scholarly journals Anticholinergic Burden and Cognitive Performance in Patients With Schizophrenia: A Systematic Literature Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Rafaella Georgiou ◽  
Demetris Lamnisos ◽  
Konstantinos Giannakou

Objective: Cognitive impairment in schizophrenia forms the key cause of the disease's disability, leading to serious functional, and socioeconomic implications. Dopaminergic-cholinergic balance is considered essential to cognitive performance in schizophrenia and patients are often treated with many drugs with anticholinergic properties. This study aims to examine the cognitive impact of anticholinergic burden in patients with schizophrenia.Methods: A systematic literature review was performed on English-language studies published on PubMed, Embase, and Web of Science, from inception to June 2021, to identify research studies that examined the effect of anticholinergic load on cognition in clinically stable patients with schizophrenia. No restrictions on study design, age of participants, or geographical distribution were applied. Two researchers performed independently the screening and shortlisting of the eligible articles. A narrative synthesis of the main characteristics and findings of studies included was reported.Results: In total, 17 articles of varying methodological design met the inclusion criteria. Three of them found statistically significant improvement in cognition after anticholinergic tapering without adverse effects. Thirteen studies found a statistically significant association between high anticholinergic burden and cognitive impairment (neurocognitive composite scores and individual cognitive domains such as learning and memory, executive function, processing speed), apart from a study, related to the specific characteristics of clozapine.Conclusions: Medication with increased anticholinergic load has been found in most of the studies to negatively affect neurocognitive performance of patients with schizophrenia. However, the clinical and methodological heterogeneity of studies included limit our interpretation and conclusions.

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1402.1-1402
Author(s):  
R. Pinheiro Torres ◽  
M. H. Fernandes Lourenco ◽  
A. Neto ◽  
F. Pimentel Dos Santos ◽  
I. Silva ◽  
...  

Background:Juvenile idiopathic arthritis (JIA), one of the most common chronic diseases in children, can be classified in seven different categories according to its onset presentation. Concerns about pregnancy outcomes play a secondary role in disease approach. However, recent data showed an increased risk of pre-term birth in women with JIA instead the small patient samples analysed.Objectives:In this review, our aim is to describe the current available knowledge on JIA adverse, maternal and fetal, outcomes.Methods:A systematic literature review was conducted since January of 2000 until December 2020, by searching the PubMed and Embase bibliographic databases. The search was limited to articles in English language, presenting a comparator group (healthy individuals or patients without known auto-immune rheumatic diseases) and at least one clinical outcome of interest. Two independent reviewers screened the titles and abstracts followed by a full-text review to assess papers regarding their eligibility.Results:Ten observational studies out of 1560 references, fulfilled the inclusion criteria, of which, 9 were retrospective and 1 prospective. A total of 6.214 women with JIA (with 6.811 pregnancies) and 18.659.513 healthy controls (with 21.339.194 pregnancies) were included in this review.Concerning maternal outcomes, delivery by caesarian section (CS) was more frequent among JIA women (in 4 out of 6 studies). Pre-eclampsia was referred in 3 out of 6 studies and a higher risk of vaginal bleeding and placenta previa in one additional study. No study found an increased risk for gestational diabetes or hypertension in pregnant women with JIA.Regarding fetal outcomes, 8 studies revealed significantly increased of pre-term birth (only in first births in one study) but one study didn’t show any increased risk. Two studies showed a higher risk of small gestational age (SGA) and in another 2, increased risk for low birth weight (LBW). No evidence of increased risk of major congenital malformations.Conclusion:This systematic review suggests an increased risk for pre-eclampsia, preterm birth, delivery by CS, SGA and LBW, among pregnant women with JIA. Conclusions should be carefully interpreted, giving the heterogeneity of studied populations regarding demography, disease type, disease activity, and prescribed medication.Disclosure of Interests:None declared


2021 ◽  
pp. 073346482110154
Author(s):  
Adriana Maria Rios Rincon ◽  
Antonio Miguel Cruz ◽  
Christine Daum ◽  
Noelannah Neubauer ◽  
Aidan Comeau ◽  
...  

The rates of dementia are on the rise as populations age. Storytelling is commonly used in therapies for persons living with dementia and can be in the form of life review, and reminiscence therapy. A systematic literature review was conducted to examine the range and extent of the use of digital technologies for facilitating storytelling in older adults and their care partners, and to identify the processes and methods, the technologies used and their readiness levels, the evidence, and the associated outcomes. Eight electronic databases were searched: Medline, EMBASE, PsycINFO, CINAHL, Abstracts in Social Gerontology, ERIC, Web of Science, and Scopus. We included 34 studies. Mild cognitive impairment or dementia represented over half of medical conditions reported in the studies. Overall, our findings indicate that the most common use of digital storytelling was to support older adults’ memory, reminiscence, identity, and self-confidence; however, the level of evidence of its effectiveness was low.


