Epub Ahead Of Print Research Articles

The Effects of Inspiratory Muscle Training (IMT) on Patients Undergoing Coronary Artery Bypass Graft (CABG) Surgery: A Systematic Review and Meta-Analysis.

To determine the effects of inspiratory muscle training (IMT) alone on inspiratory muscle strength and endurance, pulmonary function, pulmonary complications, and length of hospital stay in patients undergoing coronary artery bypass graft surgery (CABG). We conducted a literature search across databases (Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; Ovid Cochrane Database of Systematic Reviews; and Scopus) from inception to December 2021. The eligibility criteria were randomized controlled trials that investigated the effects of IMT versus usual care or sham IMT in patients undergoing CABG. A total of 12 randomized clinical trials with 918 patients were included in the meta-analysis. Postoperative IMT was associated with improved maximal inspiratory pressure (MIP), maximum inspiratory pressure (PImax), and six-minute walking test (6MWT) and with a decrease in length of hospital stay (LOS). For preoperative IMT, there was statistical significance between intervention and MIP, PImax, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), postoperative pulmonary complications (PPCs), and LOS. Pre- and postoperative IMT resulted in improvements in MIP. Isolated IMT in patients who underwent CABG improved their inspiratory muscle strength and endurance, pulmonary function, and 6MWT and helped decrease postoperative pulmonary complications and the length of hospital stay.

Self-care Practices of Patients With Heart Failure Using Wearable Electronic Devices: A Systematic Review.

Heart failure (HF) is the fastest growing cardiovascular condition globally; associated management costs and hospitalizations place an immense burden on healthcare systems. Wearable electronic devices (WEDs) may be useful tools to enhance HF management and mitigate negative health outcomes. We aimed to perform a systematic review to examine the potential of WEDs to support HF self-care in ambulatory patients at home. Five databases were searched for studies published between 2007 and May 2022, including OVID MEDLINE, EMBASE (OVID), APA PsycINFO (OVID), Cochrane Central Register of Controlled Trials (OVID), and CINAHL Plus with Full Text (Ebsco). After 6210 duplicates were removed, 4045 records were screened and 6 were included for review (2 conference abstracts and 4 full-text citations). All studies used WEDs as 1 component of a larger intervention. Outcome measures included quality of life, physical activity, self-efficacy, self-care, functional status, time to readmission, social isolation, and mood. Studies were of moderate to high quality and mixed findings were reported. Enhanced exercise habits and motivational behavior to exercise, as well as decreased adverse symptoms of fatigue and dyspnea, were identified in 2 studies. However, improvements in exercise capacity and increased motivational behavior did not lead to exercise adherence in another 2 studies. The findings from this review suggest that WEDs may be a viable health behavior improvement strategy for patients with HF. However, studies of higher quality, with the primary intervention being a WED, and consistent outcome measures are needed to replicate the positive findings of studies identified in this review.

