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Background Post-stroke dysphagia (PSD) has been associated with high risk of aspiration pneumonia and mortality. However, limited evidence on pooled prevalence of post-stroke dysphagia and influence of individual, disease and methodological factors reveals knowledge gap. Therefore, to extend previous evidence from systematic reviews, we performed the first meta-analysis to examine the pooled prevalence, risk of pneumonia and mortality and influence of prognostic factors for PSD in acute stroke. Methods Our search was conducted in CINAHL, Cochrane Library, EMBASE, Ovid-Medline, PubMed, and Web of Science an initial search in October 2020 and a follow-up search in May 2021. Data synthesis was conducted using the Freeman-Tukey double-arcsine transformation model for the pooled prevalence rate and the DerSimonian-Lard random-effects model for prognostic factors and outcomes of PSD. Results The pooled prevalence of PSD was 42% in 42 studies with 26,366 participants. PSD was associated with higher pooled odds ratio (OR) for risk of pneumonia 4.08 (95% CI, 2.13–7.79) and mortality 4.07 (95% CI, 2.17–7.63). Haemorrhagic stroke 1.52 (95% CI, 1.13–2.07), previous stroke 1.40 (95% CI, 1.18–1.67), severe stroke 1.38 (95% CI, 1.17–1.61), females 1.25 (95% CI, 1.09–1.43), and diabetes mellitus 1.24 (95% CI, 1.02–1.51) were associated with higher risk of PSD. Males 0.82 (95% CI, 0.70–0.95) and ischaemic stroke 0.54 (95% CI, 0.46–0.65) were associated with lower risk of PSD. Haemorrhagic stroke, use of instrumental assessment method, and high quality studies demonstrated to have higher prevalence of PSD in the moderator analysis. Conclusions Assessment of PSD in acute stroke with standardized valid and reliable instruments should take into account stroke type, previous stroke, severe stroke, diabetes mellitus and gender to aid in prevention and management of pneumonia and thereby, reduce the mortality rate. Trial registration https://osf.io/58bjk/?view_only=26c7c8df8b55418d9a414f6d6df68bdb .

Evidence on the long-term comparative effectiveness of posttraumatic stress disorder (PTSD) psychotherapies in adults remains unknown. Therefore, we performed an extensive network meta-analysis of randomised controlled trials (RCTs) to determine the comparative effectiveness of psychotherapies for people diagnosed with PTSD. A comprehensive search was conducted in Cochrane library, Embase, Medline-OVID, PubMed, Scopus, and Psych-Info until March 2021. Studies on the effectiveness of cognitive processing therapy (CPT), cognitive therapy (CT), eye movement desensitisation reprocessing (EMDR), narrative exposure therapy (NET), prolonged exposure (PE), cognitive behavioural therapy (CBT), present-centred therapy (PCT), brief eclectic psychotherapies (BEP), psychodynamic therapy (PDT) or combination therapies compared to no treatment (NT) or treatment as usual (TAU) in adults with PTSD were included. Frequentist and Bayesian approaches were used for analysis in R-software. We included 98 RCTs with 5567 participants from 18 897 studies. CPT, EMDR, CT, NET, PE, CBT, and PCT were significant to reduce PTSD symptoms (SMD range: -1.53 to -0.75; Certainty: very low to high) at immediate post-treatment and ranked accordingly. Longitudinal analysis found EMDR (1.02) and CPT (0.85) as the significant therapies with large effect size in short-term and long-term follow-up, respectively. NET and CPT showed higher proportion of loss of PTSD diagnosis (RR range: 5.51-3.45) while there were no significant psychotherapies for retention rate compared to NT. Our findings provide evidence for improving current guidelines and informing clinical decision-making for PTSD management. However, the best PTSD treatment plan should be tailored to patients' needs, characteristics, and clinician expertise. PROSPERO CRD42020162143.