2020 ◽  
Author(s):  
Tam Watermeyer ◽  
Jantje Goerdten ◽  
Boo Johansson ◽  
Graciela Muniz-Terrera

Abstract Background Cognitive dispersion, or inconsistencies in performance across cognitive domains, has been posited as a cost-effective tool to predict conversion to dementia in older adults. However, there is a dearth of studies exploring cognitive dispersion in the oldest-old (>80 years) and its relationship to dementia incidence. Objective The main aim of this study was to examine whether higher cognitive dispersion at baseline was associated with dementia incidence within an 8-year follow-up of very old adults, while controlling for established risk factors and suggested protective factors for dementia. Methods Participants (n = 468) were from the Origins of Variance in the Old-Old: Octogenarian Twins study, based on the Swedish Twin Registry. Cox regression analyses were performed to assess the association between baseline cognitive dispersion scores and dementia incidence, while controlling for sociodemographic variables, ApoEe4 carrier status, co-morbidities, zygosity and lifestyle engagement scores. An additional model included a composite of average cognitive performance. Results Cognitive dispersion and ApoEe4 were significantly associated with dementia diagnosis. These variables remained statistically significant when global cognitive performance was entered into the model. Likelihood ratio tests revealed that cognitive dispersion and cognitive composite scores entered together in the same model was superior to either predictor alone in the full model. Conclusions The study underscores the usefulness of cognitive dispersion metrics for dementia prediction in the oldest-old and highlights the influence of ApoEe4 on cognition in very late age. Our findings concur with others suggesting that health and lifestyle factors pose little impact upon cognition in very advanced age.


2021 ◽  
pp. 496-507
Author(s):  
Rifki S. Nompo ◽  
Andria Pragholapati ◽  
Angela L. Thome

Anxiety is a feeling of helplessness, and worry about things that are not clear, as well as a comprehensive feeling that something bad is going to happen. Anxiety is experienced subjectively and communicated interpersonally, at the same time feelings of anxiety are a necessary survival instinct. The Neuro-Linguistic Programming (NLP) is a communicative approach employs a positive view of anxiety and how it can help shape life changes, and that is the topic of this article. This research method uses a Systematic Literature Review, investigating Garuda, Pubmed, ScienceDirect, and Proquest, using boolean for keyword neurolinguistics programming (NLP) and anxiety. The inclusion criteria used were Indonesian and English language articles written within the last 5 years (from 2015 until 2020). The exclusion criteria used by the article were abstract writing style, inaccessible, or lacking national accreditation. Articles were tested with Critical Appraisal Tools. The studies indicate that good communication using NLP can help reduce anxiety and can promote changes in a person’s behavior patterns. There are several NLP techniques including sensory acuity, reframing, anchoring, rapport, and pacing, and leading. NLP can improve knowledge, skills and attitudes, communication skills, self-management, mental health, reduce work stress, and self-efficacy.   Keywords: Anxiety, Neuro-Linguistic Programming, NLP


BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S276-S276
Author(s):  
Syed Nabeel Javaid

AimsThe aim of this systematic literature review was to determine the evidence-based effectiveness of animal assisted interventions and to look at the factors that limit implementation of this intervention.BackgroundDementia is a major health issue worldwide impacting not only on the people diagnosed with dementia, but also on their families and caregivers, and the healthcare professionals. The symptoms of dementia include cognitive impairment that can range from mild to severe, and behavioural and psychological symptoms which have debilitating effects on functional capacity and quality of life. A number of non-pharmacological interventions are being developed to help people with dementia. Animal assisted therapy is one of those interventions that has demonstrated positive effects on various aspects of dementia (Filan and Llewellyn-Jones, 2006). However, there are limitations to its use and feasibility of animal assisted therapy programmes is unclear.MethodOnly randomised-controlled trials (RCTs) were to be included to evaluate high quality evidence. A systematic literature search was carried out to find using the PubMed and Cochrane databases and a search of the NICE website. Literature was screened according to inclusion and exclusion criteria. Eight randomised-controlled trials were selected to be used in this systematic review to assess the effectiveness of animal-assisted therapy.ResultThe results regarding the effectiveness of animal assisted therapy were variable. There was some improvement demonstrated in symptoms of depression, agitation, behaviour and cognitive impairment. Quality of life and activities of daily living also demonstrated positive outcomes. There was a reduction in the risk of falls in people with dementia. However, the studies conducted demonstrated limited methodologies. The factors limiting the use of animal assisted therapy were found to be concerns around adverse events to animals, issues of animal welfare and economic feasibility of animal assisted therapy programmes.ConclusionFurther research needs to be done using properly conducted randomised controlled trials with larger sample sizes to formally assess people's perceptions regarding therapy animals and develop clear guidelines and protocols for integrating these interventions in healthcare.


