Collaboration Risk Research Articles

Intranasal midazolam for procedural distress in children in the emergency department: a systematic review and meta-analysis.

Intranasal (IN) midazolam is the most common anxiolytic for children in the emergency department (ED), but evidence of benefit is conflicting. We synthesized the evidence on IN midazolam for procedural distress in children undergoing ED painful procedures. We included trials involving painful ED procedures in children 0-18years involving IN midazolam. Primary outcome was procedural distress. We summarized results using Tricco et al.'s classification of "neutral" (p ≥ 0.05), "favorable," and "unfavorable" (p < 0.05), supporting IN midazolam or comparator, respectively, or "indeterminate" (unable to judge). Where possible, we pooled results using meta-analysis.Methodologic quality of evidence was evaluated using Cochrane Collaboration's risk of bias tool and GRADE system. We included 41 trials (n = 2973 participants). Thirty trials involved intravenous insertion. IN midazolam was superior to placebo (RR = 7.2; 95% CI: 3.43, 15.25; 3 trials; I2 = 0%). However, 56-90% of the IN midazolam group resisted the procedure. Focusing on the three trials that used validated measures, IN midazolam was "neutral" versus IN ketamine and either "neutral" or "unfavorable" versus IN dexmedetomidine. There was no difference in the proportion of children with a satisfactory distress score between IN midazolam and oral midazolam (RR = 1.1; 95% CI: 0.74, 1.73; 2 trials; I2 = 53%), IN ketamine (RR = 1.1; 95% CI: 0.91, 1.25; 6 trials; I2 = 0%), or IN dexmedetomidine (RR = 0.4; 95% CI: 0.17, 1.05; 3 trials; I2 = 84%). Ten trials involved laceration repair. IN midazolam was "favorable" versus placebo; however, both groups scored in the anxious range. There was no difference in distress between IN midazolam and oral midazolam (SMD = 0.01; 95% CI:-0.32, 0.34; 2 trials; I2 = 0%) (Fig.3E) [64,65]. Using validated instruments, IN midazolam was "unfavorable" versus IN dexmedetomidine but "favorable" versus oral diazepam and placebo. There is limited methodologically rigorous evidence that IN midazolam is better than placebo for IV insertion and laceration repair. At the doses studied, preliminary evidence suggests that IN dexmedetomidine may be superior to IN midazolam for both IV insertion and laceration repair.

Methodological quality of clinical research in endodontics: A cross-sectional comparison between open access and traditional subscription-based journals

Abstract Introduction: Open access (OA) publishing provides the benefits of increased visibility, accessibility, and impact of research findings. Despite the rapidly growing number of OA journals in dentistry, there are rising concerns about their quality. Our aim is to evaluate the methodological quality of clinical endodontic studies published in OA journals and to compare them to traditional subscription (TS) journals from January 2010 to December 2022. Materials and Methods: Clinical endodontic studies published in four journals, two from OA and two from TS categories were included in this review. Methodological quality was assessed using the Cochrane Collaboration risk of bias tool for randomized trials and the methodological index for nonrandomized studies instrument for nonrandomized studies. Data were analyzed with SPSS, utilizing independent samples t-test and one-way analysis of variance (ANOVA) for statistical comparisons. Results: A total of 80 articles were included, 40 from each OA and TS journals. The majority of research articles originated from Asia (48.7%) and were primarily focused on endodontic outcomes (47.5%). A significant difference in methodological quality was noted between TS and OA journals (t-test, P = 0.022). TS journals exhibited a higher mean methodological quality score of 1.64 (±0.30) compared to 1.49 (±0.27) of OA journals. Variance in methodological quality scores among journals was also statistically significant (ANOVA, P = 0.002). Conclusion: Clinical studies published in TS journals had higher methodological quality compared to those published in OA journals. Enhancements in peer review may be necessary to ensure appropriate methodological quality in OA publications in endodontics.

