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More S, Bampidis V, Benford D, Bragard C, Hernandez‐Jerez A, Bennekou SH, Koutsoumanis K, Lambré C, Machera K, Mennes W, Mullins E, Nielsen SS, Schlatter J, Schrenk D, Turck D, Younes M, Fletcher T, Greiner M, Ntzani E, Pearce N, Vinceti M, Vrijheid M, Georgiadis M, Gervelmeyer A, Halldorsson TI. Scientific Committee guidance on appraising and integrating evidence from epidemiological studies for use in EFSA's scientific assessments. EFSA J 2024; 22:e8866. [PMID: 38974922 PMCID: PMC11224774 DOI: 10.2903/j.efsa.2024.8866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
EFSA requested its Scientific Committee to prepare a guidance document on appraising and integrating evidence from epidemiological studies for use in EFSA's scientific assessments. The guidance document provides an introduction to epidemiological studies and illustrates the typical biases, which may be present in different epidemiological study designs. It then describes key epidemiological concepts relevant for evidence appraisal. This includes brief explanations for measures of association, exposure assessment, statistical inference, systematic error and effect modification. The guidance then describes the concept of external validity and the principles of appraising epidemiological studies. The customisation of the study appraisal process is explained including tailoring of tools for assessing the risk of bias (RoB). Several examples of appraising experimental and observational studies using a RoB tool are annexed to the document to illustrate the application of the approach. The latter part of this guidance focuses on different steps of evidence integration, first within and then across different streams of evidence. With respect to risk characterisation, the guidance considers how evidence from human epidemiological studies can be used in dose-response modelling with several different options being presented. Finally, the guidance addresses the application of uncertainty factors in risk characterisation when using evidence from human epidemiological studies.
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de Ree RH, de Jong LD, Hazebroek EJ, Somford MP. Optimal timing of hip and knee arthroplasty after bariatric surgery: A systematic review. J Clin Orthop Trauma 2024; 52:102423. [PMID: 38766387 PMCID: PMC11096744 DOI: 10.1016/j.jcot.2024.102423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/18/2024] [Accepted: 04/23/2024] [Indexed: 05/22/2024] Open
Abstract
Background Obesity is a risk factor for the development of osteoarthritis and contributes to the increasing demand for total joint arthroplasty (TJA). Because a lower preoperative weight decreases the risk of complications after TJA, and because bariatric surgery (BS) can reduce weight and comorbidity burden, orthopedic surgeons often recommend BS prior to TJA in patients with obesity. However, the optimal timing of TJA after BS in terms of complications, revisions and dislocations is unknown. Methods PubMed, Embase and Cochrane CENTRAL databases were systematically searched for any type of study reporting rates of complications, revisions and dislocations in patients who had TJA after BS. The included studies' quality was assessed using the Newcastle-Ottawa Scale. Results Out of the 16 studies eligible for review, eight registry-based retrospective studies of high to moderate quality compared different time periods between BS and TJA and overall their results suggest little differences in complication rates. The remaining eight retrospective studies evaluated only one time period and had moderate to poor quality. Overall, there were no clear differences in outcomes after TJA for the different time frames between BS and TJA. Conclusion The results of this systematic review suggest that there is limited and insufficient high-quality evidence to determine the optimal timing of TJA after BS in terms of the rates of complications, revisions and dislocations. Given this lack of evidence, timing of TJA after BS will have to be decided by weighing the individual patients' risk factors against the expected benefits of TJA.
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Affiliation(s)
- Roy H.G.M. de Ree
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815, AD, Arnhem, the Netherlands
| | - Lex D. de Jong
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815, AD, Arnhem, the Netherlands
| | - Eric J. Hazebroek
- Department of Bariatric Surgery, Rijnstate Hospital, Wagnerlaan 55, 6815, AD, Arnhem, the Netherlands
| | - Matthijs P. Somford
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815, AD, Arnhem, the Netherlands
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Jiu L, Hartog M, Wang J, Vreman RA, Klungel OH, Mantel-Teeuwisse AK, Goettsch WG. Tools for assessing quality of studies investigating health interventions using real-world data: a literature review and content analysis. BMJ Open 2024; 14:e075173. [PMID: 38355183 PMCID: PMC10868255 DOI: 10.1136/bmjopen-2023-075173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVES We aimed to identify existing appraisal tools for non-randomised studies of interventions (NRSIs) and to compare the criteria that the tools provide at the quality-item level. DESIGN Literature review through three approaches: systematic search of journal articles, snowballing search of reviews on appraisal tools and grey literature search on websites of health technology assessment (HTA) agencies. DATA SOURCES Systematic search: Medline; Snowballing: starting from three articles (D'Andrea et al, Quigley et al and Faria et al); Grey literature: websites of European HTA agencies listed by the International Network of Agencies for Health Technology Assessment. Appraisal tools were searched through April 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included a tool, if it addressed quality concerns of NRSIs and was published in English (unless from grey literature). A tool was excluded, if it was only for diagnostic, prognostic, qualitative or secondary studies. DATA EXTRACTION AND SYNTHESIS Two independent researchers searched, screened and reviewed all included studies and tools, summarised quality items and scored whether and to what extent a quality item was described by a tool, for either methodological quality or reporting. RESULTS Forty-nine tools met inclusion criteria and were included for the content analysis. Concerns regarding the quality of NRSI were categorised into 4 domains and 26 items. The Research Triangle Institute Item Bank (RTI Item Bank) and STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) were the most comprehensive tools for methodological quality and reporting, respectively, as they addressed (n=20; 17) and sufficiently described (n=18; 13) the highest number of items. However, none of the tools covered all items. CONCLUSION Most of the tools have their own strengths, but none of them could address all quality concerns relevant to NRSIs. Even the most comprehensive tools can be complemented by several items. We suggest decision-makers, researchers and tool developers consider the quality-item level heterogeneity, when selecting a tool or identifying a research gap. OSF REGISTRATION NUMBER OSF registration DOI (https://doi.org/10.17605/OSF.IO/KCSGX).
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Affiliation(s)
- Li Jiu
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Michiel Hartog
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Junfeng Wang
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Rick A Vreman
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Wim G Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
- National Health Care Institute, Diemen, Netherlands
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van Zwieten A, Blyth FM, Wong G, Khalatbari-Soltani S. Consideration of overadjustment bias in guidelines and tools for systematic reviews and meta-analyses of observational studies is long overdue. Int J Epidemiol 2024; 53:dyad174. [PMID: 38129959 PMCID: PMC10859154 DOI: 10.1093/ije/dyad174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Affiliation(s)
- Anita van Zwieten
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - Fiona M Blyth
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, NSW, Australia
| | - Germaine Wong
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, NSW, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - Saman Khalatbari-Soltani
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, NSW, Australia
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Jones A, Findlay A, Knight SR, Rees J, O'Reilly D, Jones RP, Pathak S. Follow up after surgery for colorectal liver metastases: A systematic review. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107103. [PMID: 37890234 DOI: 10.1016/j.ejso.2023.107103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/04/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION Recurrence post hepatectomy for colorectal liver metastases (CRLM) occurs in 70 % of patients within two years. No established guidance on the method or intensity of follow-up currently exists. The aim of this systematic review was to summarise literature and determine whether it is possible to identify an optimal follow up regime. To this date there are no randomised prospective studies investigating this. METHODS A systematic review was performed according to PRISMA guidelines. Outcomes included general demographics, method, frequency and duration of follow up, survival and recurrence data. Quality assessment of the papers was performed. RESULTS Twenty-five articles published between 1994 and 2022 were included, including 9945 patients. CT was the most common imaging modality (n = 14) and CEA most common blood test (n = 11). Intensity of follow up was higher in the first two years post resection and only two papers continued follow up post 5 years resection. There was wide variation in outcome measures - Overall survival (OS) was most commonly reported. Nine papers reported OS ranging between 39 and 78.1 %. CONCLUSIONS There is wide variation in follow up methods and outcome reporting. There is no strong evidence to support intensive follow up, and the benefits of long term follow up are also unknown due to the lack of patient centred data. High quality, prospective studies should be the focus of future research as further retrospective data is unlikely to resolve uncertainties around optimal follow up.
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Affiliation(s)
- Annabel Jones
- University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough St, Bristol, BS1 3NU, UK
| | - Alasdair Findlay
- Department of Abdominal Medicine and Surgery, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Stephen R Knight
- Centre for Medical Informatics, Usher Institute, Nine Edinburgh BioQuarter, 9 Little France Road, EH16 4UX, UK
| | - Jonathan Rees
- University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough St, Bristol, BS1 3NU, UK
| | - David O'Reilly
- Cardiff Liver Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Robert P Jones
- Institute of Translational Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK
| | - Samir Pathak
- Department of Abdominal Medicine and Surgery, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK.
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Kaiser AH, Rotigliano N, Flessa S, Ekman B, Sundewall J. Extending universal health coverage to informal workers: A systematic review of health financing schemes in low- and middle-income countries in Southeast Asia. PLoS One 2023; 18:e0288269. [PMID: 37432943 DOI: 10.1371/journal.pone.0288269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 06/23/2023] [Indexed: 07/13/2023] Open
Abstract
Achieving universal health coverage (UHC) is a priority of most low- and middle-income countries, reflecting governments' commitments to improved population health. However, high levels of informal employment in many countries create challenges to progress toward UHC, with governments struggling to extend access and financial protection to informal workers. One region characterized by a high prevalence of informal employment is Southeast Asia. Focusing on this region, we systematically reviewed and synthesized published evidence of health financing schemes implemented to extend UHC to informal workers. Following PRISMA guidelines, we systematically searched for both peer-reviewed articles and reports in the grey literature. We appraised study quality using the Joanna Briggs Institute checklists for systematic reviews. We synthesized extracted data using thematic analysis based on a common conceptual framework for analyzing health financing schemes, and we categorized the effect of these schemes on progress towards UHC along the dimensions of financial protection, population coverage, and service access. Findings suggest that countries have taken a variety of approaches to extend UHC to informal workers and implemented schemes with different revenue raising, pooling, and purchasing provisions. Population coverage rates differed across health financing schemes; those with explicit political commitments toward UHC that adopted universalist approaches reached the highest coverage of informal workers. Results for financial protection indicators were mixed, though indicated overall downward trends in out-of-pocket expenditures, catastrophic health expenditure, and impoverishment. Publications generally reported increased utilization rates through the introduced health financing schemes. Overall, this review supports the existing evidence base that predominant reliance on general revenues with full subsidies for and mandatory coverage of informal workers are promising directions for reform. Importantly, the paper extends existing research by offering countries committed to progressively realizing UHC around the world a relevant updated resource, mapping evidence-informed approaches toward accelerated progress on the UHC goals.
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Affiliation(s)
- Andrea Hannah Kaiser
- Department of Clinical Sciences Malmö, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Improving Social Protection and Health Project, Phnom Penh, Cambodia
| | - Niccolò Rotigliano
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Improving Social Protection and Health Project, Phnom Penh, Cambodia
| | - Steffen Flessa
- Department of Health Care Management, University of Greifswald, Greifswald, Germany
| | - Björn Ekman
- Department of Clinical Sciences Malmö, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden
| | - Jesper Sundewall
- Department of Clinical Sciences Malmö, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden
- HEARD, University of KwaZulu-Natal, Durban, South Africa
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Marley-Zagar E, White IR, Royston P, Barthel FMS, Parmar MKB, Babiker AG. artbin: Extended sample size for randomized trials with binary outcomes. THE STATA JOURNAL 2023; 23:24-52. [PMID: 37461744 PMCID: PMC7614770 DOI: 10.1177/1536867x231161971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
We describe the command artbin, which offers various new facilities for the calculation of sample size for binary outcome variables that are not otherwise available in Stata. While artbin has been available since 2004, it has not been previously described in the Stata Journal. artbin has been recently updated to include new options for different statistical tests, methods and study designs, improved syntax, and better handling of noninferiority trials. In this article, we describe the updated version of artbin and detail the various formulas used within artbin in different settings.
