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Journal of Pediatric Urology May 2024This systematic review and meta-analysis aims to assess the outcomes of detrusorectomy in children with neurogenic bladder (NB). (Review)
Review
INTRODUCTION
This systematic review and meta-analysis aims to assess the outcomes of detrusorectomy in children with neurogenic bladder (NB).
MATERIALS AND METHODS
A search was performed in PUBMED, EMBASE and the Cochrane Library database in August 2023. The following search terms were used: "detrusorectomy", "detrusorotomy", "auto-augmentation". The two main primary outcomes were improvement in bladder capacity and bladder compliance after intervention. Outcomes were dichotomized into favorable and unfavorable. The secondary outcomes were the effect of postoperative bladder cycling on bladder compliance and bladder capacity and complications.
RESULTS
258 references were screened for inclusion, of these 242 were excluded. 8 of the remaining 16 studies were included for the qualitative and quantitative analysis. All studies were retrospective case series studies (165 patients). Median follow-up time varied between studies (1.75-11.1 years), while two studies reported a mean follow-up time of 8.1 years. Using a random effects meta-analysis, the overall rate for unchanged or improved bladder capacity was 95% (Proportion[CI]: 0.95 [0.61; 1.00]). The overall rate for improved bladder compliance after detrusorectomy was 67% (Proportion[CI]: 0.67 [0.26; 0.92)) (Summary Fig). In the bladder cycling group improved compliance was found in 89% of patients (Proportion[CI]: 0.89 [0.41; 0.99]), whereas it was 21% in the non-cycling group (Proportion[CI]: 0.21 [0.04; 0.61]) (p = 0.0552). Bladder cycling did not affect bladder capacity as the overall rate for unchanged or improved bladder capacity was 98% (Proportion[CI]: 0.98 [0.35; 0.92]) in the cycling and 73% (Proportion[CI]: 0.73 [0.46; 0.90]) in the non-cycling group (p > 0.05). Overall complications were encountered in 16 (9.7%) patients, with major complications (stones, bladder perforations) detected only in 5(3%) patients.
DISCUSSION
Detrusorectomy leads to an improved bladder compliance in 67% of children. As such, detrusorectomy proves to be a viable procedure to enhance bladder compliance or to cure overactivity. Importantly, the beneficial effect of detrusorectomy on bladder compliance seems to be long-lasting. Bladder capacity remained unchanged or improved in almost all patients undergoing detrusorectomy. Postoperative bladder cycling was effective in improving bladder compliance outcome compared to the non-cycling group. Proper patient selection is the key to good postoperative outcomes.
CONCLUSIONS
Detrusorectomy enhances bladder compliance in pediatric neurogenic bladders. Postoperative bladder cycling improves bladder compliance and the overall complication rate of the procedure is low. Therefore, detrusorectomy should be considered a valuable therapeutic option in the comprehensive management of neurogenic bladders in children.
PubMed: 38749867
DOI: 10.1016/j.jpurol.2024.04.020 -
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 -
International Journal of Medical... Aug 2024Health misinformation (HM) has emerged as a prominent social issue in recent years, driven by declining public trust, popularisation of digital media platforms and... (Review)
Review
BACKGROUND
Health misinformation (HM) has emerged as a prominent social issue in recent years, driven by declining public trust, popularisation of digital media platforms and escalating public health crisis. Since the Covid-19 pandemic, HM has raised critical concerns due to its significant impacts on both individuals and society as a whole. A comprehensive understanding of HM and HM-related studies would be instrumental in identifying possible solutions to address HM and the associated challenges.
METHODS
Following the PRISMA procedure, 11,739 papers published from January 2013 to December 2022 were retrieved from five electronic databases, and 813 papers matching the inclusion criteria were retained for further analysis. This article critically reviewed HM-related studies, detailing the factors facilitating HM creation and dissemination, negative impacts of HM, solutions to HM, and research methods employed in those studies.
RESULTS
A growing number of studies have focused on HM since 2013. Results of this study highlight that trust plays a significant while latent role in the circuits of HM, facilitating the creation and dissemination of HM, exacerbating the negative impacts of HM and amplifying the difficulty in addressing HM.
CONCLUSION
For health authorities and governmental institutions, it is essential to systematically build public trust in order to reduce the probability of individuals acceptation of HM and to improve the effectiveness of misinformation correction. Future studies should pay more attention to the role of trust in how to address HM.
