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Eye (London, England) Jan 2024The full-field stimulus threshold (FST) is a psychophysical measure of whole-field retinal light sensitivity. It can assess residual visual function in patients with... (Review)
Review
The full-field stimulus threshold (FST) is a psychophysical measure of whole-field retinal light sensitivity. It can assess residual visual function in patients with severe retinal disease and is increasingly being adopted as an endpoint in clinical trials. FST applications in routine ophthalmology clinics are also growing, but as yet there is no formalised standard guidance for measuring FST. This scoping review explored current variability in FST conduct and reporting, with an aim to inform further evidence synthesis and consensus guidance. A comprehensive electronic search and review of the literature was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR) checklist. Key source, participant, methodology and outcomes data from 85 included sources were qualitatively and quantitatively compared and summarised. Data from 85 sources highlight how the variability and insufficient reporting of FST methodology, including parameters such as units of flash luminance, colour, duration, test strategy and dark adaptation, can hinder comparison and interpretation of clinical significance across centres. The review also highlights an unmet need for paediatric-specific considerations for test optimisation. Further evidence synthesis, empirical research or structured panel consultation may be required to establish coherent standardised guidance on FST methodology and context or condition dependent modifications. Consistent reporting of core elements, most crucially the flash luminance equivalence to 0 dB reference level is a first step. The development of criteria for quality assurance, calibration and age-appropriate reference data generation may further strengthen rigour of measurement.
Topics: Humans; Child; Retina; Vision, Ocular; Dark Adaptation; Retinal Diseases; Checklist
PubMed: 37443335
DOI: 10.1038/s41433-023-02636-3 -
Annals of Global Health 2017Given that low- and middle-income countries (LMICs) in Asia still have high child mortality rates, improved monitoring using children's environmental health indicators... (Review)
Review
BACKGROUND
Given that low- and middle-income countries (LMICs) in Asia still have high child mortality rates, improved monitoring using children's environmental health indicators (CEHI) may help reduce preventable deaths by creating healthy environments.
OBJECTIVES
Thus, the aim of this study is to build a set of targeted CEHI that can be applied in LMICs in Asia through the CEHI initiative using a common conceptual framework.
METHODS
A systematic review was conducted to identify the most frequently used framework for developing CEHI. Due to the limited number of eligible records, a hand search of the reference lists and an extended search of Google Scholar were also performed. Based on our findings, we designed a set of targeted CEHI to address the children's environmental health situation in LMICs in Asia. The Delphi method was then adopted to assess the relevance, appropriateness, and feasibility of the targeted CEHI.
FINDINGS
The systematic review indicated that the Driving-Pressure-State-Exposure-Effect-Action framework and the Multiple-Exposures-Multiple-Effects model were the most common conceptual frameworks for developing CEHI. The Multiple-Exposures-Multiple-Effects model was adopted, given that its population of interest is children and its emphasis on the many-to-many relationship. Our review also showed that most of the previous studies covered upper-middle- or high-income countries. The Delphi results validated the targeted CEHI. The targeted CEHI were further specified by age group, gender, and place of residence (urban/rural) to enhance measurability.
CONCLUSIONS
Improved monitoring systems of children's environmental health using the targeted CEHI may mitigate the data gap and enhance the quality of data in LMICs in Asia. Furthermore, critical information on the complex interaction between the environment and children's health using the CEHI will help establish a regional environmental children's health action plan, named "The Children's Environment and Health Action Plan for Asia."
Topics: Air Pollution, Indoor; Asia; Asthma; Child Health; Child Mortality; Child, Preschool; Delphi Technique; Dengue; Developing Countries; Diarrhea; Drinking Water; Environmental Exposure; Environmental Health; Health Status Indicators; Humans; Hygiene; Infant; Infant Mortality; Malaria; Respiratory Tract Infections; Sanitation
PubMed: 29221526
DOI: 10.1016/j.aogh.2017.10.013 -
International Forum of Allergy &... Sep 2022Cystic fibrosis (CF) is a multisystem disease that often requires otolaryngology care. Individuals with CF commonly have chronic rhinosinusitis but also present with...
BACKGROUND
Cystic fibrosis (CF) is a multisystem disease that often requires otolaryngology care. Individuals with CF commonly have chronic rhinosinusitis but also present with hearing loss and dysphonia. Given these manifestations of CF, otolaryngologists are frequently involved in the care of patients with CF; however, there is limited consensus on optimal management of sinonasal, otologic, and laryngologic symptoms.
METHODS
The Cystic Fibrosis Foundation convened a multidisciplinary team of otolaryngologists, pulmonologists, audiologists, pharmacists, a social worker, a nurse coordinator, a respiratory therapist, two adults with CF, and a caregiver of a child with CF to develop consensus recommendations. Workgroups developed draft recommendation statements based on a systematic literature review, and a ≥80% consensus was required for acceptance of each recommendation statement.
