Global prevalence and factors associated with preoperative depression in women undergoing breast surgery: a meta-analysis and meta-regression.

PURPOSE: Depression is one of the main psychological responses experienced by patients with breast cancer perioperatively. Therefore, this review aimed to synthesize the prevalence rate of depression preoperatively among patients with breast cancer. METHODS: Six databases were searched for published articles, which recruited female patients aged 18 years and above, diagnosed with breast cancer and planned for breast surgery. Grey literatures were searched from ProQuest Theses and Dissertations, Science.gov and CogPrints. Studies published in English from the inception of databases to January 2023 were considered. Two reviewers screened, extracted, and appraised the data independently. Joanna Briggs Institute data collection form was used for data collection. Hoy's Risk of Bias Tool was utilized to assess the individual study's quality. Review Manager 5.4 software was utilized for meta-analysis. Subgroup analyses were conducted to explore the reasons for any heterogeneity. Publication bias was evaluated by Egger's test and funnel plot. RESULTS: Twenty studies involving 32,143 patients with breast cancer were included. Meta-analyses revealed an overall preoperative prevalence of 30% among all studies. Subgroup analyses showed that studies conducted in the Middle East and North Africa used purposive sampling, with patients undergoing mastectomy and lumpectomy and with moderate risk of bias reported higher prevalence of preoperative depression (54%, 44%, 40%, and 49%, respectively) as compared to other respective subgroups. CONCLUSION: The high prevalence of preoperative depression among women with breast cancer indicated the need for health care professionals to provide more psychological support to them.

An Exploratory Study of Alternative Timeframes and Descriptors for EQ-5D-5L in Obstructive Airway Diseases Using Mixed Methods.

OBJECTIVES: EQ-5D-5L with its recall time of "today" may limit its ability to capture episodic symptoms and exacerbations in chronic obstructive airway diseases (OAD). We examined whether longer timeframes and changing the intensity response scales to frequency scales could improve the measurement properties of EQ-5D-5L. METHODS: We used a mixed method design starting with in-depth interviews with 20 patients and clinicians to elicit preferred timeframes using concept elicitation techniques and content analyses. We then administered the top four preferred variants using one- & four-weeks' timeframes with the original intensity or an alternative frequency response scale alongside EQ-5D-5L and St George Respiratory Questionnaire (SGRQ) to OAD patients during two different visits. We compared the ceiling effects and construct validity by testing a priori hypotheses in relation to SGRQ and clinical outcomes via correlation and receiver operating characteristic (ROC) analyses, respectively. Follow-up patients were categorized into "better", "stable", and "worse" groups to assess reliability using intra-class correlation coefficient (ICC) or Cohen's Kappa (k), and responsiveness using ROC analysis. RESULTS: 184 patients (mean [SD] age: 54[18]; female: 37.0%) completed baseline assessments.120 patients also completed follow-up assessments (mean [SD] interval: 2.8 [1.7] months). The ceilings were lower in the variants compared to EQ-5D-5L (p<0.001). Reliability of the variants were comparable to or higher than EQ-5D-5L. The c-statistic values derived from ROC analyses of the variants were consistently higher than EQ-5D-5L. CONCLUSIONS: Use of longer timeframes with the original intensity or the frequency response scales may improve EQ-5D-5L's psychometric properties in OAD patients. (248 words).

The Ceiling Effects of EQ-5D-3L and 5L in General Population Health Surveys: A Systematic Review and Meta-Analysis.

