Decision Aids in the ICU: a scoping review

Objective
The purpose of this scoping review was to synthesise the effectiveness and acceptability of decision aids for critically ill patients and family members in the intensive care unit (ICU).

Methods
A systematic search of four electronic databases and grey literature was undertaken to identify relevant studies on the application of decision aids in the ICU, without publication date restriction, through March 2023. The methodological framework proposed by Arksey and O’Malley was used to guide the scoping review.

Results
Fourteen papers were ultimately included in this review. However, only nine decision aids were available, and it is noteworthy that many of these studies focused on the iterative development and testing of individual decision aids. Among the included studies, 92% (n=13) were developed in North America, with a primary focus on goals of care and life-sustaining treatments. The summary of the effect of decision aid application revealed that the most common indicators were the level of knowledge and code status, and some promising signals disappeared in randomised trials.

Conclusions
The complexity of treatment decisions in the ICU exceeds the current capabilities of existing decision aids. There is a clear gap in decision aids that are tailored to different cultural contexts, highlighting the need to expand the scope of their application. In addition, rigorous quality control is very important for randomised controlled trial, and indicators for assessing the effectiveness of decision aids need to be further clarified.

Leggi
Agosto 2023

Effect of price and income on the demand for sugar-sweetened beverages in Nigeria: an analysis of household consumption data using an almost ideal demand system (AIDS)

Objectives
To estimate the own-price, cross-price and income elasticities for carbonated soft drinks (CSDs), malt drinks, chocolate powder, sachet water and sugar in Nigeria. These elasticities can be used to estimate the potential demand response to the recently-introduced sugar tax in Nigeria.

Setting
The study uses household data from the 2018/2019 Nigeria Living Standards Survey (NLSS).

Participants
The NLSS is a national household survey. 21 114 households were included in the final sample for this analysis.

Primary and secondary outcomes
We used Deaton’s almost ideal demand system, which controls for the goods’ quality, to estimate the effect of price and income changes on the demand for CSDs, chocolate powder, malt drinks, sachet water and sugar.

Results
We found that the own-price elasticity (ordered from most to least price-responsive) was –0.99 (p

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Agosto 2023

Risky sexual practice and associated factors among adult people living with HIV/AIDS in public hospitals of Kembata Tambaro Zone, Southern Ethiopia: a cross-sectional study

Objective
This study assessed the magnitude of risky sexual practices and associated factors among adult people living with HIV (PLHIV) attending antiretroviral clinics in public hospitals in Kembata Tembaro Zone, southern Ethiopia.

Design
A cross-sectional study was conducted.

Setting
A hospital-based study was conducted among adult PLHIV in the Kambata Tambaro Zone, southern Ethiopia.

Participants
300 men and women aged 15 years and older who had been receiving HIV/AIDS care and support in four public hospitals participated in this study.

Study outcome
Risky sexual practice was the study outcome. It was defined based on responses to four items: multiple sexual partnerships, casual sex, consistent condom use and sex under the influence of alcohol. Risky sexual practice was defined based on a ‘yes’ response to any of the four items.

Results
Of the adult PLHIV who were sexually active in the 6 months preceding the survey, 75.7% (95% CI: 70.5% to 80.2%) engaged in at least one risky sexual practice, with 3.3% (95% CI: 1.8% to 6.1%) engaged in three or more. A positive attitude towards condom use and being on antiretroviral therapy for over 10 years were correlated with low odds of risky sexual practices. There was a higher likelihood of risky sexual behaviour among those who kept their HIV status secret and did not bring up using a condom before sexual contact. Whereas, those with a positive attitude towards condom use had a reduced risk of engaging in risky sexual practices.

Conclusion
A considerable proportion of adult PLHIV engage in risky sexual practices. Efforts directed at removing barriers to disclosing HIV status to partners and promoting condom use discussion among sexual partners could reduce the burden of risky sexual practices and the onward transmission of HIV.

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Luglio 2023