RESULTS
The committee voted on 25 statements. Eleven statements were adopted recommending a treatment or intervention, while five statements were formulated recommending against a specific treatment or intervention. The committee recommended eight statements as an option for select patients in certain circumstances, and one statement did not reach consensus.
CONCLUSION
These multidisciplinary consensus recommendations will help providers navigate decisions related to otolaryngology consultation, medical and surgical management of CF-CRS, hearing, and voice in individuals with CF. A collaborative and multidisciplinary approach is advocated to best care for our patients with CF. Future clinical research is needed utilizing standardized, validated outcomes with comprehensive reporting of patient outcome, effects of modulator therapies, and genetic characteristics to help continue to advance care, decrease morbidity, and improve the quality of life for individuals with CF.
Topics: Adult; Child; Consensus; Cystic Fibrosis; Humans; Otolaryngology; Quality of Life; Sinusitis
PubMed: 35089650
DOI: 10.1002/alr.22974 -
Journal of Bone and Mineral Research :... Oct 2014A preponderance of evidence from systematic reviews supports the effectiveness of weight-bearing exercises on bone mass accrual, especially during the growing years.... (Meta-Analysis)
Meta-Analysis Review
A preponderance of evidence from systematic reviews supports the effectiveness of weight-bearing exercises on bone mass accrual, especially during the growing years. However, only one systematic review (limited to randomized controlled trials) examined the role of physical activity (PA) on bone strength. Thus, our systematic review extended the scope of the previous review by including all PA intervention and observational studies, including organized sports participation studies, with child or adolescent bone strength as the main outcome. We also sought to discern the skeletal elements (eg, mass, structure, density) that accompanied significant bone strength changes. Our electronic-database, forward, and reference searches yielded 14 intervention and 23 observational studies that met our inclusion criteria. We used the Effective Public Health Practice Project (EPHPP) tool to assess the quality of studies. Due to heterogeneity across studies, we adopted a narrative synthesis for our analysis and found that bone strength adaptations to PA were related to maturity level, sex, and study quality. Three (of five) weight-bearing PA intervention studies with a strong rating reported significantly greater gains in bone strength for the intervention group (3% to 4%) compared with only three significant (of nine) moderate intervention studies. Changes in bone structure (eg, bone cross-sectional area, cortical thickness, alone or in combination) rather than bone mass most often accompanied significant bone strength outcomes. Prepuberty and peripuberty may be the most opportune time for boys and girls to enhance bone strength through PA, although this finding is tempered by the few available studies in more mature groups. Despite the central role that muscle plays in bones' response to loading, few studies discerned the specific contribution of muscle function (or surrogates) to bone strength. Although not the focus of the current review, this seems an important consideration for future studies.
Topics: Adolescent; Biomechanical Phenomena; Bone and Bones; Child; Female; Humans; Male; Motor Activity; Observational Studies as Topic; Organ Size; Randomized Controlled Trials as Topic; Sports
PubMed: 24737388
DOI: 10.1002/jbmr.2254 -
Social Science & Medicine (1982) Dec 2022Health economic assessments are used to determine whether the resources needed to generate net benefit from a screening programme, driven by multiple complex benefits...
Benefits and harms adopted by health economic assessments evaluating antenatal and newborn screening programmes in OECD countries: A systematic review of 336 articles and reports.
BACKGROUND
Health economic assessments are used to determine whether the resources needed to generate net benefit from a screening programme, driven by multiple complex benefits and harms, are justifiable. We systematically identified the benefits and harms incorporated within economic assessments evaluating antenatal and newborn screening programmes.
METHODS
For this systematic review and thematic analysis, we searched the published and grey literature from January 2000 to January 2021. Studies that included an economic evaluation of an antenatal or newborn screening programme in an OECD country were eligible. We identified benefits and harms using an integrative descriptive analysis, and illustrated a thematic framework. (Systematic review registration PROSPERO, CRD42020165236).
FINDINGS
The searches identified 52,244 articles and reports and 336 (242 antenatal and 95 newborn) were included. Eighty-six subthemes grouped into seven themes were identified: 1) diagnosis of screened for condition, 2) life years and health status adjustments, 3) treatment, 4) long-term costs, 5) overdiagnosis, 6) pregnancy loss, and 7) spillover effects on family members. Diagnosis of screened for condition (115 studies, 47.5%), life-years and health status adjustments (90 studies, 37.2%) and treatment (88 studies, 36.4%) accounted for most of the benefits and harms evaluating antenatal screening. The same themes accounted for most of the benefits and harms included in studies assessing newborn screening. Overdiagnosis and spillover effects tended to be ignored.