Contextualizing supply chain risk governance in critical infrastructure sectors: insights from the Swedish food system

PurposeCritical infrastructure (CI) sectors and their resilience are vital for societies to function. In many countries, vital societal functions (VSFs) and CIs depend on inter-organizational and international supply chains (SCs) which combine public and private actors with often competing interests and unclear responsibilities that create discontents. While collaborative supply chain risk management (SCRM) can increase the robustness and resilience of VSF&CIs, their inherent characteristics complicate SCRM. To understand this, supply chain risk governance (SCRG) has conceptually been introduced, suggesting collaborative mechanisms that facilitate inter-organizational SCRM. The purpose of this study is to elaborate on and substantiate the theoretical and practical relevance of an existing SCRG framework, by empirically exploring governance of collaborative SCRM and suggesting future research.Design/methodology/approachAn abductive case study was performed in a VSF&CI, the Swedish food system, to contextualize top-level governance of collaborative SCRM and elaborate on the conceptual SCRG framework. Archival data supplemented expert interviews with public and private actors representing direct and indirect SC actors.FindingsCurrent discourse and interventions in the Swedish food system’s SCRM confirmed discontent in governance and the importance of SCRG mechanisms and supported further conceptualization, e.g. of legal mechanisms vs economic incentives, the importance of government inquiries and the understanding of the influence of indirect public SC actors.Research limitations/implicationsConsidering the geographical scope of the study, transferability is limited but invites comparisons with both other countries and the SCRG of other VSF&CIs. Proposed research avenues guide future conceptualization and contextualization of SCRG.Practical implicationsThe framework can support CI actors to jointly find and reduce discontents related to inter-organizational SCRM and support policymakers to increase public–private collaboration.Originality/valueThe novelty lies in empirically studying SCRG in critical infrastructures by combining SCRM and risk governance lenses.

Infant feeding for women with an eating disorder: An interpretative phenomenological analysis.

Mothers with eating disorders can face additional challenges with infant feeding, and there is evidence they are likely to cease breastfeeding earlier than intended. However, there is little research exploring this. The present study used interpretative phenomenological analysis to explore the lived experience of infant feeding for mothers suffering from or recovering from an eating disorder. Semistructured interviews were conducted with six women-five who had breastfed and one who formula-fed. The women experienced two incompatible worlds-motherhood and an eating disorder. Tensions were sometimes resolved by reducing eating disordered behaviour alongside immersion in motherhood. Two participants did not find infant feeding particularly important for their journey into motherhood. Four recounted a positive shift in their relationship to their body through breastfeeding and felt their embodied experience of mothering provided a route out of eating disordered behaviour. However, doubts about their mothering and infant feeding capabilities could be amplified by feeling mistrusted by others and by the relative silence around eating disorders within maternity care services. Respectful dialogue with health care professionals was particularly valued where this occurred. Although long-term outcomes for the participants are unknown, the study suggests women with a history of eating disorders can form successful breastfeeding relationships and may be motivated to engage in collaborative risk assessment. However, they need support in managing emotional challenges. Training around eating disorders for maternity care professionals is likely to be useful for enhancing confidence in engaging mothers proactively to share concerns about eating, weight and body shape.

Nursing process for a patient with ectopic pregnancy in the Gynecology Department of a hospital in Arequipa

Introduction: Ectopic Pregnancy is the implantation and subsequent development of the fertilized ovum outside the endometrial cavity, with greater prevalence in the uterine tubes.Tubal rupture and hemorrhage causes morbimortality and is considered a true medical emergency. Objective: To elaborate the nursing care process oriented to a patient with ectopic pregnancy. Methodology: This is a descriptive qualitative research work, with a single case design, aimed at a 35-year-old patient. The Nursing Care Process was used, applying Margory Gordon's functional patterns as an assessment instrument. Result: 6 nursing diagnoses were identified, prioritizing the main diagnosis: Acute pain r/c biological injury agent manifested by verbal expressions and VAS scale 10/8. Nursing interventions were applied with effective result achieving improvement with change score +2; before PC extrauterine pregnancy and Shock CR are still in the process of improvement. Conclusions: The clinical manifestations of an ectopic pregnancy were identified in the patient; the complication risk factors were determined and the nursing role was described by applying preventive care in hypovolemic shock. Collaborative problems and risks were identified and addressed through the nursing interventions and activities included in the EAP for ectopic pregnancy, achieving better health status.

Meta-analysis and sequential analysis of acupuncture compared to carbamazepine in the treatment of trigeminal neuralgia.

