Evidence-based Research Research Articles

Racial Disparities in Sports Cardiology

ImportanceRacial disparities in cardiovascular health, including sudden cardiac death (SCD), exist among both the general and athlete populations. Among competitive athletes, disparities in health outcomes potentially influenced by social determinants of health (SDOH) and structural racism remain inadequately understood. This narrative review centers on race in sports cardiology, addressing racial disparities in SCD risk, false-positive cardiac screening rates among athletes, and the prevalence of left ventricular hypertrophy, and encourages a reexamination of race-based practices in sports cardiology, such as the interpretation of screening 12-lead electrocardiogram findings.ObservationsDrawing from an array of sources, including epidemiological data and broader medical literature, this narrative review discusses racial disparities in sports cardiology and calls for a paradigm shift in approach that encompasses 3 key principles: race-conscious awareness, clinical inclusivity, and research-driven refinement of clinical practice. These proposed principles call for a shift away from race-based assumptions towards individualized, health-focused care in sports cardiology. This shift would include fostering awareness of sociopolitical constructs, diversifying the medical team workforce, and conducting diverse, evidence-based research to better understand disparities and address inequities in sports cardiology care.Conclusions and RelevanceIn sports cardiology, inadequate consideration of the impact of structural racism and SDOH on racial disparities in health outcomes among athletes has resulted in potential biases in current normative standards and in the clinical approach to the cardiovascular care of athletes. An evidence-based approach to successfully address disparities requires pivoting from outdated race-based practices to a race-conscious framework to better understand and improve health care outcomes for diverse athletic populations.

Enriching the evidence base of co-creation research in public health with methodological principles of critical realism

ABSTRACT With the popularity of co-creation research in public health and other fields, there is a need to strengthen its evidence-base by developing a framework based on meta-theoretical principles. The lack of applying meta-theoretical principles in co-creation research impedes the theory- and evidence building. Critical realism seems a promising candidate for providing meta-theoretical principles to enrich the evidence base of co-creation research in public health. To this purpose we searched for relevant papers on critical realism methodological principles, clarified and subsequently applied such principles to a co-creation public health case study. We provide explanatory steps to apply five principles; 1) focusing on understanding an event, like childhood overweight, 2) exploring the broader structure and context surrounding the event, 3) constructing hypotheses about the underlying mechanism(s) of an event, 4) empirical testing to corroborate those hypotheses, and 5) using multiple methods and triangulation. Further, this study shows that critical realism can enrich co-creation research in public health by iteratively building theory and evidence following the five proposed principles.

Building bridges: evaluating policymakers' research capacities, engagement, and utilization in health policymaking within the Kuwaiti context: a cross-sectional study

BackgroundHealth policymaking is a critical aspect of governmental decision-making that shapes the well-being of populations. In the Middle East and North Africa, particularly in Kuwait, limited attention has been given to exploring the research capacities, engagement, and utilization among health policymakers. This study aims to bridge this gap by investigating how Kuwaiti health policymakers incorporate evidence-based research into the formulation of health-related policies.MethodsThis cross-sectional study targeted health policymakers in leadership positions within the Kuwait Ministry of Health (MOH). Using the Seeking, Engaging with and Evaluating Research (SEER) questionnaire, participants' capacities, engagement, and use of research were assessed. The targeted sample was all health policymakers in leadership positions, starting from the head of departments and above. The questionnaire comprises four domains, 14 sections, and 50 questions and utilizes Likert and binary scales, with aggregate scores predicting engagement actions and research use. The data were collected between March and July 2023. All the statistical analyses were performed using SPSS v27, and the numerical and categorical variables were analyzed using appropriate statistical tests, including t-tests, ANOVA, and Pearson's correlation.ResultsOut of 205 policymakers, 88 participated (42.9% response rate): predominantly male (51.1%) and married (78.4%). The mean age was 49.84 ± 7.28 years, with a mean MOH tenure of 24.39 ± 6.80 years. Participants demonstrated high value for research (mean score 4.29 ± 0.55) and expressed confidence in the research utilization. Organizational emphasis on research use exhibited nuanced perceptions, identifying areas where MOH support may be lacking. Access to research resources and processes for policy development guidance were highlighted as challenges.ConclusionsThis study provides crucial insights into the research capacities and engagement of Kuwaiti health policymakers. It emphasizes the need for targeted interventions to align individual perceptions with organizational expectations, address confidence disparities, and enhance collaborative efforts. Organizational investments are crucial for fostering a dynamic research ecosystem to improve evidence-based policy development in Kuwait's healthcare landscape.