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Affiliation(s)
| | - Ian R. White
- MRC Clinical Trials Unit University College London London, U.K
| | - Patrick Royston
- MRC Clinical Trials Unit University College London London, U.K
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Griffiths GS, Thompson BL, Snell DL, Dunn JA. Person-centred management of upper limb complex regional pain syndrome: an integrative review of non-pharmacological treatment. HAND THERAPY 2023; 28:16-32. [PMID: 37904811 PMCID: PMC10584071 DOI: 10.1177/17589983221138610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/25/2022] [Indexed: 11/01/2023]
Abstract
Introduction Complex Regional Pain Syndrome (CRPS) is most common in the upper limb and associated with high disability. The purpose of this review was to critically appraise and synthesise literature exploring non-pharmacological treatment for upper limb CRPS, to guide upper-limb-specific management. Methods Using an integrative review methodology, 13 databases were searched to identify all published studies on non-pharmacological management of upper limb CRPS. The Crowe Critical Appraisal Tool was used to provide quality ratings for included studies, and analysis employed a qualitative descriptive approach. Results From 236 abstracts reviewed, 113 full texts were read, and 38 articles selected for data extraction. Designs included single case (n = 14), randomised controlled trial (n = 8), prospective cohort (n = 8), case series (n = 4), retrospective (n = 3), and mixed methods (n = 1). Interventions were categorised as sensory retraining (n = 13), kinesiotherapy (n = 7), manual therapies (n = 7), physical modalities (n = 6), and interdisciplinary treatment programmes (n = 5). All studies measured pain intensity, and most (n = 24) measured physical parameters such as strength, movement, or perceptual abilities. Few measured patient-rated function (n = 13) or psychological factors (n = 4). Quality ratings ranged from 30% to 93%, with a median of 60%. Conclusion Methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor. Movement, desensitisation, and graded functional activity remain the mainstays of intervention. However, despite the impact of CRPS on wellbeing and function, psychological factors and functional outcomes are infrequently addressed. Further robust research is required to determine which aspects of treatment have the greatest influence on which symptoms, and when and how these should be introduced and progressed.
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Affiliation(s)
- Grace S Griffiths
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Bronwyn L Thompson
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Deborah L Snell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Jennifer A Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
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Munn Z, Stone JC, Aromataris E, Klugar M, Sears K, Leonardi-Bee J, Barker TH. Assessing the risk of bias of quantitative analytical studies: introducing the vision for critical appraisal within JBI systematic reviews. JBI Evid Synth 2023; 21:467-471. [PMID: 36476419 DOI: 10.11124/jbies-22-00224] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A key step in the systematic review process is the assessment of the methodological quality (or risk of bias) of the included studies. At JBI, we have developed several tools to assist with this evaluation. As evidence synthesis methods continue to evolve, it has been necessary to revise and reflect on JBI's current approach to critical appraisal and to plan a strategy for the future. In this first paper of a series focusing on risk of bias assessment, we introduce our vision for risk of bias assessment for JBI. In future papers in this series, the methodological approach taken for this revision process will be discussed, along with the revised tools and guidance for using these tools.
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Affiliation(s)
- Zachary Munn
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Jennifer C Stone
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Edoardo Aromataris
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech Republic [Middle European] Centre for Evidence-Based Healthcare: A JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Kim Sears
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, ON, Canada
| | - Jo Leonardi-Bee
- The Nottingham Centre for Evidence Based Healthcare: A JBI Centre of Excellence, School of Medicine, University of Nottingham, Nottingham, UK
| | - Timothy Hugh Barker
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Li LX, Kedgley AE, Horwitz MD. A Review of the Use of 3D Printing Technology in Treatment of Scaphoid Fractures. J Hand Surg Asian Pac Vol 2023; 28:22-33. [PMID: 36803332 DOI: 10.1142/s2424835523500042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Background: Three-dimensional (3D) printing technology is increasingly commercially viable for pre-surgical planning, intraoperative templating, jig creation and customised implant manufacture. The challenging nature of scaphoid fracture and nonunion surgery make it an obvious target. The aim of this review is to determine the use of 3D printed technologies in the treatment of scaphoid fractures. Methods: This is a review of the Medline, Embase and Cochrane Library databases examining studies aimed at therapeutic use of 3D printing, also known as rapid prototyping or additive technology, in the treatment of scaphoid fractures. All studies published up to and including November 2020 were included in the search. Relevant data extracted included modality of use (as template/model/guide/prosthesis), operative time, accuracy of reduction, radiation exposure, follow-up duration, time to union, complications and study quality. Results: A total of 649 articles were identified, of which 12 met the full inclusion criteria. Analysis of the articles showed that 3D printing techniques can be utilised in myriad ways to aid planning and delivery of scaphoid surgery. Percutaneous guides for Kirschner-wire (K-wire) fixation of non-displaced fractures can be created; custom guides can be printed to aid reduction of displaced or non-united fractures; patient-specific total prostheses may recreate near-normal carpal biomechanics and a simple model may help graft harvesting and positioning. Conclusions: This review found that the use of 3D printed patient-specific models and templates in scaphoid surgery can improve accuracy and speed, and reduce radiation exposure. 3D printed prostheses may also restore near-normal carpal biomechanics without burning bridges for potential future procedures. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Lily X Li
- Department of Trauma and Orthopaedics, St Mary's Hospital, London, UK
| | | | - Maxim D Horwitz
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, UK
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Qiu W, Ren M, Wang C, Fu Y, Liu Y. The clinicopathological and prognostic significance of mTOR and p-mTOR expression in patients with non-small cell lung cancer: A meta-analysis. Medicine (Baltimore) 2022; 101:e32340. [PMID: 36595789 PMCID: PMC9794261 DOI: 10.1097/md.0000000000032340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The mammalian target of rapamycin (mTOR) has a crucial role in carcinogenesis, angiogenesis, cellular proliferation, and metastasis; however, its significance in non-small cell lung cancer (NSCLC) remains contentious. Consequently, this study aims to assess the clinicopathological and prognostic importance of mTOR/p-mTOR expression in NSCLC. METHODS Literature retrieval was undertaken by searching English databases PubMed, EMBASE, Web of Science, and Cochrane Library as well as Chinese databases CNKI, Wan Fang, and VIP for full-text publications that satisfied our eligibility criteria up to November 2021. STATA 12.0 was used to conduct statistical analysis (STATA Corporation, College Station, TX). RESULTS This meta-analysis includes a total of 4683 patients from 28 primary publications. mTOR/p-mTOR expression was associated with sex (OR = 0.608, 95% CI: 0.442-0.836), lymph node metastasis (OR = 2.084, 95% CI: 1.437-3.182), and CEA (OR = 1.584, 95% CI: 1.135-2.209), but not with age, histological type, depth of tumor invasion, distant metastasis, TNM stage, differentiation degree, tumor size, or smoking. In addition, the expression of mTOR/p-mTOR is related to shorter overall survival in NSCLC patients (HR = 1.415, 95% CI: 1.051-1.905). CONCLUSION Positive mTOR/p-mTOR expression was substantially correlated with unfavorable conditions on the sex, lymph node metastases, and CEA levels. mTOR/p-mTOR may indicate a bad prognosis for NSCLC. The current findings must be confirmed and changed by other high-quality research employing a multivariate analysis on bigger sample size.
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Affiliation(s)
- Weiwei Qiu
- Department of Laboratory Medicine, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
- Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
| | - Meiying Ren
- Department of Laboratory Medicine, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
- * Correspondence: Meiying Ren, Department of Laboratory Medicine, the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kundulun District, Baotou City, Inner Mongolia 014010, China (e-mail: )
| | - Cuifeng Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
| | - Yuhua Fu
- Department of Laboratory Medicine, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
| | - Yan Liu
- Department of Laboratory Medicine, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
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Zouch J, Comachio J, Bussières A, Ashton-James CE, dos Reis AHS, Chen Y, Ferreira M, Ferreira P. Influence of Initial Health Care Provider on Subsequent Health Care Utilization for Patients With a New Onset of Low Back Pain: A Scoping Review. Phys Ther 2022; 102:pzac150. [PMID: 36317766 PMCID: PMC10071499 DOI: 10.1093/ptj/pzac150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/05/2022] [Accepted: 08/08/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this research was to examine the scope of evidence for the influence of a nonmedical initial provider on health care utilization and outcomes in people with low back pain (LBP). METHODS Using scoping review methodology, we conducted an electronic search of 4 databases from inception to June 2021. Studies investigating the management of patients with a new onset of LBP by a nonmedical initial health care provider were identified. Pairs of reviewers screened titles, abstracts, and eligible full-text studies. We extracted health care utilization and patient outcomes and assessed the methodological quality of the included studies using the Joanna Briggs Institute checklist. Two reviewers descriptively analyzed the data and categorized findings by outcome measure. RESULTS A total of 26,462 citations were screened, and 11 studies were eligible. Studies were primarily retrospective cohort designs using claims-based data. Four studies had a low risk of bias. Five health care outcomes were identified: medication, imaging, care seeking, cost of care, and health care procedures. Patient outcomes included patient satisfaction and functional recovery. Compared with patients initiating care with medical providers, those initiating care with a nonmedical provider showed associations with reduced opioid prescribing and imaging ordering rates but increased rates of care seeking. Results for cost of care, health care procedures, and patient outcomes were inconsistent. CONCLUSIONS Prioritizing nonmedical providers at the first point of care may decrease the use of low-value care, such as opioid prescribing and imaging referral, but may lead to an increased number of health care visits in the care of people with LBP. High-quality randomized controlled trials are needed to confirm our findings. IMPACT This scoping review provides preliminary evidence that nonmedical practitioners, as initial providers, may help reduce opioid prescription and selective imaging in people with LBP. The trend observed in this scoping review has important implications for pathways of care and the role of nonmedical providers, such as physical therapists, within primary health care systems. LAY SUMMARY This scoping review provides preliminary evidence that nonmedical practitioners, as initial providers, might help reduce opioid prescription and selective imaging in people with LBP. High-quality randomized controlled trials are needed to confirm these findings.
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Affiliation(s)
- James Zouch
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Josielli Comachio
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - André Bussières
- Department de Chiropractique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Claire E Ashton-James
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Yanyu Chen
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Manuela Ferreira
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Paulo Ferreira
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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13
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Russell K, Moghaddam N, Tickle A. Examining anxiety and depression in haematology cancer patients in ongoing treatment and under watchful waiting: A systematic review and meta-analysis. Eur J Cancer Care (Engl) 2022; 31:e13678. [PMID: 35977801 PMCID: PMC9787612 DOI: 10.1111/ecc.13678] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/21/2022] [Accepted: 08/02/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The present review aimed to establish prevalence rates of anxiety and depression in adults with haematology cancer, with a focus on the differences between patients under treatment and patients under watchful waiting. METHOD Five databases (Scopus, Medline, PsycINFO, EThOS, CINAHL) were searched throughout June 2021. Key search terms included haematology cancer, anxiety, depression, in treatment and watchful waiting. Study and sample characteristics, prevalence rates and mean self-reported scores of anxiety and depression data were extracted. RESULTS A total of 18 eligible papers were included in the review. Quality appraisal indicated papers were of adequate standard. Depression data from 2720 participants (14.5% under watchful waiting) and anxiety data from 2520 participants (15.9% under watchful waiting) were analysed through subgroup meta-analyses. The prevalence of anxiety was 34% amongst adults receiving treatment and 24.5% amongst those under watchful waiting. The prevalence of depression amongst adults receiving treatment was 31.3%, significantly higher than 16.1% of adults under watchful waiting. CONCLUSION Overall, adults with haematology cancer were at greater risk of experiencing anxiety and depression than the general population, with greatest risk in those under treatment. The findings indicate the need for future research to examine availability and effectiveness of targeted psychological interventions.
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Affiliation(s)
- Katie Russell
- Division of Psychiatry and Applied Psychology, School of MedicineUniversity of NottinghamNottinghamUK
| | - Nima Moghaddam
- Division of Psychiatry and Applied Psychology, School of MedicineUniversity of LincolnLincolnUK
| | - Anna Tickle
- Division of Psychiatry and Applied Psychology, School of MedicineUniversity of NottinghamNottinghamUK
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14
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Li Z, Weng X. Platelet-rich plasma use in meniscus repair treatment: a systematic review and meta-analysis of clinical studies. J Orthop Surg Res 2022; 17:446. [PMID: 36209223 PMCID: PMC9548158 DOI: 10.1186/s13018-022-03293-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 08/20/2022] [Indexed: 11/15/2022] Open
Abstract
Background There is conflicting clinical evidence whether platelet-rich plasma (PRP) therapies could translate to an increased meniscus healing rate and improved functional outcomes. The objective of this systematic review and meta-analysis was to compare the failure rate and patient-reported functional outcomes in meniscus repair augmented with and without PRP. Methods We comprehensively searched the PubMed, Web of Science, Medline, Embase, and Cochrane Library databases to identify studies that compared the clinical efficacy of meniscus repair performed with PRP versus without PRP. The primary outcome was the meniscus repair failure rate, while the secondary outcomes were knee-specific patient-reported outcomes, including the International Knee Documentation Committee (IKDC) score, Lysholm knee scale, visual analog scale, Tegner activity level score, Western Ontario and McMaster Universities Osteoarthritis Index score, Single Assessment Numeric Evaluation score, and Knee injury and Osteoarthritis Outcome Score. Furthermore, subgroup analyses were performed by stratifying the studies according to the PRP preparation technique to investigate the potential sources of heterogeneity among studies. Results Our meta-analysis included nine studies (two RCTs and seven non-RCTs) with 1164 participants. The failure rate in the PRP group was significantly lower than that in the non-PRP group [odds ratio: 0.64, 95% confidence interval (CI) (0.42, 0.96), P = 0.03]. Furthermore, the PRP group was associated with a statistically significant improvement in the visual analog scale for pain [Mean difference (MD): − 0.76, 95% CI (− 1.32, − 0.21), P = 0.007] and Knee injury and Osteoarthritis Outcome Score-symptom [MD: 8.02, 95% CI (2.99, 13.05), P = 0.002] compared with the non-PRP group. However, neither the IKDC score nor the Lysholm knee scale showed any differences between the two groups. In addition, the results of subgroup analyses favored PRP over platelet-rich fibrin matrix (PRFM) regarding the IKDC score. Conclusions Although meniscus repairs augmented with PRP led to significantly lower failure rates and better postoperative pain control compared with those of the non-PRP group, there is insufficient RCT evidence to support PRP augmentation of meniscus repair improving functional outcomes. Moreover, PRP could be recommended in meniscus repair augmentation compared with PRFM. PRFM was shown to have no benefit in improving functional outcomes.
