Effectiveness of online-based cognitive intervention in community-dwelling older adults with cognitive dysfunction: A systematic review and meta-analysis.

BACKGROUND: Mild cognitive impairment (MCI) or mild dementia imposes a substantial burden on patients, families, and social systems. For MCI or mild dementia patient, cognitive training is required to prevent progression to dementia. With advances in digital health, cognitive interventions using information and communication technology (ICT) have become essential for maintaining independence and functioning in dementia patients. OBJECTIVES: This study aimed to examine the effectiveness of an ICT-based cognitive intervention in community-dwelling older adults with MCI or mild dementia. METHODS: A literature search was performed in four databases: Ovid-Medline, Ovid-EMBASE, Cochrane Library, and CINAHL. We selected studies published up to April 15, 2021, on topics related to cognitive interventions using ICT in older adults with MCI or mild dementia. RESULTS: Forty-four studies were included in the analysis. Our meta-analysis showed that ICT-based cognitive interventions significantly improved the Mini-Mental State Examination score in the intervention group compared with that in the control group. Additionally, cognitive training using ICT was significantly effective for a period of more than 30 min, more than 6 weeks, and multi-domain content. Moreover, a significant reduction in depression was found in the intervention group compared with that in the control group. CONCLUSIONS: ICT-based cognitive intervention had a positive effect on cognitive function, depression, and quality of life in older adults with MCI or mild dementia. Application of ICT-based cognitive training to community-dwelling older adults with MCI or mild dementia should be expanded, and nurses should play a pivotal role in mediating between these older adults.

Effectiveness of multicomponent home-based rehabilitation in older patients after hip fracture surgery: A systematic review and meta-analysis.

BACKGROUND: Hip fracture is a major burden on health care systems worldwide and requires hospitalisation for a long period. OBJECTIVE: The aim was to evaluate the effectiveness of multicomponent home-based rehabilitation compared with different control interventions (in-hospital rehabilitation, active control or usual care) in older patients after hip fracture surgery. DESIGN: Systematic review and meta-analysis of randomised controlled studies. DATA SOURCES: We searched three electronic databases, including Ovid-MEDLINE, Ovid-Embase, CINAHL and the Cochrane Library for relevant articles up to March 2020. REVIEW METHODS: Two investigators independently extracted data and assessed study quality using the risk of bias. Data were analysed using Review Manager 5.3. The current review employs the PRISMA procedure. RESULTS: Out of 2996 studies, 22 articles were relevant for this review and meta-analysis. Among them, five compared the multicomponent home-based rehabilitation with in-hospital rehabilitation, one compared it with active control, six with usual care and ten compared the home exercise only with usual care. There was no significant difference in activities of daily living (ADL) between multicomponent home-based rehabilitation and in-hospital rehabilitation, while multicomponent home-based rehabilitation significantly increased in ADL when compared to usual care. Home exercises also had significant effects on ADL, quality of life(QoL), balance, gait and muscle strength of the knee extensor compared with usual care (p < .05). CONCLUSIONS: Multicomponent home-based rehabilitation is comparable to in-hospital rehabilitation regarding improvements in muscle strength, gait speed, balance, ADL and QoL. RELEVANT TO CLINICAL PRACTICE: Multicomponent home-based rehabilitation is comparable to in-hospital rehabilitation regarding improvements in muscle strength, gait speed, balance, ADL and QoL. Also, high adherence to home exercise may be associated with better clinical outcomes. Therefore, more compliance-oriented multicomponent home-based rehabilitation programmes for older patients after hip fracture must be developed by health care professionals, including physical therapist, to ensure optimum home-based rehabilitation.

Development of an integrated mobile application for lifestyle modification in women with polycystic ovarian syndrome.

