-
International Journal of Surgery... Feb 2024Good nutritional screening tests can triage malnourished patients for further assessment and management by dietitians before surgery to reduce the risk of postoperative... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Good nutritional screening tests can triage malnourished patients for further assessment and management by dietitians before surgery to reduce the risk of postoperative complications. The authors assessed the diagnostic test accuracy of common nutritional screening tools for preoperative malnutrition in adults undergoing surgery and determined which test had the highest accuracy.
METHODS
MEDLINE, EMBASE, CINAHL, and Web of Science were searched for relevant titles with no language restriction from inception till 1 January 2023. Studies reporting on the diagnostic test accuracy of preoperative malnutrition in adults using one or more of the following index nutritional screening tools were included: Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Mini Nutritional Assessment (MNA), short-form Mini Nutritional Assessment (MNA-SF), Nutritional Risk Index (NRI), Nutrition Risk Screening Tool 2002 (NRS-2002), and Preoperative Nutrition Screening (PONS). The reference standard was the Subjective Global Assessment (SGA) before surgery. Random-effects bivariate binomial model meta-analyses, meta-regressions, and a network meta-analysis were used to estimate the pooled and relative sensitivities and specificities.
RESULTS
Of the 16 included studies (5695 participants with an 11 957 index and 11 957 SGA tests), all were conducted after hospital admission before surgery. Eleven studies ( n =3896) were at high risk of bias using the Quality Assessment of Diagnostic Accuracy Studies tool due to a lack of blinded assessments. MUST had the highest overall test accuracy performance (sensitivity 86%, 95% CI: 75-93%; specificity 89%, 95% CI: 83-93%). Network meta-analysis showed NRI had similar relative sensitivity (0.93, 95% CI: 0.77-1.13) but lower relative specificity (0.75, 95% CI: 0.61-0.92) than MUST.
CONCLUSIONS
Of all easy-to-use tests applicable at the bedside, MUST had the highest test accuracy performance for screening preoperative malnutrition. However, its predictive accuracy is likely insufficient to justify the application of nutritional optimization interventions without additional assessments.
Topics: Adult; Humans; Nutritional Status; Nutrition Assessment; Network Meta-Analysis; Malnutrition; Mass Screening; Diagnostic Tests, Routine
PubMed: 37830947
DOI: 10.1097/JS9.0000000000000845 -
Arthroscopy : the Journal of... Apr 2024To analyze radiographic outcomes by conventional radiography, computed tomography (CT), or both and complication rates of open coracoid transfer at a minimum of... (Review)
Review
Postoperative Radiographic Outcomes Following Primary Open Coracoid Transfer (Bristow-Latarjet) Vary in Definition, Classification, and Imaging Modality: A Systematic Review.
PURPOSE
To analyze radiographic outcomes by conventional radiography, computed tomography (CT), or both and complication rates of open coracoid transfer at a minimum of 12-months follow-up.
METHODS
A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Medline (Ovid), and EMBASE library databases. Inclusion criteria were clinical studies reporting on open Latarjet as the primary surgical procedure(revision coracoid transfer after failed prior stabilization excluded) with postoperative radiographic outcomes at a minimum mean 1-year follow-up. Patient demographics, type of postoperative imaging modality, and radiographic outcomes and complications including graft union, osteoarthritis, and osteolysis were systematically reviewed. Data were summarized as ranges of reported values for each outcome metric. Each radiographic outcome was graphically represented in a Forest plot with point estimates of the incidence of radiographic outcomes with corresponding 95% confidence intervals and I.
RESULTS
Thirty-three studies met inclusion criteria, with a total of 1,456 shoulders. The most common postoperative imaging modality was plain radiography only (n = 848 [58.2%]), both CT and radiography (n = 287 [19.7%]), and CT only (n = 321 [22.1%]). Overall, the reported graft union rate ranged from 75% to 100%, of which 79.8% (n = 395) were detected on plain radiography. The most common reported postoperative radiographic complications after the open coracoid transfer were osteoarthritis (range, 0%-100%, pooled mean 28%), graft osteolysis (range, 0%-100%, pooled mean 30%), nonunion (range, 0%-32%, pooled mean 5.1%), malpositioned graft (range, 0%-75%, pooled mean 14.75%), hardware issues (range, 0%-9.1%, pooled mean 5%), and bone block fracture (range, 0%-8%, pooled mean 2.1%). Graft healing was achieved in a majority of cases (range, 75%-100%).
