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Environmental Health Perspectives Oct 2014Synthesizing what is known about the environmental drivers of health is instrumental to taking prevention-oriented action. Methods of research synthesis commonly used in... (Review)
Review
BACKGROUND
Synthesizing what is known about the environmental drivers of health is instrumental to taking prevention-oriented action. Methods of research synthesis commonly used in environmental health lag behind systematic review methods developed in the clinical sciences over the past 20 years.
OBJECTIVES
We sought to develop a proof of concept of the "Navigation Guide," a systematic and transparent method of research synthesis in environmental health.
DISCUSSION
The Navigation Guide methodology builds on best practices in research synthesis in evidence-based medicine and environmental health. Key points of departure from current methods of expert-based narrative review prevalent in environmental health include a prespecified protocol, standardized and transparent documentation including expert judgment, a comprehensive search strategy, assessment of "risk of bias," and separation of the science from values and preferences. Key points of departure from evidence-based medicine include assigning a "moderate" quality rating to human observational studies and combining diverse evidence streams.
CONCLUSIONS
The Navigation Guide methodology is a systematic and rigorous approach to research synthesis that has been developed to reduce bias and maximize transparency in the evaluation of environmental health information. Although novel aspects of the method will require further development and validation, our findings demonstrated that improved methods of research synthesis under development at the National Toxicology Program and under consideration by the U.S. Environmental Protection Agency are fully achievable. The institutionalization of robust methods of systematic and transparent review would provide a concrete mechanism for linking science to timely action to prevent harm.
Topics: Bias; Decision Support Techniques; Environmental Health; Hazardous Substances; Humans; Interdisciplinary Communication; Review Literature as Topic
PubMed: 24968373
DOI: 10.1289/ehp.1307175 -
Nurse Education in Practice Nov 2023To synthesize and analyze the literature on nursing clinical competence to assess the factors affecting nursing clinical competency. (Review)
Review
AIM
To synthesize and analyze the literature on nursing clinical competence to assess the factors affecting nursing clinical competency.
BACKGROUND
Nursing competence affects not only patients but also nurses themselves. Competent nurses contribute to patient safety. Prioritizing clinical competency enables nurses to deliver high-quality care. Clinical nursing competency is influenced by various factors including education and training, experience, professional development, clinical judgment, decision-making skills and communication.
DESIGN
This was a systematic review.
METHODS
This study utilized an extensive literature search of online databases, including SCOPUS, Web of Science and PubMed. This review followed the guidelines provided by the Effective Practice and Organization of Care (EPOC) Cochrane Group and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
RESULTS
This systematic review provided 20 valuable articles, with a total of 6273 participants across the 20 studies, including 18 cross-sectional studies and two descriptive-correlational studies, predominantly using quantitative research methods. The analysis revealed several key factors that significantly affect nurses' clinical competency. These factors included years of experience, workplace environment, theoretical knowledge and educational level, marital status, clinical training, job satisfaction, turnover intention, job stress and critical thinking.
CONCLUSIONS
Understanding and addressing these factors are crucial for enhancing nurses' clinical competence and ultimately improving patient outcomes. Further research and interventions should be directed towards promoting supportive work environments, continuous education and the development of critical thinking skills among nurses to optimize their clinical competencies.
Topics: Humans; Clinical Competence; Cross-Sectional Studies; Job Satisfaction; Communication; Nurses
PubMed: 37951064
DOI: 10.1016/j.nepr.2023.103826 -
Obesity Reviews : An Official Journal... Dec 2021Although the deleterious effects of obesity have been well documented in terms of morbidity and mortality, less is known about what it is like to live with this complex... (Review)
Review
Although the deleterious effects of obesity have been well documented in terms of morbidity and mortality, less is known about what it is like to live with this complex and chronic disease. This study systematically reviewed and synthesized peer-reviewed studies relating to the lived experience of patients with obesity. A total of 12,388 records were screened, resulting in the inclusion of 32 final studies. Meta-ethnographic synthesis of these 32 studies generated five "third-order constructs" or themes: the development of obesity; a life limited; stigma, judgment, shame, and blame; treatment and; experiences of specific or minority groups. These constructs describe, from the patient's perspective, the factors associated with the development and maintenance of obesity; the effects of the disease on their day-to-day lives; the impact of the stigma and judgment many patients are subjected to; and their experience of accessing, or trying to access, treatment for their healthcare needs. This synthesis reveals the dearth of studies that focus solely on the experience of the patient and highlights the tendency for participant-informed, rather than participatory, methods in obesity research. It concludes with a call for further participatory research into the experiences of people living with obesity.
