Updated Systematic Review and Meta-Analysis Delirium Prevalence in Iranian Hospitals’ Patients

Aim: The first systematic review and meta analysis investigating the prevalence of delirium in Iran and the importance of delirium in the health status of patients. Method: This study is a review article to determine the overall prevalence of delirium in patients admitted to the hospitals in Iran, with search time frame to 12 October 2000–12 October 2018. The study examined the prevalence of delirium in general wards and ICUs of Iran according to published article in domestic and foreign journals. The methodological quality of the papers was based on a tool used in previous studies. Data was analyzed using comprehensive meta-analysis (CMA) software. Findings: The findings showed the prevalence of delirium in hospitalized patients in Iran is 21.8% (CI: 17.5–27.5%). The prevalence of delirium in hospitalized patients in Iran based on the hospitalization in ICU is 24.7% (CI: 18.1–32.7%) and in the general ward is 17.5% (CI: 13.6–22.3%). Conclusion: Due to the relatively high prevalence of delirium in patients admitted to hospitals in Iran, prevention is necessary to reduce the incidence of delirium.

Losing a loved one to suicide is an event that can have strong and potentially traumatic impacts on the lives of the bereaved survivors, especially regarding their grief, which can be complicated. These bereaved individuals are also less likely to receive social support following their bereavement. However, besides these adverse impacts, growing evidence supports the concept of posttraumatic growth following suicide bereavement. Posttraumatic growth is the personal improvement that occurs as a consequence of experiencing a traumatic or extremely challenging event or crisis. Only 1 systematic review and meta-analysis on posttraumatic growth following suicide bereavement has been conducted; this protocol is for the planned systematic review and meta-analysis update of the original systematic review and meta-analysis, as the original review collected its data in 2018. This review aims to investigate demographic characteristics, correlational relationships, and facilitative factors of posttraumatic growth in individuals bereaved by suicide. In addition, as this is an update of a previous systematic review and meta-analysis, we aim to compare our findings with the original review and to identify any similarities or differences. This protocol outlines the planned procedures of the updated systematic review and meta-analysis. MEDLINE, PsycINFO, Embase, CINAHL, Scopus, and Web of Science (Core Collection) were examined, and the search results were imported to Covidence, where title and abstract screenings and full-text screenings occurred. The inclusion and exclusion criteria for this updated review match those in the original review: (1) the study population must contain participants bereaved by suicide, (2) the study data must be quantitative, and (3) the study must report data on posttraumatic or stress-related growth. The original review conducted its search before 2019; thus, this updated review searched databases for the timeframe of January 2019 to January 2024. The updated meta-analysis will synthesize data from both the original and updated reviews to examine trends over time. The Newcastle-Ottawa Scale (NOS) will be used to assess publication quality. Random-effects meta-analyses will be conducted using RStudio (R Foundation for Statistical Computing). The review was funded in October 2023 and is currently in progress. Results are expected to be finalized in October 2024. There are 21 articles that have been included in the review and are being analyzed at this time. We aim to submit the full article for publication in December 2024. The results of this updated systematic review and meta-analysis will be used to examine key relationships and findings regarding posttraumatic growth in individuals bereaved by suicide. The discussion will also investigate the findings of this updated review in comparison to the findings of the original review. Any differences would be highlighted. Limitations of the current review will be discussed, such as the quality of the articles included. PROSPERO CRD42024485421; https://tinyurl.com/3hzpnzr3. DERR1-10.2196/64615.

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Global incidence and prevalence of delirium and its risk factors in medically hospitalized older patients: A systematic review and meta-analysis

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Delirium is associated with future dementia progression. Yet whether this occurs subclinically over months and years, or persistent delirium merges into worsened dementia is not understood. Our objective was to estimate the prevalence of persistent delirium and understand variation in its duration. We adopted an identical search strategy to a previous systematic review, only including studies using a recognised diagnostic framework for ascertaining delirium at follow-up (persistent delirium). Studies included hospitalised older patients outside critical and palliative care settings. We searched MEDLINE, EMBASE, PsycINFO and the Cochrane Database of Systematic Reviews on 11th January 2022. We applied risk of bias assessments based on Standards of Reporting of Neurological Disorders criteria and assessed strength of recommendations using the grading of recommendation, assessment, development and evaluation (GRADE) approach. Estimates were pooled across studies using random-effects meta-analysis, and we estimated associations with follow-up duration using robust error meta-regression. We identified 13 new cohorts, which we added to 10 from the previous systematic review (23 relevant studies, with 39 reports of persistent delirium at 7 time-points in 3186 individuals admitted to hospital care (mean age 82 years and 41% dementia prevalence). Studies were mainly at moderate risk of bias. Pooled delirium prevalence estimates at discharge were 36% (95% CI 22% to 51%, 13 studies). Robust error meta-regression did not show variation in prevalence of persistent delirium over time (-1.6% per month, 95% CI -4.8 to 1.6, p=0.08). Margins estimates for this model indicate a prevalence of persistent delirium of 16% (95% CI 6% to 25%) at 12 months. This systematic review emphasises the importance of delirium as a persistent and extensive problem (GRADE certainty = moderate), raising questions on chronic delirium as a clinical entity and how it might evolve into dementia. Addressing persistent delirium will require a whole-system, integrated approach to detect, follow-up and implement opportunities for recovery across all healthcare settings.