In this randomized controlled trial (RCT) comparing current acupuncture with carbamazepine for trigeminal neuralgia, meta- and sequential analyses were utilized. To guide clinical decision making regarding the treatment of trigeminal neuralgia with carbamazepine. The RCT literature on needle comparison was searched in various Chinese biomedical databases including Chinese Biomedical Literature Database, Wanfang Data, VIP Database, as well as international databases such as Excerpt Medica Database, Cochrane Library, PubMed, and Web of Science, along with related clinical registration platforms such as World Health Organization International Clinical Trial Registry Platform, ChiCTR, and Clinical Trials up to 1 April 2020. Risk of bias was evaluated using the Cochrane Collaborative Risk Bias tool, primary outcome measures (pain reduction) were analyzed using STATA meta-analysis, outcome measures were analyzed using trial sequential analysis 0.9.5.10 Beta sequential analysis, GRADE was used to assess the evidence, and adverse reactions were documented. This study analyzed 16 RCTs with a total of 1231 participants. The meta-analysis revealed a statistically significant difference in pain reduction between acupuncture and carbamazepine [standardized mean difference (SMD) = 1.47; 95% confidence interval (CI): 0.99-1.95], although the quality of evidence was deemed to be of extremely low quality. Cumulative meta-analysis based on the year of publication indicated that carbamazepine treatment first demonstrated a statistically significant difference in pain reduction in 2014 and remained relatively stable over time [SMD = 1.84; 95%CI: 0.22-3.47]. Additionally, the number of adverse events associated with acupuncture was significantly lower compared to carbamazepine. Acupuncture for trigeminal neuralgia is better than analgesia and safer than carbamazepine; however, firm conclusions still require a high-quality, multicenter, large-sample RCT to confirm these findings.

Toward sustainable waste-to-energy solutions: risk allocation and technological innovations in public-private partnerships

ABSTRACT The energy challenge and environmental degradation are currently two of the biggest obstacles to sustainable global growth. Due to emerging countries’ rapid industrialization and population increase, people have been migrating from rural to urban areas. One of the primary causes of environmental deterioration in Egypt is the country’s hundreds of tons of municipal solid waste generated every day, as well as the country’s struggles with waste management and energy production. Waste-to-energy (WTE) programs show promise as a remedy. However, given the inherent complexity and unpredictability of these endeavors, a careful examination of risk allocation methods is important, especially in the context of public-private partnerships. The present paper intends to identify important risk considerations, evaluate their allocation methodologies, and distribute insights for stakeholders and policymakers involved in WTE projects in Egypt through an extensive assessment of the literature and case studies subsequently in practice. In order to reduce the risks associated with Waste-to-Energy (WTE) projects in Egypt, the current paper considers eight categories: land accessibility, availability, and site risks; social risks; environmental and human health concerns; design risks; construction risks; operation risks; financial market risks; and collaboration risks.

Antidepressant class and concurrent rTMS outcomes in major depressive disorder: a systematic review and meta-analysis