OBJECTIVES: This review aims to examine the ceiling effects of EQ-5D-3L (3L) and EQ-5D-5L (5L) in general adult populations and identify the factors influencing these effects. METHODS: We searched 8 databases for observational studies published in English from inception to 24 July 2023. Ceiling effects were calculated by dividing the number of participants reporting full health at dimension or profile level by the total sample size. Subgroup analysis and meta-regression using the metafor package in R software were performed. RESULTS: We identified 94 studies from 70 articles, including 4 543 647 adults across 37 countries. The global pooled proportion of individuals reporting full health ("11111") was 56% (95% CI 51%-62%) for 3L and 49% (95% CI 44%-54%) for 5L. The self-care dimension showed the highest ceiling effects (3L: 97%; 5L: 94%), whereas pain/discomfort had the lowest (3L: 69%; 5L: 60%). The ceiling effects in East/South-East Asia were higher than in Europe by 25% (95% CI 18%-32%) in 3L and 9% (95% CI -2%-20%) in 5L. Adjusting for mean age and proportion of males, significant regional differences persisted in the overall profile level of 3L, in all 3L dimensions (except for self-care), and 5L dimensions (except for pain/discomfort and anxiety/depression). CONCLUSIONS: This review highlights significant ceiling effects in the EQ-5D, especially in Asian populations. The 5L version exhibited fewer ceiling effects than the 3L, indicating its superiority for general population surveys. Further research is crucial to understand the disparities in self-reported health outcomes between Asians and other populations.

Association of a healthy ageing index with health-related outcomes in a multi-ethnic cohort from Singapore.

BACKGROUND: The global population is ageing rapidly and it is important to promote healthy ageing. The Healthy Ageing Index (HAI) is a comprehensive measure of health, but there is limited research on its association with other age-related outcomes. The management of an aging population necessitates considerations even among generally healthy adults, as age-related diseases often remain unaccounted for until later stages of life. This study explores the association of risk factors with HAI and its association with peripheral artery disease (PAD), muscle strength, health-related quality of life (HRQoL), and psychological distress in the Singapore Multi-Ethnic Cohort study. METHODS: This cross-sectional study involved 1909 participants (median (Q1, Q3) age: 53 (48, 60) years and 59.3% females) from Singapore Multi-Ethnic Cohort study. The risk factors of HAI included age, gender, ethnicity, education level, smoking, alcohol consumption, employment, BMI and past medical histories. PAD was assessed using ankle-brachial index (ABI), handgrip strength (HGS), HRQoL with the EQ-5D-5 L questionnaire and psychological distress via the Kessler Psychological Distress Scale (K10). HAI components were assessed using relevant marker tests. RESULTS: Older age, Malay and Indian ethnicities, unemployment, high BMI and histories of CHD, hypercholesterolaemia, tumours and TIA/stroke were associated with lower HAI scores indicative of poorer health. Higher HAI scores were associated with females and higher education levels. Lower HAI scores were significantly associated with low ABI, high K10 scores, mobility and anxiety/depression dimensions of EQ-5D-5 L. CONCLUSION: The most important factors associated with HAI were age, sex, ethnicity, education, unemployment, BMI and a history of health conditions. Lower HAI scores were significantly associated with PAD, lower HRQoL and psychological distress. Thus, the HAI demonstrates promise as an evaluation method for assessing PAD, overall muscle strength and HRQoL in a population-based setting.

Effects of Humanitude care on people with dementia and caregivers: A scoping review.

AIMS AND OBJECTIVES: This study aimed to comprehensively review the research literature to provide an overview of the effects of Humanitude on people with dementia and their caregivers. BACKGROUND: Humanitude is a relationship-centred and compassionate care approach that focuses on improving the communication between people with dementia and their caregivers. There is a lack of updated and comprehensive synthesis on the evidence of the effects of Humanitude in dementia care. DESIGN AND METHODS: This paper adopted the scoping review framework by Arksey and O'Malley. We searched through the following databases: Pubmed, CINAHL, EMBASE, PsycINFO, ProQuest, Scopus and Web of Science from its inception to 3 September 2021. Three investigators independently screened the titles and abstracts and assessed the full-text articles for eligibility. The PRISMA-ScR checklist was included in this scoping review. RESULTS: We retrieved 1317 articles from databases and grey sources. Eleven studies were included after the screening. The synthesised results suggest that Humanitude can reduce agitation and psychological symptoms and improve the general well-being of people with dementia. Humanitude also has positive effects in improving care communication, empathy, job satisfaction and reducing burnout among caregivers. CONCLUSION: Humanitude shows the potential for positive effects on people with dementia and their caregivers. However, most studies did not include a comparator group and could not provide rigorous findings as compared to randomised controlled trials. There is a need for randomised controlled studies to demonstrate the effectiveness of Humanitude on people with dementia and their caregivers. RELEVANCE FOR CLINICAL PRACTICE: This paper reviewed the literature on all types of publications that examine the use of Humanitude in people with dementia and their caregivers. Thus, it provided an up-to-date overview of the effects of Humanitude to inform clinical practice.

