The “Bank Finger” Principle in Hand Surgery—Retrospective Study vs. Systematic Review

Outcomes after mutilating hand injuries: review of the literature and recommendations for assessment

The aim of this review was to identify and synthesize the best available evidence to address two questions: i) what is the experience of smoking during pregnancy for Indigenous women? and ii) what are the smoking cessation needs of Indigenous women who smoke during pregnancy? Smoking during pregnancy not only affects pregnant women's general health but also causes such serious problems as pre-term delivery, low birth weight, and sudden infant death. Rates of smoking during pregnancy are particularly high among Indigenous women. Learning about Indigenous women's experiences of smoking during pregnancy and associated smoking cessation needs is important to providing informed health care to them. The participants of interest were Indigenous women who smoked during a current or past pregnancy. The phenomena of interest were the experiences of smoking during pregnancy for Indigenous women and the smoking cessation needs of Indigenous women during pregnancy. The context was any community worldwide where pregnant Indigenous women live. Studies considered for this review were those in which qualitative data were gathered and analysed on the phenomena of interest, including mixed methods research. A comprehensive search was conducted for published studies in academic databases (i.e. PubMed, CINAHL, PsycINFO, Embase, Sociological Abstracts, SocINDEX, and Web of Science), unpublished studies in sources of gray literature (i.e. ProQuest Dissertations and Theses, OAIster, LILACS, MedNar, Google, Google Scholar, OpenGrey and relevant websites), and any additional studies in reference lists. Language and date limiters were not applied. The searches included all studies globally and were carried out on October 31, 2016. Studies that met the inclusion criteria were assessed for methodological quality by two reviewers independently, using the criteria of the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Descriptive details of each study accepted for this review were extracted in accordance with the elements of the JBI Data Extraction Form for Qualitative Research. The research findings that were relevant to the phenomena of interest and had participant voice were extracted from each included study and synthesized using the JBI meta-aggregative approach. The synthesized findings were assigned confidence scores in accordance with the JBI ConQual approach. Thirteen studies were included in this review following careful consideration of the methodological quality of each study. The studies yielded a total of 116 research findings, which were grouped into 19 categories and then aggregated to form five synthesized findings. Confidence in the findings was determined to be low to very low (see ConQual Summary of Findings). There is a small body of research evidence on Indigenous women's experiences of smoking during pregnancy and their smoking cessation needs. Confidence in the synthesized findings is constrained due to methodological limitations in many of the primary studies included in this review, along with mixed credibility of the research findings from across primary studies.

BackgroundThe benefits of healthy eating are well known, yet adolescent diet is often poor. School based interventions offer a promising option to promote healthy eating, however, evidence is unclear.AimThis umbrella review synthesised the current evidence on school-based interventions for healthy eating in adolescents (10–19 years old).MethodsUsing Joanna Briggs Institute (JBI) umbrella review guidelines, a systematic search was conducted on 11 electronic databases (PubMed, CINHAL, EMBASE, Science Direct, PsycINFO, MEDLINE, Scopus, ERIC, Web of Science, Cochrane Register of Systemic Review and JBI Evidence Synthesis) to identify reviews published between January 2000 and December 2023. Methodological quality was assessed using JBI critical appraisal tool. A narrative synthesis was conducted informed by the World Health Organisation’s Health Promoting School (HPS) framework that categorises school-based interventions into three components i.e., health education, school environment changes, and family and community involvement.ResultsSeventeen reviews were identified (including 347 unique primary studies) that were published between 2008 and 2023. 87% of the reviews were based on interventions in high- income countries, limiting applicability to low- and middle-income countries. Fourteen reviews were rated as high, two as moderate, and one was rated as low methodological quality. Evidence from 71% of the reviews (n = 14 reviews, 13 = high methodological quality) found that multi-component interventions (i.e., interventions incorporating more than two components of the HPS framework) improved adolescents’ knowledge and behaviour concerning healthy eating. At the individual level, tech-driven healthy eating curricula effectively improved eating behaviours of adolescents. These individual-level interventions proved to be more effective and sustainable when supported by system-level changes, such as modifying school environments including increased availability of healthy foods and involving parents to promote healthy eating for adolescents. However, limited evidence from only three reviews suggests mixed feasibility for technology-based interventions and lower feasibility for multi-component interventions. The lack of information on stakeholder involvement in intervention design is another critical evidence gap.ConclusionSchool-based multi-component healthy eating interventions that combine individual-level interventions with system-level changes are effective in promoting healthy eating behaviours among adolescents. Future reviews should assess the effectiveness of participatory approaches in intervention design, feasibility and scale-up studies, and analysing evidence from low- and middle-income countries.

