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"You Must Learn to Age":Reflections on and Adaptations to Age-Related Changes Among Older Artists and Craftspeople
No full textStudies about older people's participation in artistic activities have increased. However, a deeper understanding of older artists' adaptation to the ageing process is still lacking. The purposes of this study were to explore how older artists and craftspeople perceive age-related changes, and to examine their adaptations to these changes. We carried out in-depth, open-ended individual interviews with 30 visual artists and craftspeople aged 60 and older. We found that almost all of them experienced age-related changes in relation to their artistic engagement, which they mainly associated with health-related issues, namely sensory losses and physical changes. In addition, we identified six strategies aimed at adjusting to age-related changes: adapting the work pace, modifying the artistic practice, using technical aids, engaging in artistic collaboration, developing environmental adaptations, and implementing self-care practices. Most participants discussed at least one strategy to adapt to age-related changes, and it was common to combine various strategies. Findings were discussed from a lifespan perspective. Our study expands previous research on experiences of artistic participation among older people, and specifically on their modes of adapting to the ageing process in the context of their artistic practices
A prediction model for electroconvulsive therapy effectiveness in patients with major depressive disorder from the Dutch ECT Consortium (DEC)
No full textReliable predictors for electroconvulsive therapy (ECT) effectiveness would allow a more precise and personalized approach for the treatment of major depressive disorder (MDD). Prediction models were created using a priori selected clinical variables based on previous meta-analyses. Multivariable linear regression analysis was used, applying backwards selection to determine predictor variables while allowing non-linear relations, to develop a prediction model for depression outcome post-ECT (and logistic regression for remission and response as secondary outcome measures). Internal validation and internal-external cross-validation were used to examine overfitting and generalizability of the model's predictive performance. In total, 1892 adult patients with MDD were included from 22 clinical and research cohorts of the twelve sites within the Dutch ECT Consortium. The final primary prediction model showed several factors that significantly predicted a lower depression score post-ECT: higher age, shorter duration of the current depressive episode, severe MDD with psychotic features, lower level of previous antidepressant resistance in the current episode, higher pre-ECT global cognitive functioning, absence of a comorbid personality disorder, and a lower level of failed psychotherapy in the current episode. The optimism-adjusted R² of the final model was 19%. This prediction model based on readily available clinical information can reduce uncertainty of ECT outcomes and hereby inform clinical decision-making, as prompt referral for ECT may be particularly beneficial for individuals with the above-mentioned characteristics. However, despite including a large number of pretreatment factors, a large proportion of the variance in depression outcome post-ECT remained unpredictable
One-minute preceptor model:An ideal teaching tool for nurse preceptors?
No full textBackground: The One-Minute Preceptor model has been widely adopted by nurses. However, there is limited empirical research on its applicability in nursing education. Aims: This study aims to establish an in-depth understanding of how nurses utilize the One-Minute Preceptor model in clinical setting, including its applicability, facilitators, and barriers. Methods: A qualitative descriptive design was employed, with semi-structured interviews conducted with 17 preceptors from a tertiary mental health institution in Singapore. Data was analyzed using direct content analysis. Results: The One-Minute Preceptor model has been widely applied by nurses but often modified to suite the clinical setting. Nurses reported that the model could enhance their teaching abilities, bolster learners’ competencies, and foster a stronger partnership. However, preceptors’ personal preferences, learners’ attitudes, and factors present in the clinical setting might hinder its utilization. Conclusion: This study provides new insight into the utilization of the One-Minute Preceptor model in nursing education. Tailored strategies are necessary to address its challenges in clinical contexts for enhancing better utilization
Adulthood dietary and lifestyle patterns and risk of breast cancer:Global Cancer Update Programme (CUP Global) systematic literature review
No full textBackground: An increasing number of studies in recent years investigate various dietary and lifestyle patterns and associated breast cancer (BC) risk. Objectives: This study aimed to comprehensively synthesize and grade the evidence on dietary and lifestyle patterns and BC risk. Methods: Databases were systematically searched up to 31 March, 2022, for evidence from randomised controlled trials and prospective cohort studies on adherence to a dietary pattern alone or in combination with lifestyle behaviors and incidence of or mortality from primary BC in adult females. Findings in all, premenopausal, and postmenopausal females were descriptively synthesized instead of meta-analyzed due to patterns heterogeneity. An independent Global Cancer Update Programme Expert Panel graded the strength of the evidence. Results: A total of 84 publications were included. Results for