Health Management Information Consortium Research Articles

Operational complexities in international clinical trials: a systematic review of challenges and proposed solutions

ObjectiveInternational trials can be challenging to operationalise due to incompatibilities between country-specific policies and infrastructures. The aim of this systematic review was to identify the operational complexities of conducting international...

Scoping review: The terminology used to describe major abdominal surgical procedures.

Major abdominal surgery (MAS) can have a profound impact on the patient but there is currently no consensus as to which surgical procedures constitute MAS. The main objective of this work is to ascertain the terminology used to describe MAS procedures and to apply these findings in order to propose a definition of MAS. The following databases were searched: Ovid MEDLINE (R) ALL, Embase Classic and Embase (via OvidSP), Global Health (via OvidSP), Health Management Information Consortium (via OvidSP), APA PsycInfo (via OvidSP), PubMed and Web of Science. Original research articles, published between 1980 and April 26, 2022 that contained a description of MAS procedure were included in this study. Article screening and data extraction was undertaken independently by 3 authors. Content analysis was performed to identify key terminology used to describe MAS. Five thousand six hundred and sixty three articles were identified, of which 767 underwent full-text review and 312 were included in the scoping review. Content analysis resulted in 4 main categories: (1) pre-operative factors, (2) intraoperative factors, (3) operation-related factors, (4) post-operative factors. Operation-related factors was the predominant category (1137 references coded). The gastrointestinal resection made the vast majority of the references coded (591). Based on these results, the term "major abdominal surgery" should be defined as an intra-peritoneal operation with no primary involvement of the thorax, involving either luminal resection and/or resection of a solid organ associated with the gastrointestinal tract. However, further work is required to verify this definition using real world data.

What is the quantity, quality and type of systematic review evidence available to inform the optimal prescribing of statins and antihypertensives? A systematic umbrella review and evidence and gap map

ObjectivesWe aimed to map the systematic review evidence available to inform the optimal prescribing of statins and antihypertensive medication.DesignSystematic umbrella review and evidence and gap map (EGM).Data sourcesEight bibliographic databases...

Approaches to deliver depression care and understanding barriers and facilitators to implementation in people with tuberculosis in LMICs: a systematic review

Background Depression is a common comorbidity in people with tuberculosis. Various approaches to delivering depression care for people with tuberculosis have been implemented in low- and middle-income countries. To date, there are no comprehensive reviews that summarise and explore the implementation of these approaches to delivering depression care for people with tuberculosis. Objectives To identify the various interventions and approaches to delivering depression care as part of routine tuberculosis care in low- and middle-income countries, and to summarise the barriers and facilitators to their implementation. Review methods We conducted a systematic review to identify the relevant evidence. We conducted searches in June and July 2020 in the following databases, from inception: MEDLINE, Scopus, PsycINFO, Web of Science, PubMed, EMBASE, Cochrane Library, SciELO and LILACS, Health Management Information Consortium. We also hand-searched the reference lists of the included studies. Two reviewers independently screened the titles and abstracts of all records. Two reviewers independently screened the full texts. We used the Mixed Methods Appraisal Tool for quality appraisal. We coded and synthesised the findings using the constructs of the Consolidated Framework for Implementation Research as an a priori guide to analyse the barriers and facilitators. Results The search retrieved 10,982 records, 39 studies were selected for full-text screening and 10 studies were included in the analysis. We categorised the interventions as psychological, combined (pharmacological and psychological), combined with socioeconomic support and screening-only approaches. The most commonly implemented types of intervention were psychological interventions, on their own or combined with pharmacological interventions or socioeconomic support. The most common barrier to implementation was the costs associated with the intervention and its implementation. There were multiple facilitators for implementation for all types of interventions in different Consolidated Framework for Implementation Research domains. Facilitators were related to the characteristics of the intervention (relative advantage), the inner setting (compatibility of the intervention with existing workflows) and the process of implementation (the positive attitudes of innovation participants). Limitations This study relied on published information; thus, it is possible that important barriers and facilitators were not reported in the published studies and were, therefore, absent from this evidence synthesis. Conclusion We identified psychological interventions as the most commonly implemented approach to the delivery of depression care for people with tuberculosis, alone or in combination with other approaches. We identified the increase in costs as a barrier experienced for all intervention types. We identified the relative advantage of the intervention, its compatibility and the beliefs and attitudes of people with tuberculosis, their families and communities as facilitators that were reported in all intervention types. The integration of depression care for people with tuberculosis in existing tuberculosis services is possible but will require the barrier of the costs associated with delivery and implementation to be addressed. This review was carried out during the COVID-19 pandemic, when the effects of the pandemic on tuberculosis and mental health services were yet to be seen. Future research should focus on the impact of the pandemic on tuberculosis and mental health services, and on people with tuberculosis and their mental health. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 17/63/130. A plain language summary of this article is available on the NIHR Journals Library website https://doi.org/10.3310/GRWH1425.