BACKGROUND: Lifestyle modification is the primary treatment for overweight and obese women with polycystic ovarian syndrome (PCOS). Developing mobile applications that motivate and provide lifestyle modification advice and evidence-based information for women with PCOS is needed. AIMS: This study is aimed at the development of an integrated mobile application for lifestyle modifications in women with PCOS. METHODS: This study is a development study to develop a lifestyle modification mobile application for PCOS based on a systematic review and needs analysis according to the ADDIE model. The survey was conducted consecutively on patients with PCOS who visited a university hospital in Incheon, Republic of Korea from 1 November 2020 to 28 February 2021. The questionnaire was developed based on prior literature, and validity was evaluated by experts. The survey investigated respondents' general characteristics, the perceptions and needs, and the preferred components of integrated mobile application for lifestyle modification. The usability of the application was evaluated by experts. STROBE statement has been followed in this study. RESULTS: The lifestyle modification programme was confirmed to be clinical effect through a systematic review. The necessity application and high scores in preference of all components was confirmed in a survey. The mobile application included every amount of intake, exercise time, menstrual period, and daily weight compared with the target weight and BMI. It also included questionnaires on hirsutism and acne, disease information, and communication with the researcher for counselling purposes. The application will motivate users to participate by giving scores according to a goal achievement each day. In usability test, experts evaluate this mobile application as suitable for use. CONCLUSION: In this study, an integrated mobile application was developed in consideration of the systematic review and needs analysis of women with PCOS. The effectiveness of the application will need to be verified through further research. RELEVANCE TO CLINICAL PRACTICE: This study developed an integrated mobile application including diet and exercise therapy, as well as weight and menstrual period management, questionnaires and disease information. In addition, the mobile application motivates women with PCOS to provide personalised counselling and achieve goals. We expect to use it in future studies for women with PCOS in clinical practice.

Factors associated with nursing needs and nursing hours in acute care hospital settings: A cross-sectional study.

AIM: The aim of this study was to identify the patient and hospital characteristics related to nursing needs and nursing hours in acute hospital settings. BACKGROUND: To determine appropriate staffing levels, accumulating empirical data through direct observation and surveys reflecting the actual situation is necessary. METHODS: In this cross-sectional study, we conducted direct observations of nurses in acute care hospitals from 1 May to 31 August 2020. Twenty-six hospitals in five cities participated, and 747 nursing personnel collected 1,681 patients' data while performing nursing activities. The data of 1,605 nurses were analysed using descriptive statistics, t tests, analysis of variance and linear regression. RESULTS: Hospital size, admission day, patients' dependence level, high fall risk and disease diagnoses were variables associated with nursing needs (F = 73.49, P < .001) and nursing hours (F = 57.7, P < .001). Comparing the correlates of nursing needs and nursing hours revealed that, unlike nursing needs, nursing hours were not significantly associated with surgery and certain diagnoses. CONCLUSION: This study confirmed the variables associated with nursing needs and nursing hours in acute hospitals; based on this, determining appropriate staffing levels, which is an important step in improving inpatients' health outcomes, is necessary. IMPLICATIONS FOR NURSING MANAGEMENT: In acute hospitals, an increased number of nurse staffing should be employed based on the number of newly hospitalized patients, patients with high dependence levels and specific diagnoses, and those at high risk of falling.

Evaluating the Correlation Between Nursing Practice and Electronic Nursing Records Using Importance-Performance Analysis.

This study aimed to analyze the importance and performance of nursing task items in the standard guidelines for comprehensive nursing services and confirm whether they are reflected in the nursing records. A total of 120 nurses from three hospitals were surveyed for the importance-performance analysis of standard nursing services and their correlation with nursing records. The average scores for importance, performance, and correlation to nursing records were 3.65, 3.31, and 3.08, respectively, demonstrating a significant positive correlation. Regarding the correlation between nursing tasks and nursing records, spiritual and emotional assessment, mobilization, education and counseling, and escaping and suicide prevention items had moderately low scores. In the importance correlation to the nursing records of the task items matrix, 10 items in quadrant 1 were strengths. Conversely, in quadrant 2, suicide and escape prevention require critical areas for improvement. The other six items were low-priority items in quadrant 3, and the three items in quadrant 4 were hygiene, elimination, and nutrition, which required excessive effort. It is necessary to evaluate the electronic nursing records system periodically according to the nursing environment and modify and supplement the records if required.

