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AIM: To synthesize evidence regarding the effectiveness of technology-based psychosocial interventions in improving health-related outcomes among family caregivers of stroke survivors. DESIGN: A systematic review and meta-analysis was reported by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS: Randomized controlled trials that investigated the effects of psychosocial interventions delivered through information and communication technologies on self-efficacy, caregiving competence, caregiver burden, perceived social support, anxiety, depression, health-related quality of life and cost-effectiveness were included. Two researchers independently selected studies, extracted data, and appraised the quality of the included studies. Subgroup analysis, sensitivity analysis, and narrative synthesis were conducted. DATA SOURCES: Ten electronic databases (PubMed, CENTRAL, Web of Science, Scopus, CINHAL, Embase, Institution of Electrical Engineers Xplore, Ovid Medline, PsycINFO, ProQuest Dissertations and Thesis) were searched up to February 2023. RESULTS: Nineteen studies involving 1717 participants fulfilled the eligibility criteria. Technology-based psychosocial interventions significantly improved self-efficacy (SMD = .62), caregiving competence (SMD = .55), depression (SMD = -.25) and anxiety (SMD = -.35). However, perceived social support, caregiver burden, and health-related quality of life did not show significant improvements. Subgroup analyses revealed that the interventions, lasting from 4 to 6 weeks and encompassing comprehensive contents, exhibited larger effect sizes. None of the studies measured cost-effectiveness. CONCLUSION: The technology-based psychosocial interventions are effective in enhancing self-efficacy and caregiving competence, as well as alleviating anxiety, and depression among family caregivers of stroke survivors. Future research should investigate interventions delivered through various digital platforms using well-designed RCTs with in-depth qualitative data collection and measurement of health and cost-effectiveness outcomes. IMPACT: Through psychosocial interventions, healthcare providers in clinical and community settings, particularly nurses, could incorporate technologies into current stroke care practices. PATIENT OR PUBLIC CONTRIBUTION: It is not applicable as this is a systematic review. REGISTRATION: The protocol was registered on PROSPERO (CRD42023402871).

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INTRODUCTION: Nurses, assuming a wide range of clinical and patient care responsibilities in a healthcare team, are highly susceptible to direct and indirect exposure to traumatic experiences. However, literature has shown that nurses with certain traits developed a new sense of personal strength in the face of adversity, known as post-traumatic growth (PTG). This review aimed to synthesize the best available evidence to evaluate personal and work-related factors associated with PTG among nurses. DESIGN: Mixed studies systematic review. METHODS: Studies examining factors influencing PTG on certified nurses from all healthcare facilities were included. Published and unpublished studies were identified by searching 12 databases from their inception until 4th February 2023. Two reviewers independently screened, appraised, piloted a data collection form, and extracted relevant data. Meta-summary, meta-synthesis, meta-analysis, as well as subgroup and sensitivity analyses were performed. Integration of results followed result-based convergent design. RESULTS: A total of 98 studies with 29,706 nurses from 18 countries were included. These included 49 quantitative, 42 qualitative, and seven mixed-methods studies. Forty-six influencing factors were meta-analyzed, whereas nine facilitating factors were meta-summarized. A PTG conceptual map was created. Four constructs emerged from the integration synthesis: (a) personal system, (b) work-related system, (c) event-related factors, and (d) cognitive transformation. CONCLUSION: The review findings highlighted areas healthcare organizations could do to facilitate PTG in nurses. Practical implications include developing intervention programs based on PTG facilitators. Further research should examine the trend of PTG and its dynamic response to different nursing factors. CLINICAL RELEVANCE: Research on trauma-focused therapies targeting nurses' mental health is lacking. Therefore, findings from this review could inform healthcare organizations on the PTG phenomenon and developing support measures for nurses through healthcare policies and clinical practice.

