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Frontiers in Public Health 2024Uncertainty and inconsistency in terminology regarding the risk factors (RFs) for in-hospital falls are present in the literature. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Uncertainty and inconsistency in terminology regarding the risk factors (RFs) for in-hospital falls are present in the literature.
OBJECTIVE
(1) To perform a literature review to identify the fall RFs among hospitalized adults; (2) to link the found RFs to the corresponding categories of international health classifications to reduce the heterogeneity of their definitions; (3) to perform a meta-analysis on the risk categories to identify the significant RFs; (4) to refine the final list of significant categories to avoid redundancies.
METHODS
Four databases were investigated. We included observational studies assessing patients who had experienced in-hospital falls. Two independent reviewers performed the inclusion and extrapolation process and evaluated the methodological quality of the included studies. RFs were grouped into categories according to three health classifications (ICF, ICD-10, and ATC). Meta-analyses were performed to obtain an overall pooled odds ratio for each RF. Finally, protective RFs or redundant RFs across different classifications were excluded.
RESULTS
Thirty-six articles were included in the meta-analysis. One thousand one hundred and eleven RFs were identified; 616 were linked to ICF classification, 450 to ICD-10, and 260 to ATC. The meta-analyses and subsequent refinement of the categories yielded 53 significant RFs. Overall, the initial number of RFs was reduced by about 21 times.
CONCLUSION
We identified 53 significant RF categories for in-hospital falls. These results provide proof of concept of the feasibility and validity of the proposed methodology. The list of significant RFs can be used as a template to build more accurate measurement instruments to predict in-hospital falls.
Topics: Accidental Falls; Humans; Risk Factors; Proof of Concept Study; Hospitalization
PubMed: 38932769
DOI: 10.3389/fpubh.2024.1390185 -
Journal of Clinical Medicine Jun 2024Potentially inappropriate polypharmacy (PIP) is among the major factors leading to adverse drug reactions, increased healthcare costs, reduced medication adherence, and... (Review)
Review
Potentially inappropriate polypharmacy (PIP) is among the major factors leading to adverse drug reactions, increased healthcare costs, reduced medication adherence, and worsened patient conditions. This study aims to identify existing interventions implemented to monitor and manage polypharmacy in the Italian setting. A systematic literature review (PROSPERO: CRD42023457049) was carried out according to the PRISMA statement guidelines. PubMed, Embase, ProQuest, and Web of Science were queried without temporal constraints, encompassing all published papers until October 2023. Inclusion criteria followed the PICO model: patients with polypharmacy; interventions to monitor/manage polypharmacy regimen versus no/any intervention; outcomes in terms of intervention effectiveness and cost variation. After duplicate deletion, 153 potentially relevant publications were extracted. Following abstract and full-text screenings, nine articles met the inclusion criteria. Overall, 78% ( = 7) were observational studies, 11% ( = 1) were experimental studies, and 11% ( = 1) were two-phase studies. A total of 44% ( = 4) of the studies involved patients aged ≥ 65 years, while 56% ( = 5) were disease-specific. Monitoring was the most prevalent choice of intervention (67%; = 6). Outcomes were mainly related to levels of polypharmacy (29%; = 6) and comorbidities (29%; = 6), effectiveness rates (14%; = 3), and avoidable costs (9%; = 2). This review outlines that Italy is still lacking in interventions to monitor/manage PIP, addressing an unmet need in developing patient-tailored strategies for reducing health-system burden.