2018 ◽  
Vol 29 (5) ◽  
pp. 768-788 ◽  
Author(s):  
Narpat Ram Sangwa ◽  
Kuldip Singh Sangwan

Purpose The purpose of this paper is to review various themes of leanness, leanness assessment approaches, leanness assessment areas, and their evolution by a systematic literature review (SLR). Design/methodology/approach The eight types of literature review methodologies are identified and compared. The SLR is selected after critically analyzing the eight types of literature reviews. A four-phased SLR (i.e. plan, do, analyze/synthesize, and propose) has been carried out based on the peer-reviewed journal and conference articles on leanness assessment. Findings The existing literature on leanness assessment shows the lack of review-based papers on lean assessment. This study attempts to build a two-fold contribution to the field of leanness assessment: first, various types of themes, approaches, and assessment areas are identified; second, a framework for leanness assessment is proposed. The study shows that the research on leanness assessment is mainly empirical using qualitative judgment. The paper traces the changes in scope, areas, and approaches to leanness assessment. The scope of leanness assessment broadened from manufacturing process assessment to whole supply chain assessment including manufacturing process. The focus of earlier assessment was manufacturing and financial areas which now includes human resource, administration, new product development, suppliers, and customers also. Tool and technique based assessment has given way to outcome-based assessment using non-financial and qualitative parameters. Research limitations/implications One of the limitations of the study is that literature search was mainly focused on peer-reviewed articles published in English language only; therefore, some papers in others languages may have been missed. Apart from this, the SLR has been conducted for the manufacturing sector only. Practical implications The study is expected to be useful for the lean practitioners to identify the causes of reported lean failures. Moreover, the authors also expect that the conducted SLR will provide the passage to the practitioners for not only fostering the concepts on leanness assessment but also provide the vital and significant knowledge about the leanness assessment to the managers for enhancing organizational performance. Originality/value As per the authors’ knowledge, this is the first SLR on leanness assessment. It is expected that this paper will help the researchers working in the area of lean manufacturing to identify new areas of research.


2020 ◽  
Vol 17 ◽  
pp. 147997311990123 ◽  
Author(s):  
Maryam Navaie ◽  
Carole Dembek ◽  
Soojin Cho-Reyes ◽  
Karen Yeh ◽  
Bartolome R Celli

Inhaled bronchodilators are the cornerstone of treatment for chronic obstructive pulmonary disease (COPD). Soft mist inhalers (SMIs) are devices that deliver bronchodilators. Although correct device use is paramount to successful medication delivery, patient errors are common. This global systematic literature review and meta-analysis examined device use errors with SMIs among patients with obstructive lung diseases. PubMed, EMBASE, PsycINFO, Cochrane, and Google Scholar were searched to identify studies published between 2010 and 2019 that met the following inclusion criteria: (a) English language; (b) a diagnosis of COPD, bronchitis, or emphysema; and (c) reported device use errors among adults receiving long-acting bronchodilator treatment with Respimat® SMI (i.e. Spiriva®, Stiolto®, Spiolto®, and Striverdi®). Descriptive statistics examined sociodemographics, clinical characteristics, and device use errors. Meta-analysis techniques were employed with random-effects models to generate pooled mean effect sizes and 95% confidence intervals (CIs) for overall and step-by-step errors. The I 2 statistic measured heterogeneity. Twelve studies ( n = 1288 patients) were included in this meta-analysis. Eighty-eight percent of patients had COPD, and most had moderate/very severe airflow limitation (Global Initiative for Chronic Obstructive Lung Disease spirometric stages II to IV). Aggregate results revealed that 58.9% (95% CI: 42.4–75.5; I 2 = 92.8%) of patients made ≥1 device use errors. Among 11 studies with step-by-step data, the most common errors were failure to (1) exhale completely and away from the device (47.8% (95% CI: 33.6–62.0)); (2) hold breath for up to 10 seconds (30.6% (95% CI: 17.5–43.7)); (3) take a slow, deep breath while pressing the dose release button (27.9% (95% CI: 14.5–41.2)); (4) hold the inhaler upright (22.6% (95% CI: 6.2–39.0)); and (5) turn the base toward the arrows until it clicked (17.6% (95% CI: 3.0–32.2)). Device use errors occurred in about 6 of 10 patients who used SMIs. An individualized approach to inhalation device selection and ongoing training and monitoring of device use are important in optimizing bronchodilator treatment.


