Final Literature Search Research Articles

Systematic review of clinical guidelines and consensus statements concerning heparin and protamine dosing and monitoring of anticoagulation levels for non-cardiac arterial procedures.

This systematic review was performed to examine all published practice Guidelines and Consensus Statements (together: GCS) on heparin dosing and monitoring during non-cardiac arterial procedures (NCAP). The objective was to scrutinize the recommendations and advice outlined within these GCS documents and to evaluate the supporting evidence for these recommendations. Additionally, the use of the activated clotting time (ACT) and target ACT values were explored. This systematic review was performed in accordance with the PRISMA Guidelines. Medline and Embase databases were searched to identify all GCSs in the English language on NCAP. The final literature search was performed in January 2023. This search was supplemented by searching websites of relevant professional vascular surgical organizations for GCSs. Titles and abstracts were assessed by two independent reviewers. Of 9716 titles identified, 27 GCSs met the predefined inclusion criteria: six GCSs regarding carotid intervention, seven regarding procedures for aneurysmal disease of the abdominal aorta and iliac arteries, 12 regarding interventions for acute and chronic peripheral arterial occlusive disease and two regarding open and endovascular interventions of thoraco-abdominal aortic aneurysms. Administration of heparin is advised for al NCAP. There was high variability concerning heparin dose: both standard dose as weight based dosing (30-150 IU/kg) was advised. Recommendations on repeated doses, ACT monitoring and heparin reversal using protamine also varied widely. In none of the GCSs, the type of the ACT measuring device or used cartridges were specified. Large variability was found between the included GCSs with regard to the recommendations on heparin dose and target ACT values during NCAP. Advice and recommendations in GCSs were based on low-quality studies or without providing any reference at all. The described variability in recommendations emphasizes the need for large prospective (randomized) studies or the incorporation of data on heparin and the use of ACT monitoring into verified vascular surgery registries, to develop evidence-based, practical and uniform applicable recommendations.

Consequences of COVID-19 Vaccine Hesitancy Among Healthcare Providers During the First 10 Months of Vaccine Availability: Scoping Review.

Throughout the COVID-19 pandemic, healthcare providers (HCPs)-including nurses-have played important roles in the vaccination effort. It is expected that COVID-19 vaccine hesitancy among HCPs has numerous consequences; however, the scope of these consequences and their impacts on providers, patients, and the broader healthcare system remained unclear. To identify existing and emerging evidence to understand the state of knowledge of the consequences of COVID-19 vaccine hesitancy among HCPs. A scoping review was completed based upon the JBI scoping review methodology. The databases searched included OVID Medline, EBSCOhost CINAHL, ProQuest Nursing and Allied Health Source, ProQuest APA PsycInfo, and ProQuest Dissertations and Theses. The final literature search was completed on June 2, 2022. Studies were screened and retrieved based on predefined inclusion and exclusion criteria using Covidence reference management software. Data extraction followed criteria recommended in the JBI scoping review framework with additional relevant variables identified by the authors. A total of 33 sources were included in the review. Consequences of HCP COVID-19 vaccine hesitancy were grouped under three themes and seven subthemes. Consequences affecting HCPs included health-related, psychosocial, and employment-related consequences. Consequences affecting patients pertained to COVID-19 vaccination communication and COVID-19 vaccination practices of HCPs. Consequences to the healthcare system involved consequences to coworkers and employment/attendance/staffing-related consequences. Healthcare provider COVID-19 vaccine hesitancy was found to have numerous consequences. By understanding the scope and extent of these consequences, healthcare leaders, researchers, and HCPs can work together to protect providers, patients, and healthcare systems.

Use of Computerized Physician Order Entry with Clinical Decision Support to Prevent Dose Errors in Pediatric Medication Orders: A Systematic Review.