Topics: Humans; COVID-19; Communication; Trust; Information Dissemination; Social Media; SARS-CoV-2; Public Health; Health Communication
PubMed: 38743994
DOI: 10.1016/j.ijmedinf.2024.105478 -
The Science of the Total Environment Jul 2024Microplastics are ubiquitous in the aquatic environment and have emerged as a significant environmental issue due to their potential impacts on human health and the... (Review)
Review
Microplastics are ubiquitous in the aquatic environment and have emerged as a significant environmental issue due to their potential impacts on human health and the ecosystem. Current laboratory-based microplastic detection methods suffer from various drawbacks, including a lack of standardisation, limited spatial and temporal coverage, high costs, and time-consuming procedures. Consequently, there is a need for the development of in-situ techniques to detect and monitor microplastics to effectively identify and understand their sources, pathways, and behaviours. Herein, we adopt a systematic literature review method to assess the development and application of experimental and field technologies designed for the in-situ detection and monitoring of aquatic microplastics, without the need for sample preparation. Four scientific databases were searched in March 2023, resulting in a review of 62 relevant studies. These studies were classified into seven sensor categories and their working principles were discussed. The sensor classes include optical devices, digital holography, Raman spectroscopy, other spectroscopy, hyperspectral imaging, remote sensing, and other methods. We also looked at how data from these technologies are integrated with machine learning models to develop classifiers capable of accurately characterising the physical and chemical properties of microplastics and discriminating them from other particles. This review concluded that in-situ detection of microplastics in aquatic environments is feasible and can be achieved with high accuracy, even though the methods are still in the early stages of development. Nonetheless, further research is still needed to enhance the in-situ detection of microplastics. This includes exploring the possibility of combining various detection methods and developing robust machine-learning classifiers. Additionally, there is a recommendation for in-situ implementation of the reviewed methods to assess their effectiveness in detecting microplastics and identify their limitations.
Topics: Microplastics; Environmental Monitoring; Water Pollutants, Chemical
PubMed: 38740219
DOI: 10.1016/j.scitotenv.2024.173111 -
Journal of Medical Systems May 2024Asthma, a common chronic respiratory disease among children and adults, affects more than 200 million people worldwide and causes about 450,000 deaths each year. Machine...
Asthma, a common chronic respiratory disease among children and adults, affects more than 200 million people worldwide and causes about 450,000 deaths each year. Machine learning is increasingly applied in healthcare to assist health practitioners in decision-making. In asthma management, machine learning excels in performing well-defined tasks, such as diagnosis, prediction, medication, and management. However, there remain uncertainties about how machine learning can be applied to predict asthma exacerbation. This study aimed to systematically review recent applications of machine learning techniques in predicting the risk of asthma attacks to assist asthma control and management. A total of 860 studies were initially identified from five databases. After the screening and full-text review, 20 studies were selected for inclusion in this review. The review considered recent studies published from January 2010 to February 2023. The 20 studies used machine learning techniques to support future asthma risk prediction by using various data sources such as clinical, medical, biological, and socio-demographic data sources, as well as environmental and meteorological data. While some studies considered prediction as a category, other studies predicted the probability of exacerbation. Only a group of studies applied prediction windows. The paper proposes a conceptual model to summarise how machine learning and available data sources can be leveraged to produce effective models for the early detection of asthma attacks. The review also generated a list of data sources that other researchers may use in similar work. Furthermore, we present opportunities for further research and the limitations of the preceding studies.
Topics: Humans; Asthma; Disease Progression; Machine Learning; Risk Assessment
PubMed: 38739297
DOI: 10.1007/s10916-024-02061-3 -
Scandinavian Journal of Trauma,... May 2024Pre-hospital endotracheal intubation (ETI) is a sophisticated procedure with a comparatively high failure rate. Especially, ETI in confined spaces may result in higher... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pre-hospital endotracheal intubation (ETI) is a sophisticated procedure with a comparatively high failure rate. Especially, ETI in confined spaces may result in higher difficulty, longer times, and a higher failure rate. This study analyses if Helicopter Emergency Medical Services (HEMS) intubation (time-to) success are influenced by noise, light, and restricted space in comparison to ground intubation. Available literature reporting these parameters was very limited, thus the reported differences between ETI in helicopter vs. ground by confronting parameters such as time to secure airway, first pass success rate and Cormack-Lehane Score were analysed.
METHODS
A systematic review and meta-analysis were conducted using PUBMED, EMBASE, Cochrane Library, and Ovid on October 15th, 2022. The database search provided 2322 studies and 6 studies met inclusion and quality criteria. The research was registered with the International Prospective Register of Systematic Reviews (CRD42022361793).