Impact of interventions to improve recovery of older adults following planned hospital admission on quality-of-life following discharge: linked-evidence synthesis.

To understand the impact of multicomponent interventions to improve recovery of older adults following planned hospital treatment, we conducted two systematic reviews, one of quantitative and one of qualitative evidence, and an overarching synthesis. These aimed to: • understand the effect of multicomponent interventions which aim to enhance recovery and/or reduce length of stay on patient-reported outcomes and health and social care utilisation • understand the experiences of patients, carers and staff involved in the delivery of interventions • understand how different aspects of the content and delivery of interventions may influence patient outcomes. We searched bibliographic databases including MEDLINE ALL, Embase and the Health Management Information Consortium, CENTRAL, and Cumulative Index to Nursing and Allied Health Literature and Allied and Complementary Medicine Database, conducted forward and backward citation searching and examined reference lists of topically similar qualitative reviews. Bibliographic database searches were completed in May/June 2021 and updated in April 2022. We sought primary research from high-income countries regarding hospital inpatients with a mean/median age of minimum 60 years, undergoing planned surgery. Patients experienced any multicomponent hospital-based intervention to reduce length of stay or improve recovery. Quantitative outcomes included length of stay and any patient-reported outcome or experience or service utilisation measure. Qualitative research focused on the experiences of patients, carers/family and staff of interventions received. Quality appraisal was undertaken using the Effective Public Health Practice Project Quality Assessment Tool or an adapted version of the Wallace checklist. We used random-effects meta-analysis to synthesise quantitative data where appropriate, meta-ethnography for qualitative studies and qualitative comparative analysis for the overarching synthesis. Quantitative review: Included 125 papers. Forty-nine studies met criteria for further synthesis. Enhanced recovery protocols resulted in improvements to length of stay, without detriment to other outcomes, with minimal improvement in patient-reported outcome measures for patients admitted for lower-limb or colorectal surgery. Qualitative review: Included 43 papers, 35 of which were prioritised for synthesis. We identified six themes: 'Home as preferred environment for recovery', 'Feeling safe', 'Individualisation of structured programme', 'Taking responsibility', 'Essential care at home' and 'Outcomes'. Overarching synthesis: Intervention components which trigger successful interventions represent individualised approaches that allow patients to understand their treatment, ask questions and build supportive relationships and strategies to help patients monitor their progress and challenge themselves through early mobilisation. Interventions to reduce hospital length of stay for older adults following planned surgery are effective, without detriment to other patient outcomes. Findings highlight the need to reconsider how to evaluate patient recovery from the perspective of the patient. Trials did not routinely evaluate patient mid- to long-term outcomes. Furthermore, when they did evaluate patient outcomes, reporting is often incomplete or conducted using a narrow range of patient-reported outcome measures or limited through asking the wrong people the wrong questions, with lack of longer-term evaluation. Findings from the qualitative and overarching synthesis will inform policy-making regarding commissioning and delivering services to support patients, carers and families before, during and after planned admission to hospital. This trial is registered as PROSPERO registration number CRD42021230620. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 130576) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 23. See the NIHR Funding and Awards website for further award information.

