the diagnostic accuracy of POCUS for identifying shoulder dislocations. We dual‐extracted data into a predefined worksheet and performed quality analysis using the QUADAS‐2 tool. We performed a meta‐analysis with subgroup analyses by technique and transducer type. As a secondary outcome, we assessed the diagnostic accuracy of identifying associated fractures. Results: Ten studies met our inclusion criteria, comprising 1,836 assessments with 636 dislocations (34.6%). Overall, POCUS was 100% (95% confidence interval [CI], 85.6%–100%) sensitive and 100% (95% CI, 79.4%–100%) specific for the diagnosis of shoulder dislocation with a LR+ of 11,254.8 (95% CI, 3.9–3.3e7) and a LR− of <0.1 (95% CI, < 0.1–0.2). When compared with the anterior/lateral technique, the posterior technique had greater sensitivity but no difference in specificity. There was no difference between transducer types. POCUS was also 96.8% (95% CI, 92.6%–98.7%) sensitive and 99.7% (95% CI, 92.5%–100%) specific for the diagnosis of associated fractures. Conclusions: POCUS is a sensitive and specific tool for the rapid identification of shoulder dislocations and reductions, as well as for the detection of associated fractures. POCUS should be considered as an alternate diagnostic tool for the diagnosis and management of shoulder dislocations. [ABSTRACT FROM AUTHOR]

Aim: To systematically review and comprehensively analyse findings of studies reporting oncology nurses' compassion satisfaction (CS), burnout (BO) and secondary traumatic stress (STS), measured by the professional quality of life (ProQOL) scale, and explore CS and CF related factors. Design: Systematic review and meta‐analysis of cross‐sectional and interventional studies. Method: Electronic databases were searched using keywords, and the review followed PRISMA guidelines. The prevalence of CS, BO and STS and their instrumental ratings were pooled using random effects meta‐analyses. Meta‐regression studies explored the effects of variables. Results: Fifteen studies (sample size 2,509) were reviewed, and nine were in the meta‐analysis. The prevalence of CS, BO, and STS were 22.89%, 62.79% and 66.84%, respectively. No substantial correlation was found for independent variables, possibly due to sample size. There was a weak negative correlation between CS and BO [−0.06(0.90)] and a weak positive correlation between CS and STS [0.20(0.70)]. [ABSTRACT FROM AUTHOR]

Aim: To examine the incidence and risk factors for asymptomatic peripherally inserted central catheter‐related thrombosis (PICC‐RT). Design: We performed a systematic review and meta‐analysis following the PRISMA guidelines. Methods: The review was registered in PROSPERO (CRD42020186732). A systematic search of EMBASE, CINAHL, PubMed, Web of Science and Cochrane was performed from inception to 4 June 2020. Meta‐analysis was performed to determine the pooled incidence of asymptomatic PICC‐RT. Results: Ten studies comprising 1591 participants with 1592 PICCs were included in this meta‐analysis. The pooled incidence of asymptomatic PICC‐RT in adults was 22% (95% CI, 0.17–0.29). The pooled incidence of PICC‐RT in cancer patients was 19% (95% CI, 0.13–0.26). Asymptomatic PICC‐RT mainly occurred in superficial veins. Most asymptomatic thrombosis occurred 3–12 days after the PICC insertion. A higher Eastern Cooperative Oncology Group score (ECOG), slower blood flow velocity and left basilic vein were independent risk factors of asymptomatic thrombosis. [ABSTRACT FROM AUTHOR]

Aim: Pressure injuries are common adverse events in clinical practice, affecting the well‐being of patients and causing considerable financial burden to healthcare systems. It is therefore essential to use reliable assessment tools to identify pressure injuries for early prevention. The Braden Scale is a widely used tool to assess pressure injury risk, but the literature is currently lacking in determining its accuracy. This study aimed to evaluate the accuracy of the Braden Scale in assessing pressure injury risk. Design: Systematic review and meta‐analysis. Methods: Articles published between 1973–2020 from periodicals indexed in the PubMed, EMBASE, CINAHL, Web of Science and the Cochrane Library were selected. Two reviewers independently selected the relevant studies for inclusion. Data were analysed by the STATA 15.0 and the RevMan 5.3 software. Results: In total, 60 studies involving 49,326 individuals were eligible for this meta‐analysis. The pooled SEN, SPE, PLR, NLR, DOR and AUC were 0.78 (95% CI: 0.74 to 0.82), 0.72 (95% CI: 0.66 to 0.78), 2.80 (95% CI: 2.30 to 3.50), 0.30 (95% CI: 0.26 to 0.35), 9.00 (95% CI: 7.00 to 13.00) and 0.82 (95% CI: 0.79 to 0.85), respectively. Subgroup analyses indicated that the AUC was higher for prospective design (0.84, 95% CI: 0.81 to 0.87), mean age <60 years (0.87, 95% CI: 0.84 to 0.90), hospital (0.82, 95% CI: 0.79 to 0.86) and Caucasian population (0.86, 95% CI: 0.82 to 0.88). In addition, 18 was found to be the optimal cut‐off value. Conclusion: The evidence indicated that the Braden Scale had a moderate predictive validity. It was more suitable for mean age <60 years, hospitalized patients and the Caucasian population, and the cut‐off value of 18 might be used for the risk assessment of pressure injuries in clinical practice. However, due to the different cut‐off values used among included studies, the results had a significant heterogeneity. Future studies should explore the optimal cut‐off value in the same clinical environment. [ABSTRACT FROM AUTHOR]

