Neighbourhood inequities in the availability of retailers selling tobacco products: a systematic review.

OBJECTIVE: To examine inequities in tobacco retailer availability by neighbourhood-level socioeconomic, racial/ethnic and same-sex couple composition. DATA SOURCES: We conducted a 10 November 2022 search of PubMed, PsycINFO, Global Health, LILACS, Embase, ABI/Inform, CINAHL, Business Source Complete, Web of Science and Scopus. STUDY SELECTION: We included records from Organisation for Economic Co-operation and Development member countries that tested associations of area-level measures of tobacco retailer availability and neighbourhood-level sociodemographic characteristics. Two coders reviewed the full text of eligible records (n=58), including 41 records and 205 effect sizes for synthesis. DATA EXTRACTION: We used dual independent screening of titles, abstracts and full texts. One author abstracted and a second author confirmed the study design, location, unit of analysis, sample size, retailer data source, availability measure, statistical approach, sociodemographic characteristic and unadjusted effect sizes. DATA SYNTHESIS: Of the 124 effect sizes related to socioeconomic inequities (60.5% of all effect sizes), 101 (81.5%) indicated evidence of inequities. Of 205 effect sizes, 69 (33.7%) tested associations between retailer availability and neighbourhood composition of racially and ethnically minoritised people, and 57/69 (82.6%) documented inequities. Tobacco availability was greater in neighbourhoods with more Black, Hispanic/Latine and Asian residents (82.8%, 90.3% and 40.0% of effect sizes, respectively). Two effect sizes found greater availability with more same-sex households. CONCLUSIONS: There are stark inequities in tobacco retailer availability. Moving beyond documenting inequities to partnering with communities to design, implement, and evaluate interventions that reduce and eliminate inequities in retail availability is needed to promote an equitable retail environment. PROSPERO REGISTRATION NUMBER: CRD42019124984.

A Scoping Review of Trends in the Size of Lesbian, Gay, and Bisexual Tobacco Use Disparities, 1996-2020, United States and Canada.

Purpose: Tobacco use is a major health disparity for lesbian, gay, bisexual, and transgender (LGBT) populations compared with heterosexual/cisgender populations. In this scoping review, we aimed to determine if LGBT tobacco use disparities are improving or worsening over time and if trends in disparities differed across subgroups. Methods: We included articles that longitudinally explored youth and adult LGB tobacco use in the United States and Canada after searching four databases and capturing records through July 2022. Two reviewers independently screened the title/abstract and full text of 2326 and 45 articles, respectively. Eleven articles from 18 larger assessments met inclusion criteria, spanning data collection from 1996 to 2020. Results: All studies consistently demonstrated tobacco disparities for LGB populations. No articles examined longitudinal transgender tobacco disparities. Most studies focused on smoking combustible cigarettes. Disparities in heavy or daily use for all LGB youth subgroups compared with heterosexual samples appear to be shrinking longitudinally. Results for early-onset, current, and lifetime smoking were less consistent. Adult evidence was relatively sparse; however, after 2010, studies show diminishing disparities over time, except for current smoking by bisexual women. Conclusions: Large tobacco use disparities persist for LGB populations, although the size of disparities may be decreasing for some groups. Initiatives for lesbian and bisexual women and girls should be prioritized, in addition to interventions addressing LGB smoking broadly. Surveillance instruments should uniformly and consistently assess LGBT identities and tobacco use behaviors.

Effect of PRISMA 2009 on reporting quality in systematic reviews and meta-analyses in high-impact dental medicine journals between 1993-2018.