PubMed: 38930058
DOI: 10.3390/jcm13123529 -
Journal of Clinical Medicine Jun 2024: Nephrolithiasis is a heterogeneous disease with a high prevalence and recurrence rate. Although there has been much progress regarding the surgical treatment of... (Review)
Review
: Nephrolithiasis is a heterogeneous disease with a high prevalence and recurrence rate. Although there has been much progress regarding the surgical treatment of stones, a standardized follow-up, especially in recurrent stone formers (SFs), has yet to be decided. This fact leads to the overuse of computed tomography (CT) scans and many reoperations in patients, thus increasing their morbidity and the financial burden on the health systems. This review systematically searched the literature for original articles regarding imaging strategies and endoscopic treatment for patients with recurrent urolithiasis, aiming to identify optimal strategies to deal with these patients. : We systematically searched the Medline database (accessed on 1 April 2024) for articles regarding imaging modalities and endoscopic treatment for patients with recurrent urinary tract lithiasis. : No specific follow-up or endoscopic treatment strategy exists for patients with recurrent urolithiasis. CT scan was the imaging modality most used in the studies, followed by X-ray, ultrasonography, and digital tomosynthesis. A transparent algorithm could not be identified. Percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and ureteroscopy (URS) were used in the studies for endoscopic treatment. PCNL showed the best stone-free (SFr) rate and lowest hazard ratio (HR) for reoperation. RIRS showed superiority over extracorporeal shockwave lithotripsy for recurrent SFs, but fragments over 4 mm increased the recurrent rate. URS has an increased HR for reoperation for bilateral stones. : The heterogeneity of urolithiasis leaves urologists without a standardized plan for recurrent SFs. Thus, each patient's follow-up should be planned individually and holistically. Pre-stenting is not to be avoided, especially in high-risk patients, and SFr status needs to be the aim. Finally, CT scans should not be generally overused but should be part of a patient's treatment plan. Prospective studies are required to define SFr status, the size of significant residual fragments, and the modalities of intervention and follow-up.
PubMed: 38929988
DOI: 10.3390/jcm13123461 -
Interdisciplinary Cardiovascular and... Jun 2024Transannular patch (TAP) repair of tetralogy of Fallot (ToF) relieves right ventricular tract obstruction but may lead to pulmonary regurgitation. Valve-sparing (VS)...
OBJECTIVES
Transannular patch (TAP) repair of tetralogy of Fallot (ToF) relieves right ventricular tract obstruction but may lead to pulmonary regurgitation. Valve-sparing (VS) procedures can avoid this but there is potential for residual pulmonic stenosis. We aimed to evaluate clinical and echocardiographic outcomes of TAP and VS repair for ToF.
METHODS
A systematic search of the PubMed, Embase, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Web of Science databases was carried out to identify articles comparing conventional TAP repair and VS repair for ToF. Clinical and echocardiographic outcomes were meta-analyzed using random-effects models.
RESULTS
40 studies were included in this meta-analysis with data on 11,723 participants (TAP: 6,171; VS: 5,045). Participants that underwent a VS procedure experienced a significantly lower cardiopulmonary bypass time (MD: -14.97; 95% CI: -22.54, -7.41), shorter ventilation duration (MD: -15.33; 95% CI: -30.20, -0.46), and shorter lengths of both ICU (MD: -0.67; 95% CI: -1.29, -0.06) and hospital stay (MD: -2.30; 95% CI: [-4.08, -0.52). There was also a lower risk of mortality (RR: 0.40; 95% CI: [0.27, 0.60]) and pulmonary regurgitation (RR: 0.35; 95% CI: [0.26, 0.46]) associated with the VS group. Most other clinical and echocardiographic outcomes were comparable in the two groups.
CONCLUSIONS
This meta-analysis confirms the well-established increased risk of pulmonary insufficiency following TAP repair, while also demonstrating that VS repairs are associated with several improved clinical outcomes. Continued research can identify the criteria for adopting a VS approach as opposed to a traditional TAP repair.
PubMed: 38924512
DOI: 10.1093/icvts/ivae124 -
Dentistry Journal Jun 2024Short dental implants have been proposed as an alternative treatment option to bone regeneration procedures for the rehabilitation of resorbed alveolar ridges. The aim... (Review)
Review
Survival Rates of Short Dental Implants (≤6 mm) Used as an Alternative to Longer (>6 mm) Implants for the Rehabilitation of Posterior Partial Edentulism: A Systematic Review of RCTs.
