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Journal of Pediatric Psychology Jan 2024Children and young people with visible differences can experience psychosocial difficulties, such as anxiety and teasing by others. Interventions targeting difficulties...
Psychosocial Interventions for Children and Young People With Visible Differences Resulting From Appearance-Altering Conditions, Injury, or Treatment Effects: An Updated Systematic Review.
OBJECTIVE
Children and young people with visible differences can experience psychosocial difficulties, such as anxiety and teasing by others. Interventions targeting difficulties have previously been reviewed by Jenkinson et al. This review aimed to identify and critically assess recent studies evaluating the effectiveness of psychosocial interventions for children and young people with visible differences on psychosocial wellbeing, self-esteem, and social experiences and compare the findings with Jenkinson et al. using a replacement review process.
METHODS
Inclusion criteria are as follows: studies with participants aged 0-18 years with visible differences; investigating a psychosocial intervention; including comparison with an alternative intervention, control group, or pre- and post-intervention; and including a quantitative measure assessed pre- and post-intervention. Exclusion criteria are as follows: participants with body dysmorphic disorder or appearance changes due to eating disorders or obesity and studies not written in English. MEDLINE, AMED, and PsycInfo were searched and grey literature was included. Results were reviewed against eligibility criteria, data were extracted, and studies were evaluated using the Cochrane Risk of Bias 2 tool.
RESULTS
Using Jenkinson et al. as one source of studies, 24 studies were included evaluating a range of interventions such as social interaction skills training, residential social camps, and cognitive behavioral therapy. Risk of bias was high in 20 studies and of some concern in four studies.
CONCLUSION
There is some evidence of the effectiveness of hypnotherapy, a relaxation response resiliency program, integrative body-mind-spirit group, and therapeutic patient education, but more rigorous research is needed to confirm their impact on psychosocial outcomes.
Topics: Child; Humans; Adolescent; Psychosocial Intervention; Cognitive Behavioral Therapy; Anxiety; Anxiety Disorders; Self Concept
PubMed: 37944011
DOI: 10.1093/jpepsy/jsad080 -
BJS Open Nov 2023Measurement of surgical quality at a population level is challenging. Composite quality measures derived from administrative and clinical information systems could...
BACKGROUND
Measurement of surgical quality at a population level is challenging. Composite quality measures derived from administrative and clinical information systems could support system-wide surgical quality improvement by providing a simple metric that can be evaluated over time. The aim of this systematic review was to identify published studies of composite measures used to assess the overall quality of abdominal surgical services at a hospital or population level.
METHODS
A search was conducted in PubMed and MEDLINE for references describing measurement instruments evaluating the overall quality of abdominal surgery. Instruments combining multiple process and quality indicators into a single composite quality score were included. The identified instruments were described in terms of transparency, justification, handling of missing data, case-mix adjustment, scale branding and choice of weight and uncertainty to assess their relative strengths and weaknesses (PROSPERO registration: CRD42022345074).
RESULTS
Of 5234 manuscripts screened, 13 were included. Ten unique composite quality measures were identified, mostly developed within the past decade. Outcome measures such as mortality rate (40 per cent), length of stay (40 per cent), complication rate (60 per cent) and morbidity rate (70 per cent) were consistently included. A major challenge for all instruments is the reliance of valid administrative data and the challenges of assigning appropriate weights to the underlying instrument components. A conceptual framework for composite measures of surgical quality was developed.
CONCLUSION
None of the composite quality measures identified demonstrated marked superiority over others. The degree to which administrative and clinical data influences each composite measure differs in important ways. There is a need for further testing and development of these measures.