INTRODUCTION: The PRISMA guidelines were published in 2009 to address inadequate reporting of key methodological details in systematic reviews and meta-analyses (SRs/MAs). This study sought to assess the impact of PRISMA on the quality of reporting in the full text of dental medicine journals. METHODS: This study assessed the impact of PRISMA (2009) on thirteen methodological details in SRs/MAs published in the highest-impact dental medicine journals between 1993-2009 (n = 211) and 2012-2018 (n = 618). The study further examined the rate of described use of PRISMA in the abstract or full text of included studies published post- PRISMA and the impact of described use of PRISMA on level of reporting. This study also examined potential effects of inclusion of PRISMA in Instructions for Authors, along with study team characteristics. RESULTS: The number of items reported in SRs/MAs increased following the publication of PRISMA (pre-PRISMA: M = 7.83, SD = 3.267; post-PRISMA: M = 10.55, SD = 1.4). Post-PRISMA, authors rarely mention PRISMA in abstracts (8.9%) and describe the use of PRISMA in the full text in 59.87% of SRs/MAs. The described use of PRISMA within the full text indicates that its intent (guidance for reporting) is not well understood, with over a third of SRs/MAs (35.6%) describing PRISMA as guiding the conduct of the review. However, any described use of PRISMA was associated with improved reporting. Among author team characteristics examined, only author team size had a positive relationship with improved reporting. CONCLUSION: Following the 2009 publication of PRISMA, the level of reporting of key methodological details improved for systematic reviews/meta-analyses published in the highest-impact dental medicine journals. The positive relationship between reference to PRISMA in the full text and level of reporting provides further evidence of the impact of PRISMA on improving transparent reporting in dental medicine SRs/MAs.

Size Matters! Anti-HBs Titer and HBV Reactivation During Anti-TNF Therapy.

BACKGROUND AND AIMS: We and others have previously described that hepatitis B surface antibody (anti-HBs) seems to protect against clinically significant HBV reactivation in cohort studies of patients undergoing anti-tumor necrosis factor (TNF) therapy. However, there were too few cases of HBV reactivation within cohort studies to assess the role of anti-HBs titer on reactivation. The purpose of this study was to systematically review the correlation between anti-HBs titer and the degree of clinically relevant HBV reactivation in patients undergoing anti-TNF therapy. METHODS AND RESULTS: We systemically reviewed all studies discussing anti-TNF therapy in patients with resolved HBV infection, defined as hepatitis surface antigen (HBsAg) negative and hepatitis B core antibody (anti-HBc) positive. We identified a total of 48 cases of reactivation from 5 cohort studies and 10 case reports or case series; 21 were anti-HBs negative, 7 were only reported as anti-HBs positive, 16 were anti-HBs positive with titer below 100, and 4 were anti-HBs positive with titer above 100. HBsAg sero-reversion was dominantly seen in patients with negative, low and/or declining anti-HBs titers. There was a significant trend toward less clinically relevant form of reactivation with increase in baseline anti-HBs titer (p = 0.022). CONCLUSION: Anti-HBs titers greater than 100 iU/L protect against clinically relevant HBV reactivation, while patients with low anti-HBs titers or negative anti-HBs had more clinically relevant HBV reactivation and higher rates of HBsAg sero-reversion. This suggests the importance of baseline quantitative anti-HBs prior to starting anti-TNF therapy and consideration vaccination for boosting anti-HBs titers prior to and/or during therapy.

Application and impact of Lasso regression in gastroenterology: A systematic review.

Least absolute shrinkage and selection operator (Lasso) regression is a statistical technique that can be used to study the effects of clinical variables in outcome prediction. In this study, we aimed at systematically reviewing the application of Lasso regression in gastroenterology for developing predictive models and providing a method of performing Lasso regression. A comprehensive search strategy was conducted in PubMed, Embase and Cochrane CENTRAL databases (Keywords: lasso regression; gastrointestinal tract/diseases) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were screened for eligibility based on pre-defined selection criteria and the data was extracted using a standardized form. Total 16 studies were included, comprising a diverse range of gastroenterological disease-related outcomes. Sample sizes ranged from 134 to 8861 subjects. Eleven studies reported liver disease-related prediction models, while five focused on non-hepatic etiology models. Lasso regression was applied for variable selection, risk prediction and model development, with various validation methods and performance metrics used. Model performance metrics included Area Under the Receiver Operating Characteristics (AUROC), C-index and calibration plots. In gastroenterology, Lasso regression has been used in various diseases such as inflammatory bowel disease, liver disease and esophageal cancer. It is valuable for complex scenarios with many predictors. However, its effectiveness depends on high-quality and complete data. While it identifies important variables, it doesn't provide causal interpretations. Therefore, cautious interpretation is necessary considering the study design and data quality.