Repetitive transcranial magnetic stimulation (rTMS) is frequently used as an adjunctive treatment with antidepressants for depression. We aimed to evaluate the clinical efficacy and safety of antidepressant classes when administered concurrently with rTMS for the management of major depressive disorder (MDD). In this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO, and the Cochrane Library were searched from inception to April 12th 2024 for terms relating to medication, depression, and rTMS and appraised by 2 independent screeners. All randomized clinical trials that prospectively evaluated a specific antidepressant adjunctively with sham rTMS as a control in MDD were included. The study was registered with PROSPERO (CRD42023418435). The primary outcome measure assessed symptomatic improvement measured by formal depression scales. We used a random-effects model with pooled Standardized Mean Differences (SMDs) and log odds ratios (OR). All studies were assessed for their methodological quality and bias using the Cochrane Collaboration Risk of Bias tool version 2 (RoB2). 14 articles from 5376 identified studies were included in the systematic review and meta-analysis. There was only sufficient trial data to evaluate the effects of rTMS and combination therapy with selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs). Across studies, 848 participants (mean [SD] age:41.1 [18.7] years for SSRIs, 51.8 [3.8] years for SNRIs) prospectively examined the efficacy of antidepressant medication with rTMS. Combining rTMS with SSRIs led to significantly lower depression scores, (SMD [CI] of-0.65 [-0.98,-0.31], p=0.0002, I2=66.1%), higher response (OR=0.97 [0.50, 1.44], p<0.0001, I2=25.33%) and remission rates (OR=1.04 [0.55, 1.52], p<0.0001, I2=0.00%) than medication with sham rTMS. No additive benefit was found for SNRIs with rTMS (SMD of 0.10 [-0.14, 0.34], p=0.42, I2=0.00%; OR=0.12 [-0.39, 0.62], p=0.64, I2=0.00%; OR=-0.31 [-0.90, 0.28], p=0.86, I2=39.9%). The overall risk of bias for the included studies ranged from low to high, with 1 study having a high risk of bias. The combination of rTMS with SSRIs, but not SNRIs, significantly reduced depression severity, increasing response and remission rates. Some analyses demonstrated high heterogeneity, which was influenced by an SSRI trial with a high effect size. Overall, these results suggest that not all antidepressant combination therapies are alike, and SSRIs should be considered when initiating rTMS. Donald T. Stuss Young Investigator Research Innovation Award from the Sandra Black Centre for Brain Resilience & Recovery and the Harquail Centre for Neuromodulation through the Sunnybrook Foundation.

Design phase collaborative risk management factors: a case study of a green rating system in South Africa

PurposeWe explore the design risk factors and associated managerial practices driving collaborative risk management for design efficacy in green building projects. By illuminating project design risk as an important project risk category in its own right, the study contributes to our understanding of optimising design efficacies for collaborative project risk management.Design/methodology/approachThe study comprises exploratory interviews conducted with 27 industry project practitioners involved in the design and delivery/implementation of Green Star-certified building projects in South Africa.FindingsThe findings discursively highlight seven sources of design risk. We also identify seven specific collaborative risk management practices for design efficacy emerging from a consideration of how risk environments vary in the Green Star-certified projects, each with its own project design risk implications.Originality/valueThe study advances our understanding of how collaborations emerging from particular relational yet context-specific practices can be optimised to strengthen project risk management.

Predicting outcomes in malignant ovarian germ cell tumors using the modified International Germ Cell Cancer Collaborative Group classification system

ObjectivesThe aim of our study was to evaluate the feasibility of the modified International Germ Cell Cancer Collaborative Group risk classification system in Chinese female patients with malignant ovarian germ...

Effects of respiratory muscle training on post-stroke rehabilitation: A systematic review and meta-analysis.

Stroke often results in significant respiratory dysfunction in patients. Respiratory muscle training (RMT) has been proposed as a rehabilitative intervention to address these challenges, but its effectiveness compared to routine training remains debated. This systematic review and meta-analysis aim to evaluate the effects of RMT on exercise tolerance, muscle strength, and pulmonary function in post-stroke patients. To systematically assess the efficacy of RMT in improving exercise tolerance, respiratory muscle strength, and pulmonary function in patients recovering from a stroke, and to evaluate whether RMT offers a significant advantage over routine training modalities in enhancing these critical health outcomes in the post-stroke population. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a comprehensive search across PubMed, Embase, Web of Science, and the Cochrane Library was conducted on October 19, 2023, without temporal restrictions. Studies were selected based on the predefined inclusion and exclusion criteria focusing on various forms of RMT, control groups, and outcome measures [including forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), maximal voluntary ventilation (MVV), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and 6-min walking test (6MWT)]. Only randomized controlled trials (RCTs) were included. Data extraction and quality assessment were conducted independently by two reviewers using the Cochrane Collaboration's risk of bias tool. Statistical analyses, including those using the fixed-effect and random-effects models, sensitivity analysis, and publication bias assessment, were performed using Review Manager software. A total of 15 RCTs were included. Results indicated significant improvements in MIP (12.51 cmH2O increase), MEP (6.24 cmH2O increase), and various pulmonary function parameters (including FEV1, FVC, MVV, and PEF). A substantial increase in 6MWT distance (22.26 meters) was also noted. However, the heterogeneity among studies was variable, and no significant publication bias was detected. RMT significantly enhances walking ability, respiratory muscle strength (MIP and MEP), and key pulmonary function parameters (FEV1, FVC, MVV, and PEF) in post-stroke patients. These findings support the incorporation of RMT into post-stroke rehabilitative protocols.