Advancing Black Men’s Type 2 Diabetes Healthcare Through Addressing Gender-centered Social Norms, Cognitive Scripts, and Manhood: An Integrated Public Health Approach for Reducing T2D Disparities

ABSTRACT In the United States, the burden of type 2 diabetes (T2D) health complications and outcomes is higher in Black men, and the diabetes disparities are escalating. Previous evidence-based research underscored the need to explore gender-specific experiences of chronic illness in social-cultural, historical, and clinical contexts. Our community-engaged qualitative study focused on learning from the live experiences of Black men (n = 15) in the Arkansas Delta area. Applying a narrative approach, we explored and learned from the participants about their perception of the consequences of T2D on manhood and the usefulness of T2D management instructions. Findings indicate that an integrated public health approach contextualizes social-cultural norms, cognitive scripts, and gender-centered expressions of manhood, a promising direction in T2D healthcare; social support is essential for emotional and physical help in continued T2D management; and connecting with Black men and their insights are vital to develop relevant and appropriate guidelines for T2D management care.

Peer creation and sharing of mnemonics in collaborative documents for pathology education: a pilot study

BackgroundMnemonic techniques are memory aids that could help improve memory encoding, storage, and retrieval. Using the brain's natural propensity for pattern recognition and association, new information is associated with something familiar, such as an image, a structure, or a pattern. This should be particularly useful for learning complex medical information. Collaborative documents have the potential to revolutionize online learning because they could increase the creativity, productivity, and efficiency of learning. The purpose of this study was to investigate the feasibility of combining peer creation and sharing of mnemonics with collaborative online documents to improve pathology education.MethodsWe carried out a prospective, quasi-experimental, pretest–posttest pilot study. The intervention group was trained to create and share mnemonics in collaborative documents for pathological cases, based on histopathological slides. The control group compared analog and digital microscopy.ResultsBoth groups consisted of 41 students and did not reveal demographic differences. Performance evaluations did not reveal significant differences between the groups' pretest and posttest scores. Our pilot study revealed several pitfalls, especially in instructional design, time on task, and digital literacy, that could have masked possible learning benefits.ConclusionsThere is a gap in evidence-based research, both on mnemonics and on CD in pathology didactics. Even though, the combination of peer creation and sharing of mnemonics is very promising from a cognitive neurobiological standpoint, and collaborative documents have great potential to promote the digital transformation of medical education and increase cooperation, creativity, productivity, and efficiency of learning. However, the incorporation of such innovative techniques requires meticulous instructional design by teachers and additional time for students to become familiar with new learning methods and the application of new digital tools to promote also digital literacy. Future studies should also take into account validated high-stakes testing for more reliable pre-posttest results, a larger cohort of students, and anticipate technical difficulties regarding new digital tools.

Examining research motivation, self-efficacy, and anxiety in TEFL graduate students: a structural equation modelling approach

ABSTRACT Applied linguistics has recently seen a surge in research and methodological approaches to do stronger studies. One important factor affecting such a new movement is the researchers’ individual differences in shaping their research repertoire. Therefore, this study, which employs a path-analytic approach, investigates the interrelationship between three significant individual factors in the EFL (English as a Foreign Language) context: research self-efficacy, anxiety, and motivation. This nationwide survey included 561 male and female Iranian MA students studying TEFL (Teaching English as a Foreign Language). The researchers administered three adopted instruments, namely the research motivation scale, the research anxiety scale, and the research self-efficacy scale. The path-analytic findings revealed such interrelationships among the three factors. In particular, the findings indicated that there is a negative relationship between research anxiety and motivation to conduct research. In our study, however, the relationship between research self-efficacy and motivation is positive. These evidence-based findings can help policymakers shape an evidence-based research policy. Recommendations and implications of the results for policymakers, research methodologists, research instructors, and MA students are discussed.

