-
European Journal of Radiology Jun 2024Cone-Beam CT (CBCT) is well established in orofacial diagnostic imaging and is currently expanding into musculoskeletal applications. This systematic review sought to... (Review)
Review
PURPOSE
Cone-Beam CT (CBCT) is well established in orofacial diagnostic imaging and is currently expanding into musculoskeletal applications. This systematic review sought to update the knowledge base on radiation dose comparisons between imaging modalities in MSK imaging and consider how research studies have reported dose measures.
METHODS
This review utilised a database search and an online literature tool. Studies with potential relevance were screened then before full text review, each performed by two independent reviewers, with a third independent reviewer available for conflicts. Data was extracted using a bespoke tool created within the literature tool.
RESULTS
21 studies were included in the review which compared CBCT with MSCT (13), conventional radiography (1), or both (7). 19 studies concluded that CBCT provided a reduced radiation dose when compared with MSCT: the factor of reduction ranging from 1.71 to 50 with an average of 12. Studies comparing CBCT to DR found DR to have an average dose reduction of 4.55.
CONCLUSIONS
The claims that CBCT produces a lower radiation dose than MSCT is borne out with most studies confirming doses less than half that of MSCT. Fewer studies include DR as a comparator but confirm that CBCT results in a higher effective dose on average, with scope for CBCT to provide an equivalent radiation dose. This review highlighted a need for consistency in methodology when conducting studies which compare radiation dose across different technologies. Potential solutions lie outside the scope of this review, likely requiring multi-discipline approach to ensure a cohesive outcome.
PubMed: 38964225
DOI: 10.1016/j.ejrad.2024.111558 -
International Journal of Nursing Studies Jun 2024Behavioural emergencies involving aggression in acute care hospitals are increasing globally. Acute care staff are often not trained or confident in their prevention or... (Review)
Review
BACKGROUND
Behavioural emergencies involving aggression in acute care hospitals are increasing globally. Acute care staff are often not trained or confident in their prevention or management. Of available training options simulation-based education is superior for clinical medical education and is gaining acceptance for teaching clinical aggression management skills.
OBJECTIVE
The aim of this study was to conduct a systematic review of the effectiveness of simulation-based education for teaching aggression management skills for health professionals working in acute healthcare settings.
METHODS
The study protocol was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement, registered (27/02/2020) and published. We included randomised controlled trials, non-randomised controlled trials, quasi-experimental studies, and observational studies involving healthcare professionals in acute hospital settings or trainee health professionals who received simulation-based training on managing patient aggression. Comprehensive searches were conducted in PubMed, Ovid MEDLINE, PsycINFO, CINAHL and The Cochrane Library. Two reviewers independently screened all records, extracted data and assessed risk of bias. The primary outcomes included patient outcomes, quality of care, and adverse effects. Secondary outcomes included workplace resource use, healthcare provider related outcomes, knowledge (de-escalation techniques), performance, attitudes, and satisfaction. A narrative synthesis of included studies was performed because substantial variation of interventions and outcome measures precluded meta-analyses.
RESULTS
Twenty-five studies were included with 2790 participants, 2585 (93 %) acute care hospital staff and 205 (7 %) undergraduate university students. Twenty-two studies combined simulation-based education with at least one other training modality. Three studies were randomised controlled trials, one was a pilot and feasibility cluster randomised controlled trial, one was a three-group post-test design and twenty were pre-/post-test design. Twenty-four studies were deemed to be high/critical or serious risk of bias. Four studies collected primary outcome data, all using different methods and with inconsistent findings. Twenty-one studies assessed performance in the test situation, seven studies provided objective ratings of performance and eighteen provided self-report data. Twenty-three studies reported objective or subjective improvements in secondary outcomes.
CONCLUSIONS
Acute healthcare staff who completed simulation-based education on managing clinical aggression showed statistically significant improvements in knowledge and self-reported confidence. However, there is a lack of evidence about the magnitude of these improvements and impact on patient outcomes.