Short dental implants have been proposed as an alternative treatment option to bone regeneration procedures for the rehabilitation of resorbed alveolar ridges. The aim of this paper was to systematically review randomized controlled trials (RCTs) comparing short implants (≤6 mm) and longer implants (>6 mm) in atrophic alveolar ridges in terms of implant survival rates, peri-implant marginal bone loss (MBL), prevalence of peri-implantitis and technical complications. A thorough electronic search was performed until September 2023. RCTs with follow-up of at least 1-year post-loading comparing short implants with rough surfaces to longer implants in the posterior jaws of systemically and periodontally healthy, partially edentulous adults were considered. Studies with incomplete information on the number of patients, follow-up or definition of "short implants" were excluded. The revised Cochrane risk-of-bias tool for randomized trials was used for Risk of bias assessment. Fixed-effects meta-analysis of the selected studies was applied to compare the outcome variables. Random-effect meta-analysis was performed, on the basis of within-study comparisons. In total, 16 articles were selected for meta-analysis and incorporated 408 short implants and 475 longer implants inserted in 317 and 388 patients, respectively. The survival rates of longer implants in pristine or augmented bone were significantly increased compared to short implants (95%CI: 2-5%, < 0.001). Standard-length implants displayed increased, although non-statistically significant MBL (95%CI: -0.17-0.04, > 0.05), and prevalence of peri-implantitis (95%CI: 0-5%, > 0.05). No statistically significant differences were observed between short and long implants in terms of technical complications (implant-level 95%CI: -4-6%, > 0.05). Short implants represent a promising alternative treatment option for the rehabilitation of posterior jaws to avoid additional bone augmentation procedures. Nonetheless, they should be selected cautiously due to a potentially limited survival rate compared to longer implants. A major limitation of this study is the variability in the included studies regarding sample size, patient profile, type of bone, loading protocol, definition of peri-implantitis, among others. This study received no external funding. The study protocol was registered in PROSPERO (CRD42023485514).
PubMed: 38920886
DOI: 10.3390/dj12060185 -
Frontiers in Psychology 2024Although the investigation of mental health and wellbeing in education has shown an exponential increase on an international scale, attention has primarily been paid to...
Although the investigation of mental health and wellbeing in education has shown an exponential increase on an international scale, attention has primarily been paid to students, leaving the concept of teacher wellbeing comparatively overlooked. Extant literature offers numerous divergent descriptions, with some academics even avoiding an explicit definition of the term. Thus, there are limitations and inconsistencies in understanding teacher wellbeing as a unique construct. The aim of the current study was three-fold; (1) to assess the extent to which existing research reflects the multidimensional nature of the term teacher wellbeing, (2) to determine whether a holistic construct of teacher wellbeing could be justified, and (3) to evaluate the methodological quality of studies identified. A systematic review following the PRISMA statement was applied to peer-reviewed papers published between 2016 and 2021. Following the screening of 1,676 studies, this paper reports on findings drawn from a final sample of 61 articles conceptualizing teacher wellbeing. Studies were organized by their dominant discourses, namely negativity/ deficiency, positivity/ flourishing, and/or professionalism. Findings illustrate that teacher wellbeing was primarily conceptualized with a professionalism approach (with 18 of the identified studies taking solely this perspective). This is not completely consistent with the prior work that focused on stress and burnout (negativity/ deficiency approach) while exploring teachers' mental health and wellbeing. More importantly, there were only 6 studies that considered all three discourses together. This paper argues that important information is lost through neglecting alternative lenses, requiring further attention in order to address teacher wellbeing comprehensively. Such an endeavor is essential for shaping interventions and strategies aimed not only at enhancing teacher wellbeing but also at improving student outcomes and, ultimately, the overall quality of education. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021278549PROSPERO, CRD42021278549.
PubMed: 38915431
DOI: 10.3389/fpsyg.2024.1358424 -
Journal of the American Medical... Jun 2024To examine randomized controlled trials (RCTs) of "hospital at home" (HAH) for admission avoidance in adults presenting with acute physical illness to identify the use... (Review)
Review
OBJECTIVES
To examine randomized controlled trials (RCTs) of "hospital at home" (HAH) for admission avoidance in adults presenting with acute physical illness to identify the use of vital sign monitoring approaches and evidence for their effectiveness.
