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Pediatrics Apr 2024Correct diagnosis is essential for the appropriate clinical management of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents.
CONTEXT
Correct diagnosis is essential for the appropriate clinical management of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents.
OBJECTIVE
This systematic review provides an overview of the available diagnostic tools.
DATA SOURCES
We identified diagnostic accuracy studies in 12 databases published from 1980 through June 2023.
STUDY SELECTION
Any ADHD tool evaluation for the diagnosis of ADHD, requiring a reference standard of a clinical diagnosis by a mental health specialist.
DATA EXTRACTION
Data were abstracted and critically appraised by 1 reviewer and checked by a methodologist. Strength of evidence and applicability assessments followed Evidence-based Practice Center standards.
RESULTS
In total, 231 studies met eligibility criteria. Studies evaluated parental ratings, teacher ratings, youth self-reports, clinician tools, neuropsychological tests, biospecimen, EEG, and neuroimaging. Multiple tools showed promising diagnostic performance, but estimates varied considerably across studies, with a generally low strength of evidence. Performance depended on whether ADHD youth were being differentiated from neurotypically developing children or from clinically referred children.
LIMITATIONS
Studies used different components of available tools and did not report sufficient data for meta-analytic models.
CONCLUSIONS
A valid and reliable diagnosis of ADHD requires the judgment of a clinician who is experienced in the evaluation of youth with and without ADHD, along with the aid of standardized rating scales and input from multiple informants across multiple settings, including parents, teachers, and youth themselves.
Topics: Child; Humans; Adolescent; Attention Deficit Disorder with Hyperactivity; Mental Health; Neuropsychological Tests; Parents; Self Report
PubMed: 38523599
DOI: 10.1542/peds.2024-065854 -
The Science of the Total Environment Feb 2022Decision Support Systems (DSS) for Sustainable Urban Drainage Systems (SUDS) are a valuable aid for SUDS widespread adoption. These tools systematize the decision-making... (Review)
Review
Decision Support Systems (DSS) for Sustainable Urban Drainage Systems (SUDS) are a valuable aid for SUDS widespread adoption. These tools systematize the decision-making criteria and eliminate the bias inherent to expert judgment, abridging the technical aspect of SUDS for non-technical users and decision-makers. Through the collection and careful assessment of 120 papers on SUDS models and SUDS-DSS, this review shows how these tools are built, selected, and used to assist decision-makers questions. The manuscript classifies the DSS based on the question they assist in answering, the spatial scale used, the software selected, among other aspects. SUDS-DSS aspects that require more attention are identified, including environmental and social considerations, SUDS trains performance and criteria for selection, stochasticity of rainfall, and future scenarios impact. Suggestions for SUDS-DSS are finally offered to better equip decision-makers in facing emerging stormwater challenges in urban centers.
PubMed: 34582871
DOI: 10.1016/j.scitotenv.2021.150447 -
The Cochrane Database of Systematic... Jan 2022Enhancing health equity is endorsed in the Sustainable Development Goals. The failure of systematic reviews to consider potential differences in effects across equity... (Review)
Review
BACKGROUND
Enhancing health equity is endorsed in the Sustainable Development Goals. The failure of systematic reviews to consider potential differences in effects across equity factors is cited by decision-makers as a limitation to their ability to inform policy and program decisions. OBJECTIVES: To explore what methods systematic reviewers use to consider health equity in systematic reviews of effectiveness.
SEARCH METHODS
We searched the following databases up to 26 February 2021: MEDLINE, PsycINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Hein Index to Foreign Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on 10 June 10 2021. We contacted authors and searched the reference lists of included studies to identify additional potentially relevant studies.
SELECTION CRITERIA
We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities. We define health inequalities as unfair and avoidable differences across socially stratifying factors that limit opportunities for health. We operationalised this by assessing studies which evaluated differences in health across any component of the PROGRESS-Plus acronym, which stands for Place of residence, Race/ethnicity/culture/language, Occupation, Gender or sex, Religion, Education, Socioeconomic status, Social capital. "Plus" stands for other factors associated with discrimination, exclusion, marginalisation or vulnerability such as personal characteristics (e.g. age, disability), relationships that limit opportunities for health (e.g. children in a household with parents who smoke) or environmental situations which provide limited control of opportunities for health (e.g. school food environment).