A systematic review of the effectiveness of patient education through patient portals.

Objective: The objective of this study was to systematically review all literature studying the effect of patient education on patient engagement through patient portals. Introduction: Patient portals provide patients access to health records, lab results, medication refills, educational materials, secure messaging, appointment scheduling, and telehealth visits, allowing patients to take a more active role in their health care decisions and management. A debate remains around whether these additional aids actually improve patient engagement and increase their ability to manage their own health conditions. This systematic review looks specifically at the effect of educational materials included in patient portals. Materials and Methods: In accordance with PRISMA guidelines, the literature search was mapped across 5 databases (PubMed, CINAHL, Scopus, PsychINFO, Embase), and implemented on June 2, 2020. Results: Fifty-two studies were included in the review. Forty-six (88.5%) reported rates of patient utilization of educational resources in the patient portal. Thirty (57.9%) shared patients' perceptions of the usefulness of the education materials. Twenty-one (40.4%) reported changes in health outcomes following educational interventions through the patient portal. This review found that efforts are indeed being made to raise awareness of educational resources in patient portals, that patients are increasingly utilizing these resources, that patients are finding them useful, and that they are improving health outcomes. Conclusion: It seems that patient portals are becoming a powerful tool for patient education and engagement, and show promise as a means of achieving the quadruple aim of healthcare. Moving forward, research should establish more uniform methods of measurement in order to strengthen the literature surrounding the effectiveness of patient education through patient portals.

Development and field test of the Salutogenic Wellness Promotion Scale - short form (SWPS-SF) in U.S. college students.

Survey research is important for understanding health and improving practice among health professions. However, survey research can have drawbacks, such as overuse and excessively lengthy questionnaires that burden respondents. These issues lead to poor response rates and incomplete questionnaires. Low and incomplete response rates result in missing data and reduced sample size, damaging the value, usability and generalizability of the information collected. To address issues related to response rates and improve health research, shorter surveys are recommended because they impose less of a burden on respondents and are useful with larger populations. Health-related surveys also often focus on the factors leading to ill health without dedicating equal attention to factors supporting positive health. This study developed and tested a short form (SF) of the validated Salutogenic Wellness Promotion Scale (SWPS), which measures causes of health (rather than causes of disease), using responses from 2052 college students. The participants answered questions about their demographics and completed the SWPS and a perceived health assessment. Statistical tests demonstrated the SWPS-SF had significant relationships with the full SWPS, health status, and Grade Point Average (GPA). Statistical tests were also used to establish cutoff scores that had a high true positive and low false negative rate. These cutoff scores demonstrated a relationship of higher performance and better health. These promising results suggest this short test can provide valid information without burdening the respondents. Authors recommend additional tests be completed to validate the SWPS-SF.

Role of Hepatitis B Surface Antibodies in Risk for Hepatitis B Virus Reactivation During Anti-Tumor Necrosis Factor Therapy.

An estimated 250 million people are chronically infected with hepatitis B virus (HBV), with more than 800,000 deaths related to HBV.1 Although the prevalence of HBV has been decreasing, reactivation remains a cause for concern.2 Reactivation is defined by the resurgence of HBV DNA and/or HBV surface antigen (HBsAg) seroreversion in patients with resolved HBV or an increase in HBV viral load in chronic hepatitis.3 Anti-tumor necrosis factor (TNF) therapies have been shown to place patients at a risk for HBV reactivation.4.

Limited Improvements in Health Behaviors Suggest Need to Review Approaches to Health Promotion: A Repeated, Cross-Sectional Study.

PURPOSE: To broadly assess changes in key health behaviors (physical activity, fruit and vegetable consumption, smoking, and alcohol consumption) and one outcome (body mass index) between 2001-2006 and 2011-2016. DESIGN: Repeated cross-sectional study. SETTING: The United States of America. PARTICIPANTS: Noninstitutionalized adults age 24 to 39 participating in the National Health and Nutrition Examination Survey. ANALYSIS: We used 2-sample t tests and χ2 tests to compare differences in health behaviors between the 2 time periods. RESULTS: Data revealed a downward trend in both moderate and vigorous physical activity (P = .00), and fruit and vegetable consumption decreased (P = .003). Cigarette smoking decreased (P = .04), and there was no substantive change in heavy drinking between the 2 time periods. Body mass index was higher in the later time period (P = .00). CONCLUSION: Despite sustained funding efforts, we found little evidence that health behaviors improved between the 2 time periods. Indeed, many health behaviors have remained the same or worsened over time. These findings suggest the need to reflect on the appropriateness of the health promotion approaches being used.