Topics: Chronic Disease; Delivery of Health Care; Humans; Obesity; Qualitative Research
PubMed: 34402150
DOI: 10.1111/obr.13334 -
Journal of Medical Internet Research Oct 2022When investigating voice disorders a series of processes are used when including voice screening and diagnosis. Both methods have limited standardized tests, which are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
When investigating voice disorders a series of processes are used when including voice screening and diagnosis. Both methods have limited standardized tests, which are affected by the clinician's experience and subjective judgment. Machine learning (ML) algorithms have been used as an objective tool in screening or diagnosing voice disorders. However, the effectiveness of ML algorithms in assessing and diagnosing voice disorders has not received sufficient scholarly attention.
OBJECTIVE
This systematic review aimed to assess the effectiveness of ML algorithms in screening and diagnosing voice disorders.
METHODS
An electronic search was conducted in 5 databases. Studies that examined the performance (accuracy, sensitivity, and specificity) of any ML algorithm in detecting pathological voice samples were included. Two reviewers independently selected the studies, extracted data from the included studies, and assessed the risk of bias. The methodological quality of each study was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool via RevMan 5 software (Cochrane Library). The characteristics of studies, population, and index tests were extracted, and meta-analyses were conducted to pool the accuracy, sensitivity, and specificity of ML techniques. The issue of heterogeneity was addressed by discussing possible sources and excluding studies when necessary.
RESULTS
Of the 1409 records retrieved, 13 studies and 4079 participants were included in this review. A total of 13 ML techniques were used in the included studies, with the most common technique being least squares support vector machine. The pooled accuracy, sensitivity, and specificity of ML techniques in screening voice disorders were 93%, 96%, and 93%, respectively. Least squares support vector machine had the highest accuracy (99%), while the K-nearest neighbor algorithm had the highest sensitivity (98%) and specificity (98%). Quadric discriminant analysis achieved the lowest accuracy (91%), sensitivity (89%), and specificity (89%).
CONCLUSIONS
ML showed promising findings in the screening of voice disorders. However, the findings were not conclusive in diagnosing voice disorders owing to the limited number of studies that used ML for diagnostic purposes; thus, more investigations are needed. While it might not be possible to use ML alone as a substitute for current diagnostic tools, it may be used as a decision support tool for clinicians to assess their patients, which could improve the management process for assessment.
TRIAL REGISTRATION
PROSPERO CRD42020214438; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=214438.
Topics: Algorithms; Humans; Machine Learning; Supervised Machine Learning; Voice Disorders
PubMed: 36239999
DOI: 10.2196/38472 -
International Forum of Allergy &... Sep 2023Despite the significant morbidity associated with chronic rhinosinusitis (CRS) in individuals with asthma (CRSwA), there is a paucity of codified, evidence-based... (Review)
Review
BACKGROUND
Despite the significant morbidity associated with chronic rhinosinusitis (CRS) in individuals with asthma (CRSwA), there is a paucity of codified, evidence-based management strategies for CRS in this population.
METHODS
Using PubMed, Embase, and Cochrane Review Databases, a systematic review was performed covering management strategies for CRSwA. A total of 5903 articles were screened, and 70 were included for full-text analysis. After application of exclusion criteria, 53 articles comprised the qualitative synthesis. The level of evidence was graded and benefit-harm assessments, as well as value judgment and recommendations, were provided RESULTS: Strong evidence confirms the benefit of oral and topical medications on sinonasal-specific outcomes in individuals with CRSwA; there is low-grade evidence demonstrating that these agents improve lung function and/or asthma control. Moderate to strong evidence suggests that endoscopic sinus surgery (ESS) improves both sinonasal- and asthma-specific quality of life. Although there is insufficient to low evidence to indicate that ESS improves pulmonary function in this population, data indicate a positive impact of this intervention on asthma control. Biologic medications strongly improve both subjective and objective sinonasal- and asthma-specific outcomes.