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Affiliation(s)
- Ziquan Li
- Department of Orthopedic Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Beijing, 100730, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Xisheng Weng
- Department of Orthopedic Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Beijing, 100730, China. .,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, 100730, China.
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15
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Baloescu C, Parhar A, Liu R, Wanjiku GW. Effect of Point-of-Care Ultrasound on Clinical Outcomes in Low-Resource Settings: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1711-1719. [PMID: 35786524 DOI: 10.1016/j.ultrasmedbio.2022.04.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Despite the potential for improved patient care, little is known of the true effect of point-of-care ultrasound (POCUS) on patient outcomes in resource-limited settings. Electronic databases were searched using medical subject heading and free text terms related to POCUS and resource-limited settings through August 2020. Two authors independently selected studies, assessed methodological quality using the Downs and Black scale and extracted data. Twenty observational studies were included in the final review. All studies had moderate to high risk of bias. No studies exhibited an effect on the pre-specified primary outcome of mortality. Varying degrees of change in differential diagnosis and management were reported, but definitions varied widely among studies. Estimates for change in diagnosis as a result of POCUS ranged from 15% to 52%, and those for change in management, from 17% to 87%. Articles on POCUS clinical utility represent a small part (4.6%) of the scholastic literature dedicated to POCUS in low-resource settings. POCUS is a valuable intervention to consider in resource-limited settings, with the potential to change diagnosis and patient management. The exact magnitude of effect remains unknown. There is a continued need for large-scale experimental studies to investigate the effect of POCUS on patient diagnosis, management and mortality.
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Affiliation(s)
- Cristiana Baloescu
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Arya Parhar
- Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - Rachel Liu
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Grace W Wanjiku
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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16
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Mathes T, Mann NK, Thürmann P, Sönnichsen A, Pieper D. Assessing the quality of evidence on safety: specifications for application and suggestions for adaptions of the GRADE-criteria in the context of preparing a list of potentially inappropriate medications for older adults. BMC Med Res Methodol 2022; 22:234. [PMID: 36042413 PMCID: PMC9426023 DOI: 10.1186/s12874-022-01715-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 08/23/2022] [Indexed: 11/27/2022] Open
Abstract
Background Systematic reviews that synthesize safety outcomes pose challenges (e.g. rare events), which raise questions for grading the strength of the body of evidence. This is maybe one reason why in many potentially inappropriate medication (PIM) lists the recommendations are not based on formalized systems for assessing the quality of the body of evidence such as GRADE. In this contribution, we describe specifications and suggest adaptions of the GRADE system for grading the quality of evidence on safety outcomes, which were developed in the context of preparing a PIM-list, namely PRISCUS. Methods We systematically assessed each of the five GRADE domains for rating-down (study limitations, imprecision, inconsistency, indirectness, publication bias) and the criteria for rating-up, considering if special considerations or revisions of the original approach were indicated. The result was gathered in a written document and discussed in a group-meeting of five members with various background until consensus. Subsequently, we performed a proof-of-concept application using a convenience sample of systematic reviews and applied the approach to systematic reviews on 19 different clinical questions. Results We describe specifications and suggest adaptions for the criteria “study limitations”, imprecision, “publication bias” and “rating-up for large effect”. In addition, we suggest a new criterion to account for data from subgroup-analyses. The proof-of-concept application did not reveal a need for further revision and thus we used the approach for the systematic reviews that were prepared for the PRISCUS-list. We assessed 51 outcomes. Each of the proposed adaptions was applied. There were neither an excessive number of low and very low ratings, nor an excessive number of high ratings, but the different methodological quality of the safety outcomes appeared to be well reflected. Conclusion The suggestions appear to have the potential to overcome some of the challenges when grading the methodological quality of harms and thus may be helpful for producers of evidence syntheses considering safety. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01715-5.
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Affiliation(s)
- Tim Mathes
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany. .,Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany. .,Institute for Research in Operative Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, Cologne, Germany.
| | - Nina-Kristin Mann
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Petra Thürmann
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Philipp Klee-Institute for Clinical Pharmacology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | | | - Dawid Pieper
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Institute for Health Services and Health System Research, Neuruppin, Germany.,Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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17
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Abstract
OBJECTIVE Older age is often identified as a risk factor for poor outcome from traumatic brain injury (TBI). However, this relates predominantly to mortality following moderate-severe TBI. It remains unclear whether increasing age exerts risk on the expected recovery from mild TBI (mTBI). In this systematic review of mTBI in older age (60+ years), a focus was to identify outcome through several domains - cognition, psychological health, and life participation. METHODS Fourteen studies were identified for review, using PRISMA guidelines. Narrative synthesis is provided for all outcomes, from acute to long-term time points, and a meta-analysis was conducted for data investigating life participation. RESULTS By 3-month follow-up, preliminary findings indicate that older adults continue to experience selective cognitive difficulties, but given the data it is possible these difficulties are due to generalised trauma or preexisting cognitive impairment. In contrast, there is stronger evidence across time points that older adults do not experience elevated levels of psychological distress following injury and endorse fewer psychological symptoms than younger adults. Meta-analysis, based on the Glasgow Outcome Scale at 6 months+ post-injury, indicates that a large proportion (67%; 95% CI 0.569, 0.761) of older adults can achieve good functional recovery, similar to younger adults. Nevertheless, individual studies using alternative life participation measures suggest more mixed rates of recovery. CONCLUSIONS Although our initial review suggests some optimism in recovery from mTBI in older age, there is an urgent need for more investigations in this under-researched but growing demographic. This is critical for ensuring adequate health service provision, if needed.
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Maccabe TA, Robertson HF, Skipworth J, Rees J, Roberts K, Pathak S. A systematic review of post-pancreatectomy haemorrhage management stratified according to ISGPS grading. HPB (Oxford) 2022; 24:1110-1118. [PMID: 35101359 DOI: 10.1016/j.hpb.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 11/15/2021] [Accepted: 12/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Morbidity and mortality from post-pancreatectomy haemorrhage (PPH) remains high. The International Study Group of Pancreatic Surgery (ISGPS) published guidelines to standardise definitions of PPH severity, management and reporting. This study aimed to i) identify the number of studies reporting PPH using ISGPS guidelines (Grade A, B or C) and ii) describe treatment modality success by grade. METHODS A systematic literature review was performed, identifying studies reporting PPH by ISGPS Grade and their subsequent management. RESULTS Of 62 studies reporting on PPH management, 17 (27.4%) stratified by ISGPS guidelines and included 608 incidences of PPH: 48 Grade A, 274 Grade B (62 early, 166 late, 46 unspecified) and 286 Grade C. 96% of Grade A PPH were treated conservatively. Of 62 early Grade B, 54.8% were managed conservatively and 37.1% surgically. Late Grade B were managed non-operatively in 25.3% (42/166), with successful endoscopy in 90.9% (10/11) and angiography in 90.3% (28/31). In Grade C, endoscopic treatment was successful in 64.4% (29/45) and angiography in 90.8% (108/119). Surgical intervention was required in 43.5% early Grade B, 7.8% late Grade B and 33.2% Grade C. CONCLUSION PPH grading is underreported and despite guidelines, inconsistencies remain when using definitions and reporting of outcomes.
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Affiliation(s)
- Thomas A Maccabe
- Department of Hepatopancreatobiliary Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol UK.
| | - Harry F Robertson
- Department of Hepatopancreatobiliary Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol UK
| | - James Skipworth
- Department of Hepatopancreatobiliary Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol UK
| | - Jonathan Rees
- Department of Hepatopancreatobiliary Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol UK
| | - Keith Roberts
- Department of Hepatopancreatobiliary Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol UK; Department of Pancreatic Surgery, University Hospitals Birmingham, UK
| | - Samir Pathak
- Department of Hepatopancreatobiliary Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol UK
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Li Y, Wang X, Yang H, Li Y, Gui J, Cui Y. Profiles of Proinflammatory Cytokines and T Cells in Patients With Tourette Syndrome: A Meta-Analysis. Front Immunol 2022; 13:843247. [PMID: 35693824 PMCID: PMC9177955 DOI: 10.3389/fimmu.2022.843247] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background Tic disorder is a neurodevelopmental disorder characterized by motor and phonic tic symptoms. Tourette syndrome (TS) is a subtype of tic disorder that shows more persistent tic symptoms. The etiological mechanism of TS concerning immune dysfunction remains unclear due to limited evidence, especially for pediatric TS patients. Method In the present study, a meta-analysis was performed to confirm the identified changes in proinflammatory cytokines and T cells of pediatric TS patients. A total of five databases, including PubMed, Web of Science, PsycINFO, Google Scholar and the China National Knowledge Infrastructure (CNKI), were used for the literature search. The standardized mean difference (SMD) and mean difference (MD) with a 95% confidence interval (CI) were used to present the effect size of each type of proinflammatory cytokine and T cell. Sensitivity analysis, subgroup analysis and meta-regression analysis were used to explore the heterogeneity of the meta-analysis. This meta-analysis was registered in the International Platform of Registered Systematic Review and Meta-analysis Protocols (number: INPLASY2021110079). Results In the 25 studies included in this meta-analysis, thirteen studies focused on the levels of T cells, and twelve studies focused on the levels of proinflammatory cytokines. Based on the random-effects model, the pooled MDs are -1.45 (95% CI: -3.44, 0.54) for CD3 cells, -4.44 (95% CI: -6.80, -2.08) for CD4 cells, and 1.94 (95% CI: -0.08, 3.97) for CD8 cells. The pooled SMDs are1.36 for IL-6 (95% CI: 0.00, 2.72) and 2.39 for tumor necrosis factor alpha (TNF-α) (95% CI: 0.93, 3.84). Conclusion We provided evidence of immune dysfunction in pediatric TS patients, with elevated levels of particular proinflammatory cytokines and disproportionate changes in T-cell subpopulations. Small to large effect sizes were identified for increased IL-6 levels as well as a reduced number of T helper cells, while a large effect size was identified for increased TNF-α levels. These results indicate a close association between peripheral immune activation and TS. However, the most direct and meaningful interaction between peripheral immune status and microglial activation in the central nervous system in TS patients requires further exploration.
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Affiliation(s)
- Ying Li
- Department of Psychiatry, Beijing Children’s Hospital, Capital Medical University, National Centre for Children’s Health, Beijing, China
| | - Xiaolin Wang
- Laboratory of Tumor Immunology, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Hanxue Yang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Chinese Academy of Sciences (CAS) Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Yanlin Li
- Department of Psychiatry, Beijing Children’s Hospital, Capital Medical University, National Centre for Children’s Health, Beijing, China
| | - Jingang Gui
- Laboratory of Tumor Immunology, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- *Correspondence: Jingang Gui, ; Yonghua Cui,
| | - Yonghua Cui
- Department of Psychiatry, Beijing Children’s Hospital, Capital Medical University, National Centre for Children’s Health, Beijing, China
- *Correspondence: Jingang Gui, ; Yonghua Cui,
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20
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Sarri G, Patorno E, Yuan H, Guo JJ, Bennett D, Wen X, Zullo AR, Largent J, Panaccio M, Gokhale M, Moga DC, Ali MS, Debray TPA. Framework for the synthesis of non-randomised studies and randomised controlled trials: a guidance on conducting a systematic review and meta-analysis for healthcare decision making. BMJ Evid Based Med 2022; 27:109-119. [PMID: 33298465 PMCID: PMC8961747 DOI: 10.1136/bmjebm-2020-111493] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION High-quality randomised controlled trials (RCTs) provide the most reliable evidence on the comparative efficacy of new medicines. However, non-randomised studies (NRS) are increasingly recognised as a source of insights into the real-world performance of novel therapeutic products, particularly when traditional RCTs are impractical or lack generalisability. This means there is a growing need for synthesising evidence from RCTs and NRS in healthcare decision making, particularly given recent developments such as innovative study designs, digital technologies and linked databases across countries. Crucially, however, no formal framework exists to guide the integration of these data types. OBJECTIVES AND METHODS To address this gap, we used a mixed methods approach (review of existing guidance, methodological papers, Delphi survey) to develop guidance for researchers and healthcare decision-makers on when and how to best combine evidence from NRS and RCTs to improve transparency and build confidence in the resulting summary effect estimates. RESULTS Our framework comprises seven steps on guiding the integration and interpretation of evidence from NRS and RCTs and we offer recommendations on the most appropriate statistical approaches based on three main analytical scenarios in healthcare decision making (specifically, 'high-bar evidence' when RCTs are the preferred source of evidence, 'medium,' and 'low' when NRS is the main source of inference). CONCLUSION Our framework augments existing guidance on assessing the quality of NRS and their compatibility with RCTs for evidence synthesis, while also highlighting potential challenges in implementing it. This manuscript received endorsement from the International Society for Pharmacoepidemiology.
