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Plastic and Reconstructive Surgery.... May 2024Implant-based breast reconstruction after nipple-sparing mastectomy (NSM) presents unique benefits and challenges. The literature has compared outcomes among total...
BACKGROUND
Implant-based breast reconstruction after nipple-sparing mastectomy (NSM) presents unique benefits and challenges. The literature has compared outcomes among total submuscular (TSM), dual-plane (DP), and prepectoral (PP) planes; however, a dedicated meta-analysis relevant to NSM is lacking.
METHODS
We conducted a systematic review of studies on immediate breast reconstruction after NSM using TSM, DP, or PP prosthesis placement in PubMed, Embase, and Cochrane databases. In total, 1317 unique articles were identified, of which 49 were included in the systematic review and six met inclusion criteria for meta-analysis. Pooled descriptive outcomes were analyzed for each cohort for all 49 studies. Fixed-effects meta-analytic methods were used to compare PP with subpectoral (TSM and DP) reconstructions.
RESULTS
A total of 1432 TSM, 1546 DP, and 1668 PP reconstructions were identified for descriptive analysis. Demographics were similar between cohorts. Pooled descriptive outcomes demonstrated overall similar rates of reconstructive failure (3.3%-5.1%) as well as capsular contracture (0%-3.9%) among cohorts. Fixed-effects meta-analysis of six comparative studies demonstrated a significantly lower rate of mastectomy flap necrosis in the PP cohort compared with the subpectoral cohort (relative risk 0.24, 95% confidence interval [0.08-0.74]). All other consistently reported outcomes, including, hematoma, seroma, infection, mastectomy flap necrosis, nipple -areola complex necrosis, and explantation were comparable.
CONCLUSIONS
A systematic review of the literature and meta-analysis demonstrated the safety of immediate prepectoral breast reconstruction after NSM, compared with submuscular techniques. Submuscular reconstruction had a higher risk of mastectomy flap necrosis, though potentially influenced by selection bias.
PubMed: 38746948
DOI: 10.1097/GOX.0000000000005808 -
International Journal of Nursing... Jun 2024Increasing evidence suggests that clinician well-being influences patient, workforce, and organizational outcomes. Despite increasing attention to well-being among... (Review)
Review
BACKGROUND
Increasing evidence suggests that clinician well-being influences patient, workforce, and organizational outcomes. Despite increasing attention to well-being among licensed clinicians (e.g., nurses and physicians), collective evidence about well-being among healthcare assistants, such as nursing and medical assistants, is limited. Healthcare assistants make up a substantial portion of the clinical workforce delivering direct patient care. The well-being of healthcare assistants is critical to ensure an ample workforce supply. The objective of this systematic review was to contribute a reproducible search, summary, appraisal, synthesis, and critique of the literature about well-being among healthcare assistants, including factors that induce or inhibit burnout, and to identify gaps in evidence that warrant future research.
METHODS
We performed a literature search across 4 databases with keywords using BOOLEAN operators. After an initial title and abstract screen, a search of relevant reference lists, and full text review was peformed independently by 2 researchers. Study quality was evaluated using Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. We extracted study characteristics, results, and deductively analyzed each study's alignment with the United States National Academy of Medicine's Clinician Well-Being Model.
RESULTS
We identified 28 articles meeting our inclusion criteria. Our synthesis indicated that most studies investigated personal factors (e.g., financial stressors or physical, emotional, and spiritual health) as opposed to organizational or policy factors (e.g., occupational policies or workplace culture) that may impact well-being. Younger workers and those with fewer years of experience appear to have higher burnout risk. Sleep health, improved unit-based culture (respect and increased decision-making with nurses), shorter shifts, and increased social support appear to be the most protective against burnout.
DISCUSSION
There remains a scarcity of evidence about factors impacting well-being among healthcare assistants. Existing literature focuses on individual, as opposed to external or organizational, contributory factors to burnout or well-being risk. Future studies should use specific methods to define and measure healthcare assistant roles, isolate harmful individual and organizational factors, and measure more specific sub-concepts of well-being such as depression. Such studies can contribute greatly to the overall understanding of healthcare assistant health and wellness, which subsequently may promote optimal patient and organizational outcomes.
TWEETABLE ABSTRACT
The hidden workforce: Systematic review demonstrates gaps in evidence about wellbeing and burnout among healthcare assistants and aides.
PubMed: 38746791
DOI: 10.1016/j.ijnsa.2024.100187 -
ArXiv May 2024High-content image-based assays have fueled significant discoveries in the life sciences in the past decade (2013-2023), including novel insights into disease etiology,...