A Systematic Review on Comparative Analyses between Ureteroscopic Lithotripsy and Shock-Wave Lithotripsy for Ureter Stone According to Stone Size.

Background and Objectives: This systematic review and meta-analysis was conducted to analyze the treatment outcomes of shock wave lithotripsy (SWL) and ureteroscopic lithotripsy (URSL) according to the ureteral stone size. Materials and Methods: In this systematic review, relevant articles that compared SWL and URSL for treatment of ureteral stones were identified. Articles were selected from four English databases including Ovid-Medline, Ovid-EMBASE, the Cochrane Central Register of controlled Trials (Central), and Google Scholar. A quality assessment was carried out by our researchers independently using the Scottish Intercollegiate Guidelines Network (SIGN). A total of 1325 studies were identified, but after removing duplicates, there remained 733 studies. Of these studies, 439 were excluded, 294 were screened, and 18 met the study eligibility criteria. Results: In randomized control trial (RCT) studies, URSL showed significantly higher SFR than SWL (p < 0.01, OR= 0.40, 95% CI 0.30-0.55, I² = 29%). The same results were shown in sub-group analysis according to the size of the stone (<1 cm: p < 0.01, OR = 0.40, 95% CI 0.25-0.63; >1 cm: p < 0.01, OR = 0.38, 95% CI 0.19-0.74, I² = 55%; not specified: p < 0.01, OR = 0.43, 95% CI 0.25-0.72, I² = 70%). In the non-RCT studies, the effectiveness of the URSL was significantly superior to that of SWL (p < 0.01, OR = 0.33, 95% CI 0.21-0.52, I² = 83%). Retreatment rate was significantly lower in URSL than in SWL regardless of stone size (p < 0.01, OR = 10.22, 95% CI 6.76-15.43, I² = 54%). Conclusions: Meta-analysis results show that SFR was higher than SWL in URSL and that URSL was superior to SWL in retreatment rate. However, more randomized trials are required to identify definitive conclusions.

Risk factors for postoperative delirium after colorectal surgery: a systematic review and meta-analysis.

PURPOSE: Postoperative delirium is common after any type of surgery and can lead to serious outcomes; thus, its prevention is important. Early assessment can help identify patients at higher risk of postoperative delirium. However, the risk factors for postoperative delirium in patients who underwent colorectal surgery are unclear. This meta-analysis aimed to identify the risk factors for postoperative delirium after colorectal cancer surgery. METHODS: We selected all articles related to postoperative delirium after colorectal surgery published up to March 2019. Studies using any method for diagnosing delirium were eligible. Ovid-Embase, Ovid-Medline, and the Cochrane library were searched. Two reviewers independently conducted quality assessment and data collection. The risk factors identified in the studies were recorded, and a meta-analysis was conducted. RESULTS: Of the 1216 studies initially screened, 1197 were reviewed by two independent reviewers. Finally, 14 articles were identified to be relevant for this review. In total, 11 of the 14 studies reported the risk factors for postoperative delirium. The incidence of postoperative delirium ranged from 8% to 54%. A total of 19 risk factors were identified, and we classified them into two categories as patient-related and treatment-related risk factors. CONCLUSION: Postoperative delirium is highly common in those undergoing colorectal surgery including cancer, with advanced old age, history of preoperative delirium and preoperative serum albumin level which are risk factors for POD. Larger multi-institutional randomized studies to address this issue are warranted in the future.

Artificial Intelligence-Driven Oncology Clinical Decision Support System for Multidisciplinary Teams.