INTERPRETATION
Our proposed framework can be used to guide the development of future health economic assessments evaluating antenatal and newborn screening programmes, to prevent exclusion of important potential benefits and harms.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Cost-Benefit Analysis; Neonatal Screening; Organisation for Economic Co-Operation and Development; Prenatal Diagnosis
PubMed: 36272385
DOI: 10.1016/j.socscimed.2022.115428 -
Journal of Educational Evaluation For... 2016The aim of this systematic review was to find best teaching strategies for teaching evidence-based practice (EBP) to undergraduate health students that have been adopted... (Review)
Review
PURPOSE
The aim of this systematic review was to find best teaching strategies for teaching evidence-based practice (EBP) to undergraduate health students that have been adopted over the last years in healthcare institutions worldwide.
METHODS
The authors carried out a systematic, comprehensive bibliographic search using Medline database for the years 2005 to March 2015 (updated in March 2016). Search terms used were chosen from the USNLM Institutes of Health list of MeSH (Medical Subject Headings) and free text key terms were used as well. Selected articles were measured based on the inclusion criteria of this study and initially compared in terms of titles or abstracts. Finally, articles relevant to the subject of this review were retrieved in full text. Critical appraisal was done to determine the effects of strategy of teaching evidence-based medicine (EBM).
RESULTS
Twenty articles were included in the review. The majority of the studies sampled medical students (n=13) and only few conducted among nursing (n=2), pharmacy (n=2), physiotherapy/therapy (n=1), dentistry (n=1), or mixed disciplines (n=1) students. Studies evaluated a variety of educational interventions of varying duration, frequency and format (lectures, tutorials, workshops, conferences, journal clubs, and online sessions), or combination of these to teach EBP. We categorized interventions into single interventions covering a workshop, conference, lecture, journal club, or e-learning and multifaceted interventions where a combination of strategies had been assessed. Seven studies reported an overall increase to all EBP domains indicating a higher EBP competence and two studies focused on the searching databases skill.
CONCLUSION
Followings were deduced from above analysis: multifaceted approach may be best suited when teaching EBM to health students; the use of technology to promote EBP through mobile devices, simulation, and the web is on the rise; and the duration of the interventions varying form some hours to even months was not related to the students' EBP competence.
Topics: Clinical Competence; Curriculum; Education, Medical, Undergraduate; Evidence-Based Practice; Health Occupations; Humans; Learning; Students, Health Occupations; Teaching
PubMed: 27649902
DOI: 10.3352/jeehp.2016.13.34 -
Journal of Research in Medical Sciences... 2020This study aimed to evaluate the epidemiological studies on the relationship between organophosphate (OP) pesticide exposure during pregnancy and neonatal anthropometric... (Review)
Review
BACKGROUND
This study aimed to evaluate the epidemiological studies on the relationship between organophosphate (OP) pesticide exposure during pregnancy and neonatal anthropometric measures.
MATERIALS AND METHODS
In this systematic review and meta analyses, a comprehensive search of the literature for the association of maternal exposure to OP pesticides and birth outcome including birth weight, birth length, and head circumference was conducted from scientific databases of MEDLINE, Scopus, Web of Science, and Cochrane library until the end of April 2019. We used the following keyword to identify the relevant studies: "birth weight," "birth length," "pregnancy outcome,""birth outcome," "organophosphate pesticides," and "organophosphate metabolites." Only English language studies investigating the relationship between pregnant mothers' exposure to OP metabolites and birth outcomes were examined.
RESULTS
Of the 10 articles reviewed, eight studies used to assess the association with birth weight, as well as five, and six studies were used in meta analysis to determine the association between OP exposure and birth length and head circumference. Pooled estimates were performed using a fixed effects model or random effects model. No significant association was observed between maternal exposure to OPs and birth weight (β = 1.520;95% confidence interval [CI] [-10.781, 13.820]), birth length (β = -0.011; [-0.132, 0.109]), and head circumference (β =0.022; 95%CI [-0.06, 0.103]).
CONCLUSION
Although the effect of maternal exposure to OP on the birth outcome is not completely clear, strategies should be adopted to control the use of these substances.
PubMed: 33088316
DOI: 10.4103/jrms.JRMS_919_19 -
Nursing Open Sep 2022This study determined the factors associated with pregnancy uptake decision among seropositive HIV people receiving antiretroviral therapy in sub-Saharan Africa. (Review)
Review
AIM
This study determined the factors associated with pregnancy uptake decision among seropositive HIV people receiving antiretroviral therapy in sub-Saharan Africa.
DESIGN
Systematic review.