Prescribing is a high-risk task within the pediatric medication-use process and requires defenses to prevent errors. Such system-centric defenses include electronic health record systems with computerized physician order entry (CPOE) and clinical decision support (CDS) tools that assist safe prescribing. The objective of this study was to examine the effects of CPOE systems with CDS functions in preventing dose errors in pediatric medication orders. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 criteria and Synthesis Without Meta-Analysis (SWiM) items. The study protocol was registered in PROSPERO (CRD42021277413). The final literature search on MEDLINE (Ovid), Scopus, Web of Science, and EMB Reviews was conducted on 10 September 2023. Only peer-reviewed studies considering both CPOE and CDS systems in pediatric inpatient or outpatient settings were included. Study selection, data extraction, and evidence quality assessment (JBI critical appraisal tool assessment and GRADE approach) were carried out by two individual reviewers. Vote counting method was used to evaluate the effects of CPOE-CDS systems on dose errors rates. A total of 17 studies published in 2007-2021 met the inclusion criteria. The most used CDS tools were dose range check (n = 14), dose calculator (n = 8), and dosing frequency check (n = 8). Alerts were recorded in 15 studies. A statistically significant reduction in dose errors was found in eight studies, whereas an increase of dose errors was not reported. The CPOE-CDS systems have the potential to reduce pediatric dose errors. Most beneficial interventions seem to be system customization, implementing CDS alerts, and the use of dose range check. While human factors are still present within the medication use process, further studies and development activities are needed to optimize the usability of CPOE-CDS systems.

Fat embolism: the hidden murder for trauma patients!

fat embolism syndrome (FES) is an acute respiratory disorder that occurs when an inflammatory response causes the embolization of fat and marrow particles into the bloodstream. The exact incidence of FES is not well defined due to the difficulty of diagnosis. FES is mostly associated with isolated long bone trauma, and it is usually misdiagnosed in other trauma cases. The scope of this study was to identify and search the current literature for cases of FES in nonorthopedic trauma patients with the aim of defining the etiology, incidence, and main clinical manifestations. we perform a literature search via the PubMed journal to find, summarize, and incorporate reports of fat embolisms in patients presenting with non-orthopedic trauma. the final literature search yielded 23 papers of patients presenting with fat embolism/FES due to non-orthopedic trauma. The presentation and etiology of these fat embolisms is varied and complex, differing from patient to patient. In this review, we highlight the importance of maintaining a clinical suspicion of FES within the trauma and critical care community. to help trauma surgeons and clinicians identify FES cases in trauma patients who do not present with long bone fracture, we also present the main clinical signs of FES as well as the possible treatment and prevention options.

Predictors requiring special attention to prevent clavicle fracture nonunion: a systematic review of literature

BackgroundClavicle fracture (CF) is the tenth most prevalent fracture, accounting for an annual incidence of 37/10,000. This systematic review highlights the factors contributing to the nonunion union of the clavicular...

Systematic Review and Meta-Analysis of Efficiency and Safety of Double-Lumen Tube and Bronchial Blocker for One-Lung Ventilation.

One-lung ventilation is also used in some thoracic or cardiac surgery, vascular surgery and oesophageal procedures. We conducted a search of the literature for relevant studies in PubMed, Web of Science, Embase, Scopus and Cochrane Library. The final literature search was performed on 10 December 2022. Primary outcomes included the quality of lung collapse. Secondary outcome measures included: the success of the first intubation attempt, malposition rate, time for device placement, lung collapse and adverse events occurrence. Twenty-five studies with 1636 patients were included. Excellent lung collapse among DLT and BB groups was 72.4% vs. 73.4%, respectively (OR = 1.20; 95%CI: 0.84 to 1.72; p = 0.31). The malposition rate was 25.3% vs. 31.9%, respectively (OR = 0.66; 95%CI: 0.49 to 0.88; p = 0.004). The use of DLT compared to BB was associated with a higher risk of hypoxemia (13.5% vs. 6.0%, respectively; OR = 2.27; 95%CI: 1.14 to 4.49; p = 0.02), hoarseness (25.2% vs. 13.0%; OR = 2.30; 95%CI: 1.39 to 3.82; p = 0.001), sore throat (40.3% vs. 23.3%; OR = 2.30; 95%CI: 1.68 to 3.14; p < 0.001), and bronchus/carina injuries (23.2% vs. 8.4%; OR = 3.45; 95%CI: 1.43 to 8.31; p = 0.006). The studies conducted so far on comparing DLT and BB are ambiguous. In the DLT compared to the BB group, the malposition rate was statistically significantly lower, and time to tube placement and lung collapse was shorter. However, the use of DLT compared to BB can be associated with a higher risk of hypoxemia, hoarseness, sore throat and bronchus/carina injuries. Multicenter randomized trials on larger groups of patients are needed to draw definitive conclusions regarding the superiority of any of these devices.

Diagnostic accuracy of SARS-CoV-2 antigen test in the pediatric population: A systematic review and meta-analysis.

BackgroundSevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused the global coronavirus disease 2019 (COVID-19) pandemic. Rapid identification and isolation of patients infected with SARS-CoV-2 are critical methods for blocking COVID-19 transmission. The advantages of antigen tests, such as their relatively low cost and short turnaround time, can contribute to the prompt identification of infectious individuals. However, the diagnostic accuracy of antigen tests for COVID-19 in children remains inconclusive. This meta-analysis aimed to evaluate the diagnostic performance of antigen tests for SARS-CoV-2 in the pediatric population.MethodsWe conducted a literature search for relevant studies in the PubMed, Embase, Google Scholar, and Biomed Central databases. Studies evaluating the diagnostic accuracy of antigen tests for SARS-CoV-2 in pediatric patients were included. In addition, we included studies that provided sufficient data to construct a 2 × 2 table on a per-patient basis. The final literature search was performed on October 10, 2021. Days after symptom onset, asymptomatic and symptomatic individuals may have been potential sources of heterogeneity. The overall sensitivity and specificity of the antigen tests were generated using a bivariate random-effects model.ResultsFive studies with 4,400 participants were included. The meta-analysis of antigen tests generated a pooled sensitivity of 65.9% (95% CI: 52.8%–77.0%) and pooled specificity of 99.9% (95% CI: 98.9%–100.0%). A subgroup analysis of studies reporting antigen test data for symptomatic patients showed a pooled sensitivity of 64.5% and a pooled specificity of 99.7%. The subgroup analysis of studies that included 881 asymptomatic participants generated a pooled sensitivity of 48.4% and a pooled specificity of 99.5%.ConclusionAntigen tests exhibit moderate sensitivity and high specificity for detecting SARS-CoV-2 in children. Antigen tests might have moderate sensitivity for detecting SARS-CoV-2 in symptomatic children, and serial testing might effectively prevent further SARS-CoV-2 transmission.

Publication of neurology clinical trials registered with clinical trial registry of India: A cross-sectional study.

Unbiased and full disclosure of trial results is vital to evidence-based medicine. Non-publication and selective publication leads to publication bias and unrealistic risk-benefit ratio. In the present study, we aim to determine the publication rate of clinical trials related to neurology registered with the Clinical Trial Registry of India (CTRI), compare the characteristics of published and unpublished trials, and evaluate the adherence of investigators to ethics-approved criteria and outcomes. A cross-sectional search using the keyword "neurology" was carried out in CTRI registry. Two independent investigators searched Pubmed, Medline, Scopus, and Google Scholar for published manuscripts. The final literature search occurred in November 2021. Out of 325 trials, 102 trials were published (31.4%). Ninety-one trials were beyond 3 years of expected time of trial completion and were still unpublished. Randomized trials had a slightly higher publication rate than non-randomized ones (56% vs. 46%, p= .223); however the difference was not statistically significant. Majority of trials sponsored by pharmaceutical companies were not published, while majority of those sponsored by non-pharmaceutical institutions were published (34.5% vs. 69.3%, p< .001). Feedback to CTRI about trial status was particularly poor (31.5% - informed vs. 68.5% - not informed, p< .001). 52 (50.9%) and 65 (63.7%) of the 102 published trials had changed the registered inclusion and exclusion criteria, respectively, in the CTRI registry compared to those in the published manuscript. In 29 (28.3%) of the 102 trials, the primary outcome did not match with that registered in the CTRI andin73 (57.8%) trials, the secondary outcomes did not match. A large proportion of neurology registered trials are still unpublished, with a majority of pharmaceutical company-sponsored trials not being published. There is scope for improving the provisions in CTRI for enlisting trial results, that may prevent publication bias and also ensure the investigators adhere to the pre-specified ethics approved trial procedures and outcomes.

Is cabri 3d software effective for teaching geometry materials? A meta-analysis study in Indonesia

This study aims to examine the effect of Cabri 3D software in teaching geometry material and explore some potential factors moderating the heterogeneity of students' mathematical academic outcomes. A meta-analysis by selecting the random effect model was employed in this study. The final literature search and selection process determined eight journal articles and six proceeding articles published from 2016 to 2021 and indexed by Scopus and Google Scholar. Numerical and categorical data of every document were extracted to a coding sheet. Data were analyzed by using the Z-test and the Q Cochran test. The tests were assisted by the Comprehensive Meta-Analysis (CMA) software. The result showed that the overall effect size of the Cabri 3D software in teaching geometry materials was g = 0,635. It meant that Cabri 3D software posed a moderately positive effect on students' mathematical learning outcomes in geometry learning. Moreover, Cabri 3D software was significantly effective for teaching geometry material. Some potential factors, such as education level, participant number, and treatment duration, did not moderate the heterogeneity of students' mathematical academic outcomes. This study suggests that mathematics teachers or lecturers utilize Cabri 3D software to teach geometry materials.

Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment.

This systematic review provides supporting evidence for the accompanying clinical practice guideline on the treatment of central disorders of hypersomnolence in adults and children. The review focuses on prescription medications with U.S. Food & Drug Administration approval and nonpharmacologic interventions studied for the treatment of symptoms caused by central disorders of hypersomnolence. The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine to perform a systematic review. Randomized controlled trials and observational studies addressing pharmacological and nonpharmacological interventions for central disorders of hypersomnolence were identified. Statistical analyses were performed to determine the clinical significance of all outcomes. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process was used to assess the evidence for the purpose of making specific treatment recommendations. The literature search identified 678 studies; 144 met the inclusion criteria and 108 provided data suitable for statistical analyses. Evidence for the following interventions is presented: armodafinil, clarithromycin, clomipramine, dextroamphetamine, flumazenil, intravenous immune globulin (IVIG), light therapy, lithium, l-carnitine, liraglutide, methylphenidate, methylprednisolone, modafinil, naps, pitolisant, selegiline, sodium oxybate, solriamfetol, and triazolam. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations. Maski K, Trotti LM, Kotagal S, etal. Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021;17(9):1895-1945.

Association Between the Age of Solid Food Introduction and Eczema: A Systematic Review and a Meta-analysis

To review all available literature to determine if the timing of solid food introduction influences the risk of atopic eczema. Cow’s milk was purposely excluded in this review because it is not given as a solid food.Children enrolled in 11 cohort studies, 2 case controls, 1 cross-sectional study, and 2 randomized controlled trials were included.PubMed and Embase databases were searched using the key words solid food, complementary and allergenic food introduction, and eczema, with the final literature search performed on February 18, 2017. Two authors independently assessed all applicable English-language human studies and performed data extraction. Cohort studies, case-controlled studies, cross-sectional studies, and randomized controlled trials containing original data were included in this review.A total of 1414 articles were initially identified; after removal of duplicates, 1092 articles underwent title and abstract screening, with 987 articles being excluded. The remaining 105 articles underwent full text review, and 89 articles were excluded. A total of 17 articles met the inclusion criteria: 11 were cohort studies (1 cohort study generated 2 publications), 2 were case controls, 1 was a cross-sectional study, and 2 were randomized controlled trials. In the 2 randomized controlled trials, researchers examined early egg introduction; in 1 of these studies, researchers showed that early egg introduction (between 4 and 6 months) may reduce the risk of atopic eczema, whereas researchers in the other trial failed to demonstrate this response. Because of heterogeneity between the studies, a limited meta-analysis was performed; this did not show an association between the age of solid food introduction and risk of eczema.No strong evidence was found that early solid food introduction was associated with less risk of atopic eczema.Every day, parents ask health care providers, when should my infant start solid foods? How early is early? Can this help prevent eczema? The takeaway from this study is that early solid food introduction has little bearing on an infant’s risk of eczema development. On the basis of recommendations from many national and international health organizations, solid food introduction should occur around 6 months of age and not before 4 months of age.

Quality of Life After Sex Reassignment Surgery: A Systematic Review and Meta-Analysis

Context: Gender identity disorder (GID) or gender dysphoria is a disorder in which an individual identifies him/herself with the opposite sex. GID following sex reassignment surgery (SRS) is usually associated with severe distress and several limitations in the personal and social aspects of life as a transgender. Objectives: The current systematic review and meta-analysis aimed at evaluating the quality of life (QoL) after SRS in transgender individuals. Data Sources: A search was conducted in English databases, including PubMed, Scopus, PsycINFO, ScienceDirect, and Google Scholar. In addition, the reference lists of the included articles were reviewed without any time limitations. The final literature search was performed on 12 June 2017. Study Selection: All relevant cross sectional and observational studies were evaluated in the current review. The keywords included sex, gender, reassignment surgery, reassignment operation, sex change, sex reversal, transpersonal, sexual transition, gender dysphoria, transsexual, transgender, gender identity, male-to-female transsexual, female-to-male transsexual, quality of life, QoL, quality adjusted, and wellbeing. Data Extraction: After screening 941 articles, 16 studies were reviewed systematically, six of which were included in the meta-analysis. Comprehensive Meta-Analysis Software version 2 was used for all meta-analyses. Results: QoL improved after SRS in some dimensions, including bodily pain, emotional role, and mental health in male-to-female (MtF) transsexuals, and physical function and physical role in female-to-male (FtM) transsexuals. Physical role, vitality, and social function in MtF transsexuals were not significantly different from the general population. In other words, bodily pain, general health, social function, vitality, mental health, and emotional role in FtM transsexuals, as well as physical function and general health in MtF transsexuals, were lower than the general population. Conclusions: Based on the findings, SRS could improve some dimensions of QoL, including bodily pain, emotional role, and mental health in MtF transsexuals, and physical function as well as physical role in FtM transsexuals. Nevertheless, further research is necessary in this area.

Long-term cognition and behavior in children born at early term gestation: A systematic review.

Recent recommendations characterize deliveries at 37+0 weeks through 38+6 weeks as early term. We aimed to review the literature systematically on long-term cognition, school performance and behavior in children born early term (37+0 to 38+6 weeks) compared with full term (39+0 to 40+6 weeks). The review was performed according to the PRISMA Statement. The final literature search was performed on 31 January 2019. We located studies in PubMed, Embase, CINAHL and Cochrane Library. Eligible studies were randomized controlled trials, cohort studies and case-control studies, with outcome assessment performed at 2-19 years. We collected information using a structured data form and evaluated study quality using the Newcastle-Ottawa Scale (NOS). We included 42 observational studies published between 2006 and 2018. No restriction on year of publication was made. The mean NOS score was 5.8 with a range from 3 to 9. Compared with children born full term, children born early term had a lower intelligence score in early adulthood and up to some 30% increased risk of attention-deficit/hyperactivity disorder. Furthermore, we found some 10%-40% increased risk of cognitive problems, some 25% higher risk of language impairments and another 8%-75% with poorer overall school performance. No meta-analysis was conducted due to heterogeneity in the outcome measures. Only 10 studies presented subgroup analyses in spontaneous deliveries or adjusted for type of labor onset/induction. Children born early term are at increased risk of cognitive deficits, poorer school performance and behavioral problems compared with children born full term.

No. 370-Management of Squamous Cell Cancer of the Vulva.

This guideline reviews the clinical evaluation and management of squamous cell cancer (SCC) of the vulva with respect to diagnosis, primary surgical, radiation, or chemotherapy management and need for adjuvant treatment with chemotherapy and/or radiation therapy. Other vulvar cancer pathologic diagnoses are not included in the guideline. The first part of this document which includes recommendations 1 through 3 is for general gynaecologists, obstetricians, family doctors, registered nurses, nurse practitioners, residents, and health care providers with a focus on the presentation, diagnosis, and updated information about surgical procedures performed by subspecialists. The surgical management and treatment of advanced vulvar cancer are intended for gynaecologic oncologists, radiation oncologists, and medical oncologists who treat these complex patients. This guideline is intended to provide information for interested parties who may follow these patients once treatment is complete. Adult women (18 years and older) with SCC of the vulva. Excluded from these guidelines are women with preinvasive disease. Women diagnosed with SCC of the vulva should be referred to a gynaecologic oncologist for initial evaluation, consideration for primary surgery and inguinal lymph node assessment, and potentially adjuvant radiation and/or chemotherapy. All cases of vulvar cancer should have access to discussion at a multidisciplinary cancer case conference. Women who would otherwise require radical surgery such as abdominal-perineal resection or exenterative procedures may be considered for primary treatment with radiation and/or chemotherapy. For this guideline, relevant studies were searched in PubMed, Medline, and the Cochrane Systematic Reviews using the following terms, either alone or in combination, with the search limited to English language materials: vulva, vulvar cancer, inguinofemoral lymph node dissection, sentinel nodes, systemic chemotherapy, radiotherapy, neoadjuvant, adjuvant, primary, exenteration, survival, follow up. The initial search was performed in September 2016 with a final literature search in May 2017. Relevant evidence was selected for inclusion in the following order: meta-analyses, systematic reviews, guidelines, randomized controlled trials, prospective cohort studies, observational studies, non-systematic reviews, case series, and reports. Additional significant articles were identified through cross-referencing the identified reviews. The total number of studies identified was 286, and 78 studies were included in this review. The content and recommendations were drafted and agreed upon by the principal authors. The Executive and Board of the Society of Gynecologic Oncology of Canada reviewed the content and submitted comments for consideration, and the Board of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology framework (Table 1). The interpretation of strong and weak recommendations is described in Table 2. The Summary of Findings is available upon request. These guidelines are to encourage physicians in the appropriate use of sentinel inguinal lymph node assessment for SCC of the vulva. The committee also promotes the centralization of treatment of vulvar cancer in specialized treatment centres. Evidence will be reviewed 5 years after publication to decide whether all or part of the guideline should be updated. However, if important new evidence is published prior to the 5-year cycle, the review process may be accelerated for a more rapid update of some recommendations. This guideline was developed with resources funded by the Society of Gynecologic Oncology of Canada and the Society of Obstetricians and Gynaecologists of Canada. RECOMMENDATIONS.

An Evaluation of the Rotator Cuff Repair Research Pipeline.

Background:We conducted a study of recommendations from the American Academy of Orthopaedic Surgeons (AAOS) guideline, “Optimizing the Management of Rotator Cuff Problems.” Using these recommendations, we conducted searches of clinical trial registries and bibliographic databases to note the extent to which new research has been undertaken to address areas of deficiency.Hypothesis:Newly conducted research regarding rotator cuff repair and injury is available that will fill knowledge gaps identified by the AAOS guideline.Study Design:Cross-sectional study.Methods:For each recommendation in the AAOS guideline, we created PICO (participants, intervention, comparator, outcome) questions and search strings. Searches were conducted of ClinicalTrials.gov, the World Health Organization’s International Clinical Trials Registry Platform, MEDLINE via PubMed, and EMBASE to locate studies undertaken after the final literature search performed by the AAOS work group.Results:We located 210 newly registered trials and 448 published studies that are relevant to the recommendations made in the rotator cuff guideline. The majority of the recommendations have been addressed by relevant registered trials or published studies. Of the 448 published studies, 185 directly addressed the guideline recommendations. Additionally, 71% of the 185 published studies directly addressing the recommendations were randomized trials or systematic reviews/meta-analyses. The most important finding of our study was that the recommendations in the AAOS rotator cuff guideline have been adequately addressed.Conclusion:Orthopaedic researchers have adequately addressed knowledge gaps regarding rotator cuff repair treatment and management options. As such, the AAOS may consider a guideline update to ensure that recommendations reflect current findings in orthopaedic literature.

An analysis of the literature addressing tonsillectomy knowledge gaps

ImportanceThe ability of clinical practice guidelines to improve patient outcomes depends on the quality of evidence that they are built upon. Research into tonsillectomy in children is lacking, and the gaps in evidence were identified by guideline authors. ObjectiveThe objective of this study is to evaluate the extent that new research is addressing the gaps identified in the AAO-HNS Tonsillectomy in Children Guideline. DesignFor each recommendation in the AAO-HNS guideline Tonsillectomy In Children, we created PICO (Participants, Intervention, Comparator, Outcome) questions and search strings. PubMed was searched to locate studies undertaken after the final literature search performed by the AAO-HNS work group. These studies were then extracted and analyzed. SettingThis study is relevant to all invested in focusing otolaryngological research on questions which currently lack strong evidence. ParticipantsTrials in tonsillectomy that started after the development of the AAO-HNS clinical practice guidelines. Main outcome measuresThe main outcome measures of this study is the extent to which tonsillectomy research is addressing the evidence gaps listed in the clinical practice guideline. ResultsOf the 2519 studies included in our sample, 276 (11%) were relevant to the 18 recommendations made within the Tonsillectomy in Pediatric Patients clinical practice guideline. All but one of the recommendations was met by at least one study. Conclusionsand Relevance: Our findings indicate that knowledge gaps within the guideline at publication may have since been addressed and a guideline update may thus be warranted. Level of evidenceNA.