CONCLUSION
Postoperative radiographic outcomes after open coracoid transfer vary greatly in definition, classification, and imaging modality of choice. Greater consistency in postoperative radiographic outcomes is essential to evaluate graft healing, osteolysis, and nonunion.
LEVEL OF EVIDENCE
Level IV, systematic review of Level III-IV studies.
Topics: Humans; Shoulder Joint; Osteolysis; Joint Instability; Shoulder; Shoulder Dislocation; Osteoarthritis; Fractures, Bone; Coracoid Process
PubMed: 37827435
DOI: 10.1016/j.arthro.2023.09.032 -
PeerJ 2023Dual-energy computed tomography (DECT) imaging technology opens a new idea and method for analyzing stone composition, which can obtain several quantitative parameters... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Dual-energy computed tomography (DECT) imaging technology opens a new idea and method for analyzing stone composition, which can obtain several quantitative parameters reflecting tissue-related information and energy images different from traditional images. However, the application of DECT in diagnosing urinary calculi remains unknown. This study aims to evaluate the value of DECT in diagnosing urinary calculi by meta-analysis.
METHODS
PubMed, EMBASE, Web of Science, and the Cochrane Library were searched to articles published from the establishment of the databases to April 18, 2023. We reviewed the articles on the diagnosis of urinary calculi detected by DECT, established standards, screened the articles, and extracted data. Two researchers carried out data extraction and the Cohen's unweighted kappa was estimated for inter-investigator reliability. The quality of the literature was evaluated by the diagnostic test accuracy quality evaluation tool (QUADAS-2). The heterogeneity and threshold effects were analyzed by Meta-Disc 1.4 software, and the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic ratio were calculated. The combined receiver-operating characteristic (ROC) curve was drawn, and the value of DECT in the diagnosis of urinary calculi was evaluated by the area under the curve (AUC). The meta-analysis was registered at PROSPERO (CRD42023418204).
RESULTS
One thousand and twenty-seven stones were detected in 1,223 samples from 10 diagnostic tests. The analyzed kappa alternated between 0.78-0.85 for the document's retrieval and detection procedure. The sensitivity of DECT in the diagnosis of urinary calculi was 0.94 (95% CI [0.92-0.96]). The positive likelihood ratio (PLR) of DECT in the diagnosis of urinary stones was 0.91 (95% CI [0.88-0.94]), and the negative likelihood ratio (NLR) was 0.08 (95% CI [0.05-0.11]). The specificity of DECT for detecting urinary calculi was 0.91 (95% CI [0.88-0.94]). The area under the curve of the summary receiver operator characteristic (SROC) was 0.9875. The sensitivity of dual-energy CT in the diagnosis of urinary calculi diameter <3 mm was 0.94 (95% CI [0.91-0.96]). The PLR of DECT in the diagnosis of urinary stones diameter <3 mm was 10.79 (95% CI [5.25 to 22.17]), and the NLR was 0.08 (95% CI [0.05-0.13]). The specificity of DECT for detecting urinary calculi <3 mm was 0.91 (95% CI [0.87-0.94]). The SROC was 0.9772.
CONCLUSION
The DECT has noble application value in detecting urinary calculi.
