High-quality Research Research Articles

Optimal traditional Chinese medicine formulas in treating ulcerative colitis: Choose one or take it all?

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that presents significant treatment challenges due to its complexity, especially in terms of the various side effects that traditional medications may bring during the chronic course of the disease. Traditional Chinese medicine (TCM) has emerged as a promising complementary therapy for UC. Based on the latest research, our editorial explored the current issues and potential essential research directions for TCM in treating UC. We anticipate that future high-quality research will pave the way for the optimization of TCM formulas for UC and their broader global application.

Definitions of clinical study outcome measures for cardiovascular diseases: the European Unified Registries for Heart Care Evaluation and Randomized Trials (EuroHeart).

Standardized definitions for outcome measures in randomized clinical trials and observational studies are essential for robust and valid evaluation of medical products, interventions, care, and outcomes. The European Unified Registries for Heart Care Evaluation and Randomised Trials (EuroHeart) project of the European Society of Cardiology aimed to create international data standards for cardiovascular clinical study outcome measures. The EuroHeart methods for data standard development were used. From a Global Cardiovascular Outcomes Consortium of 82 experts, five Working Groups were formed to identify and define key outcome measures for: cardiovascular disease (generic outcomes), acute coronary syndrome and percutaneous coronary intervention (ACS/PCI), atrial fibrillation (AF), heart failure (HF) and transcatheter aortic valve implantation (TAVI). A systematic review of the literature informed a modified Delphi method to reach consensus on a final set of variables. For each variable, the Working Group provided a definition and categorized the variable as mandatory (Level 1) or optional (Level 2) based on its clinical importance and feasibility. Across the five domains, 24 Level 1 (generic: 5, ACS/PCI: 8, AF: 2; HF: 5, TAVI: 4) and 48 Level 2 (generic: 18, ACS-PCI: 7, AF: 6, HF: 2, TAVI: 15) outcome measures were defined. Internationally derived and endorsed definitions for outcome measures for a range of common cardiovascular diseases and interventions are presented. These may be used for data alignment to enable high-quality observational and randomized clinical research, audit, and quality improvement for patient benefit.

Diversity in Family Medicine Research.

In conjunction with the North American Primary Care Research Group (NAPCRG) Annual Conference in 2023, leaders in the field of family medicine came together to discuss and produce a Family Medicine Research Agenda. While multiple areas were discussed, diversity, equity, and inclusion did not rise to the top as research priorities. This article discusses the 3 areas family medicine leaders see as necessary to produce high-quality research. The authors present ideas on how diversity, equity, and inclusion can be prioritized in each area. In the first area, "Grow the family medicine research workforce by expanding pathways and strengthening mentorship," the authors present existing models, with an emphasis on those pathway programs proven to increase scholarship and research, such as the Leadership Through Scholarship Fellowship sponsored by the Society of Teachers of Family Medicine (STFM) and the Building Research Capacity Program sponsored by the Association of Departments of Family Medicine (ADFM). In the second area, "Increase funding for family medicine research and advocate for enhanced health policy and support," the authors present ideas on greater utilization of NIH diversity supplements as well as institutional advocacy by family medicine chairs to create seed grants and provide opportunities for diverse faculty to engage in research. Chairs can also increase the diversity of the researcher pool by recruiting among local full-time clinicians, a more diverse group than most faculties. For the final area, "Build a national infrastructure for organizing and optimizing family medicine research opportunities," the authors present solutions including following demographic data surrounding authorship and reviewing for journals; having dedicated committees or editors focused on diversity, equity, and inclusion; and using demographic data from conference submissions to encourage those from underrepresented backgrounds to translate their presentations into a manuscript. These strategies can help equity, diversity, and inclusion become central to our research and be used as a national model for other specialties attempting to do the same.

Chromium supplementation and type 2 diabetes mellitus: an extensive systematic review.

Diabetes is a global public health concern with increasing prevalence worldwide. Chromium (Cr), a trace element found in soil, water, and food, has been proposed to have a possible positive effect in glucose metabolism and diabetes mellitus prevention. However, the relationship between trivalent chromium [Cr(III)] exposure, mainly through the consumption of diet supplements, and type 2 diabetes mellitus (T2DM) remains controversial. An extensive systematic review of the current literature on randomized controlled studies (RCTs) was conducted from 1 January 2000, to January 2024 using the databases PubMed, Scopus, ScienceDirect, and Cochrane, with specific keywords and inclusion as well as exclusion criteria. After close screening of the research studies retrieved from the mentioned websites was conducted, the most related studies were included in the final systematic review. The studies were evaluated for the degree of relevance, quality, and risk bias, using appropriate quality assessment tools. Several of the included RCT studies reported possible benefits of Cr(III) supplementation, mainly in the form of chromium picolinate (CrPic), chromium yeast (CY), chromium chloride (CrCl3), and chromium nicotinate (CrN). The dosage of chromium was between 50 and 1000μg/day and it was consumed from 2 to 6months. Glycemic control markers, including FPG, insulin, HbA1C, and HOMA-IR levels, significantly decrease following chromium supplementation, mainly in studies with a longer intervention period. Supplementing with chromium (Cr) indicated that could significantly improve lipid profile by raising high-density lipoprotein and lowering triglyceride and total cholesterol while having little effect on low-density lipoprotein. However, most research findings include significant limitations, such as inconsistent dosage and type of chromium, formulation of supplements, and study duration. Further well-designed and high-quality research is needed to fully understand the role of chromium dietary supplementation and the potential risks related to its mechanisms of action, type, and dose, in the prevention and treatment of type 2 diabetes mellitus.