METHODS
The population, intervention, comparison and outcomes framework was adopted to search for literature after a scoping review using the preferred reporting items for systematic reviews and meta-analyses guidelines adopted in searching, and screening articles from four databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and Google scholar) to find 12 articles suitable for this study.
RESULTS
Motivators of pregnancy uptake among HIV-positive women include desire to have children, knowledge about PMTCT, cultural duty for married women to have children, and household income. Demotivating factors included the modern method of contraception and burden associated with pregnancy.
CONCLUSION
There is a need to improve on services that reduce conception-related risks especially for women who choose to conceive and to incorporate fertility-related counselling into HIV treatment services.
Topics: Africa South of the Sahara; Child; Contraception; Female; HIV Infections; Health Services Accessibility; Humans; Mass Screening; Pregnancy
PubMed: 35643950
DOI: 10.1002/nop2.1251 -
Eye (London, England) Mar 2021Amblyopia screening can target reduced visual acuity (VA), its refractive risk factors, or both. VA testing is imprecise under 4 years of age, so automated risk-factor... (Review)
Review
BACKGROUND
Amblyopia screening can target reduced visual acuity (VA), its refractive risk factors, or both. VA testing is imprecise under 4 years of age, so automated risk-factor photoscreening appears an attractive option. This review considers photoscreening used in community services, focusing on costs, cost-effectiveness and scope of use, compared with EUSCREEN project Country Reports describing how photo- and automated screening is used internationally.
METHODS
A systematic narrative review was carried out of all English language photoscreening literature to September 10th 2018, using publicly available search terms. Where costs were considered, a CASP economic evaluation checklist was used to assess data quality.
RESULTS
Of 370 abstracts reviewed, 55 reported large-scale community photoscreening projects. Five addressed cost-effectiveness specifically, without original data. Photoscreening was a stand-alone, single, test event in 71% of projects. In contrast, 25 of 45 EUSCREEN Country Reports showed that if adopted, photoscreening often supplements other tests in established programmes and is rarely used as a stand-alone test. Reported costs varied widely and evidence of cost-effectiveness was sparse in the literature, or in international practice. Only eight (13%) papers compared the diagnostic accuracy or cost-effectiveness of photoscreening and VA testing, and when they did, cost-effectiveness of photoscreening compared unfavourably.
DISCUSSION
Evidence that photoscreening reduces amblyopia or strabismus prevalence or improves overall outcomes is weak, as is evidence of cost-effectiveness, compared to later VA screening. Currently, the most cost-effective option seems to be a later, expert VA screening with the opportunity for a re-test before referral.
Topics: Amblyopia; Child; Cost-Benefit Analysis; Humans; Strabismus; Vision Disorders; Vision Screening
PubMed: 33257800
DOI: 10.1038/s41433-020-01261-8 -
Medical Education Online Dec 2024Non-clinical approaches such as meditation, yoga, and mindfulness are popular traditional therapeutical interventions adopted by many educational institutions to improve... (Meta-Analysis)
Meta-Analysis Review
Non-clinical approaches such as meditation, yoga, and mindfulness are popular traditional therapeutical interventions adopted by many educational institutions to improve the physical and mental well-being of learners. This study aimed to evaluate the effectiveness of yoga intervention in improving cardiopulmonary parameters such as blood pressure, heart rate, pulmonary function tests and psychosomatic symptoms such as depression, anxiety and stress in medical and dental students. Using the PRISMA protocol, a search from databases such as PubMed, Scopus, and Embase resulted in 304 relevant articles. After screening the title and abstracts, 47 papers were analyzed thoroughly and included in the qualitative analysis. 18 articles with homogenous statistical data on physiology and psychological parameters were included for meta-analysis. In comparison to the control group, the study showed a significant reduction of systolic blood pressure (SBP: 6.82 mmHg, z = -3.06, = 0.002), diastolic blood pressure (DBP: 2.92 mmHg, z = -2.22, = 0.03), and heart rate (HR: 2.55 beats/min, z = -2.77, = 0.006). Additionally, data from 4 studies yielded a significant overall effect of a stress reduction of 0.77 on standardized assessments due to the yoga intervention (z = 5.29, < 0.0001). Lastly, the results also showed a significant (z = -2.52, = 0.01) reduction of 1.2 in standardized anxiety tests in intervention group compared to the control. The findings offer promising prospects for medical educators globally, encouraging them to consider reformation and policymaking in medical curricula to enhance academic success and improve the overall quality of life for medical students worldwide.
Topics: Yoga; Humans; Blood Pressure; Heart Rate; Stress, Psychological; Anxiety; Education, Medical; Depression; Students, Medical; Respiratory Function Tests
PubMed: 38861675
DOI: 10.1080/10872981.2024.2364486