Effectiveness of Concussion Curriculum (CC) in Postgraduate Medical Education

Research Objectives Objectives: The aims of this review are to describe and assess the effects of concussion curriculum on medical learning. Design A systematic search of six databases (MEDLINE/ PUBMED, Ovid MEDLINE: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily and Ovid MEDLINE, Embase, ERIC, Cochrane, CINAHL) was conducted, using the text-word and MeSH-heading search strategy, in December 2021. Eligibility criteria included studies in a postgraduate education context that reported on the effects on learning. The validated MINORS (Methodological Index for Nonrandomized Studies) tool was utilized to assess the risk of bias. Kirkpatrick's evaluation model and Miller's assessment pyramid were used as frameworks to determine the impacts of CC on post-graduate learning. Setting Literature review. Participants N/A. Interventions Implementing a spiral curriculum following the systematic review of concussion curricula. Main Outcome Measures Competency. Results Six articles were identified, reporting on 2 retrospective studies and 4 cohort studies. Although there were mixed findings overall, the highest positive learning outcome reported was knowledge (Miller Level 1), and no studies assessed higher levels of curriculum impacts. Conclusions The effectiveness of CC in post-graduate medical education remains unknown regarding how the learning can be transferred to change practice and affect patient outcomes. Educational research should be built on conceptual frameworks and theories. Those with success employed constructivism, situated learning theory, and social learning theory/community of practice as the underpinning theories. To develop an effective CC, further prospective, competency-based concussion educational scholarship with mixed-method (quantitative and qualitative) evaluation is needed to capture curriculum processes and impacts over time. Using iterative usability approaches and medical educational frameworks, future CC research studies will be valuable to support competency-based medical education development. Author(s) Disclosures The authors of this study have no conflicts of interest to disclose and received no financial benefits. This research received no specific grant from any funding agency in public, commercial or not-for-profit sectors. Objectives: The aims of this review are to describe and assess the effects of concussion curriculum on medical learning. A systematic search of six databases (MEDLINE/ PUBMED, Ovid MEDLINE: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily and Ovid MEDLINE, Embase, ERIC, Cochrane, CINAHL) was conducted, using the text-word and MeSH-heading search strategy, in December 2021. Eligibility criteria included studies in a postgraduate education context that reported on the effects on learning. The validated MINORS (Methodological Index for Nonrandomized Studies) tool was utilized to assess the risk of bias. Kirkpatrick's evaluation model and Miller's assessment pyramid were used as frameworks to determine the impacts of CC on post-graduate learning. Literature review. N/A. Implementing a spiral curriculum following the systematic review of concussion curricula. Competency. Six articles were identified, reporting on 2 retrospective studies and 4 cohort studies. Although there were mixed findings overall, the highest positive learning outcome reported was knowledge (Miller Level 1), and no studies assessed higher levels of curriculum impacts. The effectiveness of CC in post-graduate medical education remains unknown regarding how the learning can be transferred to change practice and affect patient outcomes. Educational research should be built on conceptual frameworks and theories. Those with success employed constructivism, situated learning theory, and social learning theory/community of practice as the underpinning theories. To develop an effective CC, further prospective, competency-based concussion educational scholarship with mixed-method (quantitative and qualitative) evaluation is needed to capture curriculum processes and impacts over time. Using iterative usability approaches and medical educational frameworks, future CC research studies will be valuable to support competency-based medical education development.

Statin Use and Survival Among Men Receiving Androgen-Ablative Therapies for Advanced Prostate Cancer

Epidemiological evidence supports a role for statins in improving survival in advanced prostate cancer, particularly among men receiving androgen-ablative therapies. To study the association between statin use and survival among men with prostate cancer receiving androgen deprivation therapy (ADT) or androgen receptor axis-targeted therapies (ARATs). This systemic review and meta-analysis used sources from MEDLINE, EMBASE, Epub Ahead of Print, Cochrane Clinical Trials, Cochrane Systematic Reviews, and Web of Science from inception to September 6, 2022. Observational studies reporting associations of concurrent statin use and survival outcomes (in hazard ratios [HRs]). Two authors independently abstracted all data. Summary estimates pooled multivariable HRs with 95% CIs using the generic inverse variance method with random-effects modeling. A priori specified subgroup and sensitivity analyses were undertaken, and heterogeneity, study quality, and publication bias were evaluated. Confidence in the evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Overall mortality and prostate cancer-specific mortality (PCSM). Twenty-five cohorts of 119 878 men (65 488 statin users [55%]) with more than 74 416 deaths were included. Concurrent statin use was associated with a 27% reduction in the risk of overall mortality (HR, 0.73 [95% CI, 0.66-0.82]; I2 = 83%) and a 35% reduction in the risk of PCSM (HR, 0.65 [95% CI, 0.58-0.73]; I2 = 74%), with substantial heterogeneity in both estimates. Subgroup analyses identified a PCSM advantage associated with statins for men receiving ARATs compared with ADT alone (HR, 0.40 [95% CI, 0.30-0.55] vs 0.68 [95% CI, 0.60-0.76]; P = .002 for difference). Confidence in the evidence was rated low for both outcomes. The findings of this meta-analysis show that concurrent statin use was associated with reduced overall mortality and PCSM among men receiving androgen-ablative therapies for advanced prostate cancer. These findings are limited by the observational nature of the data and residual unexplained interstudy heterogeneity. Randomized clinical trials are warranted to validate these results.

Rescue therapy with novel waveform spinal cord stimulation for patients with failed back surgery syndrome refractory to conventional stimulation: a systematic review and meta-analysis.

