Daniela Cardoso

The effectiveness of nonpharmacological interventions in older adults with depressive disorders: a systematic review.

Background It is widely acknowledged that mental disorders are common in old age and that depression is one of the most serious threats to the mental health of older adults. The lives of older adults are adversely affected both by major depression and subsyndromal depression. Depression should be approached with both pharmacotherapy and complementary therapies. The disadvantages posed by psychopharmacotherapy may be more prominent among older adults and there is a greater probability of drug interference. Different nonpharmacological interventions have been reported to reduce depressive symptoms in older adults with no adverse side effects. Objectives This review aimed to identify and synthesize the best available evidence on the effectiveness of nonpharmacological interventions for older adults with depressive disorders. Inclusion criteria Types of participants This review considered studies that included older adults: adult patients, aged over 65 years with any type of depressive disorder, regardless of comorbidities and any previous treatments, but excluded those with manic or psychotic episodes/symptoms. Patients receiving pharmacological treatment for depression or other illnesses were included. Types of intervention(s)/phenomena of interest This review considered studies that used nonpharmacological interventions for older adults with depressive disorders. Types of studies This review considered any experimental study design, including randomized controlled trials, non‐randomized controlled trials, or other quasi‐experimental studies, including before and after studies. Types of outcomes This review considered studies that included the following outcome measures: depressive symptomatology. The secondary outcomes were the level of autonomy in activities of daily living, cognitive function, health‐related quality of life and wellbeing. Search strategy An initial search of MEDLINE and CINAHL was undertaken, followed by a second search for published and unpublished studies from January 2000 to March 2012 of major healthcare‐related electronic databases. Studies in English, Spanish and Portuguese were included in the review. Methodological quality Methodological quality was assessed by two independent reviewers using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta‐Analysis of Statistics Assessment and Review Instrument. Two independent reviewers assessed 23 studies. There was general agreement among the reviewers to include six of the studies in this review. Data extraction Data were extracted using the Joanna Briggs Institute data extraction form for experimental studies and included participant characteristics, intervention characteristics and methods of the study. Data synthesis The impact of interventions on depression outcomes was described in a narrative format for each specific intervention. Data from two studies were pooled in a meta‐analysis. Results Twenty‐three studies met the inclusion criteria. Of those, 17 studies were excluded after assessment of their methodological quality. The remaining six original articles, which included 520 participants, were included in this review. Five were randomized clinical trials and one was a quasi‐experimental study. The interventions included in this systematic review were: cognitive behavior therapy, competitive memory training, reminiscence group therapy, problem‐adaptation therapy, and problem‐solving therapy in home care. Evidence suggests that all of these interventions reduce depressive symptoms. Data from two studies reporting the effectiveness of problem‐solving therapy in home care were pooled in a meta‐analysis. The meta‐analysis showed homogeneity (heterogeneity Chi‐squared=2.83, p=0.09). The analysis estimated a statistically significant reduction (z= 11.19; p< 0.0001) of ‐10.23 points (CI: ‐12.03, ‐8.44) in the 17‐item Hamilton Depression Rating Scale (HAM‐D‐17). Conclusions Evidence suggests that all of these interventions reduce depressive symptoms and, therefore, may be useful in practice. However, due to the diversity of interventions and the low number of studies per intervention included in this systematic review, evidence is not strong enough to produce a best practice guideline.

Efeito da estimulação cognitiva em Idosos

Context: evidence suggests that cognitive stimulation (CS) has a positive effect on cognition, depressive symptomatology (DS), and autonomy in ...

The effects of emergency department overcrowding on admitted patient outcomes: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE The objective of this review is to identify the effects of emergency department (ED) overcrowding on admitted patient outcomes.More specifically, the questions are: does ED overcrowding increase the admitted patients mortality? Does ED overcrowding increase the admitted patients hospital length-of-stay? Does ED overcrowding increase the delay in door-to-needle time to treatment (time to antibiotic, time to thrombolysis and time to analgesic)?