Xenogeneic Collagen Matrix Versus Free Gingival Graft for Augmenting Peri-Implant Keratinized Mucosa Around Dental Implants: A Systematic Review and Meta-Analysis.

There is a growing evidence to suggest augmenting peri-implant keratinized mucosa in the presence of ≤ 2 mm of keratinized mucosa. However, the most appropriate surgical technique and augmentation materials have yet to be defined. The aim of this systematic review and meta-analyses was to evaluate the clinical and patient-reported outcomes of augmenting keratinized mucosa around implants using free gingival graft (FGG) versus xenogeneic collagen matrix (XCM) before commencing prosthetic implant treatment. Electronic databases were searched to identify observational studies comparing implant sites augmented with FGG to those augmented with XCM. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Six studies with 174 participants were included in the present review. Of these, 87 participants had FGG, whereas the remaining participants had XCM. At 6 months, sites augmented with FGG were associated with less changes in the gained width of peri-implant keratinized mucosa compared to those augmented with XCM (mean difference 1.06; 95% confidence interval -0.01 to 2.13; p = 0.05). The difference, however, was marginally significant. The difference between the two groups in changes in thickness of peri-implant keratinized mucosa at 6 months was statistically significantly in favor of FGG. On the other hand, XCM had significantly shorter surgical time, lower postoperative pain score, and higher color match compared to FGG. Within the limitation of this review, the augmentation of keratinized mucosa using FGG before the placement of the final prosthesis may have short-term positive effects on soft tissue thickness. XCM might be considered in aesthetically demanding implant sites and where patient comfortor shorter surgical time is a priority. The evidence support, however, is of low to moderate certainty; therefore, further studies are needed to support the findings of the present review.

Bridging the gap: Navigating the impact of dietary supplements on abdominal aortic aneurysm progression- A systematic review.

Vitamins D, E, A, B, C, and Omega-3 play crucial roles in modulating inflammatory and oxidative stress pathways, both implicated in abdominal aortic aneurysm (AAA) development. Recent research has explored the potential impact of dietary supplements on AAA progression. The systematic review aims to assess interventional studies investigating the effects of various dietary supplements on the development and severity of abdominal aortic aneurysms. A systematic search using relevant keywords related to abdominal aortic aneurysm and dietary supplements was conducted across four databases (PubMed, Embase, Scopus, and Web of Science). Quality assessment for animal studies employed SYRCLE and the Cochrane Collaboration Risk of Bias Tool for randomized control trials. The study protocol is registered in PROSPERO under the registry code CRD42023455958. Supplementation with Omega-3, Vitamins A, C, D, E, and the Vitamin B family exhibited positive effects in AAA progression. These supplements contributed to a reduction in AAA diameter, elastin degradation, inflammatory responses, and reactive oxygen species. Additional supplements such as Zinc, methionine, and phytoestrogen also played roles in mitigating AAA progression. The findings of this study underscore the potential role of dietary supplements in the progression of AAA. Predominantly based on animal studies, the results indicate that these supplements can limit AAA progression, primarily evidenced by their ability to mitigate inflammatory processes and oxidative stress pathways.

Equilibrium bifurcation and extreme risk in the EU carbon futures market

Considering the long-term memory and volatility clustering of the European Union (EU) Carbon Emission Allowances (EUA) futures returns, based on the economy–energy–environment system perspective and the assumption of investors' heterogeneity, this study proposes a joint modeling approach combining the fractionally integrated generalized autoregressive conditional heteroscedasticity model (FIGARCH) and the stochastic cusp catastrophe model (SCC) to examine the equilibrium bifurcations and extreme risks in the EU carbon futures market. The relevant results are threefold. (1) The SCC model has good fitting effect and interpretability, and is an effective method for investigating catastrophe reactions under time-varying volatility conditions. (2) In the EUA futures market, chartists are mainly affected by short-term price and trading volume changes, which leads to the emergence of equilibrium bifurcations, while fundamentalists make investment decisions based on the economy, the energy market, and market supply–demand, which affects the asymmetry of equilibrium bifurcations. (3) Using the catastrophe criterion (i.e., Cardan's discriminant of the equilibrium surface equation), we identify148 equilibrium bifurcation time points in the EUA futures market from December 3, 2009 to September 16, 2020, most of which are concentrated in two upward periods with an average scale of extreme risks is about 32.51 %. Our analysis provides theoretical support for regulatory authorities to stabilize the carbon futures market and build a collaborative extreme risk management framework covering energy and macroeconomics, also proposing suggestions for traders to effectively prevent extreme risks.