Conventional spinal cord stimulators (SCSs) have demonstrated efficacy in individuals with failed back surgery syndrome (FBSS). However, a subgroup of patients may become refractory to the effects of conventional waveforms over time. The objective of this study was to systematically review and evaluate the current literature on the use of novel waveform spinal cord stimulation for the management of FBSS refractory to conventional SCSs. A comprehensive electronic search of the literature published in electronic databases, including Ovid MEDLINE and Epub Ahead of Print, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus, was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The outcomes of interest were reduction in back pain and/or leg pain after conversion from conventional to novel SCSs. Risk of bias was assessed with the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool. The strength of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. A total of 6 studies with 137 patients with FBSS were identified. Studies were published between 2013 and 2021. The mean ± SD age of the pooled patient sample was 55 ± 10.5 years. All patients who underwent treatment with conventional SCSs were identified. Two studies evaluated the efficacy of high-density spinal cord stimulation, 3 studies evaluated burst spinal cord stimulation, and 1 study assessed multimodal waveforms. The mean difference in back pain scores after conversion from a standard SCS to a novel waveform SCS was 2.55 (95% CI 1.59-4.08), demonstrating a significant reduction in back pain after conversion to novel stimulation. The authors also performed a subgroup analysis to compare burst stimulation to tonic waveforms. In this analysis, the authors found no significant difference in the average reductions in back pain between the 2 groups (p = 0.534).The authors found an I2 statistic equivalent to 98.47% in the meta-regression model used to assess the effect of follow-up duration on study outcome; this value implied that the variability in the data can be attributed to the remaining between-study heterogeneity. The overall certainty was moderate, with a high risk of bias across studies. Rescue therapy with novel waveform spinal cord stimulation is a potential option for pain reduction in patients who become refractory to conventional SCSs. Conversion to novel waveform SCSs may potentially mitigate expenses and complications.

Barriers and facilitators to education experienced by students with disabilities in low- and middle-income African countries: a systematic review of qualitative evidence.

This review sought to collect and synthesize studies that investigated the lived experience of barriers and facilitators to educational access and excellence for students with disabilities in low- and middle-income African countries. Access to education in low- and middle-income African countries for students with disabilities is often inequitable. Although governments have developed policies and programs for student with disabilities, much of the literature guiding policy and program development has focused on the views of academics, parents, teachers, and political figures. This systematic review considered studies that included participants who were students or trainees at the time of the study, have a disability, and were located in a low- and middle-income African country. The phenomena of interest were barriers and facilitators to educational success for students with disabilities. This review included qualitative, interpretive, and critical studies that drew on the experiences of students with disabilities. An initial search was conducted in CINAHL and MEDLINE, followed by development of a full search strategy that was used for AMED, Embase, CINAHL, Global Health, MEDLINE, and Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Daily and Versions, spanning from 1910-2021. Articles were limited to those published in English. The JBI approach was followed for study selection, critical appraisal, data extraction, data synthesis, and assessing confidence in the findings with ConQual. Thirteen qualitative studies were included from seven African countries, and included primary, secondary and postsecondary students. The data were qualitatively synthesized into 64 findings, within six categories, which then formed two synthesized findings. The synthesized findings were: barriers and challenges to engaging in education, and supports for educational success. This review is a synthesis of the lived experiences of students with disabilities in low- and middle-income African countries to understand, in their own words, the challenges and supports they encounter during their educational journeys. Although many barriers and supports reported by students with disabilities and other stakeholders (eg, parents, teachers, administrators) are similar to those identified in this review, our findings identify that integrated research that includes students with disabilities will provide contextual and individual factors that are crucial for students to achieve equitable access to education. PROSPERO CRD42019137951.

Understanding strategies to improve medication adherence among persons with type 2 diabetes: A scoping review.