Effectiveness of heparin versus 0.9% saline solution in maintaining the permeability of central venous catheters: a systematic review

OBJETIVO Determinar qual e a solucao (flush heparina comparado com oflushde soro fisiologico 0.9%) mais eficaz na reducao do risco de oclusoes de cateteres venosos centrais (CVC) em adultos. METODO A revisao sistematica seguiu os principios propostos pelo Cochrane Handbook; a analise critica, a extracao e a sintese dos dados foram realizadas por dois investigadores, isoladamente; e a analise estatistica efetuada com recurso ao programa RevMan 5.2.8. RESULTADOS Foram incluidos oito estudos randomizados controlados e um estudo de coorte e os resultados da meta-analise mostram nao existir diferencas (RR=0.68, IC 95%=0.41-1.10; p=0.12). A analise por subgrupos mostra que nos CVC totalmente implantados nao se verificaram diferencas (RR=1.09, IC 95%=0.53-2.22; p=0.82); nos CVC com varios lumens existiu um efeito benefico no grupo da heparina (RR=0.53, IC 95%=0.29-0.95;p=0.03); nos CVC de duplo lumen para hemodialise (RR=1.18, IC 95%=0.08-17.82; p=0.90) e nos CVC de insercao periferica (RR=0.14, IC 95%=0.01-2.60; p=0.19) tambem nao se verificaram diferencas. CONCLUSAO O soro fisiologico e suficiente para manter a permeabilidade dos cateteres venosos centrais, prevenindo os riscos associados a administracao da heparina.OBJECTIVE Determining which is the most effective solution (heparin flush compared to 0.9% saline flush) for reducing the risk of occlusions in central venous catheters (CVC) in adults. METHOD The systematic review followed the principles proposed by the Cochrane Handbook; critical analysis, extraction and synthesis of data were performed by two independent researchers; statistical analysis was performed using the RevMan program 5.2.8. RESULTS Eight randomized controlled trials and one cohort study were included and the results of the meta-analysis showed no difference (RR=0.68, 95% CI=0.41-1.10; p=0.12). Analysis by subgroups showed that there was no difference in fully deployed CVC (RR=1.09, CI 95%=0.53-2.22; p=0.82); Multi-Lumen CVC showed beneficial effects in the heparin group (RR=0.53, CI 95%=0.29-0.95; p=0.03); in Double-Lumen CVC for hemodialysis (RR=1.18, CI 95%=0.08-17.82; p=0.90) and Peripherally inserted CVC (RR=0.14, CI 95%=0.01-2.60; p=0.19) also showed no difference. CONCLUSION Saline solution is sufficient for maintaining patency of the central venous catheter, preventing the risks associated with heparin administration.

Prevalence of burnout in health professionals working in palliative care: a systematic review.

BackgroundMore than ever, the current increasing need for palliative care leads to health professionals providing this type of care which further leads to multiple challenges, and stressful and demanding situations. The multiple challenges of working in palliative care put health professionals working in this context at the risk of burnout. ObjectivesTo examine the evidence on the prevalence of burnout among health professionals working in palliative care. Inclusion criteria Types of participantsThe current review included studies that encompass qualified health professionals working in palliative care, caring for patients 18 years of age or older. ConditionThe current review considered studies reporting on the point prevalence of burnout, measured by a burnout scale, such as, but not limited to, the Maslach Burnout Inventory, Burnout Measure and Copenhagen Burnout Inventory. ContextThe current review considered studies conducted in the context of specialist palliative care, more specifically, palliative care units, specialized palliative home care or hospices. Types of studiesThe current review considered observational study designs, including prospective and retrospective cohort, case-control and cross-sectional studies. Search strategyAn initial search of MEDLINE (via PubMed) and CINAHL was undertaken, followed by a second search for published and unpublished studies since 1975 in major healthcare-related electronic databases. Studies written in English, Spanish and Portuguese were included. Methodological qualityTwo independent reviewers assessed the methodological quality of studies using the standardized critical appraisal instrument from the Joanna Briggs Institute. No studies were excluded from the review based on the methodological appraisal. Data extractionData were extracted using a data extraction table, taking into account the review questions. Data synthesisSignificant differences were found between condition measures, thus we were unable to perform a meta-analysis. ResultsEight cross-sectional studies met the inclusion criteria, with a total of 1406 health professionals. The sample was limited to nurses, physicians and social workers. None of the included articles presented data about other health professionals. Seven of the included studies assessed the prevalence of burnout using the same instrument – the Maslach Burnout Inventory. Data revealed a prevalence of burnout of 17.3% among health professionals. Personal Accomplishment was the sub-scale from the Maslach Burnout Inventory that had the highest prevalence (19.5%). Nurses had higher levels of Emotional Exhaustion (19.5%) and Depersonalization (8.2%), and physicians had lower levels of Personal Accomplishment (41.2%). The prevalence of burnout was, however, higher in social workers (27%). The palliative care context with the highest prevalence of burnout was home care (19.6%). ConclusionThe current systematic review contributes to a body of empirical knowledge that can facilitate the professional development of palliative care teams by highlighting the prevalence of burnout in health professionals, which staff category is the most affected (social workers), and which palliative care context has the highest prevalence (home care).