Watson for Oncology (WfO) is a clinical decision support system driven by artificial intelligence. In Korea, WfO is used by multidisciplinary teams (MDTs) caring for cancer patients. This study aimed to investigate the effect of WfO use on hospital satisfaction and perception among patients cared for by MDTs. This was a descriptive study that used a written survey to gather information from cancer patients at a hospital in Korea. The rate of positive change in patient perception after treatment was 86.8% in the MDT-WfO group and 71.2% in the MDT group. In terms of easily understandable explanations, the MDT-WfO (9.53 points) group reported higher satisfaction than the MDT group (9.24 points). Younger patients in the MDT-WfO group showed high levels of satisfaction and reliability of treatment. When WfO was used, the probability of positive change in patient perception of the hospital was 2.53 times higher than when WfO was not used. With a one-point increase in overall satisfaction, the probability of positive change in patient perception of the hospital increased 1.97 times. Therefore, if WfO is used appropriately in the medical field, it may enhance patient satisfaction and change patient perception positively.

Developmental trajectory and relationships between Adolescents' social capital, self-esteem, and depressive symptoms: A latent growth model.

The aim of this study was to evaluate the longitudinal influence of social capital and self-esteem on depressive symptoms among adolescents. A multivariate latent growth model was used to test secondary data obtained from the Korea Youth Panel Survey. Social capital and self-esteem tended to increase over periods of four years, whereas depressive symptoms had a tendency to decrease in the same periods. In the case of indirect effects on depressive symptoms by way of self-esteem, significant indirect associations were identified. The results indicated that the intercept of social capital had a significant indirect effect and total effect on the intercept of depressive symptoms. In addition, the slope of social capital had a significant indirect effect and total effect on the slope of depressive symptom. The initial development of social capital and self-esteem is shown to be effective for reducing adolescents' depressive symptoms.

Effectiveness of Percutaneous Nephrolithotomy, Retrograde Intrarenal Surgery, and Extracorporeal Shock Wave Lithotripsy for Treatment of Renal Stones: A Systematic Review and Meta-Analysis.

Background and objectives: To perform a updated systematic review and meta-analysis comparing effectiveness of percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stones (RS). Materials and Methods: A total of 37 studies were included in this systematic review and meta-analysis about effectiveness to treat RS. Endpoints were stone-free rates (SFR), incidence of auxiliary procedure, retreatment, and complications. We also conducted a sub-analysis of ≥2 cm stones. Results: First, PCNL had the highest SFR than others regardless of stone sizes and RIRS showed a higher SFR than ESWL in <2 cm stones. Second, auxiliary procedures were higher in ESWL than others, and it did not differ between PCNL and RIRS. Finally, in <2 cm stones, the retreatment rate of ESWL was higher than others. RIRS required significantly more retreatment procedures than PCNL in ≥2 cm stones. Complication was higher in PCNL than others, but there was no statistically significant difference in complications between RIRS and PCNL in ≥2 cm stones. For ≥2 cm stones, PCNL had the highest SFR, and auxiliary procedures and retreatment rates were significantly lower than others. Conclusions: We suggest that PCNL is a safe and effective treatment, especially for large RS.

Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a systematic review and meta-analysis.

PURPOSE: Few studies have compared robotic and laparoscopic intersphincteric resection (ISR) in rectal cancer. Therefore, we performed a meta-analysis of recently published studies to compare perioperative outcomes of ISR for the treatment of low rectal cancer. METHODS: We performed a systematic literature search of the Ovid-Medline, Ovid-EMBASE, and Cochrane Central Register of Controlled Trials databases for studies comparing robotic and laparoscopic ISR in patients with low rectal cancer. Demographic and clinical data were extracted from articles that met the inclusion and exclusion criteria. Perioperative outcomes of interest included the rate of diverting stoma, open conversion rate, operation time, estimated blood loss, length of hospital stay, time to first flatus, and time to initiate the postoperative diet. Oncological outcomes included the number of retrieved lymph nodes, distal resection margin, proximal resection margin, circumferential resection margin, 3-year overall survival, 3-year disease-free survival, and local recurrence. Postoperative complications included overall complications, a Dindo-Clavien classification ≥ III, and anastomotic leakage. All outcomes were compared between the two groups. RESULTS: We included 5 retrospective cohort studies with a total of 510 patients undergoing 273 (53.5%) robotic ISR procedures and 237 (46.5%) laparoscopic ISR procedures. The robotic ISR group lower conversion rate, lower blood loss, and longer operation times than the laparoscopic group. We also noted that fewer lymph nodes were harvested in the robotic ISR group; however, this difference was not statistically significant. Other outcomes were similar between the two groups. CONCLUSIONS: Robotic and laparoscopic ISR showed comparable perioperative outcomes, functional outcomes, and 3-year oncologic outcomes; however, robotic ISR was associated with a lower conversion rate and less blood loss despite longer operation times compared to laparoscopic ISR. These findings suggest that robotic ISR maybe a safe and effective technique for treating low rectal cancer in selected patients. The potential oncologic and functional benefits of robotic ISR should be evaluated in larger randomized controlled trials.