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OBJECTIVE: Technology-based psychosocial interventions (TBPIs) have increasingly gained intention. However, the effectiveness of TBPIs on psychological outcomes remains inconclusive. This review aimed to evaluate the effectiveness of TBPIs on health-related quality of life (HRQOL), coping, self-efficacy, and depression among adult cancer patients and caregivers. DATA SOURCES: Randomised controlled trials (RCTs) evaluating the effectiveness of TBPIs targeting adult cancer patients, caregivers, or patient-caregiver dyads were included. English articles dated from 2012 to 2022 were retrieved from eight electronic databases, three clinical trial registries, and six grey literature databases. Two reviewers independently screened, appraised, and extracted data. The Cochrane risk of bias assessment tool and GRADE were used to appraise the methodological quality of included studies. Meta-analyses and subgroup analyses were undertaken with statistical pooling of standardized mean differences based on the random-effects model. CONCLUSION: Totally, 37 RCTs were included in the review, with 35 trials for meta-analysis. Results demonstrated improvements in HRQOL, self-efficacy, and depression among cancer patients and caregivers with varying pooled effect sizes. Subgroup analyses suggested that dyadic TBPIs were more effective in improving HRQOL among cancer patients and caregivers, compared with those solely targeted at cancer patients or caregivers. IMPLICATION FOR NURSING PRACTICE: Findings value-added to the existing evidence base on TBPIs. An interactive patient-caregiver dyadic program integrating TBPIs into routine oncology care is recommended to improve health outcomes for cancer patients and caregivers. Well-designed future RCTs are required to further evaluate the effectiveness of dyadic TBPIs, with emphasis on coping and self-efficacy outcomes among cancer patients and caregivers.

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OBJECTIVE: This review will systematically examine and synthesize existing evidence of the effectiveness of ergonomic interventions in preventing work-related musculoskeletal disorders in agricultural workers. INTRODUCTION: Agricultural workers are at particular risk of developing musculoskeletal disorders due to the nature of their activities and work conditions. Ergonomic interventions designed to prevent work-related musculoskeletal disorders among agricultural workers can benefit their health and productivity. INCLUSION CRITERIA: The review will consider quantitative study designs. These studies should be about agricultural workers who were involved in occupational situations that might contribute to musculoskeletal disorders. METHODS: The databases including PubMed, CINAHL, Cochrane Central Register of Controlled Trials, Scopus and grey literature will be searched to identify published and unpublished studies reported in English and other languages from 1991 onwards. At least two independent reviewers will screen titles and abstracts and assess the selected full texts against certain inclusion criteria. The identified studies will be assessed for methodological quality using JBI critical appraisal instruments. Data will be extracted, and the effectiveness of the interventions will be determined. Where possible, data will be pooled in a meta-analysis. Data from heterogeneous studies will be reported narratively. The GRADE approach will be used to assess the quality of evidence. Systematic review registration number: PROSPERO CRD42022321098.

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OBJECTIVE: To evaluate the effectiveness of a therapeutic robot, 'Paro', on anxiety, agitation, depression, apathy, medication use, total sleep time, and sociability among older adults with dementia. DESIGN: Systematic review and meta-analysis with narrative synthesis. SETTING AND PARTICIPANTS: Older adults aged 60 years and above with any form of dementia in the community, nursing homes, or care facilities. METHODS: A three-step search strategy was conducted by two independent reviewers. Nine databases were searched (January 2003 to November 2022). Randomised controlled, crossover, and cluster trials on Paro for older adults with dementia published in English were included. All relevant trials were screened and assessed for risk of bias. Data were extracted using the Cochrane data collection form. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence. RESULTS: In total, 12 articles involving 1461 participants were included. Results of the meta-analysis showed that Paro had a moderate effect on medication use (SMD: -0.63) and small effect on anxiety (SMD: -0.17), agitation (SMD: -0.27) and depression (SMD: -0.40). However, Paro exhibited negligible effect on total sleep time (SMD: -0.12). The overall quality of evidence for all outcomes were graded as low due to methodological limitations, small sample size, and wide confidence intervals. Narrative synthesis suggested that Paro reduced apathy and increase sociability. CONCLUSION AND IMPLICATIONS: Paro could be a beneficial non-pharmacological approach to improve behavioural and psychological symptoms of dementia, reducing medication use, and increasing sociability for older adults with dementia. However, the results should be interpreted with caution as limited studies were available. Additionally, there were a variety of approaches across the studies (i.e. group and individual interventions, facilitated and non-facilitated) which made it difficult to determine which interventional approach is optimal to produce beneficial effects of Paro. Hence, more rigorous studies with a larger sample size are needed to fully understand the mechanism and effectiveness of Paro in older adults with dementia. The protocol was registered on PROSPERO (CRD42022296504).