Mutilated hand injuries are a profound challenge to the plastic surgeon, and such injuries often lead to limb loss and severe functional impairment. Hyperbaric oxygen therapy (HBOT) appears to counteract tissue hypoxia and stimulate acute wound healing. This study was performed to evaluate the efficacy of HBOT as an adjunctive therapy in patients with a mutilated hand injury. Between January 2006 and December 2014, 45 patients with a mutilated hand injury were enrolled. After reconstruction or revascularisation, patients underwent 120 minutes of HBOT with oxygen at 2·5 atmospheres absolute while breathing 100% oxygen. Outcomes such as amputee survival and surgery-related complications were recorded. The patients were 38 men and 7 women with average age of 37·2 years (range 18-62). The mean defect area was 131·5 cm2 (range 40-300). Most patients experienced a pure crush injury (53%). The average number of operations from the initial debridement to the first reconstruction was 3·8 (range 1-6). A total of 33 patients (73%) underwent replantation during the initial reconstruction. For flap coverage, most patients received a free flap using an anterolateral thigh flap (18 patients) or local flap using an abdomen/groin flap (nine patients). The average time from the first reconstruction or revascularisation to the first HBOT was 6·5 hours (range 2-12). The average number of HBOT sessions was 9·1 (range 6-14 sessions). The survival rate of the replanted fingers was 81%, and the survival rate of the palms was 100%. Most complications in the initial reconstruction involved partial loss of an avulsed flap, and most complications in the chronic stage (≥3 months) involved scar contracture. When combined with delicate microsurgery, early intervention using adjunctive HBOT was effective in preserving partially viable tissue and restoring hand function in patients with a mutilated hand injury.

The objective of the review was to synthesize the best available qualitative evidence on the experiences and preferences of people with Parkinson's disease for physical activity, their perceived motivators and barriers to engagement, as well as their views on support mechanisms and behavior change interventions designed to sustain participation. National and international guidelines recommend regular physical activity to improve health and wellbeing and to prevent disease. Research on Parkinson's disease indicates that physical activity programs can be beneficial in addressing both physical symptoms and overall wellbeing. However, despite recommendations, sustained engagement in regular physical activity among people with Parkinson's disease is limited. To promote physical activity it is important to understand their perspectives on this topic. This review considered studies that included a qualitative evaluation of the experiences and views of people with Parkinson's disease regarding physical activity and interventions designed to sustain participation. The databases MEDLINE, Embase, CINAHL, AMED, Scopus and Web of Science, and unpublished studies in sources of grey literature (Google, OpenGrey, MedNar, Conference Paper Index, PQDT) were searched. Language limiters were restricted to English and dates ranged from the inception of the database to June 30, 2017. Two reviewers assessed studies that met the inclusion criteria independently, using the criteria of the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. One reviewer completed data extraction using the standardized qualitative data extraction tool. This was checked for accuracy by a second reviewer. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings. Nineteen studies were included in this review following assessment of the methodological quality of each study. Two studies were excluded after the methodological review as the findings were not supported by illustrations of the participant voice. Subsequently, 105 findings were extracted and aggregated into 20 categories and eight synthesized findings. Methodological quality was variable and overall confidence in the findings was determined to be low. This review revealed that people with Parkinson's disease viewed physical activity as an enjoyable and positive experience, which aided with control of their symptoms and enhanced their wellbeing and quality of life. Aligned with evidence from older adults and those with long-term conditions, this review identified disease presentation, intrapersonal characteristics, program design, external support and the social and physical environment as contributory factors which influenced the ability of people with Parkinson's disease to sustain engagement in physical activity. The unique contribution and weighting of these factors will affect an individual's participation in physical activity. This review provides important insights into the challenges of undertaking physical activity while living with a progressive and fluctuating disease. These qualitative findings give healthcare providers an insight into the views and experiences of people with Parkinson's disease and are useful, alongside quantitative evidence of effectiveness, for the design of physical activity programs that are meaningful for this population. However, a limitation of this review is that it does not address the views and experiences of people with Parkinson's disease who are inactive.