Dose-related effect of statins in patients with endovascular coiling or microsurgical clipping for aneurysmal subarachnoid hemorrhage: updated study-level meta-analysis.

PURPOSE: We aimed to quantitatively assess the effects of short-term statin use on delayed ischemic neurologic deficits (DINDs) and clinical outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH) through a meta-analysis of the available evidence. METHODS: We searched the electronic databases up to April 8, 2016 to retrieve relevant studies comparing the outcomes between immediate statin-treated in statin-naïve patients and untreated patients following aneurysmal SAH. Meta-analysis was performed using Review Manager 5.3. RESULTS: Eight randomized controlled clinical trials (RCTs) and 5 observational studies involving 2148 patients met the eligibility criteria. In the RCTs, statins were found to significantly reduce the occurrence of DINDs (relative risk (RR), 0.76; 95% confidence interval (CI), 0.61-0.94; P = 0.01), but did not significantly reduce poor functional outcomes (RR, 1.01; 95% CI, 0.87-1.16; P = 0.93) or mortality (RR, 0.80; 95% CI, 0.58-1.11; P = 0.18). In observational studies, statin use was not associated with any reduction in DINDs, poor outcome, or mortality. Meta-analysis of RCTs indicated a significant reduction in DINDs and mortality in patients with high-dose statin use (RR, 0.63; 95% CI, 0.42-0.95; P = 0.03; I 2 = 0%; and RR, 0.36; 95% CI, 0.15-0.86; P = 0.02; I 2 = 0%, respectively). CONCLUSION: The present meta-analysis suggests that statin use may prevent DINDs in patients with aneurysmal SAH. Based on our findings, the role of statins in improving neurological outcome was limited. However, the risk of DINDs and mortality decreased with higher statin doses in a dose-dependent manner. Hence, further well-designed RCTs with modified protocols in specific patients are required.

Exercise Interventions for Preventing Falls Among Older People in Care Facilities: A Meta-Analysis.

BACKGROUND: Falls in older people are a common problem, often leading to considerable morbidity. However, the overall effect of exercise interventions on fall prevention in care facilities remains controversial. AIMS: To evaluate the effectiveness of exercise interventions on the rate of falls and number of fallers in care facilities. METHODS: A meta-analysis was conducted of randomized controlled trials published up to December 2014. Eight databases were searched including Ovid-Medline, Embase, CINAHL, Cochrane Library, KoreaMed, KMbase, KISS, and KisTi. Two investigators independently extracted data and assessed study quality. RESULTS: Twenty-one studies were selected, that included 5,540 participants. Fifteen studies included exercise as a single intervention, whereas the remaining six included exercise combined with two or more fall interventions tailored to each resident's fall risk (i.e., medication review, environmental modification or staff education). Meta-analysis showed that exercise had a preventive effect on the rate of falls (risk ratio [RR] 0.81, 95% CI 0.68-0.97). This effect was stronger when exercise combined with other fall interventions on the rate of falls (RR 0.61, 95% CI 0.52-0.72) and on the number of fallers (RR 0.85, 95% CI 0.77-0.95). Exercise interventions including balance training (i.e., gait, balance, and functional training; or balance and strength) resulted in reduced the rate of falls. Sensitivity analyses indicated that exercise interventions resulted in reduced numbers of recurrent fallers (RR 0.71, 95% CI 0.53-0.97). LINKING EVIDENCE TO ACTION: This review provides an important basis for developing evidence-based exercise intervention protocols for older people living in care facilities. Exercise programs, which are combined with tailored other fall interventions and challenge balance training to improve balance skills, should be applied to frail older people with functional limitations in institutional settings.