Reducing unplanned hospital admissions from care homes: a systematic review

Background Care homes predominantly care for older people with complex health and care needs, who are at high risk of unplanned hospital admissions. While often necessary, such admissions can be distressing and provide an opportunity cost as well as a financial cost. Objectives Our objective was to update a 2014 evidence review of interventions to reduce unplanned admissions of care home residents. We carried out a systematic review of interventions used in the UK and other high-income countries by synthesising evidence of effects of these interventions on hospital admissions; feasibility and acceptability; costs and value for money; and factors affecting applicability of international evidence to UK settings. Data sources We searched the following databases in December 2021 for studies published since 2014: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews; Cumulative Index to Nursing and Allied Health Literature; Health Management Information Consortium; Medline; PsycINFO; Science and Social Sciences Citation Indexes; Social Care Online; and Social Service Abstracts. ‘Grey’ literature (January 2022) and citations were searched and reference lists were checked. Methods We included studies of any design reporting interventions delivered in care homes (with or without nursing) or hospitals to reduce unplanned hospital admissions. A taxonomy of interventions was developed from an initial scoping search. Outcomes of interest included measures of effect on unplanned admissions among care home residents; barriers/facilitators to implementation in a UK setting and acceptability to care home residents, their families and staff. Study selection, data extraction and risk of bias assessment were performed by two independent reviewers. We used published frameworks to extract data on intervention characteristics, implementation barriers/facilitators and applicability of international evidence. We performed a narrative synthesis grouped by intervention type and setting. Overall strength of evidence for admission reduction was assessed using a framework based on study design, study numbers and direction of effect. Results We included 124 publications/reports (30 from the UK). Integrated care and quality improvement programmes providing additional support to care homes (e.g. the English Care Homes Vanguard initiatives and hospital-based services in Australia) appeared to reduce unplanned admissions relative to usual care. Simpler training and staff development initiatives showed mixed results, as did interventions aimed at tackling specific problems (e.g. medication review). Advance care planning was key to the success of most quality improvement programmes but do-not-hospitalise orders were problematic. Qualitative research identified tensions affecting decision-making involving paramedics, care home staff and residents/family carers. The best way to reduce end-of-life admissions through access to palliative care was unclear in the face of inconsistent and generally low-quality evidence. Conclusions Effective implementation of interventions at various stages of residents’ care pathways may reduce unplanned admissions. Most interventions are complex and require adaptation to local contexts. Work at the interface between health and social care is key to successful implementation. Limitations Much of the evidence identified was of low quality because of factors such as uncontrolled study designs and small sample size. Meta-analysis was not possible. Future work We identified a need for improved economic evidence and the evaluation of integrated care models of the type delivered by hospital-based teams. Researchers should carefully consider what is realistic in terms of study design and data collection given the current context of extreme pressure on care homes. Study registration This study is registered as PROSPERO database CRD42021289418. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (award number NIHR133884) and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 18. See the NIHR Journals Library website for further project information.

What is the existing evidence base for adult medical same day emergency care in UK NHS hospitals? A scoping review protocol

ObjectivesSame day emergency care (SDEC) is a new model of care, which has emerged over the past 5 years, building on prior ambulatory care services. The National Health Service (NHS)...