Topics: Humans; Quality Indicators, Health Care; Hospitals; Risk Adjustment; Outcome Assessment, Health Care
PubMed: 37931232
DOI: 10.1093/bjsopen/zrad082 -
Journal of Neuroengineering and... Nov 2023The prosthetic socket is a key component that influences prosthesis satisfaction, with a poorly fitting prosthetic socket linked to prosthesis abandonment and reduced... (Review)
Review
BACKGROUND
The prosthetic socket is a key component that influences prosthesis satisfaction, with a poorly fitting prosthetic socket linked to prosthesis abandonment and reduced community participation. This paper reviews adjustable socket designs, as they have the potential to improve prosthetic fit and comfort through accommodating residual limb volume fluctuations and alleviating undue socket pressure.
METHODS
Systematic literature and patent searches were conducted across multiple databases to identify articles and patents that discussed adjustable prosthetic sockets. The patents were used to find companies, organisations, and institutions who currently sell adjustable sockets or who are developing devices.
RESULTS
50 literature articles and 63 patents were identified for inclusion, representing 35 different designs used in literature and 16 commercially available products. Adjustable sockets are becoming more prevalent with 73% of publications (literature, patents, and news) occurring within the last ten years. Two key design characteristics were identified: principle of adjustability (inflatable bladders, moveable panels, circumferential adjustment, variable length), and surface form (conformable, rigid multi-DOF, and rigid single DOF). Inflatable bladders contributed to 40% of literature used designs with only one identified commercially available design (n = 16) using this approach. Whereas circumferential adjustment designs covered 75% of identified industry designs compared to only 36% of literature devices. Clinical studies were generally small in size and only 17.6% of them assessed a commercially available socket.
DISCUSSION
There are clear differences in the design focus taken by industry and researchers, with justification for choice of design and range of adjustment often being unclear. Whilst comfort is often reported as improved with an adjustable socket, the rationale behind this is not often discussed, and small study sizes reduce the outcome viability. Many adjustable sockets lack appropriate safety features to limit over or under tightening, which may present a risk of tissue damage or provide inadequate coupling, affecting function and satisfaction. Furthermore, the relationship between design and comfort or function are rarely investigated and remain a significant gap in the literature. Finally, this review highlights the need for improved collaboration between academia and industry, with a strong disconnect observed between commercial devices and published research studies.
Topics: Humans; Prosthesis Design; Research Design; Amputation Stumps; Artificial Limbs; Extremities
PubMed: 37926807
DOI: 10.1186/s12984-023-01270-0 -
Clinical Lymphoma, Myeloma & Leukemia Feb 2024Multiple myeloma (MM) accounts for 10% of hematologic cancers in the U.S.; however, incidence and mortality occur disproportionately between racial groups in real-world...
Multiple myeloma (MM) accounts for 10% of hematologic cancers in the U.S.; however, incidence and mortality occur disproportionately between racial groups in real-world settings. Our study's objective was to systematically characterize the disparities in overall survival (OS) among Black and White patients with MM in the US using real-world evidence studies. A systematic literature review was undertaken by searching Embase and MEDLINE for observational studies conducted in the US, published between January 1, 2015 and October 25, 2021, and reporting OS for Black and White patients with MM. Records were reviewed by 2 independent researchers. OS data were extracted as hazard ratios (HR), median survival, or %, with methods of adjustment, as reported. Evidence quality was assessed by data source, population, and variables for which HRs for risk of death were adjusted. We included 33 US studies comprising 410,086 patients (21.5% Black; 78.5% White) with MM. Receipt of treatment varied; however, most studies reported that patients either underwent stem cell transplant and/or received systemic therapy. HRs from 9 studies were considered "high quality" by comparing nationally representative, generalizable cohorts and adjusting for key prognostic, treatment, and/or socioeconomic factors. After adjustment, these data suggested that Black patients exhibit similar or superior survival outcomes compared with their White counterparts. When data are adjusted for important confounders, Black patients exhibit better or equal survival to White patients, indicating that similarities in patient populations and equal access to treatment can bridge the disparity in patient outcomes between races.
