Types of studies and research design

Advancing Patient Setup: A Comprehensive Scoping Review of Tattoo-less Techniques in Radiation Therapy

In recent years, alternative methods to dark ink tattoos for patient positioning in radiotherapy have been explored. This review aims to analyse the evidence for alternative strategies to traditional dark tattoos. An electronic search was conducted in PubMed, EMBASE, Cochrane Library, Web of Sciences and SCOPUS. Twenty-one articles out of 383 titles fulfilled the selection criteria and were included in the review. These studies were categorized into tattoo-less methods (n=14), UV ink tattoos (n=4) and other techniques (n=3). In most of the selected articles (n=13) focusing on tattoo-less treatments, SGRT is used for patient positioning. These three alternative techniques to dark tattoos are used in different anatomical regions and treatment modalities, with breast cancer being the most prevalent. Tattoo-less techniques are a promising alternative to traditional tattoo-based methods for patient positioning. They have the potential to improve the patient experience and represent an area of ongoing innovation and improvement.

Open-Face Masks in Radiotherapy: Enhancing Therapeutic Strategies for Head and Neck and Brain Cancer Patients-A Comprehensive Scoping Review

Introduction: The main goal of radiotherapy (RT) is to deliver a precise dose to the target while sparing the surrounding normal tissue and minimizing side effects. Appropriate patient immobilization is crucial, especially for head and neck cancer (HNC) and Brain Cancer (BC). Conventional closed-face masks (CFMs), while effective in minimizing head motion, can cause significant discomfort, anxiety, and claustrophobia. Open-face masks (OFMs) have been developed to increase patient comfort while providing precise immobilization. Methods: Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) extension for scoping reviews and the Arskey and O'Malley framework, an electronic search of EMBASE, PubMed, SCOPUS, and Web of Science was conducted to identify original studies reporting the use and description of OFMs in clinical practice up to April 2024. The inclusion criteria were English-language articles focusing on OFMs for HNC and BC patients undergoing RT. Results: Of 618 titles, 19 articles fulfilled the selection criteria. Most studies were comparative (n = 13) or observational (n = 6). The articles were categorized by treatment site, resulting in three groups: BC (n = 14, 68.4%), HNC (n = 4, 21.4%), and mixed (n = 2, 10.5%), which includes both BC and HNC. Of note, 82.4% (n = 16) of the included studies were published from 2020 onwards, emphasizing the recent adoption of OFM in clinical practice. Conclusions: The reviewed studies show that OFMs, in combination with SGRT, offer significant advantages in terms of patient comfort and positioning accuracy in HNC and BC treatments. Reproducibility in the sub-millimeter and sub-degree range can be achieved, which supports the use of OFMs in clinical practice. Future research should explore innovative combinations of immobilization and monitoring to further improve RT outcomes and ensure precise treatment while increasing patient comfort.

Overview of health research in Greenland from 2001 to 2020

AIMS

Health research in Greenlanders is challenged by a small population, few dedicated researchers and limited funding. Some research areas have proven impactful but gaps in knowledge are unknown. We aimed to quantify health research in Greenland, providing insights for researchers, policymakers and funding agencies to guide future research.

METHODS

We identified all peer-reviewed health research publications with the term 'Greenland***' in title or abstract from 2001 to 2020 through the platform entitled The Lens. Our bibliometric analysis included number of publications, publication rate, research types, research topics, citations and author affiliations, as well as funding.

RESULTS

From 2001 to 2020, a total of 640 health research publications concerning Greenland or Greenlanders were identified, with an average annual publication growth rate of 2.9%. The major health research topics studied in Greenland were infectious diseases, environmental health and general health. Several research fields, including rheumatology, nephrology and dermatology among others proved understudied at best. Three Danish universities contributed with 33% of all publications, with the International Journal of Circumpolar Health (N=176, 28%) being the top journal destination. The most productive author had 119 article authorships during the period.

CONCLUSION

During the past 20 years, Greenland's annual publication rate has been steadily increasing, with an average of 32 articles about health research published each year, which is a higher publication rate than world average. The health research in Greenland is primarily epidemiologic with infectious disease being the most studied research area. Most publications were anchored in Denmark and centred around a few highly productive authors.