patterns reflecting both a healthy diet and lifestyle were more consistent than for patterns that included diet only. There was strong-probable evidence that a priori World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) and American Cancer Society (ACS) dietary and lifestyle scores may reduce BC risk in all and postmenopausal females, whereas in premenopausal females, less evidence was found contributing to limited-suggestive grade. There was also a limited-suggestive evidence that adherence to the Healthy Lifestyle Index and other diet and lifestyle scores may reduce BC risk in postmenopausal females; a posteriori Western/Meat/Alcohol dietary patterns may increase BC risk in postmenopausal females; and Prudent/Vegetarian/Mediterranean dietary patterns may reduce BC risk in all females. For the remaining patterns, evidence was graded as limited-no conclusions. Conclusions: Advice to adopt combined aspects of a healthy diet and lifestyle according to WCRF/AICR and ACS scores, encouraging a healthy weight, physical activity, alcohol and smoking avoidance, and a healthy diet rich in fruits, vegetables, (whole)grains and cereals and discouraging red and processed meat, can be proposed to females to lower BC risk. This review was registered at PROSPERO as ID CRD42021270129 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021270129) on 28 August, 2021, and further updated on 4 May, 2022, in order to extend the search period.</p
Exploring shared clinical features and successful therapeutic interventions in <i>CARD14</i>-associated papulosquamous eruption
No full textThe effect of altered sleep timing on glycaemic outcomes:Systematic review of human intervention studies
No full textAimsAlterations in sleep timing can lead to disturbances in glycaemic control, although the evidence is inconsistent. Therefore, this systematic review summarizes results from human intervention studies of altered sleep timing on glycaemic outcomes.Materials and MethodsAs part of a broader search on the effect of altering timing of sleep, physical activity and dietary intake, Medline and Embase were searched from inception to February 2023, and subsequent reference searches were done. With the help of a machine learning-aided program 'ASReview', we selected any type of intervention study in the general adult population, which acutely delayed sleep by >= 2 h for at least one night, while the total time in bed was the same between early and late sleep. Quality assessment was done using the quality assessment tool for quantitative studies.ResultsIn total, 14 studies (159 adults with normal or increased weight) were identified. Methodological quality was high (n = 4), moderate (n = 7) or low (n = 3). Acute delays of sleep onset showed unfavourable effects in 10 out of 27 measured glycaemic outcomes (one-six studies reported on each outcome) with outcomes mostly measured in the postprandial period, compared to (early) nighttime sleep.ConclusionsAcutely delaying sleep timing might have unfavourable effects on glycaemic outcomes, compared to (early) nighttime sleep. Future research does however need better controlled trials, also measuring and controlling sleep quantity, sleep quality, physical activity and dietary intake, with longer follow-up periods, consistent outcomes and designs and more diverse populations to provide targeted advice regarding the optimal timing for sleep.Protocol registrationThis review is part of a larger search 'The effect of altering timing of physical activity, sleep and energy intake on glycaemia and Type 2 Diabetes risk in humans', of which the protocol was registered in the PROSPERO database on 27 November 2021 under number: CRD42021287828
Can We Better Understand, Diagnose, and Treat Ketamine-Induced Uropathy, and Can It Be Reversed? ICI-RS 2024
No full textIntroduction: Ketamine, a versatile anesthetic, has seen increased recreational use, leading to significant health issues, including ketamine-induced uropathy (KIU). KIU manifests with lower urinary tract symptoms (LUTS) and can involve the upper urinary tract. This study aims to provide a comprehensive overview of KIU, addressing its pathophysiology, diagnostic strategies, and treatment options; and to define/identify future research priorities. Methods: During the 2024 meeting of the International Consultation on Incontinence Research Society (ICI-RS) in Bristol, a dedicated Proposal (P) convened to explore KIU. This initiative involved a thorough review of existing literature, expert presentations, and consensus-driven discussions. The methodology ensured a comprehensive exploration of KIU from both clinical and pre-clinical perspectives, leading to actionable research recommendations. Results: Understanding the mechanisms of KIU is crucial for developing effective treatment options targeting specific pathophysiological pathways. Key findings include bladder fibrosis driven by transforming growth factor-β1 (TGF-β1), elevated purinergic responses and upregulated P2X1 purinoceptor expression, decreased barrier function due to increased expression of antiproliferative factor (APF), and functional loss of the bladder through Cav1.2 channel blockade. Research indicates that fibrosis, typically considered irreversible, may be mitigated. However, the exact timing and extent of fibrosis initiation and its impact on long-term outcomes require further research. LUTS typically improve after ketamine cessation but relapse upon resumption, indicating a hypersensitivity mechanism involving elevated serum IgE levels. Advanced stages of KIU do not always correlate with LUTS severity, shedding light on potential systemic effects and the need for evaluating liver enzymes. Furthermore, psychological dependency on ketamine, due to its positive perceptive and mood-altering effects, complicates cessation efforts. Long-term management requires a holistic approach, integrating medical treatments and supportive measures to help patients navigate life with potentially irreversible complications. Conclusion: This comprehensive review spans from fundamental pathology to practical clinical management, addressing both urological and systemic complications, and bridging insights from animal models to human applications. Developing effective treatment strategies necessitates addressing both the physical and psychological aspects of ketamine dependency.</p