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Affiliation(s)
- Grammati Sarri
- Real World Evidence Sciences, Visible Analytics Ltd, Oxford, UK
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Dept. of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Hongbo Yuan
- Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Ontario, Canada
| | - Jianfei Jeff Guo
- Department of Pharmacy Practice & Administrative Sciences, University of Cincinnati College of Pharmacy, Cincinnati, Ohio, USA
| | | | - Xuerong Wen
- Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Andrew R Zullo
- Health Services, Policy, and Practice, Brown University, Providence, Rhode Island, USA
| | - Joan Largent
- Real-World Solutions, IQVIA, California, Colorado, USA
| | - Mary Panaccio
- Epidemiology and Outcomes Research, Research Outcomes Innovations LLC, New York City, New York, USA
| | | | - Daniela Claudia Moga
- University of Kentucky, Department of Pharmacy Practice and Science, Lexington, Kentucky, USA
| | - M Sanni Ali
- NDORMS, Center for Statistics in Medicine, University of Oxford, Oxford, UK
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
- Department of Public Heath, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
- Smart Data Analysis and Statistics, Utrecht, The Netherlands
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21
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Hilton Boon M, Burns J, Craig P, Griebler U, Heise TL, Vittal Katikireddi S, Rehfuess E, Shepperd S, Thomson H, Bero L. Value and Challenges of Using Observational Studies in Systematic Reviews of Public Health Interventions. Am J Public Health 2022; 112:548-552. [PMID: 35319925 PMCID: PMC8961824 DOI: 10.2105/ajph.2021.306658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Michele Hilton Boon
- Michele Hilton Boon, Peter Craig, S. Vittal Katikireddi, and Hilary Thomson are with the Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. Jacob Burns and Eva Rehfuess are with the Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany. Ursula Griebler is with the Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Krems an der Donau, Austria. Thomas L. Heise is with the Leibniz Institute for Prevention Research and Epidemiology-BIPS, University of Bremen, Bremen, Germany. Sasha Shepperd is with the Nuffield Department of Population Health, University of Oxford, Oxford, UK. Lisa Bero is with the School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jacob Burns
- Michele Hilton Boon, Peter Craig, S. Vittal Katikireddi, and Hilary Thomson are with the Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. Jacob Burns and Eva Rehfuess are with the Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany. Ursula Griebler is with the Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Krems an der Donau, Austria. Thomas L. Heise is with the Leibniz Institute for Prevention Research and Epidemiology-BIPS, University of Bremen, Bremen, Germany. Sasha Shepperd is with the Nuffield Department of Population Health, University of Oxford, Oxford, UK. Lisa Bero is with the School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Peter Craig
- Michele Hilton Boon, Peter Craig, S. Vittal Katikireddi, and Hilary Thomson are with the Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. Jacob Burns and Eva Rehfuess are with the Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany. Ursula Griebler is with the Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Krems an der Donau, Austria. Thomas L. Heise is with the Leibniz Institute for Prevention Research and Epidemiology-BIPS, University of Bremen, Bremen, Germany. Sasha Shepperd is with the Nuffield Department of Population Health, University of Oxford, Oxford, UK. Lisa Bero is with the School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ursula Griebler
- Michele Hilton Boon, Peter Craig, S. Vittal Katikireddi, and Hilary Thomson are with the Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. Jacob Burns and Eva Rehfuess are with the Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany. Ursula Griebler is with the Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Krems an der Donau, Austria. Thomas L. Heise is with the Leibniz Institute for Prevention Research and Epidemiology-BIPS, University of Bremen, Bremen, Germany. Sasha Shepperd is with the Nuffield Department of Population Health, University of Oxford, Oxford, UK. Lisa Bero is with the School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Thomas L Heise
- Michele Hilton Boon, Peter Craig, S. Vittal Katikireddi, and Hilary Thomson are with the Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. Jacob Burns and Eva Rehfuess are with the Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany. Ursula Griebler is with the Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Krems an der Donau, Austria. Thomas L. Heise is with the Leibniz Institute for Prevention Research and Epidemiology-BIPS, University of Bremen, Bremen, Germany. Sasha Shepperd is with the Nuffield Department of Population Health, University of Oxford, Oxford, UK. Lisa Bero is with the School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - S Vittal Katikireddi
- Michele Hilton Boon, Peter Craig, S. Vittal Katikireddi, and Hilary Thomson are with the Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. Jacob Burns and Eva Rehfuess are with the Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany. Ursula Griebler is with the Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Krems an der Donau, Austria. Thomas L. Heise is with the Leibniz Institute for Prevention Research and Epidemiology-BIPS, University of Bremen, Bremen, Germany. Sasha Shepperd is with the Nuffield Department of Population Health, University of Oxford, Oxford, UK. Lisa Bero is with the School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Eva Rehfuess
- Michele Hilton Boon, Peter Craig, S. Vittal Katikireddi, and Hilary Thomson are with the Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. Jacob Burns and Eva Rehfuess are with the Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany. Ursula Griebler is with the Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Krems an der Donau, Austria. Thomas L. Heise is with the Leibniz Institute for Prevention Research and Epidemiology-BIPS, University of Bremen, Bremen, Germany. Sasha Shepperd is with the Nuffield Department of Population Health, University of Oxford, Oxford, UK. Lisa Bero is with the School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Sasha Shepperd
- Michele Hilton Boon, Peter Craig, S. Vittal Katikireddi, and Hilary Thomson are with the Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. Jacob Burns and Eva Rehfuess are with the Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany. Ursula Griebler is with the Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Krems an der Donau, Austria. Thomas L. Heise is with the Leibniz Institute for Prevention Research and Epidemiology-BIPS, University of Bremen, Bremen, Germany. Sasha Shepperd is with the Nuffield Department of Population Health, University of Oxford, Oxford, UK. Lisa Bero is with the School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Hilary Thomson
- Michele Hilton Boon, Peter Craig, S. Vittal Katikireddi, and Hilary Thomson are with the Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. Jacob Burns and Eva Rehfuess are with the Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany. Ursula Griebler is with the Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Krems an der Donau, Austria. Thomas L. Heise is with the Leibniz Institute for Prevention Research and Epidemiology-BIPS, University of Bremen, Bremen, Germany. Sasha Shepperd is with the Nuffield Department of Population Health, University of Oxford, Oxford, UK. Lisa Bero is with the School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Lisa Bero
- Michele Hilton Boon, Peter Craig, S. Vittal Katikireddi, and Hilary Thomson are with the Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. Jacob Burns and Eva Rehfuess are with the Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany. Ursula Griebler is with the Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Krems an der Donau, Austria. Thomas L. Heise is with the Leibniz Institute for Prevention Research and Epidemiology-BIPS, University of Bremen, Bremen, Germany. Sasha Shepperd is with the Nuffield Department of Population Health, University of Oxford, Oxford, UK. Lisa Bero is with the School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
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22
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Booth J, Perriman DM, Szczepanski J, Walton-Sonda D, Smith PN. What's old is best again Is anterior plating best for fixation of type-C pelvic fractures? A systematic review and meta-analysis. Injury 2022; 53:301-312. [PMID: 34625237 DOI: 10.1016/j.injury.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/20/2021] [Accepted: 09/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Type-C pelvic fractures are a rare but potentially fatal injury that often leads to poor outcomes, despite surgical fixation. Many fixation methods are used but the optimal method remains contentious, with failure and complications common. This study compared outcomes for each fixation method. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A search of studies which reported on outcomes after surgically treated type-C pelvic fractures was undertaken. Data retrieved included fixation method, length of follow up, surgical revision, and complications rates (hardware breakage, post-operative outcomes, screw mal-positioning, screw loosening, loss of reduction and infection). Study quality was assessed using the Methodological Index for Non-Randomised Studies (MINORS). Pooled revision, outcome and complication rates were calculated using a quality-adjusted model in MetaXL 5.3. RESULTS Fifty-two studies met the inclusion criteria representing 1567 patients and 7 fixation methods. The meta-analyses demonstrated high rates of 'less-than-good' outcomes for most fixation methods, with a higher rate for bilateral injuries (overall 23%; unilateral 21% v bilateral 41%). The mean pooled rate for surgical revision rate was 4%, hardware breakage 3%, screw mal-positioning 2%, screw loosening 3%, loss of reduction 5% and infection 4%. Each fixation method had different performance profiles; however, anterior plating outperformed all other fixation methods for patient outcomes, with a 'less-than-good' rate of just 7% vs the pooled mean of 23% and demonstrated at or below pooled mean rates for all complications except revision which was 5%. CONCLUSIONS Post-operative outcomes for surgically treated type-C pelvic fractures revealed a 'less-than-good' pooled outcome rate of 23% and a revision rate of 4%. Anterior plates outperformed most other systems particularly for patient reported outcomes. Pooled revision, patient-reported outcome and complication rates for type-C pelvic fractures have not previously been reported and these data provide a benchmark for practice and future research.
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Affiliation(s)
- Joshua Booth
- The Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia; The Australian National University, Canberra, Australian Capital Territory, Australia.
| | - Diana M Perriman
- The Australian National University, Canberra, Australian Capital Territory, Australia; The Australian Capital Territory Health Library and Multimedia Service, The Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Jason Szczepanski
- The Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Dianne Walton-Sonda
- The Australian Capital Territory Health Library and Multimedia Service, The Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Paul N Smith
- The Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia; The Australian National University, Canberra, Australian Capital Territory, Australia
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23
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Zeverijn LJ, van Waalwijk van Doorn-Khosrovani SB, van Roy AAMGP, Timmers L, Ly Tran TH, de Boer JE, de Wit GF, Geurts BS, Gelderblom H, Verheul HMW, Blijlevens N, Wymenga ANM, Eskens FALM, Smit EF, Bloemendal HJ, Voest EE. Harmonising patient-access programmes: the Dutch DRUG Access Protocol platform. Lancet Oncol 2022; 23:198-201. [DOI: 10.1016/s1470-2045(21)00707-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
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24
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Poppleton A, Howells K, Adeyemi I, Chew‐Graham C, Dikomitis L, Sanders C. The perceptions of general practice among Central and Eastern Europeans in the United Kingdom: A systematic scoping review. Health Expect 2022; 25:2107-2123. [DOI: 10.1111/hex.13433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Aaron Poppleton
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
- School of Medicine Keele University Keele UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (GM‐PSTRC) Manchester UK
| | - Kelly Howells
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
| | - Isabel Adeyemi
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
| | | | - Lisa Dikomitis
- Kent and Medway Medical School University of Kent and Canterbury Christ Church University Canterbury UK
| | - Caroline Sanders
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (GM‐PSTRC) Manchester UK
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25
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Alfayez OM, Aldmasi KS, Alruwais NH, Bin Awad NM, Al Yami MS, Almohammed OA, Almutairi AR. Incidence of Diabetic Ketoacidosis Among Pediatrics With Type 1 Diabetes Prior to and During COVID-19 Pandemic: A Meta-Analysis of Observational Studies. Front Endocrinol (Lausanne) 2022; 13:856958. [PMID: 35355556 PMCID: PMC8959619 DOI: 10.3389/fendo.2022.856958] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/08/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Previous reports suggest that the Coronavirus Disease-2019 (COVID-19) pandemic might have affected incidences of diabetic ketoacidosis (DKA) and new diagnoses of type 1 diabetes. This systematic review and meta-analysis aimed to estimate the risk of DKA, including severe DKA, during the COVID-19 pandemic versus the prior-to-COVID-19 period among pediatric patients with type 1 diabetes. METHODS PubMed and EMBASE were searched for observational studies investigating the risk of DKA among pediatric patients with type 1 diabetes during the COVID-19 pandemic and the prior-to-COVID-19 period. A random meta-analysis model was performed to estimate the relative risk of DKA during the COVID-19 pandemic compared to before the pandemic. Subgroup analyses were conducted based on the type 1 diabetes status, established or newly diagnosed. In addition, sensitivity analysis was conducted for studies that reported results from adjusted analysis for potential confounders using fixed effect model. RESULTS A total of 20 observational studies reported the risk of DKA, of which 18 reported the risk of severe DKA. The risks of DKA and severe DKA were 35% (RR 1.35, 95%CI 1.2-1.53, I2 = 71%) and 76% (RR 1.76, 95%CI 1.33-2.33, I2 = 44%) higher in the during-COVID-19 group compared to the prior-to-COVID-19 group, respectively. Among patients with newly diagnosed type 1 diabetes, the risk of DKA was 44% higher for the during-COVID-19 group compared to the prior-to-COVID-19 group (RR 1.44, 95%CI 1.26-1.65; I2 = 64%). Only two studies reported the risk of DKA among patients with established type 1 diabetes and the cumulative risk was not statistically significant. In the sensitivity analysis, four studies reported an adjusted odds ratio (aOR) of the risk of DKA during COVID-19 compared to the prior-to-COVID-19 period. The fixed estimate from the meta-analysis found an increase in the risk of DKA in the during-COVID-19 group compared to the prior-to-COVID-19 group (aOR 2.04, 95%CI 1.66-2.50). CONCLUSIONS This study showed that DKA risk, especially the risk of severe DKA, has increased significantly during the pandemic. Healthcare systems must be aware and prepared for such an increase in DKA cases and take all necessary measures to prevent future spikes during the pandemic. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272775, identifier PROSPERO [CRD42021272775].