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AIMS: To evaluate the effectiveness of mindfulness-based interventions (MBIs) on mental and cognitive outcomes including, anxiety, depression, attention, memory, global cognition and neuroplastic changes in older adults with mild cognitive impairment (MCI). DESIGN: Systematic review and meta-analysis. DATA SOURCE: A three-step search strategy was conducted on eight electronic databases, grey literature and reference lists from inception to February 2022. REVIEW METHODS: Randomized controlled trials (RCTs) examining MBIs on older adults with MCI were screened and assessed for risk of bias using the Cochrane Risk of Bias Tool. Meta-analysis was conducted using RevMan using a random-effect model. Narrative synthesis was performed for studies where results could not be pooled statistically. RESULTS: Ten RCTs were included in the review. Results suggested that right frontal parietal and left inferior temporal gyrus of the brain showed increased cortical thickness after receiving MBIs. There were significant interaction effects for global efficiency and significant interactions in the insular and gyrus regions. Functional connectivity between the posterior cingulate cortex, bilateral medial prefrontal cortex and left hippocampus were increased in participants undergoing MBIs. Nevertheless, meta-analysis showed non-significant pooled effects, favouring control groups on anxiety, depression, attention, memory and global cognition. CONCLUSION: This review suggested the potential effects of MBIs in improving cortical thickness and connectivity in regions associated with memory and attention. Nevertheless, the effects of MBIs compared to active control groups on depression, anxiety, attention, memory and global cognition are inconclusive due to the lack of studies and non-significant results. IMPACT: The review advocates for more rigorous studies with larger sample size and utilizing wait-list controls to evaluate the effects of MBIs. MBIs can be considered as an adjunct with other therapies to further enhance the effect on psychological and cognitive outcomes for older adults with MCI. No Patient or Public Contribution as this is a meta-analysis.

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OBJECTIVES: This review evaluated the best available evidence concerning the effectiveness of photobiomodulation compared to oral cryotherapy in oral-mucositis prevention among patients with hematological stem cell transplantation (HSCT) receiving chemo-conditioning. DATA SOURCES: An extensive search for published and unpublished studies was conducted in 11 electronic databases and reference lists. Only randomized controlled trials (RCTs) were included. Two reviewers independently screened relevant studies for eligibility, extracted data using a standardized data collection form, and appraised data using the Cochrane Risk of Bias Tool and Grading Recommendations, Assessment, Development and Evaluation (GRADE). Meta-analyses using a random-effect model was performed using Review Manager software. Subgroup analyses were conducted to examine the differential effect of interventions across subgroups and to explore potential sources of heterogeneity. Meta-analyses included 18 RCTs (involving 1,018 patients). Both photobiomodulation and cryotherapy were effective in reducing oral-mucositis severity, severe oral-mucositis incidence, duration, and pain with small to large effect sizes. No significant differences were detected between photobiomodulation and cryotherapy across all outcomes. Subgroup analyses showed significant differences for chemo-conditioning regimens. The overall Grading Recommendations, Assessment, Development and Evaluation quality of evidence was low. CONCLUSION: Both photobiomodulation and cryotherapy were effective nonpharmacological oral-mucositis prophylaxis and analgesia, with no significant difference in effectiveness. Chemo-conditioning regimens may influence their effectiveness. Future RCTs may directly compare the effectiveness of photobiomodulation and cryotherapy on the HSCT patients. Rigorous cost-effectiveness studies are also required. IMPLICATIONS FOR NURSING PRACTICE: Photobiomodulation and cryotherapy can be offered to HSCT patients in clinical settings. A clinical guideline of both interventions can be also developed.