The objectives of this scoping review were to: (1) identify the target audience and contexts in which strategies to improve type 2 diabetes mellitus (T2DM) medication adherence have been used, (2) provide an overview of behaviour change techniques (BCTs) used, (3) describe the determinants of behaviour targeted by strategies and (4) to identify current gaps in strategies. A systemic search for articles related to T2DM, medication adherence and strategies was conducted in EMBASE, Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily using the OvidSP platform on 11 March 2021. All publications involving strategies to overcome medication non-adherence among adults with T2DM were included. Strategies were categorized according to the BCT taxonomy and the determinants of behaviour targeted by each strategy were classified by using the Theoretical Domains Framework (TDF). The search identified 58 articles and 61 strategies. The BCT categories Antecedents and Natural consequences and BCTs Feedback on outcome(s) of behaviour, Adding objects to the environment and Information about health consequences were identified most frequently as components of strategies resulting in statistically significant improvement in medication adherence. Strategies targeting the TDF domains Reinforcement and Beliefs about Consequences most often resulted in statistically significant improvements in adherence measures. The findings from this review identify BCTs and targeted behaviours with demonstrated success. Further exploration of the myriad of BCTs and the corresponding determinants of behaviour which were not accessed may be warranted for the development of future strategies to improve medication adherence in type 2 diabetes.

Acupuncture for treating overactive bladder in adults.

Acupuncture for treating overactive bladder in adults.

Cold exposure and musculoskeletal conditions; A scoping review.

Background: Musculoskeletal conditions are major contributors to years lived with disability. Cold exposure can be a risk factor, but any conclusion is obscure. Aim: The aim of the present scoping review was to identify the existing evidence of an association between cold exposure and musculoskeletal conditions. The aim also included to consider pain in different regions and their assessment, as well as different measures of cold exposure, effect sizes, and to assess the feasibility of future systematic reviews and meta-analyses. Eligibility criteria: The studies must have: an epidemiological design, defined cold exposure to come prior to the health outcome, defined exposure and outcome(s), existence of effect estimate(s) or data that made it possible to calculate such an estimate. Further, studies were required to be in English language and published in peer-reviewed journals. Studies that had a specific goal of studying cold exposure as an aggravator of already existing health problems were excluded. Sources: We searched Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Daily and Versions(R), and Embase Classic + Embase for original studies. Charting method: The included studies were reviewed for study population, measurement of exposure and outcome, and effect size. Each publication was assessed for risk of bias. Results: The included studies were heterogeneous in populations, measures of cold exposure and musculoskeletal conditions. Most studies used self-reported data. They were mostly cross-sectional studies, only two were prospective and one was a case-control study. Associations were found for different cold exposures and regional musculoskeletal conditions, but the heterogeneity and lack of studies impeded valid synthesis of risk magnitude, or meta-analyses. Conclusion: The studies identified in this review indicate that cold exposure increases the risk of musculoskeletal conditions. However, there is a need for studies that better assess temporality between exposure and outcome. Future studies should also include better exposure assessment, including both objective measurements and measures of subjective experience of cold exposure. The heterogeneity in measurement of exposure and outcome impeded any meta-analysis.

Systematic review of electronic health records to manage chronic conditions among displaced populations

ObjectivesThe objective of this study was to assess the impact of electronic health records (EHRs) on health outcomes and care of displaced people with chronic health conditions and determine barriers...

Palliative care interventions for people who use substances during communicable disease outbreaks: a scoping review

ObjectivesWhen resources are strained during communicable disease outbreaks, novel palliative care interventions may be required to optimally support people who use substances with life-limiting illnesses. Therefore, we asked the question,...

The Role of Base Excision Repair in Major Depressive Disorder and Bipolar Disorder

IntroductionIn vivo and in vitro studies suggest that inflammation and oxidative damage may contribute to the pathogenesis of major depressive disorder (MDD) and bipolar disorder (BD). Imbalance between DNA damage and repair is an emerging research area examining pathophysiological mechanisms of these major mood disorders.ObjectivesThis systematic review sought to examine current evidence on the association between mood disorders and deficits in base excision repair (BER), the primary repair mechanism for repair of oxidation-induced DNA lesions.MethodsWe conducted a comprehensive literature search of Ovid MEDLINE® Epub Ahead of Print, Ovid MEDLINE® In-Process & Other Non-Indexed Citations, Ovid MEDLINE® Daily, EMBASE (1947), and PsycINFO for studies investigating the alterations in base excision repair in patients with MDD or BD.ResultsA total of 1,364 records were identified. 1,352 records remained after duplicates were removed. 24 records were selected for full-text screening and a remaining 12 articles were included in the qualitative synthesis. SNPs (Single Nucleotide Polymorphisms) of several BER genes have been shown to be associated with MDD and BD. However, it was difficult to draw conclusions from BER gene expression studies due to conflicting findings and the small number of studies.ConclusionsFuture studies comparing DNA repair during the manic or depressive episode to remission will give us a better insight regarding the role of DNA repair in mood disorders. These alterations might be utilized as diagnostic and prognostic biomarkers as well as measuring treatment response.DisclosureNo significant relationships.

