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Cureus Nov 2023The radial forearm free flap (RFFF) is a surgical technique for addressing intraoral reconstruction. However, with the limitation of an unavoidable defect at the RFFF... (Review)
Review
The radial forearm free flap (RFFF) is a surgical technique for addressing intraoral reconstruction. However, with the limitation of an unavoidable defect at the RFFF donor site, split-thickness skin grafts (STSGs) have been a solution for repairing these defects, but they are not without challenges. This study aimed to evaluate an approach using full-thickness skin grafts (FTSGs), comparing their effectiveness in terms of aesthetics, pain, complications, and scarring. A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing FTSG with STSG for RFFF donor site repair in head and neck cancer patients were included. Primary outcomes measured were appearance and pain at the RFFF site, and secondary outcomes were infection, tendon exposure, graft loss, and scar assessment. A meta-analysis and systematic review of eight studies demonstrated that FTSG provided a superior aesthetic appearance at the RFFF donor site compared to STSG (p = 0.001), with low heterogeneity among the studies. The analysis found no significant difference in donor site pain between techniques. There were no significant differences in infection, tendon exposure, or skin graft loss between the two graft methods. This study suggests that FTSG is comparable to STSG in terms of donor site pain, scarring, and infection while offering superior aesthetic outcomes.
PubMed: 38143661
DOI: 10.7759/cureus.49279 -
Cureus Jan 2024Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural... (Review)
Review
Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural puncture (ADP) happens during epidural anesthesia. The treatment and prevention options for PDPH differ widely from one institution to another. The management of PDPH is heterogeneous in many institutions because of the absence of clear guidelines and protocols for the management of PDPH. This study aimed to summarize all articles published during the past decade that discussed the treatment or prevention of PDPH. From 2013 to 2023, 345 publications were filtered for all treatment and prevention approaches used for PDPH patients. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines were followed for conducting this systematic review, and 38 articles were included for analysis and review. Existing data come from small randomized clinical trials and retrospective or prospective cohort studies. This review supports the effect of oral pregabalin and intravenous aminophylline in both treatment and prevention. Intravenous mannitol, intravenous hydrocortisone, triple prophylactic regimen, and neostigmine plus atropine combination showed effective and beneficial outcomes. On the other hand, neither neuraxial morphine nor epidural dexamethasone showed promising results. Consequently, the use of neuraxial morphine or epidural dexamethasone for the prevention of PDPH remains questionable. Regarding the posture of the patient and its consequences on the incidence of the headache, lateral decubitus is better than a sitting position, and a prone position is better than a supine position. Smaller non-cutting needles play a role in avoiding PDPH. Minimally invasive nerve blocks, including sphenopalatine ganglion or greater occipital nerves, are satisfyingly effective. Epidural blood patches remain the more invasive but the gold standard and ultimate solution in patients resisting medical therapy. This study highlights the need for larger research to define the best approach to prevent and treat PDPH.
PubMed: 38361721
DOI: 10.7759/cureus.52330 -
Health Promotion Perspectives 2023ChatGPT is an artificial intelligence based tool developed by OpenAI (California, USA). This systematic review examines the potential of ChatGPT in patient care and its...
BACKGROUND
ChatGPT is an artificial intelligence based tool developed by OpenAI (California, USA). This systematic review examines the potential of ChatGPT in patient care and its role in medical research.
METHODS
The systematic review was done according to the PRISMA guidelines. Embase, Scopus, PubMed and Google Scholar data bases were searched. We also searched preprint data bases. Our search was aimed to identify all kinds of publications, without any restrictions, on ChatGPT and its application in medical research, medical publishing and patient care. We used search term "ChatGPT". We reviewed all kinds of publications including original articles, reviews, editorial/ commentaries, and even letter to the editor. Each selected records were analysed using ChatGPT and responses generated were compiled in a table. The word table was transformed in to a PDF and was further analysed using ChatPDF.
