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The Turkish Journal of Gastroenterology... Sep 2023Mucosal healing has been considered a treatment goal for patients with inflammatory bowel disease. To compare the accuracy of fecal immunochemical test and fecal... (Meta-Analysis)
Meta-Analysis
Mucosal healing has been considered a treatment goal for patients with inflammatory bowel disease. To compare the accuracy of fecal immunochemical test and fecal calprotectin in the judgment of mucosal healing in ulcerative colitis, a meta-analysis was performed. We searched the PubMed, Cochrane Library, Web of Science, and Embase for the studies on fecal immunochemical test and fecal calprotectin predicting mucosal healing in ulcerative colitis. The comprehensive sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio were calculated to evaluate the accuracy. By analyzing 22 publications, we found that the combined sensitivity and specificity of fecal immunochemical test were 0.87 (95% CI, 0.80-0.92) and 0.73 (95% CI, 0.62-0.81), respectively. The combined sensitivity and specificity of fecal calprotectin were 0.76 (95% CI, 0.70-0.80) and 0.80 (95% CI, 0.76-0.84), respectively. The area under the curve values of the fecal immunochemical test and fecal calprotectin summary receiver operating characteristic (SROC) curves were 0.88 and 0.85, respectively. Consequently, fecal immunochemical test had higher sensitivity in predicting mucosal healing in ulcerative colitis patients, while fecal calprotectin had higher specificity. Compared with fecal calprotectin, fecal immunochemical test was more accurate in judging mucosal healing in ulcerative colitis.
Topics: Humans; Colitis, Ulcerative; Leukocyte L1 Antigen Complex; Biomarkers; Intestinal Mucosa; Sensitivity and Specificity; Feces; Colonoscopy; Severity of Illness Index
PubMed: 37427885
DOI: 10.5152/tjg.2023.22812 -
Open Access Journal of Contraception 2023In sub-Saharan African countries (SSA), despite the efforts to enable adolescents to access sexual and reproductive health (SRH) services, there are limited systematic... (Review)
Review
Socio-Ecological Analysis of Barriers to Access and Utilization of Adolescent Sexual and Reproductive Health Services in Sub-Saharan Africa: A Qualitative Systematic Review.
BACKGROUND
In sub-Saharan African countries (SSA), despite the efforts to enable adolescents to access sexual and reproductive health (SRH) services, there are limited systematic review studies that comprehensively synthesize barriers to accessing services using a social-ecological model. Therefore, this review was conducted to fill this gap.
METHODS
This study protocol was registered in the PROSPERO database (CRD42022259095). We followed PRISMA guideline to conduct this review. PubMed, Google Scholar, Embase and African Journal Online databases were used. Two authors individually screened articles. Only qualitative articles published in the English in last 10 years were included in this review.
RESULTS
From the total of 4890 studies, 23 qualitative studies fulfilled the eligibility criteria. Those studies were from 11 SSA countries. This review finding revealed that inadequate information about the services, the incorrect perception about services, low self-esteem, fear of being noticed by family members, and financial constraints are barriers at the intrapersonal level. Unsupportive families and lack of open communication between adolescent-parent about sexuality issues were interpersonal barriers to access. Lack of provider competency, provider attitude, an unsupportive environment, physical inaccessibility of services, and shortage of medicine, and supplies were identified as institutional-level barriers. Moreover, community-level barriers like community stigma, social, religious, and gender norms within the society were identified as the main barriers to accessing services for adolescents.
CONCLUSION
This review finding reveals that the main barriers to access SRH services for adolescents living in SSA are misperception about services, low self-esteem to access services, financial constraints, unsupportive families, community stigma and social norms, unsupportive environments in health facilities, healthcare provider behavior, poor competency, being judgmental attitude, and breaking privacy and confidentiality. This study finding calls for new approach like a multi-pronged that works with service providers, with community, with families, and with adolescent to improve SRH services utilization of adolescent.
PubMed: 37398897
DOI: 10.2147/OAJC.S411924 -
Journal of Interpersonal Violence Oct 2023Despite the pervasiveness of intimate partner violence (IPV) in Canada, research examining IPV in the context of Asian Canadians is scarce. Our study examined whether...