Disparities in socioeconomic status and neighborhood characteristics affect all-cause mortality in patients with newly diagnosed hypertension in Korea: a nationwide cohort study, 2002-2013.

BACKGROUND: Previous studies have shown that contextual factors and individual socioeconomic status (SES) were associated with mortality in Western developed countries. In Korea, there are few empirical studies that have evaluated the association between SES and health outcomes. METHODS: We conducted cohort study to investigate the socioeconomic disparity in all-cause mortality for patients newly diagnosed with hypertension in the setting of universal health care coverage. We used stratified random sample of Korean National Health Insurance enrollees (2002-2013). We included patients newly diagnosed with hypertension (n = 28,306) from 2003-2006, who received oral medication to control their hypertension. We generated a frailty model using Cox's proportional hazard regression to assess risk factors for mortality. RESULTS: A total of 7,825 (27.6%) of the 28,306 eligible subjects died during the study period. Compared to high income patients from advantaged neighborhoods, the adjusted hazard ratio (HR) for high income patients from disadvantaged neighborhoods was 1.10 (95% CI, 1.00-1.20; p-value = 0.05). The adjusted HR for middle income patients who lived in advantaged versus disadvantaged neighborhoods was 1.17 (95% CI, 1.08-1.26) and 1.27 (95% CI, 1.17-1.38), respectively. For low income patients, the adjusted HR for patients who lived in disadvantaged neighborhoods was higher than those who lived in advantaged neighborhoods (HR, 1.35; 95% CI, 1.22-1.49 vs HR, 1.28; 95% CI, 1.16-1.41). CONCLUSIONS: Neighborhood deprivation can exacerbate the influence of individual SES on all-cause mortality among patients with newly diagnosed hypertension.

Impact of continuity of care on preventable hospitalization of patients with type 2 diabetes: a nationwide Korean cohort study, 2002-10.

OBJECTIVE: To determine whether patients with greater continuity of care (COC) have fewer preventable hospitalizations. DESIGN: We conducted a cohort study using a stratified random sample of Korean National Health Insurance enrollees from 2002 to 2010. The COC index was calculated for each year post-diagnosis based on ambulatory care visits. We performed a recurrent event survival analysis via Cox proportional hazard regression analysis of preventable hospitalizations. STUDY PARTICIPANTS: A total of 5163 patients newly diagnosed with type 2 diabetes mellitus in 2003-6 and receiving oral hypoglycemic medication. MAIN OUTCOME MEASURE: Preventable hospitalization. RESULTS: Of 5163 eligible participants, 6.4% (n = 328) experienced a preventable hospitalization during the study period. The adjusted hazard ratio (HR) was 8.69 (95% CI, 2.62-28.83) for subjects with a COC score of 0.00-0.19, 7.03 (95% CI, 4.50-10.96) for those with a score of 0.20-0.39, 3.01 (95% CI, 2.06-4.40) for those with a score of 0.40-059, 4.42 (95% CI, 3.04-6.42) for those with a score of 0.60-0.79 and 5.82 (95% CI, 3.87-8.75) for those with a score of 0.80-0.99. The difference in cumulative incidence of preventable hospitalizations in patients with COC scores of 0.00-0.19 relative to those with COC scores of 1.00 was the greatest, at 0.97% points. CONCLUSIONS: Greater COC was associated with fewer preventable hospitalizations in subjects with type 2 diabetes.

A systematic review on current status of health technology reassessment: insights for South Korea.