Surgical and non­surgical methods of penis enlargement

Abstract. In this scientific study we reviewed the literature on non-invasive and invasive methods of male genital enhancement. A non-systematic review of current scientific evidence was conducted to obtain reliable data on surgical and non-surgical penile procedures, which may form the basis of possible indications and recommendations for the future. To achieve this goal, we conducted a systematic search for scientific medical information in English-language databases such as MEDLINE, Embase, AMED (Allied and Complementary Medicine) and HMIC (Health Management Information Consortium). We analyzed all articles that met the specified search parameters. In addition, a manual search for relevant references in the found texts was conducted. The study conducted in this paper examined and recorded the main results related to changes in penis size in men who used both non-surgical and surgical methods of penis enlargement. One of the key goals of this study was to examine in detail the impact of different methods on the length and girth of the penis, as well as to analyze possible complications after these procedures. The principles of choosing treatment methods for patients who express a desire to increase the size of the penis are based on the individual characteristics of the patient, his medical indicators and personal preferences. Doctors should take into account the patient's general health status, possible risks of complications, and his realistic expectations of the procedure. Based on the results of the literature analysis, a strategy for working with patients before penis enlargement procedures was generalized. This strategy includes detailed counseling of the patient about possible methods, their benefits and risks, as well as taking into account his personal wishes. An important step is to prepare the patient for the procedure, including all the necessary examinations and tests to determine his suitability for the intervention.

373 Scoping Review: Definition of Major Abdominal Surgery

Abstract Aim The aim of this scoping review was to propose a definition major abdominal surgery (MAS). Method We searched the following databases: Medline, EMBASE, Web of Science, Global Health, Health Management Information Consortium, APA PsycInfo. Original research articles, systematic reviews or meta-analyses published between 1980 and 26 April 2022 were included in this scoping review. Inclusion criteria consisted of: specific reference to the operation, adult population, treatment within secondary care, and availability of full text. Three authors assessed each article’s eligibility for inclusion. Results 5,663 articles were identified in our search, of which 767 underwent full-text review and 312 were included in the scoping review. Half of the included articles were observational trials (54.5%) and one third were randomised control trials (37.8%). A significant proportion of studies were conducted in Europe (47.4%) or North America (19.2%), with a minority of studies conducted in the UK (4.5%). Just under half of these studies were led by anaesthetists (47.4%) rather than surgeons with 45.8% of studies focused on post-operative care and outcomes. Analysis of these studies revealed that the description of major abdominal surgery fell into 4 broad categories: anatomical criteria, procedure-based criteria, specialty-specific resections, and arbitrary procedures. Conclusions We established that there is no agreed definition of major abdominal surgery. We propose that any definition of major abdominal surgery should be based on anatomical criteria alone. Research is underway to confirm a difference in the post-operative recovery profiles of patients undergoing MAS and non-MAS procedures as per our classification.

Preoperative tumor marking with indocyanine green (ICG) prior to minimally invasive colorectal cancer: a systematic review of current literature.

To describe the currently available evidence regarding the efficacy and safety of preoperative tumor marking using indocyanine green (ICG) prior to laparoscopic or robotic colorectal resections. A systematic search for relevant studies was conducted using the following databases: Embase (OVID), MEDLINE® (OVID), APA PsycInfo (OVID), Global Health (OVID) and HMIC Health Management Information Consortium (OVID) through June 2022 reported according to PRISMA 2020 guidelines. Primary outcome was the detection rate of the tumor sites preoperatively marked with ICG. Secondary outcomes were timing of ICG injection in days prior to the operation and technique-related complications. Eight single center studies, published between 2008 and 2022, were identified yielding a total of 1,061 patients, of whom 696 were preoperatively tattooed with ICG. Injection dosage of diluted ICG ranged from 0.1-1.5 ml. Four studies used the saline test injection method prior to ICG injection. When the marking was placed within one week, the visualization rate was 650/668 (97%), whereas when it was longer than one week, the detection rate was 8/56 (14%). No severe complications were reported. Preoperative tumor marking using ICG prior to minimally invasive colorectal resections is safe and effective, allowing intraoperative tumor site location when performed up to a week prior to surgery without disturbing the surgical view in potential mild complications.