Safety outcomes of SGLT2i in the heart failure trials: A systematic review and Meta-analysis.

AIMS: Sodium-glucose co-transporter inhibitors (SGLT2i) are emerging as a new treatment for heart failure (HF) after demonstrating favorable clinical outcomes in several randomized controlled trials (RCTs). In this meta-analysis, we assessed the safety of SGLT2i in the trials that prespecified heart failure in their inclusion criteria. MATERIALS AND METHODS: We searched the databases for RCTs comparing SGLT2i to placebo in heart failure patients. The primary outcome was the incidence of serious adverse events (SAEs). A sensitivity analysis according to the class of HF was also performed. RESULTS: The incidence of SAEs was significantly lower in the SGLT2i group (OR, 0.85; 95% CI, 0.77-0.92; P, 0.0002) and SAEs remained significantly lower after performing the sensitivity analysis (OR, 0.82; 95% CI, 0.75-0.89; P, <0.00001). Genital infections, urinary tract infections (UTIs), and hypotension were significantly higher in the SGLT2i group. CONCLUSIONS: SGLT2i remain a safe option for patients with HF with a lower incidence of SAEs. However, since they increase the risk of genital infection, UTIs and hypotension, the risks vs benefits in each patient should be weighed when making a prescribing decision.

Health sciences and medical librarians conducting research and their experiences asking for co-authorship.

Objective: Health sciences librarians frequently engage in scholarly publication, both with other librarians undertaking intradisciplinary scholarship, and increasingly as members of research teams centered in other disciplines. We sought to assess the emotional and institutional context of authorship among health sciences librarians, including emotions experienced during authorship negotiation, the frequency with which authorship is denied, and the correlation of perceived support from supervisors and the research community with the number of publications produced. Methods: 342 medical and health sciences librarians took an online survey of 47 questions regarding emotions experienced when asking for authorship, denial of authorship, if they have been given authorship without asking, and the extent to which they felt supported to conduct research in their current job. Results: Authorship negotiation creates varied and complex emotions among librarians. The emotions reported differed when negotiating authorship with librarian colleagues and when negotiating authorship with professionals in another field. Negative emotions were reported when asking either type of colleague for authorship. Respondents reported feeling mostly supported and encouraged by their supervisors, research communities, and workplaces. Nearly one quarter (24.4%) of respondents reported being denied authorship by colleagues outside of their departments. Perceived research appreciation and support by the research community is correlated with the total number of articles or publications produced by librarians. Conclusion: Authorship negotiation among health sciences librarians involves complex and frequently negative emotions. Denial of authorship is frequently reported. Institutional and professional support appear to be critical to publication among health sciences librarians.

Associations of tobacco retailer density and proximity with adult tobacco use behaviours and health outcomes: a meta-analysis.