BACKGROUND: To systematically investigate the current status and methodology of health technology reassessment (HTR) in various countries to draw insights for the healthcare system in South Korea. METHODS: A systematic literature search was conducted on the articles published between January 2000 and February 2015 on Medline, EMBASE, the Cochrane Library, CINAHL, and PubMed. The titles and abstracts of retrieved records were screened and selected by two independent reviewers. Data related to HTR were extracted using a pre-standardised form. The review was conducted using narrative synthesis to understand and summarise the HTR process and policies. RESULTS: Forty five studies, conducted in seven countries, including the United Kingdom, Australia, Canada, Spain, Sweden, Denmark, and the United States of America, fulfilled the inclusion criteria. Informed by the literature review, and complemented by informant interviews, we focused on HTR activities in four jurisdictions: the United Kingdom, Canada, Australia, and Spain. There were similarities in the HTR processes, namely the use of existing health technology assessment agencies, reassessment candidate technology identification and priority setting, stakeholder involvement, support for reimbursement coverage, and implementation strategies. Considering the findings of the systematic review in the context of the domestic healthcare environment in Korea, an appropriate HTR model was developed. This model included four stages, those of identification, prioritisation, reassessment and decision. CONCLUSIONS: Disinvestment and reinvestment through the HTR was used to increase the efficiency and quality of care to help patients receive optimal treatment. Based on the lessons learnt from other countries' experiences, Korea should make efforts to establish an HTR process that optimises the National Healthcare Insurance system through revision of the existing Medical Service Act.

Surgical safety and oncologic effectiveness in robotic versus conventional open thyroidectomy in thyroid cancer: a systematic review and meta-analysis.

BACKGROUND: Although many experiences using the da Vinci Robot System have been reported by several groups, there is substantial controversy over the role of the robot in thyroidectomy. We performed a systematic review and meta-analyses in order to evaluate the safety and effectiveness of robotic thyroidectomy (RT) compared with open thyroidectomy (OT) in thyroid cancer. METHODS: A literature search for the systematic review was conducted using English databases (Ovid MEDLINE, Ovid EMBASE, and the Cochrane Library), as well as domestic databases, up to June 2014.Outcomes of interest included demographic characteristics, adverse events and complications, and outcomes of effectiveness. RESULTS: Fourteen publications including 3,136 cases were finally selected for the systematic review and meta-analysis. RT was associated with an equivalent complication rate including transient and permanent hypocalcemia, transient and permanent recurrent laryngeal nerve palsy, bleeding, chyle leakage, seroma, length of hospital stay, and postoperative thyroglobulin level when compared with OT. RT also had lesser blood loss (weighted mean difference [WMD]-0.28, p = 0.04), better cosmetic satisfaction (odds ratio 4.79, p < 0.001), and lower level of swallowing impairment (WMD -4.17, p < 0.001) than OT. OT was in favor of operation time (WMD 39.77, p < 0.001) and retrieved lymph nodes (WMD -0.62, p = 0.02) compared with RT. CONCLUSIONS: RT seems to be associated with a lesser amount of estimated blood loss, better cosmetic satisfaction, and a low level of swallowing impairment, while OT was associated with a shorter operation time and more retrieved lymph nodes. Randomized clinical trials with large samples and comparative studies that reflect long-term follow-up data are needed to validate our findings.

Effectiveness of the online-based comprehensive cognitive training application, Smart Brain, for community-dwelling older adults with dementia: a randomized controlled trial.