Identification performance across the life span:Lineups and the reaction time-based Concealed Information Test
No full textCognitive and social factors can deteriorate eyewitness identification performance in children and older adults. An identification procedure that mitigates the effect of such factors could be beneficial for child and older adult witnesses. In a field experiment, we mapped identification performance in a large community sample (N = 1239) across the lifespan (ages 6-79 years) for two different identification procedures: classic lineups and reaction time-based Concealed Information Test (RT-CIT). Visitors of a science museum or science fair witnessed a recorded mock theft and then took either a classic lineup, or the RT-CIT. Young adults (18-35-year-olds) outperformed younger and older age groups in lineup performance. The RT-CIT showed a moderate capacity to diagnose face recognition and absence of recognition in the target-absent condition. Age did not affect identification with the RT-CIT. However, children were often not able to follow the RT-CIT instructions, leading to a large number of exclusions. A direct comparison of lineup vs. RT-CIT performance showed that children and adolescents showed better identification performance in RT-CIT than lineups. For young adults, there was no difference between the two procedures. The trend turned around at mid-adult age who showed better identification performance when they were given a lineup compared to an RT-CIT. These findings suggest that the RTCIT might be considered an alternative identification procedure for children and adolescents, offering protection for innocent suspects
Noninfectious Complications of Dorsal Root Ganglion Stimulation:A Systematic Review and Meta-Analysis
No full textINTRODUCTION: Dorsal root ganglion stimulation (DRGS) has emerged as a promising treatment for chronic neuropathic pain. However, its safety and complications are not fully understood, with existing literature primarily based on case reports, observational studies, and data base analyses. This systematic review and meta-analysis aims to assess the prevalence of noninfectious complications associated with DRGS, focusing on the trial phase, postimplantation period, and revisions, while identifying risk factors for these outcomes. MATERIALS AND METHODS: This systematic review adhered to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and was registered in the International Prospective Register of Systematic Reviews database. A comprehensive search was conducted across multiple data bases in June 2023. Studies included randomized and nonrandomized trials, and cohort studies involving =20 patients with DRGS. The exclusion criteria were studies that did not differentiate DRGS-specific complications, focused solely on infections, lacked sufficient data for prevalence estimation, or presented only subanalyses from larger studies. A meta-analysis of proportions was performed to estimate the overall prevalence of complications. RESULTS: Thirteen studies with 634 participants were included. The pooled prevalence of all complications was 37% (95% CI: 19%-57%), with device-related complications being the most common at 27% (95% CI: 15%-42%). Lead fractures and migrations were the most frequently reported device-related complications with, respectively, 6% (95% CI: 2%-12%) and 6% (95% CI: 2%-10%). Procedure-related complications had a pooled prevalence of 1% (95% CI: 0%-5%), with dural puncture being the most common. The prevalence of DRGS explantations was 12%, primarily due to insufficient pain relief. CONCLUSIONS: DRGS shows a safety profile comparable to that of spinal cord stimulation, with similar rates of lead migrations and fractures. Improvements in surgical techniques, technology, and clinician expertise are expected to reduce complications. Future research should standardize reporting practices and detail implantation techniques to better understand and refine best practices in DRGS implantation
On the bright side of blindsight. Considerations from new observations of awareness in a blindsight patient
No full textBlindsight refers to the ability to make accurate visual discriminations without conscious awareness of the stimuli. In this study, we present new evidence from naturalistic observations of a patient with bilateral damage to the striate cortex, who surprisingly demonstrated the ability to detect colored objects, particularly red ones. Despite the slow and effortful process, the patient reported full awareness of the color aspect of the stimuli. These observations cannot be explained by traditional concepts of type 1 or type 2 blindsight, raising intriguing questions about the boundaries between objective and subjective blindness, as well as the nature of visual experience and epistemic agency. Moreover, these findings underscore the significant role that blindsight could play in future research, especially in understanding how higher cortical functions are involved in emotions and feelings. This highlights the necessity for further exploration to better understand the visual features that contribute to the phenomenon of affective blindsight