Novel Spinal Cord Stimulation Waveforms for Treating Back and Leg Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Spinal cord stimulation (SCS) has been suggested as a treatment option to improve the quality-adjusted life years of individuals with low back pain. However, previous reviews have some methodologic limitations. This review aims to evaluate the effectiveness of novel SCS waveforms on pain outcomes in patients with low back pain (LBP) compared with traditional SCS or placebo comparator. MATERIALS AND METHODS: Nine electronic data bases, ongoing trials, gray literature, and targeted journals were searched from inception to December 27, 2021. The Cochrane risk of bias and Grading of Recommendation, Assessment, Development, and Evaluations were used to appraise individual and overall evidence. Subjects aged ≥ 18 years with or without previous surgeries and having LBP for at least three months were included. The primary outcome was pain intensity including back or leg pain scores at postintervention. Secondary outcomes comprised decrease in back, leg, and overall pain, and health-related quality of life. RESULTS: A total of 11 randomized controlled trials (RCTs) involving 955 participants across four countries were included. Our meta-analysis revealed that novel SCS waveform was superior to traditional SCS or placebo comparator for treating leg pain (Z = -2.12, p = 0.03) with a small effect size (Hedges' g = -0.18, 95% CI: -0.34 to -0.01). Back-pain intensity (g = -0.22, 95% CI: -0.47 to 0.02) and health-related quality of life (g = -0.12, 95% CI: -0.43 to 0.18) were similar between the novel SCS waveform group and the traditional SCS or placebo comparator groups. The meta-regression did not identify any effect of the covariates on back-pain intensity. CONCLUSIONS: With low certainty of evidence, this finding provides a rationale for considering the novel SCS waveform as complements to the usual therapeutic plan. Future trials should adopt well-designed RCTs with larger sample size and follow-up assessment.

The effect of wearable-delivered sleep interventions on sleep outcomes among adults: A systematic review and meta-analysis of randomized controlled trials.

The aims of the review were to (i) evaluate the effectiveness of wearable-delivered sleep interventions on sleep outcomes among adults, and (ii) explore the effect of factors affecting total sleep time. Eight databases were searched to identify relevant studies in English from inception until December 23, 2021. The Cochrane Risk of Bias tool version 2.0 and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria were used to assess the risk of bias and certainty of the evidence, respectively. Twenty randomized controlled trials (RCTs) were included, involving 1608 adults across nine countries. Wearable-delivered sleep interventions elicited significant improvement of 1.96 events/h for the oxygen desaturation index and 3.13 events/h for the respiratory distress index. Meta-analyses found that wearable-delivered sleep interventions significantly decreased sleep disturbance (Hedges' g [g] = -0.37, 95% confidence interval [CI]: -0.59, -0.15) and sleep-related impairment (g = -1.06, 95% CI: -1.99, -0.13) versus the comparators. The wearable-delivered sleep interventions may complement usual care to improve sleep outcomes. More rigorous RCTs with a long-term assessment in a wide range of populations are warranted.

High body mass index and sleep problems during pregnancy: A meta-analysis and meta-regression of observational studies.