Assessment of Herd, Calf, and Colostrum Management Practices on Austrian Dairy Farms Using a Scoring System

The objectives of the study were to describe colostrum management on Austrian dairy farms and to explore differences between regions (alpine/flatlands), organic and conventional producing farms, and full-time or part-time operated farms. An online survey (24 questions) on general farm characteristics and herd and calf management was sent to 16,246 farmers. In total, 2328 farmers (response rate 14.3%) answered the questionnaire. To allow an objective comparison, a scoring system was implemented. Farm size is, on average, smaller in the alpine regions than in the foothills/flatlands regions of Austria. Small farms were more often organic-producing farms (81.6%) and operated part-time (93.8%). In foothills/flatland regions, 70.0% of farms have a separate calving area, and in the alpine regions, it is solely 42.8%. Colostrum testing is still mostly done by visual appraisal (63.7%); only a few farmers use a colostrometer (8.8%), brix-refractometer (18.3%), or ColostroCheck® (9.2%, a cone-shaped device to rate the flow velocity of colostrum). The results of the present study using the scoring system showed differences in herd and calf management practices in all sectors. In the future, the findings and especially the scoring system can support Austrian dairy farmers or veterinarians to better assess areas of improvement on farms in order to prevent calves from suffering from Failure of Transfer of Passive Immunity.

Study design methodology in neurosurgical research

Background

Medical research has evolved from individual expert-described opinions and techniques to scientifically designed methodology-based studies. There are different study designs, and selecting an appropriate study design is critical to appropriately answer the research question being investigated.

Main body

A research question may be addressed using different approaches that can be descriptive, analytical, or experimental. The choice of study design is influenced by features as that related to exposure (intervention) and disease (outcome); considerations related to time, resources, ethics and gaps in scientific knowledge that remain to be filled. The purpose of this review is to provide an overview of the basic study designs as it is the foundation of neurosurgical research to provide valid scientific evidence.

Conclusion

Quality in scientific research begins with a clear hypothesis and a well-formulated design. This entails a thorough understanding of the different study designs to choose the best suited to answer the investigated research question.

Effect of Lycopene Intake on the Fasting Blood Glucose Level: A Systematic Review with Meta-Analysis

Lycopene is a lipophilic unsaturated carotenoid exhibiting a strong singlet oxygen-quenching ability. Herein, we investigated the effect of lycopene intake on the fasting blood glucose (FBG) level by conducting a systematic review and meta-analyses. We searched 15 databases (from the earliest date to June 2022 for PubMed or to August or September 2018 for the other databases) and included human interventional studies that assessed the effects of oral lycopene intake on FBG levels of participants ≥ 18 years of age. Three authors independently selected applicable studies and then assessed the study quality. Data were pooled as standardized mean difference (SMD) and analyzed by the random-effects model. Heterogeneity was assessed by I² statistics. A meta-analysis including 11 trial arms (n = 750) revealed a tendency towards a significant decrease in FBG level with not-important heterogeneity [SMD = -0.15 (95% CI: -0.31, 0.00), p = 0.05, I² = 9%]. Subgroup meta-analysis including two studies (n = 152) in type 2 diabetes patients revealed significantly decreased FBG levels with not-important heterogeneity [SMD = -0.37 (95% CI: -0.69, -0.05), p = 0.02, I² = 0%]. Most studies meeting the eligibility criteria had a moderate risk of bias. The funnel plot for FBG suggested an absence of publication bias. In conclusion, this systematic review and meta-analyses suggested that lycopene intake exerted an FBG-decreasing effect.

Dissertation writing in post graduate medical education

A dissertation is a practical exercise that educates students about basics of research methodology, promotes scientific writing and encourages critical thinking. The National Medical Commission (India) regulations make assessment of a dissertation by a minimum of three examiners mandatory. The candidate can appear for the final examination only after acceptance of the dissertation. An important role in a dissertation is that of the guide who has to guide his protégés through the process. This manuscript aims to assist students and guides on the basics of conduct of a dissertation and writing the dissertation. For students who will ultimately become researchers, a dissertation serves as an early exercise. Even for people who may never do research after their degree, a dissertation will help them discern the merits of new treatment options available in literature for the benefit of their patients.