REGISTRATION
PROSPERO Registration Number CRD42020151002.
TWEETABLE ABSTRACT
Simulation-based education improved acute healthcare clinician knowledge and confidence in managing aggression.
PubMed: 38964221
DOI: 10.1016/j.ijnurstu.2024.104842 -
Breastfeeding Medicine : the Official... Jul 2024Gestational weight gain (GWG) may be associated with delayed onset of lactogenesis II (DOL II), but it is still unclear and controversial. The study aims to evaluate... (Review)
Review
Gestational weight gain (GWG) may be associated with delayed onset of lactogenesis II (DOL II), but it is still unclear and controversial. The study aims to evaluate the relationship between GWG and DOL II. A comprehensive search was performed in 10 electronic databases from inception to May 21, 2023, for studies that reported outcomes in breastfeeding. Data were extracted by two independent reviewers. A meta-analysis was conducted to calculate the pooled estimates of association using random-effect models with Review Manager (RevMan) software version 5.4. The primary outcome was the rate of DOL II. In this study, 248,515 women were included in 16 eligible articles. Women with excessive GWG have a higher risk of DOL II (odds ratio [OR] = 1.28; 95% confidence interval [CI]: 1.15-1.43). Specifically, prepregnancy overweight and obese women with GWG above recommendations (OR = 3.01, 95% CI: 1.38-6.57) and underweight women with excessive GWG before pregnancy have a higher risk of DOL II (OR = 3.32, 95% CI: 1.69-6.53). Nonetheless, there is no distinction between women with inadequate GWG and those with adequate GWG in DOL II(OR = 1.08, 95% CI: 0.88-1.33). In addition, the women whose GWG is above the recommendations also tend to stop exclusive breastfeeding 1 month postpartum (OR = 0.82, 95% CI: 0.80-0.85). Excessive GWG has a negative influence on the timing of the onset of lactogenesis and exclusive breastfeeding within 1 month postpartum.
PubMed: 38963776
DOI: 10.1089/bfm.2024.0032 -
Environmental Monitoring and Assessment Jul 2024The United Nations (UN) emphasizes the pivotal role of sustainable agriculture in addressing persistent starvation and working towards zero hunger by 2030 through global... (Review)
Review
The United Nations (UN) emphasizes the pivotal role of sustainable agriculture in addressing persistent starvation and working towards zero hunger by 2030 through global development. Intensive agricultural practices have adversely impacted soil quality, necessitating soil nutrient analysis for enhancing farm productivity and environmental sustainability. Researchers increasingly turn to Artificial Intelligence (AI) techniques to improve crop yield estimation and optimize soil nutrition management. This study reviews 155 papers published from 2014 to 2024, assessing the use of machine learning (ML) and deep learning (DL) in predicting soil nutrients. It highlights the potential of hyperspectral and multispectral sensors, which enable precise nutrient identification through spectral analysis across multiple bands. The study underscores the importance of feature selection techniques to improve model performance by eliminating redundant spectral bands with weak correlations to targeted nutrients. Additionally, the use of spectral indices, derived from mathematical ratios of spectral bands based on absorption spectra, is examined for its effectiveness in accurately predicting soil nutrient levels. By evaluating various performance measures and datasets related to soil nutrient prediction, this paper offers comprehensive insights into the applicability of AI techniques in optimizing soil nutrition management. The insights gained from this review can inform future research and policy decisions to achieve global development goals and promote environmental sustainability.