RESULTS
A total of six studies were selected and analysed as part of the systematic review and meta-analysis. The first pass success rate of ETI was more likely to fail in the helicopter setting as compared to the ground (82,4% vs. 87,3%), but the final success rate was similar between the two settings (96,8% vs. 97,8%). The success rate of intubation in literature was reported higher in physician-staffed HEMS than in paramedic-staffed HEMS. The impact of aircraft type and location inside the vehicle on intubation success rates was inconclusive across studies. The meta-analysis revealed inconsistent results for the mean duration of intubation, with one study reporting shorter intubation times in helicopters (13,0s vs.15,5s), another reporting no significant differences (16,5s vs. 16,8s), and a third reporting longer intubation times in helicopters (16,1s vs. 15,0s).
CONCLUSION
Further research is needed to assess the impact of environmental factors on the quality of ETI on HEMS. While the success rate of endotracheal intubation in helicopters vs. on the ground is not significantly different, the duration and time to secure the airway, and Cormack-Lehane Score may be influenced by environmental factors. However, the limited number of studies reporting on these factors highlights the need for further research in this area.
Topics: Intubation, Intratracheal; Humans; Air Ambulances; Emergency Medical Services
PubMed: 38730289
DOI: 10.1186/s13049-024-01213-1 -
Computers in Biology and Medicine Jun 2024Heart failure (HF), a global health challenge, requires innovative diagnostic and management approaches. The rapid evolution of deep learning (DL) in healthcare... (Review)
Review
BACKGROUND
Heart failure (HF), a global health challenge, requires innovative diagnostic and management approaches. The rapid evolution of deep learning (DL) in healthcare necessitates a comprehensive review to evaluate these developments and their potential to enhance HF evaluation, aligning clinical practices with technological advancements.
OBJECTIVE
This review aims to systematically explore the contributions of DL technologies in the assessment of HF, focusing on their potential to improve diagnostic accuracy, personalize treatment strategies, and address the impact of comorbidities.
METHODS
A thorough literature search was conducted across four major electronic databases: PubMed, Scopus, Web of Science and IEEE Xplore, yielding 137 articles that were subsequently categorized into five primary application areas: cardiovascular disease (CVD) classification, HF detection, image analysis, risk assessment, and other clinical analyses. The selection criteria focused on studies utilizing DL algorithms for HF assessment, not limited to HF detection but extending to any attempt in analyzing and interpreting HF-related data.
RESULTS
The analysis revealed a notable emphasis on CVD classification and HF detection, with DL algorithms showing significant promise in distinguishing between affected individuals and healthy subjects. Furthermore, the review highlights DL's capacity to identify underlying cardiomyopathies and other comorbidities, underscoring its utility in refining diagnostic processes and tailoring treatment plans to individual patient needs.
CONCLUSIONS
This review establishes DL as a key innovation in HF management, highlighting its role in advancing diagnostic accuracy and personalized care. The insights provided advocate for the integration of DL in clinical settings and suggest directions for future research to enhance patient outcomes in HF care.
Topics: Humans; Deep Learning; Heart Failure
PubMed: 38728995
DOI: 10.1016/j.compbiomed.2024.108557 -
Environmental Pollution (Barking, Essex... Jul 2024Exposure assessment is a crucial component of environmental health research, providing essential information on the potential risks associated with various chemicals. A...
Exposure assessment is a crucial component of environmental health research, providing essential information on the potential risks associated with various chemicals. A systematic scoping review was conducted to acquire an overview of accessible human exposure assessment methods and computational tools to support and ultimately improve risk assessment. The systematic scoping review was performed in Sysrev, a web platform that introduces machine learning techniques into the review process aiming for increased accuracy and efficiency. Included publications were restricted to a publication date after the year 2000, where exposure methods were properly described. Exposure assessments methods were found to be used for a broad range of environmental chemicals including pesticides, metals, persistent chemicals, volatile organic compounds, and other chemical classes. Our results show that after the year 2000, for all the types of exposure routes, probabilistic analysis, and computational methods to calculate human exposure have increased. Sixty-three mathematical models and toolboxes were identified that have been developed in Europe, North America, and globally. However, only twelve occur frequently and their usefulness were associated with exposure route, chemical classes and input parameters used to estimate exposure. The outcome of the combined associations can function as a basis and/or guide for decision making for the selection of most appropriate method and tool to be used for environmental chemical human exposure assessments in Ontology-driven and artificial intelligence-based repeated dose toxicity testing of chemicals for next generation risk assessment (ONTOX) project and elsewhere. Finally, the choice of input parameters used in each mathematical model and toolbox shown by our analysis can contribute to the harmonization process of the exposure models and tools increasing the prospect for comparison between studies and consistency in the regulatory process in the future.