Despite the well-established correlation of weight and sleeping problems, little is known about the nature of the association. The present study examined whether pregnant women with high body mass index have a risk of developing sleep problems, and identified any covariates that affect this relationship. We systematically searched electronic databases, specialized journals, various clinical trial registries, grey literature databases and the reference list of the identified studies. All observational studies were obtained from inception until 9 August 2020. The Newcastle-Ottawa Scale was adopted to assess the quality of studies. Stata software was used to conduct meta-analysis and meta-regression. Forty-six observational studies involving 2,240,804 participants across 16 countries were included. Quality assessment scores ranged from 4 to 10 (median = 6). Meta-analyses revealed that the risk of sleep apnea, habitual snoring, short sleep duration and poor sleep quality is increased in pregnant women with high body mass index, but not for daytime sleepiness, insomnia or restless legs syndrome. Subgroup differences were detected on body mass index between different regions, nature of population, year of publication, age group and study quality. Random-effects meta-regression analyses showed that year and quality of publication were covariates on the relationships between pre-pregnant body mass index and sleep apnea risk. Our review shows that sleep apnea, habitual snoring, short sleep duration and poor sleep quality are important concerns for pregnant women with high body mass index. Developing screening and targeted interventions is recommended to promote efficacious perinatal care.

Robot-assisted distal training improves upper limb dexterity and function after stroke: a systematic review and meta-regression.

INTRODUCTION: Stroke is one of the top 10 causes of death worldwide, and more than half of stroke patients face distal upper extremity dysfunction. Considering that robot-assisted training may be effective in improving distal upper extremity function, the review evaluated the effect of robot-assisted distal training on motor function, hand dexterity, and spasticity after stroke. METHODS: Eleven databases were systematically searched for randomised controlled trials (RCTs) from inception until Aug 28, 2021. Meta-analysis and meta-regression were performed to investigate the overall effect and source of heterogeneity, respectively. RESULTS: Twenty-two trials involving 758 participants were included in this systematic review. The overall effect of robot-assisted distal training on the motor function of the wrists and hands was significant improvement (MD = 3.92; 95% CI, 3.04-4.80; P < 0.001). The robot-assisted training had a significantly beneficial effect on other motor functions (MD = 2.84; 95% CI, 1.54-4.14; P < 0.001); dexterity (MD = 9.01; 95% CI, -12.07--5.95; P < 0.001), spasticity, upper extremity strength (SMD = 0.42; 95% CI, 0.07-0.78; P = 0.02) and activities of daily living (SMD = 0.70; 95% CI, 0.29-1.23; P < 0.001). A series of subgroup analyses showed preferable design and effective regime of training. Meta-regression indicated the statistically significant effect of the year of trial, country, and duration on the effectiveness of training. CONCLUSION: Robot-assisted distal training has a significant effect on motor function, dexterity and spasticity of the upper extremity, compared to conventional therapy.

Effectiveness of Exercise in Improving Sleep Outcomes among Perinatal Women: A Systematic Review and Meta-analysis of randomised Controlled Trials.

BACKGROUND: Sleep problems are prevalent among perinatal women, contributing to the poor overall well-being of mother and child. Exercise is an inexpensive and sustainable intervention to improve sleep outcomes and can be personalized accordingly to individuals. This systematic review and meta-analysis aim to consolidate available evidence to evaluate the effectiveness of exercise on improving sleep outcomes among perinatal women. METHODS: Eight databases (CINAHL, Cochrane, EMBASE, PsycINFO, PubMed, Scopus, Web of Science and ProQuest) were used to perform a systematic search for studies in the English language from the inception of each database to 7 December 2019. The quality of studies was assessed using the risk of bias and GRADE. Review Manager was used for meta-analyses. Heterogeneity was determined by Cochran's Q (chi-square) and I2 values. The overall effect was evaluated using effect size and Z-statistics. RESULTS: A total of 2,139 records were identified. Ten randomized controlled trials were included, with seven in the meta-analysis, involving 998 pregnant and postpartum women across eight countries. With medium to very large effect sizes, the results favored exercise interventions on sleep quality, sleep efficiency, sleep duration, sleep latency, insomnia, diurnal tiredness and daytime dysfunction. CONCLUSION: Exercise interventions produced significant effects on improving sleep among perinatal women. This can increase advocacy for exercise among perinatal women to improve sleep and general health. Future randomized controlled trial designs should adhere to the Consolidated Standards of Reporting Trials and Template to ensure reliability when conducting and reporting such studies.