Association of Schizophrenia With the Risk of Breast Cancer Incidence

Patients with schizophrenia are considered to have many risk factors for the development of cancer. However, the incidence of breast cancer in women with schizophrenia compared with the general population remains uncertain. To perform an updated meta-analysis to evaluate the association between schizophrenia and the risk of breast cancer. A systematic search of the PubMed and EMBASE databases was conducted using the search terms schizophrenia, schizophrenic, psychosis, combined with breast and cancer, tumor, neoplasm, or carcinoma. The final literature search was performed on August 15, 2017. Cohort studies reporting the standardized incidence ratio (SIR) for the risk of breast cancer in women with schizophrenia compared with the general population. The meta-analysis adhered to Meta-analysis of Observational Studies in Epidemiology and the Cochrane Handbook for Systematic Reviews of Interventions. Data extraction was performed independently. A random-effects model was used to pool the results, and a recently proposed prediction interval was calculated to describe the heterogeneity. The SIR for the risk of breast cancer in women with schizophrenia compared with the general population or those without schizophrenia. Twelve cohorts including 125 760 women were included in this meta-analysis. The results of the meta-analysis showed that schizophrenia was associated with a significantly increased risk of breast cancer incidence in women (SIR, 1.31; 95% CI, 1.14-1.50; P < .001), with significant heterogeneity (P < .001; I2 = 89%). Substantial between-study variance was also suggested by the wide prediction interval (0.81-2.10), which indicated that it is possible that a future study will show a decreased breast cancer risk in women with schizophrenia compared with the general population. The subgroup analysis results showed that the association was not significantly affected by whether breast cancer cases were excluded at baseline or the sample size of the included studies. The incidence of breast cancer in women with schizophrenia is higher than that of the general female population. However, significant heterogeneity exists among the included studies. Women with schizophrenia deserve intensive prevention and treatment of breast cancer.

No. 344-Opportunistic Salpingectomy and Other Methods of Risk Reduction for Ovarian/Fallopian Tube/Peritoneal Cancer in the General Population.

This guideline reviews the potential benefits of opportunistic salpingectomy to prevent the development of high grade serous cancers (HGSC) of the ovary/fallopian tube/peritoneum based on current evidence supporting the fallopian tube origin of disease. Gynaecologists, obstetricians, family doctors, registered nurses, nurse practitioners, residents, and health care providers. Adult women (18 and older): OPTIONS: Women considering hysterectomy who wish to retain their ovaries in situ have traditionally also retained their fallopian tubes. In addition, women undergoing permanent surgical sterilization have usually undergone tubal ligation using various methods rather than undergoing surgical removal of the entire fallopian tube. For the sections "Evidence Supporting the Hypothesis That HGSC Originates in the Fallopian Tube" and "Current Literature on the Effects and Safety of Opportunistic Salpingectomy," relevant studies were searched in PubMed, Medline, and the Cochrane Systematic Reviews using the following terms, either alone or in combination, with the search limited to English language materials: "high grade serous cancers ovary," "fallopian tube," "peritoneum," "opportunistic salpingectomy," "epithelial ovarian cancers," "origin," "tubal carcinoma in situ," "BRCA mutation," "prophylactic salpingectomy," "inflammation," "clear cell," and "endometrioid." The initial search was performed in March 2015 with a final literature search in March 2016. Relevant evidence was selected for inclusion in the following order: meta-analyses, systematic reviews, guidelines, randomized controlled trials, prospective cohort studies, observational studies, non-systematic reviews, case series, and reports. The total number of studies identified was 458, and 56 studies were included in this review. For the section "Other Factors Influencing the Risk of Developing "Ovarian" Cancers" a general Medline search was carried out using the terms "ovarian neoplasm" and "prevention." The search included papers published from December 2005 to March 2016. Meta-analyses were preferentially selected except where no such review was found. Additional searches for each subheading were also conducted (e.g., "ovarian neoplasm" and "tubal ligation.") Additional significant articles were identified through cross-referencing the identified reviews. For the search for "ovarian neoplasm" and "prevention," 10meta-analyses were identified. For the search for "ovarian neoplasm" and "tubal ligation," an additional 4 meta-analyses were identified. The content and recommendations were drafted and agreed on by the principal authors. The Executive and Board of the Society of Gynecologic Oncology of Canada reviewed the content and submitted comments for consideration, and the Board of the SOGC approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation methodology framework (Table1). The interpretation of strong and weak recommendations is described in Table2. The summary of findings is available on request. The addition of opportunistic salpingectomy to a planned hysterectomy or permanent sterilization did not increase rates of hospital readmission (OR 0.91, 95% CI 0.75 to 1.10 and OR 0.8, 95% CI 0.56 to 1.21, respectively) or blood transfusions (OR 0.86, 95% CI 0.67 to 1.10 and OR 0.75, 95% CI 0.32 to 1.73, respectively) but did increase the overall operating time (by 16 minutes and 10 minutes, respectively) in a retrospective review of 43 931 women. The riskof repeat surgery for tubal pathology among women with retained fallopian tubes after hysterectomy was at least doubled (OR 2.13, 95% CI 1.88 to 2.42 in a population-based study of 170 000 women). If general gynaecologists were to consider removal of fallopian tubes at the time of every hysterectomy and sterilization procedure with referral of all patients with HGSC for hereditary cancer counselling and genetic testing, experts project a potential reduction in the rate of HGSC by 40% over the next 20years. Evidence will be reviewed 5 years after publication to decide whether all or part of the guideline should be updated. However, if important new evidence is published prior to the 5-year cycle, the review process may be accelerated for a more rapid update of some recommendations. This guideline was developed with resources funded by the Society of Gynecologic Oncology of Canada and SOGC. RECOMMENDATIONS.