Methods to Disseminate Nursing Research: A Brief Overview.

Editor's note: This is the 22nd article in a series on clinical research by nurses. The series is designed to be used as a resource for nurses to understand the concepts and principles essential to research. Each column will present the concepts that underpin evidence-based practice-from research design to data interpretation. To see all the articles in the series, go to https://links.lww.com/AJN/A204.

Preservation Rhinoplasty by the Ones Who Do It: A Worldwide Survey.

Dorsal preservation (DP) rhinoplasty techniques, including surface techniques (STs) and foundation techniques (FTs) have garnered significant attention internationally over the past few years. The practice patterns and opinions from 117 of these surgeons were surveyed from a cohort of these surgeons who participate in an online Evidence-Based Rhinoplasty Research Group. The findings of the survey are merely a snapshot of the international rhinoplasty community's practices, yet did capture data from surgeons from a diverse geographic, years of experience, and training background. STs were most used for the bone changes, and the high-strip technique was preferred for the cartilaginous septal surgery. STs are mostly performed by younger surgeons (<10 years of experience), whereas FTs were more common in older surgeons (10-30 years of experience). STs were considered more stable (p < 0.001), more predictable (p < 0.001), and associate with a shorter learning curve (p = 0.015). Revision surgery rates were not different. Regarding why many surgeons using DP still perform structural rhinoplasty, the most cited concern was hump persistence/recurrence. In summary, among surgeons using DP rhinoplasty techniques, the majority perform DP in over half of their primary rhinoplasty surgeries, highlighting the importance of updating educational programs in medical training, conferences, and courses.

A New Paradigm in the Management of Scalp Pruritus: Findings From the SCALP-PR Trial

PurposeThe “Impact of scalp pruritus in dermatological consultations in Spain: The SCALP-PR trial” was initiated to address the common yet often insufficiently examined issue of scalp pruritus in dermatology. This condition leads to an uncontrollable urge to scratch, affecting the patients’ quality of life and potentially causing scalp damage. This study aimed to explore the prevalence, patient profile, underlying conditions, and therapeutic approaches for scalp pruritus in Spain, and to assess the safety and efficacy profile, as well as the tolerability of a non-pharmacologic treatment. MethodsFrom 2021 through 2022, 75 dermatologists enrolled a total of 359 patients in a study on scalp pruritus, approved by the Bellvitge University Hospital Research Ethics Committee, Barcelona, Spain. This evidence-based research combined a meta-analysis with observational study techniques focused on real-world evidence to examine the therapeutic impact on quality of life (QoL). Utilizing the Dermatology Life Quality Index (DLQI) for QoL assessments, the study evaluated the effectiveness of the topical product over 15 days. Data collection was conducted via an eCRF and analyzed with statistical methods to provide reliable insights into the management of scalp pruritus. ResultsThe prevalence of scalp pruritus in Spain was found to be 6.9%, predominantly among women with a mean age of 52.5 years. The leading causes identified were seborrheic dermatitis and pruritus of undetermined etiology or sensitive scalp. Stress was noted as a key factor, with corticosteroids and hygienic measures being common therapies. The topical product demonstrated significant reductions in pruritus and scratching in more than 90% of patients after 15 days. Improvements were also seen in dermatological quality of life, with 87.1% of patients showing enhancements in DLQI scores. The product was well-received thanks to its cosmetic properties, with high ratings in texture, ease of application, and fragrance. ConclusionThe topical product studied is a safe, effective, and cosmetically appealing treatment, improving scalp pruritus in various etiologies for most patients. The results highlight the need for patient-center treatments in dermatology, providing important insights for clinical practice and future research.

Interventions Addressing Symptoms in Older Adults with Multimorbidity: An Umbrella Review.