BackgroundExosomes show promise as biomarkers for essential hypertension (EH) progression and complications. However, existing studies on dysregulation of exosomal biomarkers in hypertension lack consistency. Thus, we conducted a comprehensive systematic review to synthesize evidence on exosomal biomarkers associated with EH.MethodsWe performed an exhaustive search across PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, and Chinese Clinical Trial Registry. Our search encompassed all available Chinese and English records from their inception through August 14th, 2025, without any restrictions on study design. The primary outcome focused on exosomal microRNA (miRNA) alterations, with secondary analyses of other cargo types (e.g., proteins). We employed the Joanna Briggs Institute (JBI) critical appraisal tool and the risk of bias in non-randomized studies of interventions (ROBINS-I) tool to assess the risk of bias. Due to the limitations of the data in the included studies, we conducted a qualitative narrative synthesis to summarize key study characteristics and synthesize their principal findings. The protocol was prospectively registered on PROSPERO (CRD42023470885).ResultsThe qualitative analysis included 11 identified studies, which revealed moderate-to-high methodological quality (JBI: 6 moderate, 4 high), with one study exhibiting a moderate risk of bias (ROBINS-I). This systematic review revealed that exosomal biomarkers in blood and urine had diagnostic potential for hypertension and its complications. Evidence suggested that exosomal biomarkers were associated with hypertensive vascular dysfunction (e.g., increased miR-320d/423-5p) and may provide a molecular basis for precise typing of hypertension (platelet-derived extracellular vesicles). Notably, exosomal biomarkers may serve as indicators of target organ damage, reflecting early renal injury (decreased miR-26a-5p) and cognitive dysfunction (decreased miR-330-3p) in hypertension.ConclusionsThis systematic review highlights the value of blood and urine exosomal biomarkers in the early diagnosis, precise typing, and monitoring of target organ damage in hypertension and its complications. Future studies should systematically compare exosomal biomarkers with conventional markers using standardized protocols. Methodological improvements should focus on expanding larger sample sizes, enhancing reporting completeness and transparency, and standardizing data-sharing practices.

Predicting Functional Recovery and Return to Work After Mutilating Hand Injuries: Usefulness of Campbell's Hand Injury Severity Score

The inferior alveolar nerve (IAN) is an essential branch of the trigeminal nerve in the mandible. It provides the nerve supply to the lower lip, chin, and teeth. Despite various nerve repair strategies having been explored to enhance functional recovery, the optimal approach remains unclear. This review aims to identify evidence-based surgical repair techniques for managing iatrogenic IAN injuries. The systematic review inclusion criteria were restricted to English-language full-text articles reporting clinical outcomes of nerve repair interventions in iatrogenic IAN injury. Comprehensive literature searches were performed in PubMed, Embase, and Cochrane Library using relevant keywords and Boolean operators from 2000 to 2025. The review was conducted according to PRISMA guidelines. The methodological quality of included studies was appraised using the Joanna Briggs Institute (JBI) critical appraisal tools for randomized controlled trials (RCTs) and cohort studies.The systematic review examined outcomes of nerve decompression, neurorrhaphy, and grafting surgeries, with populations ranging from six to 167 patients and average ages between 36 and 56 years, predominantly female. Common causes of inferior alveolar nerve (IAN) injury included third molar extractions (37.6% of cases), dental implant placement, endodontic treatments, and orthognathic surgeries, while non-surgical causes like trauma, delayed intervention, anatomical variations, and patient-related factors (e.g., age) also influenced outcomes. Surgical techniques such as decompression, neurolysis, autogenous nerve grafts (e.g., sural nerve), and neurorrhaphy were compared, with decompression and neurolysis showing 85% and 75% success rates, respectively, for minor injuries. In comparison, grafts and neurorrhaphy achieved 87.3% and 88.9% success rates for severe cases. Recovery times and outcomes were better with early intervention (<12 months), and factors like age, surgical precision, and technique (e.g., piezosurgery reducing thermal damage) significantly impacted results. Complications included donor site morbidity (e.g., temporary numbness) and incomplete recovery in delayed cases, underscoring the need for timely, skilled intervention. The review highlighted that early surgical intervention is a key determinant in achieving optimal results for IAN injury treatment. Results indicated that the selection of the surgical nerve repair strategy depends upon the patient factors, type of injury, and severity. Moreover, when surgical strategies are performed within two months of the incident, this greatly improves the chances of regaining functional sensory recovery in the affected area. The highest success rate was found with direct neurorrhaphy and sural nerve grafting among a variety of surgical techniques, most noticeable in clean injuries. The decompression and neurolysis techniques showed modest effectiveness, although they worked better in a few chronic compression cases. New approaches like using piezosurgery and computers to help with surgical navigation improve safety and lessen the injury caused by surgery. Nevertheless, nerve grafting usually leads to some short-term and easy-to-handle donor site morbidity. The lack of standardized outcome reporting and direct comparative randomized controlled trials with homogenous assessment tools limits the generalizability of the findings and recommends further validation.

Impact of masticatory training on masticatory function: A systematic review and meta-analysis.