Be Kind to Your Behind: A Systematic Review of the Habitual Use of Bidets in Benign Perianal Disease.

Background Benign perianal disease carries significant morbidity and financial burden on the healthcare system. Given that sitz baths are recommended as a treatment modality, we considered whether using a continuous stream of water, in the form of a bidet, offers a convenient and effective alternative. Bidet use is the predominant form of perianal hygiene in Asia, but its role in perianal disease is unknown. Purpose To critically analyze and systematically review the current evidence regarding the effect of habitual bidet use on symptoms of benign perianal disease. Data Sources. A database search was conducted on MEDLINE and Epub Ahead of Print, Embase, ClinicalTrials.gov, the Cochrane Library, and ProQuest Dissertations. All studies on bidet use in pruritus ani, hemorrhoids, or anal fissures were included. Data Extraction. The studies were screened and critically analyzed by two independent reviewers in line with PRISMA guidelines. Results Two prospective trials and 1 cross-sectional study found that habitual use of bidets had no impact on the odds of developing hemorrhoids or hemorrhoidal symptoms. One RCT concluded that using bidets was non-inferior to sitz bath for post-hemorrhoidectomy pain. Two prospective trials and 1 cross-sectional study determined that habitual bidet use may increase the odds of developing pruritus ani. Two case series found that habitual bidet use may cause perianal burns or anterior anal fissures. A meta-analysis was not performed because only a limited number of studies were available, and they were of variable quality. Conclusion The current evidence does not identify using bidets as a treatment modality for perianal disease, and further research is warranted to study this increasingly utilized technology.

Prevalence of Sarcopenia in Pain Patients and Correlation Between the Two Conditions: A Systematic Review and Meta-Analysis.

Sarcopenia is a generalized and progressive skeletal muscle disorder and has been proven to be associated with many diseases; however, the correlation between sarcopenia and pain has not yet been systematically clarified. This review aimed to investigate the prevalence of sarcopenia in patients with pain and to ascertain whether pain is independently associated with sarcopenia. Systematic review and meta-analysis. A systematic literature search was performed from the Cochrane Central Register of Controlled Trials, Embase, MEDLINE and Epub Ahead of Print, In-Process, In-Data-Review, and Other Non-Indexed Citations, Daily and Versions for observational studies from inception until February 2021, and our search was updated on December 31,2021. Sarcopenia prevalence was calculated according to the corresponding number of patients with sarcopenia and pain. We performed meta-analyses with random effects models to calculate the pooled prevalence of sarcopenia in pain and its correlations. Subgroup analyses were also performed based on pain classification, pain location, and diagnostic criteria for sarcopenia. Heterogeneity between the studies was described using the I2 statistic. Fourteen observational studies (13,953 participants, 44% women, and mean age from 40.1 to 76.6years) were included. Study quality was rated moderate to high. The overall sarcopenia prevalence in patients with pain was 0.11 (95% CI 0.07-0.15, P < .001; I2= 92.3%). People with pain were independently associated with a higher risk of sarcopenia than those without pain [odds ratio (OR) 1.35; 95% CI 1.17-1.56; P= .025; I2= 51.1%]. Subgroup analyses showed that the cumulative prevalence and effect measures of sarcopenia were increased when individuals suffered secondary musculoskeletal pain(Prevalence= 12%; OR 1.45; 95% CI 1.19-1.78) and low back pain (Prevalence= 21%; OR 1.95; 95% CI 1.22-3.12). The prevalence of sarcopenia in patients with pain is relatively high, and pain is significantly associated with sarcopenia in older adults. Attention is needed to screen sarcopenia among patients with pain and optimize its early detection and management in clinical practice.