Purpose This meta‐analysis aimed to summarize and synthesize the effectiveness of bereavement support for adult family caregivers in palliative care. Methods Meta‐analysis was conducted. The databases of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, Medline, PubMed, Scopus, and Web of Science were comprehensively searched from inception until January 2020. This study followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and standard methods for conducting a meta‐analysis. Data analysis was performed using Comprehensive Meta‐analysis version 3.0, and the random‐effects model was adopted. Findings In total, 19 randomized controlled trials with an overall sample size of 2,690 participants met the inclusion criteria. The study showed that bereavement support had a significant effect on reducing grief (Hedges’ g score = ‐0.198; 95% confidence interval [CI] ‐0.310 to ‐0.087), depression (Hedges’ g score = ‐0.252; 95% CI ‐0.406 to ‐0.098), and anxiety (Hedges’ g score = ‐0.153; 95% CI ‐0.283 to ‐0.023); however, high heterogeneity was present. No statistically significant difference was shown for traumatic feelings. Based on moderator analysis, a group format was more effective for grief, a combined individual and group format for depression, and an individual format for anxiety. Bereavement support was more effective when delivered by professionals, when delivered in more than six sessions, and need to be evaluated within 6 months. Conclusions Bereavement support was effective in reducing grief, depression, and anxiety. The majority of the included studies had moderate heterogeneity, which limited the comparability of the evidence. Therefore, more robust randomized controlled trials are needed to confirm these study results. Clinical Relevance This meta‐analysis provides evidence that bereavement support delivered in the palliative care setting is effective for reducing grief, depression, and anxiety. Nurses and other healthcare professionals can make recommendations for adult family caregivers based on this study in reducing psychological symptoms due to a loss in the palliative care domain.

ObjectivesCaring for a family member with a life-threatening illness may lead to increased levels of psychological morbidity. Given the lack of recognition of caregivers’ grief, this study aimed to determine the prevalence of anticipatory grief disorders in caregivers of persons with a life-threatening illness for better intervention and management.MethodsCINAHL, Cochrane, Embase, Medline, PubMed, Scopus, PsycINFO and Web of Science were searched up to 21 March 2021 without language and time restrictions. The quality of the included studies was assessed with Hoy’s criteria. A random-effects model was applied to calculate pooled prevalence rates, and multi-regression was performed to examine heterogeneity among studies.ResultsA total of 3278 citations were retrieved, and 18 studies met the eligibility criteria involving 5470 caregivers. The pooled prevalence of anticipatory grief was 24.78% (95% CI 19.04% to 30.99%). The prevalence rates were significantly higher in female caregivers (16.64%; 95% CI 12.24% to 21.53%) compared with male caregivers (6.11%; 95% CI 4.55% to 7.87%). The married group also had a higher risk (14.66%; 95% CI 10.66% to 19.16%) than single group (5.47%; 95% CI 4.31% to 6.76%).ConclusionsThe overall pooled prevalence is substantially higher compared with after-loss grief in the general population and supported the presumptions that preloss grief has a greater magnitude compared with after-loss grief. Bereavement support, educational programmes and relevant resources should be delivered even before the actual loss to address the burden of caregivers.

To examine the effectiveness of prone positioning on COVID-19 patients with acute respiratory distress syndrome with moderating factors in both traditional prone positioning (invasive mechanical ventilation) and awake self-prone positioning patients (non-invasive ventilation). A comprehensive search was conducted in CINAHL, Cochrane library, Embase, Medline-OVID, NCBI SARS-CoV-2 Resources, ProQuest, Scopus, and Web of Science without language restrictions. All studies with prospective and experimental designs evaluating the effect of prone position patients with COVID-19 related to acute respiratory distress syndrome were included. Pooled standardised mean differences were calculated after prone position for primary (PaO2/FiO2) and secondary outcomes (SpO2 and PaO2) A total of 15 articles were eligible and included in the final analysis. Prone position had a statistically significant effect in improving PaO2/FiO2 with standardised mean difference of 1.10 (95%CI 0.60–1.59), SpO2 with standardised mean difference of 3.39 (95% CI 1.30–5.48), and PaO2 with standardised mean difference of 0.77 (95% CI 0.19–1.35). Patients with higher body mass index and longer duration/day are associated with larger standardised mean difference effect sizes for prone positioning. Our findings demonstrate that prone position significantly improved oxygen saturation in COVID-19 patients with acute respiratory distress syndrome in both traditional prone positioning and awake self-prone positioning patients. Prone position should be recommended for patients with higher body mass index and longer durations to obtain the maximum effect.