This umbrella review was to synthesize the summarized evidence-based research regarding interventions addressing symptoms in older populations with multimorbidity. Three databases including PsycINFO, MEDLINE, and CINAHL were searched systematically. The JBI Methodology for Umbrella Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements were used to report this review. Six reviews published between 2016 and 2010 were included for analysis. Interventions were mixed and included components on health-related behaviors, body systems or functions, activities and participation domains, and the environment. Outcomes concerning physiological/clinical functioning were most reported. The evidence regarding the symptoms-related interventions was mixed, but all showed promising outcomes compared with usual care or not. To sum up, this umbrella review reveals the lack of strong empirical evidence for the effectiveness of intervention addressing symptoms in older adults with multimorbidity. It highlights the need to evaluate the established approach of interventions further to support this population.

Integrating energy strategies and urban planning: overcoming challenges for collective energy initiatives

ABSTRACT The study advocates for a qualitative research design to address knowledge gaps regarding Collective Energy Initiatives (CEIs), utilising evidence-based research and a maximum variation principle. Focused on EU countries, the study employs desk research and surveys to identify stages of CEI development and explore impactful practices. It examines initiatives aligned with EU Directives and broader energy transition efforts, categorising them by complexity. Through surveys, the study identifies drivers and barriers to coalition phenomena, aiming to enhance understanding of energy policies’ impact. This approach responds to the need for comprehensive investigations into energy initiatives’ impediments and facilitators, aligning with recent calls for research in this area.

Hypes in undergraduate thesis abstracts by Indonesian students across years

Previous studies showed that as a result of intense competition to succeed in academic pursuits such as publishing research papers and securing grants, promotional language known as hypes are pervasive in academic texts. This paper investigates hypes in a corpus of undergraduate thesis abstracts written by Indonesian English learners in a span of ten years, from 2011 to 2020. Taking a corpus-based approach, it examines the extent to which hypes are used in the thesis abstracts, including their linguistic manifestations, frequencies over the years, and the values they promote. We found hypes in all five moves of thesis abstracts, but they were most frequent in the introduction, in which they emphasized the importance and novelty of the research and stress the urgency of the research problems. In the span of the ten years, the frequencies of hypes generally increase, indicating the students’ awareness of the need to convince thesis supervisors, board of examiners, and their colleagues and the efforts to stand out in a competitive academic landscape. Important, investigate, and reveal were the most frequent hype words over the years and their instances suggest a growing emphasis on significance, a stronger commitment to evidence-based research, and desire to contribute new and concrete findings.

Towards resilient communities through prototypes for human-centered public spaces

MARCELLA DEL SIGNORE Architect, urbanist, educator, scholar, and the principal of X-Topia, a design-research practice that explores the intersection of architecture and urbanism with technology and the public, social, cultural, and cognitive realm. She has been involved in evidence-based research and applied-design projects investigating the intersection of architecture, urbanism,emerging technology, livability, and emotional/cognitive spaces. She is an Associate Professor and Director of the Master of Science in Architecture, Urban Design at New York Institute of Technology. Since 2007, she has taught Architecture and Urban Design in international institutions of higher education in the USA and Europe, and in 2019 she received the NYIT Presidential Award for the integration of Technology and in 2023 the Outstanding Faculty Research Award. She has published five books on urbanism, human-centered design, and emerging technologies, including Urban Machines: Public Space in a Digital Culture (LISTLab, 2018; OROEditions 2020) and "Data, Matter, and Design" (Routledge, 2020). She co-curated the Data and Matter exhibition during the 2018 Architecture Venice Biennale. She was invited to exhibit at the 17th Architecture Venice Biennale in 2021 in the Italian Pavilion Resilient Communities, and she was the deputy curator of the NYIT Students as Researchers Collateral Event at the 18th Architecture Venice Biennale in 2023.

Perception of Tourists on Chatbot Service Usage on Tourism Destination: A Study of Kainji Lake National Park, Nigeria

