Background Many systematic reviews and meta-analyses have assessed the efficacy of dietary patterns on blood pressure (BP) lowering but their findings are largely conflicting. Objective This umbrella review aims to provide an update on the available evidence for the efficacy of different dietary patterns on BP lowering. Methods PubMed and Scopus databases were searched to identify relevant studies through to June 2020. Systematic reviews with meta-analyses of randomized controlled trials (RCTs) were eligible if they measured the effect of dietary patterns on systolic (SBP) and/or diastolic blood pressure (DBP) levels. The methodological quality of included systematic reviews was assessed by A Measurement Tool to Assess Systematic Review version 2. The efficacy of each dietary pattern was summarized qualitatively. The confidence of the effect estimates for each dietary pattern was graded using the NutriGrade scoring system. Results Fifty systematic reviews and meta-analyses of RCTs were eligible for review. Twelve dietary patterns namely the Dietary Approaches to Stop Hypertension (DASH), Mediterranean, Nordic, vegetarian, low-salt, low-carbohydrate, low-fat, high-protein, low glycemic index, portfolio, pulse, and Paleolithic diets were included in this umbrella review. Among these dietary patterns, the DASH diet was associated with the greatest overall reduction in BP with unstandardized mean differences ranging from −3.20 to −7.62 mmHg for SBP and from −2.50 to −4.22 mmHg for DBP. Adherence to Nordic, portfolio, and low-salt diets also significantly decreased SBP and DBP levels. In contrast, evidence for the efficacy of BP lowering using the Mediterranean, vegetarian, Paleolithic, low-carbohydrate, low glycemic index, high-protein, and low-fat diets was inconsistent. Conclusion Adherence to the DASH, Nordic, and portfolio diets effectively reduced BP. Low-salt diets significantly decreased BP levels in normotensive Afro-Caribbean people and in hypertensive patients of all ethnic origins. This review was registered at PROSPERO as CRD42018104733.

BackgroundIntroducing reflective writing to a medical curriculum requires the acceptance and participation of teachers. The purpose of this study was to explore medical teachers’ views on the benefits of introducing a reflective writing exercise into an undergraduate medical curriculum, including their levels of satisfaction and their concerns. We also investigated effects on the teachers’ personal and professional development arising from their roles as novice facilitators.MethodsA qualitative approach was employed using semi-structured interviews. During an attachment to Primary Care Medicine course, fourth-year medical students (n = 180) in the Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand were assigned to write a reflective essay titled, “A Significant Event in My First Clinical Year”. After reading the essays and facilitating between one to three small group discussions based on these, each of the 18 teachers enrolled in our study completed an in-depth face to face interview. Transcripts of these were studied, using thematic content analysis to identify emerging themes.ResultsThe novice facilitators felt that facilitated reflection was both valuable and appropriate for students. They also perceived that it had a positive impact on their own personal and professional lives. In the early phase of implementing this activity, teachers expressed concerns about 1) their ability and confidence as facilitators in small group discussion 2) their ability to deal with emotions raised within their groups 3) the effectiveness of the activity 4) poor presentation and possible fabrication of student work.ConclusionsMost teachers regarded this activity as being beneficial to them, to student learning, and to the curriculum. Their insights, including concerns about the level of skill needed for facilitation, provide valuable material for planning a comprehensive faculty development programme.

ObjectivesTo systematically review and compare the efficacy of all available home-based non-pharmacological treatments of depression.DesignSystematic review and network meta-analysis of randomised controlled trials.Data sourcesMedline, Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched since inceptions to 7 August 2016.Eligibility criteriaRandomised controlled trials comparing the efficacy of home-based non-pharmacological interventions with usual care of patients with depression were included in the review.Main outcomesDepression symptom scores and disease remission rates at the end of treatment.ResultsSeventeen studies were included in the review. Home-based non-pharmacological interventions were categorised as (1) home-based psychological intervention, (2) home-based exercise intervention, (3) combined home-based psychological intervention with exercise intervention and (4) complementary medicine. Complementary medicine approaches were excluded from the meta-analysis due to heterogeneity. The standardised mean differences of post-treatment depression symptom scores between usual care groups and home-based psychological intervention, home-based exercise intervention and combined home-based psychological intervention with exercise intervention were −0.57 (95% CI −0.84 to −0.31), −1.03 (95% CI −2.89 to 0.82) and −0.78 (95% CI −1.09 to −0.47), respectively. These results suggest that only home-based psychological intervention and combined home-based psychological intervention with exercise intervention could significantly decrease depression scores. Compared with usual care groups, the disease remission rate was also significantly higher for home-based psychological intervention (pooled risk ratio=1.53; 95% CI 1.19 to 1.98) and combined home-based psychological intervention with exercise intervention (pooled risk ratio=3.47; 95% CI 2.11 to 5.70). Of all the studied interventions, combined home-based psychological intervention with exercise intervention had the highest probability of resulting in disease remission.ConclusionOur study confirms the efficacy of home-based psychological intervention and combined home-based psychological intervention with exercise intervention in the treatment of depression. Combined home-based psychological intervention and exercise intervention was the best treatment and should be considered for inclusion in clinical guidelines for managing depression.