The Effectiveness of Transcranial Stimulation in Improving Swallowing Outcomes in Adults with Poststroke Dysphagia: A Systematic Review and Meta-analysis.

Transcranial stimulation has been proposed as an alternative rehabilitation therapy for adults with post-stroke dysphagia (PSD). This systematic review sought to determine the effectiveness of transcranial stimulation in patients with post-stroke dysphagia to improve swallowing function. From inception to January 3, 2021, an extensive search was conducted in PubMed, EMBASE, Cochrane, CINAHL, and Scopus, Web of Science. The randomized controlled trials (RCTs) included studies in adults aged 18 years and older who suffered from post-stroke dysphagia. Using Hedges' g as effect size, meta-analyses were conducted using random-effects models. To investigate potential sources of heterogeneity, subgroup analyses, and multivariable meta-regression analyses were conducted. Sixteen RCTs were included in this review, and 13 RCTs were used for meta-analysis. The meta-analysis showed that a large effect size in improving swallowing function after repetitive Transcranial Magnetic Stimulation (g = - 0.86, 95% CI - 1.57, - 0.16) and medium effect size in Transcranial Direct Current Stimulation (g = - 0.61, 95% CI - 1.04, - 0.17) at post-intervention, respectively. Subgroup and meta-regression analysis indicated that stimulation of the esophagus cortical area and middle-aged adults had a greater effect on swallowing function. The overall certainty of evidence assessed using the GRADE approach was low. Despite the positive results, transcranial stimulation requires additional research to reach definitive conclusions about the optimal stimulation protocol and to achieve the greatest benefit. Future trials should be more rigorous and include a larger sample size to demonstrate the efficacy of transcranial stimulation. Transcranial stimulation enables a more efficacious approach to dysphagia mitigation in PSD rehabilitation.

Evaluating the effectiveness of interprofessional advanced cardiac life support training: a sequential mixed-methods approach.

Interprofessional advanced cardiac life support (IP-ACLS) training is a holistic learning experience; thus, our research team incorporated this training into an undergraduate programme. Considering that IP-ACLS training is a new paradigm in nursing education, evaluating its effectiveness is essential. This research aimed to (1) evaluate the effectiveness of this training on improving the perceived level of interprofessional collaboration, self-efficacy and emotion regulation and (2) explore the learning experience of nursing students during training. The study design adopted a sequential mixed-method approach comprising a two-group pretest and posttest design amongst 120 students, followed by nine focus group discussions. Quantitative results demonstrated significant improvements in the perceived level of interprofessional collaboration, self-efficacy and emotion regulation at post-intervention and follow-up. Qualitative data were collected through video recording and field notes. Thematic analysis was performed following the method of Braun and Clarke. Qualitative analysis of focus group transcripts identified three themes: synergistic partnership, clinical readiness and improving further training. Quantitative and qualitative results were integrated in accordance with the mixed data analysis framework. These results complemented one another. The training provided an authentic learning experience and a good steppingstone to nursing students who are preparing to work interprofessionally in the future.

Global prevalence of resilience in health care professionals: A systematic review, meta-analysis and meta-regression.