Topics: Soil; Machine Learning; Agriculture; Environmental Monitoring; Nutrients
PubMed: 38963427
DOI: 10.1007/s10661-024-12817-6 -
Annals of Cardiac Anaesthesia Jul 2024With the advancements in regional anesthesia and ultrasound techniques, the use of non-neuraxial blocks like the erector spinae plane block (ESPB) has been increasing in... (Meta-Analysis)
Meta-Analysis
With the advancements in regional anesthesia and ultrasound techniques, the use of non-neuraxial blocks like the erector spinae plane block (ESPB) has been increasing in cardiac surgeries with promising outcomes. A total of 3,264 articles were identified through a literature search. Intervention was defined as ESPB. Comparators were no regional technique performed or sham blocks. Four studies with a total of 226 patients were included. Postoperative opioid consumption was lower in the group that received ESPB than the group that did not (weighted mean difference [WMD]: -204.08; 95% CI: -239.98 to -168.19; P < 0.00001). Intraoperative opioid consumption did not differ between the two groups (WMD: -398.14; 95% CI: -812.17 to 15.98; P = 0.06). Pain scores at 0 hours were lower in the group that received ESPB than the group that did not (WMD: -1.27; 95% CI: -1.99 to -0.56; P = 0.0005). Pain scores did not differ between the two groups at 4-6 hours (WMD: -0.79; 95% CI: -1.70 to 0.13; P = 0.09) and 12 hours (WMD: -0.83; 95% CI: -1.82 to 0.16; P = 0.10). Duration of mechanical ventilation in minutes was lower in the group that received ESPB than the group that did not (WMD: -45.12; 95% CI: -68.82 to -21.43; P = 0.0002). Given the limited number of studies and the substantial heterogeneity of measured outcomes and interventions, further studies are required to assess the benefit of ESPB in midline sternotomies.
Topics: Humans; Nerve Block; Randomized Controlled Trials as Topic; Pain, Postoperative; Paraspinal Muscles; Analgesia; Treatment Outcome; Perioperative Care; Thoracotomy
PubMed: 38963353
DOI: 10.4103/aca.aca_134_23 -
The Cochrane Database of Systematic... Jul 2024An inguinal hernia occurs when part of the intestine protrudes through the abdominal muscles. In adults, this common condition is much more likely in men than in women.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
An inguinal hernia occurs when part of the intestine protrudes through the abdominal muscles. In adults, this common condition is much more likely in men than in women. Inguinal hernia can be monitored by 'watchful waiting', but if symptoms persist or worsen, surgery is usually required, which can be open or laparoscopic. Laparoscopic (keyhole) repair of inguinal hernias in adults is generally performed using either the transabdominal preperitoneal (TAPP) or the totally extraperitoneal (TEP) method. Both methods include the use of mesh placed in front of the peritoneal lining of the abdominal wall, but for the TAPP technique, the abdominal cavity needs to be entered to place the mesh, and for the TEP technique, the whole procedure is done on the outside of the peritoneal lining of the abdominall wall. Whether one method is superior to the other has not been established, and there is debate about their relative benefits and harms. An advantage of TEP is its avoidance of the abdominal cavity; the downside is that it requires a steeper learning curve for clinicians. TAPP is considered simpler and makes it possible to inspect the contralateral side, but TAPP may have a higher risk of visceral injury compared to TEP. This is an update of a Cochrane review first published in 2005.
OBJECTIVES
To compare the benefits and harms of laparoscopic TAPP technique versus laparoscopic TEP technique for inguinal hernia repair in adults.
SEARCH METHODS
On 25 October 2022, the authors searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, and Ovid MEDLINE(R); and Ovid Embase, for published randomised controlled trials. To identify studies in progress, we searched ClinicalTrials.gov and the WHO International Clinical Trial Registry Platform (ICTRP).
SELECTION CRITERIA
All prospective randomised, quasi-randomised, and cluster-randomised trials that compared the laparoscopic TAPP technique with the laparoscopic TEP technique for inguinal hernia repair in adults were eligible for inclusion. We included studies that involved a mix of different types of groin hernia if we could extract data for the inguinal hernias. Studies may have also included a group of participants receiving hernia repair by open surgery, but these groups were not included in our review.