High-content image-based assays have fueled significant discoveries in the life sciences in the past decade (2013-2023), including novel insights into disease etiology, mechanism of action, new therapeutics, and toxicology predictions. Here, we systematically review the substantial methodological advancements and applications of Cell Painting. Advancements include improvements in the Cell Painting protocol, assay adaptations for different types of perturbations and applications, and improved methodologies for feature extraction, quality control, and batch effect correction. Moreover, machine learning methods recently surpassed classical approaches in their ability to extract biologically useful information from Cell Painting images. Cell Painting data have been used alone or in combination with other -omics data to decipher the mechanism of action of a compound, its toxicity profile, and many other biological effects. Overall, key methodological advances have expanded Cell Painting's ability to capture cellular responses to various perturbations. Future advances will likely lie in advancing computational and experimental techniques, developing new publicly available datasets, and integrating them with other high-content data types.
PubMed: 38745696
DOI: No ID Found -
Nature Communications May 2024Cohort and case-control data have suggested an association between low to moderate alcohol consumption and decreased risk of ischemic heart disease (IHD), yet results... (Meta-Analysis)
Meta-Analysis
Cohort and case-control data have suggested an association between low to moderate alcohol consumption and decreased risk of ischemic heart disease (IHD), yet results from Mendelian randomization (MR) studies designed to reduce bias have shown either no or a harmful association. Here we conducted an updated systematic review and re-evaluated existing cohort, case-control, and MR data using the burden of proof meta-analytical framework. Cohort and case-control data show low to moderate alcohol consumption is associated with decreased IHD risk - specifically, intake is inversely related to IHD and myocardial infarction morbidity in both sexes and IHD mortality in males - while pooled MR data show no association, confirming that self-reported versus genetically predicted alcohol use data yield conflicting findings about the alcohol-IHD relationship. Our results highlight the need to advance MR methodologies and emulate randomized trials using large observational databases to obtain more definitive answers to this critical public health question.
Topics: Humans; Myocardial Ischemia; Alcohol Drinking; Mendelian Randomization Analysis; Male; Female; Case-Control Studies; Myocardial Infarction; Cohort Studies; Risk Factors
PubMed: 38744810
DOI: 10.1038/s41467-024-47632-7 -
Journal of the American Heart... May 2024There is a potential concern about increased bleeding risk in patients receiving omega-3 polyunsaturated fatty acids (PUFAs). The aims of this study-level meta-analysis... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is a potential concern about increased bleeding risk in patients receiving omega-3 polyunsaturated fatty acids (PUFAs). The aims of this study-level meta-analysis were to determine the risk of bleeding and to assess whether this relationship is linked to the received dose of omega-3 PUFAs or the background use of antiplatelet treatment.
METHODS AND RESULTS
Electronic databases were searched through May 2023 to identify randomized clinical trials of patients receiving omega-3 PUFAs. Overall bleeding events, including fatal and central nervous system events, were identified and compared with those of a control group. A total of 120 643 patients from 11 randomized clinical trials were included. There was no difference in the pooled meta-analytic events of bleeding among patients receiving omega-3 PUFAs and those in the control group (rate ratio [RR], 1.09 [95% CI, 0.91-1.31]; =0.34). Likewise, the incidence of hemorrhagic stroke, intracranial bleeding, and gastrointestinal bleeding were similar. A prespecified analysis was performed in patients receiving high-dose purified eicosapentaenoic acid (EPA), which demonstrated a 50% increase in the relative risk of bleeding but only a modest increase in the absolute risk of bleeding (0.6%) when compared with placebo. Bleeding risk was associated with the dose of EPA (risk difference, 0.24 [95% CI, 0.05-0.43]; =0.02) but not the background use of antiplatelet therapy (risk difference, -0.01 [95% CI, -0.02 to 0]; =0.056).
CONCLUSIONS
Omega-3 PUFAs were not associated with increased bleeding risk. Patients receiving high-dose purified EPA may incur additional bleeding risk, although its clinical significance is very modest.
Topics: Humans; Fatty Acids, Omega-3; Randomized Controlled Trials as Topic; Hemorrhage; Risk Assessment; Risk Factors; Platelet Aggregation Inhibitors
PubMed: 38742535
DOI: 10.1161/JAHA.123.032390 -
European Heart Journal Open May 2024High lipoprotein(a) [Lp(a)] level has been demonstrated as an important risk factor for atherosclerotic cardiovascular diseases (ASCVD) amongst the older populations,...