AIMS: This review aims to examine the prevalence estimate of low resilience among health care professionals and identify the factors affecting the prevalence. BACKGROUND: Health care professionals experience high levels of stress. Understanding the health care professionals' resilience may provide an insight into how they perform in a highly stressed environment. EVALUATION: A comprehensive search of 11 databases was conducted. Studies that provided prevalence rates for low resilience among health care professionals working in a health care setting were included. Meta-analyses, sensitivity, subgroup analyses and meta-regression were conducted. KEY ISSUES: Among 27,720 studies, 41 studies (N = 17,073) across 16 countries were included. The prevalence of low resilience was 26% (95% CI: 20-32). Subgroup analyses indicated that types of resilience measures affect resilience prevalence significantly. A higher prevalence of low resilience was observed among allied health professions during the COVID-19 pandemic in the Middle East. CONCLUSIONS: This review indicated the prevalence of low resilience and type of resilience measurement instruments that affected the prevalence. IMPLICATIONS FOR NURSING MANAGEMENT: This review provides a roadmap to design tailored, discipline-specific and sustainable resilience training for nurses. Nursing managers should monitor the working hours and workload of nursing staffing in order to provide a protective working environment. This is a systematic review, and the PROSPERO registration number is CRD42021235350.

Efficacy of low-level light therapy for improving healing of diabetic foot ulcers: A systematic review and meta-analysis of randomized controlled trials.

Diabetic foot ulcers are prevalent among patients with diabetes and negatively affect mortality and life expectancy. This study aimed to synthesize and systematically review the best evidence to assess the efficacy of low-level light therapy in improving healing of diabetic foot ulcers. We search CINAHL, Cochrane Library, EMBASE, ProQuest, PubMed, Scopus, and Web of Science from inception until September 30, 2019. Meta-analysis was performed using the Comprehensive Meta-analysis 3.0 software. Overall effect was measured using Hedges' g and determined using the Z-statistic at a significance level of P < .05. Heterogeneity was assessed using χ2 and I2 statistics. Twelve randomized controlled trials were included. Meta-analysis revealed that 30.90% of the ulcer area was significantly reduced in the therapy group compared with the control group (Z = 3.95, P < .001) with a very large effect (g = 2.81). A 4.2 cm2 reduction of the ulcer area was observed in the therapy group compared with the control group (Z = 2.17, P = .03) with a very large effect (g = 1.37). In addition, diabetic foot ulcers in the therapy group was 4.65 times more likely to heal completely than those in the control group (Z = 3.02, P = .003). Low-level light therapy accelerates wound healing and reduces the size of diabetic foot ulcers. However, our review does not allow any recommendation for the best treatment parameters required to achieve improved healing. Future trials need to include a good design and large sample size in defining the optimal treatment parameters for ulcers of different sizes.

Measurement Properties of the EQ VAS Around the Globe: A Systematic Review and Meta-Regression Analysis.

OBJECTIVES: This study aimed to synthesize and evaluate published evidence on the measurement properties of the EQ VAS, a component of all EQ-5D questionnaires. METHODS: This systematic review followed the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines. Five electronic databases were searched for EQ-5D-3L and EQ-5D-5L validation articles published from January 1, 2009, to November 5, 2019. Evidence for construct validity, test-retest reliability, and responsiveness was extracted from individual studies before being aggregated for evaluation of the populations represented by the studied samples. Multivariable logistic meta-regression was conducted to explore the effects of potential covariates on construct validity. RESULTS: A total of 50 articles containing 488 studies, using samples drawn from 12 different populations, were identified. Generally, the quality of evidence was high for construct validity studies (n = 397) but only moderate for both test-retest reliability studies (n = 21) and responsiveness studies (n = 70). "Sufficient" construct validity of EQ VAS was found in 8 of 12 populations, "sufficient" test-retest reliability was found in 3 of 11 populations, and "sufficient" responsiveness was found in 5 of 12 populations. Meta-regression analyses suggested that construct validity studies from the Asian-Pacific region were more likely to show a negative rating compared with studies from Europe and North America. CONCLUSION: The EQ VAS exhibits "sufficient" construct validity, "inconsistent" test-retest reliability, and "inconsistent" responsiveness across a broad range of populations. Additional studies are needed to explore the suboptimal validity of the EQ VAS in the Asian-Pacific region, whereas more high-quality validation studies are needed to assess its reliability and responsiveness.