Background: Cutaneous abscesses are common presentations to the emergency department. While the primary treatment for most abscesses is conventional incision and drainage (CID), this is painful and can lead to multiple return visits. The loop drainage technique (LDT) has been proposed as an alternate, less‐invasive approach to abscess management. The primary outcome of this study was to compare LDT with CID for skin and soft tissue abscesses. Methods: PubMed, Scopus, CINAHL, LILACS, Google Scholar, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and bibliographies of selected articles were assessed for all retrospective, prospective observational, and randomized controlled trials comparing treatment failures between LDT and CID among patients with skin and soft tissue abscesses. Data were dual extracted into a predefined worksheet and quality analysis was performed using the Cochrane Risk of Bias tool or the Newcastle‐Ottawa scale. Data were summarized and presented as odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup analyses were performed for adult and pediatric patients. Results: A total of 1,374 studies were identified with eight studies (n = 910 patients) selected for inclusion. Overall, CID failed in 69 of 487 patients (14.17%), while LDT failed in 35 of 423 patients (8.27%). There was an OR of 2.02 (95% CI = 1.29 to 3.18) in favor of higher failures in the CID group. This finding remained consistent with only randomized controlled trials (OR = 1.75, 95% CI = 1.07 to 2.86), but no difference was identified in the adult or pediatric subgroups. Conclusion: The LDT was associated with reduced treatment failures when compared with CID. Future studies should further assess the impact on pain, cosmetic outcomes, and health care costs. [ABSTRACT FROM AUTHOR]

Background: Dementia is underrecognized in older adult emergency department (ED) patients, which threatens operational efficiency, diagnostic accuracy, and patient satisfaction. The Society for Academic Emergency Medicine geriatric ED guidelines advocate dementia screening using validated instruments. Objectives: The objective was to perform a systematic review and meta‐analysis of the diagnostic accuracy of sufficiently brief screening instruments for dementia in geriatric ED patients. A secondary objective was to define an evidence‐based pretest probability of dementia based on published research and then estimate disease thresholds at which dementia screening is most appropriate. This systematic review was registered with PROSPERO (CRD42017074855). Methods: PubMed, EMBASE, CINAHL, CENTRAL, DARE, and SCOPUS were searched. Studies in which ED patients ages 65 years or older for dementia were included if sufficient details to reconstruct 2 × 2 tables were reported. QUADAS‐2 was used to assess study quality with meta‐analysis reported if more than one study evaluated the same instrument against the same reference standard. Outcomes were sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR–). To identify test and treatment thresholds, we employed the Pauker‐Kassirer method. Results: A total of 1,616 publications were identified, of which 16 underwent full text‐review; nine studies were included with a weighted average dementia prevalence of 31% (range, 12%–43%). Eight studies used the Mini Mental Status Examination (MMSE) as the reference standard and the other study used the MMSE in conjunction with a geriatrician's neurocognitive evaluation. Blinding to the index test and/or reference standard was inadequate in four studies. Eight instruments were evaluated in 2,423 patients across four countries in Europe and North America. The Abbreviated Mental Test (AMT‐4) most accurately ruled in dementia (LR+ = 7.69 [95% confidence interval {CI} = 3.45–17.10]) while the Brief Alzheimer's Screen most accurately ruled out dementia (LR– = 0.10 [95% CI = 0.02–0.28]). Using estimates of diagnostic accuracy for AMT‐4 from this meta‐analysis as one trigger for more comprehensive geriatric vulnerability assessments, ED dementia screening benefits patients when the prescreening probability of dementia is between 14 and 36%. Conclusions: ED‐based diagnostic research for dementia screening is limited to a few studies using an inadequate criterion standard with variable masking of interpreter's access to the index test and the criterion standard. Standardizing the geriatric ED cognitive assessment methods, measures, and nomenclature is necessary to reduce uncertainties about diagnostic accuracy, reliability, and relevance in this acute care setting. The AMT‐4 is currently the most accurate ED screening instrument to increase the probability of dementia and the Brief Alzheimer's Screen is the most accurate to decrease the probability of dementia. Dementia screening as one marker of vulnerability to initiate comprehensive geriatric assessment is warranted based on test–treatment threshold calculations. [ABSTRACT FROM AUTHOR]