EFFECTIVENESS OF HYALURONIC ACID INJECTIONS FOR PENIS ENLARGEMENT

Introduction. Penis enlargement procedures are becoming increasingly common among men seeking to achieve more desirable aesthetics of their male organ. This paper reviews the literature to identify and analyze scientific studies on the use of hyaluronic acid in andrology to increase penis size.
 The aim. To evaluate the effectiveness and safety of the procedure of injectable penis enlargement using hyaluronic acid filler.
 Materials and Methods. We evaluated the current scientific evidence on all available injectable penis enlargement methods to assess their effectiveness. To achieve this goal, we conducted a systematic search for scientific medical information in English-language databases such as MEDLINE, Embase, AMED (Allied and Complementary Medicine) and HMIC (Health Management Information Consortium). We analyzed all articles that met the specified search parameters. In addition, we manually searched for relevant references in the found texts.
 Results. The analysis of the literature shows that the use of hyaluronic acid to increase penile girth is a fairly effective method. The injection of hyaluronic acid demonstrates safety and effectiveness in practice, contributing to an increase in penis circumference. The results of studies confirm the long-term success and satisfaction of patients using this method, in particular in long-term follow-up.
 Conclusions. The use of hyaluronic acid as a filler to increase the size of the penis is effective and has several advantages. This minimally invasive method has fast and noticeable effect, increasing both the volume and length of the penis. This can improve patients' self-esteem and quality of life in the area of sexual relations. In addition, the procedure does not require complex surgical interventions and has a minimal recovery time, because hyaluronic acid is injectable. In general, the use of hyaluronic acid for penis enlargement is a convenient and effective option that allows patients to quickly achieve the desired result and improve the quality of their intimate life.

Healthcare interventions for sex workers: protocol for a scoping review

IntroductionSex workers, who provide sexual or erotic acts in exchange for payment, often experience multiple disadvantages, including mental ill health and substance misuse. Mainstream healthcare services are generally not configured...

A systematic review of barriers and enablers that health professionals experience to the delivery of type 2 diabetes care for adults with severe mental illness.

People with severe mental illness have a heightened risk for type 2 diabetes. They also experience poorer outcomes, including more diabetes complications, more emergency admissions, lower quality of life and excess mortality. This systematic review aimed to identify health professionals' barriers to and enablers of delivering and organising type 2 diabetes care for people with severe mental illness. Searches were conducted in Medline, EMBASE, PsycInfo, CINAHL, OVID Nursing, Cochrane Library, Google Scholar, OpenGrey, PsycExtra, Health Management Information Consortium and Ethos in March 2019, with updates in September 2019 and January 2023. There were no restrictions on study design, but studies were excluded if they did not include the perspective of health professionals or were not in English. Barriers and/or enablers of type 2 diabetes care for people with a severe mental illness were organised using the theoretical domains framework with additional inductive thematic coding. Twenty-eight studies were included in the review. Overall, eight domains were identified as important with barriers and enablers identified at individual, interpersonal and organisational levels. Focussing on providing a collaborative healthcare environment which actively supports type 2 diabetes care, fostering improved communication both between professionals and service users, ensuring clear boundaries around roles and responsibilities as well as individual skill and knowledge support alongside confidence building all offer opportunities to improve type 2 diabetes care.

What Works Where and How for Uptake and Impact of Artificial Intelligence in Pathology: Review of Theories for a Realist Evaluation