OBJECTIVE: We sought to conduct a systematic review and meta-analysis of evidence to inform policies that reduce density and proximity of tobacco retailers. DATA SOURCES: Ten databases were searched on 16 October 2020: MEDLINE via PubMed, PsycINFO, Global Health, LILACS, Embase, ABI/Inform, CINAHL, Business Source Complete, Web of Science and Scopus, plus grey literature searches using Google and the RAND Publication Database. STUDY SELECTION: Included studies used inferential statistics about adult participants to examine associations between tobacco retailer density/proximity and tobacco use behaviours and health outcomes. Of 7373 studies reviewed by independent coders, 37 (0.5%) met inclusion criteria. DATA EXTRACTION: Effect sizes were converted to a relative risk reduction (RRR) metric, indicating the presumed reduction in tobacco use outcomes based on reducing tobacco retailer density and decreasing proximity. DATA SYNTHESIS: We conducted a random effects meta-analysis and examined heterogeneity across 27 studies through subgroup analyses and meta-regression. Tobacco retailer density (RRR=2.55, 95% CI 1.91 to 3.19, k=155) and proximity (RRR=2.38, 95% CI 1.39 to 3.37, k=100) were associated with tobacco use behaviours. Pooled results including both density and proximity found an estimated 2.48% reduction in risk of tobacco use from reductions in tobacco retailer density and proximity (RRR=2.48, 95% CI 1.95 to 3.02, k=255). Results for health outcomes came from just two studies and were not significant. Considerable heterogeneity existed. CONCLUSIONS: Across studies, lower levels of tobacco retailer density and decreased proximity are associated with lower tobacco use. Reducing tobacco supply by limiting retailer density and proximity may lead to reductions in tobacco use. Policy evaluations are needed.

The effect of librarian involvement on the quality of systematic reviews in dental medicine.

OBJECTIVES: To determine whether librarian or information specialist authorship is associated with better reproducibility of the search, at least three databases searched, and better reporting quality in dental systematic reviews (SRs). METHODS: SRs from the top ten dental research journals (as determined by Journal Citation Reports and Scimago) were reviewed for search quality and reproducibility by independent reviewers using two Qualtrics survey instruments. Data was reviewed for all SRs based on reproducibility and librarian participation and further reviewed for search quality of reproducible searches. RESULTS: Librarians were co-authors in only 2.5% of the 913 included SRs and librarians were mentioned or acknowledged in only 9% of included SRs. Librarian coauthors were associated with more reproducible searches, higher search quality, and at least three databases searched. Although the results indicate librarians are associated with improved SR quality, due to the small number of SRs that included a librarian, results were not statistically significant. CONCLUSION: Despite guidance from organizations that produce SR guidelines recommending the inclusion of a librarian or information specialist on the review team, and despite evidence showing that librarians improve the reproducibility of searches and the reporting of methodology in SRs, librarians are not being included in SRs in the field of dental medicine. The authors of this review recommend the inclusion of a librarian on SR teams in dental medicine and other fields.

Implications of microscale lung damage for COVID-19 pulmonary ventilation dynamics: A narrative review.

The COVID-19 pandemic surges on as vast research is produced to study the novel SARS-CoV-2 virus and the disease state it induces. Still, little is known about the impact of COVID-19-induced microscale damage in the lung on global lung dynamics. This review summarizes the key histological features of SARS-CoV-2 infected alveoli and links the findings to structural tissue changes and surfactant dysfunction affecting tissue mechanical behavior similar to changes seen in other lung injury. Along with typical findings of diffuse alveolar damage affecting the interstitium of the alveolar walls and blood-gas barrier in the alveolar airspace, COVID-19 can cause extensive microangiopathy in alveolar capillaries that further contribute to mechanical changes in the tissues and may differentiate it from previously studied infectious lung injury. Understanding microlevel damage impact on tissue mechanics allows for better understanding of macroscale respiratory dynamics. Knowledge gained from studies into the relationship between microscale and macroscale lung mechanics can allow for optimized treatments to improve patient outcomes in case of COVID-19 and future respiratory-spread pandemics.

Hepatitis B surface antibody titres and hepatitis B reactivation with direct-acting antiviral therapy for hepatitis C.

HBV reactivation can occur while undergoing direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV). The role of hepatitis B surface antibody (HBsAb) has not been systematically explored. Therefore, the purpose of this systematic review was to explore the role of the presence of HBsAb on the risk of HBV reactivation related to DAA therapy. We reviewed MEDLINE, CINAHL, EMBASE and Cochrane Central for studies on DAA therapy and data on HBsAb in patients with resolved hepatitis B (hepatitis B surface antigen-negative and hepatitis B core antibody-positive). We identified twenty-nine reports: thirteen case reports with HBV reactivation (10 HBsAb-negative and 3 HBsAb-positive patients) and sixteen cohort studies totalling 2528 patients with resolved HBV infection (1429 HBsAb negative, 1099 HBsAb positive). Reactivation was found in 12 (0.8%) HBsAb-negative and 7 (0.6%) HBsAb-positive individuals of cohort studies. All but two HBV reactivation occurred in patients with HBsAb titre <30 iU/L. The presence of HBsAb showed a trend towards delayed reactivation (median 12 weeks vs 9.5 weeks; P = .07). Importantly, with the exception of a patient with escape variant and an HIV-infected individual, no HBsAb-positive individual demonstrated clinical reactivation. HBsAb presence seems to protect from clinical HBV reactivation related to DAA therapy. The most pronounced prevention for reactivation may require titres greater than 30 iU/L.