Injectable Biologics for Neuropathic Pain: A Systematic Review

Neuropathic pain is a complex condition that can be refractory to conventional management and can cause persistent suffering in patients. Current pharmacologic treatments can provide temporary symptomatic relief; however, the mechanism of these therapies does not address the underlying cause of neuropathic pain. The use of injectable biologics for neuropathic pain has multiple proposed mechanisms for analgesia including attenuation of inflammatory mediated processes, arrest or delay of the degenerative process, inhibition of apoptotic pathways, and augmentation of the survival and recovery of injured and uninjured nerves. A systematic review of human studies involving the use of injectable biologics for neuropathic pain. A comprehensive search of several data bases including Ovid MEDLINE ® and Epub Ahead of Print, In Process & Other Non-Indexed Citations and Daily, and Ovid Embase from inception to November 24, 2020. The initial search yielded 3,450 studies with an additional 6 studies identified through other resources. Twenty-seven studies were included after independent review by two of the investigators. The included studies assessed the efficacy of injectable biologics for the treatment of neuropathic pain defined as pain reduction. Secondary outcome measures included functional improvement as well as safety of the procedures. A qualitative assessment of the literature without meta-analysis was performed due to the heterogeneity of the data. According to the GRADE criteria, there is very low certainty of evidence in support of the efficacy of injectable biologics for treatment of neuropathic pain. Future efforts should focus on creating a standardized methodology and study design with respect to preparation, dosage and route of administration of biologics. This will serve as a catalyst for higher quality randomized trials with generation of more useful data to help drive informed clinical decision making.

The Impact of Health Information Technology for Early Detection of Patient Deterioration on Mortality and Length of Stay in the Hospital Acute Care Setting: Systematic Review and Meta-Analysis.

To evaluate the impact of health information technology (HIT) for early detection of patient deterioration on patient mortality and length of stay (LOS) in acute care hospital settings. We searched MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from 1990 to January 19, 2021. We included studies that enrolled patients hospitalized on the floor, in the ICU, or admitted through the emergency department. Eligible studies compared HIT for early detection of patient deterioration with usual care and reported at least one end point of interest: hospital or ICU LOS or mortality at any time point. Study data were abstracted by two independent reviewers using a standardized data extraction form. Random-effects meta-analysis was used to pool data. Among the 30 eligible studies, seven were randomized controlled trials (RCTs) and 23 were pre-post studies. Compared with usual care, HIT for early detection of patient deterioration was not associated with a reduction in hospital mortality or LOS in the meta-analyses of RCTs. In the meta-analyses of pre-post studies, HIT interventions demonstrated a significant association with improved hospital mortality for the entire study cohort (odds ratio, 0.78 [95% CI, 0.70-0.87]) and reduced hospital LOS overall. HIT for early detection of patient deterioration in acute care settings was not significantly associated with improved mortality or LOS in the meta-analyses of RCTs. In the meta-analyses of pre-post studies, HIT was associated with improved hospital mortality and LOS; however, these results should be interpreted with caution. The differences in patient outcomes between the findings of the RCTs and pre-post studies may be secondary to confounding caused by unmeasured improvements in practice and workflow over time.

Clinical signs and symptoms of diaper dermatitis in newborns, infants, and young children: A scoping review

RationaleDiaper dermatitis (DD) is a significant problem in the care of newborns, infants, and young children and good recognition of signs and symptoms optimises timely treatment. There is also a need for a standardised set of related descriptors to enable communication between health care providers about diagnosis and treatment. ObjectiveThe study aimed to review the literature for descriptive words to define the clinical signs, symptoms, and characteristics, including anatomical locations and assessment scales or tools, in the newborn, infants and young children population who have been diagnosed with DD. MethodsA systematic review process utilising PRISMA guidelines [1] was conducted using advanced search techniques to analyse the terms from the database thesauri and keywords. Data bases including Ovid MEDLINE® and Epub Ahead of Print, in-Process & Other Non-Indexed Citations, Daily and Versions® were searched from 1946 to March 18, 2021. Cochrane Handbook Searching for and selecting studies were used as a guide and as best practice to conduct the search. ResultsOf the 551 publications originally identified, 55 full text publications were examined and 21 met the inclusion criteria. The wide range of descriptors used in the literature for DD supports the need for a clearer approach to report the signs and symptoms, and the severity, of DD. ConclusionsThese findings point to gaps in the literature, both in recording signs and symptoms of DD and features such as wetness, infection, anatomical location, severity and pain in newborns, infants, and young children. There is a need to develop a robust methodological tool to bridge the gap and link a common terminology on signs and symptoms to support diagnosis of the severity of DD.

