scholarly journals The impacts and effectiveness of support for people bereaved through advanced illness: A systematic review and thematic synthesis

2020 ◽  
Vol 34 (7) ◽  
pp. 871-888 ◽  
Author(s):  
Emily Harrop ◽  
Fiona Morgan ◽  
Mirella Longo ◽  
Lenira Semedo ◽  
Jim Fitzgibbon ◽  
...  

Background: Bereavement support is a key component of palliative care, with different types of support recommended according to need. Previous reviews have typically focused on specialised interventions and have not considered more generic forms of support, drawing on different research methodologies. Aim: To review the quantitative and qualitative evidence on the effectiveness and impact of interventions and services providing support for adults bereaved through advanced illness. Design: A mixed-methods systematic review was conducted, with narrative synthesis of quantitative results and thematic synthesis of qualitative results. The review protocol is published in PROSPERO ( www.crd.york.ac.uk/prospero , CRD42016043530). Data sources: The databases MEDLINE, Embase, PsycINFO, CINAHL and Social Policy and Practice were searched from 1990 to March 2019. Studies were included which reported evaluation results of bereavement interventions, following screening by two independent researchers. Study quality was assessed using GATE checklists. Results: A total of 31 studies were included, reporting on bereavement support groups, psychological and counselling interventions and a mix of other forms of support. Improvements in study outcomes were commonly reported, but the quality of the quantitative evidence was generally poor or mixed. Three main impacts were identified in the qualitative evidence, which also varied in quality: ‘loss and grief resolution’, ‘sense of mastery and moving ahead’ and ‘social support’. Conclusion: Conclusions on effectiveness are limited by small sample sizes and heterogeneity in study populations, models of care and outcomes. The qualitative evidence suggests several cross-cutting benefits and helps explain the impact mechanisms and contextual factors that are integral to the support.

2021 ◽  
Vol 10 (8) ◽  
pp. 1740
Author(s):  
Marion Bareille ◽  
Michaël Hardy ◽  
Jonathan Douxfils ◽  
Stéphanie Roullet ◽  
Dominique Lasne ◽  
...  

Infection by SARS-CoV-2 is associated with a high risk of thrombosis. The laboratory documentation of hypercoagulability and impaired fibrinolysis remains a challenge. Our aim was to assess the potential usefulness of viscoelastometric testing (VET) to predict thrombotic events in COVID-19 patients according to the literature. We also (i) analyzed the impact of anticoagulation and the methods used to neutralize heparin, (ii) analyzed whether maximal clot mechanical strength brings more information than Clauss fibrinogen, and (iii) critically scrutinized the diagnosis of hypofibrinolysis. We performed a systematic search in PubMed and Scopus databases until December 31st, 2020. VET methods and parameters, and patients’ features and outcomes were extracted. VET was performed for 1063 patients (893 intensive care unit (ICU) and 170 non-ICU, 44 studies). There was extensive heterogeneity concerning study design, VET device used (ROTEM, TEG, Quantra and ClotPro) and reagents (with non-systematic use of heparin neutralization), timing of assay, and definition of hypercoagulable state. Notably, only 4 out of 25 studies using ROTEM reported data with heparinase (HEPTEM). The common findings were increased clot mechanical strength mainly due to excessive fibrinogen component and impaired to absent fibrinolysis, more conspicuous in the presence of an added plasminogen activator. Only 4 studies out of the 16 that addressed the point found an association of VETs with thrombotic events. So-called functional fibrinogen assessed by VETs showed a variable correlation with Clauss fibrinogen. Abnormal VET pattern, often evidenced despite standard prophylactic anticoagulation, tended to normalize after increased dosing. VET studies reported heterogeneity, and small sample sizes do not support an association between the poorly defined prothrombotic phenotype of COVID-19 and thrombotic events.


2009 ◽  
Vol 111 (3) ◽  
pp. 545-554 ◽  
Author(s):  
Abtin Tabaee ◽  
Vijay K. Anand ◽  
Yolanda Barrón ◽  
David H. Hiltzik ◽  
Seth M. Brown ◽  
...  