RESULTS
We reviewed full texts of 118 articles. ChatGPT can assist with patient enquiries, note writing, decision-making, trial enrolment, data management, decision support, research support, and patient education. But the solutions it offers are usually insufficient and contradictory, raising questions about their originality, privacy, correctness, bias, and legality. Due to its lack of human-like qualities, ChatGPT's legitimacy as an author is questioned when used for academic writing. ChatGPT generated contents have concerns with bias and possible plagiarism.
CONCLUSION
Although it can help with patient treatment and research, there are issues with accuracy, authorship, and bias. ChatGPT can serve as a "clinical assistant" and be a help in research and scholarly writing.
PubMed: 37808939
DOI: 10.34172/hpp.2023.22 -
Implementation Science : IS Nov 2023Informal caregivers of people with dementia (PwD) living at home are often the primary source of care, and, in their role, they often experience loss of quality of life.... (Review)
Review
BACKGROUND
Informal caregivers of people with dementia (PwD) living at home are often the primary source of care, and, in their role, they often experience loss of quality of life. Implementation science knowledge is needed to optimize the real-world outcomes of evidence-based interventions (EBIs) for informal caregivers. This scoping review aims to systematically synthesize the literature that reports implementation strategies employed to deliver home- and community-based EBIs for informal caregivers of PwD, implementation outcomes, and the barriers and facilitators to implementation of these EBIs.
METHODS
Embase, MEDLINE, Web of Science, and Cochrane Library were searched from inception to March 2021; included studies focused on "implementation science," "home- and community-based interventions," and "informal caregivers of people with dementia." Titles and abstracts were screened using ASReview (an innovative AI-based tool for evidence reviews), and data extraction was guided by the ERIC taxonomy, the Implementation Outcome Framework, and the Consolidated Framework for Implementation Science Research; each framework was used to examine a unique element of implementation.
RESULTS
Sixty-seven studies were included in the review. Multicomponent (26.9%) and eHealth (22.3%) interventions were most commonly reported, and 31.3% of included studies were guided by an implementation science framework. Training and education-related strategies and provision of interactive assistance were the implementation strategy clusters of the ERIC taxonomy where most implementation strategies were reported across the reviewed studies. Acceptability (82.1%), penetration (77.6%), and appropriateness (73.1%) were the most frequently reported implementation outcomes. Design quality and packaging (intervention component suitability) and cosmopolitanism (partnerships) constructs, and patient's needs and resources and available resources (infrastructure) constructs as per the CFIR framework, reflected the most frequently reported barriers and facilitators to implementation.
CONCLUSION
Included studies focused largely on intervention outcomes rather than implementation outcomes and lacked detailed insights on inner and outer setting determinants of implementation success or failure. Recent publications suggest implementation science in dementia research is developing but remains in nascent stages, requiring future studies to apply implementation science knowledge to obtain more contextually relevant findings and to structurally examine the mechanisms through which implementation partners can strategically leverage existing resources and regional networks to streamline local implementation. Mapping local evidence ecosystems will facilitate structured implementation planning and support implementation-focused theory building.
TRIAL REGISTRATION
Not applicable.
Topics: Humans; Caregivers; Quality of Life; Ecosystem; Dementia
PubMed: 37940960
DOI: 10.1186/s13012-023-01314-y -
BMC Medical Education Aug 2023Micromanagement in clinical supervision in health professions education generally refers to supervision characterized by unproductive excessive control and attention to...
Micromanagement in clinical supervision in health professions education generally refers to supervision characterized by unproductive excessive control and attention to detail. It can affect autonomy, competence, well-being of learners, teamwork, and ultimately patient care. Despite its potential negative impact on learners and patients, no comprehensive review of this phenomenon has been conducted. This scoping review aims to explore the breadth of extant literature concerning micromanagement in clinical supervision in health professions education and map the body of research on the topic. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Review (PRISMA-ScR). We searched eight databases, and the final review and analysis comprised 12 articles that examined micromanagement in clinical supervision across health professions education. Micromanagement was conceptualized as ineffective supervisory practices such as undue scrutiny, excessive control, domination, and ineffectual leadership. Conversely, alternatives to micromanagement included entrusting or granting autonomy, coaching for independent practice, and providing effective supervision and leadership. Overall, micromanagement was attributed to individual behavioral and personality factors, such as distrust, perfectionism, self-conviction, and low self-esteem. The consequences of micromanagement included inadequacies in professional development and well-being of trainees and patient care, and organizational dysfunction. Suggested solutions included entrusting or empowering trainees with encouragement and clear communication, open communication efforts by trainees, organizational management for quality supervision, and faculty's valuing both clinical and educational goals. Current literature on micromanagement-in the context of clinical supervision in health professions education-was found to be sparse, implying a need for more rigorous research and discourse on this understudied area. The findings can be used to recognize, solve, and prevent the prevalent, and often unrecognized, phenomena of micromanagement, which may improve clinical supervision, the professional development of trainees and faculty, organizational management, and ultimately patient care.