Topics: Humans; Retrospective Studies; Reproducibility of Results; Tomography, X-Ray Computed; Urinary Calculi; Urolithiasis
PubMed: 37810769
DOI: 10.7717/peerj.16076 -
Nigerian Journal of Clinical Practice Sep 2023Dental implants are considered an ideal treatment for a missing single tooth. Immediate loading of implants can hasten the procedure, providing comfort to the patients.... (Review)
Review
Dental implants are considered an ideal treatment for a missing single tooth. Immediate loading of implants can hasten the procedure, providing comfort to the patients. Recently, immediate loading of implants has gained much importance as it helps hasten the procedure and provides more comfort to patients. A previous systematic review published 5 years ago compared the success rates between immediate and conventional loading. There are several factors that influence the success rate of implants that were not discussed in detail in the previous review. Hence, the present systematic review is done to report differences in the outcomes from single implant restorations of missing teeth in the posterior region in patients who were subjected to immediate loading and conventional loading. A follow up for 1 year was done. Electronic databases of Medline, Scopus, and Web of Science were searched for publications in the English Language during May 2021. The search results yielded 306 articles, out of which 225 were excluded based on title and abstract screening. Screening of the remaining 81 full text articles yielded 14 original research articles that satisfied the predefined inclusion criteria. Meta analysis was not possible due to the heterogeneity of the data. The overall success rate of the immediate loading of a single implant is 94.31%. Implants in the maxillary region had a higher survival rate than those in the mandibular region. The age range between 18 and 80 years showed good prognosis and outcomes in older individuals. Good oral hygiene was emphasized for all patients to prevent any secondary conditions or delays in healing.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Humans; Middle Aged; Young Adult; Anodontia; Dental Implants; Dental Prosthesis, Implant-Supported; Immediate Dental Implant Loading; Tooth Loss
PubMed: 37794532
DOI: 10.4103/njcp.njcp_884_22 -
World Journal of Nephrology Sep 2023Minimally invasive techniques for treatment of urinary stones requires expertise, experience and endoscopic skills. Simulators provide a low-stress and low-risk...
BACKGROUND
Minimally invasive techniques for treatment of urinary stones requires expertise, experience and endoscopic skills. Simulators provide a low-stress and low-risk environment while providing a realistic set-up and training opportunities.
AIM
To report the publication trend of 'simulation in urolithiasis' over the last 26 years.
METHODS
Research of all published papers on "Simulation in Urolithiasis" was performed through PubMed database over the last 26 years, from January 1997 to December 2022. Papers were labelled and divided in three subgroups: (1) Training papers; (2) Clinical simulation application or surgical procedures; and (3) Diagnostic radiology simulation. Each subgroup was then divided into two 13-year time periods to compare and identify the contrast of different decades: period-1 (1997-2009) and period-2 (2010-2022).
RESULTS
A total of 168 articles published on the application of simulation in urolithiasis over the last 26 years (training: = 94, surgical procedures: = 66, and radiology: = 8). The overall number of papers published in simulation in urolithiasis was 35 in Period-1 and 129 in Period-2, an increase of +269% ( = 0.0002). Each subgroup shows a growing trend of publications from Period-1 to Period-2: training papers +279% ( = 0.001), surgical simulations +264% ( = 0.0180) and radiological simulations +200% ( = 0.2105).
CONCLUSION
In the last decades there has been a step up of papers regarding training protocols with the aid of various simulation devices, with simulators now a part of training programs. With the development of 3D-printed and high-fidelity models, simulation for surgical procedure planning and patients counseling is also a growing field and this trend will continue to rise in the next few years.
PubMed: 37766839
DOI: 10.5527/wjn.v12.i4.104 -
BMJ Open Sep 2023Faecal occult blood testing (FOBT) and faecal immunochemical testing (FIT) are among the most used screening modalities for colorectal cancer (CRC). Colonoscopy is also...
OBJECTIVES
Faecal occult blood testing (FOBT) and faecal immunochemical testing (FIT) are among the most used screening modalities for colorectal cancer (CRC). Colonoscopy is also widely used as a screening and diagnostic test for adults with a positive FOBT/FIT. Patient experience of colonoscopy is an important component for most CRC screening programmes. Individuals with negative experiences are less likely to engage with colonoscopy in the future and can deter others from attending colonoscopy when invited. This review synthesised data on patient experience with colonoscopy, following a positive result, to provide insights into how to improve patient experience within the English Bowel Cancer Screening Programme.
METHODS
MEDLINE, EMBASE and PsycINFO were searched for quantitative questionnaire studies evaluating patient-reported experience with colonoscopy, following a positive screening FOB/FIT result. The search was limited to studies published between 2000 and 2021 (ie, when the first FOBT/FIT screening programmes for CRC were introduced). Data-driven and narrative summary techniques were used to summarise the literature.
RESULTS
In total, six studies from the UK (n=4), Spain (n=1) and the Netherlands (n=1) were included in the review (total participants: 152 329; response rate: 68.0-79.3%). Patient experiences were categorised into three 'stages': 'pre-colonoscopy', 'during the test' and 'post-colonoscopy'. Overall, patients reported a positive experience in all six studies. Bowel preparation was the most frequently endorsed issue experienced pre-test (experienced by 10.0-41.0% of individuals, across all studies), pain and discomfort for during the test (experienced by 10.0-21.0% of participants) and abdominal pain and discomfort after the test (these were experienced by 14.8-22% of patients).