Object Surgery on the pituitary gland is increasingly being performed through an endoscopic approach. However, there is little published data on its safety and relative advantages over traditional microscope-based approaches. Published reports are limited by small sample size and nonrandomized study design. A meta-analysis allows for a description of the impact of endoscopic surgery on short-term outcomes. Methods The authors performed retrospective review of data from their institution as well as a systematic review of the literature. The pooled data were analyzed for descriptive statistics on short-term outcomes. Results Nine studies (821 patients) met inclusion criteria. Overall, the pooled rate of gross tumor removal was 78% (95% CI 67–89%). Hormone resolution was achieved in 81% (95% CI 71–91%) of adrenocorticotropic hormone secreting tumors, 84% (95% CI 76–92%) of growth hormone secreting tumors, and 82% (95% CI 70–94%) of prolactin secreting tumors. The pooled complication rates were 2% (95% CI 0–4%) for CSF leak and 1% (95% CI 0–2%) for permanent diabetes insipidus. There were 2 deaths reported in the literature that were both related to vascular injury, giving an overall mortality rate of 0.24%. Conclusions The results of this meta-analysis support the safety and short-term efficacy of endoscopic pituitary surgery. Future studies with long-term follow-up are required to determine tumor control.


2021 ◽  
Author(s):  
Neil Stewart Coulson ◽  
Heather Buchanan

BACKGROUND Online support groups provide opportunities for individuals affected by HIV/AIDS to seek information, advice and support from peers. However, if and how engagement with online support groups helps individuals affected by HIV/AIDS remains unclear. OBJECTIVE To systematically review the evidence (both quantitative and qualitative) around the benefits of online support groups for individuals affected by HIV/AIDS in terms of psychosocial wellbeing and/or illness management. In addition, the review sought to identify and describe any negative aspects experienced by individuals as well as the types of social support exchanged within such online groups. METHODS A systematic review of English language articles was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases searched included Medline, PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL (Cochrane Register of Controlled Trials) and SCOPUS. Key findings were critically synthesized using a narrative and thematic approach. RESULTS 22 papers met the inclusion criteria from an initial pool of 4501 abstracts. These papers included 5 quantitative, 2 mixed-methods and 15 qualitative studies published between 2007 and 2019. CONCLUSIONS Some cross-sectional and qualitative studies suggest there may be an association between engagement and a range of psychosocial processes and outcomes. However, studies with robust methodological designs are needed to definitively establish whether HIV/AIDS-related online support groups improve psychosocial well-being and/or illness management. Qualitative data highlights users can have negative experiences in terms of interpersonal conflict and the challenges of encountering negative content. In addition, there may be aspects of the internet-mediated nature of the online communication which compromise member experiences. Finally, HIV/AIDS-related online support groups are venues through which individuals can solicit support, most commonly informational or emotional support. Future research should seek to examine the impact of engagement with online support groups over time including appropriate control or comparison groups. CLINICALTRIAL N/A


2018 ◽  
Vol 29 (1) ◽  
pp. 124-134 ◽  
Author(s):  
Jamie Hartmann-Boyce ◽  
Anne-Marie Boylan ◽  
Susan A. Jebb ◽  
Paul Aveyard

The experience and role of self-monitoring in self-directed weight loss attempts may be distinctly different from that within formal interventions, and has yet to be fully explored. We systematically reviewed qualitative studies to examine experiences of self-monitoring as an aid to self-directed weight loss. Thematic synthesis was used to construct descriptive and analytical themes from the available data. In all, 22 studies (681 participants) were included, in which the uses of self-monitoring ranged from an aid to increase adherence to a tool for facilitating analysis. Self-monitoring also influenced and was influenced by self-perception and emotions. Feelings of shame were linked with abandonment of efforts. Findings highlight the centrality of interpretation of self-monitored data, the implications this interpretation has on sense of self, and the impact of broader discourses. Explicitly framing self-monitoring as a positive tool with which to aid analysis may encourage helpful use of this technique.


2018 ◽  
Vol 66 (5) ◽  
pp. 1031-1039 ◽  
Author(s):  
Simon N. Etkind ◽  
Anna E. Bone ◽  
Natasha Lovell ◽  
Irene J. Higginson ◽  
Fliss E. M. Murtagh

2013 ◽  
Vol 23 (7) ◽  
pp. 1171-1177 ◽  
Author(s):  
Mulubrhan F. Mogos ◽  
Shams Rahman ◽  
Hamisu M. Salihu ◽  
Abraham A. Salinas-Miranda ◽  
Dawood H. Sultan