Topics: Humans; Faculty; Leadership; Preceptorship
PubMed: 37559079
DOI: 10.1186/s12909-023-04543-3 -
Diagnostics (Basel, Switzerland) Aug 2023Muscular skeletal disorder is a difficult challenge faced by the working population. Motion capture (MoCap) is used for recording the movement of people for clinical,... (Review)
Review
Muscular skeletal disorder is a difficult challenge faced by the working population. Motion capture (MoCap) is used for recording the movement of people for clinical, ergonomic and rehabilitation solutions. However, knowledge barriers about these MoCap systems have made them difficult to use for many people. Despite this, no state-of-the-art literature review on MoCap systems for human clinical, rehabilitation and ergonomic analysis has been conducted. A medical diagnosis using AI applies machine learning algorithms and motion capture technologies to analyze patient data, enhancing diagnostic accuracy, enabling early disease detection and facilitating personalized treatment plans. It revolutionizes healthcare by harnessing the power of data-driven insights for improved patient outcomes and efficient clinical decision-making. The current review aimed to investigate: (i) the most used MoCap systems for clinical use, ergonomics and rehabilitation, (ii) their application and (iii) the target population. We used preferred reporting items for systematic reviews and meta-analysis guidelines for the review. Google Scholar, PubMed, Scopus and Web of Science were used to search for relevant published articles. The articles obtained were scrutinized by reading the abstracts and titles to determine their inclusion eligibility. Accordingly, articles with insufficient or irrelevant information were excluded from the screening. The search included studies published between 2013 and 2023 (including additional criteria). A total of 40 articles were eligible for review. The selected articles were further categorized in terms of the types of MoCap used, their application and the domain of the experiments. This review will serve as a guide for researchers and organizational management.
PubMed: 37568956
DOI: 10.3390/diagnostics13152593 -
Conventional Cardiotocography Computerized CTG Analysis and Perinatal Outcomes: a Systematic Review.Maedica Sep 2023Cardiotocography (CTG) constitutes a major and generally used tool for the assessment of fetal well-being. Subjectivity is the main difficulty in the interpretation of...
Cardiotocography (CTG) constitutes a major and generally used tool for the assessment of fetal well-being. Subjectivity is the main difficulty in the interpretation of CTG. Inter- and intra-observer variability are substantival features of the interpretation of CTGs. An auspicious answer for reduction of inter- and intra-observer variability is the computerized analysis of fetal heart rate (FHR). Moreover, computerized analysis contributes to the reduction of adverse maternal and fetal outcomes. The aim of the present review was to compare the visual and computerized analysis of CTG for establishing whether computerized CTG was related to better perinatal outcomes. Three electronic medical related databases (PubMed, Scopus and Cochrane) were searched from May to June 2023 in order to find randomized controlled trials (RCTs) in English. Studies were evaluated for their methodological quality with the CONSORT checklist. The target population comprised pregnant or intrapartum women into cardiotocographic monitoring. The intervention was represented by the visual analysis of CTG, and the comparison intervention by the computerized analysis of CTG. Primary outcomes included adverse perinatal outcomes. A total of 47 studies relevant with the topic were examined. However, only five articles met all inclusion and methodological criteria; four of those demonstrated that computerized analysis had no significant reduction in the rate of metabolic acidosis or obstetric interventions, and one study found a lower incidence of adverse perinatal outcome with conventional CTG (with fetal blood sampling). However, all reviews propose further development of decision-support software and more large-scale RCTs in the future. The computerized analysis of FHR is a promising solution for the reduction of adverse perinatal outcomes and elimination of inter- and intra-observer variability.