DESIGN
Systematic review.
SETTING AND PARTICIPANTS
This review compared strategies for vital sign monitoring in admission avoidance HAH for adults presenting with acute physical illness. Vital sign monitoring can support HAH acute multidisciplinary care by contributing to safety, determining requirement of further assessment, and guiding clinical decisions. There are a wide range of systems currently available, including reliable and automated continuous remote monitoring using wearable devices.
METHODS
Eligible studies were identified through updated database and trial registries searches (March 2, 2016, to February 15, 2023), and existing systematic reviews. Risk of bias was assessed using the Cochrane risk of bias 2 tool. Random effects meta-analyses were performed, and narrative summaries provided stratified by vital sign monitoring approach.
RESULTS
Twenty-one eligible RCTs (3459 participants) were identified. Two approaches to vital sign monitoring were characterized: manual and automated. Reporting was insufficient in the majority of studies for classification. For HAH compared to hospital care, 6-monthly mortality risk ratio (RR) was 0.94 (95% CI 0.78-1.12), 3-monthly readmission to hospital RR 1.02 (0.77-1.35), and length of stay mean difference 1.91 days (0.71-3.12). Readmission to hospital was reduced in the automated monitoring subgroup (RR 0.30 95% CI 0.11-0.86).
CONCLUSIONS AND IMPLICATIONS
This review highlights gaps in the reporting and evidence base informing remote vital sign monitoring in alternatives to admission for acute illness, despite expanding implementation in clinical practice. Although continuous vital sign monitoring using wearable devices may offer added benefit, its use in existing RCTs is limited. Recommendations for the implementation and evaluation of remote monitoring in future clinical trials are proposed.
PubMed: 38908399
DOI: 10.1016/j.jamda.2024.105080 -
World Journal of Urology Jun 2024Current potential living kidney donor's assessment includes functional and anatomical evaluation. Scintigraphy is recommended in some cases and some centers include this...
BACKGROUND
Current potential living kidney donor's assessment includes functional and anatomical evaluation. Scintigraphy is recommended in some cases and some centers include this test in the donor's protocol. Recent studies advocate for the avoidance of this test as CT or MRI volumetry showed to accurately assess donor's renal function.
OBJECTIVE
To summarize scientific evidence on image tests for pre-donation and/or post-nephrectomy renal function evaluation.
EVIDENCE ACQUISITION
This review followed the guidelines set by the European Association of Urology and adhered to PRISMA 2020 recommendations. The protocol was registered in PROSPERO on 10th December 2022 (ID: CRD42022379273).
EVIDENCE SYNTHESIS
Twenty-one studies met the inclusion criteria after thorough screening and eligibility assessment. According to QUADAS-2, patient selection and flow/timing domains showed a predominant low risk of bias. The correlation between split renal function (SRF) using CT and scintigraphy varied from weak (r = 0.21) to remarkably strong (r = 0.949). Bland-Altman agreement demonstrated moderate to excellent results, with mean differences ranging from -0.06% to 1.76%. The correlation between split renal volume (CT) and estimated glomerular filtration rate (eGFR) at 6 months or 1 year after nephrectomy showed a moderate correlation, with coefficients ranging from 0.708 to 0.83. The correlation between SRF (MRI) and renal scintigraphy reported a moderate correlation, with correlation coefficients of 0.58 and 0.84. MRI and scintigraphy displayed a good agreement, with a 66% agreement observed and mean differences of ± 0.3%.
CONCLUSIONS
Despite study heterogeneity, MRI or CT-based renal volumetry appears promising compared to scintigraphy, with favorable correlations and agreement.