CONCLUSION
This review highlighted that patient-reported experiences associated with colonoscopy were generally positive. To improve the colonoscopy experience, bowel screening centres should investigate means to: make bowel preparation more acceptable, make colonoscopy less painful and reduce post-colonoscopy symptoms.
Topics: Adult; Humans; Occult Blood; Abdominal Pain; Colonoscopy; MEDLINE; Diagnostic Tests, Routine
PubMed: 37734900
DOI: 10.1136/bmjopen-2022-071391 -
Renal Failure 2023The needle size used in ultrasound-guided percutaneous renal biopsy significantly influences the efficacy and safety of the procedure. The aim of this study is to... (Meta-Analysis)
Meta-Analysis Review
The needle size used in ultrasound-guided percutaneous renal biopsy significantly influences the efficacy and safety of the procedure. The aim of this study is to perform a comparative analysis of 16-gauge and 18-gauge needles for ultrasound-guided percutaneous renal biopsy. This systematic review and meta-analysis included randomized controlled trials and observational studies that compared the outcomes of using 18-gauge and 16-gauge needles for ultrasound-guided percutaneous renal biopsy. The efficacy parameters included a mean number of glomeruli obtained and the number of passes, while the safety parameters focused on the rate of complications. We searched multiple databases, assessed the risk of bias, and conducted statistical analyses using appropriate models. Fifteen studies were included. Compared to the 18-gauge needle, the use of 16-gauge needle for the biopsy was associated with the significantly higher mean number of glomeruli obtained (pooled SMD 0.61, 95%CI: 0.32 to 0.89; < 0.001) and fewer required passes (pooled SMD -0.57, 95%CI: -0.97 to -0.18; = 0.004). No significant difference was observed in the individual safety parameters, including pain, hematuria, need for blood transfusion, major, and minor complications. However, the use of 16-gauge needle was associated with higher odds of total complications (pooled OR 1.57, 95%CI: 1.16 to 2.13; = 0.004). While the 16-gauge needle for ultrasound-guided percutaneous renal biopsy offers improved efficacy in terms of a higher mean number of glomeruli and fewer required passes, it is associated with higher total complications. A judicious needle size selection that would consider patient-specific factors and risk-benefit ratio, is crucial for optimizing patient outcomes.
Topics: Humans; Kidney; Kidney Glomerulus; Biopsy; Hematuria; Ultrasonography, Interventional; Observational Studies as Topic
PubMed: 37724553
DOI: 10.1080/0886022X.2023.2257806 -
Journal of ISAKOS : Joint Disorders &... Feb 2024Early periprosthetic joint infection (PJI) represents one of the most fearsome complications of joint replacement. No international consensus has been reached regarding... (Review)
Review
PURPOSE
Early periprosthetic joint infection (PJI) represents one of the most fearsome complications of joint replacement. No international consensus has been reached regarding the best approach for early prosthetic knee and hip infections. The aim of this updated systematic review is to assess whether debridement, antibiotics, and implant retention (DAIR) is an effective choice of treatment in early postoperative and acute hematogenous PJI.
METHODS
This systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The diagnostic criteria defining a PJI, the most present pathogen, and the days between the index procedure and the onset of the PJI were extracted from the selected articles. Additionally, the mean follow-up, antibiotic regimen, and success rate of the treatment were also reported.
RESULTS
The articles included provided a cohort of 970 patients. Ten studies specified the joint of their cohort in PJIs regarding either hip prostheses or knee prostheses, resulting in 454 total knees and 460 total hips. The age of the patients ranged from 18 to 92 years old. Success rates for the DAIR treatments in the following cohort ranged from 55.5% up to a maximum of 90% (mean value of 71%).
CONCLUSION
Even though the DAIR procedure is quite limited, it is still considered an effective option for patients developing an early post-operative or acute hematogenous PJI. However, there is a lack of studies, in particular randomized control trials (RCTs), comparing DAIR with one-stage and two-stage revision protocols in the setting of early PJIs, reflecting the necessity to conduct further high-quality studies to face the burden of early PJI.