CONCLUSION
Evidence supports managing CRS in individuals with CRSwA in a stepwise fashion, starting with traditional nonbiologic oral and topical medication, and escalating to second-line treatments, such as ESS and biologics. Optimal treatment of individuals who have CRSwA often requires concurrent, directed management of asthma, as not all CRS interventions impact asthma status.
Topics: Humans; Quality of Life; Rhinitis; Sinusitis; Asthma; Chronic Disease; Endoscopy
PubMed: 36579899
DOI: 10.1002/alr.23130 -
Journal of Orthopaedic Surgery and... Dec 2022In the emergency room, clinicians spend a lot of time and are exposed to mental stress. In addition, fracture classification is important for determining the surgical...
BACKGROUND
In the emergency room, clinicians spend a lot of time and are exposed to mental stress. In addition, fracture classification is important for determining the surgical method and restoring the patient's mobility. Recently, with the help of computers using artificial intelligence (AI) or machine learning (ML), diagnosis and classification of hip fractures can be performed easily and quickly. The purpose of this systematic review is to search for studies that diagnose and classify for hip fracture using AI or ML, organize the results of each study, analyze the usefulness of this technology and its future use value.
METHODS
PubMed Central, OVID Medline, Cochrane Collaboration Library, Web of Science, EMBASE, and AHRQ databases were searched to identify relevant studies published up to June 2022 with English language restriction. The following search terms were used [All Fields] AND (", "[MeSH Terms] OR (""[All Fields] AND "bone"[All Fields]) OR "bone fractures"[All Fields] OR "fracture"[All Fields]). The following information was extracted from the included articles: authors, publication year, study period, type of image, type of fracture, number of patient or used images, fracture classification, reference diagnosis of fracture diagnosis and classification, and augments of each studies. In addition, AI name, CNN architecture type, ROI or important region labeling, data input proportion in training/validation/test, and diagnosis accuracy/AUC, classification accuracy/AUC of each studies were also extracted.
RESULTS
In 14 finally included studies, the accuracy of diagnosis for hip fracture by AI was 79.3-98%, and the accuracy of fracture diagnosis in AI aided humans was 90.5-97.1. The accuracy of human fracture diagnosis was 77.5-93.5. AUC of fracture diagnosis by AI was 0.905-0.99. The accuracy of fracture classification by AI was 86-98.5 and AUC was 0.873-1.0. The forest plot represented that the mean AI diagnosis accuracy was 0.92, the mean AI diagnosis AUC was 0.969, the mean AI classification accuracy was 0.914, and the mean AI classification AUC was 0.933. Among the included studies, the architecture based on the GoogLeNet architectural model or the DenseNet architectural model was the most common with three each. Among the data input proportions, the study with the lowest training rate was 57%, and the study with the highest training rate was 95%. In 14 studies, 5 studies used Grad-CAM for highlight important regions.
CONCLUSION
We expected that our study may be helpful in making judgments about the use of AI in the diagnosis and classification of hip fractures. It is clear that AI is a tool that can help medical staff reduce the time and effort required for hip fracture diagnosis with high accuracy. Further studies are needed to determine what effect this causes in actual clinical situations.
Topics: Humans; Artificial Intelligence; Hip Fractures; Machine Learning; Databases, Factual; Emergency Service, Hospital
PubMed: 36456982
DOI: 10.1186/s13018-022-03408-7 -
Ultrasound in Obstetrics & Gynecology :... Dec 2017To establish reference values for flow-mediated dilatation (FMD) and brachial artery diameter (BAD) in pregnancy and to provide insight into the physiological and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To establish reference values for flow-mediated dilatation (FMD) and brachial artery diameter (BAD) in pregnancy and to provide insight into the physiological and pathological course of endothelial adaptation throughout human singleton pregnancy.