PubMed: 38023753
DOI: 10.26574/maedica.2023.18.3.483 -
Orthopaedic Journal of Sports Medicine Dec 2023While increased posterior tibial slope (PTS) is an important risk factor for failure after anterior cruciate ligament (ACL) reconstruction, controversy exists regarding... (Review)
Review
BACKGROUND
While increased posterior tibial slope (PTS) is an important risk factor for failure after anterior cruciate ligament (ACL) reconstruction, controversy exists regarding indications and outcomes of proximal tibia anterior closing-wedge osteotomy (ACWO) with concomitant ACL reconstruction in patients with ACL tears.
PURPOSE
To assess clinical outcomes after combined ACL reconstruction and proximal tibia ACWO.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, we performed a systematic review of the existing literature on ACWO and ACL reconstruction using PubMed (MEDLINE), Cochrane Library, Scopus, and Embase. The search phrases included "anterior closing wedge osteotomy,""anterior closing wedge tibial osteotomy,""anterior closing wedge proximal tibial osteotomy,""anterior cruciate ligament," and "revision anterior cruciate ligament." Non-English publications and single-patient case reports were excluded. Extracted data included study details, patient demographics, patient-reported outcomes (PROs), clinical outcomes, radiographic outcomes, complications, and return-to-sport (RTS) rates.
RESULTS
A total of 6 studies with 110 patients (110 knees) were included. Two-stage ACWO and ACL reconstruction was reported in 2 studies of 78 patients (71%), while a single-stage technique was reported in 4 studies of 32 patients (29%). ACWO was performed in the setting of primary ACL tear in 23 patients (21%) and in recurrent ACL tear in 87 patients (79%). Patients demonstrated postoperative improvements in Lysholm, pivot-shift test, and side-to-side difference in anterior tibial translation. After ACWO, all studies reported mean postoperative PTS of <10° (range, 4.4°-9.2°). Of patients with available RTS data (n = 43), the same-level RTS rate ranged from 65% to 100%. A two-stage procedure reported in 1 study had a lower RTS rate (n = 13 of 20 [65%]) than that of 2 studies with single-stage procedure (n = 4 of 5 [80%] and n = 18 of 18 [100%]). The overall complication rate was 0.9% to 1.3%, and there were no reported ACL retears.
CONCLUSION
The current evidence, which is constrained by the quantity and quality of studies, showed that ACWO with single- or two-stage ACL reconstruction in patients with ACL insufficiency and increased PTS was associated with significant improvements in PROs and high RTS rates.
PubMed: 38107842
DOI: 10.1177/23259671231210549 -
Frontiers in Psychiatry 2024To date, only one systematic review and meta-analysis of randomized controlled trials (RCTs) has evaluated the effect of neurofeedback in PTSD, which included only four...
BACKGROUND
To date, only one systematic review and meta-analysis of randomized controlled trials (RCTs) has evaluated the effect of neurofeedback in PTSD, which included only four studies and found an uncertainty of the effect of EEG-NF on PTSD symptoms. This meta-analysis is an update considering that numerous studies have since been published. Additionally, more recent studies have included fMRI-NF as well as fMRI-guided or -inspired EEG NF.
METHODS
Systematic literature searches for RCTs were conducted in three online databases. Additional hand searches of each study identified and of systematic reviews and meta-analyses published were also undertaken. Outcomes evaluated the effect of neurofeedback vs. a control (active, sham, and waiting list) on their effects in reducing PTSD symptoms using various health instruments. Meta-analytical methods used were inverse variance random-effects models measuring both mean and standardized mean differences. Quality and certainty of the evidence were assessed using GRADE. Adverse events were also evaluated.