The safety and efficacy of five surgical treatments in prostate enucleation: a network meta-analysis

PurposeThe aim of our study was to investigate the comparative outcomes of five different energy types on surgical efficacy and postoperative recovery in patients with benign prostate hyperplasia.MethodsThe literature was systematically reviewed on December 1st, 2023, encompassing studies retrieved from PubMed, Embase, Web of Science, and The Cochrane Library databases that incorporated clinical studies of holmium laser enucleation of the prostate (HoLEP), Thulium:YAG laser enucleation of the prostate (ThuLEP), transurethral plasmakinetic enucleation of prostate (PKEP), diode laser enucleation of the prostate (DiLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) in the treatment of prostatic hyperplasia. Two independent reviewers extracted study data and conducted quality assessments using the Cochrane Collaboration's Risk of Bias tool and Newcastle–Ottawa Scale (NOS). Network meta-analysis (NMA) was employed to indirectly analyze the outcomes of endoscopic enucleation of the prostate (EEP) techniques.ResultsThe study included a total of 38 studies, comprising 21 non-randomized controlled trials (nRCTs) and 17 randomized controlled trials (RCTs), incorporating five distinct techniques: holmium laser, Thulium:YAG laser, bipolar plasma, diode laser and thulium fiber laser. In comparing treatment durations, ThuLEP and HoLEP had shorter overall hospital stays than PKEP, while the enucleation time of ThuLEP and HoLEP was shorter than that of ThuFLEP. Moreover, the enucleation tissue weight of both thulium fiber laser and holmium laser was heavier than bipolar plasma. However, the analysis did not reveal any statistically significant variation in complications among the various types of enucleation. In postoperative follow-up, the IPSS at 3 months post-operation was superior in the Thulium:YAG laser group compared to the holmium laser group. The thulium fiber laser technique demonstrated significant advantages over other enucleation methods in terms of QoL and PVR at 12 months after surgery.ConclusionTheoretical properties may vary among different energy sources; however, there are no discernible clinical differences in operation-related parameters, postoperative complications, and postoperative follow-up. Therefore, the choice of laser does not significantly impact the outcome. However, due to the limited number of included studies, future research should focus on larger sample sizes and multicenter investigations to further validate the findings of this study.

Is duct-to-mucosa pancreaticojejunostomy necessary after pancreaticoduodenectomy: A meta-analysis of randomized controlled trials

The incidence of postoperative pancreatic fistula is influenced by the effectiveness of the pancreaticojejunostomy, and the most suitable pancreaticojejunostomy for pancreaticoduodenectomy remains uncertain. Since grade A postoperative pancreatic fistula is no longer considered a true fistula, the purpose of this meta-analysis was to compare the effectiveness of duct-to-mucosa anastomosis and invagination anastomosis in reducing the incidence of grade B/C postoperative pancreatic fistula. The meta-analysis was conducted using software Review Manager 5.3, and the fixed-effect model was employed for pooled statistic calculations. The Cochrane Collaboration Risk of Bias Tool was utilized for quality assessment. Ten randomized controlled trials from Embase, Web of Science, MEDLINE, and the Cochrane Library (1990.01–2022.10) including 1471 patients, met the inclusion criteria. This meta-analysis has been registered on PROSPERO with the registration number CRD42023491673. The incidence of grade B/C fistula was significantly lower in the invagination group (7.7 %) compared to the duct-to-mucosa group (12.8 %, mostly Cattell manner)(RR = 1.65, 95%CI: 1.14–2.39, P = 0.008; heterogeneity: P = 0.008, I2 = 68 %),heterogeneity among the results was addressed through sensitivity analysis. In patients with a soft pancreas, the incidence of grade B/C fistula was significantly lower in those who underwent invagination anastomosis (10 %) compared to those who underwent duct-to-mucosa anastomosis (41.9 %)(RR = 4.19, 95%CI: 1.33–13.25, P = 0.01).No significant differences were observed in terms of the occurrence of grade B/C fistula in firm pancreas, postoperative mortality, other major postoperative complications, anastomosis time, and postoperative bile leak. Therefore, we concluded that invagination anastomosis is significantly superior to duct-to-mucosa anastomosis in reducing the incidence of grade B/C fistula, especially in patients with a soft pancreas.