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BACKGROUND: Psychological well-being (PWB) is a significant indicator of positive psychology. Thus far, the predictors of PWB are not well-understood among university students in Asian countries. PURPOSE: This study aimed to investigate the relationships between PWB and its predictors (stress, resilience, mindfulness, self-efficacy, and social support) in Thai and Singaporean undergraduates. Stress is perceived to have a negative influence on PWB, but mindfulness, resilience, self-efficacy, and social support indicate positive influences. METHODS: A cross-sectional descriptive predictive research design was used with 966 Thai and 696 Singaporean university students. After calculating an adequate sample size and performing convenience sampling, we administered the following six standard scales: the Perceived Stress Scale, the Connor-Davidson Resilience Scale, the Mindfulness Awareness Scale, the General Self-Efficacy Scale, the Multi-dimensional Scale of Perceived Social Support, and the Psychological Well-being Scale, along with a demographic questionnaire. Descriptive statistics, correlation analysis, and structural equation modeling were performed for participants' PWB. RESULTS: Mindfulness had significant effects on both factors of PWB, including autonomy and growth, and cognitive triad, across two samples. In the Thai sample, resilience most strongly predicted autonomy and growth and perceived stress did so the cognitive triad, whereas in the Singaporean sample, perceived control most strongly predicted autonomy and growth and support from friends did so the cognitive triad. CONCLUSION: These findings provide specific knowledge towards enhancing psychosocial interventions and promoting PWB to strengthen mindfulness, resilience, perceived control of stress, and social support.

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BACKGROUND: Mental health has become an increasingly significant issue in the workplace. Non-health care workers are experiencing increased levels of psychological symptoms in their workplaces, especially during the COVID-19 pandemic, which limited social interactions and health service access. These conditions have a negative effect on employees' mental health and may also be associated with work-related outcomes, such as reduced levels of work engagement. Cognitive behavioral therapy (CBT) is one of the most effective methods used for treating workers with mental illness and preventing work-related psychological outcomes. The delivery of internet-based CBT (iCBT) has been established as a result of both technological improvements that have influenced health promotion and prevention components, and limited social contact and health service access. OBJECTIVE: The purpose of this systematic review is to synthesize the best available evidence concerning the preventive effect of iCBT on employees. METHODS: A systematic search will be conducted across 12 electronic databases, including a hand search for main journals and reference lists. Randomized controlled trials testing the effects of iCBT on psychological outcomes and work engagement among employees will be eligible. Initial keywords will cover the concepts of employees, workers, non-health care personnel, internet-based, web-based, eHealth cognitive behavioral interventions, stress, depression, anxiety, and work engagement, and then a full search strategy will be developed. Following titles, abstracts and the full text will be screened for assessment against the inclusion criteria for the review. Search results will be fully reported and presented per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers will screen and extract data, appraise methodological quality using the Cochrane risk-of-bias assessment tool, and assess overall quality of evidence with the Grading of Recommendations Assessment, Development, and Evaluation approach. A random effects meta-analysis and standardized mean differences using review manager software will be applied to synthesize the effect of iCBT based on similar outcomes. RESULTS: This protocol was registered in the International Prospective Register of Systematic Reviews in March 2022 and is now an ongoing process. The data will be analyzed in August 2022, and the review process should be completed by December 2022. All included studies will be synthesized and presented to demonstrate the effectiveness of iCBT in decreasing psychological distress and optimizing work engagement outcomes among employees. CONCLUSIONS: According to the findings of this study, iCBT therapies will be used to promote mental health concerns such as depressive symptoms, anxiety, psychological distress, stress, insomnia, and resilience among non-health care professionals. In addition, the results will be used to ensure the policy related to reducing psychological distress and optimizing work engagement in the workplace. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/38597.