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data using a pre-tested form. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews. MAIN RESULTS: In total, 48,814 studies were identified and the titles and abstracts were screened in duplicate. In this updated review, we identified an additional 124 methodological studies published in the 10 years since the first version of this review, which included 34 studies. Thus, 158 methodological studies met our criteria for inclusion. The methods used by these studies focused on evidence relevant to populations experiencing health inequity (108 out of 158 studies), assess subgroup analysis across PROGRESS-Plus (26 out of 158 studies), assess analysis of a gradient in effect across PROGRESS-Plus (2 out of 158 studies) or use a combination of subgroup analysis and focused approaches (20 out of 158 studies). The most common PROGRESS-Plus factors assessed were age (43 studies), socioeconomic status in 35 studies, low- and middle-income countries in 24 studies, gender or sex in 22 studies, race or ethnicity in 17 studies, and four studies assessed multiple factors across which health inequity may exist. Only 16 studies provided a definition of health inequity. Five methodological approaches to consider health equity in systematic reviews of effectiveness were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (140 of 158 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (50 studies); 3) analytic approaches which assessed differential effects across one or more PROGRESS-Plus factors (16 studies); 4) applicability assessment (25 studies) and 5) stakeholder engagement (28 studies), which is a new finding in this update and examines the appraisal of whether relevant stakeholders with lived experience of health inequity were included in the design of systematic reviews or design and delivery of interventions. Reporting for both approaches (analytic and applicability) lacked transparency and was insufficiently detailed to enable the assessment of credibility.
AUTHORS' CONCLUSIONS
There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to consider health equity in systematic reviews of effectiveness.
Topics: Child; Health Equity; Humans; Parents; Research Design; Systematic Reviews as Topic
PubMed: 35040487
DOI: 10.1002/14651858.MR000028.pub3 -
Academic Pediatrics 2022Entrustable Professional Activities (EPAs) provide a framework to make judgments of trainees' abilities in several settings including postgraduate medical education. No... (Review)
Review
BACKGROUND
Entrustable Professional Activities (EPAs) provide a framework to make judgments of trainees' abilities in several settings including postgraduate medical education. No systematic review of the role of EPAs in pediatrics has yet been performed.
OBJECTIVES
In our systematic review, we sought to determine the use of EPAs in pediatrics to identify research gaps, summarize and discuss evidence relating to the development, implementation, and assessment.
DATA SOURCES
Medline, Scopus, PsycINFO, MedEdPortal, and Web of Science.
STUDY ELIGIBILITY CRITERIA
Two independent reviewers used a structured screening protocol in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Association for Medical Education in Europe's guide for systematic reviews to include all articles reporting on EPAs in postgraduate medical education and pediatrics in particular. There were no restrictions due to language, study design, or participants.
STUDY APPRAISAL AND SYNTHESIS METHODS
Data on development, implementation, feasibility, acceptance, and assessment of EPAs were extracted and analyzed by the 2 independent researchers.
RESULTS
Twenty-eight articles published between 2014 and 2020 were included in the review. We found an increase in publications and a notable shift from descriptions of development processes toward aspects beyond development, ie, implementation, feasibility, acceptance/perception, and assessment.
LIMITATIONS
Studies from non-English-speaking countries are scarce which might lead to an inaccurate representation of actual international practice.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS
We provide a comprehensive overview of EPAs in pediatrics to guide future curriculum developers in collaborative development, implementation and assessment of EPAs in pediatric postgraduate medical education.
Topics: Child; Clinical Competence; Competency-Based Education; Education, Medical; Humans; Internship and Residency; Pediatrics
PubMed: 34256178
DOI: 10.1016/j.acap.2021.07.007 -
Iranian Journal of Nursing and... 2022Blinding is one of the critical criteria of clinical trials that prevents probable bias. Judgment regarding results of an intervention significantly depends on the... (Review)
Review
BACKGROUND
Blinding is one of the critical criteria of clinical trials that prevents probable bias. Judgment regarding results of an intervention significantly depends on the quality of such studies, one of which is blinding. This study aimed to investigate blinding and its quality in clinical trials in patients with breast cancer.
MATERIALS AND METHODS
A systematic review was conducted on the online databases of PubMed, ScienceDirect and ProQuest using keywords, MeSH terms and grey literature. Articles were screened by predefined inclusion and exclusion criteria. They were evaluated based on the checklists introduced by Cochrane database.
RESULTS
From 22519 articles obtained at the initial stage, 20 articles remained after screening for the inclusion and exclusion criteria. Fifteen articles had used single, five: double and none had used triple or quadruple blinding. Seventeen studies had described the details of blinding. Of the 15 single blind articles, the blinded subjects were patients in five, patients and research assistants in three, research assistants in five studies, and two had not given any details.
