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Canadian Medical Education Journal Sep 2023Training future doctors in the skills of evidence-based medicine (EBM) is clearly important. Journal club (JCs) are well-recognized educational interventions for... (Review)
Review
BACKGROUND
Training future doctors in the skills of evidence-based medicine (EBM) is clearly important. Journal club (JCs) are well-recognized educational interventions for teaching EBM. In contrast to postgraduate medical education, JCs use in undergraduate medical education (UME) has not been adequately explored. We conducted a realist review of the effectiveness of JCs in UME to unpack the underlying mechanisms by which the intervention works (or fails) in teaching EBM.
METHODS
The scope of review was the evaluation of the effectiveness of JCs in UME settings. We searched major bibliographic databases - MEDLINE, Embase, ERIC, PSYCInfo, CINAHL, Scopus, and Web of Science and found fifteen articles eligible for inclusion. Data was extracted aided by a modified Kirkpatrick framework and presented in evidence tables. Themes and chains of inference were identified, and finally, we formulated new hypotheses on how and why JC intervention works.
RESULTS
Mandatory vs. voluntary JC did not differentially impact attendance of JC in UME settings though JC duration beyond two hours decreased attendees' self-reported satisfaction. Coupling lectures to JCs positively impacts knowledge gain and retention. Coupled Mentorship or using critical appraisal worksheets helped the achievement of manuscript writing skills and a positive attitude towards EBM.
CONCLUSIONS
Journal clubs are effective interventions to teach EBM in UME settings and are well-received by learners. They improve specific learning outcomes of knowledge gain and retention, skills of manuscript writing and critical appraisal. However, we found no evidence that these translates to the practice of EBM nor impacts patient outcomes.
Topics: Humans; Students; Education, Medical; Databases, Bibliographic; Education, Medical, Undergraduate; Evidence-Based Medicine
PubMed: 37719396
DOI: 10.36834/cmej.72758 -
Autoimmunity Reviews Jun 2022Antinuclear antibodies (ANA) detected in juvenile idiopathic arthritis (JIA) sera are considered to be a biomarker for JIA-related uveitis. There is an unclear consensus... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Antinuclear antibodies (ANA) detected in juvenile idiopathic arthritis (JIA) sera are considered to be a biomarker for JIA-related uveitis. There is an unclear consensus on the screening dilutions of ANA as detected by the HEp-2 indirect immunofluorescence assay (IFA) that should be used when predicting the risk of uveitis in JIA. The primary aim of this systematic review and meta-analysis was to summarize the evidence regarding ANA prevalence and performance in JIA and JIA-associated uveitis.
METHODS
A search of five databases identified 1766 abstracts, using the search terms juvenile idiopathic arthritis; pediatric; sensitivity or diagnostic; and ANA. Studies that met inclusion/exclusion criteria were analyzed for the proportion of JIA patients with a positive ANA. Forest plots and pooled estimates were generated for the proportion of JIA patients and those with uveitis who were positive for ANA stratified by screening dilution. Study heterogeneity was also assessed.
RESULTS
Twenty-eight studies met inclusion criteria yielding 6250 unique patients; 5902 had JIA and 348 were healthy controls or were known to have other autoimmune diseases. The most reported IFA serum screening dilution was ≥1:80, representing 41.9% of patients and this screening dilution had the highest proportion of JIA ANA positivity (41.0%; 95% CI 25.0%-57.0%). ANA screening for JIA uveitis had a sensitivity and specificity of ANA at ≥1:40 of 75% (95% CI 46%-100%) and 66% (95% CI 39%-93%), respectively. There was significant study heterogeneity across both JIA subtypes and ANA titres.
CONCLUSIONS
Although there was a large variation of ANA IFA screening dilutions used for investigation of JIA, the most common dilution was 1:80. The current literature has several important deficiencies that are identified in this review requiring additional studies to inform the ANA screening dilutions of clinical value in JIA and JIA-associated uveitis.