Should Baseline Hemoglobin A1c or Dose of SGLT-2i Guide Treatment With SGLT-2i Versus DPP-4i in People With Type 2 Diabetes? A Meta-Analysis and Systematic Review.

Our aim was to explore whether the baseline hemoglobin A1c or the dose of sodium glucose cotransporter-2 inhibitor (SGLT-2i) chosen better predicted the efficacy of SGLT-2i versus dipeptidyl peptidase-4 inhibitor (DPP-4i) in type 2 diabetes. We searched for randomized trials that compared SGLT-2i with DPP-4i in type 2 diabetes and reported a change in hemoglobin A1c over time. We created 2 separate analyses (one based on baseline hemoglobin A1c and the other according to US Food and Drug Administration [FDA]-approved SGLT-2i dose). Thirteen trials were included. In the analysis according to baseline hemoglobin A1c , there was a significantly greater reduction in hemoglobin A1c when baseline hemoglobin A1c was ≥8.5%, favoring SGLT-2i over DPP-4i but not when baseline hemoglobin A1c was <8.5% (mean difference [95%CI], -0.36% [-0.53% to -0.18%] and 0.04% [-0.09% to 0.17%], respectively). On restricting the analysis to trials stratifying hemoglobin A1c to <8.0% or ≥8.0%, results did not change. In the analysis based on FDA-approved SGLT-2i doses, higher SGLT-2i doses caused a significantly greater hemoglobin A1c reduction at ≤26 and ≥52 weeks compared with the highest DPP-4i doses (mean difference [95%CI], -0.11% [-0.18% to -0.04%] and -0.24% [-0.34% to -0.15%], respectively). Lower SGLT-2i doses caused a significantly greater hemoglobin A1c reduction at ≥52 weeks but not at ≤26 weeks compared with the highest DPP-4i doses (mean difference [95%CI], -0.12% [-0.23% to -0.02%] and 0.01% [-0.05% to 0.07%], respectively). In people with type 2 diabetes and a baseline hemoglobin A1c ≥ 8.0%, SGLT-2i produced significantly greater reductions in hemoglobin A1c compared with DPP-4i and may be preferred. SGLT-2i dose titration to a higher FDA-approved dose is recommended in suitable patients.

Intravenous Amide Anesthetics to Treat Pain Associated with Renal Colic in the Emergency Department: a Systematic Review.

INTRODUCTION: Renal colic affects 12% of the U.S. population, accounting for nearly 1% of emergency department (ED) visits. Current recommendations advocate narcotic-limiting multimodal analgesia regimens. The objective of this review is to determine if in patients with renal colic (Population), intravenous (IV) amide anesthetics (Intervention) result in better pain control, lower requirements for rescue analgesia, or less adverse medication effects (outcome) compared to placebo, non-steroidal anti-inflammatory drugs (NSAIDs), or opiates (Comparisons). METHODS: Scholarly databases and relevant bibliographies were searched using a pre-designed systematic review protocol and registered with PROSPERO. Inclusion criteria were: (1) randomized clinical trial (RCT), (2) age ≥ 18 years, (3) confirmed or presumed renal colic, (4) amide anesthetic administered IV. Eligible comparison groups included: placebo, conventional therapy, acetaminophen, NSAID, or opiate. The primary outcome was pain intensity at baseline, 30, 60, and 120 minutes. Trial quality was graded, and risk-of-bias was assessed. RESULTS: Of the 3930 identified references, 4 RCTs (479 participants) were included. One trial (n=240) reported improved analgesia with IV lidocaine (LidoIV) plus metoclopramide, compared to morphine. All other trials reported unchanged or less analgesia compared to placebo, ketorolac, or fentanyl. Very severe heterogeneity (I2= 88%) precluded pooling data. CONCLUSION: Current evidence precludes drawing a firm conclusion on the efficacy or superiority of LidoIV over traditional therapies for ED patients with renal colic. Evidence suggests LidoIV may be an effective non-opiate analgesic alliterative; however, it's efficacy may not exceed that of NSAIDs or opiates. Further study is needed to validate the potential improved efficacy of LidoIV plus metoclopramide.

