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BMC Musculoskeletal Disorders Jul 2023Humeral shaft fractures (HSFs) can be treated non-operatively (Non-OP), with open reduction and plate osteosynthesis (ORPO), minimally invasive plate osteosynthesis... (Meta-Analysis)
Meta-Analysis
PURPOSE
Humeral shaft fractures (HSFs) can be treated non-operatively (Non-OP), with open reduction and plate osteosynthesis (ORPO), minimally invasive plate osteosynthesis (MIPO), or with intramedullary nails (IMN). However, the best treatment for HSFs still remains controversial.We performed a network meta-analysis to explore which should be the best method for HSFs.
METHODS
The computerized search had been conducted on electronic databases PubMed, EMBASE, Cochrane Library, and Medline from the establishment of the database to the end of December 2022. The quality evaluation of the included literature had been completed by Review Manager (version 5.4.1). Stata 17.0 software (Stata Corporation, College Station, Texas, USA)was used for network meta-analysis.We included randomized controlled trials (RCTs) comparing different treatments to treating HSFs.
RESULTS
The pairwise comparison results demonstrated that there was no statistical difference between IMN, MIPO, Non-OP, and ORPO in terms of radial nerve injury and infection, and Non-OP presented significantly more nonunion than ORPO, IMN, and MIPO. However, no statistically significant difference between ORPO, IMN, and MIPO was discovered. The results of the network meta-analysis displayed that surface under the cumulative ranking curve (SUCRA) probabilities of IMN, MIPO, Non-OP, and ORPO in radial nerve injury were 46.5%, 66.9%, 77.3%, and 9.3%, respectively, in contrast, that in infection were 68.6%, 53.3%, 62.4%, and 15.4%, respectively, and that in nonunion were 51.7%, 93.1%, 0.7%, and 54.5%, respectively.
CONCLUSION
We came to the conclusion that MIPO is currently the most effective way to treat HSFs.
TRIAL REGISTRATION
Name of the registry: Prospero, 2. Unique Identifying number or registration ID: CRD42023411293.
Topics: Humans; Network Meta-Analysis; Minimally Invasive Surgical Procedures; Randomized Controlled Trials as Topic; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Humeral Fractures; Bone Plates; Humerus; Treatment Outcome
PubMed: 37460932
DOI: 10.1186/s12891-023-06626-0 -
BMJ Open May 2024In the temperate world, Lyme disease (LD) is the most common vector-borne disease affecting humans. In North America, LD surveillance and research have revealed an... (Review)
Review
INTRODUCTION
In the temperate world, Lyme disease (LD) is the most common vector-borne disease affecting humans. In North America, LD surveillance and research have revealed an increasing territorial expansion of hosts, bacteria and vectors that has accompanied an increasing incidence of the disease in humans. To better understand the factors driving disease spread, predictive models can use current and historical data to predict disease occurrence in populations across time and space. Various prediction methods have been used, including approaches to evaluate prediction accuracy and/or performance and a range of predictors in LD risk prediction research. With this scoping review, we aim to document the different modelling approaches including types of forecasting and/or prediction methods, predictors and approaches to evaluating model performance (eg, accuracy).
METHODS AND ANALYSIS
This scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines. Electronic databases will be searched via keywords and subject headings (eg, Medical Subject Heading terms). The search will be performed in the following databases: PubMed/MEDLINE, EMBASE, CAB Abstracts, Global Health and SCOPUS. Studies reported in English or French investigating the risk of LD in humans through spatial prediction and temporal forecasting methodologies will be identified and screened. Eligibility criteria will be applied to the list of articles to identify which to retain. Two reviewers will screen titles and abstracts, followed by a full-text screening of the articles' content. Data will be extracted and charted into a standard form, synthesised and interpreted.
ETHICS AND DISSEMINATION
This scoping review is based on published literature and does not require ethics approval. Findings will be published in peer-reviewed journals and presented at scientific conferences.
Topics: Lyme Disease; Humans; Research Design; Forecasting; Review Literature as Topic
PubMed: 38772589
DOI: 10.1136/bmjopen-2022-071402 -
PloS One 2023A considerable number of risk models, which predict outcomes in mortality and readmission rates, have been developed for patients with acute heart failure (AHF) to help...