Review Questions/Objective The overall aim of this comprehensive systematic review is to synthesise the best available evidence on the experience of lateral/horizontal violence in the profession of nursing and the effectiveness of programs/strategies meant to decrease its prevalence or mitigate its negative effects. Specifically, this review will seek to answer the following questions: •What is the experience of being a licensed nurse who is a victim of lateral/horizontal violence? •What is the experience of being a student nurse who is a victim of lateral/horizontal violence? •What is the impact of experiencing lateral/horizontal violence on job retention and job satisfaction? •What are the most effective interventions/strategies for decreasing the prevalence or mitigating the negative effects of lateral/horizontal violence on licensed nurses? Inclusion Criteria Types of Participants This review will consider studies with a focus on licensed nurses and student nurses. For purposes of this review ‘licensed nurse’ refers to a nurse who holds a license to practice nursing at any level. Due to the ambiguity of nomenclature, different titles for licensed nurse will be considered, including but not limited to registered nurse, practical nurse, vocational nurse.) Types of Interventions/Phenomena of Interest The qualitative component of this review will consider as phenomena of interest the actual experience of horizontal/lateral violence by licensed nurses and student nurses. The quantitative component of this review will examine interventions/strategies meant to decrease the prevalence or mitigate the effects of lateral/horizontal violence on licensed or student nurses. Some examples of programs or strategies reported in the literature are intense education programs, cognitive rehearsal strategies, zero tolerance policies and workshops. Context This review will consider research on the experience of lateral/horizontal violence in the profession of nursing and the efficacy/effectiveness of programs/strategies that are designed to decrease its prevalence or mitigate its negative effects in any setting where licensed or student nurses practise. Types of Outcomes The qualitative component of this review will include experiential accounts of being a nurse or student nurse who has experienced lateral/horizontal violence. The quantitative component of this review will consider studies that report outcomes such as but not limited to: •types and intensity/severity of effects of lateral/horizontal violence on licensed or student nurses •number of lateral/horizontal violence episodes/ prevalence of lateral/horizontal violence. •job satisfaction •job retention.

IntroductionThe number of patients with advanced cancer is rapidly increasing, and the disease burden among those with low socioeconomic status (SES) has accordingly become a global concern. Low SES can...

IntroductionRacialized population groups have worse health outcomes across the world compared with non-racialized populations. Evidence suggests that collecting race-based data should be done to mitigate racism as a barrier to...

IntroductionLong-term care needs for people with dementia are predicted to increase due to increased life expectancy and dementia diagnoses. Most published meta- syntheses of dementia care focus on hospitals or...

Immune-mediated necrotizing myopathy (IMNM) is a rare, antibody-defined subset of idiopathic inflammatory myopathies characterized by rapidly progressive proximal muscle weakness, markedly elevated creatine kinase (CK) levels, and myofiber necrosis with minimal lymphocytic infiltration. Two major autoantibody subtypes-anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) and anti-signal recognition particle (anti-SRP)-define distinct clinical phenotypes, pathophysiologic mechanisms, and treatment responses. Despite growing recognition, optimal management strategies remain uncertain. Following PRISMA 2020 and MOOSE guidelines, PubMed, Scopus, Web of Science, and Embase were systematically searched for studies published between January 2011 and May 2025 using terms related to “immune-mediated necrotizing myopathy,” “anti-HMGCR,” and “anti-SRP”. Eligible publications included biopsy-confirmed IMNM cases with antibody documentation and treatment or outcome data. Data extraction encompassed clinical features, immunopathology, therapeutic interventions, and relapse rates. Methodological quality was evaluated using the Joanna Briggs Institute (JBI) Checklist, NIH Quality Assessment Tool, Newcastle-Ottawa Scale (NOS), and ROBINS-I, depending on study design. Eighty-eight studies (n ≈ 230 patients) met the inclusion criteria. Anti-HMGCR IMNM typically affected middle-aged adults and was frequently associated with statin exposure, while anti-SRP IMNM presented at younger ages with more severe and treatment-refractory disease. Corticosteroids and IVIG were the most commonly used first-line agents, with additional benefit from steroid-sparing immunosuppressants (mycophenolate, azathioprine, methotrexate). Rituximab and other B-cell-targeted biologics achieved remission in approximately 60-70% of refractory cases, and emerging complement or FcRn-directed therapies showed early promise. Relapse occurred in 25-35% of cases, most often after tapering corticosteroids or immunosuppressants. Overall methodological quality was moderate to high, with 82% of studies meeting ≥75% of appraisal criteria across risk-of-bias domains. IMNM demonstrates antibody-specific differences in clinical course, therapeutic response, and prognosis. Early, aggressive, and combination immunotherapy improves outcomes, while novel biologic agents may benefit refractory disease. The overall certainty of evidence is moderate, supporting current management strategies yet underscoring the need for standardized diagnostic criteria and prospective multicenter studies to refine treatment algorithms and identify biomarkers of durable remission.

The effect of impaction on the mineralisation of third molars and forensic age estimation: A systematic review and meta-analysis.