The impacts of faculty caring on nursing students' intent to graduate: A systematic literature review.

OBJECTIVES: To examine the current studies about the impacts of faculty caring on nursing students' intent to graduate and provide recommendations. The nursing profession continues to face nursing shortages. One of the solutions recognized to alleviate the shortage is increasing the number of students graduating from nursing schools. It lacks a literature review synthesizing the current research about the impacts of faculty caring on nursing students' intent to graduate and indicate areas for future research. METHODS: This is a systematic literature review. The search of the literature was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Databases searched included MEDLINE via PubMed, CINAHL, PsycINFO, and ProQuest Search. Search terms included 'attrition,' 'dropouts,' 'graduation rate,' 'faculty,' 'instructor,' 'professor,' 'nursing,' and 'caring.' RESULTS: Ten articles met the inclusion criteria. The articles were conducted in the Associate Degree of Nursing and the Bachelor of Science in Nursing programs. Nursing faculties played a significant role in students' intent to graduate by building students' confidence, creating a compassionate learning environment, and promoting students' competence. Faculties' caring behaviors, including respecting students, showing empathy, and using caring communication skills, were essential characteristics to affect students' learning environments. CONCLUSIONS: The findings indicate that students' perceptions of faculty caring can affect their perceptions of the learning environment and sense of belonging, and therefore, impact their intent to graduate. Students' perceptions of their instructors' caring behaviors are instrumental in motivating them to continue learning. The capacity of faculty caring plays a significant role in students' success.

Real-time audio-visual feedback with handheld nonautomated external defibrillator devices during cardiopulmonary resuscitation for in-hospital cardiac arrest: A meta-analysis.

OBJECTIVE: Restoring cardiopulmonary circulation with effective chest compression remains the cornerstone of resuscitation, yet real-time compressions may be suboptimal. This project aims to determine whether in patients with in-hospital cardiac arrest (IHCA; population), chest compressions performed with free-standing audiovisual feedback (AVF) device as compared to standard manual chest compression (comparison) results in improved outcomes, including the sustained return of spontaneous circulation (ROSC), and survival to the intensive care unit (ICU) and hospital discharge (outcomes). METHODS: Scholarly databases and relevant bibliographies were searched, as were clinical trial registries and relevant conference proceedings to limit publication bias. Studies were not limited by date, language, or publication status. Clinical randomized controlled trials (RCT) were included that enrolled adults (age ≥ 18 years) with IHCA and assessed real-time chest compressions delivered with either the standard manual technique or with AVF from a freestanding device not linked to an automated external defibrillator (AED) or automated compressor. RESULTS: Four clinical trials met inclusion criteria and were included. No ongoing trials were identified. One RCT assessed the Ambu CardioPump (Ambu Inc., Columbia, MD, USA), whereas three assessed Cardio First Angel™ (Inotech, Nubberg, Germany). No clinical RCTs compared AVF devices head-to-head. Three RCTs were multi-center. Sustained ROSC (4 studies, n = 1064) was improved with AVF use (Relative risk [RR] 1.68, 95% confidence interval [CI] 1.39-2.04), as was survival to hospital discharge (2 studies, n = 922; RR 1.78, 95% CI 1.54-2.06) and survival to hospital discharge (3 studies, n = 984; RR 1.91, 95% CI 1.62-2.25). CONCLUSION: The moderate-quality evidence suggests that chest compressions performed using a non-AED free-standing AVF device during resuscitation for IHCA improves sustained ROSC and survival to ICU and hospital discharge. TRIAL REGISTRATION: PROSPERO (CRD42020157536).