36-fold higher estimate of deaths attributable to red meat intake in GBD 2019: is this reliable?

Impact of psychological status on cardiovascular diseases: Is it time for upgrading risk score charts?

Background: Needlestick and sharp injuries have been identified as the most dangerous factor among health-care workers. The Centers for Disease Control and Prevention estimates that 385,000 health-care workers experience needlestick each year. Methods: The aim of this study was to determine the prevalence of needlestick injuries (NSIs) in Iranian health-care workers. In this review and meta-analysis, the local and international databases such as Scopus, Medline, PubMed, ScienceDirect, Web of Science, Google Scholar, Scientific Information Database (SID), and Magiran were searched using keywords including “prevalence” OR “needle” OR “needle stick” OR “Sharp injury” OR “Iranian personnel's” OR “Iranian health care workers” OR “Iranian hospitals” OR “Iran.” The original researches that determined the prevalence of NSIs among Iranian health-care workers and published from January 2005 to June 2019 were included in the current study. The pooled prevalence of NSIs was determined using a random-effects model with a 95% confidence interval. All analyses were performed using STATA version 11 (Stata Corporation, College Station, TX, USA). P

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BackgroundThere are limited data on the clinical benefits of adding surgical resection in patients with recurrent or metastatic gastrointestinal stromal tumors (GISTs). This protocol outlines the planned scope and methods for a systematic review and meta-analysis update that will compare the clinical outcomes of surgical resection combined with tyrosine kinase inhibitor (TKI) with TKI treatment alone in patients with recurrent or metastatic GISTs.MethodsThis review will update a previously published systematic review by our team. This protocol is presented in accordance with the PRISMA-P guideline. PubMed, Embase, and Cochrane Central Register of Controlled Trials will be systematically searched and supplemented by a secondary screening of the references of all included studies. We will include randomized controlled trials (RCTs) and non-randomized studies (NRS) in this review update. The outcomes evaluated will be overall survival and progression-free survival. Two reviewers will independently screen and select studies, extract data from the included studies, and assess the risk of bias of the included studies. Data extracted from RCTs and NRS will be analysed and reported separately. Preplanned subgroup analyses and sensitivity analyses are detailed within this protocol. The strength of the body of evidence will be assessed using GRADE.DiscussionThis systematic review and meta-analysis update will provide a current assessment of the evidence for the role of surgery in patients with recurrent or metastatic advanced GISTs. These findings will be used by the Chinese Society of Clinical Oncology (CSCO) GIST guideline recommendations on surgical treatment for recurrent or metastatic advanced GIST patients in China.Systematic review registrationThis protocol was prospectively registered in the Open Science Framework Registry (https://osf.io/xus7m).

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WITHDRAWN: Evidence Synthesis to Advance Clinical Practice and Scientific Research: A CGH Pillar

Background Delirium, an acute encephalopathy characterized by acute onset, fluctuation, and attention deficits, is associated with increased mortality and morbidity, and with precipitation or worsening of dementia. Thus, delirium prevention, timely detection, and appropriate management are crucial. Methods On World Delirium Awareness Day (15th March 2023), a global survey was assessed delirium prevalence and care. A senior clinical staff member on each participating ward reported on delirium prevalence at 8AM and 8PM, and on usual ward practice; data was entered into an online survey by a data collector (typically an on-site clinician, visiting several wards to record data). This study reports data from Irish hospitals. Results In total, 132 wards from 15 hospitals across Ireland participated. Delirium prevalence, using a formal assessment tool, was 15.9% across all wards, highest in geriatric wards (20.5%). However, on wards where 'personal judgment' to detect delirium was utilized, the prevalence rate was 11.5%, implying that delirium may be missed on these wards. Intensive care units (76.2%), geriatric wards (70%), and Emergency Departments/Acute Medical Units (ED/AMUA; 66.7%) had the highest rate of written delirium protocols. Similarly, staff training (51.5% overall), was highest in ED/AMAU (88.9%), followed by general surgical (66.7%), and geriatrics wards (60%). In contrast, only 30.8% (4/13) of non-acute wards had provided staff with delirium training in the preceding year. Having at least one training session in the preceding year was associated with higher use of formal delirium tools (18.8% versus 60.3%). Wards reported staff training/educating as the main care improvement priority; 72.7% of wards identified lack of time to train staff as a key barrier. Conclusion Delirium is prevalent in Irish hospitals and appears under-detected without formal screening. Training staff in delirium-related skills, including the use of simple screening tools for delirium detection and causation, could be paramount to improving patient outcomes.