Topics: Antibodies, Antinuclear; Arthritis, Juvenile; Child; Fluorescent Antibody Technique, Indirect; Humans; Prevalence; Retrospective Studies; Uveitis
PubMed: 35398272
DOI: 10.1016/j.autrev.2022.103086 -
Cancers Jul 2023Sarcoma may show similarities to malignant melanoma in terms of morphologic and immunohistochemical aspects, making it difficult to differentiate between these two... (Review)
Review
BACKGROUND
Sarcoma may show similarities to malignant melanoma in terms of morphologic and immunohistochemical aspects, making it difficult to differentiate between these two neoplasms during the diagnostic process. This systematic review aims to summarize available evidence on cases of sarcoma that were initially diagnosed as melanoma.
METHODS
A comprehensive search of the MEDLINE/Pubmed, EMBASE, and SCOPUS databases was conducted through March 2023. We included case series and case reports of sarcoma patients that were initially diagnosed as malignant melanoma. PRISMA guidelines were followed.
RESULTS
Twenty-three case reports and four case series with a total of 34 patients were included. The clinical presentation was heterogeneous, and the most involved anatomical regions were lower limbs (24%), head/neck (24%), and upper limbs (21%). IHC positivity was reported for S100 (69%), HMB45 (63%), MelanA (31%), and MiTF (3%). The main reasons for a second assessment were unusual presentation (48%) and uncertain diagnosis (28%). EWSR1 translocation was investigated in 17/34 patients (50%) and found to be positive in 16/17 (94%). The final diagnosis was clear cell sarcoma (50%) or other soft tissue sarcomas (50%).
CONCLUSIONS
Melanoma and some histotypes of sarcoma share many similarities. In cases of atypical lesions, a second diagnosis should be considered, and ESWR1 translocation should be investigated.
PubMed: 37509250
DOI: 10.3390/cancers15143584 -
BMC Geriatrics Dec 2023Sedentary behaviour is considered to contribute to sarcopenia when combined with physical inactivity. Whether sedentary behaviour is independently associated with... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Sedentary behaviour is considered to contribute to sarcopenia when combined with physical inactivity. Whether sedentary behaviour is independently associated with sarcopenia remains controversial. The aim of this study is to explore the association between sedentary behaviour and sarcopenia in older adults in community and long-term care facility settings.
METHODS
Eight electronic databases including MEDLINE, PsycINFO, Wanfang were searched from inception until August 2023. The review included cross-sectional and longitudinal studies concerning the association between sedentary behaviour and sarcopenia among participants over 60 years old. Evidence was pooled by both random-effects meta-analysis and narrative synthesis. Subgroup analyses explored variation according to adjustment of physical activity, settings, and measurements of sedentary behaviour and sarcopenia. Quality assessment for individual studies was performed with the Joanna Briggs Institute (JBI) Critical Appraisal Checklist.
RESULTS
Seventeen articles (16 cross-sectional studies and 1 longitudinal study) of 25,788 participants from community or long-term care facility settings were included. The overall quality of the included studies was rated high. Meta-analysis of 14 cross-sectional studies showed that sedentary behaviour was independently positively associated with sarcopenia: pooled odd ratio 1.36 (95% confidence interval, 1.18-1.58). The independent positive association remained in subgroup analyses by adjustment of physical activity, settings, and measurements of sedentary behaviour and sarcopenia. The narrative analysis corroborated the findings of the meta-analysis and provided additional evidence suggesting that interruptions in sedentary periods were linked to a decreased likelihood of developing sarcopenia.
CONCLUSIONS
The findings support the hypothesis that sedentary behaviour is independently positively associated with sarcopenia in older adults, providing vital indications for the development of strategies to prevent sarcopenia.
SYSTEMATIC REVIEW REGISTRATION
The systematic review protocol has been registered with the PROSPERO database (CRD42022311399).