Human factors applications in the design of decision support systems for population health: a scoping review

IntroductionPublic health professionals engage in complex cognitive tasks, often using evidence-based decision support tools to bolster their decision-making. Human factors methods take a user-centred approach to improve the design of...

Valuable Informal Bereavement Support Strategies for Bereaved Parents of Stillborn, Young Children, and Adult Children: A Scoping Review.

Background: Informal support of a bereaved parent is common after the loss of a child (stillborn, young or adult child); however, it is not clear which aspects of informal support were perceived to be helpful by the bereaved parent. The aim of this scoping review is to clarify from the standpoint of bereaved parents what are considered helpful and unhelpful characteristics of informal support given by the support network of bereaved parents. Methods: A comprehensive search of databases from 2000 to April 20, 2020 was conducted for clinical studies published in English on informal bereavement support of adult bereaved parents of stillborn to adult children; 52 articles met criteria for the scoping review. The databases included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Ovid PsycINFO, and Scopus. Results: Specific supportive strategies reported by parents as helpful more frequently included talking with other supportive persons felt to be supportive, meeting another person with a similar type of loss, and a loss-specific peer support group. Other support included peer support groups in general, tangible aid, talking with the spouse about the child who died and/or accepting each other's different grieving styles, and remembrance gestures. Specific supportive strategies reported by parents as unhelpful more frequently included feeling of stigma or blame due to type of death or feeling that the type of death was not considered equal to other deaths and platitudes & insensitive comments. Other unhelpful support included talking with others felt to be unsupportive about discussing the loss, others stating a time limit to grief, others actively avoiding or stopping all communication with the bereaved parent, and one spouse not accepting the grieving style of the other or the spouse not willing to discuss the loss. Conclusion: Support focused on supportive verbal and nonverbal communication towards the bereaved parent and tangible aid were noted to be helpful informal support. Feeling stigma for or judged by others due to the type of death or the death not being considered equal (such as in deaths due to suicide and stillborn deaths) to other types of deaths as well as informational support (utilization of clichés/platitudes, advice giving, statements about the process and end point of grieving) were noted to be unhelpful informal support.

Neuroendocrine Neoplasms of the Oropharynx—A Literature Review

<h3>Purpose/Objective(s)</h3> Neuroendocrine neoplasms (NEN) are a diverse group of rare tumors. The most common primary sites are gastrointestinal tract and lung, though these neoplasms can occur throughout the body. Neuroendocrine neoplasms of the head and neck are rare, with those of the oropharynx being especially uncommon. Case studies and small series make up most of the literature on oropharyngeal neuroendocrine tumors, and there is no clear consensus on how to treat these unique cancers. Therefore, we aim to explore the current literature describing neuroendocrine neoplasms of the oropharynx. <h3>Materials/Methods</h3> A comprehensive search of several databases including Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Web of Science, and Scopus from inception to May 19, 2021 was conducted. Inclusion criteria included diagnosis of neuroendocrine neoplasm of the tonsil, base of tongue, soft palate, or posterior pharyngeal wall with histopathology available for review. Cases with distant metastatic disease at presentation, review papers, large database studies, papers not in English, papers without outcomes of interest reported, and conference abstracts were excluded. Information including patient demographics, symptoms at presentation, radiologic findings, diagnostic approach, treatment approach, and outcomes were recorded. <h3>Results</h3> The search resulted in 1,154 papers. After title and abstract screening, 93 papers qualified for full review, with 28 were included ultimately in our review. In these papers, 52 unique cases were identified. The average age at presentation was 62 years. Of the patients identified, 73% were male (n=38), 25% were female (n=13), and 2%were unspecified (n=1). The most common site was the tonsil at 36% (n= 21). This was followed by 35% in the tongue base (n=18), 17% in the oropharynx (unspecified) (n=10), 2% in the soft palate (n=1), and 3% unknown primary sites (n=2). The most common histology was small cell neuroendocrine carcinoma at 45% (n= 26). HPV status was reported in 24 patients, with 75% being HPV positive (n=18) and 25% HPV negative (n=6). Treatment modalities varied, with definitive therapy being the most common, in 19 cases. <h3>Conclusion</h3> Neuroendocrine neoplasms of the head and neck are a rare subtype of oropharyngeal cancer, and there is limited data available to drive treatment. More work is needed to elucidate guidelines for how to treat these rare tumors.