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Shiftwork is related to an increased risk of several diseases, including gastric ulcers, myocardial infarction, and diabetes. Several shiftwork patterns are related to poor sleep quality, such as a quick returns or extended shifts. This study aimed to find the shiftwork patterns strongly associated with poor sleep quality amongst nurses. A cross-sectional analytical study was conducted among nurses working for at least one month. The sub-groups were the good sleep quality group (n = 150) and the poor sleep quality group (n = 472). Eligible participants were asked to complete a self-reported questionnaire comprising personal characteristics, job characteristics, shiftwork characteristics, and sleep quality. Factors associated with poor sleep quality were determined using logistic regression analysis. Two factors associated with poor sleep quality remained in the final model: viz., depression and backward rotational shift. The only independent factor for poor sleep quality was a backward rotational shift with an adjusted odds ratio (95% CI) of 1.946 (1.344, 2.871). In conclusion, compared with other shift patterns, backward shiftwork was the most significant factor associated with poor sleep quality and should be avoided.

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AIM: To synthesize and present the currently available literature on the experiences of spousal and adult child caregivers of stroke patients in transitional care. DESIGN: This is a qualitative systematic review. DATA SOURCES: Eight electronic databases (PubMed, CINAHL, Cochrane, Embase, Web of Science, PsychINFO, ProQuest and Scopus) were searched from September 2020 to April 2022 for relevant literature and grey literature. Qualitative studies exploring the experiences of sspousal or adult child caregivers of stroke survivors up till 1 year after discharge were included. REVIEW METHODS: The selection of articles was done by two independent reviewers who screened the titles and the abstracts of studies, and the full texts of selected articles. Quality appraisal and data extraction of selected articles were undertaken by two independent reviewers using Joanna Briggs Institute (JBI) critical appraisal tools. Data synthesis was conducted using a meta-aggregative approach recommended by JBI. RESULTS: A total of 19 papers were included in this review. A total of three synthesized findings centred around caregivers' experience with healthcare professionals, changes in their life roles and needs, effects of caregiving and how they adapted to their changes were aggregated. CONCLUSION: Spousal and adult child caregivers faced multiple barriers during transitional care, such as the lack of resources and an inability to cope with changes in their lives. Support and adequate preparation were key facilitators in easing stroke caregivers into their role. IMPACT: The findings from this review can be used to guide future implementations of caregiver education programmes and comprehensive discharge planning for stroke survivors.

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Mental health literacy (MHL) promotes mental health among youths. We aimed to evaluate the effectiveness of the newly developed HOPE intervention in improving depression literacy, anxiety literacy, psychological well-being, and reducing personal stigma and stress levels amongst young adults at a university in Singapore. After two pilot studies, we conducted a randomised controlled trial (RCT) and recruited 174 participants aged 18-24 years old through social media platforms. The HOPE intervention group received four online sessions over two weeks and the control group received online inspirational quotes. Study outcomes were measured with self-reported questionnaires and they were assessed at baseline, post-intervention, and two-month follow-up (ClinicalTrials.gov: NCT04266119). Compared with the control arm, the intervention group was associated with increased depression and anxiety literacy levels at post-intervention and two-month follow-up. In addition, personal stigma for depression was reduced at the post-intervention juncture. However, there were no statistically significant changes in the ratings of psychological well-being and stress levels between the two groups. Longitudinal studies with larger sample sizes are warranted to replicate and extend the extant findings.

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OBJECTIVE: This study aimed to compare the healing outcomes between three types of compression therapy-two-layer bandage (2LB), four-layer bandage (4LB), and compression stockings, and to identify the predictors of venous leg ulcer (VLU) healing. METHOD: A retrospective review of the medical records of patients diagnosed with VLU between 2011 and 2016 in Singapore was conducted. Univariate and multivariate analyses were done between healed and unhealed VLU patients at three and six months, based on potential factors, ranging from demographic profile to comorbidities and treatment-related variables. RESULTS: Data from 377 patients' medical records were analysed. The healing rates with the three types of compression system, 4LB, 2LB and compression stockings, were 22.3%, 34.9% and 8.7% respectively at three months; at six months they were 44.2%, 41.9% and 34.8% respectively. Patients on 2LB reported a significantly higher proportion of healed ulcers at three months (p=0.003) but at six months there was no difference in healing rates between the three types of therapy. At three and six months, the duration of compression therapy was found to be an independent predictor of healing (p<0.001). CONCLUSION: In this study, the 2LB appeared to show the most favourable healing outcome in the short-term but as VLUs persisted beyond the months, the type of compression system used did not make a difference in the healing outcome. Our findings suggested that, as the duration became more prolonged, VLUs became more resistant to healing despite compression therapy. Therefore, it may be necessary for clinicians to consider adjuvant therapies for hard-to-heal ulcers at an earlier stage.