Effect of core strength training on the badminton player's performance: A systematic review & meta-analysis.

Core strength training (CST) has been shown to improve performance in several sports disciplines. CST is recognized as one of the crucial elements that enhance athletic performance, particularly impacting badminton skills. Despite its popularity as a strength training method among badminton players, there is a lack of comprehensive studies examining the effectiveness of CST on the performance of these athletes. This study aims to ascertain CST's effects on badminton players' performance. This study followed PRISMA principles and conducted comprehensive searches in well-known academic databases (SCOPUS, Pubmed, CNKI, Web of Science, Core Collection, and EBSCOhost) up to August 2023. The inclusive criteria were established using the PICOS framework. Following their inclusion based on PICOS criteria, the selected studies underwent literature review and meta-analysis. The methodological quality of the assessments was evaluated using Cochrane Collaboration's risk of bias tools bias risk tools and recommendations for a graded assessment, development, and evaluation. The analysis included participants aged 10-19 years from 13 studies of moderate quality, totaling 208 individuals. The CST intervention s lasted between 4 to 16 weeks, with a frequency of 1 to 4 sessions per week and each session lasting 20 to 120 minutes. Sample sizes across these studies ranged from 8 to 34 participants. According to the meta-analysis, CST significantly influenced badminton performance, particularly in areas of explosive power (ES = 0.03 P = 0.04), front-court skill (ES = 2.53, P = 0.003), and back-court skill (ES = 2.33, P = 0.002). CST enhances badminton players' fitness (strength, power, balance, and stability), in situ (front/back-court) skills, and movement position hitting. However, its effects on speed, endurance, agility, flexibility, and coordination are unclear, revealing a research gap. The precise benefits of CST, especially on flexibility and specific hitting skills (smashes, clears, drives, net shots, crosscourt, push, and lift shots), need more investigation. Additionally, research on CST's impact on female athletes is significantly lacking.

Attitudes of nurses and nurse managers towards violence risk assessment and management: A cross-sectional study in psychiatric inpatient settings.

Workplace violence is a significant challenge in psychiatric hospital care. Some existing practices of violence risk assessment and management are based on nurses' intuition and clinical experience instead of structured tools. Nurses and nurse managers consider violence risk assessment and management their responsibility. Still, nurses and nurse managers have mixed attitudes towards the use of validated risk assessment tools. The attitudes towards service users' positive risk-taking in nurses and nurse managers vary, with some nurses and nurse managers supporting its importance. Change in nurses' and nurse managers' attitudes towards risk assessment tools is required before their implementation into practice. More profound change in practices towards recovery-oriented care is required also in risk assessment. INTRODUCTION: Workplace violence is a prevalent issue in psychiatric inpatient care. Prevention efforts require the identification of at-risk service users using validated violence risk assessment tools. The shift in violence prevention emphasises preventive measures and collaborative risk assessment together with service users. Nurses have a central role in this process. Therefore, their attitudes are crucial when implementing evidence-based methods. To assess the attitudes of nurses and nurse managers towards violence risk assessment and management. A cross-sectional online survey in Finnish psychiatric inpatient care. Data analysis was conducted with statistical methods. The STROBE guideline was used in reporting. Nurses (n = 142) valued risk assessment and felt that it was their responsibility. Attitudes towards service users' risk-taking as part of their recovery varied. Nurses had mixed attitudes regarding the effectiveness of risk assessment tools. Older participants and nurse managers had more positive attitudes towards risk assessment tools. The study findings highlight a feeling of responsibility of nurses towards violence risk assessment and at the same time their preference towards their own clinical judgement. Understanding nurses' attitudes is crucial in training and implementation processes to address concerns, provide support and enhance positive attitudes.