Background: Lumbar punctures (LPs) are a common procedure in emergency medicine. However, studies have found that failed procedure rates can be as high as 50%. Ultrasound has been suggested to improve success rates by visually identifying the location and trajectory for the LP procedure. This systematic review and meta‐analysis was performed to determine whether the use of ultrasound improved the rate of successful LP performance. Methods: PubMed, CINAHL, Scopus, LILACS, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and bibliographies of selected articles were assessed for all randomized controlled trials comparing the success rates of ultrasound‐assisted LP with landmark‐based LP. Secondary outcomes included the rate of traumatic LPs, time to procedural success, number of needle passes, and patient pain score. Data were dual extracted into a predefined worksheet, and quality analysis was performed using the Cochrane Risk of Bias tool. Data were summarized and a meta‐analysis was performed with subgroup analyses by pediatric versus adult patients and by operator training level. Results: Twelve studies (n = 957 total patients) were identified. Ultrasound‐assisted LP was successful in 90.0% of patients and landmark‐based LP was successful in 81.4% of patients. The calculated risk difference (RD) was 8.9% (95% confidence interval [CI] = 1.2% to 16.7%) with an odds ratio (OR) of 2.22 (95% CI = 1.03 to 4.77) in favor of the ultrasound‐assisted group. There were fewer traumatic LPs in the ultrasound‐assisted group (10.7% vs. 26.5%; RD = –16.4%, 95% CI = –27.6% to –5.2%; OR = 0.28, 95% CI = 0.18 to 0.45). Ultrasound‐assisted LP was also associated with a shorter time to successful LP (6.87 minutes vs. 7.97 minutes), fewer mean needle passes (2.07 vs. 2.66), and lower patient pain scores (3.75 vs. 6.31). Conclusions: Ultrasound‐assisted LPs were associated with higher success rates, fewer traumatic LPs, shorter time to successful LP, fewer needle passes, and lower patient pain scores. Ultrasound should be considered prior to performing all LPs, especially in patients with difficult anatomy. Further studies are recommended to determine whether this effect is consistent in both adult and pediatric subgroups, as well as the impact of transducer type and body habitus on this technique. [ABSTRACT FROM AUTHOR]

This article presents a systematic literature review on whether dietary intake influences the risk for perinatal depression, i.e. depression during pregnancy or post‐partum. Such a link has been hypothesized given that certain nutrients are important in the neurotransmission system and pregnancy depletes essential nutrients. PubMed, EMBASE and CINAHL databases were searched for relevant articles until 30 May 2015. We included peer‐reviewed studies of any design that evaluated whether perinatal depression is related to dietary intake, which was defined as adherence to certain diets, food‐derived intake of essential nutrients or supplements. We identified 4808 studies, of which 35 fulfilled inclusion criteria: six randomized controlled trials, 12 cohort, one case‐control and 16 cross‐sectional studies, representing 88 051 distinct subjects. Studies were grouped into four main categories based on the analysis of dietary intake: adherence to dietary patterns (nine studies); full panel of essential nutrients (six studies); specific nutrients (including B vitamins, Vitamin D, calcium and zinc; eight studies); and intake of fish or polyunsaturated fatty acids (PUFAs; 12 studies). While 13 studies, including three PUFA supplementation trials, found no evidence of an association, 22 studies showed protective effects from healthy dietary patterns, multivitamin supplementation, fish and PUFA intake, calcium, Vitamin D, zinc and possibly selenium. Given the methodological limitations of existing studies and inconsistencies in findings across studies, the evidence on whether nutritional factors influence the risk of perinatal depression is still inconclusive. Further longitudinal studies are needed, with robust and consistent measurement of dietary intake and depressive symptoms, ideally starting before pregnancy. [ABSTRACT FROM AUTHOR]

Background We have no clear overview of the extent to which health-care providers involve patients in the decision-making process during consultations. The Observing Patient Involvement in Decision Making instrument ( OPTION) was designed to assess this. Objective To systematically review studies that used the OPTION instrument to observe the extent to which health-care providers involve patients in decision making across a range of clinical contexts, including different health professions and lengths of consultation. Search strategy We conducted online literature searches in multiple databases (2001-12) and gathered further data through networking. Inclusion criteria (i) OPTION scores as reported outcomes and (ii) health-care providers and patients as study participants. For analysis, we only included studies using the revised scale. Data extraction Extracted data included: (i) study and participant characteristics and (ii) OPTION outcomes (scores, statistical associations and reported psychometric results). We also assessed the quality of OPTION outcomes reporting. Main results We found 33 eligible studies, 29 of which used the revised scale. Overall, we found low levels of patient-involving behaviours: in cases where no intervention was used to implement shared decision making ( SDM), the mean OPTION score was 23 ± 14 (0-100 scale). When assessed, the variables most consistently associated with higher OPTION scores were interventions to implement SDM ( n = 8/9) and duration of consultations ( n = 8/15). Conclusions Whatever the clinical context, few health-care providers consistently attempt to facilitate patient involvement, and even fewer adjust care to patient preferences. However, both SDM interventions and longer consultations could improve this. [ABSTRACT FROM AUTHOR]