Despite the pervasiveness of intimate partner violence (IPV) in Canada, research examining IPV in the context of Asian Canadians is scarce. Our study examined whether and how Canadian judges consider culture when determining a sentence in IPV cases involving an Asian offender and/or an Asian victim. We systematically searched for publicly published cases through CanLII. A total of 50 cases met the inclusion criteria. Cultural themes were identified using a direct content analysis approach to capture a priori themes in the literature, as well as identify any other factors considered. Our findings indicated culture was most often considered in only a superficial way ( = 31, 62.0%), where judges only made statements that simply identified the ethnicity of the offender and not how culture may have impacted the case. When examining cases where culture was meaningfully considered there were no prominent culture themes identified (all themes present in <14% of cases). We suggest this may not only reflect the heterogeneity of Asian Canadians, but could also reflect the lack of cultural consideration by the judges. Cultural factors were also rarely considered explicitly as an aggravating or mitigating factor in a case ( = 2; 4.0% and = 7; 14.0% of the total sample, respectively). The findings reveal the current lack of meaningful consideration of culture in IPV legal cases involving Asian Canadians. We outline how this contrasts the increased attention to the meaningful consideration of culture in the Canadian legal arena and prompt all professionals involved in assessing and managing IPV risk to consider racial, ethnic, and cultural factors in these cases.
Topics: Humans; Canada; Criminal Law; Cultural Competency; Culture; Intimate Partner Violence; Judgment; Judicial Role; Asian
PubMed: 37350459
DOI: 10.1177/08862605231178494 -
Journal of Clinical Medicine May 2023Vocal fold polyps (VFP) are a common cause of voice disorders and laryngeal discomfort. They are usually treated by behavioral voice therapy (VT) or phonosurgery, or a...
BACKGROUND
Vocal fold polyps (VFP) are a common cause of voice disorders and laryngeal discomfort. They are usually treated by behavioral voice therapy (VT) or phonosurgery, or a combination (CT) of both. However, the superiority of either of these treatments has not been clearly established.
METHODS
Three databases were searched from inception to October 2022 and a manual search was performed. All clinical trials of VFP treatment were included that reported at least auditory-perceptual judgment, aerodynamics, acoustics, and the patient-perceived handicap.
RESULTS
We identified 31 eligible studies (VT: n = 47-194; phonosurgery: n = 404-1039; CT: n = 237-350). All treatment approaches were highly effective, with large effect sizes ( > 0.8) and significant improvements in almost all voice parameters (-values < 0.05). Phonosurgery reduced roughness and NHR, and the emotional and functional subscales of the VHI-30 were the most compared to behavioral voice therapy and combined treatment (-values < 0.001). Combined treatment improved hoarseness, jitter, shimmer, MPT, and the physical subscale of the VHI-30 more than phonosurgery and behavioral voice therapy (-values < 0.001).
CONCLUSIONS
All three treatment approaches were effective in eliminating vocal fold polyps or their negative sequelae, with phonosurgery and combined treatment providing the greatest improvement. These results may inform future treatment decisions for patients with vocal fold polyps.
PubMed: 37240557
DOI: 10.3390/jcm12103451 -
Canadian Journal of Pain = Revue... 2023Graded Motor Imagery (GMI) is a non-invasive and inexpensive therapy used to treat Phantom Limb Pain (PLP) by sequentially activating motor networks in such a way that... (Review)
Review
INTRODUCTION
Graded Motor Imagery (GMI) is a non-invasive and inexpensive therapy used to treat Phantom Limb Pain (PLP) by sequentially activating motor networks in such a way that movement and pain are unpaired. The objective of this systematic review was to critically appraise relevant data on the efficacy of GMI and its components for reducing PLP and disability in amputees.
METHODS
We searched 11 electronic databases for controlled trials investigating GMI and its components in amputees with PLP from inception until February 2023. Two reviewers independently screened studies and extracted relevant data. Study-level data were entered using the inverse variance function of the Review Manager 5 and pooled with the random effects model.
RESULTS
Eleven studies with varying risk of bias were eligible. No eligible study considered left/right judgement tasks in isolation. Studies showed no effect for imagined movements, but positive effects were seen for GMI [weighted mean difference: -21.29 (95%CI: -31.55, -11.02), I= 0%] and mirror therapy [weighted mean difference: -8.55 (95%CI: -14.74, -2.35, I= 61%]. A comparison of mirror therapy versus sham showed no difference [weighted mean difference: -4.43 (95%CI: -16.03, 7.16), I= 51%].
CONCLUSION
Our findings suggest that GMI and mirror therapy may be effective for reducing PLP. However, this conclusion was drawn from a limited body of evidence, and the certainty of the evidence was very low. Therefore, rigorous, high-quality trials are needed to address the gap in the literature and inform practice.
PubMed: 37214633
DOI: 10.1080/24740527.2023.2188899 -
Frontiers in Veterinary Science 2023Raising a healthy calf up to puberty is essential for optimal farm performance. It is therefore, it is necessary to promote animal welfare from the three spheres during...