CONCLUSIONS
The majority of researchers had used the single blind method, though using double, triple or quadruple blinding increases the trustworthiness of results and increases the quality of clinical trials. The details of blinding should be explained to other researchers and for a better understanding of the method if it is to be repeated. Thereafter, nurses can apply new interventions and earn their patients' trust and help those with breast cancer by relieving them of their disease symptoms and its treatment complications.
PubMed: 35280192
DOI: 10.4103/ijnmr.IJNMR_49_20 -
Journal of Eating Disorders Oct 2023Studies have established the central role of the family in the recognition, treatment, and recovery of anorexia nervosa. The objective of this study was to review,... (Review)
Review
BACKGROUND
Studies have established the central role of the family in the recognition, treatment, and recovery of anorexia nervosa. The objective of this study was to review, synthesize, and critically appraise the literature on parents' views on the treatment and recovery process of anorexia nervosa in their adolescent child.
METHOD
A systematic search of Medline, PsychINFO, CINHAL, EMBASE, Cochrane library, and SSCI was conducted for qualitative studies published regarding parents' views about the treatment of anorexia nervosa. The quality of articles was assessed using the critical appraisal skills program (CASP) and findings were analysed using thematic synthesis.
RESULTS
A total of 25 studies from nine countries reporting the views of 357 parents met the inclusion criteria. Four major themes were developed from the analysis: understanding the child and the disease, experience of services and treatment modalities, the role of professionals, and the experience of recovery.
CONCLUSION
Parents report struggles with delays in finding help, judgmental attitudes of professionals, and uncertainty about the future. Recognition of the challenges faced by parents and families empowers clinicians to build stronger therapeutic relationships essential for long-term recovery from anorexia nervosa.
PubMed: 37904246
DOI: 10.1186/s40337-023-00910-z -
Neuropsychology Review Mar 2023The current systematic review examines the behavioral effects of TMS on reading. Transcranial magnetic stimulation (TMS) to targeted nodes of the brain's reading network... (Review)
Review
The current systematic review examines the behavioral effects of TMS on reading. Transcranial magnetic stimulation (TMS) to targeted nodes of the brain's reading network has been shown to impact reading. Extracted data included (a) study characteristics, (b) methodology, (c) targeted nodes, (d) control paradigm, (e) type of reading task, (f) adverse effects, and (g) main findings. Data was classified by type of reading task: 1) phonological processing, 2) semantic judgment, 3) lexical decision, 4) whole word reading, and 5) visual or text characteristics. Seventy records from 46 studies (n = 844) were identified. Results indicate that TMS modulates semantic judgments when focused in the anterior aspects of the reading circuit, phonological processes after stimulation within the dorsal circuit, and impacts single word recognition and contextual reading when administered to the ventral circuit. Findings suggest that changes in specific behavioral aspects of reading following TMS may contribute to identification of foci for use as part of reading interventions.
Topics: Humans; Transcranial Magnetic Stimulation; Brain Mapping; Magnetic Resonance Imaging; Semantics
PubMed: 35119625
DOI: 10.1007/s11065-022-09534-7 -
Microsurgery Sep 2023Indocyanine green angiography (ICG-A) has been widely applied for intraoperative flap assessment in DIEP flap breast reconstruction. However, the beneficial effect of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Indocyanine green angiography (ICG-A) has been widely applied for intraoperative flap assessment in DIEP flap breast reconstruction. However, the beneficial effect of ICG-A in DIEP flap breast reconstruction is still uncertain and no standardized protocol is available. This study aims to analyze the clinical outcome and comprehensively review protocols of this field.
METHODS
A systematic review was conducted in MEDLINE, EMBASE, and Cochrane CENTRAL databases until September 15, 2022. Studies on the utility of intraoperative ICG-A in DIEP breast reconstruction were included. Data reporting reconstruction outcomes were extracted for pooled analysis.
RESULTS
A total of 22 studies were enrolled in the review, among five studies with 1021 patients included in the meta-analysis. The protocols of ICG-A assessment of DIEP flap varied among studies. According to the pooled results, the incidence of postoperative fat necrosis was 10.89% (50 of 459 patients) with ICG-A and 21.53% (121 of 562 patients) with clinical judgment. The risk for postoperative fat necrosis was significantly lower in patients with intraoperative ICG-A than without (RR 0.47 95% CI 0.29-0.78, p = .004, I = 51%). Reoperation occurred in 5 of 48 patients (10.42%) in the ICG-A group and in 21 of 64 patients (32.82%) in the control group summarized from reports in two studies. The risk for reoperation was lower in the ICG-A group than in the control group (RR 0.41 95% CI 0.18-0.93, p = .03, I = 0%). Other complications, including flap loss, seroma, hematoma, dehiscence, mastectomy skin necrosis, and infection, were comparable between the two groups. Heterogeneities among studies were acceptable. No significant influence of specific studies was identified in sensitivity analysis.