2018 ◽  
Vol 7 (3) ◽  
pp. 217-229 ◽  
Author(s):  
Sarah Seleznyov

Purpose The purpose of this paper is to explore the popularity of Japanese lesson study (JLS) beyond Japan and the challenges this translation might pose. It notes that there is not a universally accepted definition of lesson study (LS) and seeks to identify the “critical components” of JLS through a review of the literature. It then uses a systematic literature review of recent studies of the implementation of LS with in-service teachers beyond Japan to analyse the models of LS used against these seven critical components in order to explore the degree of fidelity to the Japanese model. Design/methodology/approach A broad review of the literature on JLS available in the English language identifies seven “critical components”. A systematic literature review of 200 recent English language studies of the implementation of LS with in-service teachers beyond Japan is then carried out. Articles published between 2005 and 2015 are explored, including peer reviewed articles, scientific journals, book chapters and PhD dissertations. This systematic review enables an analysis of the models of LS used in studies from beyond Japan against the “seven critical components” of JLS. Findings The analysis shows that there is not an internationally shared understanding of Japanese lesson study (JLS) and that many of the missing components are those which distinguish LS as a research process, not simply a collaborative professional development approach. It also reveals that UK LS models seem particularly far from the Japanese model in those critical components which connect teachers’ knowledge and understanding within groups, to knowledge and understanding that exists beyond it. The study discusses whether these differences could be attributed to structural or cultural differences between Japan and other nations. Research limitations/implications The search for descriptions of the JLS is limited to articles available in the English language, which, therefore, represent a quite limited body of authority on the “critical components” of LS. The systematic review is similarly limited to English language articles, and there is a clear bias towards the USA, with the Far East and the UK making up the majority of the remaining studies. The study suggests that future research on LS beyond Japan should consider teachers’ attitudes towards the research elements of the process as well as their skills and confidence in carrying out research into practice. Practical implications The study strikes a note of caution for schools wishing to implement JLS as an approach to teacher professional development in the UK and beyond. Japan’s systemic approach has embedded LS experience and expertise into the education system, meaning a uniform approach to LS is much more likely. In addition, other systemic challenges may arise, for example, UK professional development time and resources is not designed with JLS in mind and may therefore require a significant reworking. Originality/value Whilst several systematic reviews of LS have explored its growth, geographical spread, impact and key features, this study provides a different perspective. It analyses whether and to what degree the “lesson study” models these studies describe align with the literature on JLS, and the implications of this for researchers and practitioners.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S90-S90
Author(s):  
Eloise Williams ◽  
Adam W Jenney ◽  
Denis W Spelman

Abstract Background Nocardia bacteremia is a rare but important phenomenon, with previous studies describing a 50% mortality rate. We undertake a single-center review and the largest systematic review of Nocardia bacteremia performed over the past 20 years. Methods A single-center review of cases of Nocardia bacteremia was performed using hospital microbiology records from January 1, 2010 to December 31, 2017. A systematic literature review was also performed to identify cases of Nocardia bacteremia described in the English language literature between January 1, 1999 and December 31, 2018 using the NCBI PubMed database and snowballing from citations of relevant publications. Results Single-center case series: Four cases of Nocardia bacteremia are described. Three patients had an intravascular device in situ prior to the onset of Nocardia bacteremia and three patients were immunocompromised; one patient had both risk factors. Systematic literature review: A systematic review identified 50 publications that described 85 cases with sufficient patient data to be reviewed in detail. Including the 4 cases described in our institution, 89 cases of Nocardia bacteremia were included in the analysis. The median age was 57 years [interquartile range (IQR) 42–68] and 69% were male. Eighty-two percent of cases were immunocompromised and 38% had endovascular devices. Pulmonary infection was the most common concurrent site of clinical disease (66%), followed by central nervous system (25%), pleural (17%) disease, and endocarditis (11%). Blood cultures were the only positive microbiological specimen that isolated Nocardia in 45% of cases. Median incubation time to blood culture positivity was 4 days [IQR 3–6]. Thirty-day all-cause mortality was 24% and overall all-cause mortality was 42%. Conclusion Four new cases of Nocardia bacteremia are described. Isolation of Nocardia from blood cultures is rare but represents serious infection with high associated overall mortality. Nocardia bacteremia is most frequently identified in immunocompromised patients and those with intravascular devices. Disclosures All authors: No reported disclosures.


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