Cognitive function, working memory, attention, and coordination are higher-level functions sharing a complex relationship. Limited evidence exists on the effectiveness of multi-domain cognitive function interventions to improve cognitive outcomes. We evaluated the effectiveness of such interventions on cognitive function, working memory, attention, and coordination in older adults with mild cognitive impairment and mild dementia. We conducted a double-blind, two-arm, parallel-group randomised controlled trial in community care centres of Northern Taiwan. We recruited 72 participants aged≥65 years and randomly allocated them using 1:1 block randomization (block size = 4) into experimental (multi-domain cognitive function training) (MCFT) and control groups (passive information activities) (PIA) (n = 36/group). We administered the interventions in both groups for 30 minutes per session, three sessions per week for eight weeks, for a total of 24 sessions. The outcome indicators were cognitive function assessed (mini-mental status examination), working memory (digit span), selective attention (Stroop test), visual-spatial attention (trail making test-A (TMT-A)), divided attention (trail making test-B (TMT-B)), and coordination (Berry visual-motor integration (Berry-VMI)). We evaluated the study outcomes at baseline, immediate post-test, one-month follow-up, and one-year follow-up. We found no significant differences between the groups at baseline except for education. The average age of participants was 82.3 years, and most (76.4%) were female. We analysed the results by generalised estimating equations (GEE) based on the intention-to-treat (ITT) principle. The multi-domain cognitive function training was effective in improving cognitive function (β = 1.7; 95% confidence interval (CI) = 0.63-2.31; P = 0.001), working memory (β = -1.45; 95% CI = -2.62, -0.27; P = 0.016), and selective attention (β = -23.3; 95% = CI -43.9, -2.76; P = 0.026) compared to passive information activities at 1-month follow-up. The effects of multi-domain cognitive function training on cognitive function (β = 1.51; 95% CI = 0.40-2.63; P = 0.008), working memory (β = -1.93; 95% CI -3.33, -0.54; P = 0.007), selective attention (β = -27.8; 95% CI = -47.1, -8.48; P = 0.005), and coordination (β = 1.61; 95% CI = 0.25, 2.96; P = 0.020) were maintained for one year. There were no significant improvements in attention outcomes (visual-spatial and divided attention) after training. MCFT intervention demonstrated favourable effects in improving global cognitive function, working memory, selective attention, and coordination among older adults with mild cognitive impairment and mild dementia. Thus, applying multi-domain cognitive training in older adults with mild cognitive impairment and mild dementia could help to delay the cognitive decline. Chinese Clinical Trial Registry (ChiCTR2000039306).

Interest in the relationship between nurses and physicians has been increasing over the past few decades. Teamwork between the two disciplines was first studied in the 1970s and interest surged again in the 1980s, when evidence suggested that better teamwork saved more lives. This study presents a cross-sectional analysis linking 2006-2007 nurse survey data, hospital administrative data, and patient discharge data. The study sample comprised of 665 hospitals, 1,321,904 patients, and 29,391 nurses. Logistic regression models were used to assess the association between higher levels of nurse-physician teamwork and patient outcomes (30-day mortality and failure-to-rescue). Regression models were also used to examine whether any associations between nurse-physician teamwork and patient outcomes depends upon the level of other modifiable characteristics of hospital nursing (nurse staffing and education levels) in acute hospital settings. Final analysis revealed decreased odds of both 30-day mortality (OR = 0.943, 95% CI 0.930,0.958) and failure-to-rescue (OR = 0.939, 95% CI 0.925, 0.953) for surgical patients cared for in hospitals with better nurse reported nurse-physician teamwork, adjusting for hospital structural characteristics and patient characteristics. In addition, there was a significant interaction between nurse staffing and nurse-physician teamwork on surgical patient 30-day mortality, and failure-to-rescue rates. There was also a significant interaction between nurse education and nurse-physician teamwork on surgical patient 30-day mortality, and failure-to-rescue rates. Our analysis found a trend of decrease in odds of death and failure-to-rescue for hospitals with both higher nurse-physician teamwork scores and lower patient-per-nurse ratios. Similarly, there is a trend of a decrease in odds of death and failure-to-rescue in hospitals with higher nurse-physician teamwork scores and higher proportion of BSN educated nurses. In order for initiatives to improve interprofessional teamwork to have greater impact on patient outcomes, nurse staffing and nurse education need to be at sufficient levels.