The prevalence of burnout in health professionals working in palliative care: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE The objective of this review is to examine the evidence on the prevalence of burnout among health professionals working in palliative care.More specifically, the review focuses on the following questions: What is the prevalence of burnout among health professionals working in palliative care? Is there a difference in the prevalence of burnout in different subgroups of health professionals working in palliative care (such as, but not limited to, nurses, physicians, social workers, psychologists)? Is there a difference in the prevalence of burnout among health professionals working in different contexts of palliative care (palliative care units, home care, hospices)?

Contribuição para a adaptação da Geriatric Depression Scale -15 para a língua portuguesa

Theoretical framework: Depressive symptoms are common among the elderly, and it is important to have access to a reliable and easy- to-use screening scale. ...

Use of non-pharmacological interventions for comforting patients in palliative care: a scoping review.

BackgroundPalliative care aims to provide the maximum possible comfort to people with advanced and incurable diseases. The use of non-pharmacological interventions to promote comfort in palliative care settings has been increasing.However, information on implemented and evaluated interventions, their characteristics, contexts of application, and population is scattered in the literature, hampering the formulation of accurate questions on the effectiveness of those interventions and, consequently, the development of a systematic review. ObjectiveThe objective of this scoping review is to examine and map the non-pharmacological interventions implemented and evaluated to provide comfort in palliative care. Inclusion criteria Types of participantsThis scoping review considered all studies that focused on patients with advanced and incurable diseases, aged 18 years or older, assisted by palliative care teams. ConceptThis scoping review considered all studies that addressed non-pharmacological interventions implemented and evaluated to provide comfort for patients with advanced and incurable diseases.It considered non-pharmacological interventions implemented to provide not only comfort but also well-being, and relief of pain, suffering, anxiety, depression, stress and fatigue which are comfort-related concepts. ContextThis scoping review considered all non-pharmacological interventions implemented and evaluated in the context of palliative care. This included home care, hospices or palliative care units (PCUs). Types of sourcesThis scoping review considered quantitative and qualitative studies, and systematic reviews. Search strategyA three-step search strategy was undertaken: 1) an initial limited search of CINAHL and MEDLINE; 2) an extensive search using all identified keywords and index terms across all included databases; and 3) a hand search of the reference lists of included articles.This review was limited to studies published in English, Spanish and Portuguese in any year. Extraction of resultsA data extraction instrument was developed. Two reviewers extracted data independently. Any disagreements that arose between the reviewers were resolved through discussion, or with a third reviewer. When necessary, primary authors were contacted for further information/clarification of data. Presentation of resultsEighteen studies were included covering 10 non-pharmacological interventions implemented and evaluated to provide comfort. The interventions included one to 14 sessions. The interventions lasted between five and 60 minutes. Most of the interventions were implemented in PCUs and hospice settings. Ten of the 18 interventions were implemented and evaluated exclusively in cancer patients. ConclusionsTen non-pharmacological interventions were identified, of which the most common were music therapy and massage therapy. Their characteristics differed significantly across interventions and even in the same intervention. They were mostly implemented in palliative care units and hospices, and in patients with a cancer diagnosis. These data raise questions for future primary studies and systematic reviews. Implications for researchFuture research should focus on the implementation of interventions not only with cancer patients but also with non-cancer patients and patients receiving palliative care at home. Systematic reviews on the effect of massage therapy and music therapy should be conducted.