Rectal mobilization: the place of Denonvilliers' fascia and inconsistencies in the literature.

Confusion remains as to what is meant by Denonvilliers' fascia. This review searched the literature on pelvic surgical anatomy to determine whether there is agreement with Denonvilliers' original description and its implication in defining the correct anterior plane of dissection when mobilizing the rectum. The original French description of the fascia was translated into English and then compared both with French and with English studies identified by searching PubMed, Medline and Scopus from 1836 to June 2015. Special emphasis was given to the years between 1980 and 2015 in order to capture the literature pertinent to, and following on from, the description of total mesorectal excision for rectal cancer. The final literature search revealed 16 studies from the original 2150 citations. Much of the debate was concerned with the origin and development of the fascia, arising from either the 'fusion' or the 'condensation' of local primitive tissue into a mature 'multilayered' structure. Controversy regarding the correct plane of rectal mobilization occurs as a result of different interpretations by surgeons, anatomists and radiologists and bears little resemblance to Denonvilliers' original description. This may reflect wide anatomical variability in the adult pelvis or a form of dissection artefact. Further study is required to investigate this. Logically, for both men and women, the plane of rectal mobilization should be behind Denonvilliers' fascia and between it and the fascia propria of the rectum.

Surveillance and Epidemiology in Natural Disasters: A Novel Framework and Assessment of Reliability

Objective: To create a framework and methodology for organizing relevant disaster epidemiology literature. The target audience for the framework is local public health practitioners conducting emergency surveillance in the setting of preparedness or response to natural disasters. Methods: The approach to developing the framework involved utilizing the public health and emergency management literature. It was created along four axes. The first was the type of natural disaster; second was according to phase of disaster cycle; third was the impact of the disaster (health, infrastructure, economic); and fourth was related to the main outcome of the study (ie. injuries or infectious diseases). A literature review was conducted and subsequently the current literature was utilized to perform a reliability test of the established framework, using two independent reviewers. Results: Using existing disaster classification systems and risk analysis tools, a framework was developed along the four axes. The final literature search resulted in 85 articles on surveillance in natural disaster settings. The majority of studies are on the subject of hurricanes with a catastrophic impact rating. The phase of testing reliability of the framework resulted in percent agreement of 74%. Conclusions: A reliable framework was developed that enables local public health practitioners to easily access appropriate and previously utilized surveillance methods for a natural disaster emergency. This framework contributes to an evidence-informed approach to surveillance in natural disasters with public health impacts.