AIMS
High lipoprotein(a) [Lp(a)] level has been demonstrated as an important risk factor for atherosclerotic cardiovascular diseases (ASCVD) amongst the older populations, whereas its effects in the younger population remain unclear. This study evaluated the associations between Lp(a) and the risk of premature ASCVD.
METHOD AND RESULTS
PubMed and Embase were searched for related studies until 12 November 2023. Fifty-one studies including 100 540 participants were included. Mean age of patients ranged from 35.3 to 62.3 years. The proportion of male participants ranged from 0% to 100%. The mean follow-up was provided in five studies ranging from 1 year to 40 years. The definition of elevated Lp(a) varied among studies, such as >30 mg/dL, >50 mg/dL, the top tertiles, the top quartiles, the top quintiles, and so on. Higher Lp(a) was significantly associated with the composite ASCVD [odds ratio (OR): 2.15, 95% confidence interval (95% CI): 1.53-3.02, < 0.001], especially for coronary artery disease (OR: 2.44, 95% CI: 2.06-2.90, < 0.001) and peripheral arterial disease (OR: 2.56, 95% CI: 1.56-4.21, < 0.001). This association remained significant in familial hypercholesterolaemia (FH) (OR: 3.11, 95% CI: 1.63-5.96, < 0.001) and type 2 diabetes mellitus (T2DM) patients (OR: 2.23; 95% CI: 1.54-3.23, < 0.001).Significant results were observed in South Asians (OR: 3.71, 95% CI: 2.31-5.96, < 0.001), Caucasians (OR: 3.17, 95% CI: 2.22-4.52, < 0.001), and patients with baseline low-density lipoprotein cholesterol (LDL-c) level ≥ 2.6 mmol/L.
CONCLUSION
Elevated Lp(a) predicts the risk of the composite or individual ASCVD in young, regardless of study design, gender, population characteristics (community or hospitalized), different premature definitions, and various Lp(a) measurement approaches. This association was important in South Asians, Caucasians, FH patients, T2DM patients, and patients with baseline LDL-c level ≥ 2.6 mmol/L.
PubMed: 38737415
DOI: 10.1093/ehjopen/oeae031 -
Clinical Kidney Journal May 2024Chronic kidney disease (CKD) is a major global health problem and its early identification would allow timely intervention to reduce complications. We performed a...
BACKGROUND
Chronic kidney disease (CKD) is a major global health problem and its early identification would allow timely intervention to reduce complications. We performed a systematic review and meta-analysis of multivariable prediction models derived and/or validated in community-based electronic health records (EHRs) for the prediction of incident CKD in the community.
METHODS
Ovid Medline and Ovid Embase were searched for records from 1947 to 31 January 2024. Measures of discrimination were extracted and pooled by Bayesian meta-analysis, with heterogeneity assessed through a 95% prediction interval (PI). Risk of bias was assessed using Prediction model Risk Of Bias ASsessment Tool (PROBAST) and certainty in effect estimates by Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
RESULTS
Seven studies met inclusion criteria, describing 12 prediction models, with two eligible for meta-analysis including 2 173 202 patients. The Chronic Kidney Disease Prognosis Consortium (CKD-PC) (summary c-statistic 0.847; 95% CI 0.827-0.867; 95% PI 0.780-0.905) and SCreening for Occult REnal Disease (SCORED) (summary c-statistic 0.811; 95% CI 0.691-0.926; 95% PI 0.514-0.992) models had good model discrimination performance. Risk of bias was high in 64% of models, and driven by the analysis domain. No model met eligibility for meta-analysis if studies at high risk of bias were excluded, and certainty of effect estimates was 'low'. No clinical utility analyses or clinical impact studies were found for any of the models.
CONCLUSIONS
Models derived and/or externally validated for prediction of incident CKD in community-based EHRs demonstrate good prediction performance, but assessment of clinical usefulness is limited by high risk of bias, low certainty of evidence and a lack of impact studies.
PubMed: 38737345
DOI: 10.1093/ckj/sfae098 -
Journal of Sport and Health Science May 2024When recommending avoidance of static stretching prior to athletic performance, authors and practitioners commonly refer to available systematic reviews. However, effect... (Review)
Review
BACKGROUND
When recommending avoidance of static stretching prior to athletic performance, authors and practitioners commonly refer to available systematic reviews. However, effect sizes (ES) in previous reviews were extracted in major part from studies lacking control conditions and/or pre-post testing designs. Also, currently available reviews conducted calculations without accounting for multiple study outcomes, with ES: -0.03 to 0.10, which would commonly be classified as trivial.