Topics: Aged; Humans; Cross-Sectional Studies; Longitudinal Studies; Sarcopenia; Sedentary Behavior
PubMed: 38124026
DOI: 10.1186/s12877-023-04489-7 -
Journal of Medical Internet Research Apr 2023Positive health behavior changes before pregnancy can optimize perinatal outcomes for mothers, babies, and future generations. Women are often motivated to positively... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Positive health behavior changes before pregnancy can optimize perinatal outcomes for mothers, babies, and future generations. Women are often motivated to positively change their behavior in preparation for pregnancy to enhance their health and well-being. Mobile phone apps may provide an opportunity to deliver public health interventions during the preconception period.
OBJECTIVE
This review aimed to synthesize the evidence of the effectiveness of mobile phone apps in promoting positive behavior changes in women of reproductive age before they are pregnant (preconception and interconception periods), which may improve future outcomes for mothers and babies.
METHODS
Five databases were searched in February 2022 for studies exploring mobile phone apps as a prepregnancy intervention to promote positive behavior change. The identified studies were retrieved and exported to EndNote (Thomson Reuters). Using Covidence (Veritas Health Innovation), a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) study flow diagram was generated to map the number of records identified, included, and excluded. Three independent reviewers assessed the risk of bias and conducted data extraction using the Review Manager software (version 5.4, The Cochrane Collaboration), and the data were then pooled using a random-effects model. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess the certainty of the evidence.
RESULTS
Of the 2973 publications identified, 7 (0.24%) were included. The total number of participants across the 7 trials was 3161. Of the 7 studies, 4 (57%) included participants in the interconception period, and 3 (43%) included women in the preconception period. Of the 7 studies, 5 (71%) studies focused on weight reduction, assessing the outcomes of reductions in adiposity and weight. Of the 7 studies, nutrition and dietary outcomes were evaluated in 2 (29%) studies, blood pressure outcomes were compared in 4 (57%) studies, and biochemical and marker outcomes associated with managing disease symptoms were included in 4 (57%) studies. Analysis showed that there were no statistically significant differences in energy intake; weight loss; body fat; and biomarkers such as glycated hemoglobin, total cholesterol, fasting lipid profiles, or blood pressure when compared with standard care.
CONCLUSIONS
Owing to the limited number of studies and low certainty of the evidence, no firm conclusions can be drawn on the effects of mobile phone app interventions on promoting positive behavior changes in women of reproductive age before they are pregnant (preconception and interconception periods).
TRIAL REGISTRATION
PROSPERO CRD42017065903; https://tinyurl.com/2p9dwk4a.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
RR2-10.1186/s13643-019-0996-6.
Topics: Female; Humans; Pregnancy; Cell Phone; Diet; Health Behavior; Mobile Applications; Obesity
PubMed: 37074767
DOI: 10.2196/41900 -
Circulation Reports Jul 2022The aim of this study was to assess and discuss the diagnostic accuracy of prehospital ECG interpretation through systematic review and meta-analyses. Relevant... (Review)
Review
The aim of this study was to assess and discuss the diagnostic accuracy of prehospital ECG interpretation through systematic review and meta-analyses. Relevant literature published up to July 2020 was identified using PubMed. All human studies of prehospital adult patients suspected of ST-segment elevation myocardial infarction in which prehospital electrocardiogram (ECG) interpretation by paramedics or computers was evaluated and reporting all 4 (true-positive, false-positive, false-negative, and true-negative) values were included. Meta-analyses were conducted separately for the diagnostic accuracy of prehospital ECG interpretation by paramedics (Clinical Question [CQ] 1) and computers (CQ2). After screening, 4 studies for CQ1 and 6 studies for CQ2 were finally included in the meta-analysis. Regarding CQ1, the pooled sensitivity and specificity were 95.5% (95% confidence interval [CI] 82.5-99.0%) and 95.8% (95% CI 82.3-99.1%), respectively. Regarding CQ2, the pooled sensitivity and specificity were 85.4% (95% CI 74.1-92.3%) and 95.4% (95% CI 87.3-98.4%), respectively. This meta-analysis suggests that the diagnostic accuracy of paramedic prehospital ECG interpretations is favorable, with high pooled sensitivity and specificity, with an acceptable estimated number of false positives and false negatives. Computer-assisted ECG interpretation showed high pooled specificity with an acceptable estimated number of false positives, whereas the pooled sensitivity was relatively low.