Quest for satisfying tourists and customers’ expectations across the globe led to the development and application of various information communication technologies (ICT) in the hospitality and tourism industry. These information communication technologies have been adopted by tourism enterprises and managers such as Email, Mobile Phone, Social Media Networking (Facebook, WhatsApp, Zoom, Artificial Intelligence). Also, the quest for providing friendly interaction among tourists and destination managers further led to the development of one of the artificial intelligence algorithms known as chatbot. Chatbots are Artificial Intelligence (AI) test and/or voice-based virtual assistants that aid customers to get what they ask for quickly and accurately through a conversation in natural human language. Chatbots have been reported to be the technology for hotels, travel agencies, and airlines, however, there is no evidence-based research on the factors that explain consumers’ willingness to interact with chatbots. It is on this basis that this research is carried out. The research examined tourists’ usage of chatbots, focusing on the Kainji Lake Park (Nigeria). It is an exploratory research that utilized descriptive statistics to analyze data collected. The findings reveal that tourists are aware of the existence of chatbots as deployed to tourism industry. Also, it found that chatbots enhance destination information search. As an emerging market, stakeholders and management in the tourism industry should integrate chatbots into their main information communication technologies to enhance customer patronage.

Jellyfish Stings: A Review of Skin Symptoms, Pathophysiology, and Management.

With the surge in the human coastal population and the increasing frequency of human activities along the coast, cases of marine envenomation, particularly jellyfish envenomation, have notably risen. Jellyfish stings can induce a spectrum of symptoms that vary in severity, encompassing skin injuries, acute systemic venom effects, delayed indirect sequelae, and even fatality, causing significant distress to patients. Among these manifestations, the occurrence of skin lesions following jellyfish stings is prevalent and substantial. These lesions are characterized by evident blister formation, development of bullae, subcutaneous hemorrhage, erythema, papules, wheal, ecchymosis, and ulceration or skin necrosis. Local cutaneous manifestations may persist for several weeks or even months after the initial sting. Despite aggressive treatment, many skin injuries still result in significant pigmentation or scarring after recovery. To address this issue effectively, it is imperative to conduct comprehensive evidence-based medical research, elucidate various components within jellyfish venom, and elucidate its pathogenic mechanism to develop targeted treatment programs. This article aims to review the skin symptoms, pathophysiology, and management of jellyfish stings. Such considerations can provide comprehensive guidance to medical professionals and the public and minimize the harm caused by jellyfish stings.

Standardizing the diagnosis and treatment of ocular hypertension based on evidence-based medicine

Ocular hypertension (OHT) refers to a condition in which the intraocular pressure increases without causing glaucomatous optic nerve changes or visual field damage. The incidence rate of OHT in people over 40 years old is as high as 4% to 10%. According to the OHT Treatment Study (OHTS), the incidence of primary open angle glaucoma (POAG) among OHT patients is increasing year by year, so it is necessary to conduct long-term follow-up. This article elaborates on five major risk factors for the progression of OHT to POAG: age, intraocular pressure, vertical cup-disc ratio, pattern standard deviation of visual field, and central corneal thickness. It also summarizes other potential risk factors, such as long-term fluctuations in intraocular pressure, asymmetry of intraocular pressure and visual field between the two eyes, structural phenotypes of the optic disk, and optic disk hemorrhage. Predicting the risk of OHT progression to POAG based on risk factors, patients with different risk levels require different timing for treatment initiation and follow-up intervals. Those with higher risks should start preventive treatment earlier and have shorter follow-up intervals. Both drug therapy and selective laser trabeculoplasty can serve as initial treatment options for OHT. Combining evidence-based medicine research and individualized evaluation of treatment can enhance the clinical diagnosis and treatment level of OHT.

Guidelines for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (2024 edition)

Chronic thromboembolic pulmonary hypertension (CTEPH) is classified as group 4 pulmonary hypertension, characterized by pulmonary arterial thrombotic occlusion leading to vascular stenosis or obstruction, progressive elevation of pulmonary vascular resistance and pulmonary arterial pressure, ultimately leading to right heart failure and even death. Recent years have seen rapid progress in the diagnostic and therapeutic in CTEPH field. More and more patients with CTEPH have been accurately diagnosed and assessed in time. Nevertheless, there is still a lot of work to do in the popularization of CTEPH diagnostic and therapeutic technique and the building of CTEPH expert center. To better guide clinical practice in our country, Pulmonary Embolism & Pulmonary Vascular Diseases Group of the Chinese Thoracic Society, Pulmonary Embolism & Pulmonary Vascular Disease Working Group of Chinese Association of Chest Physicians, National Cooperation Group on Prevention & Treatment of Pulmonary Embolism & Pulmonary Vascular Disease, National Expert Panel on the Development of a Standardized Framework for Pulmonary Arterial Hypertension, convened multidisciplinary experts for deliberation and Delphi expert consensus to develop the "Guidelines for the Diagnosis and Treatment of Chronic Thromboembolic Pulmonary Hypertension (2024 edition) ". These guidelines systematically evaluate domestic and international evidence-based medical research on CTEPH and propose recommendations tailored to clinical practice in our country. The key areas covered include definitions, epidemiology, pathogenesis, diagnosis and assessment, treatment, and management, with the aim of further standardizing the clinical diagnosis and treatment of CTEPH in our country.