INTRODUCTION
Raising a healthy calf up to puberty is essential for optimal farm performance. It is therefore, it is necessary to promote animal welfare from the three spheres during this short period. Social management has been postulated as essential in lowering stress and consequently improving calf welfare during this period. Only the health sphere has been studied for a long time, but more recent studies have recently promoted positive experiences and emotional states from affective states or cognitive judgment and natural living spheres. A systematic review of different management strategies in rearing dairy calves according to the three spheres of animal welfare has been conducted using an electronic search strategy.
METHODS
The analysis and extraction of information from the studies were performed according to a protocol. From 1,783 publications screened, only 351 met the inclusion criteria.
RESULTS
The publications identified in the search can be divided into two main groups, feeding and social management, based on the main topic of the publication. This review provides an overview of social management, understood as the calf's interaction with others around it.
DISCUSSION
Primary social management issues that emerged were social housing with congeners, separation from the mother and human-animal interaction, distributed in the three broad spheres of animal welfare. The review highlights unresolved questions about how social management practices affect the three spheres of animal welfare at this life stage and the need to standardize good socialization practices for this stage. In conclusion, all the information shows that social housing has improved animal welfare from affective states, cognitive judgment, and natural living spheres. However, gaps in research were identified in relation to the optimal time to separate the calf from the mother, the optimal time to group with conspecifics after birth and group size. Further research on positive welfare through socialization are needed.
PubMed: 37138913
DOI: 10.3389/fvets.2023.1154555 -
CoDAS 2023To identify the effects of prophylactic, non-pharmacological measures on the progression of dysphagia in patients with head and neck cancer undergoing radiotherapy. (Meta-Analysis)
Meta-Analysis
PURPOSE
To identify the effects of prophylactic, non-pharmacological measures on the progression of dysphagia in patients with head and neck cancer undergoing radiotherapy.
RESEARCH STRATEGIES
The search was performed in Medline (via PubMed), Scopus, and Embase databases, as well as in the gray literature.
SELECTION CRITERIA
Randomized clinical trials were included, with adult patients (≥ 18 years old) and diagnosed with head and neck cancer, treated with radiotherapy (with or without surgery and chemotherapy), and submitted to non-pharmacological protocols for the prevention of dysphagia.
DATA ANALYSIS
The risk of bias was assessed using the PEDRO scale and the overall quality of evidence was assessed using the GRADE instrument.
RESULTS
Four studies were considered eligible, and of these, two were included in the meta-analysis. The result favored the intervention group, with a mean difference of 1.27 [95% CI: 0.74 to 1.80]. There was low heterogeneity and the mean score for risk of bias was 7.5 out of 11 points. The lack of detail in the care with selection, performance, detection, attrition, and reporting biases contributed to the judgment of the quality of the evidence, considered low.
CONCLUSION
Prophylactic measures to contain dysphagia can promote important benefits on the oral intake of patients with head and neck cancer when compared to those who did not undergo such a therapeutic measure during radiotherapy.
Topics: Adult; Humans; Adolescent; Deglutition Disorders; Head and Neck Neoplasms
PubMed: 37132697
DOI: 10.1590/2317-1782/20232021246pt -
Frontiers in Pediatrics 2023This systematic review aimed to analyze the characteristics of different diagnostic techniques for micrognathia, summarize the consistent diagnostic criteria of each... (Review)
Review
PURPOSE
This systematic review aimed to analyze the characteristics of different diagnostic techniques for micrognathia, summarize the consistent diagnostic criteria of each technique, and provide a simple and convenient prenatal diagnosis strategy for micrognathia.
METHODS
In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the search was undertaken in three international databases (PubMed, Scopus, and Web of Science). The three reviewers assessed all papers and extracted the following variables: author's name and year of publication, country, study design, number of participants, gestational age, equipment for prenatal examination, biometric parameters related to micrognathia, main results.
RESULTS
A total of 25 articles included in the analysis. Nineteen articles described cross-sectional studies (76 percent), 4 (16 percent) were case-control studies, and 2 (8 percent) were cohort studies. Fifteen studies (60 percent) had a prospective design, 9 (36 percent) had a retrospective design, and one (4 percent) had both prospective and retrospective design. Thirty-two percent of the studies ( = 8) were performed in USA, and the remaining studies were performed in China ( = 4), Israel ( = 3), Netherlands ( = 3), UK ( = 1), France ( = 1), Italy ( = 1), Belgium( = 1), Germany ( = 1), Spain ( = 1), and Austria ( = 1). The prenatal diagnosis of micrognathia can be performed as early as possible in the first trimester, while the second and third trimester of pregnancy were the main prenatal diagnosis period. The articles that were included in the qualitative synthesis describe 30 biometric parameters related to the mandible.
CONCLUSION
Of the 30 biometric parameters related to the mandible, 15 can obtain the simple and convenient diagnostic criteria or warning value for micrognathia. Based on these diagnostic criteria or warning value, clinicians can quickly make a preliminary judgment on facial deformities, to carry out cytologic examination to further clarify the diagnosis of micrognathia.
PubMed: 37124181
DOI: 10.3389/fped.2023.1161421 -
The Cochrane Database of Systematic... Apr 2023Neovascular glaucoma (NVG) is a potentially blinding, secondary glaucoma. It is caused by the formation of abnormal new blood vessels, which prevent normal drainage of... (Review)
Review
BACKGROUND
Neovascular glaucoma (NVG) is a potentially blinding, secondary glaucoma. It is caused by the formation of abnormal new blood vessels, which prevent normal drainage of aqueous from the anterior segment of the eye. Anti-vascular endothelial growth factor (anti-VEGF) medications are specific inhibitors of the primary mediators of neovascularization. Studies have reported the effectiveness of anti-VEGF medications for the control of intraocular pressure (IOP) in NVG.
OBJECTIVES
To assess the effectiveness of intraocular anti-VEGF medications, alone or with one or more types of conventional therapy, compared with no anti-VEGF medications for the treatment of NVG.
SEARCH METHODS
We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register); MEDLINE; Embase; PubMed; and LILACS to 19 October 2021; metaRegister of Controlled Trials to 19 October 2021; and two additional trial registers to 19 October 2021. We did not use any date or language restrictions in the electronic search for trials.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) of people treated with anti-VEGF medications for NVG.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed the search results for trials, extracted data, and assessed risk of bias, and the certainty of the evidence. We resolved discrepancies through discussion.
MAIN RESULTS
We included five RCTs (356 eyes of 353 participants). Each trial was conducted in a different country: two in China, and one each in Brazil, Egypt, and Japan. All five RCTs included both men and women; the mean age of participants was 55 years or older. Two RCTs compared intravitreal bevacizumab combined with Ahmed valve implantation and panretinal photocoagulation (PRP) with Ahmed valve implantation and PRP alone. One RCT randomized participants to receive an injection of either intravitreal aflibercept or placebo at the first visit, followed by non-randomized treatment according to clinical findings after one week. The remaining two RCTs randomized participants to PRP with and without ranibizumab, one of which had insufficient details for further analysis. We assessed the RCTs to have an unclear risk of bias for most domains due to insufficient information to permit judgment. Four RCTs examined achieving control of IOP, three of which reported our time points of interest. Only one RCT reported our critical time point at one month; it found that the anti-VEGF group had a 1.3-fold higher chance of achieving control of IOP at one month (RR 1.32, 95% 1.10 to 1.59; 93 participants) than the non-anti-VEGF group (low certainty of evidence). For other time points, one RCT found a three-fold greater achievement in control of IOP in the anti-VEGF group when compared with the non-anti-VEGF group at one year (RR 3.00; 95% CI:1.35 to 6.68; 40 participants). However, another RCT found an inconclusive result at the time period ranging from 1.5 years to three years (RR 1.08; 95% CI: 0.67 to 1.75; 40 participants). All five RCTs examined mean IOP, but at different time points. Very-low-certainty evidence showed that anti-VEGFs were effective in reducing mean IOP by 6.37 mmHg (95% CI: -10.09 to -2.65; 3 RCTs; 173 participants) at four to six weeks when compared with no anti-VEGFs. Anti-VEGFs may reduce mean IOP at three months (MD -4.25; 95% CI -12.05 to 3.54; 2 studies; 75 participants), six months (MD -5.93; 95% CI -18.13 to 6.26; 2 studies; 75 participants), one year (MD -5.36; 95% CI -18.50 to 7.77; 2 studies; 75 participants), and more than one year (MD -7.05; 95% CI -16.61 to 2.51; 2 studies; 75 participants) when compared with no anti-VEGFs, but such effects remain uncertain. Two RCTs reported the proportion of participants who achieved an improvement in visual acuity with specified time points. Participants receiving anti-VEGFs had a 2.6 times (95% CI 1.60 to 4.08; 1 study; 93 participants) higher chance of improving visual acuity when compared with those not receiving anti-VEGFs at one month (very low certainty of evidence). Likewise, another RCT found a similar result at 18 months (RR 4.00, 95% CI 1.33 to 12.05; 1 study; 40 participants). Two RCTs reported the outcome, complete regression of new iris vessels, at our time points of interest. Low-certainty evidence showed that anti-VEGFs had a nearly three times higher chance of complete regression of new iris vessels when compared with no anti-VEGFs (RR 2.63, 95% CI 1.65 to 4.18; 1 study; 93 participants). A similar finding was observed at more than one year in another RCT (RR 3.20, 95% CI 1.45 to 7.05; 1 study; 40 participants). Regarding adverse events, there was no evidence that the risks of hypotony and tractional retinal detachment were different between the two groups (RR 0.67; 95% CI: 0.12 to 3.57 and RR 0.33; 95% CI: 0.01 to 7.72, respectively; 1 study; 40 participants). No RCTs reported incidents of endophthalmitis, vitreous hemorrhage, no light perception, and serious adverse events. Evidence for the adverse events of anti-VEGFs was low due to limitations in the study design due to insufficient information to permit judgments and imprecision of results due to the small sample size. No trial reported the proportion of participants with relief of pain and resolution of redness at any time point.