Interpretable machine learning predicts postpartum hemorrhage with severe maternal morbidity in a lower-risk laboring obstetric population

BackgroundEarly identification of patients at increased risk for postpartum hemorrhage (PPH) associated with severe maternal morbidity (SMM) is critical for preparation and preventative intervention. However, prediction is challenging in patients without obvious risk factors for postpartum hemorrhage with severe maternal morbidity. Current tools for hemorrhage risk assessment use lists of risk factors rather than predictive models. ObjectiveTo develop, validate (internally and externally), and compare a machine learning model for predicting PPH associated with SMM against a standard hemorrhage risk assessment tool in a lower risk laboring obstetric population. Study DesignThis retrospective cross-sectional study included clinical data from singleton, term births (>=37 weeks’ gestation) at 19 US hospitals (2016–2021) using data from 58,023 births at 11 hospitals to train a generalized additive model (GAM) and 27,743 births at 8 held-out hospitals to externally validate the model. The outcome of interest was PPH with severe maternal morbidity (blood transfusion, hysterectomy, vascular embolization, intrauterine balloon tamponade, uterine artery ligation suture, uterine compression suture, or admission to intensive care). Cesarean birth without a trial of vaginal birth and patients with a history of cesarean were excluded. We compared the model performance to that of the California Maternal Quality Care Collaborative (CMQCC) Obstetric Hemorrhage Risk Factor Assessment Screen. ResultsThe GAM predicted PPH with an area under the receiver-operating characteristic curve (AUROC) of 0.67 (95% CI 0.64–0.68) on external validation, significantly outperforming the CMQCC risk screen AUROC of 0.52 (95% CI 0.50–0.53). Additionally, the GAM had better sensitivity of 36.9% (95% CI 33.01–41.02) than the CMQCC screen sensitivity of 20.30% (95% CI 17.40–22.52) at the CMQCC screen positive rate of 16.8%. The GAM identified in-vitro fertilization as a risk factor (adjusted OR 1.5; 95% CI 1.2–1.8) and nulliparous births as the highest PPH risk factor (adjusted OR 1.5; 95% CI 1.4–1.6). ConclusionOur model identified almost twice as many cases of PPH as the CMQCC rules-based approach for the same screen positive rate and identified in-vitro fertilization and first-time births as risk factors for PPH. Adopting predictive models over traditional screens can enhance PPH prediction.

Collaboration matters: A randomized controlled trial of patient-clinician collaboration in suicide risk assessment and intervention

BackgroundClinician collaboration can help high-risk individuals to manage their suicidal crises. However, limited research has directly examined how higher patient-clinician collaboration during assessment and intervention can effectively reduce suicidal ideation. This novel randomized clinical trial compared a high vs. low level of patient-clinician collaboration by pairing commonly used assessment (Structured Interview vs. Narrative Assessment) and intervention approaches (Safety Planning Intervention vs. Crisis Response Planning). We hypothesized that the interventions involving higher (than lower) patient-clinician collaboration during assessment (Narrative Assessment) or intervention (Crisis Response Planning) would lead to larger reductions in suicidal ideation. MethodsEighty-two participants with a history of suicide ideation and/or attempts were randomly assigned to one of the four interventions varying in patient-clinician collaboration. After attrition, sixty-six participants completed the study. Suicidal ideation via ecological momentary assessment was measured 14 days before and 14 days after treatment. ResultsAlthough the severity of suicidal ideation decreased in all groups, the two groups that included highly collaborative assessment had larger pre-post reductions in suicidal ideation (Narrative Assessment+Safety Plan; dwithin = 0.26, and Narrative Assessment+Crisis Response Plan; dwithin = 0.19) than the groups that included a checklist-based assessment (Structured Interview). LimitationsLonger follow-up periods with a larger sample would have provided an understanding of the durability of intervention effects. ConclusionResults suggest that the inclusion of higher patient-clinician collaboration techniques during suicide risk assessment can effectively reduce suicidal thoughts. Thus, clinician-led collaborative risk assessment approaches can enhance the effects of safety planning-type interventions among patients with elevated risk for suicide versus checklist-based assessment approaches.