Hospice interventions for persons living with dementia, family members and clinicians: A systematic review.

BACKGROUND: Hospice care was initially designed for seriously ill individuals with cancer. Thus, the model and clinicians were geared toward caring for this population. Despite the proportion of persons living with dementia (PLWD) receiving hospice care substantially increased over the past 10 years, and their longer lengths of stay, established hospice interventions for this population are scarce. No systematic review has previously evaluated those interventions that do exist. We synthesized hospice intervention studies for PLWD, their families, and hospice professionals by describing the types of interventions, participants, outcomes, and results; assessing study quality; and identifying promising intervention strategies. METHODS: A systematic review was conducted using a comprehensive search of five databases through March 2021 and follow-up hand searches. Included studies were peer-reviewed, available in English, and focused on hospice interventions for persons with dementia, and/or care partners, and clinicians. Using pre-determined inclusion and exclusion criteria, data was extracted guided by the Cochrane Checklist, and quality was assessed using a 26-item Consolidated Standards of Reporting Trials (CONSORT) Checklist. RESULTS: The search identified 3235 unique studies in total, of which 10 studies met inclusion criteria. The search revealed three types of interventions: clinical education and training, usual care plus care add-on services, and "other" delivered to 707 participants (mostly clinicians). Five studies included underrepresented racial and ethnic groups. Outcomes measured knowledge and skills, psychosocial and health outcomes, feasibility, and acceptability, with significant improvements in six studies. Study quality was reflective of early-stage research with clinical education and training strategies showing deliberate progression towards real-world efficacy testing. IMPLICATIONS: Hospice interventions for PLWD are sparse and in early-phase research. More research is needed with rigorous designs, diverse samples, and outcomes considering the concordance of care.

Emerging Viral Infections, Hypertension, and Cardiovascular Disease in Sub-Saharan Africa: A Narrative Review.

BACKGROUND: Sub-Saharan Africa (SSA) has the highest age-adjusted burden of hypertension and cardiovascular disease (CVD). SSA also experiences many viral infections due to unique environmental and societal factors. The purpose of this narrative review is to examine evidence around how hypertension, CVD, and emerging viral infections interact in SSA. METHODS: In September 2021, we conducted a search in MEDLINE, Embase, and Scopus, limited to English language studies published since 1990, and found a total of 1169 articles. Forty-seven original studies were included, with 32 on COVID-19 and 15 on other emerging viruses. RESULTS: Seven articles, including those with the largest sample size and most robust study design, found an association between preexisting hypertension or CVD and COVID-19 severity or death. Ten smaller studies found no association, and 17 did not calculate statistics to compare groups. Two studies assessed the impact of COVID-19 on incident CVD, with one finding an increase in stroke admissions. For other emerging viruses, 3 studies did not find an association between preexisting hypertension or CVD on West Nile and Lassa fever mortality. Twelve studies examined other emerging viral infections and incident CVD, with 4 finding no association and 8 not calculating statistics. CONCLUSIONS: Growing evidence from COVID-19 suggests viruses, hypertension, and CVD interact on multiple levels in SSA, but research gaps remain especially for other emerging viral infections. SSA can and must play a leading role in the study and control of emerging viral infections, with expansion of research and public health infrastructure to address these interactions.

Groupthink among health professional teams in patient care: A scoping review.

There is emerging interest in understanding group decision making among a team of health professionals. Groupthink, a term coined by Irving Janis to depict premature consensus seeking in highly cohesive groups, is a theory that has been widely discussed in disciplines outside health care. However, it remains unclear how it has been conceptualized, studied, and mitigated in the context of health professionals conducting patient care. This scoping review aimed to examine the conceptualization of groupthink in health care, empirical research conducted in healthcare teams, and recommendations to avoid groupthink. Eight databases were systematically searched for articles focusing on groupthink among health professional teams using a scoping review methodology. A total of 22 articles were included-most were commentaries or narrative reviews with only four empirical research studies. This review found that focus on groupthink and group decision making in medicine is relatively new and growing in interest. Few empirical studies on groupthink in health professional teams have been performed and there is conceptual disagreement on how to interpret groupthink in the context of clinical practice. Future research should develop a theoretical framework that applies groupthink theory to clinical decision making and medical education, validate the groupthink framework in clinical settings, develop measures of groupthink, evaluate interventions that mitigate groupthink in clinical practice, and examine how groupthink may be situated amidst other emerging social cognitive theories of collaborative clinical decision making.

Total Joint Arthroplasty During the COVID-19 Pandemic: A Scoping Review with Implications for Future Practice.

BACKGROUND: Recent studies have examined the impact of the COVID-19 pandemic on the practice of total joint arthroplasty. A scoping review of the literature with compiled recommendations is a useful tool for arthroplasty surgeons as they resume their orthopedic practices during the pandemic. METHODS: In June 2020, PubMed, Embase (Ovid), Cochrane Library (Wiley), Scopus, LitCovid, CINAHL, medRxiv, and bioRxiv were queried for articles using controlled vocabulary and keywords pertaining to COVID-19 and total joint arthroplasty. Studies were characterized by their region of origin, design, and Center of Evidence Based Medicine level of evidence. The identified relevant studies were grouped into 6 categories: changes to future clinical workflow, education, impact on patients, impact on surgeons, technology, and surgical volume. RESULTS: The COVID-19 pandemic has had a significant impact on arthroplasty practice, including the disruption of the clinical teaching environment, personal and financial consequences for patients and physicians, and the drastic reduction in surgical volume. New pathways for clinical workflow have emerged, along with novel technologies with applications for both patients and trainees. CONCLUSIONS: The COVID-19 pandemic emphasizes the recent trend in arthroplasty toward risk stratification and outpatient surgery, which may result in improved clinical outcomes and significant cost-savings. Furthermore, virtual technologies are a promising area of future focus that may ultimately improve upon previous existing inefficiencies in the education and clinical environments.