Mechanism of action of Nrf2 and its related natural regulators in rheumatoid arthritis.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by synovitis that can lead to joint deformities. To date, more than 18 million individuals worldwide have been diagnosed with RA, making it one of the most prevalent autoimmune diseases globally and posing a significant threat to public health and safety. Due to the complex pathogenesis of the disease, which involves autoimmunity, genetics, inflammation and oxidative stress in the body's tissues, the current drug therapy generally targets a single molecule, and effective and efficient drugs involving multiple levels and targets are lacking; thus, there is an urgent need for high-quality research and treatment in this field. Nuclear transcription factor erythroid 2-associated factor 2 (Nrf2) plays a crucial role in cellular resistance to oxidative stress and electrophilic attacks and is a potential pharmacological target for chronic disease treatment. While currently no drugs that target Nrf2 have been approved specifically for RA treatment, such an approach holds great significance. In recent years, the use of natural products to treat RA and other chronic conditions has become increasingly widespread because of their superior efficacy and minimal side effects. Therefore, this article provides a review of the mechanism of Nrf2 in RA and summarizes natural products that target Nrf2 and its associated pathways in the treatment of RA, aiming to offer new insights and strategies for the prevention and management of RA.

Relationship between reticulospinal system sensitization and proprioceptive pathways in the development of dynamic spasticity (ReProDS) post-spinal cord injury: protocol for a prospective, observational cohort study.

Dynamic spasticity (DS) is a common complication post-spinal cord injury (SCI), marked by intermittent increases in muscle tone during postural transitions or movement. Despite its prevalence, high-quality research on DS incidence, risk factors, and underlying mechanisms in SCI patients remains limited. With the growing application of spinal cord stimulation (SCS) for spasticity control, the role of proprioception in DS development has garnered attention. Additionally, advances in diffusion tensor imaging (DTI) allow for the analysis of the reticulospinal tract's (RST) role in postural control among SCI patients. However, the impact of microstructural changes in RST and proprioception on DS following SCI remains unclear. To investigate the relationship between microstructural changes in the RST and proprioceptive circuits in SCI patients, exploring their association with DS and potential predictive factors that influence recovery. This is a 12-month prospective cohort study. The neurophysiological and global functional status of the participants will be assessed. Primary outcomes include DTI indices of RST and proprioception, and spasticity assessment. Secondary outcomes include auditory startle reflex (ASR), H-reflex, shear wave velocity (SWV), overall functional status including spinal cord independence measure, gait analysis, modified Barthel Index, and the 36-item short form health survey. Data will be collected at 1, 3, 6, and 12 months after enrolment. Matched healthy controls will be measured during the same period after recruitment. This study is the first to explore the role of microstructural changes in the RST and proprioception in the assessment and prediction of DS following SCI. The findings aim to enhance theoretical understanding of SCS in spasticity management and to establish pre-treatment criteria for SCS interventions targeting motor function recovery in SCI. ChiCTR2400090724.

THE FUTURE WAR AND THE STRATEGIC ENVIRONMENT OF THE SOUTH ATLANTIC: AN ANALYSIS FOR THE DEVELOPMENT OF THE BRAZILIAN DEFENSE INDUSTRIAL BASE

This work aims to analyze the Future War, focusing on a scenario extending to 2039, and Brazil's interstate relations, with emphasis on the strategic environment of the South Atlantic, while observing classical geopolitical studies. Considering that the stability of the South Atlantic fundamentally depends on processes occurring on the western coast of Africa, this explains why Brazil's strategic environment extends to the other side of the Atlantic. This perspective also clarifies why Brazil contributes to the development of the African countries bordering the Atlantic Ocean. The study further extends its analysis to the Rio Grande Elevation Project. The entire context will serve as a foundation to examine the impacts on the development of the Brazilian Defense Industrial Base (BID). To carry out the research, the methodological approach is mixed: a qualitative perspective based on existing academic literature and field research, along with a quantitative structure, measuring data related to the BID and assessing the impacts of interstate relations on it. The direct result intended by this study is to produce new knowledge (scientific, doctrinal, and technological) in the field of defense through high-quality research, contributing to state policy. Indirectly, it aims to generate insights into Defense Studies and improve the decision-making process associated with the use of force, particularly as it relates to the BID.

A07 - EDI&S Outputs of appointing a Trainee Executive Group in delivering a multi-centre randomized controlled surgical trial: Lessons learnt from The Sunflower Study

Abstract Background Randomised controlled trials (RCTs) are widely accepted as the ