Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: a mixed methods systematic review

Background Evidence from disease epidemics shows that healthcare workers are at risk of developing short‐ and long‐term mental health problems. The World Health Organization (WHO) has warned about the potential negative impact of the COVID‐19 crisis on the mental well‐being of health and social care professionals. Symptoms of mental health problems commonly include depression, anxiety, stress, and additional cognitive and social problems; these can impact on function in the workplace. The mental health and resilience (ability to cope with the negative effects of stress) of frontline health and social care professionals ('frontline workers' in this review) could be supported during disease epidemics by workplace interventions, interventions to support basic daily needs, psychological support interventions, pharmacological interventions, or a combination of any or all of these. Objectives Objective 1: to assess the effects of interventions aimed at supporting the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic. Objective 2: to identify barriers and facilitators that may impact on the implementation of interventions aimed at supporting the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic. Search methods On 28 May 2020 we searched the Cochrane Database of Systematic Reviews, CENTRAL, MEDLINE, Embase, Web of Science, PsycINFO, CINAHL, Global Index Medicus databases and WHO Institutional Repository for Information Sharing. We also searched ongoing trials registers and Google Scholar. We ran all searches from the year 2002 onwards, with no language restrictions. Selection criteria We included studies in which participants were health and social care professionals working at the front line during infectious disease outbreaks, categorised as epidemics or pandemics by WHO, from 2002 onwards. For objective 1 we included quantitative evidence from randomised trials, non‐randomised trials, controlled before‐after studies and interrupted time series studies, which investigated the effect of any intervention to support mental health or resilience, compared to no intervention, standard care, placebo or attention control intervention, or other active interventions. For objective 2 we included qualitative evidence from studies that described barriers and facilitators to the implementation of interventions. Outcomes critical to this review were general mental health and resilience. Additional outcomes included psychological symptoms of anxiety, depression or stress; burnout; other mental health disorders; workplace staffing; and adverse events arising from interventions. Data collection and analysis Pairs of review authors independently applied selection criteria to abstracts and full papers, with disagreements resolved through discussion. One review author systematically extracted data, cross‐checked by a second review author. For objective 1, we assessed risk of bias of studies of effectiveness using the Cochrane 'Risk of bias' tool. For objective 2, we assessed methodological limitations using either the CASP (Critical Appraisal Skills Programme) qualitative study tool, for qualitative studies, or WEIRD (Ways of Evaluating Important and Relevant Data) tool, for descriptive studies. We planned meta‐analyses of pairwise comparisons for outcomes if direct evidence were available. Two review authors extracted evidence relating to barriers and facilitators to implementation, organised these around the domains of the Consolidated Framework of Implementation Research, and used the GRADE‐CERQual approach to assess confidence in each finding. We planned to produce an overarching synthesis, bringing quantitative and qualitative findings together. Main results We included 16 studies that reported implementation of an intervention aimed at supporting the resilience or mental health of frontline workers during disease outbreaks (severe acute respiratory syndrome (SARS): 2; Ebola: 9; Middle East respiratory syndrome (MERS): 1; COVID‐19: 4). Interventions studied included workplace interventions, such as training, structure and communication (6 studies); psychological support interventions, such as counselling and psychology services (8 studies); and multifaceted interventions (2 studies). Objective 1: a mixed‐methods study that incorporated a cluster‐randomised trial, investigating the effect of a work‐based intervention, provided very low‐certainty evidence about the effect of training frontline healthcare workers to deliver psychological first aid on a measure of burnout. Objective 2: we included all 16 studies in our qualitative evidence synthesis; we classified seven as qualitative and nine as descriptive studies. We identified 17 key findings from multiple barriers and facilitators reported in studies. We did not have high confidence in any of the findings; we had moderate confidence in six findings and low to very low confidence in 11 findings. We are moderately confident that the following two factors were barriers to intervention implementation: frontline workers, or the organisations in which they worked, not being fully aware of what they needed to support their mental well‐being; and a lack of equipment, staff time or skills needed for an intervention. We are moderately confident that the following three factors were facilitators of intervention implementation: interventions that could be adapted for local needs; having effective communication, both formally and socially; and having positive, safe and supportive learning environments for frontline workers. We are moderately confident that the knowledge or beliefs, or both, that people have about an intervention can act as either barriers or facilitators to implementation of the intervention. Authors' conclusions There is a lack of both quantitative and qualitative evidence from studies carried out during or after disease epidemics and pandemics that can inform the selection of interventions that are beneficial to the resilience and mental health of frontline workers. Alternative sources of evidence (e.g. from other healthcare crises, and general evidence about interventions that support mental well‐being) could therefore be used to inform decision making. When selecting interventions aimed at supporting frontline workers' mental health, organisational, social, personal, and psychological factors may all be important. Research to determine the effectiveness of interventions is a high priority. The COVID‐19 pandemic provides unique opportunities for robust evaluation of interventions. Future studies must be developed with appropriately rigorous planning, including development, peer review and transparent reporting of research protocols, following guidance and standards for best practice, and with appropriate length of follow‐up. Factors that may act as barriers and facilitators to implementation of interventions should be considered during the planning of future research and when selecting interventions to deliver within local settings

Palliative care after stroke: A review.

BACKGROUND: Palliative care is an integral aspect of stroke unit care. In 2016, the American Stroke Association published a policy statement on palliative care and stroke. Since then there has been an expansion in the literature on palliative care and stroke. AIM: Our aim was to narratively review research on palliative care and stroke, published since 2015. RESULTS: The literature fell into three broad categories: (a) scope and scale of palliative care needs, (b) organization of palliative care for stroke, and (c) shared decision making. Most literature was observational. There was a lack of evidence about interventions that address specific palliative symptoms or improve shared decision making. Racial disparities exist in access to palliative care after stroke. There was a dearth of literature from low- and middle-income countries. CONCLUSION: We recommend further research, especially in low- and middle-income countries, including research to explore why racial disparities in access to palliative care exist. Randomized trials are needed to address specific palliative care needs after stroke and to understand how best to facilitate shared decision making

Clinical Study Limited Effects of Endurance or Interval Training on Visceral Adipose Tissue and Systemic Inflammation in Sedentary Middle-Aged Men

properly cited. Purpose. Limited data exists for the effects of sprint-interval training (SIT) and endurance training (ET) on total body composition, abdominal visceral adipose tissue, and plasma inflammation. Moreover, whether "active" or "passive" recovery in SIT provides a differential effect on these measures remains uncertain. Methods. Sedentary middle-aged men ( = 62; 49.5±5.8 y; 29.7±3.7 kg⋅m 2 ) underwent abdominal computed tomography, dual-energy X-ray absorptiometry, venepuncture, and exercise testing before and after the interventions, which included the following: 12 wks 3 d⋅wk −1 ET ( = 15; 50-60 min cycling; 80% HR max ), SIT (4-10 × 30 s sprint efforts) with passive (P-SIT; = 15) or active recovery (A-SIT; = 15); or nonexercise control condition (CON; = 14). Changes in cardiorespiratory fitness, whole-body and visceral fat mass, and plasma systemic inflammation were examined. Results. Compared to CON, significant increases in interpolated power output (P-SIT, < 0.001; ET, = 0.012; A-SIT, = 0.041) and test duration (P-SIT, = 0.001; ET, = 0.012; A-SIT, = 0.046) occurred after training. Final VO 2 consumption was increased after P-SIT only ( < 0.001). Despite >90% exercise compliance, there was no change in whole-body or visceral fat mass or plasma inflammation ( > 0.05). Conclusion. In sedentary middle-aged men, SIT was a time-effective alternative to ET in facilitating conditioning responses yet was ineffective in altering body composition and plasma inflammation, and compared to passive recovery, evidenced diminished conditioning responses when employing active recovery

Systematic review: Pharmacological interventions for the treatment of post-stroke fatigue

Background: Post-stroke fatigue (PSF) affects around 50% of stroke survivors. Previous systematic reviews of randomized controlled trials found insufficient evidence to guide practice, but most excluded Chinese studies. Furthermore, their searches are now out-of-date. Aims: To systematically review and perform a meta-analysis of randomized placebo-controlled trials of pharmacological interventions for treating PSF. Methods: We screened Airitri, CNKI, VIP, CINAHL, ClinicalTrials.gov, CENTRAL, Cochrane Stroke Group Trial Register, EMBASE, EU Clinical Trial Register, ISRCTN, MEDLINE, PsycINFO, Wanfang, and WHO ICTRP up to 11 November 2022. Our primary outcome was fatigue severity. We conducted subgroup analysis by drug type and sensitivity analysis after excluding the trials at high risk of bias. Secondary outcomes included mood and quality of life. Results: We screened 33,297 citations and identified 10 published completed trials, 6 unpublished completed trials, and 6 ongoing trials. Pharmacological treatments were associated with lower fatigue severity at the end of treatment (10 published completed trials, 600 participants, pooled standardized mean difference (SMD) = −0.80, 95% confidence interval (CI): −1.29 to −0.31; I2 = 86%, p < 0.00001), but not at follow-up (265 participants, pooled SMD = −0.14, 95% CI: −0.38 to 0.10; I2 = 0, p = 0.51). However, these trials were small and had considerable risk of bias. Beneficial effects were seen in trials with low risk of bias on randomization, missing outcome data, and reporting bias. There were insufficient data on secondary outcomes for meta-analysis, but six trials reported improved quality of life. Conclusion: There is insufficient evidence to support a particular pharmacological treatment for PSF, thus current clinical guidelines do not require amendment

Clinical care of pregnant and postpartum women with COVID-19: Living recommendations from the National COVID-19 Clinical Evidence Taskforce

To date, 18 living recommendations for the clinical care of pregnant and postpartum women with COVID-19 have been issued by the National COVID-19 Clinical Evidence Taskforce. This includes recommendations on mode of birth, delayed umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, antenatal corticosteroids, angiotensin-converting enzyme inhibitors, disease-modifying treatments (including dexamethasone, remdesivir and hydroxychloroquine), venous thromboembolism prophylaxis and advanced respiratory support interventions (prone positioning and extracorporeal membrane oxygenation). Through continuous evidence surveillance, these living recommendations are updated in near real-time to ensure clinicians in Australia have reliable, evidence-based guidelines for clinical decision-making. Please visit https://covid19evidence.net.au/ for the latest recommendation updates

Search strategy for retrieval of references on stroke healthcare in MEDLINE Ovid

Constructed using the MEDLINE Ovid platform between January and May 2020, this search strategy is designed to retrieve all potential references in stroke healthcare and medicine (including transient ischaemic attack, cerebral small vessel disease, and subarachnoid haemorrhage) on in the MEDLINE database on the Ovid platform. The search strategy contains 16 separate search lines and incorporates a combination of Medical Subject Headings (MeSH) from the National Library of Medicine, uncontrolled vocabulary/keywords in the Text Word (.tw) field, and Boolean operators to maximise sensitivity and recall. The Text Word in the MEDLINE Ovid field includes both the Title (.ti) and Abstract (.ab) fields. This strategy can be used as a stand-alone search strategy or combined with additional subject specific strategies or filters.Cheyne, JD. (2020). Search strategy for retrieval of references on stroke healthcare in MEDLINE Ovid, [text]. University of Edinburgh. College of Medicine and Veterinary Medicine. Cochrane Stroke Group. https://doi.org/10.7488/ds/2862

Search strategies for retrieval of references for effective interventions to support the resilience and mental health of frontline health and social care staff during a global health crisis and following de-escalation

These searches were designed constructed between April and May 2020 to support a series of evidence reviews designed to retrieve all potential references for interventions or management strategies to support the resilience and mental health of frontline health and social care staff during a global health crisis and following de-escalation. This series of evidence reviews aim to answer the following questions: 1. What research evidence is there relating to the resilience and mental health of health and social care professionals during, and after, a disease outbreak, epidemic or pandemic? (Stage 1. Scoping review); 2. What are the most effective interventions to support the resilience and mental health of these health and social care professionals, during, and after, a disease outbreak, epidemic or pandemic? (Stage 2a. Cochrane systematic review of evidence of effectiveness); and 3. What are the barriers and facilitators that may impact on the implementation of effective interventions to support the resilience and mental health of these health and social care professionals, during, and after, a disease outbreak, epidemic or pandemic? (Stage 2b. Systematic review of factors affecting implementation). The protocol search strategy was designed for MEDLINE Ovid, and adapted for use in the Cochrane Database of Systematic Reviews (CDSR) and Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, Embase Ovid, Web of Science Indexes, PsycINFO Ovid, CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature), Global Index Medicus databases, the WHO Library Database (WHO IRIS) (Institutional Repository for Information Sharing), US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and Google Scholar using the 2dSearch interface. Each search strategy contains separate search lines and incorporates a combination of uncontrolled vocabulary/keywords and controlled vocabulary terms for (a) resilience and mental health interventions, (b) health and social care personnel, and (c) pandemics, epidemics and health outbreaks. Boolean operators and proximity operators were used to maximise sensitivity and recall where available. Publication date were restricted to publication from 2002 onwards using date limiter functions.Cheyne, JD. (2020). Search strategies for retrieval of references for effective interventions to support the resilience and mental health of frontline health and social care staff during a global health crisis and following de-escalation, [dataset]. University of Edinburgh. College of Medicine and Veterinary Medicine. Cochrane Stroke Group. https://doi.org/10.7488/ds/2947

Limited effects of endurance or interval training on visceral adipose tissue and systemic inflammation in sedentary middle-aged men

Purpose. Limited data exists for the effects of sprint-interval training (SIT) and endurance training (ET) on total body composition, abdominal visceral adipose tissue, and plasma inflammation. Moreover, whether “active” or “passive” recovery in SIT provides a differential effect on these measures remains uncertain. Methods. Sedentary middle-aged men (n = 62; 49.5 ± 5.8 y; 29.7 ± 3.7 kg·m2) underwent abdominal computed tomography, dual-energy X-ray absorptiometry, venepuncture, and exercise testing before and after the interventions, which included the following: 12 wks 3 d·wk−1 ET (n = 15; 50–60 min cycling; 80% HRmax), SIT (4–10 × 30 s sprint efforts) with passive (P-SIT; n = 15) or active recovery (A-SIT; n = 15); or nonexercise control condition (CON; n = 14). Changes in cardiorespiratory fitness, whole-body and visceral fat mass, and plasma systemic inflammation were examined. Results. Compared to CON, significant increases in interpolated power output (P-SIT, P 90% exercise compliance, there was no change in whole-body or visceral fat mass or plasma inflammation (P > 0.05). Conclusion. In sedentary middle-aged men, SIT was a time-effective alternative to ET in facilitating conditioning responses yet was ineffective in altering body composition and plasma inflammation, and compared to passive recovery, evidenced diminished conditioning responses when employing active recovery

Search strategies for retrieval of references to support a rapid literature review of health inequalities in stroke commissioned by the Stroke Association