PubMed: 35860351
DOI: 10.1253/circrep.CR-22-0002 -
Infectious Agents and Cancer Nov 2023Understanding the role of naturally acquired (i.e., infection-induced) human papillomavirus (HPV) antibodies against reinfection is important given the high incidence of... (Review)
Review
BACKGROUND
Understanding the role of naturally acquired (i.e., infection-induced) human papillomavirus (HPV) antibodies against reinfection is important given the high incidence of this sexually transmitted infection. However, the protective effect of naturally acquired antibodies in terms of the level of protection, duration, and differential effect by sex remains incompletely understood. We conducted a systematic review and a meta-analysis to (1) strengthen the evidence on the association between HPV antibodies acquired through past infection and subsequent type-specific HPV detection, (2) investigate the potential influence of type-specific HPV antibody levels, and (3) assess differential effects by HIV status.
METHODS
We searched Embase and Medline databases to identify studies which prospectively assessed the risk of type-specific HPV detection by baseline homologous HPV serostatus among unvaccinated individuals. Random-effect models were used to pool the measures of association of naturally acquired HPV antibodies against subsequent incident detection and persistent HPV positivity. Sources of heterogeneity for each type were assessed through subgroup analyses stratified by sex, anatomical site of infection, male sexual orientation, age group, and length of follow-up period. Evidence of a dose-response relationship of the association between levels of baseline HPV antibodies and type-specific HPV detection was assessed. Finally, we pooled estimates from publications reporting associations between HPV serostatus and type-specific HPV detection by baseline HIV status.
RESULTS
We identified 26 publications (16 independent studies, with 62,363 participants) reporting associations between baseline HPV serostatus and incident HPV detection, mainly for HPV-16 and HPV-18, the most detected HPV type. We found evidence of protective effects of baseline HPV seropositivity and subsequent detection of HPV DNA (0.70, 95% CI 0.61-0.80, N = 11) and persistent HPV positivity (0.65, 95% CI 0.42-1.01, N = 5) mainly for HPV-16 among females, but not among males, nor for HPV-18. Estimates from 8 studies suggested a negative dose-response relationship between HPV antibody level and subsequent detection among females. Finally, we did not observe any differential effect by baseline HIV status due to the limited number of studies available.
CONCLUSION
We did not find evidence that naturally acquired HPV antibodies protect against subsequent HPV positivity in males and provide only modest protection among females for HPV-16. One potential limitation to the interpretation of these findings is potential misclassification biases due to different causes.
PubMed: 37941016
DOI: 10.1186/s13027-023-00546-3 -
International Journal of Environmental... Jul 2022Narrow-band imaging (NBI) represents a valid aid in laryngeal squamous cell carcinoma (LSCC) diagnosis for detecting vascular changes. However, LSCC and laryngeal... (Review)
Review
Narrow-band imaging (NBI) represents a valid aid in laryngeal squamous cell carcinoma (LSCC) diagnosis for detecting vascular changes. However, LSCC and laryngeal papillomatosis (LP) show similar vascular patterns that may lead to misdiagnosis and improper treatment. This review aims to deepen this NBI limit in order to stress a careful preoperative evaluation of laryngeal lesions. The research was carried out on PubMed, Web of Science and Scopus databases using specific keywords. The topic of research was assessed by these parameters: accuracy, sensitivity, specificity, and positive and negative predictive values. This review included only five articles: they demonstrated that NBI is better than white-light endoscopy in detecting LSCC and LP. They also reported that LP is frequently mistaken for LSCC, resulting in high rates of false positives using NBI. This is the first review that emphasized this NBI limitation in distinguishing between LP and LSCC in cases of a type V pattern of intraepithelial papillary capillary loop. Although NBI application increased the rate of early cancer detection, LP reduces NBI accuracy. This drawback may lead to misdiagnosis and improper treatment. Our advice is to be careful in cases of type V pattern on NBI and to research LP epithelial and clinical features because it could be a pitfall.