Replacing Paper Informed Consent with Electronic Informed Consent for Research in Academic Medical Centers: A Scoping Review.

Although experts have identified benefits to replacing paper with electronic consent (eConsent) for research, a comprehensive understanding of strategies to overcome barriers to adoption is unknown. To address this gap, we performed a scoping review of the literature describing eConsent in academic medical centers. Of 69 studies that met inclusion criteria, 81% (n=56) addressed ethical, legal, and social issues; 67% (n=46) described user interface/user experience considerations; 39% (n=27) compared electronic versus paper approaches; 33% (n=23) discussed approaches to enterprise scalability; and 25% (n=17) described changes to consent elections. Findings indicate a lack of a leading commercial eConsent vendor, as articles described a myriad of homegrown systems and extensions of vendor EHR patient portals. Opportunities appear to exist for researchers and commercial software vendors to develop eConsent approaches that address the five critical areas identified in this review.

Retained Temporary Epicardial Pacing Wires: A Systematic Review and Treatment Algorithm.

INTRODUCTION: Temporary epicardial pacing wires (TEPW) are used in the immediate postoperative cardiac surgery period for the identification, diagnosis, and treatment of acute arrhythmias. They are usually removed before discharge, but are sometimes clipped and left to retract into the skin and are thus retained. Rare complications from these retained wires have been documented in numerous case reports. We describe a case of a 57-year-old man with chronically draining wounds due to infected retained pacing wires. This case prompted a systematic review of these patients to delineate complications and to create a novel treatment algorithm. METHODS: The authors conducted a systematic review of MEDLINE, Embase, and the Cochrane Library databases and retrieved relevant, English-language articles published between 1986 and 2018. Two reviewers critically appraised the studies that met inclusion and exclusion criteria. RESULTS: Thirty-one articles met inclusion criteria with a total of 35 patients included. The existing articles represent either level IV or level V evidence. Mean ± SD time of presentation from initial TEPW placement was 4.9 ± 5.9 years, with a range of 1 month to 24 years and 77% of patients were symptomatic. The TEPW wire migration occurred in 74% of patients, with invasion into vasculature, visceral organs, and subcutaneous tissue. Most of the patients who underwent wire removal had complete recovery. The relevant literature suggests that there is a wide range of complications, and migration is more often associated with need for surgical intervention. CONCLUSIONS: In patients with severe symptoms or evidence of migration, surgical intervention and removal should be strongly considered to prevent potentially deadly complications. We propose an algorithm to minimize these complications based on a literature analysis in accordance with PRISMA guidelines.

Kidney disease among children in sub-Saharan Africa: systematic review.

The global burden of kidney disease is increasing, and several etiologies first begin in childhood. Risk factors for pediatric kidney disease are common in Africa, but data regarding its prevalence are lacking. We completed a systematic review of community-based studies describing the prevalence of proteinuria, hematuria, abnormal imaging, or kidney dysfunction among children in sub-Saharan Africa (SSA). Medline and Embase were searched. Five hundred twenty-three references were reviewed. Thirty-two references from nine countries in SSA were included in the qualitative synthesis. The degree of kidney damage and abnormal imaging varied widely: proteinuria 32.5% (2.2-56.0%), hematuria 31.1% (0.6-67.0%), hydronephrosis 11.3% (0.0-38.0%), hydroureter 7.5% (0.0-26.4%), and major kidney abnormalities 0.1% (0.0-0.8%). Serum creatinine was reported in four studies with insufficient detail to identify the prevalence renal dysfunction. A majority of the studies were performed in Schistosoma haematobium endemic areas. A lower prevalence of kidney disease was observed in the few studies from nonendemic areas. Published data on pediatric kidney disease in SSA are highly variable and dependent on S. haematobium prevalence. More community-based studies are needed to describe the burden of pediatric kidney disease, particularly in regions where S. haematobium infection is nonendemic.

Plaque echolucency and stroke risk in asymptomatic carotid stenosis: a systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Ultrasonographic plaque echolucency has been studied as a stroke risk marker in carotid atherosclerotic disease. We performed a systematic review and meta-analysis to summarize the association between ultrasound-determined carotid plaque echolucency and future ipsilateral stroke risk. METHODS: We searched the medical literature for studies evaluating the association between carotid plaque echolucency and future stroke in asymptomatic patients. We included prospective observational studies with stroke outcome ascertainment after baseline carotid plaque echolucency assessment. We performed a meta-analysis and assessed study heterogeneity and publication bias. We also performed subgroup analyses limited to patients with stenosis ≥50%, studies in which plaque echolucency was determined via subjective visual interpretation, studies with a relatively lower risk of bias, and studies published after the year 2000. RESULTS: We analyzed data from 7 studies on 7557 subjects with a mean follow-up of 37.2 months. We found a significant positive relationship between predominantly echolucent (compared with predominantly echogenic) plaques and the risk of future ipsilateral stroke across all stenosis severities (0% to 99%; relative risk, 2.31; 95% confidence interval, 1.58-3.39; P<0.001) and in subjects with ≥50% stenosis (relative risk, 2.61; 95% confidence interval, 1.47-4.63; P=0.001). A statistically significant increased relative risk for future stroke was preserved in all additional subgroup analyses. No statistically significant heterogeneity or publication bias was present in any of the meta-analyses. CONCLUSIONS: The presence of ultrasound-determined carotid plaque echolucency provides predictive information in asymptomatic carotid artery stenosis beyond luminal stenosis. However, the magnitude of the increased risk is not sufficient on its own to iden tify patients likely to benefit from surgical revascularization.