Topics: Humans; Living Donors; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Radionuclide Imaging; Kidney Transplantation; Nephrectomy; Kidney; Kidney Function Tests; Tissue and Organ Harvesting
PubMed: 38904679
DOI: 10.1007/s00345-024-05024-y -
International Journal of Medical... Jun 2024The surge in emergency head CT imaging and artificial intelligence (AI) advancements, especially deep learning (DL) and convolutional neural networks (CNN), have... (Review)
Review
BACKGROUND
The surge in emergency head CT imaging and artificial intelligence (AI) advancements, especially deep learning (DL) and convolutional neural networks (CNN), have accelerated the development of computer-aided diagnosis (CADx) for emergency imaging. External validation assesses model generalizability, providing preliminary evidence of clinical potential.
OBJECTIVES
This study systematically reviews externally validated CNN-CADx models for emergency head CT scans, critically appraises diagnostic test accuracy (DTA), and assesses adherence to reporting guidelines.
METHODS
Studies comparing CNN-CADx model performance to reference standard were eligible. The review was registered in PROSPERO (CRD42023411641) and conducted on Medline, Embase, EBM-Reviews and Web of Science following PRISMA-DTA guideline. DTA reporting were systematically extracted and appraised using standardised checklists (STARD, CHARMS, CLAIM, TRIPOD, PROBAST, QUADAS-2).
RESULTS
Six of 5636 identified studies were eligible. The common target condition was intracranial haemorrhage (ICH), and intended workflow roles auxiliary to experts. Due to methodological and clinical between-study variation, meta-analysis was inappropriate. The scan-level sensitivity exceeded 90 % in 5/6 studies, while specificities ranged from 58,0-97,7 %. The SROC 95 % predictive region was markedly broader than the confidence region, ranging above 50 % sensitivity and 20 % specificity. All studies had unclear or high risk of bias and concern for applicability (QUADAS-2, PROBAST), and reporting adherence was below 50 % in 20 of 32 TRIPOD items.
CONCLUSION
0.01 % of identified studies met the eligibility criteria. The evidence on the DTA of CNN-CADx models for emergency head CT scans remains limited in the scope of this review, as the reviewed studies were scarce, inapt for meta-analysis and undermined by inadequate methodological conduct and reporting. Properly conducted, external validation remains preliminary for evaluating the clinical potential of AI-CADx models, but prospective and pragmatic clinical validation in comparative trials remains most crucial. In conclusion, future AI-CADx research processes should be methodologically standardized and reported in a clinically meaningful way to avoid research waste.
PubMed: 38901270
DOI: 10.1016/j.ijmedinf.2024.105523 -
Clinical Psychology Review Jun 2024Perception has been conceptualised as an active and adaptive process, based upon incoming sensory inputs, which are modified by top-down factors such as cognitions.... (Review)
Review
Perception has been conceptualised as an active and adaptive process, based upon incoming sensory inputs, which are modified by top-down factors such as cognitions. Visuospatial perception is thought to be scaled based on threat, with highly threatening objects or contexts visually inflated to promote escape or avoidance behaviours. This meta-analytical systematic review quantified the effect and evidence quality of threat-evoked visuospatial scaling, as well as how visuospatial scaling relates to affordances (perceived action capabilities) and behavioural avoidance/escape outcomes. Databases and grey literature were systematically searched inclusive to 10/04/24. Studies were assessed with a customised Risk of Bias form and meta-analysis was performed using a random-effects model. 12,354 records were identified. Of these, 49 experiments (n = 3027) were included in the review. There was consistent evidence that threat the of height influenced contextual perception (g = 0.66, 95% CI: 0.45, 0.88) and affordances (g = -0.43, 95% CI: -0.84, -0.03). Threatening objects were viewed as larger (g = 0.76, 95% CI: 0.26, 1.26) and as closer (g = 0.30, 95% CI: 0.17, 0.42). Bodily threat (pain) yielded conflicting effects on visuospatial perception/affordances. We conclude that threat may influence visuospatial perception and affordances. However, since behavioural measures were poorly reported, their relationship with visuospatial perception/affordances remains elusive.
PubMed: 38901066
DOI: 10.1016/j.cpr.2024.102449