How is COVID-19 perceived by medical students? A survey in Aceh province, Indonesia

The coronavirus disease 2019 (COVID-19) has burdened the health system and medical education programmes both locally and globally, requiring medical students to continue their education whilst engaging in prevention programmes to support primary health services. This study aims to describe medical students' knowledge, attitudes in the prevention of COVID-19, and to determine the relationship between the knowledge of COVID-19 preventive behaviour and attitudes towards it. This study used an analytical cross-sectional observational design with a sample of 290 students. Data were collected through a self-assessment method using a validated questionnaire. Analysis of the frequency distribution test for knowledge found that 54.1% of the respondents and 99.0% of the students had a good understanding of the mode of transmission of COVID-19. The majority of medical students (73.1%) also had a good attitude towards COVID-19 and around 84.3% of the students considered that good ethics is needed when coughing or sneezing during this pandemic. As many as 46.6% of the respondents had good preventive behaviour against COVID-19 and always imposed restrictions on using public transportation during a pandemic. The Spearman's correlation test shows a weak but meaningful relationship between knowledge (r = 0.214, p = 0.000) and COVID-19 preventive behaviour, and a significant relationship between attitudes (r = 0.477, p = 0.000) towards COVID-19 preventive behaviour. This study concludes that medical students have good knowledge, preventive behaviour and an understanding of infection risk. An enhanced knowledge and awareness will increase preventive behaviours that will provide support in controlling the disease.

Effects of lycopene intake on HDL-cholesterol and triglyceride levels: A systematic review with meta-analysis

Lycopene is a lipophilic unsaturated carotenoid and has a very strong singlet oxygen-quenching ability. Increased serum or plasma lycopene levels have been reported to be associated with a lower risk of metabolic syndrome. We aimed to investigate the effects of lycopene intake on blood HDL-cholesterol (HCL-c) and triglyceride (TG) levels, which are metabolic syndrome biomarkers, by systematic review and meta-analyses of human interventional trials. We searched 15 databases and included studies that assessed the effects of oral lycopene intake on blood HDL-c and TG levels of participants ≥18 years of age. Three reviewers independently selected applicable studies, then assessed study qualities. Data were pooled as standardized mean difference (SMD) and analyzed by random-effects model. Heterogeneity was assessed by I² statistics. Meta-analysis including 12 trial arms (n = 781) revealed a significantly increased HDL-c level in the lycopene group compared with that in the control group (SMD = 0.33 [95% CI: 0.12, 0.54], p = 0.002) and moderate heterogeneity (I²  = 45%). Most subgroup meta-analyses (restricted to study design, test food type, intake period, and participants' characteristics) showed similar results for HDL-c level. On the other hand, meta-analysis including 11 studies (n = 854) revealed no significant difference in TG level between the lycopene and control groups. Most studies which met eligibility criteria had moderate risk of bias. Funnel plots for HDL-c and TG suggested an absence of publication bias. In conclusion, this systematic review and meta-analyses suggested that lycopene intake significantly improved blood HDL-c levels but not TG levels.

National guidelines on nutrient reference values for the healthy adult population and for pregnant or lactating women are based on heterogeneous sources of evidence: review of guidelines

Many countries provide dietary guidelines for health practitioners and/or the general population. However, there is no general, international guideline serving as a template for national dietary guidelines, and there is little to no consensus regarding reference values for different nutrients. The present review compared 27 national dietary guidelines for healthy adults as well as for pregnant and/or breastfeeding women, and analysed their quality and the evidence behind their recommendations. The guidelines were evaluated for their quality using the instrument Agree II, and found to be heterogeneous (overall quality score 14%-100%) and often insufficient (quality score < 50%) due to missing information about their methodology and sources of evidence. We analysed the evidence (number of studies, study types and publication years) of reference values of a number of nutrients using the five guidelines that provided the highest scores in the Agree II assessment. The reference values varied among guidelines, were rarely based on up-to-date meta-analyses, and were often based on insufficiently reported evidence (22/27 guidelines with quality score < 50%). We recommend systematic reviews of high quality studies to formulate future guidelines, and to use guidelines on how to write guidelines.

