Conectar
This systematic review examined eHealth solutions used to assess and monitor symptoms among adults with CKD.
A systematic review was conducted and reported in accordance with the PRISMA checklist. The review protocol was registered in PROSPERO (CRD4202452973).
Seven databases were searched for English language studies that reported eHealth solutions for symptom assessment and monitoring in CKD between January 2000 and May 2024. The methodological quality of studies was evaluated using the Mixed Methods Appraisal Tool and a co-design evaluation tool.
Thirty-eight studies involving 4345 participants with CKD were included. Most of the included studies were non-randomised controlled trials (n = 16) and non-experimental studies (n = 13); only a few studies (n = 9) were randomised controlled trials. Current eHealth solutions varied in technologies and functions but were primarily focused on self-monitoring (n = 22), data recording (n = 14), education (n = 13), providing information (n = 10) and reminders/alerts (n = 10). There was limited evidence from few intervention studies involving eHealth solutions showing improvements in CKD symptoms and/or health-related quality of life. Among the 14 studies that assessed user satisfaction, satisfaction was high, but challenges and barriers to implementing these solutions were reported.
eHealth solutions have the potential to facilitate symptom assessment and monitoring for adults with CKD, but further high-quality experimental studies are required to provide better evidence in practice.
eHealth symptom assessment and monitoring are increasing in practice. While some adults are willing and able to use eHealth solutions, barriers remain due to limited digital health literacy. As few randomised controlled trials exist, further studies are needed to evaluate the benefits of reducing chronic kidney disease symptom burden.
No Patient or Public Contribution.
Virtual reality is an emerging non-drug treatment for pain caused by endoscopy procedure. We conducted a meta-analysis to evaluate the effectiveness and safety of virtual reality based interventions for pain during endoscopy.
PubMed, EMBASE, Cochrane Library, Web of Science and Clinical Trials database were searched until 26 May 2024. Randomised controlled trials on the application of virtual reality in endoscopic examinations were included. The standardised mean difference (SMD) was calculated using random-effects models, and included studies were appraised using Cochrane Risk of Bias tool version 1. Meta- analysis was conducted using Stata Statistical Software version 17.0.
Overall, 21 studies enrolling 1721 participants were included. Our results demonstrated that the patients receiving the virtual reality intervention had lower pain scores than those receiving the usual care (SMD = −0.42; 95% CI = −0.65, −0.20). Subgroup analysis showed that real-time assessment of pain scores during the medical process had less heterogeneity (I 2 = 20.2%, p = 0.257) and a smaller range of confidence intervals (95% CI = −0.43, −0.14) than retrospective assessment (95% CI = −0.75, −0.09). For different types of endoscopes, virtual reality was statistically significant for reducing pain during colonoscopy (SMD = −0.70; 95% CI = −1.12, −0.28), cystoscopy (SMD = −0.28; 95% CI = −0.53, −0.04) and laparoscopy (SMD = −0.54; 95% CI = −0.98, −0.10). Additionally, statistically significant improvements in relieving anxiety were reported when using virtual reality (SMD = −0.56; 95% CI = −0.78, −0.35).
The application of virtual reality can effectively relieve the pain and anxiety of endoscopy. The types of endoscopy and the way of retrospective evaluation of pain scores were the main sources of heterogeneity. More rigorous studies about the relationship between virtual reality and endoscopic pain relief will be needed.
The application effect of virtual reality technology on endoscopy was verified by summarising several randomised controlled trials. Patients and healthcare providers can be better informed about the use of such intervention to relieve pain.
Virtual reality is recommended as being potentially useful and practical for reducing the pain of endoscopy.
To explore the associations between depression, anxiety, decisional conflict and advance care planning engagement and the potential mediating role of decisional conflict in the associations between depression, anxiety and advance care planning among community-dwelling older adults.
A cross-sectional study was conducted with 262 community-dwelling older Australians across metropolitan, regional and rural communities between August and October 2022.
Validated self-reported questions were used to collect data on anxiety, depression (Hospital Anxiety and Depression Scale), decisional conflict (Decisional Conflict Scale), advance care planning engagement (Advance Care Planning Engagement Survey) and covariates (demographic characteristics, health literacy [Health Literacy Screening Questions]), overall health status (Short form 36). Data analysis included descriptive statistics, bivariate association analysis, general linear modelling and path analysis.
Anxiety and decisional conflict were directly associated with advance care planning engagement even after controlling for potential effects of demographic characteristics, health literacy and overall health status. The model, including age, gender, country of birth, language spoken at home, education, overall health status, anxiety, depression, decisional conflict and interaction between anxiety and decisional conflict, explained 24.3% of the variance in their advance care planning engagement. Decisional conflict mediated the association between anxiety and advance care planning engagement.
Increased anxiety and decisional conflict were associated with reduced advance care planning engagement directly, even among community-dwelling older adults with higher levels of education and health literacy. Increased anxiety was associated with reduced advance care planning engagement indirectly via increased decisional conflict. Healthcare professionals should assess community-dwelling older adults' anxiety and implement interventions to manage their anxiety and decisional conflict, as these may facilitate their engagement in advance care planning.
Understanding factors associated with advance care planning engagement among community-dwelling older adults may inform strategies facilitating their future engagement in advance care planning. Findings from this study may be used as evidence for future implementation to facilitate the engagement of community-dwelling older adults in advance care planning.
The STROBE statement checklist was used as a guide to writing the manuscript.
The study was advertised publicly through social media (e.g. Twitter and Facebook) and newsletters (e.g. Advance Care Planning Australia, Centre for Volunteering, Palliative Care Australia and a large home care service provider with approximately 7000 older clients receiving support or services) to recruit participants. People aged 65 years and older living independently in the Australian community who could communicate in English were invited to participate and answer the questionnaire.
FreshRSS