INTRODUCTION
A considerable number of risk models, which predict outcomes in mortality and readmission rates, have been developed for patients with acute heart failure (AHF) to help stratify patients by risk level, improve decision making, and save medical resources. However, some models exist in a clinically useful manner such as risk scores or online calculators, while others are not, providing only limited information that prevents clinicians and patients from using them. The reported performance of some models varied greatly when predicting at multiple time points and being validated in different cohorts, which causes model users uncertainty about the predictive accuracy of these models. The foregoing leads to users facing difficulties in the selection of prediction models, and even sometimes being reluctant to utilize models. Therefore, a systematic review to assess the performance at multiple time points, applicability, and clinical impact of extant prediction models for mortality and readmission in AHF patients is essential. It may facilitate the selection of models for clinical implementation.
METHOD AND ANALYSIS
Four databases will be searched from their inception onwards. Multivariable prognostic models for mortality and/or readmission in AHF patients will be eligible for review. Characteristics and the clinical impact of included models will be summarized qualitatively and quantitatively, and models with clinical utility will be compared with those without. Predictive performance measures of included models with an analogous clinical outcome appraised repeatedly, will be compared and synthesized by a meta-analysis. Meta-analysis of validation studies for a common prediction model at the same time point will also be performed. We will also provide an overview of critical appraisal of the risk of bias, applicability, and reporting transparency of included studies using the PROBAST tool and TRIPOD statement.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration number CRD42021256416.
Topics: Humans; Patient Readmission; Prognosis; Heart Failure; Systematic Reviews as Topic; Meta-Analysis as Topic
PubMed: 37523342
DOI: 10.1371/journal.pone.0283307 -
Periodontology 2000 Oct 2023Lateral ridge augmentation is a standard surgical procedure that can be performed prior to (staged) or simultaneously with implant placement. The decision between a... (Review)
Review
Lateral ridge augmentation is a standard surgical procedure that can be performed prior to (staged) or simultaneously with implant placement. The decision between a simultaneous or staged approach involves considering multiple variables. This paper proposed a decision-making process that serves as a guideline for choosing the best treatment choice based on the available evidence and the author's clinical experience.
Topics: Humans; Dental Implantation, Endosseous; Alveolar Ridge Augmentation; Bone Transplantation; Guided Tissue Regeneration, Periodontal; Patient Selection; Dental Implants
PubMed: 37529966
DOI: 10.1111/prd.12512 -
Journal of Dairy Science Dec 2023Allowing the dam to rear her calf is an alternative practice in the dairy industry where cow and calf may gain welfare benefits from performing natural and highly...
Allowing the dam to rear her calf is an alternative practice in the dairy industry where cow and calf may gain welfare benefits from performing natural and highly motivated behaviors. However, this system has been linked to an increased separation and weaning response. Reducing the daily dam-calf contact time may be a way to prepare the calf for weaning and separation. The first aim of the present study was to investigate the effect of 8 wk of half-day dam-calf contact on calf response to weaning and separation, compared with calves reared with whole-day dam-calf contact and an artificially reared, group-housed control with unrestricted access to milk for 20 min twice daily. Weaning off milk and separation from the dam can be viewed as 2 independent stressors. By introducing each stressor separately, it may be possible to reduce the overall behavioral response. The second aim of the present study was to investigate the effect of 1-wk fence-line weaning before permanent separation. The study was conducted with a 3 × 2 factorial design with dam contact treatments (whole-day, half-day, and control) and weaning treatments (simultaneous, and stepwise). Whole-day calves were separated twice daily from their dams during milking, whereas half-day calves were separated daily from the afternoon milking and until next morning milking. Simultaneous weaning and separation were done in wk 9, and stepwise weaning and separation started in wk 8 with calves being fence-line weaned before permanent separation in wk 9. Data were collected on 69 dairy calves in wk 8 and wk 9, and data were summarized over the 2 weeks for analysis. Stepwise weaning and separation reduced the number of high-pitched vocalizations and activity of dam-reared dairy calves but had little effect on control calves. There was no difference between whole-day and half-day calves in their response to separation, but as expected, dam-reared calves reacted more strongly than the control group. This was also reflected in the average daily BW gain the week after weaning, with control calves having higher average daily gains than whole-day, while half-day calves were intermediate. However, the behavioral response did not fully wane within the observation period (0-48 h of interventions). In conclusion, 1-wk fence-line weaning reduced the summed weaning and separation response in dam-reared calves. However, no difference between half-day dam-calf contact and whole-day dam contact was detected in the behavioral response to weaning and separation.
Topics: Female; Animals; Cattle; Weaning; Behavior, Animal; Milk; Research Design; Dairying; Animal Feed
PubMed: 37641322
DOI: 10.3168/jds.2023-23393 -
BMJ Open Oct 2023Exposure of pregnant women and newborns to secondhand smoke (SHS) can lead to adverse maternal and neonatal health outcomes. Among expectant and new fathers, who are the...