There is increasing interest in the use of artificial intelligence (AI) in pathology to increase accuracy and efficiency. To date, studies of clinicians' perceptions of AI have found only moderate acceptability, suggesting the need for further research regarding how to integrate it into clinical practice. The aim of the study was to determine contextual factors that may support or constrain the uptake of AI in pathology. To go beyond a simple listing of barriers and facilitators, we drew on the approach of realist evaluation and undertook a review of the literature to elicit stakeholders' theories of how, for whom, and in what circumstances AI can provide benefit in pathology. Searches were designed by an information specialist and peer-reviewed by a second information specialist. Searches were run on the arXiv.org repository, MEDLINE, and the Health Management Information Consortium, with additional searches undertaken on a range of websites to identify gray literature. In line with a realist approach, we also made use of relevant theory. Included documents were indexed in NVivo 12, using codes to capture different contexts, mechanisms, and outcomes that could affect the introduction of AI in pathology. Coded data were used to produce narrative summaries of each of the identified contexts, mechanisms, and outcomes, which were then translated into theories in the form of context-mechanism-outcome configurations. A total of 101 relevant documents were identified. Our analysis indicates that the benefits that can be achieved will vary according to the size and nature of the pathology department's workload and the extent to which pathologists work collaboratively; the major perceived benefit for specialist centers is in reducing workload. For uptake of AI, pathologists' trust is essential. Existing theories suggest that if pathologists are able to "make sense" of AI, engage in the adoption process, receive support in adapting their work processes, and can identify potential benefits to its introduction, it is more likely to be accepted. For uptake of AI in pathology, for all but the most simple quantitative tasks, measures will be required that either increase confidence in the system or provide users with an understanding of the performance of the system. For specialist centers, efforts should focus on reducing workload rather than increasing accuracy. Designers also need to give careful thought to usability and how AI is integrated into pathologists' workflow.

Adherence to physical rehabilitation delivered via tele-rehabilitation for people with multiple sclerosis: a scoping review protocol

IntroductionUsing tele-rehabilitation methods to deliver exercise, physical activity (PA) and behaviour change interventions for people with multiple sclerosis (pwMS) has increased in recent years, especially since the SARS-CoV-2 pandemic. This...

Patients' and Healthcare Professionals' Experiences and Views of Recurrent Urinary Tract Infections in Women: Qualitative Evidence Synthesis and Meta-Ethnography.

Urinary tract infections (UTIs) are a common and significant problem for patients, clinicians, and healthcare services. Recurrent UTIs (rUTIs) are common, with a 3% prevalence in the UK. Although acute UTIs have a significant negative impact on the lives of patients, evidence of the impact of rUTIs is limited. To enhance shared decision-making around rUTI management, it is important to understand both the patients' and healthcare professionals' (HCPs') perspectives. The objective of this qualitative evidence synthesis is to understand patients' and HCPs' experiences and views in the management of rUTIs. A qualitative evidence synthesis (QES) was performed that included primary qualitative studies involving patients with rUTIs or primary care HCPs who manage patients with rUTIs, up to June 2022. The following databases were searched: MEDLINE, Embase, CINAHL, PsycInfo, ASSIA, Web of Science, Cochrane Database of Systematic Reviews, Epistemonikos, Cochrane Central Registry of Controlled Trials, OpenGrey, and the Health Management Information Consortium (HMIC). The QES was prospectively registered on PROSPERO (CRD42022295662). Reciprocal translation was conducted and developed into a line of argument synthesis. We appraised the confidence in our review findings by using GRADE-CERQual. Twelve studies were included in the final review; ten of those included patients, and three included HCPs (one study included both). Our review demonstrates that women with rUTIs have a unique experience, but it is generally of a chronic condition with significant impacts on numerous aspects of their lives. Antibiotics can be "transformative", but patients have serious concerns about their use and feel non-antibiotic options need further research and discussion. HCPs share similar views about the impacts of rUTIs and concerns about antibiotic use and find the management of rUTIs to be complex and challenging. Based on our GRADE-CERQual assessment of the review findings, we have moderate confidence in those related to patients and low confidence in those related to HCPs. New conceptual models for both patients and HCPs are presented. This review has significant clinical implications. Patients require information on antibiotic alternative acute and preventative treatments for rUTIs, and this is not currently being addressed. There are communication gaps around the impact of rUTIs on patients, their perceived expectation for antibiotics, and the reasons for treatment failure. Further development of current clinical guidance and a patient decision aid would help address these issues.

A Scoping Review of Disability Assessment in Prospective and Cross-Sectional Studies That Included Device-Based Measurement of Physical Activity.