Topics: Humans; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Debridement; Anti-Bacterial Agents; Retrospective Studies; Treatment Outcome; Prosthesis-Related Infections; Arthroplasty, Replacement, Hip; Arthritis, Infectious
PubMed: 37714518
DOI: 10.1016/j.jisako.2023.09.003 -
Journal of Pediatric Urology Dec 2023The current EAU/ESPU and recently retired AAP pediatric UTI guidelines recommend renal bladder ultrasound after first febrile UTI in children to screen for structural... (Meta-Analysis)
Meta-Analysis Review
Revisiting the utility of prenatal ultrasound in the routine workup of first febrile UTI: A systematic review and meta-analysis of the negative predictive value of prenatal ultrasound for identification of urinary tract abnormalities after first febrile urinary tract infection in children.
CONTEXT
The current EAU/ESPU and recently retired AAP pediatric UTI guidelines recommend renal bladder ultrasound after first febrile UTI in children to screen for structural abnormalities, regardless of findings on prenatal ultrasound.
OBJECTIVE
Test the hypothesis that a normal prenatal ultrasound could rule out urinary tract abnormality on post-UTI ultrasound.
DATA SOURCES
Medline, Embase, Cochrane Library.
STUDY SELECTION
Studies including pediatric patients with first febrile UTI who had both prenatal and post-UTI ultrasound.
DATA EXTRACTION
Anatomical abnormalities detected by prenatal and post-UTI ultrasound as reported per individual study criteria were extracted. Meta-analyses of 9 studies (2981 patients) were performed using a random-effects model and composite estimates of the negative predictive value (NPV) of prenatal ultrasound were calculated.
RESULTS
Overall summary NPV of prenatal ultrasound for all pediatric patients was 77%, with heterogeneity score (I) 97.9%. Summary NPV of prenatal ultrasound for all patients under two years of age was similar at 75%, with I 98.2% For the 4 studies to which we could apply a more stringent definition of abnormality, summary NPV was 85% and I 97.5% for prediction of moderate post-UTI ultrasound abnormalities and summary NPV was 93% and I 90.4% for severe abnormalities.
DISCUSSION
While we calculated an 85% NPV for a normal prenatal ultrasound to rule out significant postnatal abnormality as defined within individual studies, substantial heterogeneity amongst publications limited the precision of our estimates. This highlights the need for more rigorous investigations with attention to timing of ultrasound and the application of clinically meaningful definitions for abnormal prenatal and post-UTI studies. This may allow judicious use of prenatal ultrasound to guide clinical management for children with first febrile UTI and minimize redundant imaging with potential for false positive results. Until then, the current guidelines are justified based on the limited and heterogenous data from the currently available published studies.
Topics: Humans; Child; Pregnancy; Infant; Female; Predictive Value of Tests; Urinary Tract Infections; Urinary Tract; Kidney; Fever; Urogenital Abnormalities; Ultrasonography, Prenatal
PubMed: 37704528
DOI: 10.1016/j.jpurol.2023.08.020 -
The Japanese Dental Science Review Dec 2023Approximately 10 % of the general population is affected by temporomandibular disorder (TMD) pain. Diagnosis of myogenous TMD pain (i.e., TM myalgia) may be challenging,... (Review)
Review
Approximately 10 % of the general population is affected by temporomandibular disorder (TMD) pain. Diagnosis of myogenous TMD pain (i.e., TM myalgia) may be challenging, while an adequate assessment of this pain is crucial to establish an adequate management strategy. We aim to analyze if there is a relation between inflammation and TM myalgia, and if we can identify and measure inflammatory markers in patients suffering from this condition. An electronic literature search was conducted from inception up to July 14 2022 through the databases PubMed, Cochrane Library, Web of Science, and Embase in collaboration with a medical information specialist. Studies on patients with masticatory muscle inflammation and/or pain were included. After a screening procedure, only nine full-text articles met the criteria for inclusion. In the included studies 9-131 patients showed TM myalgia, and presence of inflammation was reported with analysis of interleukines IL-1, IL-6, IL-10, tumor necrosis factor alpha, and prostaglandins from blood, saliva, and extracellular fluid of masseter muscle using microdialysis. Our results contributed to the identification of the relation between inflammation and TM myalgia and established that measurement of inflammatory cytokines may be a valid diagnostic tool, which is an essential step towards finding a better treatment.
PubMed: 37680612
DOI: 10.1016/j.jdsr.2023.08.006