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Affiliation(s)
- Osamah M. Alfayez
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
- *Correspondence: Osamah M. Alfayez,
| | | | - Nada H. Alruwais
- College of Pharmacy, University of Shaqra, Al Dawadmi, Saudi Arabia
| | - Nouf M. Bin Awad
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, United States
| | - Majed S. Al Yami
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Omar A. Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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26
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Timpel P, Herrmann S, Flößel P, Beck H, Schwarz PE. Effectiveness of digital primary prevention interventions targeting physical activity, motor skills and nutrition in children aged 3-10 years in the setting of day care and primary school: protocol for a systematic review. BMJ Open 2021; 11:e053628. [PMID: 34949625 PMCID: PMC8705251 DOI: 10.1136/bmjopen-2021-053628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Available evidence points to an association of increased screen time and the availability of digital tools during childhood with negative health outcomes in later life. For many years, public discourse focused on restricting access and use of digital technologies below certain ages. However, little is known about the specific benefit of a responsible use of digital primary prevention in the setting of (early) childhood education. The objective of this evidence synthesis is to investigate the effectiveness of digital primary prevention interventions targeting physical activity, motor skills and/or nutrition in children aged 3-10 years in day-care facilities and (pre-) schools. METHODS AND ANALYSIS We present the rationale and methodological steps of a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures. Automated searches will be conducted by applying a pretested search strategy to the databases MEDLINE/PubMed, EMBASE and PsycInfo to identify relevant interventional (randomised controlled trials, controlled trials, crossover trials and pilot and feasibility) and observational (case-control, cohort) studies in English or German, with no date restrictions. The overall search will be complemented by backward, forward and additional hand searches. Two researchers will independently screen titles/abstracts and assess full texts by applying predefined eligibility criteria. Data extraction will be conducted by using a pretested data extraction sheet. The assessment of methodological quality will be performed independently by two review authors using the Critical Appraisals Skills Programme relevant to the study design applied in the given study. Additionally, qualitative content analysis will be conducted to analyse priorities for future research extracted from the discussion sections and conclusions of included studies. PROSPERO REGISTRATION NUMBER CRD42020207682.
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Affiliation(s)
- Patrick Timpel
- Medical Faculty Carl Gustav Carus, Department of Medicine III, Prevention and Care of Diabetes, Technische Universität Dresden, Dresden, Sachsen, Germany
| | - Sandra Herrmann
- Medical Faculty Carl Gustav Carus, Department of Medicine III, Prevention and Care of Diabetes, Technische Universität Dresden, Dresden, Sachsen, Germany
| | - Philipp Flößel
- UniversityCenter for Orthopedics, Trauma & Plastic Surgery, Section Sports Medicine and Rehabilitation, Technische Universität Dresden, Dresden, Sachsen, Germany
| | - Heidrun Beck
- UniversityCenter for Orthopedics, Trauma & Plastic Surgery, Section Sports Medicine and Rehabilitation, Technische Universität Dresden, Dresden, Sachsen, Germany
| | - Peter Eh Schwarz
- Medical Faculty Carl Gustav Carus, Department of Medicine III, Prevention and Care of Diabetes, Technische Universität Dresden, Dresden, Sachsen, Germany
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27
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Zeraatkar D, Kohut A, Bhasin A, Morassut RE, Churchill I, Gupta A, Lawson D, Miroshnychenko A, Sirotich E, Aryal K, Azab M, Beyene J, de Souza RJ. Assessments of risk of bias in systematic reviews of observational nutritional epidemiologic studies are often not appropriate or comprehensive: a methodological study. BMJ Nutr Prev Health 2021; 4:487-500. [PMID: 35028518 PMCID: PMC8718856 DOI: 10.1136/bmjnph-2021-000248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 08/02/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND An essential component of systematic reviews is the assessment of risk of bias. To date, there has been no investigation of how reviews of non-randomised studies of nutritional exposures (called 'nutritional epidemiologic studies') assess risk of bias. OBJECTIVE To describe methods for the assessment of risk of bias in reviews of nutritional epidemiologic studies. METHODS We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews (Jan 2018-Aug 2019) and sampled 150 systematic reviews of nutritional epidemiologic studies. RESULTS Most reviews (n=131/150; 87.3%) attempted to assess risk of bias. Commonly used tools neglected to address all important sources of bias, such as selective reporting (n=25/28; 89.3%), and frequently included constructs unrelated to risk of bias, such as reporting (n=14/28; 50.0%). Most reviews (n=66/101; 65.3%) did not incorporate risk of bias in the synthesis. While more than half of reviews considered biases due to confounding and misclassification of the exposure in their interpretation of findings, other biases, such as selective reporting, were rarely considered (n=1/150; 0.7%). CONCLUSION Reviews of nutritional epidemiologic studies have important limitations in their assessment of risk of bias.
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Affiliation(s)
- Dena Zeraatkar
- Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alana Kohut
- McMaster University, Hamilton, Ontario, Canada
| | - Arrti Bhasin
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rita E Morassut
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Isabella Churchill
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Arnav Gupta
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Daeria Lawson
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anna Miroshnychenko
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Emily Sirotich
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Komal Aryal
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maria Azab
- McMaster University, Hamilton, Ontario, Canada
| | - Joseph Beyene
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
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28
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AlSomali K, Kholinne E, Van Nguyen T, Cho CH, Kwak JM, Koh KH, Jeon IH. Outcomes and Return to Sport and Work After Open Bankart Repair for Recurrent Shoulder Instability: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211026907. [PMID: 34660820 PMCID: PMC8511924 DOI: 10.1177/23259671211026907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Open Bankart repair provides surgeons and patients with an alternative
solution for managing recurrent instability in young athletes with or
without minimal bone loss. Despite many studies that have reported low
recurrence rates and good functional outcomes after open Bankart repair, we
have limited knowledge about the return to sport and work for high-demand
populations. Purpose: To assess the return to sport and work for high-demand populations after open
Bankart repair for recurrent anterior shoulder instability, outcomes of open
Bankart repair with regard to recurrence, and development of osteoarthritic
(OA) changes. Study Design: Systematic review; Level of evidence, 4. Methods: We searched PubMed, EMBASE, Cochrane Library, Scopus, and Google Scholar
databases using keywords as well as Medical Subject Headings terms and
Emtree using “(Open Bankart OR Bankart surgery) (NOT arthroscopy NOT
revision)” for English-language studies. We conducted a systematic review in
accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews
and Meta-Analyses) guidelines. Results: In total, 11 articles (10 with level 4 and 1 with level 3 evidence) including
563 patients (566 shoulders) were identified. The majority of patients were
male (82%), the average age at the time of surgery was 27.4 years, and the
mean follow-up was 11.5 years (range, 2.5-29 years). The most common
functional score used was the Rowe score (95%) for the reported outcome
measures, which showed good to excellent results (mean, 88.5 points). The
overall recurrent instability rate, including dislocation and subluxation as
a postoperative complication, was 8.5%. A total of 87% of patients were able
to return to sport and work postoperatively. Overall, OA changes were
reported in 33% of the patients, and the overall revision rate was 1%. Conclusion: Open Bankart repair exhibited favorable results, with a low postoperative
instability rate. It is a reliable surgical procedure that allows
high-demand patients to return to sport and work.
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Affiliation(s)
- Khalid AlSomali
- Department of Orthopedic Surgery, King Fahad Military Medical Complex, Dhahran, Saudi Arabia.,Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea.,Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
| | - Thanh Van Nguyen
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea.,Department of Orthopedic Surgery, University Medical Center, Ho Chi Minh, Vietnam
| | - Chang-Ho Cho
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
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29
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Jobin B, Zahal R, Bussières EL, Frasnelli J, Boller B. Olfactory Identification in Subjective Cognitive Decline: A Meta-Analysis. J Alzheimers Dis 2021; 79:1497-1507. [PMID: 33459721 DOI: 10.3233/jad-201022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recently, subjective cognitive decline (SCD) has been considered to be one of the first signs of Alzheimer's disease (AD). Since this potential early marker is sensitive but not specific to AD, combining it with other markers could ensure higher accuracy when predicting which persons with SCD will convert to AD. Since olfactory dysfunction is observable in both AD and mild cognitive impairment (MCI), it is a promising marker that could help improve the early diagnosis of AD. OBJECTIVE The aim of this meta-analysis was to verify whether the presence of SCD is associated with a decrease in olfactory identification ability. METHODS We collected articles from the following databases: PsychNet, PubMed, Ebsco, and ProQuest using the keywords: "SCD", "subjective cognitive decline", "subjective cognitive impairment", "subjective memory impairment", "subjective memory decline", "cognitive complaints", "memory complaints", "cognitive concerns", "memory concerns", "olfac*" and "smell". We included articles according to the following criteria: 1) participants aged 50 and over; 2) presence of an SCD group or a conceptual equivalent; 3) presence of a healthy control group with the same age range; and 4) assessment of olfactory identification ability. RESULTS Five studies met the inclusion criteria. Small and homogeneous effects were observed for olfactory identification alteration in individuals with SCD relative to controls (g = -0.16, 95% CI [-0.46, 0.14]). CONCLUSION Despite the low number of studies included, the findings suggest that odor identification is slightly altered in SCD compared to healthy older adults. This alteration in individuals with SCD could be an early marker of AD.
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Affiliation(s)
- Benoît Jobin
- Department of Psychology, Université du Québec à Trois-Rivières, QC, Canada.,Research Centre of the Hôpital du Sacré-Cœur de Montréal, QC, Canada.,Research Centre of the Institut Universitaire de Gériatrie de Montréal, QC, Canada
| | - Rayane Zahal
- Research Centre of the Hôpital du Sacré-Cœur de Montréal, QC, Canada.,Department of Psychology, Université de Montréal, QC, Canada
| | - Eve-Line Bussières
- Department of Psychology, Université du Québec à Trois-Rivières, QC, Canada
| | - Johannes Frasnelli
- Research Centre of the Hôpital du Sacré-Cœur de Montréal, QC, Canada.,Department of Anatomy, Université du Québec à Trois-Rivières, QC, Canada
| | - Benjamin Boller
- Department of Psychology, Université du Québec à Trois-Rivières, QC, Canada.,Research Centre of the Institut Universitaire de Gériatrie de Montréal, QC, Canada
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30
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Pollock D, Tricco AC, Peters MDJ, McInerney PA, Khalil H, Godfrey CM, Alexander LA, Munn Z. Methodological quality, guidance, and tools in scoping reviews: a scoping review protocol. JBI Evid Synth 2021; 20:1098-1105. [PMID: 34446668 DOI: 10.11124/jbies-20-00570] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review is to identify and report upon evidence (such as guidance) or tools regarding methodological quality or risk of bias of scoping reviews. INTRODUCTION Scoping reviews have gained popularity in recent years but have been criticized for variations in their approaches. This scoping review will examine evidence on the methodological quality of scoping reviews, as well as identify and describe potential tools to inform the development of a tool for appraising the quality of scoping reviews. INCLUSION CRITERIA The scoping review will include all documents reporting on the development, evaluation, or conduct of tools addressing the critical appraisal or risk of bias of scoping reviews. The literature search will seek evidence published from 2005 onwards, corresponding with the publication of Arksey and O'Malley's framework for scoping reviews. METHODS The search strategy will aim to locate both published and unpublished documents utilizing a three-step search strategy. An initial search of PubMed has identified keyword and MeSH terms. A second search of PubMed, Embase, and CINAHL will follow. Google and Google Scholar will be searched for difficult-to-locate and unpublished literature. Authors will endeavor to consult with relevant methodologists through the authors' professional networks, social media accounts, and professional newsletters to obtain materials that can be considered for inclusion. Documents will be independently screened, selected, and extracted by two researchers and the data will be presented in tables.