RESULTS
A total of 17 studies were identified evaluating a total of 628 patients. There were 10 studies used in the meta-analysis. Results from all studies identified favored neurofeedback's effect on reducing PTSD symptoms including BDI pretest-posttest [mean difference (MD): 8.30 (95% CI: 3.09 to 13.52; P = 0.002; = 0%)]; BDI pretest-follow-up (MD: 8.75 (95% CI: 3.53 to 13.97; P < 0.00001; = 0%); CAPS-5 pretest-posttest [MD: 7.01 (95% CI: 1.36 to 12.66; P = 0.02; = 86%)]; CAPS-5 pretest-follow-up (MD: 10 (95% CI: 1.29 to 21.29; P = 0.006; = 77%); PCL-5 pretest-posttest (MD: 7.14 (95% CI: 3.08 to 11.2; P = 0.0006; = 0%); PCL-5 pretest-follow-up (MD: 14.95 (95% CI: 7.95 to 21.96; P < 0.0001; = 0%). Other studies reported improvements using various other instruments. GRADE assessments of CAPS, PCL, and BDI demonstrated a moderate/high level in the quality of the evidence that NF has a positive clinical effect.
CONCLUSION
Based on newer published studies and the outcomes measured, NF has demonstrated a clinically meaningful effect size, with an increased effect size at follow-up. This clinically meaningful effect appears to be driven by newer fMRI-guided NF and deeper brain derivates of it.
PubMed: 38577405
DOI: 10.3389/fpsyt.2024.1323485 -
International Journal of Nursing Studies Nov 2023Extensive research shows associations between increased nurse staffing levels, skill mix and patient outcomes. However, showing that improved staffing levels are linked... (Review)
Review
BACKGROUND
Extensive research shows associations between increased nurse staffing levels, skill mix and patient outcomes. However, showing that improved staffing levels are linked to improved outcomes is not sufficient to provide a case for increasing them. This review of economic studies in acute hospitals aims to identify costs and consequences associated with different nurse staffing configurations in hospitals.
METHODS
We included economic studies exploring the effect of variation in nurse staffing. We searched PubMed, CINAHL, Embase Econlit, Cochrane library, DARE, NHS EED and the INAHTA website. Risk of bias was assessed using a framework based on the NICE guidance for public health reviews and Henrikson's framework for economic evaluations. Inclusion, data extraction and critical appraisal were undertaken by pairs of reviewers with disagreements resolved by the entire review team. Results were synthesised using a hierarchical matrix to summarise findings of economic evaluations.
RESULTS
We found 23 observational studies conducted in the United States of America (16), Australia, Belgium, China, South Korea, and the United Kingdom (3). Fourteen had high risk of bias and nine moderate. Most studies addressed levels of staffing by RNs and/or licensed practical nurses. Six studies found that increased nurse staffing levels were associated with improved outcomes and reduced or unchanged net costs, but most showed increased costs and outcomes. Studies undertaken outside the USA showed that increased nurse staffing was likely to be cost-effective at a per capita gross domestic product (GDP) threshold or lower. Four studies found that increased skill mix was associated with improved outcomes but increased staff costs. Three studies considering net costs found increased registered nurse skill mix associated with net savings and similar or improved outcomes.
CONCLUSION
Although more evidence on cost-effectiveness is still needed, increases in absolute or relative numbers of registered nurses in general medical and surgical wards have the potential to be highly cost-effective. The preponderance of the evidence suggests that increasing the proportion of registered nurses is associated with improved outcomes and, potentially, reduced net cost. Conversely, policies that lead to a reduction in the proportion of registered nurses in nursing teams could give worse outcomes at increased costs and there is no evidence that such approaches are cost-effective. In an era of registered nurse scarcity, these results favour investment in registered nurse supply as opposed to using lesser qualified staff as substitutes, especially where baseline nurse staffing and skill mix are low.
REGISTRATION
PROSPERO (CRD42021281202).
TWEETABLE ABSTRACT
Increasing registered nurse staffing and skill mix can be a net cost-saving solution to nurse shortages. Contrary to the strong policy push towards a dilution of nursing skill mix, investment in supply of RNs should become the priority.
Topics: Humans; United States; Cost-Benefit Analysis; Personnel Staffing and Scheduling; Nursing Staff, Hospital; Workforce; Hospitals
PubMed: 37742413
DOI: 10.1016/j.ijnurstu.2023.104601