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OBJECTIVES: This study aimed to synthesise the best available evidence on the effectiveness of education interventions to teach evidence-based practice (EBP) on nurse-related and patient-related outcomes. DESIGN: This is a systematic review and meta-analytic paper. DATA SOURCES: Published and unpublished studies in English were searched from 10 databases from 2005 to 2021. REVIEW METHODS: Randomised controlled trials (RCTs) and clinical controlled trials (CCTs) describing education interventions to improve EBP knowledge, skills, attitude, confidence and behaviours among nurses were eligible. Two reviewers independently screened, appraised and extracted data. Meta-analysis was conducted using a random-effect model to synthesise data using review manager software. Standardised mean difference (SMD) represented an effect measure. Heterogeneity was assessed using Cochran-Q square test and I square statistics. Subgroup and narrative synthesis were also conducted. RESULTS: Ten studies (6 RCTs and 4 CCTs) were selected for this review. Results from a CCT suggested that education interventions improved EBP knowledge with a large effect size (SMD = 2.01). Education interventions also enhanced EBP skills (n = 1), combined knowledge/skills (SMD = 0.48, N = 5), attitude toward EBP (SMD = 0.39, N = 4), confidence to conduct EBP (SMD = 0.43, n = 1) and EBP behaviour (SMD = 0.26, n = 5). None of the studies used patient-related outcomes. CONCLUSION: Overall, education interventions improved nurses' EBP knowledge, skills, attitude, confidence and behaviour. EBP education interventions should be part of nurses' professional development in clinical settings. The interventions may be delivered through combined lectures, group discussions, hands-on practice via face-to-face and/or online learning. Future research should test education interventions using RCTs, large sample size, and in-depth qualitative data.

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OBJECTIVES: This review aimed to synthesize the best available evidence concerning the effectiveness of electronic health, mindfulness-based interventions (eHealth-MBIs) on anxiety, depression, mindfulness and quality of life (QoL) among cancer patients/survivors. METHODS: Published and unpublished studies were retrieved from 10 electronic databases. Two independent authors screened and selected articles, extracted data using a standardized form and appraised the studies with the Cochrane risk of bias assessment tool. Meta-analyses were performed using a random-effect model with Review Manager (REVMAN). Standardized mean differences (SMDs) were used to determine intervention effects. Narrative syntheses were conducted for studies not suitable for meta-analyses. Heterogeneity was identified through I2 and chi-square statistics. Subgroup analyses were performed based on types of controls, age groups and gender. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess overall quality. RESULTS: In total, 18 studies were included. The eHealth-MBIs improved primary outcomes of anxiety (SMD = -0.28) and depression (SMD = -0.24), among cancer patients/survivors with small effect sizes. Effects for the secondary outcomes of QoL (SMD = 0.25) and mindfulness (SMD = 0.29) were observed at short-term follow-up assessments but not at post-intervention. Overall quality was rated as low for the primary and very low for the secondary outcomes. CONCLUSION: The eHealth-MBIs can be offered as a cost-effective and accessible alternative for cancer patients and survivors in healthcare settings. Future research may further explore the effectiveness of eHealth-MBIs based on different types of MBIs, cancer types, modes of delivery and other outcomes such as stress and post-traumatic growth.