METHODS
A meta-analysis was performed following a systematic review of current literature on FMD, as a derivative for endothelial function, and BAD, throughout uncomplicated and complicated pregnancy. PubMed (NCBI) and EMBASE (Ovid) electronic databases were used for the literature search, which was performed from inception to 9 June 2016. To allow judgment of changes in comparison with the non-pregnant state, studies were required to report both non-pregnant mean reference of FMD (matched control group, prepregnancy or postpartum measurement) and mean FMD at a predetermined and reported gestational age. Pooled mean differences between the reference and pregnant FMD values were calculated for predefined intervals of gestational age.
RESULTS
Fourteen studies that enrolled 1231 participants met the inclusion criteria. Publication dates ranged from 1999 to 2014. In uncomplicated pregnancy, FMD was increased in the second and third trimesters. Between 15 and 21 weeks of gestation, absolute FMD increased the most, by a mean (95% CI) of 1.89% (0.25-3.53%). This was a relative increase of 22.5% (3.0-42.0%) compared with the non-pregnant reference. BAD increased progressively, in a steady manner, by the second trimester but not significantly in the first half of the second trimester. We could not discern differences in FMD and BAD between complicated and uncomplicated pregnancies at 29-35 weeks' gestation, reported in the three studies that met our inclusion criteria. Despite the increase in FMD and BAD throughout gestation, both reference curves were characterized by wide 95% CIs.
CONCLUSION
During healthy pregnancy, endothelium-dependent vasodilatation and BAD increase. Women with a complicated pregnancy had FMD values within the lower range when compared with those with uncomplicated pregnancy but, as a group, did not differ from each other. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Adaptation, Physiological; Brachial Artery; Endothelium, Vascular; Female; Humans; Hypertension, Pregnancy-Induced; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Regional Blood Flow; Vasodilation
PubMed: 28170124
DOI: 10.1002/uog.17431 -
PloS One 2017This systematic review and meta-analysis aims to assess the therapeutic and adverse effects of acupuncture for benign prostatic hyperplasia (BPH) in randomized... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This systematic review and meta-analysis aims to assess the therapeutic and adverse effects of acupuncture for benign prostatic hyperplasia (BPH) in randomized controlled trials (RCTs).
METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, the Chinese Biomedical Database, the China National Knowledge Infrastructure, the VIP Database and the Wanfang Database. Parallel-group RCTs of acupuncture for men with symptomatic BPH were included. Data from the included trials were extracted by two independent reviewers and were analyzed with The Cochrane Collaboration Review Manager software (RevMan 5.3.5) after risk of bias judgments. The primary outcome measure of this review was a change in urological symptoms.
RESULTS
Eight RCTs, which involved 661 men with BPH, were included. Follow-up varied from 4 weeks to 18 months. Pooling of the data from three trials that compared acupuncture with sham-acupuncture revealed that in the short term (4-6 weeks), acupuncture can significantly improve IPSS (MD -1.90, 95% CI -3.58 to -0.21). A sensitivity analysis of the short-term endpoint showed the same result (MD -3.01, 95% CI -5.19 to -0.84) with a borderline minimal clinical important difference (MCID). Qmax of the short-term endpoint indicated statistically positive beneficial effects of acupuncture (MD -1.78, 95%CI -3.43, -0.14). A meta-analysis after medium-term follow-up (12-18 weeks) indicated no significant effect on IPSS when the data from two trials were combined (MD -2.04, 95% CI -4.19, 0.10).
CONCLUSION
Statistically significant changes were observed in favor of acupuncture in moderate to severe BPH with respect to short-term follow-up endpoints. The clinical significance of these changes needs to be tested by further studies with rigorous designs and longer follow-up times.
TRIAL REGISTRATION NUMBER
PROSPERO CRD42014013645.