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Affiliation(s)
- Danielle Pollock
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada Epidemiology Division, Dalla Lana School of Public Health and Institute for Health, Management, and Evaluation, University of Toronto, Toronto, ON, Canada Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Kingston, ON, Canada University of South Australia, UniSA Clinical and Health Sciences, Rosemary Bryant AO Research Centre, Adelaide, SA, Australia Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia The Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence, Adelaide, SA, Australia The Wits-JBI Centre for Evidence-Based Practice: A JBI Affiliated Group, Faculty of Health Sciences, University of the Witwatersrand, South Africa School of Psychology and Public Health, Department of Public Health, La Trobe University, Melbourne, Vic, Australia Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Kingston, ON, Canada School of Health Sciences, Robert Gordon University, Aberdeen, Great Britain The Scottish Centre for Evidence-based Multi-professional Practice: A JBI Centre of Excellence, Aberdeen, Great Britain
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31
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Mamikutty R, Aly AS, Marhazlinda J. Selecting Risk of Bias Tools for Observational Studies for a Systematic Review of Anthropometric Measurements and Dental Caries among Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8623. [PMID: 34444374 PMCID: PMC8391268 DOI: 10.3390/ijerph18168623] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 12/04/2022]
Abstract
In conducting a systematic review, assessing the risk of bias of the included studies is a vital step; thus, choosing the most pertinent risk of bias (ROB) tools is crucial. This paper determined the most appropriate ROB tools for assessing observational studies in a systematic review assessing the association between anthropometric measurements and dental caries among children. First, we determined the ROB tools used in previous reviews on a similar topic. Subsequently, we reviewed articles on ROB tools to identify the most recommended ROB tools for observational studies. Of the twelve ROB tools identified from the previous steps, three ROB tools that best fit the eight criteria of a good ROB tool were the Newcastle-Ottawa Scale (NOS) for cohort and case-control studies, and Agency for Healthcare Research and Quality (AHRQ) and the Effective Public Health Practice Project (EPHPP) for a cross-sectional study. We further assessed the inter-rater reliability for all three tools by analysing the percentage agreement, inter-class correlation coefficient (ICC) and kappa score. The overall percentage agreements and reliability scores of these tools ranged from good to excellent. Two ROB tools for the cross-sectional study were further evaluated qualitatively against nine of a tool's advantages and disadvantages. Finally, the AHRQ and NOS were selected as the most appropriate ROB tool to assess cross-sectional and cohort studies in the present review.
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Affiliation(s)
- Rokiah Mamikutty
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia; (R.M.); (A.S.A.)
- Oral Health Programme, Ministry of Health Malaysia, Federal Government Administrative Centre, Putrajaya 62590, Malaysia
| | - Ameera Syafiqah Aly
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia; (R.M.); (A.S.A.)
- Oral Health Programme, Ministry of Health Malaysia, Federal Government Administrative Centre, Putrajaya 62590, Malaysia
| | - Jamaludin Marhazlinda
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia; (R.M.); (A.S.A.)
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Matthews D, Elgueta Cancino E, Falla D, Khatibi A. Exploring pain interference with motor skill learning in humans: a protocol for a systematic review. BMJ Open 2021; 11:e045841. [PMID: 34272217 PMCID: PMC8287617 DOI: 10.1136/bmjopen-2020-045841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Motor skill learning is intrinsic to living. Pain demands attention and may disrupt non-pain-related goals such as learning new motor skills. Although rehabilitation approaches have used motor skill learning for individuals in pain, there is uncertainty on the impact of pain on learning motor skills. METHODS AND ANALYSIS The protocol of this systematic review has been designed and is reported in accordance with criteria set out by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Web of Science, Scopus, MEDLINE, Embase and CINAHL databases; key journals; and grey literature will be searched up until March 2021, using subject-specific searches. Two independent assessors will oversee searching, screening and extracting of data and assessment of risk of bias. Both behavioural and activity-dependent plasticity outcome measures of motor learning will be synthesised and presented. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION No patient data will be collected, and therefore, ethical approval was not required for this review. The results of this review will provide further understanding into the complex effects of pain and may guide clinicians in their use of motor learning strategies for the rehabilitation of individuals in pain. The results of this review will be published in a peer-reviewed journal and presented at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42020213240.
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Affiliation(s)
- David Matthews
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Edith Elgueta Cancino
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Ali Khatibi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
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del Carpio L, Paul S, Paterson A, Rasmussen S. A systematic review of controlled studies of suicidal and self-harming behaviours in adolescents following bereavement by suicide. PLoS One 2021; 16:e0254203. [PMID: 34242305 PMCID: PMC8270178 DOI: 10.1371/journal.pone.0254203] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/23/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Research suggests that being exposed to the suicide of others increases risk of subsequent suicidal or self-harming thoughts or behaviours. What is less clear is whether this applies to adolescents, and if the risk exceeds that following other causes of death, which has implications on suicide prevention approaches. This study aimed to systematically review the evidence on adolescent bereavement experiences by different causes to address this gap. METHODS A comprehensive literature search using four databases (MEDLINE, PsycInfo, Web of Science, and Embase) identified 21 studies which measured suicidal or self-harm outcomes among bereaved adolescents aged between 12 to 18 years old. The literature was screened, data was extracted using pre-piloted forms, and risk of bias was assessed using versions of the Newcastle-Ottawa Scale; a proportion of papers were double extracted and assessed for bias. The review has been registered with PROSPERO (CRD42016051125). RESULTS A narrative synthesis of the literature demonstrated divergent findings depending on the outcome being measured. Suicide bereavement appears to be strongly associated with suicide mortality among parentally bereaved youth, while self-harm or non-fatal suicide attempts (either presenting to hospital or self-reported) showed mixed evidence. Suicidal ideation was not uniquely associated with suicide bereavement. An exploration of circumstances surrounding the death, characteristics of the person who died, and characteristics of the young person across each outcome measure suggested that earlier experiences of loss, shorter timeframes following the death, and maternal death are associated with particularly elevated risk of suicidal outcomes. CONCLUSIONS Findings suggest that suicide loss is associated with subsequent suicide, and may be associated with non-fatal self-harm. A detailed account of the risk and protective factors surrounding suicide bereavement among young people is crucial to understand the pathways through which suicidal behaviours develop. Researchers, policy makers and practitioners with an interest in suicide prevention will benefit from clarity around the needs of young bereaved individuals.
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Affiliation(s)
- Laura del Carpio
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Sally Paul
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, United Kingdom
| | - Abigail Paterson
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Susan Rasmussen
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
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A Systematic Review and Meta-Analysis of the Association Between Perceived Injustice and Depression. THE JOURNAL OF PAIN 2021; 22:643-654. [DOI: 10.1016/j.jpain.2020.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/27/2020] [Accepted: 12/16/2020] [Indexed: 12/30/2022]
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Moloney NA, Pocovi NC, Dylke ES, Graham PL, De Groef A. Psychological Factors Are Associated with Pain at All Time Frames After Breast Cancer Surgery: A Systematic Review with Meta-Analyses. PAIN MEDICINE 2021; 22:915-947. [PMID: 33547465 DOI: 10.1093/pm/pnaa363] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This systematic review aimed to 1) assess associations between psychological factors and pain after breast cancer (BC) treatment and 2) determine which preoperative psychological factors predicted pain in the acute, subacute, and chronic time frames after BC surgery. DESIGN A systematic review with meta-analysis. SUBJECTS Women with early-stage BC. METHODS The Medline, EMBASE, CINAHL, and Web of Science databases were searched between 1990 and January 2019. Studies that evaluated psychological factors and pain after surgery for early-stage BC were included. Associations between psychological factors and pain, from early after surgery to >12 months after surgery, were extracted. Effect size correlations (r equivalents) were calculated and pooled by using random-effects meta-analysis models. RESULTS Of 4,137 studies, 47 were included (n = 15,987 participants; 26 studies ≤12 months after surgery and 22 studies >12 months after surgery). The majority of the studies had low to moderate risk of bias. Higher preoperative anxiety and depression were weak but significant predictors of pain at all time points up to 12 months (r equivalent: 0.15-0.22). Higher preoperative pain catastrophizing and distress were also weak but significant predictors of pain during the acute (0-7 days) and chronic (3-12 months) periods (r equivalent: 0.10-0.20). For the period >12 months after surgery, weak but significant cross-sectional associations with pain were identified for anxiety, depression, pain catastrophizing, and distress (r equivalents: 0.15, 0.17, 0.25, 0.14, respectively). CONCLUSION Significant pooled effect size correlations between psychological factors and pain were identified across all time frames. Though weak, these associations should encourage assessment of key psychological factors during preoperative screening and pain assessments at all postoperative time frames.
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Affiliation(s)
- Niamh A Moloney
- Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.,THRIVE Physiotherapy, Guernsey, Channel Islands
| | - Natasha C Pocovi
- Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Elizabeth S Dylke
- Faculty of Medicine and Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Petra L Graham
- Department of Mathematics and Statistics, Faculty of Science and Engineering, Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie Business School, and Macquarie University, Sydney, NSW, Australia
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
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Feasibility, acceptability, and efficacy of online supportive care for individuals living with and beyond lung cancer: a systematic review. Support Care Cancer 2021; 29:6995-7011. [PMID: 34008080 PMCID: PMC8130779 DOI: 10.1007/s00520-021-06274-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/04/2021] [Indexed: 12/01/2022]
Abstract
Purpose To examine the evidence of the feasibility, acceptability, and potential efficacy of online supportive care interventions for people living with and beyond lung cancer (LWBLC). Methods Studies were identified through searches of Medline, EMBASE, PsychINFO, and CINAHL databases using a structured search strategy. The inclusion criteria (1) examined the feasibility, acceptability, and/or efficacy of an online intervention aiming to provide supportive care for people living with and beyond lung cancer; (2) delivered an intervention in a single arm or RCT study pre/post design; (3) if a mixed sample, presented independent lung cancer data. Results Eight studies were included; two randomised controlled trials (RCTs). Included studies reported on the following outcomes: feasibility and acceptability of an online, supportive care intervention, and/or changes in quality of life, emotional functioning, physical functioning, and/or symptom distress. Conclusion Preliminary evidence suggests that online supportive care among individuals LWBLC is feasible and acceptable, although there is little high-level evidence. Most were small pilot and feasibility studies, suggesting that online supportive care in this group is in its infancy. The integration of online supportive care into the cancer pathway may improve quality of life, physical and emotional functioning, and reduce symptom distress. Online modalities of supportive care can increase reach and accessibility of supportive care platforms, which could provide tailored support. People LWBLC display high symptom burden and unmet supportive care needs. More research is needed to address the dearth of literature in online supportive care for people LWBLC. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06274-x.
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Munn Z, Barker TH, Moola S, Tufanaru C, Stern C, McArthur A, Stephenson M, Aromataris E. Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Evid Synth 2021; 18:2127-2133. [PMID: 33038125 DOI: 10.11124/jbisrir-d-19-00099] [Citation(s) in RCA: 356] [Impact Index Per Article: 118.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Systematic reviews provide a rigorous synthesis of the best available evidence regarding a certain question. Where high-quality evidence is lacking, systematic reviewers may choose to rely on case series studies to provide information in relation to their question. However, to date there has been limited guidance on how to incorporate case series studies within systematic reviews assessing the effectiveness of an intervention, particularly with reference to assessing the methodological quality or risk of bias of these studies. METHODS An international working group was formed to review the methodological literature regarding case series as a form of evidence for inclusion in systematic reviews. The group then developed a critical appraisal tool based on the epidemiological literature relating to bias within these studies. This was then piloted, reviewed, and approved by JBI's international Scientific Committee. RESULTS The JBI critical appraisal tool for case series studies includes 10 questions addressing the internal validity and risk of bias of case series designs, particularly confounding, selection, and information bias, in addition to the importance of clear reporting. CONCLUSION In certain situations, case series designs may represent the best available evidence to inform clinical practice. The JBI critical appraisal tool for case series offers systematic reviewers an approved method to assess the methodological quality of these studies.