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Population ageing resulting from declining fertility and extended life expectancy has been occurring rapidly throughout the world. Older adults are faced with multiple physical, psychological and social changes that challenge their sense of self and capacity for healthy ageing. Intergenerational programmes (IGP) in communities have been developed to address a variety of social issues brought about by the population ageing. These programmes focus on promoting intergenerational social contact, supporting educational programmes and facilitating intellectual and/or physical activities in the older adults. This study intended to explore the perception of community-dwelling older adults towards an IGP in a senior day care centre in Singapore. Purposive sampling was adopted to recruit 15 participants for the study. Individual face-to-face interviews were conducted until data saturation was achieved. Interviews were audio-taped and transcribed verbatim. Thematic analysis was carried out. Four themes and 13 sub-themes emerged: (1) IGP enhances memory and strength; (2) social interaction between older adults and younger generation; (3) emotional responses to IGP; and (4) attitudes and perception towards the younger generation. The current study illustrated the dynamic social interaction between older adults and the younger generation, as well as the perceived benefits of the IGP. The relationship formed between the two generations entailed companionship, mutual care, trust and affection. Participation in the IGP provided the older adults an opportunity for active engagement in society and development. Continuous effort must be put in to ensure continuity of integration and empowerment of older adults, including the removal of obstacles and barriers that exclude or discriminate against them. The study findings will help facilitate the customisation of IGP to meet the needs of the older adults. With a well-planned and structured IGP, significant physical, emotional and psychosocial outcomes could benefit the older adults and the younger generation.

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OBJECTIVE: This study aimed to synthesize the best available evidence regarding the effectiveness of non-pharmacological interventions on body mass index (BMI), body dissatisfaction, depression and anxiety among individuals with anorexia nervosa (AN). METHODS: Published studies in English were searched using seven databases (such as PubMed). Grey literature was searched using ProQuest and Scopus. Studies were screened, appraised and extracted by two independent reviewers. Meta-analysis was performed and standardized mean difference was used as an effect measure. Heterogeneity was determined by I2 statistics and Cochran χ2 test. Publication bias was appraised using funnel plots. Sensitivity and subgroup analyses were also conducted. RESULTS: Nineteen RCTs from eight different countries were included in this review. Behavioral family system therapy (BFST) was found to enhance BMI while conjoint family therapy (CFT) was more effective in ameliorating depression. Studies implementing combined family and individual therapy and those with longer therapeutic durations produced larger effect sizes. CONCLUSION: This review provided evidence to support BSFT, CFT and combined family and individual therapy for adolescents with AN. PRACTICAL IMPLICATIONS: Healthcare professionals may offer the two interventions to adolescents with AN in clinical settings. Future research may further investigate the effectiveness of BSFT and CFT on BMI and depression.

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AIMS: To evaluate the effectiveness of technology-based interventions in reducing psychological morbidities such as depressive symptomology, anxiety, burden and improving quality of life and self-efficacy in informal caregivers of stroke survivors. DESIGN: A systematic review and meta-analysis. DATA SOURCES: An extensive search was systematically undertaken at CENTRAL, PubMed, Embase, Scopus, CINHAL, Web of Science and PsycInfo until January 2021. Grey literature and dissertations were searched in Google Scholar, ProQuest & Scholarbank@NUS. Studies involving registered trials were retrieved from Clinicaltrials.gov and CENTRAL, respectively. REVIEW METHODS: Two reviewers independently screened the trials, conducted quality appraisal and extracted the data. Quality of the studies included in the review was assessed using Cochrane Risk of bias tool. Meta-analysis was conducted using RevMan 5.4. Narrative synthesis was performed for studies where results could not be pooled statistically. The results were reported abiding Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: This review included 15 trials with a total of 1276 informal caregivers of stroke survivors. Eleven trials were included in the meta-analysis. Subgroup analyses revealed that technology-based interventions with structured educational programs were statistically significant in reducing depressive symptoms (d = -0.27, 95% CI [-0.49 to -0.05], p = .02). Technology-based interventions with structured educational programs <3-month revealed significant effects (d = -0.31, 95% CI [-0.49 to -0.13], p = .0009). Results of narrative synthesis reported technology-based intervention with face-to-face training minimized depressive symptoms of informal caregivers. Notably, there were no statistically significant effects on anxiety, burden, quality of life and self-efficacy outcomes. CONCLUSION: Technology-based interventions had beneficial effects in alleviating depressive symptoms among informal caregivers. IMPACT: Technology-based interventions serve as a support mechanism for informal caregivers of stroke survivors who face time-constrains. Further high-quality randomized controlled trials are warranted to elucidate sustainability, optimal format and dosage of intervention.