Topics: Humans; Healthcare Disparities; Multiple Myeloma; Proportional Hazards Models; Racial Groups; Black or African American; White; Survival Rate
PubMed: 37923653
DOI: 10.1016/j.clml.2023.09.009 -
Hormone and Metabolic Research =... Dec 2023Previous studies showed conflicting results regarding the association between metabolic syndrome (MetS) and risk of lung cancer. We performed a systemic review and... (Meta-Analysis)
Meta-Analysis
Previous studies showed conflicting results regarding the association between metabolic syndrome (MetS) and risk of lung cancer. We performed a systemic review and meta-analysis to determine the relationship between MetS and lung cancer incidence and mortality in adults. Longitudinal follow-up studies were identified by search of Medline, Embase, Cochrane Library, and Web of Science. By incorporating potential heterogeneity into the model, a randomized-effects model was selected to pool the results. Fourteen observational studies were included. Pooled results showed that MetS was associated with a higher risk of lung cancer incidence [risk ratio (RR): 1.15, 95% confidence interval (CI): 1.05 to 1.26, p=0.002; I=89%). Subgroup analysis suggested that the association was not significantly affected by study country, design, sex of the participants, adjustment of smoking, or different study quality scores (p for subgroup difference all>0.05). The association was predominantly contributed by studies with MetS defined by the National Cholesterol Education Program Adult Treatment Panel-III rather than those with MetS defined by the International Diabetes Foundation criteria, and the association seemed to be stronger in studies with follow-up within 6 years than those over 6 years (p for subgroup difference=0.03 and 0.04, respectively). In addition, pooled results also showed that MetS was associated with a higher risk of lung cancer mortality (RR: 1.46, 95% CI: 1.19 to 1.79, p <0.001; I=0%). In conclusion, in adult population, MetS may be a risk factor of lung cancer incidence and mortality.
Topics: Adult; Humans; Metabolic Syndrome; Lung Neoplasms; Risk Factors; Incidence; Odds Ratio
PubMed: 37918822
DOI: 10.1055/a-2179-0809 -
BMC Sports Science, Medicine &... Oct 2023To compare the effect of low-load blood flow restricted resistance training (BFR-RT) versus high-load resistance training (HL-RT) on muscle strength, muscle mass,...
OBJECTIVE
To compare the effect of low-load blood flow restricted resistance training (BFR-RT) versus high-load resistance training (HL-RT) on muscle strength, muscle mass, physical function, patient-reported outcomes, and adherence to training in clinical musculoskeletal populations.
DATA SOURCES
Web of Science, Cochrane Central, Medline, Embase, SportDiscus was searched on the 30 May 2022.
REVIEW METHODS
This study was conducted as a systematic review and meta-analysis. Randomized Controlled Trials (RCTs) were included if they (i) included patients, (ii) comprised of a BFR-RT intervention protocol and a group who performed HL-RT (≥ 70%1RM) for at least eight exercise sessions, and (iii) involved at least 1 exercise that targeted the lower limbs. The Cochrane Risk of Bias tool was used to evaluate the risk of bias. The meta-analyses were performed using a random effects model with an adjustment to the confidence interval.
RESULTS
Seven RCTs comprising 303 participants (BFR-RT: n = 151; HL-RT: n = 152) were identified. HL-RT and BFR-RT showed similar gains in dynamic (1-10RM) knee extensor strength and leg press strength, quadriceps cross sectional area, sit-to-stand performance, and patient reported pain and function. There was a moderate effect favoring BFR-RT for increasing maximal isometric knee extensor strength. The grading of certainty in evidence was low-to-very low for all outcome variables.
CONCLUSION
This systematic review and meta-analysis extends our current knowledge about BFR-RT and HL-RT as equally effective exercise methods for inducing gains in maximal muscle strength in healthy populations, by now also comprising patients suffering from various clinical musculoskeletal conditions. The certainty in the estimates was low-to-very low, prompting the inclusion of future higher-quality trials.
TRIAL REGISTRATION
PROSPERO ID (CRD42022337173). Registered June 18th 2022.