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Affiliation(s)
- Zachary Munn
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Timothy Hugh Barker
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Sandeep Moola
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,The George Institute for Global Health, Telangana, India
| | - Catalin Tufanaru
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.,Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Sydney, NSW, Australia
| | - Cindy Stern
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Alexa McArthur
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Matthew Stephenson
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Edoardo Aromataris
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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D'Andrea E, Vinals L, Patorno E, Franklin JM, Bennett D, Largent JA, Moga DC, Yuan H, Wen X, Zullo AR, Debray TPA, Sarri G. How well can we assess the validity of non-randomised studies of medications? A systematic review of assessment tools. BMJ Open 2021; 11:e043961. [PMID: 33762237 PMCID: PMC7993210 DOI: 10.1136/bmjopen-2020-043961] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/15/2020] [Accepted: 01/09/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To determine whether assessment tools for non-randomised studies (NRS) address critical elements that influence the validity of NRS findings for comparative safety and effectiveness of medications. DESIGN Systematic review and Delphi survey. DATA SOURCES We searched PubMed, Embase, Google, bibliographies of reviews and websites of influential organisations from inception to November 2019. In parallel, we conducted a Delphi survey among the International Society for Pharmacoepidemiology Comparative Effectiveness Research Special Interest Group to identify key methodological challenges for NRS of medications. We created a framework consisting of the reported methodological challenges to evaluate the selected NRS tools. STUDY SELECTION Checklists or scales assessing NRS. DATA EXTRACTION Two reviewers extracted general information and content data related to the prespecified framework. RESULTS Of 44 tools reviewed, 48% (n=21) assess multiple NRS designs, while other tools specifically addressed case-control (n=12, 27%) or cohort studies (n=11, 25%) only. Response rate to the Delphi survey was 73% (35 out of 48 content experts), and a consensus was reached in only two rounds. Most tools evaluated methods for selecting study participants (n=43, 98%), although only one addressed selection bias due to depletion of susceptibles (2%). Many tools addressed the measurement of exposure and outcome (n=40, 91%), and measurement and control for confounders (n=40, 91%). Most tools have at least one item/question on design-specific sources of bias (n=40, 91%), but only a few investigate reverse causation (n=8, 18%), detection bias (n=4, 9%), time-related bias (n=3, 7%), lack of new-user design (n=2, 5%) or active comparator design (n=0). Few tools address the appropriateness of statistical analyses (n=15, 34%), methods for assessing internal (n=15, 34%) or external validity (n=11, 25%) and statistical uncertainty in the findings (n=21, 48%). None of the reviewed tools investigated all the methodological domains and subdomains. CONCLUSIONS The acknowledgement of major design-specific sources of bias (eg, lack of new-user design, lack of active comparator design, time-related bias, depletion of susceptibles, reverse causation) and statistical assessment of internal and external validity is currently not sufficiently addressed in most of the existing tools. These critical elements should be integrated to systematically investigate the validity of NRS on comparative safety and effectiveness of medications. SYSTEMATIC REVIEW PROTOCOL AND REGISTRATION: https://osf.io/es65q.
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Affiliation(s)
- Elvira D'Andrea
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lydia Vinals
- HEOR Department, Cytel Inc, Toronto, Quebec, Canada
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica M Franklin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Dimitri Bennett
- Pharmacoepidemiology, Takeda Pharmaceutical, Cambridge, Massachusetts, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joan A Largent
- Real-World Solutions, IQVIA, California, Los Angeles, USA
| | - Daniela C Moga
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Hongbo Yuan
- Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Ontario, Canada
| | - Xuerong Wen
- Department of Pharmacy Practice, University of Rhode Island, Kingston, RI, USA
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island, USA
- Center of Innovation in Long-term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Thomas P A Debray
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
- Smart Data Analysis and Statistics, Utrecht, The Netherlands
| | - Grammati Sarri
- Real World Evidence Sciences, Visible Analytics Ltd, Oxford, UK
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Gursen C, Dylke ES, Moloney N, Meeus M, De Vrieze T, Devoogdt N, De Groef A. Self-reported signs and symptoms of secondary upper limb lymphoedema related to breast cancer treatment: Systematic review. Eur J Cancer Care (Engl) 2021; 30:e13440. [PMID: 33733550 DOI: 10.1111/ecc.13440] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 01/15/2021] [Accepted: 02/25/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Breast cancer survivors with secondary upper limb lymphoedema (ULL) may report a wide range of self-reported symptoms. At the moment, no overview of ULL-specific symptoms is available. The first aim, therefore, was to compare the prevalence rates of self-reported signs and symptoms in people with and without secondary ULL due to breast cancer treatment. The second aim was to determine whether symptoms of lymphoedema could be predictive for the development of ULL. The third aim was to describe the association between the presence/severity of symptoms and the presence/severity of ULL. METHODS A systematic search was conducted in Medline, Scopus, CINAHL and EMBASE databases, with key words related to breast cancer, symptoms and ULL. RESULTS Twenty-nine articles were eligible. The most frequently reported signs and symptoms were swelling (80.9%) and heaviness (66.7%) in the ULL group and tenderness (37%) and numbness (27%) in the non-ULL group. Perceived larger arm size, as well as feelings of arm tightness, stiffness, puffiness, pain, sensory disturbances and functional changes were predictive for the development of ULL. Moderate correlations were found between the presence of swelling, firmness in the past year and tightness now and severity of ULL. There was also moderate correlation between the presence of swelling and heaviness now and the presence of ULL. CONCLUSIONS Swelling and heaviness are the most commonly reported symptoms in patients with ULL. The presences of these two symptoms are moderately correlated with the presence and/or severity of ULL. Although limited information regarding the predictive self-reported symptoms for the development of ULL was found. Further research with standardised definitions of ULL and validated questionnaires for self-reported signs and symptoms are needed to confirm which signs and symptoms are related to ULL and which to other upper limb morbidities.
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Affiliation(s)
- Ceren Gursen
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | | | - Niamh Moloney
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium.,Pain in Motion International Research Group
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, Centre for Lymphedema, Leuven, Belgium
| | - An De Groef
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, Centre for Lymphedema, Leuven, Belgium
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Lee HR, Kim K, Lee SW, Song JH, Lee JH, Hwang SD. Effect of rituximab dose on induction therapy in ABO-incompatible living kidney transplantation: A network meta-analysis. Medicine (Baltimore) 2021; 100:e24853. [PMID: 33725841 PMCID: PMC7969271 DOI: 10.1097/md.0000000000024853] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Rituximab is an induction immunosuppressant essential for ABO-incompatible kidney transplantation (ABOi KT). However, studies on its dosing, which differs among countries and transplant centers, are lacking. Therefore, we retrospectively investigated the effectiveness of the induction dose of rituximab against patient mortality, graft failure, and adverse events. METHODS We included the studies referring to at least 2 of eligible induction doses (200 mg, 200-500 mg, or 500 mg) of rituximab during ABOi KT and relevant outcomes such as patient survival, graft failure, and bacterial and viral infections. We performed direct and indirect network meta-analyses using Bayesian models and ranked different rituximab doses using generation mixed treatment comparison. Publications were retrieved using CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded databases from 1970 to February 2020 and analyzed. The GRADE of network meta-analysis approach specified 4 levels of certainty for a given result: high, moderate, low, and very low. RESULTS Among the 4256 patients from 21 trials, glomerular filtration rate, graft loss, antibody-mediated rejection, T-cell mediated rejection, fungal infection, bacterial infection, and CMV infection did not differ among ABOi groups treated with different rituximab doses. The effect on mortality was significantly higher in rituximab 200 to 500 mg, and rituximab 500 mg groups (odds ratios [OR] 3.5, 95% CrI: 1.3-9.8, and OR 3.0, 95% CrI 1.1-9.8), but not in rituximab 20 mg group (OR 0.45, 95% CrI 0.036-2.5). The incidence of BK virus was significantly lower in the rituximab 200-mg group than in the other groups. DISCUSSION In ABO-incompatible kidney transplantation, low-dose rituximab is more efficacious than higher doses and reduces serious infection risks. Additional randomized controlled trials might be needed to confirm these findings due to small sample size.
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Affiliation(s)
- Hee Ryong Lee
- Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan
| | - Kipyo Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Jin Ho Lee
- Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
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Sevigny EL, Pacula RL, Aloe AM, Medhin DN, Greathouse J. PROTOCOL: The effects of cannabis liberalization laws on health, safety, and socioeconomic outcomes: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1137. [PMID: 37050965 PMCID: PMC8356275 DOI: 10.1002/cl2.1137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Affiliation(s)
- Eric L. Sevigny
- Department of Criminal Justice and Criminology, Andrew Young School of Policy StudiesGeorgia State UniversityAtlantaGeorgiaUSA
| | - Rosalie L. Pacula
- Sol Price School of Public Policy and Schaeffer Center for Health Policy & EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Ariel M. Aloe
- College of EducationUniversity of IowaIowa CityIowaUSA
| | - Danye N. Medhin
- Department of Criminal Justice and Criminology, Andrew Young School of Policy StudiesGeorgia State UniversityAtlantaGeorgiaUSA
| | - Jared Greathouse
- Department of Political ScienceGeorgia State UniversityAtlantaGeorgiaUSA
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Abstract
Objectives Because of the heterogeneous nature of the evidence regarding dentists’ job satisfaction, an overview was necessary to examine dentists’ level of job satisfaction and to determine related work environmental factors. Materials and methods A literature search was conducted using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Electronic database searches of PubMed/MEDLINE, EMBASE, and Web of Science were performed until March 1, 2020. Two independent authors collected data and assessed the methodological quality of primary studies using the Newcastle Ottawa Scale. Results Nine studies were included from the 1987 initially retrieved. Among the included studies, 5 exhibited a neutral level of satisfaction and originated from China, South Korea, Egypt, and the United States, and 3 studies from Canada, Lithuania, and the United States showed a high level of satisfaction. Only 1 study did not report the mean job satisfaction score. According to bias evaluation, 9 studies were considered low risk. Conclusion The findings showed that dentists were satisfied with their jobs at a moderate to high level, and specialists were more satisfied than general dentists. Regarding work environmental factors, the 6 most satisfied factors were patient relationships, respect, delivery of care, staff, professional relationship, and professional environment. Five of the least satisfied factors were personal time, stress, income, practice management, and professional time. However, longitudinal studies would be required to identify changes in these factors. Further studies should be performed in middle- and low-income countries using the Dentist Satisfaction Survey, including stress evaluation.
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Affiliation(s)
- Van Nhat Thang Le
- Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Republic of Korea; Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea; Faculty of Odonto-Stomatology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Minh-Huy Dang
- Faculty of Odonto-Stomatology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Jae-Gon Kim
- Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Republic of Korea; Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Yeon-Mi Yang
- Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Republic of Korea; Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Dae-Woo Lee
- Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Republic of Korea; Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
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Jung RG, Di Santo P, Clifford C, Prosperi-Porta G, Skanes S, Hung A, Parlow S, Visintini S, Ramirez FD, Simard T, Hibbert B. Methodological quality of COVID-19 clinical research. Nat Commun 2021; 12:943. [PMID: 33574258 PMCID: PMC7878793 DOI: 10.1038/s41467-021-21220-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/13/2021] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic began in early 2020 with major health consequences. While a need to disseminate information to the medical community and general public was paramount, concerns have been raised regarding the scientific rigor in published reports. We performed a systematic review to evaluate the methodological quality of currently available COVID-19 studies compared to historical controls. A total of 9895 titles and abstracts were screened and 686 COVID-19 articles were included in the final analysis. Comparative analysis of COVID-19 to historical articles reveals a shorter time to acceptance (13.0[IQR, 5.0-25.0] days vs. 110.0[IQR, 71.0-156.0] days in COVID-19 and control articles, respectively; p < 0.0001). Furthermore, methodological quality scores are lower in COVID-19 articles across all study designs. COVID-19 clinical studies have a shorter time to publication and have lower methodological quality scores than control studies in the same journal. These studies should be revisited with the emergence of stronger evidence.
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Affiliation(s)
- Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Cole Clifford
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | | | - Annie Hung
- Division of Internal Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Simon Parlow
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sarah Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - F Daniel Ramirez
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
- L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Benjamin Hibbert
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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Deutsch S, Hadaschik B, Lebentrau S, Ubrig B, Burger M, May M. Clinical Importance of a Peritoneal Interposition Flap to Prevent Symptomatic Lymphoceles after Robot-Assisted Radical Prostatectomy and Pelvic Lymph Node Dissection: A Systematic Review and Meta-Analysis. Urol Int 2021; 106:28-34. [PMID: 33567440 DOI: 10.1159/000512960] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Robot-assisted radical prostatectomy (RARP) including pelvic lymph node dissection (PLND) is the current state of the art in surgical therapy of localized prostate cancer with intermediate or high risk. PLND in particular is associated with morbidity inherent to this method; the rate of symptomatic lymphoceles (sLCs), for example, ranges up to 10%. OBJECTIVE Various intraoperative modifications have been developed with the aim of reducing the sLC rate. Based on current studies, a peritoneal interposition flap (PIF) appears to be one of the most effective methods for this purpose. Under the criteria of a systematic review, 5 retrospective studies have been identified until now, 4 of which showed a positive effect of PIF on the sLC rate. RESULTS AND LIMITATIONS A total of 1,308 patients were included in the aggregated analysis of these 5 studies. The amount of sLCs was 1.3% (8/604) and 5.7% (40/704) in the PIF and standard groups, respectively (p < 0.001). The resulting odds ratio (OR) was 0.23 (95% confidence interval [CI]: 0.05-0.99), taking in-to account a noteworthy heterogeneity of the 5 studies (Q = 9.47, p = 0.05; I2 = 58%). In addition, a prospective randomized and blinded study (Pianoforte trial) with corresponding sLC rates of 8.3% (9/108) versus 9.7% (12/124) (p = 0.820) exists. In this study, the OR was 0.85 (95% CI: 0.34-2.10, p = 0.722). CONCLUSION Despite positive results from retrospective studies with indirect evidence, the role of the PIF in the reduction of sLC in RARP could not be conclusively assessed yet. The results of the first prospective randomized study do not show a positive effect of PIF, declaring a research gap for further studies with direct evidence.