The nursing outlook of the self- and family management support programs among Indonesian with diabetes: An umbrella review

BACKGROUND AND AIMS

Diabetes is one of the most critical diseases particularly in developing countries such as Indonesia. Various diabetes approaches have been well conducted to prevent complications. However, little has been discussed in association with the achievement of self- and family management support programs in Indonesia. Thus, the objective of the umbrella review is to evaluate the implementation of the self- and family management support programs among Indonesian with diabetes.

METHOD

To guide this review, the revised self- and family management framework developed by Grey, Schulman-Green, Knafl, and Reynolds (2015) was used. A literature search was conducted via online databases including Cochrane, Scopus, ProQuest, SAGE, EBSCO, and PubMed. The inclusion criteria were diabetes studies related to self- and family management in Indonesia; articles published from 2000 to 2019; quantitative, qualitative, and review studies; used humans as research subjects; and English articles were prioritized. Meanwhile, the exclusion criteria were studies not addressing the nature of self- and family management in Indonesia, laboratory-based research using human cell and study protocol.

RESULTS

A total of 78 studies were involved in the final analysis. The facilitators and barriers, process, and outcomes (distal and proximal) were presented. The results indicated that the implementation of the self- and family management process generated favorable outcomes for the diabetes population in Indonesia.

CONCLUSIONS

The self- and family management support program is a promising strategy to improve the facilitators and overcome the barriers to diabetes care. Patients, families, diabetes nurses, and health policymakers are recommended to work in tandem to achieve successful diabetes care, particularly in the community.

Role of pharmacist during the COVID-19 pandemic: A scoping review

BACKGROUND

Since the start of the new Coronavirus (COVID-19) outbreak in December 2019, pharmacists worldwide are playing a key role adopting innovative strategies to minimize the adverse impact of the pandemic.

OBJECTIVES

To identify and describe core services provided by the pharmacist during the COVID-19 pandemic.

METHODS

A literature search was performed in MEDLINE, Embase, Scopus, and LILACS for studies published between December 1st, 2019 and May 20th, 2020 without language restriction. Studies that reported services provided by pharmacists during the COVID-19 pandemic were included. Two independent authors performed study selection and data extraction with a consensus process. The pharmacist's intervention identified in the included studies were described based on key domains in the DEPICT v.2.

RESULTS

A total of 1189 records were identified, of which 11 studies fully met the eligibility criteria. Most of them were conducted in the United States of America (n = 4) and China (n = 4). The most common type of publication were letters (n = 4) describing the workplace of the pharmacist in hospitals (n = 8). These findings showed the different roles of pharmacists during the COVID-19 pandemic, such as disease prevention and infection control, adequate storage and drug supply, patient care and support for healthcare professionals. Pharmacists' interventions were mostly conducted for healthcare professionals and patients (n = 7), through one-to-one contact (n = 11), telephone (n = 6) or video conference (n = 5). The pharmacists' main responsibility was to provide drug information for healthcare professionals (n = 7) as well as patient counseling (n = 8).

CONCLUSIONS

A reasonable number of studies that described the role of the pharmacists during the COVID-19 pandemic were found. All studies reported actions taken by pharmacists, although without providing a satisfactory description. Thus, future research with more detailed description as well as an evaluation of the impact of pharmacist intervention is needed in order to guide future actions in this and/or other pandemic.

Nursing Personnel in the Era of Personalized Healthcare in Clinical Practice

Personalized, stratified, or precision medicine (PM) introduces a new era in healthcare that tries to identify and predict optimum treatment outcomes for a patient or a cohort. It also introduces new scientific terminologies regarding therapeutic approaches and the need of their adoption from healthcare providers. Till today, evidence-based practice (EBP) was focusing on population averages and their variances among cohorts for clinical values that are essential for optimizing healthcare outcome. It can be stated that EBP and PM are complementary approaches for a modern healthcare system. Healthcare providers through EBP often see the forest (population averages) but miss the trees (individual patients), whereas utilization of PM may not see the forest for the trees. Nursing personnel (NP) play an important role in modern healthcare since they are consulting, educating, and providing care to patients whose needs often needs to be individualized (personalized nursing care, PNC). Based on the clinical issues earlier addressed from clinical pharmacology, EBP, and now encompassed in PM, this review tries to describe the challenges that NP have to face in order to meet the requisites of the new era in healthcare. It presents the demands that should be met for upgrading the provided education and expertise of NP toward an updated role in a modern healthcare system.