Topics: Humans; Environmental Exposure; Environmental Monitoring; Environmental Pollutants; Machine Learning; Pesticides; Risk Assessment
PubMed: 38718961
DOI: 10.1016/j.envpol.2024.124109 -
JSES Reviews, Reports, and Techniques May 2024Therapeutic exercise has been considered a useful tool to rehabilitate shoulder pain, namely through its influence on scapular dynamics. Accordingly, the effectiveness... (Review)
Review
BACKGROUND
Therapeutic exercise has been considered a useful tool to rehabilitate shoulder pain, namely through its influence on scapular dynamics. Accordingly, the effectiveness of scapular therapeutic exercise needs to be explored. The present study aims to evaluate the effectiveness of scapular therapeutic exercises in shoulder pain and to identify the most effective exercise type (focal or multijoint) and ways of delivering them (as dose and progression).
METHODS
Search was conducted at EMBASE, Cochrane Library, MEDLINE via PubMed, Web of Science, PEDro (Physiotherapy Evidence Database), and trial registration databases. The meta-analysis considered randomized controlled/crossover trials that compared the effect of scapular exercises against other types of intervention in the shoulder pain, shoulder function, scapular motion, and/or muscular activity. The risk of bias was assessed through the PEDro scale.
RESULTS
From the 8318 records identified, 8 (high to low risk of bias- scoring from 4 to 8 on the PEDro scale) were included. The overall data, before sensitivity analysis, indicated that the scapular therapeutic exercises are: a) more effective than comparators in improving shoulder function (standardized mean difference [SMD] = 0.52 [95% Cl: 0.05, 0.99], = .03, = 76%); and b) as effective as comparators in reducing shoulder pain (SMD = 0.32 [95% Cl: -0.09, 0.73], = .13, = 70%). Subgroup analysis revealed that scapular exercises are more effective in improving shoulder function when the program duration is equal to or higher than 6 weeks (SMD = 0.43 [95% Cl: 0.09, 0.76] = .01, = 21%) and/or when the maximum number of exercise repetitions per session is lower than 30 (SMD = 0.79 [95% Cl: 0.15, 1.42], = .01, = 77%). Only 1 study considered scapular motion as an outcome measure, revealing therapeutic exercise effectiveness to improve scapular range of motion.
CONCLUSIONS
Intervention programs involving scapular therapeutic exercises are effective in improving shoulder function, presenting benefits when performed for 6 or more weeks and/or when used up to a maximum of 30 repetitions per exercise, per session.
PubMed: 38706660
DOI: 10.1016/j.xrrt.2023.12.006 -
Journal of Infection and Chemotherapy :... May 2024Specific data concerning the efficacy of alternative antibiotics for carbapenems against complicated urinary tract infections (cUTIs) attributed to...
Efficacy of carbapenems and alternative antimicrobials for treating complicated urinary tract infections caused by third-generation cephalosporin-resistant gram-negative bacteria: A systematic review and meta-analysis of randomised controlled trials.
BACKGROUND
Specific data concerning the efficacy of alternative antibiotics for carbapenems against complicated urinary tract infections (cUTIs) attributed to antimicrobial-resistant (AMR) uropathogens are lacking.
OBJECTIVES
This study aimed to assess the efficacy of carbapenems and non-carbapenem antibiotics in the clinical outcomes of cUTIs caused by AMR uropathogens.
METHODS
In this systematic review and meta-analysis, databases, including MEDLINE/PubMed, the Cochrane Library, Embase and ClinicalTrials.gov, were searched. The study eligibility criteria were research articles conducted as randomised controlled trials that evaluated the composite outcomes of cUTIs. Participants were adult patients with cUTIs caused by gram-negative uropathogens resistant to third-generation cephalosporins. The intervention involved a non-carbapenem class of antimicrobial agents with in vitro activities against gram-negative uropathogens resistant to third-generation cephalosporins. Two independent researchers assessed the risk-of-bias using the second version of the Cochrane risk-of-bias tool for randomised trials. The treatment effects on each outcome were estimated as a risk ratio (RR) with a 95 % confidence interval (CI) using the random-effects model. Heterogeneity was assessed using the Cochrane Q-test and I statistics.
RESULTS
Through database searches, 955 articles were retrieved. After screening the titles and abstracts, 52 articles were screened in full text. Finally, 12 studies met the inclusion criteria. No significant differences in efficacy were observed between alternative antibiotics and carbapenems (composite outcome, RR, 0.96; 95 % CI, 0.63-1.49; I = 21 %; low certainty of evidence).
CONCLUSIONS
Alternative antibiotics had clinical efficacy similar to that of carbapenems for treating patients with cUTI caused by gram-negative uropathogens resistant to third-generation cephalosporins.
PubMed: 38705237
DOI: 10.1016/j.jiac.2024.05.001