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Affiliation(s)
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Steffen Lebentrau
- Department of Urology, Brandenburg Medical School Theodor Fontane, Ruppiner Kliniken, Neuruppin, Germany
| | - Burkhard Ubrig
- Department of Urology, Augusta Kliniken Bochum Hattingen, Bochum, Germany
| | - Max Burger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Matthias May
- Department of Urology, St. Elisabeth-Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
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Arvanitidis M, Falla D, Sanderson A, Martinez-Valdes E. Does pain influence force steadiness? A protocol for a systematic review. BMJ Open 2021; 11:e042525. [PMID: 33419915 PMCID: PMC7798681 DOI: 10.1136/bmjopen-2020-042525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/26/2020] [Accepted: 12/30/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Performing contractions with minimum force fluctuations is essential for everyday life as reduced force steadiness impacts on the precision of voluntary movements and functional ability. Several studies have investigated the effect of experimental or clinical musculoskeletal pain on force steadiness but with conflicting findings. The aim of this systematic review is to summarise the current literature to determine whether pain, whether it be clinical or experimental, influences force steadiness. METHODS AND ANALYSIS This protocol for a systematic review was informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and the Cochrane Handbook for Systematic Reviews of Interventions. Key databases will be searched from inception to 31 August 2020, including MEDLINE, EMBASE, PubMed, CINAHL Plus, ZETOC and Web of Science. Grey literature and key journals will be also reviewed. Risk of bias will be assessed with the Newcastle-Ottawa tool, and the quality of the cumulative evidence assessed with the Grading of Recommendations, Assessment, Development and Evaluation guidelines. If homogeneity exists between groups of studies, meta-analysis will be conducted. Otherwise, a narrative synthesis approach and a vote-counting method will be used, while the results will be presented as net increases or decreases of force steadiness. ETHICS AND DISSEMINATION The findings will be presented at conferences and the review will be also submitted for publication in a refereed journal. No ethical approval was required. PROSPERO REGISTRATION NUMBER CRD42020196479.
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Affiliation(s)
- Michail Arvanitidis
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Andy Sanderson
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, Greater Manchester, UK
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Gates A, Pillay J, Reynolds D, Stirling R, Traversy G, Korownyk C, Moore A, Thériault G, Thombs BD, Little J, Popadiuk C, van Niekerk D, Keto-Lambert D, Vandermeer B, Hartling L. Screening for the prevention and early detection of cervical cancer: protocol for systematic reviews to inform Canadian recommendations. Syst Rev 2021; 10:2. [PMID: 33388083 PMCID: PMC7777363 DOI: 10.1186/s13643-020-01538-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To inform recommendations by the Canadian Task Force on Preventive Health Care on screening in primary care for the prevention and early detection of cervical cancer by systematically reviewing evidence of (a) effectiveness; (b) test accuracy; (c) individuals' values and preferences; and (d) strategies aimed at improving screening rates. METHODS De novo reviews will be conducted to evaluate effectiveness and to assess values and preferences. For test accuracy and strategies to improve screening rates, we will integrate studies from existing systematic reviews with search updates to the present. Two Cochrane reviews will provide evidence of adverse pregnancy outcomes from the conservative management of cervical intraepithelial neoplasia. We will search Medline, Embase, and Cochrane Central (except for individuals' values and preferences, where Medline, Scopus, and EconLit will be searched) via peer-reviewed search strategies and the reference lists of included studies and reviews. We will search ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. Two reviewers will screen potentially eligible studies and agree on those to include. Data will be extracted by one reviewer with verification by another. Two reviewers will independently assess risk of bias and reach consensus. Where possible and suitable, we will pool studies via meta-analysis. We will compare accuracy data per outcome and per comparison using the Rutter and Gatsonis hierarchical summary receiver operating characteristic model and report relative sensitivities and specificities. Findings on values and preferences will be synthesized using a narrative synthesis approach and thematic analysis, depending on study designs. Two reviewers will appraise the certainty of evidence for all outcomes using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and come to consensus. DISCUSSION The publication of guidance on screening in primary care for the prevention and early detection of cervical cancer by the Task Force in 2013 focused on cytology. Since 2013, new studies using human papillomavirus tests for cervical screening have been published that will improve our understanding of screening in primary care settings. This review will inform updated recommendations based on currently available studies and address key evidence gaps noted in our previous review.
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Affiliation(s)
- Allison Gates
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Jennifer Pillay
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Donna Reynolds
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Rob Stirling
- Centre for Chronic Disease Prevention and Health Equity, Public Health Agency of Canada, Ottawa, Canada
| | - Gregory Traversy
- Centre for Chronic Disease Prevention and Health Equity, Public Health Agency of Canada, Ottawa, Canada
| | | | - Ainsley Moore
- Family Medicine, McMaster University, Hamilton, Canada
| | | | - Brett D. Thombs
- Faculty of Medicine, McGill University and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Dirk van Niekerk
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, Canada
| | - Diana Keto-Lambert
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
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Daoud AK, Hall JK, Petrick H, Strong A, Piggott C. The Potential for Cloth Masks to Protect Health Care Clinicians From SARS-CoV-2: A Rapid Review. Ann Fam Med 2021; 19:55-62. [PMID: 33431393 PMCID: PMC7800735 DOI: 10.1370/afm.2640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/20/2020] [Accepted: 08/03/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has led at times to a scarcity of personal protective equipment, including medical masks, for health care clinicians, especially in primary care settings. The objective of this review was to summarize current evidence regarding the use of cloth masks to prevent respiratory viral infections, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), among health care clinicians. METHODS We searched 5 databases, the Centers for Disease Control and Prevention website, and the reference lists of identified articles on April 3, 2020. All identified publications were independently screened by 2 reviewers. Two authors independently extracted data and graded the studies. Randomized control trials (RCTs) were graded using the Consolidated Standards of Reporting Trials (CONSORT) checklist, and observational and nonhuman subject studies were graded using 11 domains common across frequently used critical appraisal tools. All discrepancies were resolved by consensus. RESULTS Our search identified 136 original publications. Nine studies met inclusion criteria. We performed a qualitative synthesis of the data from these studies. Four nonrandomized trials, 3 laboratory studies, 1 single-case experiment, and 1 RCT were identified. The laboratory studies found that cloth materials provided measurable levels of particle filtration but were less efficacious at blocking biologic material than medical masks. The RCT found that cloth masks were associated with significantly more viral infections than medical masks. CONCLUSIONS The current literature suggests that cloth materials are somewhat efficacious in filtering particulate matter and aerosols but provide a worse fit and inferior protection compared to medical masks in clinical environments. The quality and quantity of literature addressing this question are lacking. Cloth masks lack evidence for adequate protection of health care clinicians against respiratory viral infections.
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Affiliation(s)
- Ariel Kiyomi Daoud
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Jessica Kole Hall
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Haylie Petrick
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Anne Strong
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Abstract
Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patient to reach appropriate health-care decisions. The synthesis and translation of a large amount of evidence into practice recommendations should ultimately reduce the use of unnecessary or harmful interventions, help patients to achieve maximum benefit, and minimize risk, all at an acceptable cost.In the past, CPGs were developed based on expert opinion, and using consensus methodology either formally or informally. Over the last 30 years, the evolution of increasingly transparent and robust methodology has led to more "evidence-based" recommendations. Clinical practice guidelines should be developed within the principles of bias minimization, systematic evidence retrieval and review, and a focus on patient relevant outcomes. Multiple nationally based and international groups now have published specific guidance for the development, dissemination, and evaluation of CPG.This chapter describes the key principles of CPG development, including the importance of updating, disseminating, and evaluating the impact of CPG , and attempts to differentiate CPG intended for populations of patients from "evidence-based decision making" for individual patients, recognizing that the fundamental principles are the same.
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Pilkington JJ, Davies TW, Schaff O, Alexander MY, Pritchett J, Wilkinson FL, Sheen AJ. Systemic biomarkers currently implicated in the formation of abdominal wall hernia: A systematic review of the literature. Am J Surg 2020; 222:56-66. [PMID: 33189313 DOI: 10.1016/j.amjsurg.2020.10.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgery to the abdominal wall is ubiquitous worldwide and hernia treatment is challenging and expensive, posing a critical need to tailor treatment to individual patient risk-factors. In this systematic review, we consider specific systemic factors with potential as biomarkers of hernia formation. METHODS A healthcare database-assisted search, following PRISMA guidelines, identified journal articles for inclusion and analysis. RESULTS 14 biomarker studies were selected, comparing hernia patients and hernia-free controls, focusing on markers of extracellular matrix (ECM) remodelling and collagen turnover. Matrix metalloproteinase-2 was increased in patients with inguinal hernia. Markers of type IV collagen synthesis were increased in patients with abdominal wall hernia; while markers of fibrillar collagen synthesis were reduced. Additional other ECM signalling proteins differ significantly within published studies. CONCLUSION We identify a lack of high-quality evidence of systemic biomarkers in tailoring treatment strategies relative to patient-specific risks, but recognise the potential held within biomarker-based diagnostic studies to improve management of hernia pathogeneses.
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Affiliation(s)
- J J Pilkington
- Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK; Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - T W Davies
- Department of Anaesthesia, Royal Free London NHS Foundation Trust, London, UK; UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, London, UK
| | - O Schaff
- Trust Library Services, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Y Alexander
- Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK
| | - J Pritchett
- Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK
| | - F L Wilkinson
- Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK
| | - A J Sheen
- Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK; Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
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Nichani P, Micieli JA. Retinal Manifestations of Idiopathic Intracranial Hypertension. Ophthalmol Retina 2020; 5:429-437. [PMID: 32860958 DOI: 10.1016/j.oret.2020.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/12/2020] [Accepted: 08/19/2020] [Indexed: 11/26/2022]
Abstract
TOPIC This review presents a case series and systematic review to understand retinal changes in patients with idiopathic intracranial hypertension (IIH) using fundus photography and OCT. CLINICAL RELEVANCE IIH is a condition of raised intracranial pressure of unknown cause, usually observed in young, obese women. Ophthalmologic manifestations of IIH such as papilledema and abducens nerve palsy are well recognized, but less common retinal manifestations may occur. METHODS A retrospective institutional chart review (July 2018-March 2020) was performed on consecutive IIH patients. Fundus photographs were obtained followed by neuro-ophthalmology assessment to elicit clinical characteristics and for diagnosis. Patients who met the modified Dandy criteria were included. A systematic review of observational studies was conducted using Ovid MEDLINE and EMBASE to November 17, 2019, to supplement the case series data. RESULTS Of 144 consecutive IIH clinical patients reviewed, 10 (6.9%) and over 182 patients from the literature showed retinal findings (% in case series, % in literature, respectively): subretinal fluid (SRF; 30,9), chorioretinal folds (30,68), macular exudate (ME; 20,5), choroidal neovascular membrane (CNVM; 10,15), venous stasis retinopathy (VSR; 10,2), choroidal infarction (0,1), and branch retinal artery occlusion (BRAO; 0,1). Eight clinical patients were women (80%), average age was 32.00 ± 13.99 years, body mass index was 40.63 ± 7.43 kg/m2, baseline visual acuity (VA) was 0.79 ± 0.30 in both eyes, and visual field (VF) results were -9.89 ± 11.52 dB in both eyes. Among clinical patients, 2 (1 with SRF, 1 with CNVM) had distinctive retina-related VF defects at presentation. Outer retinal abnormalities persisted on OCT in patients after resolution of SRF and papilledema. Surgical treatment (peritoneal shunt) was required for 2 patients (1 with VSR, 1 with SRF); others were treated with weight loss and acetazolamide alone. The patient with significant ME had hypertension that was treated. DISCUSSION Significant retinal manifestations associated with IIH include CNVM, ME, SRF, VSR, chorioretinal folds, choroidal infarction, and BRAO. These may reduce VA or cause VF defects unrelated to papilledema, emphasizing the importance of a detailed dilated fundus examination. Consultation with a retina specialist is advised in patients with peripapillary CNVM.
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Affiliation(s)
- Prem Nichani
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jonathan A Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada; Kensington Vision and Research Centre, Toronto, Canada.
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