AUTHORS' CONCLUSIONS
Anti-VEGFs as an adjunct to conventional treatment could help reduce IOP in NVG in the short term (four to six weeks), but there is no evidence that this is likely in the longer term. Currently available evidence regarding the short- and long-term effectiveness and safety of anti-VEGFs in achieving control of IOP, visual acuity, and complete regression of new iris vessels in NVG is insufficient. More research is needed to investigate the effect of these medications compared with, or in addition to, conventional surgical or medical treatment in achieving these outcomes in NVG.
Topics: Female; Humans; Male; Middle Aged; Bevacizumab; Glaucoma, Neovascular; Ranibizumab; Vascular Endothelial Growth Factor A
PubMed: 37010901
DOI: 10.1002/14651858.CD007920.pub4 -
International Journal of Nursing... Dec 2023Nurses' clinical decision-making, i.e., the data collection, analysis, and evaluation process through which they reach clinical judgements and makes clinical decisions,... (Review)
Review
BACKGROUND
Nurses' clinical decision-making, i.e., the data collection, analysis, and evaluation process through which they reach clinical judgements and makes clinical decisions, is at the core of nursing practice and essential to provide safe and quality care. Instruments to assess nurses' perceptions of their clinical decision-making abilities or skills have been developed for research and education. Thus, it is essential to determine the most valid and reliable instruments available to reflect nurses' self-reported clinical decision-making accurately.
OBJECTIVE
To evaluate the measurement properties of self-reported clinical decision-making instruments in nursing.
METHODS
A systematic review based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) was conducted (PROSPERO registration: CRD42022364549). Five bibliographical databases were searched in July 2022 using descriptors and keywords related to nurses, clinical decision-making, and studies on measurement properties. Two independent reviewers conducted reference selection and data extraction. The evaluation of the instruments' measurement properties involved assessing the quality of the studies, the quality of each measurement property (i.e., validity, reliability, responsiveness), and the quality of evidence based on the COSMIN.
RESULTS
Nine instruments evaluated in eleven studies with registered nurses or nursing students from various clinical contexts were identified. Five of the nine instruments were originals; four were translations or adaptations. Most focused on analytical and intuitive decision-making, although some were based on clinical judgment and clinical reasoning theories. Structural validity and internal consistency were the most frequently reported measurement properties; other properties, such as measurement error, criterion validity, and responsiveness, were not assessed for any instruments. A gap was also identified in the involvement of nurses or nursing students in the instrument development process and the content validity assessment. Six instruments appear promising based on the COSMIN criteria, but further studies are needed to confirm their validity and reliability.
CONCLUSIONS
The evidence regarding instruments to assess nurses' self-reported clinical decision-making is still minimal. Although no instruments could be recommended based on the COSMIN criteria, the Nurses Clinical Reasoning Scale had the most robust supporting evidence, followed by the adapted version of the Clinical Decision Making in Nursing Scale. Future efforts should be made to systematically assess content validity through the involvement of the target population and by ensuring that the results of other measurement properties, such as reliability, measurement error, or hypothesis testing, are rigorously assessed and reported.
TWEETABLE ABSTRACT
Despite limited evidence, this COSMIN review identified six promising instruments to assess nurses' clinical #decision-making, especially the Nurses Clinical Reasoning Scale and an adaptation of the Clinical Decision Making in Nursing Scale. #nursingresearch #nursingeducation.
PubMed: 38746590
DOI: 10.1016/j.ijnsa.2023.100122