DATA COLLECTION AND ANALYSIS
Both review authors independently evaluated trial eligibility, extracted data from included studies, and assessed the risk of bias in the included studies. The review's primary outcomes were serious adverse events, chronic pain (persisting for at least six months after surgery), and hernia recurrence. We also assessed a variety of secondary outcomes at perioperative, early postoperative, and late postoperative time points. We performed statistical analyses using the random-effects model, and expressed the results as odds ratios (ORs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, with their respective 95% confidence intervals (CIs). We used GRADE to assess the certainty of evidence for key outcomes as high, moderate, low or very low.
MAIN RESULTS
We included 23 studies in this review update, which randomised 1156 people to TAPP and 1110 people to TEP, all requiring repair of inguinal hernias. Study sample sizes varied from 40 to 316 participants. The vast majority of study participants were male. We judged most studies to be at 'high' or 'unclear' risk of bias. Our judgements of the certainty of the evidence were low or very low for all outcomes we assessed. There may be little to no difference between TAPP and TEP laparoscopic techniques for serious adverse events (0.4% versus 0.7%; OR 0.58, 95% CI 0.15 to 2.32, P = 0.45, I = 0%; 19 studies, 1735 participants; low certainty of evidence); and hernia recurrence (1.2% versus 1.1%; OR 1.14, 95% CI 0.49 to 2.62, P = 0.97, I = 0%; 17 studies, 1712 participants; low certainty of evidence). The evidence is very uncertain about the effects of TAPP versus TEP techniques on chronic pain (OR 0.62, 95% CI 0.20 to 1.97, P = 0.68, I = 0%; 6 studies, 860 participants; very low certainty of evidence). In terms of secondary outcomes, the evidence is very uncertain for TAPP versus TEP techniques for perioperative visceral and vascular injury (15 studies, 1523 participants; very low certainty of evidence), and for haematoma or seroma during the early (≤ 30 days) postoperative phase (OR 0.86, 95% CI 0.54 to 1.37, P = 0.3861, I = 0%; 15 studies, 1423 participants; very low certainty of evidence). TEP technique may carry a higher risk of conversion to another hernia repair method (either TAPP technique or open surgery) when compared to TAPP (2.5% versus 0.7%; OR 0.28, 95% CI 0.09 to 0.84, P = 0.02, I = 0%; 13 studies, 1178 participants; low certainty of evidence). Only two studies (474 participants) reported quality of life in the late (> 30 days) postoperative phase; overall, there was an improvement in quality of life from the pre- to post-operative assessment, but the evidence suggests little to no difference between the techniques (low certainty of evidence).
AUTHORS' CONCLUSIONS
This review update found that there may be little to no difference between the TAPP and TEP techniques for serious adverse events, hernia recurrence, or chronic pain (low- to very-low-certainty evidence). Decisions about which method to use will most likely reflect surgeon and patient preference until high-certainty evidence becomes available. There may be a higher risk of needing to convert from TEP to TAPP or open surgery when compared to the risk of needing to convert from TAPP to open surgery (low-certainty evidence). If surgeons opt for TEP as their standard laparoscopic method, they could consider having a strategy for how to handle the potential need for conversion. This might include proficiency in the TAPP approach or having informed the patient about the risk of conversion to open surgery. For surgeons or surgical departments, the choice of a laparoscopic technique should involve shared decision-making with patients and their families or carers. Future research could focus on patient-reported outcomes, such as quality of life.
Topics: Humans; Hernia, Inguinal; Laparoscopy; Randomized Controlled Trials as Topic; Surgical Mesh; Male; Adult; Female; Herniorrhaphy; Operative Time; Peritoneum
PubMed: 38963034
DOI: 10.1002/14651858.CD004703.pub3 -
Cancer Diagnosis & Prognosis 2024Hypomagnesemia is a common side effect of anti-epidermal growth factor receptor (EGFR) antibodies, which may lead to arrhythmia. However, there are no evidence-based... (Review)
Review
BACKGROUND/AIM
Hypomagnesemia is a common side effect of anti-epidermal growth factor receptor (EGFR) antibodies, which may lead to arrhythmia. However, there are no evidence-based guidelines for magnesium (Mg) supplementation in the management of hypomagnesemia in patients with anti-EGFR antibodies. Therefore, we performed a systematic review to address clinical questions regarding these cancer patients.