METHODS
Since new meta-analytical software and controlled research articles have appeared since 2013, we revisited the available literature and performed a multilevel meta-analysis using robust variance estimation of controlled pre-post trials to provide updated evidence. Furthermore, previous research described reduced electromyography activity-also attributable to fatiguing training routines-as being responsible for decreased subsequent performance. The second part of this study opposed stretching and alternative interventions sufficient to induce general fatigue to examine whether static stretching induces higher performance losses compared to other exercise routines.
RESULTS
Including 83 studies with more than 400 ES from 2012 participants, our results indicate a significant, small ES for a static stretch-induced maximal strength loss (ES = -0.21, p = 0.003), with high magnitude ES (ES = -0.84, p = 0.004) for stretching durations ≥60 s per bout when compared to passive controls. When opposed to active controls, the maximal strength loss ranges between ES: -0.17 to -0.28, p < 0.001 and 0.040 with mostly no to small heterogeneity. However, stretching did not negatively influence athletic performance in general (when compared to both passive and active controls); in fact, a positive effect on subsequent jumping performance (ES = 0.15, p = 0.006) was found in adults.
CONCLUSION
Regarding strength testing of isolated muscles (e.g., leg extensions or calf raises), our results confirm previous findings. Nevertheless, since no (or even positive) effects could be found for athletic performance, our results do not support previous recommendations to exclude static stretching from warm-up routines prior to, for example, jumping or sprinting.
PubMed: 38735533
DOI: 10.1016/j.jshs.2024.05.002 -
The Lancet. Microbe May 2024Early after the start of the COVID-19 pandemic, the detection of influenza B/Yamagata cases decreased globally. Given the potential public health implications of this... (Review)
Review
Early after the start of the COVID-19 pandemic, the detection of influenza B/Yamagata cases decreased globally. Given the potential public health implications of this decline, in this Review, we systematically analysed data on influenza B/Yamagata virus circulation (for 2020-23) from multiple complementary sources of information. We identified relevant articles published in PubMed and Embase, and data from the FluNet, Global Initiative on Sharing All Influenza Data, and GenBank databases, webpages of respiratory virus surveillance systems from countries worldwide, and the Global Influenza Hospital Surveillance Network. A progressive decline of influenza B/Yamagata detections was reported across all sources, in absolute terms (total number of cases), as positivity rate, and as a proportion of influenza B detections. Sporadically reported influenza B/Yamagata cases since March, 2020 were mostly vaccine-derived, attributed to data entry errors, or have yet to be definitively confirmed. The likelihood of extinction necessitates a rapid response in terms of reassessing the composition of influenza vaccines, enhanced surveillance for B/Yamagata, and a possible change in the biosafety level when handling B/Yamagata viruses in laboratories.
PubMed: 38729197
DOI: 10.1016/S2666-5247(24)00066-1 -
Phytomedicine : International Journal... Jul 2024It has been a current research hospots using fingerprinting technology for quality control of Chinese herbal medicines (CHMs), which provides a scientific basis for...
BACKGROUND
It has been a current research hospots using fingerprinting technology for quality control of Chinese herbal medicines (CHMs), which provides a scientific basis for establishment of overall quality control in accordance with the characteristics of CHMs. The fingerprinting technology for CHMs is diverse, and the research field covers many disciplines, such as analytical chemistry, pharmacology, pharmaceutics, biochemistry, and molecular biology.
PURPOSE
To effectively understand the key areas and future directions of research regarding the fingerprint and adulteration of CHMs.
METHODS/RESULTS
this paper analyzed 879 articles in this field in the Web of Science Core Collection from 2000 to 2023 with CiteSpace and VOSviewer, and systematically assessed the research process, hotspots, topic distribution among disciplines, etc. The most prominent contributors of fingerprint and adulteration of CHMs research are mainly from China, India, the United States, England, and Brazil. The knowledge domains of fingerprint and adulteration of CHMs research focus mainly on the topics of molecular authentication, DNA barcoding, HPLC, near-infrared spectroscopy, manage data, chemometrics, and electrochemical fingerprinting. Most countries have recognized the pharmaceutical potential of natural products, and have paid more attention to the fingerprint and adulteration of CHMs in the past decade. Future the research tends to focus more on molecular identification and authentication, and electrochemical and chromatographic fingerprinting in controlling the adulteration of CHMs.
CONCLUSION
This research provides a valuable reference for scholars in related fields to analyze existing research results, understand the development trend, and explore new research directions.
Topics: Drugs, Chinese Herbal; Drug Contamination; Quality Control; Chromatography, High Pressure Liquid; DNA Barcoding, Taxonomic
PubMed: 38728918
DOI: 10.1016/j.phymed.2024.155667