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OBJECTIVES: High prevalence of delirium superimposed on dementia (DSD) was previously reported, with associated negative impact on hospitalized older adults. However, data were conflicting, and no meta-analysis has been conducted. Although dementia is the leading risk factor for delirium, risk factors for DSD have not been adequately studied. This systematic review and meta-analysis aims to elucidate the prevalence, risk factors, and impact of DSD in hospitalized older adults. Comparisons were made between older adults with DSD and persons with dementia alone (PWDs). DESIGN: Systematic review and meta-analysis. SETTING AND PARTICIPANTS: Observational studies reporting prevalence, risk factors, or impact of DSD in hospitalized older adults. METHODS: Database search was conducted till December 2020 in PubMed, Embase, CENTRAL, PsycINFO, CINAHL, Scopus, Web of Science, ProQuest, and OpenGrey for relevant primary and secondary studies. A piloted data collection form was used for data extraction, and methodological quality was assessed using Joanna Briggs Institute critical appraisal checklists. Meta-analyses, with risk ratio and mean differences as effect measures, were performed using random effects model with Review Manager software. Cochran's Q and I2 statistics were used to assess heterogeneity, which was investigated using subgroup analyses. RESULTS: A total of 81 studies were eligible. The pooled prevalence of DSD was 48.9%, with the highest prevalence found in the Americas and orthopedic wards. Risk factors, including nonmodifiable hospital-, illness-, and medication-related factors, were found to precipitate DSD. Patients with DSD had longer length of hospitalization, disclosed worse cognitive and functional outcomes, and a higher risk of institutionalization and mortality than patients with dementia. CONCLUSIONS AND IMPLICATIONS: These findings suggested high prevalence and detrimental impact of DSD in hospitalized older adults, highlighting a need for early identification, prevention, and treatments. Further research on risk factors of DSD should be conducted as data were sparse and conflicting. Future high-quality studies regarding DSD are warranted to improve knowledge of this common but under-recognized phenomenon.

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AIM: To summarise the psychological impacts of social isolation amongst older adults during COVID-19 and review the benefits and limitations of online interventions used to combat social isolation. DESIGN: A scoping review was performed. DATA SOURCES: A systematic search was performed from October 2020 to January 2021 in seven electronic databases: China National Knowledge Infrastructure (CNKI), PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Cochrane Library and Web of Science. A hand search of the reference lists of included papers and WHO publications was performed. Grey literature search was carried out from Scopus, ProQuest Dissertation and Google Scholar. REVIEW METHODS: Studies were screened, appraised and extracted independently by two reviewers. Thematic analysis was used to synthesise data, which were presented in a descriptive manner and organised into categories and themes. RESULTS: Totally, 33 studies were included. Four themes and eight sub-themes emerged: (1) negative impacts and experiences of older adults during social isolation, (2) adopting coping behaviours in the midst of COVID-19, (3) online interventions to combat the consequences of social isolation, (4) barriers to online intervention. CONCLUSION: The COVID-19 pandemic has taken an emotional toll on older adults' psychological wellbeing and has highlighted the untapped strengths of older adults facing isolation. Online interventions, which could be a new normal in the COVID era, were beneficial in combating social isolation. Strategies by various stakeholders were recommended to tackle the barriers of online interventions. IMPACT: With the COVID-19 pandemic still in progress, this review provides insights on the psychological impacts of social isolation amongst older adults. Nurses in the community and long-term care facilities could adopt strategies and online intervention to better support the older adults, contribute to a stronger COVID-19 response and support system, and an overall better road to recovery from this crisis.

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