BACKGROUND: The fourth industrial revolution has brought about developments in information and communication technologies for interventions in older adults with dementia. Currently, most interventions focus on single interventions. However, community-dwelling older adults with dementia require comprehensive cognitive interventions, and clinical studies analyzing the effects of comprehensive interventions based on randomized controlled trials are lacking. AIM: The aim of the study was to examine the effects of an information and communication technology-based comprehensive cognitive training program, Smart Brain, on multi-domain function among community-dwelling older adults with dementia. DESIGN: This was a two-group, randomized, controlled trial. SETTING: This study was conducted at participant's home. POPULATION: We analyzed older adults with dementia. METHODS: Participants were randomly allocated to either the intervention group (N.=30) or the control group (N.=30). Older adults with dementia in the intervention group received 8 weeks of Smart Brain comprehensive cognitive training using a tablet, whereas the control group received a similar tablet but without the training. We measured the outcomes at baseline, and at 4 and 8 weeks. Cognitive function, depression, quality of life, balance confidence, physical ability, nutrition, and caregiver burden were compared between groups. RESULTS: In the intervention group, cognitive function statistically increased from baseline to both week 4 (2.03; 95% CI 1.26 to 2.81) and week 8 (2.70; 95% CI 1.76 to 3.64). Depression was statistically different from week 0 to week 8 (-1.67, 95% CI -2.85 to -0.48). Physical ability statistically increased from baseline to both week 4 (-0.85; 95% CI 1.49 to -0.20) and week 8 (-1.44; 95% CI -2.29 to -0.59). Nutrition statistically increased from baseline to both week 4 (0.67; 95% CI 0.05 to 1.28) and week 8 (1.10; 95% CI 0.36 to 1.84). CONCLUSIONS: Smart Brain significantly improved cognitive function, reduced depression, and enhanced physical and nutritional status in older adults with dementia. This demonstrates its potential as an effective non-pharmacological intervention in community-based dementia care. CLINICAL REHABILITATION IMPACT: Smart Brain's personalized approach, which integrates user-specific preferences and expert guidance, enhances engagement and goal achievement in dementia care. This enhances self-esteem and clinical outcomes, demonstrates the application's potential to innovate rehabilitation practices.

Effects of community-based fall prevention interventions for older adults using information and communication technology: A systematic review and meta-analysis.

Objectives: This systematic review and meta-analysis aimed to investigate the effect of fall prevention interventions using information and communication technology (ICT). Methods: A comprehensive search across four databases was performed. The inclusion criteria were fall prevention interventions including telehealth, computerized balance training, exergaming, mobile application education, virtual reality exercise, and cognitive-behavioral training for community-dwelling adults aged ≥60 years. Results: Thirty-four studies were selected. Telehealth, smart home systems, and exergames reduced the risk of falls (RR = 0.63, 95% CI [0.54, 0.75]). Telehealth and exergame improved balance (MD = 3.30, 95% CI [1.91, 4.68]; MD = 4.40, 95% CI [3.09, 5.71]). Telehealth improved physical function (SMD = 0.69, 95% CI [0.23, 1.16]). Overall, ICT fall interventions improved fall efficacy but not cognitive function. For quality of life (QOL), mixed results were found depending on the assessment tools. Conclusion: Future investigations on telehealth, smart home systems, or exergames are needed to motivate older adults to exercise and prevent falls.

Exploring Factors Influencing Caregiver Burden: A Systematic Review of Family Caregivers of Older Adults with Chronic Illness in Local Communities.

This study aimed to systematically review and analyze factors contributing to caregiver burden among family caregivers of older adults with chronic illnesses in local communities. Specific objectives included exploring the characteristics of older adults with chronic illness and caregiver burden through an extensive literature review and identifying factors influencing caregiver burden in this population. Using Korean (RISS, KISS, and KoreaMed) and international (EMBASE, MEDLINE, CINAHL, and the Cochrane Library) databases, this study employed systematic search methods to identify relevant literature. The inclusion and exclusion criteria were systematically applied in accordance with the PRISMA guidelines, focusing on studies that addressed caregiver burden among family caregivers of older adults with chronic illnesses in local communities. Following the database search, 15,962 articles were identified. After eliminating duplicates and applying the selection criteria, 18 studies were included in this review. These studies, representing various countries, contribute to a diverse dataset covering caregiver and care-recipient characteristics, including age, sex, chronic conditions, and various caregiver burden assessment tools. This systematic review provides a comprehensive understanding of the factors that influence caregiver burden among family caregivers of older adults with chronic illness in local communities. These findings emphasize the need for integrated nursing interventions and community efforts to address the welfare concerns of this population and support their caregivers.