Stroke association MEDLINEv2.1 Joshua David Cheyne (JDC), Ramona Naicker (RN), and Verity Longley (VL) editions. This collection of search strategies was designed and constructed to support a rapid literature review on health inequalities in stroke commissioned by the Stroke Association, and to identify the knowns and unknowns about health inequalities in stroke care across the stroke pathway - from prevention, through treatment, to rehabilitation and long-term-care, as well as end-of-life. The protocol search strategy was designed for MEDLINE Ovid in December 2021 and January 2022, and adapted for use in the Cochrane Database of Systematic Reviews (CDSR) and Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, Embase Ovid, PsycINFO Ovid, and CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature). The protocol search was designed and constructed using the MEDLINE Ovid platform and contains 38 separate search lines and incorporates a combination of Medical Subject Headings (MeSH) from the National Library of Medicine, uncontrolled vocabulary/keywords in the Text Word (.tw) index field, and Boolean operators and proximity operators were used to maximise sensitivity and recall where available. The Text Word in the MEDLINE Ovid field includes both the Title (.ti) and Abstract (.ab) index fields. This high sensitivity search strategy consists of stroke healthcare and medicine terms (including transient ischaemic attack, cerebral small vessel disease, and subarachnoid haemorrhage), health inequalities and inequities terms and separate search lines for minority groups (lines 1-9, 10-18, and 19-34). Publication date were restricted to publication from 2009 onwards using date limiter functions. The health inequalities terms are based on the following four lenses: 1. Socio-economic status and deprivation, for example unemployed, low income, people living in deprived areas (issues such as poor housing, poor education and/or unemployment). 2. Protected characteristics, including age, sex, race, sexual orientation, disability. 3. Vulnerable groups of society, or “inclusion health” groups such as migrants, asylum seekers, Gypsy, Roma and traveller communities, rough sleepers and homeless people, sex workers, prisoners. 4. Geography–whether urban, rural or coastal. The search strategies for MEDLINE Ovid, Embase Ovid, and CENTRAL/ CDSR in The Cochrane Library were written and adapted by JDC. CINAHL and APA PsycINFO search strategies were written and adapted by RN

Moderate continuous- and high-intensity interval training elicit comparable cardiovascular effect among middle-aged men regardless of recovery mode

To assess the effect of active and passive intra-interval recovery modes in time-efficient high-intensity interval training (HIT) on cardiorespiratory fitness, autonomic function, and endothelial function in sedentary middle-aged men. Participants (n = 62; age: 49.5 ± 5.8 y; BMI: 29.7 ± 3.7 kg·m−2) completed the assessments of cardiorespiratory fitness, flow-mediated dilation (FMD) and heart rate variability before being randomly allocated to control (CON; n = 14), moderate intensity continuous training (MICT; n = 15), HIT with passive (P-HIT; n-15), or active recovery (A-HIT; n = 15). Participants performed thrice weekly exercise sessions for 12 weeks. MICT completed 50–60 min of continuous cycling at 60–70% heart rate (HR) maximum. HIT completed 30-s work intervals (∼85% HR) interspaced with 2.5 min of active or passive recovery. All exercise modalities increased oxygen uptake (V̇O2) (MD: ≥ 3.1 ml·kg−1·min−1, 95%CI: 1.5–4.7 ml·kg−1·min−1; P < 0.001), power output (MD: ≥ 26 W, 95%CI: 15–37 W; P < 0.001) and cycle duration (MD: ≥ 62 s, 95%CI: 36–88 s; P < 0.001) at 85% HRM. Significant pre-to-post differences were observed among all exercise groups for FMD (MD: ≥ 3.4%, 95%CI: 0.3–6.5%; P < 0.05), while MICT and P-HIT significantly increased the standard deviation of all NN intervals (SDNN) pre-to-post intervention (MD: ≥ 7 ms, 2–13 ms; P ≤ 0.05). Time-efficient HIT elicits significant improvements in cardiorespiratory fitness, FMD and autonomic modulation following a thrice weekly 12-week exercise intervention among sedentary middle-aged men. Active recovery between successive high-intensity intervals provided no additional benefit among this deconditioned cohort.</p