ObjectiveThis study aimed to review studies that addressed the impact of previous reproductive cancer diagnosis on selected fetal birth outcomes.Materials and MethodsWe searched PubMed and Web of Knowledge to identify peer-reviewed articles published from January 1992 to December 2012, investigating the association between reproductive cancer and birth outcomes. After applying exclusion criteria, 49 articles were identified for full review, and 36 articles were finally selected for this systematic review. The quality of the studies was assessed by independent reviewers.ResultsWe found 13 cervical cancer studies, 16 ovarian cancer studies, and 7 corpus uteri cancers that reported subsequent pregnancies (n = 688 pregnancies in 477 women). Of these, 489 pregnancies reached third trimester. Among viable pregnancies, only 416 pregnancies had information on maturity status based on gestational age and/or birth weight. For those with cervical cancer, the preterm birth (PTB) rate was 48.5%. For those with ovarian cancer, there were no cases of PTB. For those with corpus uteri cancers, the PTB was 7.7%. All studies had small sample sizes, and there was considerable heterogeneity of results. Abortions, ectopic pregnancies, and terminations were also reported.ConclusionsReproductive cancers may be associated to subsequent adverse fetal birth outcomes; however, the quality of evidence is still insufficient to infer a relationship between reproductive cancers treated conservatively and adverse fetal birth outcomes in subsequent pregnancies.


2015 ◽  
Vol 30 (3) ◽  
Author(s):  
Yousef S. Khader ◽  
Mostafa Abdelrahman ◽  
Nour Abdo ◽  
Munjed Al-Sharif ◽  
Ahmed Elbetieha ◽  
...  

AbstractTo summarize the existing knowledge of the impact of climate change on health from previous research in the Eastern Mediterranean region (EMR) and identify knowledge and research gaps.Different databases were searched for relevant studies published in the region between 2000 and 2014. The review was limited to studies reporting the impacts of climate change on health or studying associations between meteorological parameters and well-defined human health outcomes.This systematic review of 78 studies identified many knowledge and research gaps. Research linking climate change and health is scarce in the most vulnerable countries of the region. There is limited information regarding how changes in temperature, precipitation and other weather variables might affect the geographic range and incidence of mortality and morbidity from various diseases. Available research has many limitations and shortcomings that arise from inappropriate study designs, poor assessment of exposure and outcomes, questionable sources of data, lack of standardized methods, poor adjustment of confounders, limited geographical area studies, small sample sizes, poor statistical modeling and not testing for possible interactions between exposures.Research and information on the effect of climate change on health are limited. Longitudinal studies over extended periods of time that investigate the link between climate change and health are needed. There is a need for studies to be expanded to include more countries in the region and to include other environmental, social and economic factors that might affect the spread of the disease.


BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e023832 ◽  
Author(s):  
David Silvério Rodrigues ◽  
Paulo Faria Sousa ◽  
Nuno Basílio ◽  
Ana Antunes ◽  
Maria da Luz Antunes ◽  
...  

IntroductionGood patient outcomes correlate with the physicians’ capacity for good clinical judgement. Multimorbidity is common and it increases uncertainty and complexity in the clinical encounter. However, healthcare systems and medical education are centred on individual diseases. In consequence, recognition of the patient as the centre of the decision-making process becomes even more difficult. Research in clinical reasoning and medical decision in a real-world context is needed. The aim of the present review is to identify and synthesise available qualitative evidence on primary care physicians’ perspectives, views or experiences on decision-making with patients with multimorbidity.Methods and analysisThis will be a systematic review of qualitative research where PubMed, CINAHL, PsycINFO, Embase and Web of Science will be searched, supplemented with manual searches of reference lists of included studies. Qualitative studies published in Portuguese, Spanish and English language will be included, with no date limit. Studies will be eligible when they evaluate family physicians’ perspectives, opinions or perceptions on decision-making for patients with multimorbidity in primary care. The methodological quality of studies selected for retrieval will be assessed by two independent reviewers before inclusion in the review using the Critical Appraisal Skills Programme (CASP) tool. Thematic synthesis will be used to identify key categories and themes from the qualitative data. The Confidence in the Evidence from Reviews of Qualitative research approach will be used to assess how much confidence to place in findings from the qualitative evidence synthesis.Ethics and disseminationThis review will use published data. No ethical issues are foreseen. The findings will be disseminated to the medical community via journal publication and conference presentation(s).PROSPERO registration numberID 91978.


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