INTRODUCTION
Exposure of pregnant women and newborns to secondhand smoke (SHS) can lead to adverse maternal and neonatal health outcomes. Among expectant and new fathers, who are the main source of SHS exposure for pregnant women, new mothers and babies, smoking rates remain high. A partner's pregnancy potentially constitutes a critical period where expectant and new fathers are motivated to quit smoking. However, there is no consensus on the optimal form and delivery of smoking cessation and relapse-prevention interventions. We present a systematic review and network meta-analysis protocol that aims to synthesise and evaluate the effectiveness of smoking cessation and relapse-prevention interventions tailored for this population.
METHODS AND ANALYSIS
To identify relevant studies, we will conduct a comprehensive search, in English and Chinese, of 10 electronic databases. The review will include randomised and quasi-randomised controlled trials that compare behavioural interventions (tailored and non-tailored) with/without the addition of pharmacotherapy with usual care, a minimal or placebo control for assisting expectant and new fathers to quit smoking and prevent smoking relapse. The primary outcome of interest is the self-reported and/or biochemically verified smoking abstinence at ≥1-month follow-up. Two reviewers will independently screen, select and extract relevant studies, and perform a quality assessment. Disagreements will be resolved by a consensus or third-party adjudication. The Cochrane Risk of Bias tool V.2 will be used to assess the risk of bias in the included studies. We will obtain the results of the systematic review through pooled quantitative analyses using a network meta-analysis. Sensitivity and subgroup analyses will be performed.
ETHICS AND DISSEMINATION
Ethical approval is not required for this systematic review of published data. The findings will be disseminated via peer-reviewed publication.
PROSPERO REGISTRATION NUMBER
CRD42022340617.
Topics: Humans; Female; Infant, Newborn; Pregnancy; Male; Smoking Cessation; Network Meta-Analysis; Systematic Reviews as Topic; Pregnant Women; Fathers; Meta-Analysis as Topic
PubMed: 37802607
DOI: 10.1136/bmjopen-2023-071745 -
BMJ Open Aug 2023High-performing primary care is recognised as the foundation of an effective and efficient healthcare system. Many medical graduates report they are not prepared for...
INTRODUCTION
High-performing primary care is recognised as the foundation of an effective and efficient healthcare system. Many medical graduates report they are not prepared for independent practice. To date, no research has been conducted to identify the key capabilities and competencies of high-performing family medicine graduates in Canada. This pilot project aims to identify the capabilities and competencies of high-performing early-career family physicians in Ontario, Canada, and explore opportunities for enhancing learning, teaching and assessment within family medicine residency programmes.
METHODS AND ANALYSIS
Employing a mixed-methods explanatory sequential study design, this research will use a theory-driven Professional Capability Framework, previously validated in studies across nine professions, to guide the investigation. The first (quantitative) phase involves surveying ~50 high-performing early-career family physicians identified as high performing by educators, colleagues and leaders. The objective of the survey is to identify the key competencies and personal, interpersonal and cognitive capabilities of high-performing family physicians. The second (qualitative) phase involves conducting workshops with stakeholders, including educators, professional associations, regulators and colleges, to test the veracity of the results. Quantitative data will be analysed using descriptive statistics, and qualitative data will be analysed using Braun and Clarke's thematic analysis. The first and second phases will identify the key capabilities and competencies required to confidently adapt to the independent practice of comprehensive family medicine and inform fit-for-purpose educational strategies for teaching, learning and assessment.
ETHICS AND DISSEMINATION
The study is approved by the University of Toronto's Health Sciences Research Ethics Board (#41799). Research findings will be discussed with professional bodies, educators responsible for family medicine curricula and universities. Study findings will also be disseminated through academic conferences and academic publications in peer-reviewed journals. Project summaries and infographics will be developed and disseminated to key stakeholders.
Topics: Humans; Physicians, Family; Pilot Projects; Family Practice; Research Design; Ontario
PubMed: 37591643
DOI: 10.1136/bmjopen-2023-072266 -
The European Journal of Health... Aug 2023Understanding young people's preferences for healthcare is critical for reducing the negative effect of undesirable choices. This review aims to synthesise the evidence...
OBJECTIVES
Understanding young people's preferences for healthcare is critical for reducing the negative effect of undesirable choices. This review aims to synthesise the evidence obtained from discrete choice experiments (DCEs) eliciting young people's preferences for healthcare interventions and service deliveries, specifically, to (1) examine the methodology, including a selection of attributes and levels, experimental design, estimation procedure and validity; (2) evaluate similarities, differences and rigour of designs to the general population DCEs; and, (3) compare the DCEs' application to the seven health priority areas defined by the World Health Organisation (WHO).