Sixty genetic loci associated with abdominal obesity, measured by waist circumference (WC) and waist-hip ratio (WHR), have been previously identified, primarily from studies conducted in European-ancestry populations. We conducted a meta-analysis of associations of abdominal obesity with approximately 2.5 million single nucleotide polymorphisms (SNPs) among 53,052 (for WC) and 48,312 (for WHR) individuals of Asian descent and replicated 33 selected SNPs among 3,762 to 17,110 additional individuals. We identified four novel loci near the EFEMP1, ADAMTSL3 , CNPY2 and GNAS genes that were associated with WC after adjustment for body mass index (BMI); two loci near the NID2 and HLA-DRB5 genes associated with WHR after adjustment for BMI and three loci near the CEP120 , TSC22D2 and SLC22A2 genes associated with WC without adjustment for BMI. Functional enrichment analyses revealed enrichment of corticotropin-releasing hormone signaling, GNRH signaling, and/or CDK5 signaling pathways for those newly-identified loci. Our study provides additional insight on genetic contribution to abdominal obesity.

The chimeric peptide M617, galanin(1-13)-Gln^sup 14^-bradykinin(2-9)amide, is a novel galanin receptor ligand with increased subtype specificity for GalR1 and agonistic activity in cultured cells as well as in vivo. Displacement studies on cell membranes expressing hGalR1 or hGalR2 show the presence of a high affinity binding site for M617 on GalR1 (K^sub i^=0.23±.12 nM) while lower affinity was seen towards GalR2 (K^sub i^=5.71±1.28 nM) resulting in 25-fold specificity for GalR1. Activation of GalR1 upon stimulation with M617 is further confirmed by internalization of a GalR1-EGFP conjugate. Intracellular signaling studies show the ability of M617 to inhibit forskolin stimulated cAMP formation with 57% and to produce a 5-fold increase in inositol phosphate (IP) accumulation. Agonistic effects on signal transduction are shown on both receptors studied after treatment with M617 in the presence of galanin. In noradrenergic locus coeruleus neurons, M617 induces an outward current even in the presence of TTX plus Ca^sup 2+^, high Mg^sup 2+^, suggesting a postsynaptic effect. Intracerebroventricular (i.c.v.) administration of M617 dose-dependently stimulates food uptake in rats while, in contrast, M35 completely fails to affect the feeding behavior. Spinal cord flexor reflex is facilitated by intrathecal (i.t.) administration of M617 as well as galanin with no significant change upon pre-treatment with M617. M617 dose dependently antagonizes the spinal cord hyperexcitablility induced by C-fiber conditioning stimulus and does neither enhance nor antagonize the effect of galanin. These data demonstrate a novel galanin receptor ligand with subtype specificity for GalR1 and agonistic activity, both in vitro and in vivo.[PUBLICATION ABSTRACT]

Resident macrophages and infiltrating monocytes in kidneys of patients with lupus nephritis are altered both in frequency and function relative to their counterparts in healthy kidneys. The extent to which mouse models might be useful in developing approaches to target these cells for treating lupus nephritis is poorly understood. Here, we studied four common lupus mouse models that share clinical, serologic, and histopathologic kidney changes with humans. Using single-cell profiling and multiplex spatial imaging to analyze the intrarenal myeloid compartment with the onset of clinical disease in these models, we identified monocyte and macrophage subsets that expand or contract in kidneys with clinical nephritis. A unique subset of classical monocytes expanded with the onset of disease and expressed genes such as CD9, Spp1, Ctsd, Cd63, Apoe, and Trem2 that were previously shown to be induced by tissue injury and play a role in inflammation, lipid metabolism and tissue repair in other organs. Resident macrophages transitioned from a pro-inflammatory to a similar injury-associated state with onset of disease. To test whether these findings in mouse models were also observed in humans, we re-analyzed monocytes and macrophages in a single-cell RNAseq dataset of kidney biopsies from 155 patients with lupus nephritis and 30 healthy donors, collected by the NIH AMP RA/SLE consortium. Human monocytes and macrophages showed conserved changes in gene expression programs associated with lupus nephritis disease indices, and localized to similar kidney microenvironments as in mice. By identifying myeloid subsets and disease-associated alterations in biological processes that are conserved across species, we provide a strong rationale for functional studies of these cells and pathways in mice to uncover mechanisms and find targets relevant to human lupus nephritis. This study characterizes intrarenal myeloid cells from four lupus mouse models and 155 patients with lupus nephritis using single-cell RNA-seq and imaging, and identifies novel infiltrating and resident myeloid subsets that are conserved between mouse and human lupus nephritis, thus providing a map and strong rationale for functional studies in mice with relevance to human disease.