Effectiveness of haloperidol prophylaxis in critically ill patients with a high risk of delirium: a systematic review

Background Delirium is associated with increased intensive care unit and hospital length of stay, prolonged duration of mechanical ventilation, unplanned removal of tubes and catheters, and increased morbidity and mortality. Prophylactic treatment with low-dose haloperidol may have beneficial effects for critically ill patients with a high risk of delirium. Objectives To identify the effectiveness of haloperidol prophylaxis in critically ill patients with a high risk for delirium. Inclusion criteria Types of participants Patients with a predicted high risk of delirium, aged 18 years or over, and in intensive care units. Patients with a history of concurrent antipsychotic medication use were excluded. Types of intervention(s)/phenomena of interest Haloperidol prophylaxis for preventing delirium. Types of studies Experimental and epidemiological study designs. Outcomes Primary outcome is the incidence of delirium. Secondary outcomes are duration of mechanical ventilation, incidence of re-intubation, incidence of unplanned/accidental removal of tubes/lines and catheters, intensive care unit and hospital length of stay, and re-admissions to both settings. Search strategy An initial search of MEDLINE and CINAHL was undertaken, followed by a second search for published and unpublished studies from January 1967 to September 2015 in major healthcare-related electronic databases. Studies in English, Spanish and Portuguese were included. Methodological quality Two independent reviewers assessed the methodological quality of five studies using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. There was general agreement among the reviewers to exclude one relevant study due to methodological quality. Data extraction Data were extracted using the JBI data extraction form for experimental studies and included details about the interventions, populations, study methods and outcomes of significance to the review questions. Data synthesis Significant differences were found between participants, interventions, outcome measures (clinical heterogeneity) and designs (methodological heterogeneity). For these reasons, we were unable to perform a meta-analysis. Therefore, the results have been described in a narrative format. Results Five studies met the inclusion criteria. One of these studies was excluded due to poor methodological quality. The remaining four original studies (total of 1142 patients) were included in this review. Three studies were randomized controlled trials and one was a cohort study. Two studies confirmed the effectiveness of haloperidol prophylaxis in critically ill patients with a high risk of delirium. These studies showed that short-term prophylactic administration of low-dose intravenous haloperidol significantly decreased the incidence of delirium in elderly patients admitted to intensive care units after non-cardiac surgery and in general intensive care unit patients with a high risk of delirium. However, the two remaining studies showed contradictory results in mechanically ventilated critically ill adults, revealing that the administration of haloperidol reduced delirium prevalence, delayed its occurrence, and/or shorten its duration. Conclusions The evidence related to the effectiveness of haloperidol prophylaxis in critically ill patients with a high risk of delirium is contradictory. However, balancing the benefits and low side effects associated with haloperidol prophylaxis, this preventive intervention may be useful to reduce the incidence of delirium in critically ill adults in intensive care units.

The effectiveness of acupuncture on pain, physical function and health-related quality of life in patients with rheumatoid arthritis: a systematic review protocol

REVIEW QUESTION/OBJECTIVE The objective of this review is to identify and synthesize the best available evidence on the effectiveness of acupuncture on pain, physical function and health-related quality of life in patients with rheumatoid arthritis.More specifically, the review questions are:• Is acupuncture effective in improving health-related quality of life in patients with RA?• Is acupuncture effective in relieving pain in patients with RA?• Is acupuncture effective in improving physical function in patients with RA?