PubMed: 37880727
DOI: 10.1186/s13102-023-00750-z -
Frontiers in Pediatrics 2023Mortality rates in infancy and childhood are lower in females than males. However, for children admitted to Paediatric Intensive Care Units (PICU), mortality has been... (Review)
Review
INTRODUCTION
Mortality rates in infancy and childhood are lower in females than males. However, for children admitted to Paediatric Intensive Care Units (PICU), mortality has been reported to be lower in males, although males have higher admission rates. This female mortality excess for the subgroup of children admitted in intensive care is not well understood. To address this, we carried out a systematic literature review to summarise the available evidence. Our review studies the differences in mortality between males and females aged 0 to <18 years, while in a PICU, to examine whether there was a clear difference (in either direction) in PICU mortality between the two sexes, and, if present, to describe the magnitude and direction of this difference.
METHODS
Any studies that directly or indirectly reported the rates of mortality in children admitted to intensive care by sex were eligible for inclusion. The search strings were based on terms related to the population (those admitted into a paediatric intensive care unit), the exposure (sex), and the outcome (mortality). We used the search databases MEDLINE, Embase, and Web of Science as these cover relevant clinical publications. We assessed the reliability of included studies using a modified version of the risk of bias in observational studies of exposures (ROBINS-E) tool. We considered estimating a pooled effect if there were at least three studies with similar populations, periods of follow-up while in PICU, and adjustment variables.
RESULTS
We identified 124 studies of which 114 reported counts of deaths by males and females which gave a population of 278,274 children for analysis, involving 121,800 (44%) females and 156,474 males (56%). The number of deaths and mortality rate for females were 5,614 (4.61%), and for males 6,828 (4.36%). In the pooled analysis, the odds ratio of female to male mortality was 1.06 [1.01 to 1.11] for the fixed effect model, and 1.10 [1.00 to 1.21] for the random effects model.
DISCUSSION
Overall, males have a higher admission rate to PCU, and potentially lower overall mortality in PICU than females.
SYSTEMATIC REVIEW REGISTRATION
www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=203009, identifier (CRD42020203009).
PubMed: 37876523
DOI: 10.3389/fped.2023.1225684 -
Cureus Sep 2023Lung cancer is the leading cause of cancer deaths worldwide, with the majority consisting of non-small cell lung cancer (NSCLC). Genetic mutations present an opportunity... (Review)
Review
Lung cancer is the leading cause of cancer deaths worldwide, with the majority consisting of non-small cell lung cancer (NSCLC). Genetic mutations present an opportunity for targeted therapy, in addition to current mainstay treatments such as chemotherapy and radiotherapy. Overall, 5% of NSCLCs have an anaplastic lymphoma kinase (ALK) mutation, often prevalent in a younger population. Crizotinib is an ALK inhibitor that was approved to treat ALK-mutated advanced NSCLC. While common side effects such as nausea, fatigue, and diarrhea are mostly well tolerated, adverse side effects can lead to treatment discontinuation or adjustment or can be fatal. This systematic review used articles searched on Google Scholar and PubMed which were assessed using the Cochrane risk-of-bias tool and Newcastle-Ottawa Scale. This yielded nine papers consisting of randomized controlled trials and cohort studies. Side effects resulting in cessation of treatment or dose reduction included liver dysfunction, nausea, neutropenia, and QT prolongation. This review showed that crizotinib has a better side effect profile than chemotherapy in ALK-positive NSCLC, even though toxicities leading to treatment withdrawal are present. Adverse effects were tackled by dose reduction, temporary withdrawal from treatment, and close monitoring.
PubMed: 37868485
DOI: 10.7759/cureus.45517 -
Translational Cancer Research Sep 2023Radiotherapy is a common treatment for nasopharyngeal carcinoma (NPC) but can cause radiation-induced temporal lobe injury (RTLI), resulting in irreversible damage....