School-based interventions for the treatment of childhood obesity: a systematic review, meta-analysis and meta-regression of cluster randomised controlled trials.

OBJECTIVE: Schools offer an ideal setting for childhood obesity interventions due to their access to children and adolescents. This review aimed to systematically review the impact of school-based intervention for the treatment of childhood obesity. DESIGN: Eight databases were searched from inception till 30 May 2020. A revised Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development and Evaluations criteria were used to evaluate the risk of bias and overall evidence. Meta-analysis and meta-regression were performed on Stata software using the random effects model. Overall effect was evaluated using Hedges' g, and heterogeneity was assessed using Cochran's Q and I2. SETTING: Cluster randomised controlled trials (cluster-RCT) delivered in school. PARTICIPANTS: Children and adolescents (6-18 years of age) with overweight and obesity. RESULTS: Twelve cluster-RCT from seven countries with 1755 participants were included in the meta-analysis. School-based interventions for the treatment of childhood obesity reduced BMI and BMI z-scores with a medium effect (g = 0·52). Subgroup analyses showed greater effectiveness of brief school-based interventions and the interventions conducted in lower-middle to upper-middle economies. Meta-regression assessed the heterogeneity and the final model, with covariates of the type of economies and trial duration, accounted for 41·2 % of the variability. The overall quality of evidence was rated low because of the high risk of bias and inconsistency. CONCLUSIONS: School-based interventions are a possible approach to provide universal healthcare for the treatment of childhood obesity, and further well-designed cluster-RCT with longer follow-up are needed. This study is registered with PROSPERO (CRD42020160735).

Personalised eHealth interventions in adults with overweight and obesity: A systematic review and meta-analysis of randomised controlled trials.

Given that many existing electronic health (eHealth) interventions with a general approach have limited effects, a personalised approach is necessary. We aimed to evaluate the effectiveness of personalised eHealth interventions in reducing body weight and identify the effective key features of such interventions. We searched seven databases for randomised controlled trials (RCTs) from inception until September 6, 2018. Of the 26,733 records identified, 15 RCTs were included. Meta-analysis revealed a significant reduction (-2.77 kg, 95% confidence interval - 3.54 to -2.00 kg) in the personalised eHealth intervention group compared with that in the control group (Z = -7.04, p < .001). The duration of the interventions ranged from 14 weeks and three trials had follow-up assessments at 6 and 12 months. Our subgroup analyses highlighted several crucial design elements of future personalised eHealth interventions by utilising a combination of tailored content and customised feedback with human feedback, usage of theoretical basis, short message service, device, reminder, self-monitoring, goal setting and synchronous communication for 12 to 14 weeks. Egger's regression asymmetry test suggested no evidence of publication bias (p = .458). Using meta-regression we found evidence that a statistically significant impact of age and year of publication on the effectiveness of intervention. The overall evidence grade of outcomes ranged from very low to low, hence future trials should use well-designed RCTs.

Technology-Delivered Psychotherapeutic Interventions in Improving Depressive Symptoms Among People with HIV/AIDS: A Systematic Review and Meta-analysis of Randomised Controlled Trials.

With the increasing popularity of advanced technology, technology-delivered psychotherapeutic interventions (TPIs) may play a promising role in improving depressive symptoms among PLWHA. However, its effectiveness remains unclear. We aimed to synthesise the evidence of the effectiveness of TPIs in improving depressive symptoms of PLWHA using a meta-analytic approach. Seven databases were systematically searched for randomised controlled trials (RCTs) from the inception until August 14, 2018. Random-effects meta-analysis was adopted to assess effect size. Cochran's Q test and I2 were used to investigate the problem of heterogeneity. Sensitivity, subgroup analyses and meta-regression were performed. Of the 43,048 records identified, 14 RCTs were included. The meta-analysis revealed a small effect on reducing depressive symptom scores (d = 0.23, 95% CI - 0.39 to - 0.06) after TPIs. Random-effects meta-regression showed that publication year was a significant moderator (p = 0.013), whereby the latest trials had larger effect size in reducing the depressive symptoms than earlier trials. Our review suggested a possible future approach of utilising TPIs by means of mobile applications and internet-based interventions for PLWHA to reduce their depressive symptoms. This review highlighted the essential key features in designing future TPIs. The overall low-quality evidence suggested the need to conduct further high-quality.