CONCLUSIONS
ICG-A is an accurate and reliable way to identify problematic perfusion of DIEP flaps during breast reconstruction. Protocols of ICG-A differed in current studies. Intraoperative ICG-A significantly decreases the rate of fat necrosis and reoperation in patients undergoing DIEP breast reconstruction. The synthesized results should be interpreted sensibly due to the sample size limitation. RCTs on the outcomes and high-quality studies for an optimized ICG-A protocol are still needed in the future.
Topics: Humans; Female; Mastectomy; Indocyanine Green; Perforator Flap; Fat Necrosis; Breast Neoplasms; Mammaplasty; Angiography; Perfusion; Postoperative Complications; Epigastric Arteries; Retrospective Studies
PubMed: 37165852
DOI: 10.1002/micr.31056 -
Diagnosis (Berlin, Germany) Nov 2023To assess the usefulness of case reports as sources for research on diagnostic errors in uncommon diseases and atypical presentations. (Review)
Review
OBJECTIVES
To assess the usefulness of case reports as sources for research on diagnostic errors in uncommon diseases and atypical presentations.
CONTENT
We reviewed 563 case reports of diagnostic error. The commonality of the final diagnoses was classified based on the description in the articles, Orphanet, or epidemiological data on available references; the typicality of presentation was classified based on the description in the articles and the judgment of the physician researchers. Diagnosis Error Evaluation and Research (DEER), Reliable Diagnosis Challenges (RDC), and Generic Diagnostic Pitfalls (GDP) taxonomies were used to assess the factors contributing to diagnostic errors.
SUMMARY AND OUTLOOK
Excluding three cases in that commonality could not be classified, 560 cases were classified into four categories: typical presentations of common diseases (60, 10.7 %), atypical presentations of common diseases (35, 6.2 %), typical presentations of uncommon diseases (276, 49.3 %), and atypical presentations of uncommon diseases (189, 33.8 %). The most important DEER taxonomy was "Failure/delay in considering the diagnosis" among the four categories, whereas the most important RDC and GDP taxonomies varied with the categories. Case reports can be a useful data source for research on the diagnostic errors of uncommon diseases with or without atypical presentations.
Topics: Humans; Diagnostic Errors; Electron Spin Resonance Spectroscopy; Judgment; Case Reports as Topic
PubMed: 37561056
DOI: 10.1515/dx-2023-0030 -
Frontiers in Neuroscience 2023The purpose of this study is to evaluate the efficacy and safety of stimulating the vagus nerve in patients with disorders of consciousness (DOCs). (Review)
Review
PURPOSE
The purpose of this study is to evaluate the efficacy and safety of stimulating the vagus nerve in patients with disorders of consciousness (DOCs).
METHODS
A comprehensive systematic review was conducted, encompassing the search of databases such as PubMed, CENTRAL, EMBASE and PEDro from their inception until July 2023. Additionally, manual searches and exploration of grey literature were performed. The literature review was conducted independently by two reviewers for search strategy, selection of studies, data extraction, and judgment of evidence quality according to the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) Study Quality Scale.
RESULTS
A total of 1,269 articles were retrieved, and 10 studies met the inclusion criteria. Among these, there were three case reports, five case series, and only two randomized controlled trials (RCTs). Preliminary studies have suggested that stimulation of vagus nerve can enhance the levels of DOCs in both vegetative state/unresponsive wakefulness state (VS/UWS) and minimally conscious state (MCS). However, due to a lack of high-quality RCTs research and evidence-based medical evidence, no definitive conclusion can be drawn regarding the intervention's effectiveness on consciousness level. Additionally, there were no significant adverse effects observed following stimulation of vagus nerve.
CONCLUSION
A definitive conclusion cannot be drawn from this systematic review as there was a limited number of eligible studies and low-quality evidence. The findings of this systematic review can serve as a roadmap for future research on the use of stimulation of vagus nerve to facilitate recovery from DOCs.
PubMed: 37781261
DOI: 10.3389/fnins.2023.1257378