BACKGROUND
Radiotherapy is a common treatment for nasopharyngeal carcinoma (NPC) but can cause radiation-induced temporal lobe injury (RTLI), resulting in irreversible damage. Predicting RTLI at the early stage may help with that issue by personalized adjustment of radiation dose based on the predicted risk. Machine learning (ML) models have recently been used to predict RTLI but their predictive accuracy remains unclear because the reported concordance index (C-index) varied widely from around 0.31 to 0.97. Therefore, a meta-analysis was needed.
METHODS
The PubMed, Web of Science, Embase, and Cochrane Library databases were searched from inception to November 2022. Studies that fully develop one or more ML risk models of RTLI after radiotherapy for NPC were included. The Prediction model Risk Of Bias Assessment Tool (PROBAST) was used to assess the risk of bias in the included research. The primary outcome of this review was the C-index, specificity (Spe), and sensitivity (Sen).
RESULTS
The meta-analysis included 14 studies with 15,573 NPC patients reporting a total of 72 prediction models. Overall, 94.44% of models were found to have a high risk of bias. Radiomics was included in 57 models, dosimetric predictors in 28, and clinical data in 27. The pooled C-index for ML models predicting RTLI was 0.77 [95% confidence interval (CI): 0.75-0.79] in the training set and 0.78 (95% CI: 0.75-0.81) in the validation set. The pooled Sen was 0.75 (95% CI: 0.69-0.80) in the training set and 0.70 (95% CI: 0.66-0.73) in the validation set and the pooled Spe was 0.78 (95% CI: 0.73-0.82) in the training set and 0.79 (95% CI: 0.75-0.82) in the validation set. Models with radiomics and clinical data achieved the most excellent discriminative performance, with a pooled C-index of 0.895.
CONCLUSIONS
ML models can accurately predict RTLI at an early stage, allowing for timely interventions to prevent further damage. The kind of ML methods and the selection of predictors may influence the predictive accuracy.
PubMed: 37859745
DOI: 10.21037/tcr-23-859 -
Frontiers in Immunology 2023Several studies have investigated the impact of circulating complement-activating anti-human leukocyte antigen donor-specific antibodies (anti-HLA DSAs) on organ... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Several studies have investigated the impact of circulating complement-activating anti-human leukocyte antigen donor-specific antibodies (anti-HLA DSAs) on organ transplant outcomes. However, a critical appraisal of these studies and a demonstration of the prognostic value of complement-activating status over anti-HLA DSA mean fluorescence intensity (MFI) level are lacking.
METHODS
We conducted a systematic review, meta-analysis and critical appraisal evaluating the role of complement-activating anti-HLA DSAs on allograft outcomes in different solid organ transplants. We included studies through Medline, Cochrane, Scopus, and Embase since inception of databases till May 05, 2023. We evaluated allograft loss as the primary outcome, and allograft rejection as the secondary outcome. We used the Newcastle-Ottawa Scale and funnel plots to assess risk of bias and used bias adjustment methods when appropriate. We performed multiple subgroup analyses to account for sources of heterogeneity and studied the added value of complement assays over anti-HLA DSA MFI level.
RESULTS
In total, 52 studies were included in the final meta-analysis (11,035 patients). Complement-activating anti-HLA DSAs were associated with an increased risk of allograft loss (HR 2.77; 95% CI 2.33-3.29, p<0.001; I²=46.2%), and allograft rejection (HR 4.98; 95% CI 2.96-8.36, p<0.01; I²=70.9%). These results remained significant after adjustment for potential sources of bias and across multiple subgroup analyses. After adjusting on pan-IgG anti-HLA DSA defined by the MFI levels, complement-activating anti-HLA DSAs were significantly and independently associated with an increased risk of allograft loss.
DISCUSSION
We demonstrated in this systematic review, meta-analysis and critical appraisal the significant deleterious impact and the independent prognostic value of circulating complement-activating anti-HLA DSAs on solid organ transplant risk of allograft loss and rejection.
Topics: Humans; Graft Rejection; Organ Transplantation; Complement System Proteins; Transplantation, Homologous; HLA Antigens
PubMed: 37849755
DOI: 10.3389/fimmu.2023.1265796