METHODS
A systematic review searching Medline, EconLIT, PsychINFO, Scopus, and Web of Science was performed up until May 2021.
INCLUSION CRITERIA
a DCE, eliciting young peoples' preferences (10-24 years of age), on a healthcare-related topic defined by WHO, peer-reviewed, full-text available in English. A bespoke checklist was used to assess the methodological quality of the included studies.
RESULTS
Eighteen DCE studies were included in the review, exploring interventions and service in sexual and reproductive health (n = 9; 50%), smoking cessation (n = 4; 22%), mental health (n = 1), nutrition (n = 1), unintentional injuries (n = 1), vaccination against severe but rare diseases (n = 1); and diabetes (n = 1). Compared to the general population, DCEs eliciting young people's preferences had a high proportion of monetary measures and a smaller number of choices per respondent with the overwhelming number of surveys using fractional factorial design. The majority of studies were of moderate quality (50-75% of the criteria met).
CONCLUSIONS
While identified DCEs touched on most health priority areas, the scope was limited. The conduct and reporting of DCEs with young people could be improved by including the state-of-the-art design, estimation procedures and analysis.
Topics: Humans; Adolescent; Checklist; Mental Health; Rare Diseases; Research Design; Delivery of Health Care; Choice Behavior; Patient Preference
PubMed: 36169764
DOI: 10.1007/s10198-022-01528-9 -
Diagnostics (Basel, Switzerland) May 2024Computed tomography (CT)-guided lung biopsy is one of the oldest and most widely known minimally invasive percutaneous procedures. Despite being conceptually simple,... (Review)
Review
Computed tomography (CT)-guided lung biopsy is one of the oldest and most widely known minimally invasive percutaneous procedures. Despite being conceptually simple, this procedure needs to be performed rapidly and can be subject to meaningful complications that need to be managed properly. Therefore, knowledge of principles and techniques is required by every general or interventional radiologist who performs the procedure. This review aims to contain all the information that the operator needs to know before performing the procedure. The paper starts with the description of indications, devices, and types of percutaneous CT-guided lung biopsies, along with their reported results in the literature. Then, pre-procedural evaluation and the practical aspects to be considered during procedure (i.e., patient positioning and breathing) are discussed. The subsequent section is dedicated to complications, with their incidence, risk factors, and the evidence-based measures necessary to both prevent or manage them; special attention is given to pneumothorax and hemorrhage. After conventional CT, this review describes other available CT modalities, including CT fluoroscopy and cone-beam CT. At the end, more advanced techniques, which are already used in clinical practice, like fusion imaging, are included.
PubMed: 38893616
DOI: 10.3390/diagnostics14111089 -
Frontiers in Public Health 2023The choice of the debridement method is very important for the healing of diabetic foot ulcers (DFUs), but the relative effectiveness of different debridement methods in... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The choice of the debridement method is very important for the healing of diabetic foot ulcers (DFUs), but the relative effectiveness of different debridement methods in the healing of DFUs remains unclear. This study conducted a network meta-analysis of the relative healing effectiveness of different debridement methods in patients with DFUs.
METHODS
We performed a literature search in PubMed, Embase, and Cochrane Library from database inception up to 30 June 2023 for screening randomized controlled trials on the healing effectiveness of debridement in DFUs. Outcome measures included ulcer healing rate and ulcer area reduction rate. The Cochrane Risk Bias Tool, version 2.0, was used to assess the risk of bias in the included trials. R software was used for performing statistical analysis and GraphPad Prism was used for image plotting.
RESULTS
A total of 19 randomized controlled trials were included, and 900 patients with DFUs were assessed in this analysis. The proteolytic fraction from the latex of (P1G10) in enzymatic debridement showed the best ulcer healing rate (SURCA = 0.919) when compared with the standard of care (SOC) group, with a mean difference (MD) and 95% confidence interval (CI) of 1.40 (0.57, 2.36). Kiwifruit extract demonstrated the best effect on the ulcer area reduction rate (SURCA = 0.931), when compared with that in the SOC group, with an MD and 95% CI of 0.47 (0.27, 0.66).
CONCLUSION
Enzymatic debridement was superior to other debridement methods in terms of ulcer healing rate and ulcer area reduction rate in patients with DFUs. However, as the quality of the included trials is low, enzymatic debridement can be used as a candidate debridement method in addition to sharp-based debridement in clinical practice.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023441715.
Topics: Humans; Diabetic Foot; Debridement; Network Meta-Analysis; Randomized Controlled Trials as Topic; Wound Healing; Diabetes Mellitus
PubMed: 38146472
DOI: 10.3389/fpubh.2023.1271706