Topics: Humans; Laryngeal Neoplasms; Laryngoscopy; Narrow Band Imaging; Papilloma; Sensitivity and Specificity
PubMed: 35886569
DOI: 10.3390/ijerph19148716 -
Trauma, Violence & Abuse Jul 2024This review aimed to examine the relationship between intimate partner violence (IPV) perpetration and trait narcissism, and whether the strength of this relationship... (Meta-Analysis)
Meta-Analysis Review
This review aimed to examine the relationship between intimate partner violence (IPV) perpetration and trait narcissism, and whether the strength of this relationship differs depending on narcissism type (grandiose or vulnerable), the type of violence perpetrated, or the perpetrator's gender. Scopus, Medline, PsycInfo, and Academic Search Complete databases were searched on August 11, 2022. Studies were included if they were in English, measured IPV perpetration and trait narcissism, and examined the relationship between trait narcissism and IPV perpetration. Studies were excluded if they were review papers, conference extracts, book chapters, or if the data was not specific to trait narcissism. The AXIS tool was used to assess the quality and risk of bias of the studies. Twenty-two studies ( = 11,520 participants) were included in the random effects meta-analysis revealing a significant, weak, positive relationship between trait narcissism and IPV perpetration, = .15. Subgroup analyses revealed physical IPV perpetration was not significantly related to trait narcissism while cyber and psychological IPV perpetration were significantly, positively, weakly related to trait narcissism. No significant difference in the strength of the relationship with IPV perpetration was found between males and females. The relationship between trait narcissism and IPV perpetration was significantly greater for vulnerable narcissism than grandiose narcissism. Overall, the quality of the included studies was high, and risk of bias was low. All measures were self-report and underreporting could be present given both narcissistic traits and IPV perpetration are considered socially undesirable. Future research examining these relationships should specify IPV and narcissism types.
Topics: Female; Humans; Male; Intimate Partner Violence; Narcissism
PubMed: 37702183
DOI: 10.1177/15248380231196115 -
AIDS (London, England) Nov 2023A strong global commitment exists to eliminate HIV-related stigma and discrimination, and multiple strategies to reduce or eliminate stigma and discrimination have been...
A strong global commitment exists to eliminate HIV-related stigma and discrimination, and multiple strategies to reduce or eliminate stigma and discrimination have been tried. Using a PICOTS framework and applying the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria, we undertook a systematic review to determine the success of interventions aiming to address internalized stigma, stigma and discrimination in healthcare, and at the legal or policy level, and to identify their critical success factors. Random effects meta-analyses summarized results wherever possible. We carried out a component analysis to identify and characterize successful interventions. Internalized stigma interventions were diverse: across all studies, we found a reduction of stigma but it was not statistically significant [standardized mean difference (SMD) 0.56; confidence interval (CI) 0.31-1.02; 17 studies). For interventions to address stigma and discrimination in healthcare settings, effect estimates varied considerably but most studies showed positive effects (SMD 0.71; CI 0.60-0.84, 8 studies). Boosted regression analyses found that a combined approach comprising education, counseling, community participation, support person, and access to a HIV specialist often yielded success. Studies of efforts to address stigma and discrimination through law and policy documented, mostly qualitatively, the effect of court cases and directives. Across a range of settings and populations, promising interventions have been identified that, through diverse pathways, have positively impacted the types of stigma and discrimination studied. This evidence base must be built upon and brought to scale to help reach global HIV-related targets and, most importantly, improve the health and quality of life of people with HIV.
Topics: Humans; Quality of Life; HIV Infections; Social Stigma; Counseling
PubMed: 37352492
DOI: 10.1097/QAD.0000000000003628