Evidence on the prevalence, determinants, and health outcomes of physical activity in disabled people is limited. It is possible that the limited availability of high-quality scientific evidence is due to the extent and nature of disability assessment in physical activity research. This scoping review explores how disability has been measured in epidemiological studies that included accelerometer-based measurement of physical activity. Data sources: MEDLINE (Ovid), Embase, PsychINFO, Health Management Information Consortium, Web of Science, SPORTDiscus, and CINAHL. Prospective and cross-sectional studies that included an accelerometer measurement of physical activity. Survey instruments used in these studies were obtained, and questions relating to the International Classification of Functioning, Disability and Health domains of (1)health conditions, (2)body functions and structures, and (3)activities and participation, were extracted for analysis. Eighty-four studies met the inclusion criteria, from which complete information on the 3 domains was obtained for 68. Seventy-five percent of studies (n = 51) captured whether a person had at least one health condition, 63% (n = 43) had questions related to body functions and structures, and 75% (n = 51) included questions related to activities and participation. While most studies asked something about one of the 3 domains, there was substantial diversity in the focus and style of questions. This diversity indicates a lack of consensus on how these concepts should be assessed, with implications for the comparability of evidence across studies and subsequent understanding of the relationships between disability, physical activity, and health.

COMPLICATIONS AFTER PENIS ENHANCEMENT WITH HYALURONIC ACID: A LITERATURE REVIEW

Introduction. The penis is a symbol of the primal sense of male fertility and sexual activity, which affects the sense of male personality and the ability to satisfy a partner. Some patients experience discomfort, even if their penis is within the normal size range from an anatomical point of view. The reason for the spread of penis enlargement procedures is related to the feeling of masculinity that the appearance of the genitals can give a man, as well as a changed perception of his body. Penis enlargement procedures are becoming more and more common among men who seek to achieve a more desirable aesthetic of their male organ. In addition, penis enlargement methods remain a controversial issue, as they do not have clear indications and can cause complications. Materials and methods. This study reviewed the literature on complications after penile enhancement with hyaluronic acid (HA). To achieve this goal, we conducted a systematic search for scientific medical information in English-language databases such as MEDLINE, Embase, AMED (Allied and Complementary Medicine), and HMIC (Health Management Information Consortium). We analyzed all articles that met the specified search parameters. In addition, we manually searched for relevant references in the found texts. Results. The use of HA injections for penis enlargement in men shows a low rate of complications both in the early- and long-term period after the procedure. In a small percentage of patients, early and expected side effects included swelling, bruising, subcutaneous nodules, and infections. In this work, radical ways of their correction are proposed for all types of complications, which makes the use of HA safe and effective for penis enlargement. Conclusions. Nowadays, there is a lack of high-level evidence-based information on complications after HA injections. Due to the growing demand for these procedures, the issue of their safety is relevant. According to the available statistics, the overall incidence of complications after HA injections is spontaneous without further side effects. If complications are detected, the prognosis after treatment is satisfactory. As a result, there are no standardized surgical protocols and recommendations for penile enhancement with hyaluronic acid in the world.

A Systematic Review of Acute Thoracic Aortic Dissections in Africa-The Need for a Registry.

In this systematic review, the available literature on the presentation and management of acute thoracic aortic dissections in Africa is examined. Though Africa has 17% of the world population, it accounts for approximately 1% of the available literature with much of our understanding coming from registries arising from the developed world, such as the International Registry of Acute Aortic Dissection. The literature from the African continent consists mainly of case reports, small case series, and few original studies. Case reports make an important contribution to our understanding of uncommon conditions but can skew our understanding of aortic dissections in this region by describing unusual presentations and management. In this review, we describe the available studies retrieved from large medical databases (Medline and Health Management Information Consortium) and motivate the need for national registries to provide a more accurate appreciation of the scope of the problem on this continent.

Approaches to enabling rapid evaluation of innovations in health and social care: a scoping review of evidence from high-income countries

ObjectiveThe COVID-19 pandemic increased the demand for rapid evaluation of innovation in health and social care. Assessment of rapid methodologies is lacking although challenges in ensuring rigour and effective use...