A systematic review and meta-analysis: Vinegar consumption on glycaemic control in adults with type 2 diabetes mellitus.

AIM: To systematically review the effectiveness of vinegar consumption in improving glycaemic control in adults with type 2 diabetes mellitus. DESIGN: A systematic review and meta-analysis. REVIEW SOURCES: The CINAHL, Excerpta Medica database (EMBASE), Medline, PubMed, Scopus and Cochrane databases were searched in April 2019. Interventional studies published in the English language, from inception to 15 April 2019, were included. REVIEW METHODS: Two investigators independently assessed the quality of the studies, discussed their findings to reach consensus and complied with the standards of the Cochrane Handbook for Systematic Reviews of Interventions. Random-effects meta-analysis was conducted in Review Manager 5.3.5 to assess the effect size. A series of subgroup and sensitivity analyses were conducted to explore the causes of heterogeneity. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS: A total of six relevant studies, including 317 patients with type 2 diabetes mellitus, were selected from 356 studies identified through electronic searches and reference lists. The meta-analysis showed significantly better fasting blood glucose and haemoglobin A1c (HbA1c) level. In secondary analyses, there was a remarkable reduction in total cholesterol and low-density lipoprotein postintervention. CONCLUSION: Vinegar content varied across the studies, and the sample sizes in the included studies were relatively small. Therefore, caution should be exercised when trying to extrapolate the results to a larger population. IMPACT: Existing reviews are limited to narrative synthesis, lacking critical appraisal, heterogenous outcomes, nor any report of fasting blood glucose and HbA1c. This meta-analysis review extends the evidence on the beneficial effects of vinegar on glycaemic control as measured by HbA1c and fasting blood glucose. Clinicians could incorporate vinegar consumption as part of their dietary advice for patients with diabetes.

Nursing teamwork in general ward settings: A mixed-methods exploratory study among enrolled and registered nurses.

AIM: To examine the perceived level of nursing teamwork and factors influencing teamwork among enrolled nurses (ENs) and registered nurses (RNs) in general ward settings. BACKGROUND: The nursing care delivery model includes RNs, ENs and others who work as a team to deliver patient care. The potential impact of teamwork on nursing care highlights the need to explore the work of nursing teams. DESIGN: A mixed-methods exploratory study. METHOD: Quantitative and qualitative data were collected concurrently from ENs and RNs in 2018. Two hundred and forty-eight (n = 248) nurses completed the Nursing Teamwork Survey. Sixteen nurses participated in focus group discussions. Qualitative data were reported following COREQ guidelines, while quantitative data followed the STROBE guidelines. RESULTS: Both ENs and RNs scored highest for the shared mental model subscale but lowest for the team orientation subscale. Factors including qualification level, years of working experience, perceived job staffing adequacy and job satisfaction were found to influence teamwork. Three themes emerged from the qualitative findings: expectations of each other's role, delegation practices and interpersonal relationships. ENs and RNs differed in their expectations of their role in basic patient care activities and faced power struggles related to delegation practices. Open and structured communication was deemed essential in building interpersonal relationships. CONCLUSION: The ENs and RNs have clear understanding of their personal roles and responsibilities towards achieving a common goal. However, teamwork may be improved with a shared mental model in performing basic nursing care tasks, mutual support for workload management, better delegation practices, effective communication, enhanced interpersonal relationships and better team orientation. RELEVANCE TO CLINICAL PRACTICE: Nurse managers and educators need to work collaboratively to foster positive delegation practices in clinical practice supported by applicable team training that enhances mutual trust, backup behaviours and collective orientation in nursing teams.