Topics: Acupuncture Therapy; Humans; Male; Prostatic Hyperplasia; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 28376120
DOI: 10.1371/journal.pone.0174586 -
Journal of Cosmetic Dermatology Oct 2022Recent developments in surgical techniques and grading schemas to treat temporal hollowing necessitate critically assessing their efficacy. This systematic review... (Review)
Review
BACKGROUND
Recent developments in surgical techniques and grading schemas to treat temporal hollowing necessitate critically assessing their efficacy. This systematic review presents the currently available protocols for temporal hollowing, aimed toward improving the clinical approach, for the benefit of the surgeon and patient.
METHODS
A search was conducted in PubMed, EMBASE, and Google Scholar in September 2021 using the keywords "temporal hollowing" and "temporal augmentation." Inclusion criteria were English-written articles published in peer-reviewed journals that reported an outcome relating to the cause, classification, or procedure used to prevent or correct hollowing in humans.
RESULTS
Of the 413, 966 publications retrieved, 24 met the study inclusion criteria. Twenty-one publications discussed the etiology of temporal hollowing, 12 discussed a classification or grading system for temporal hollowing, and 19 discussed a procedure to prevent or correct temporal hollowing. The most commonly reported etiology for temporal hollowing was iatrogenic (63%). For classifying temporal hollowing severity, visual analogue scales (25%) were most commonly used. Mesh (26%) and autologous fat grafts (26%) were the most popular procedures used to prevent or correct temporal hollowing.
DISCUSSION
We presented the spectrum of temporal hollowing grading schemas and treatment modalities currently published in the field. The use, by a majority of publications, of a grading system based on the subjective judgment of the examiner (either alone or adjunct to imaging results) suggests the need for a more standardized measurement tool. Future studies should investigate a universally applicable temporal hollowing classification system and its impact on treatment outcomes.
Topics: Humans; Adipose Tissue; Plastic Surgery Procedures; Treatment Outcome; Transplantation, Autologous
PubMed: 35467073
DOI: 10.1111/jocd.15021 -
The American Journal of Sports Medicine Jul 2016One of the most frequent demands from athletes after rotator cuff tear repair is to return to sport, if possible at the same level of play. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
One of the most frequent demands from athletes after rotator cuff tear repair is to return to sport, if possible at the same level of play.
PURPOSE
The main goal of this study was to determine the rate of return to sport after treatment of rotator cuff tears.
STUDY DESIGN
Meta-analysis and systematic review.
METHODS
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis of the results in the literature, as well as for the presentation of results. A search of the literature was performed on the electronic databases MEDLINE, Scopus, EMBASE, and the Cochrane Library. The quality of the included studies was evaluated according to the MINORS (Methodological Index for Nonrandomized Studies) checklist. Inclusion criteria were studies in English evaluating return to sport after treatment of traumatic, degenerative, partial or full-thickness rotator cuff tears in patients practicing a sport regularly, whatever the level, all ages and sports included. The main judgment criterion was the number of patients who returned to a sports activity after treatment of a rotator cuff tear. The criterion was analyzed in 2 ways: return to sport (yes/no) and the level of play (identical or higher/lower level).
RESULTS
Twenty-five studies were reviewed, including 859 patients (683 athletes), all treated surgically after a mean follow-up of 3.4 years (range, 0.3-13.4 years). The level of sports was recorded in 23 studies or 635 (93%) athletes and included 286 competitive or professional athletes and 349 recreational athletes. The most commonly practiced sports were baseball (224 participants), tennis (104 participants), and golf (54 participants). The overall rate of return to sport was 84.7% (95% CI, 77.6%-89.8%), including 65.9% (95% CI, 54.9%-75.4%) at an equivalent level of play, after 4 to 17 months. Of the professional and competitive athletes, 49.9% (95% CI, 35.3-64.6%) returned to the same level of play.
CONCLUSION
Most recreational athletes return to sports at the same level of play as before their injury, but only half of professional and competitive athletes return to an equivalent level of play.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Athletic Injuries; Baseball; Female; Golf; Humans; Male; Middle Aged; Return to Sport; Rotator Cuff Injuries; Tennis; Young Adult
PubMed: 26316611
DOI: 10.1177/0363546515598995