MATERIALS AND METHODS
Three electronic databases were searched for articles published until June 18, 2021. The main outcomes used were "anti-EGFR antibody" and "hypomagnesemia".
RESULTS
After screening 78 references in PubMed, Cochrane Library, and ICHUSHI-web databases, three studies were included in the review. One study revealed the effectiveness of Mg supplementation in the management of hypomagnesemia in patients receiving cetuximab. However, no studies have investigated whether correcting hypomagnesemia can lead to the suppression of arrhythmias as a clinical outcome.
CONCLUSION
Weak evidence suggests that Mg supplementation, as a preventive measure when developing hypomagnesemia following the initiation of anti-EGFR antibody therapy, may prevent the worsening of hypomagnesemia, and subsequently prevent associated arrhythmia occurrence.
PubMed: 38962544
DOI: 10.21873/cdp.10337 -
Frontiers in Neurology 2024Executive dysfunction is a core symptom of vascular cognitive impairment (VCI), which seriously affects patients' prognosis. This paper aims to investigate the...
OBJECTIVE
Executive dysfunction is a core symptom of vascular cognitive impairment (VCI), which seriously affects patients' prognosis. This paper aims to investigate the effectiveness of rTMS on executive function in VCI.
METHODS
The databases selected for this study included Pubmed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, China Science and Technology Journal Database (VIP), and China Biology Medicine Disc (CBM). The screening times were conducted from the time of library construction until August 23, 2023. The inclusion criteria for this meta-analysis were randomized controlled trials (RCTs) on rTMS for VCI, which include executive function scores. The primary metrics were executive subscale scores of the Cognitive Comprehensive Scale and total scores of the Executive Specificity Scale. The secondary metrics were subscale scores of the Executive Specificity Scale. The quality of each eligible study was assessed using the Cochrane Risk of Bias tool. Meta-analysis and bias analysis were performed using Stata (version 16.0) and RevMan (version 5.3).
RESULTS
A total of 20 high-quality clinical RCTs with 1,049 samples were included in this paper. The findings from the primary outcomes revealed that within the rTMS group, there were significantly higher scores observed for the executive sub-item on the cognitive composite scale (SMD = 0.93, 95% CI = 0.77-1.08, < 0.00001, = 14%) and the total score on the executive specific scale (SMD = 0.69, 95% CI = 0.44-0.94, < 0.00001, = 0%) compared to the control group. As for the secondary outcome measures, as shown by the Trail Making Test-A (time) (MD = -35.75, 95% CI = -68.37 to -3.12, = 0.03, = 55%), the Stroop-C card (time) (SMD = -0.46, 95% CI = -0.86 to -0.06, = 0.02, = 0%) and the Stroop-C card (correct number) (SMD = 0.49, 95% CI = 0.04-0.94, = 0.03, = 0%), the experimental group shorts time and enhances accuracy of executive task in comparison to the control group. Subgroup analysis of the main outcome demonstrated that intermittent theta burst stimulation (iTBS), higher frequency, lower intensity, longer duration, and combined comprehensive therapy exhibited superior efficacy.
CONCLUSION
rTMS is effective in the treatment of the executive function of VCI. The present study has some limitations, so multi-center, large-sample, objective indicators and parameters are needed to further explore in the future.https://www.crd.york.ac.uk/prospero/, CRD42023459669.
PubMed: 38962482
DOI: 10.3389/fneur.2024.1374395 -
Frontiers in Nutrition 2024Cumulative evidence has suggested that vitamin D deficiency is related with an increased susceptibility to various types of cancers. However, the association between...