The new frontier: utilizing ChatGPT to expand craniofacial research.

Due to the importance of evidence-based research in plastic surgery, the authors of this study aimed to assess the accuracy of ChatGPT in generating novel systematic review ideas within the field of craniofacial surgery. ChatGPT was prompted to generate 20 novel systematic review ideas for 10 different subcategories within the field of craniofacial surgery. For each topic, the chatbot was told to give 10 "general" and 10 "specific" ideas that were related to the concept. In order to determine the accuracy of ChatGPT, a literature review was conducted using PubMed, CINAHL, Embase, and Cochrane. In total, 200 total systematic review research ideas were generated by ChatGPT. We found that the algorithm had an overall 57.5% accuracy at identifying novel systematic review ideas. ChatGPT was found to be 39% accurate for general topics and 76% accurate for specific topics. Craniofacial surgeons should use ChatGPT as a tool. We found that ChatGPT provided more precise answers with specific research questions than with general questions and helped narrow down the search scope, leading to a more relevant and accurate response. Beyond research purposes, ChatGPT can augment patient consultations, improve healthcare equity, and assist in clinical decisionmaking. With rapid advancements in artificial intelligence (AI), it is important for plastic surgeons to consider using AI in their clinical practice to improve patient-centered outcomes.

Osteopathy as a field of scientific knowledge: the path to evidence-based research

Osteopathy as a field of scientific knowledge: the path to evidence-based research

Designing Novel Endodontic Implants and Evaluation of the Stress Distribution in Maxillary Anteriors Using Finite Element Analysis.

Introduction Endodontic implants, or didontic implants, offer a promising solution for stabilizing compromised teeth with a guarded prognosis and prolonging their clinical survival rate. Despite their potential benefits, they retired out of practice due to failures that arose from the lack of a biocompatible seal and engaging in dentin. Novel designs, based on evidence-based research with the help of bioceramics, present an opportunity to overcome these challenges andhence, enhance the clinical efficacy of endodontic implants. Thus the aim of this study is to design novel endodontic implants and evaluate their stress distribution in maxillary incisors using finite element analysis (FEA). Materials and methodology FEAis a biomechanical study to assess the stress distribution and extent of displacementto assess the clinical efficacy of novel endodontic implants in maxillary anterior teeth. Three 3D models (Model 1, Model 2, and Model 3)are designed to be meshed, and material elastic properties of the tooth and periapical tissues are applied. Boundary conditions were established, and a constant axial load value of 600 N was applied at a 45° angle. The FEA analysis was done under the loading conditions to assess the stress patterns for the three 3D models in comparison to the intact tooth on the ANSYS software (ANSYS Inc, Pennsylvania). Results FEA simulations revealed the distribution of stress within the tooth structure under functional occlusal forces, as Von Misses stresses were analyzed to assess the likelihood of material yielding and failure, which was comparable to that of an intact tooth. The maximum stress of deformation was as follows: intact: 1.7589e-5 MAX; Model 1:3.3804e-6 MAX; Model 2:2.638e-5 MAX; and Model 3: 2.1986e-5 MAX. The area of stress concentrations did not occur at the interface of the coronal or apical seal, which prevented catastrophic failures. Conclusion By leveraging advanced design principles and materials, these implants offer a promising alternative to traditional approaches,particularlyin trauma cases with a poor prognosis for the survival of the teeth leading to loss of tooth. Further clinical studies are warranted to validate the efficacy and long-term success of these novel endodontic implants in diverse patient populations.