BACKGROUND
Cumulative evidence has suggested that vitamin D deficiency is related with an increased susceptibility to various types of cancers. However, the association between vitamin D and thyroid cancer (TC) has remained to be unknown. Thus, there has been an urgent need for a meta-analysis to summarize existing evidence on vitamin D levels and the risk of TC.
OBJECTIVE
This meta-analysis aimed to figure out the association between vitamin D level and the risk of TC.
METHODS
A systematic search was performed for eligible articles on the association between vitamin D and TC based on PubMed, Embase, Web of Science, Cochrane, and ClinicalTrials.gov. Outcomes were the vitamin D level of cases with TC and the incidence of vitamin D deficiency in cases with TC comparing with the controls. The effect measures included standardized mean difference (SMD), ratio of means (RoM), and odds ratio (OR). A dose-response meta-analysis was performed to assess the correlation between vitamin D level and the risk of TC. Subgroup analyses and meta-regressions were conducted to explore the source of heterogeneity. And publication bias was evaluated through Begg's and Egger's tests.
RESULTS
Results of the meta-analysis revealed lower levels of vitamin D in TC cases comparing with those in control [SMD = -0.25, 95% CI: (-0.38, -0.12); RoM = 0.87, 95% CI: (0.81, 0.94)] and the levels of 1,25 (OH)D in cases with TC were also lower than controls [SMD = -0.49, 95% CI: (-0.80, -0.19); RoM = 0.90, 95% CI: (0.85, 0.96)]. And vitamin D deficiency was associated with the increased risk of TC [OR = 1.49, 95% CI: (1.23, 1.80)]. Additionally, results from the dose-response meta-analysis showed that there is a 6% increase in the risk of TC for each 10 ng/ml decrease in 25 (OH)D levels [OR = 0.94; 95% CI: (0.89, 0.99)].
CONCLUSIONS
Individuals with TC had lower levels of vitamin D compared to controls, and vitamin D deficiency was correlated with an increase risk of TC.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=504417, identifier: CRD42024504417.
PubMed: 38962442
DOI: 10.3389/fnut.2024.1423305 -
Frontiers in Psychology 2024In this PRISMA-compliant systematic review, we identify and synthesize the findings of research in which neuroimaging and assessments of achievement have been used to...
INTRODUCTION AND METHODS
In this PRISMA-compliant systematic review, we identify and synthesize the findings of research in which neuroimaging and assessments of achievement have been used to examine the relationships among aspects of developmental programming, neurodevelopment, and achievement in reading and mathematics.
RESULTS
Forty-seven studies met inclusion criteria. The majority examined the impact of prematurity ( = 32) and prenatal alcohol exposure ( = 13). Several prematurity studies reported a positive correlation between white-matter integrity of callosal fibers and executive functioning and/or achievement, and white matter properties were consistently associated with cognitive and academic performance in preterm and full-term children. Volumetric studies reported positive associations between academic and cognitive abilities and white and gray matter volume in regions such as the insula, putamen, and prefrontal lobes. Functional MRI studies demonstrated increased right-hemispheric language processing among preterm children. Altered activation of the frontoparietal network related to numerical abilities was also reported. Prenatal alcohol exposure studies reported alterations in white matter microstructure linked to deficits in cognitive functioning and academic achievement, including mathematics, reading, and vocabulary skills. Volumetric studies reported reductions in cerebral, cerebellar, and subcortical gray matter volumes associated with decreased scores on measures of executive functioning, attention, working memory, and academic performance. Functional MRI studies demonstrated broad, diffuse activation, reduced activation in canonical regions, and increased activation in non-canonical regions during numeric tasks.
DISCUSSION
A preponderance of studies linked prematurity and prenatal alcohol exposure to altered neurodevelopmental processes and suboptimal academic achievement. Limitations and recommendations for future research are discussed.
SYSTEMATIC REVIEW REGISTRATION
Identifier: DOI 10.17605/OSF.IO/ZAN67.
PubMed: 38962224
DOI: 10.3389/fpsyg.2024.1352241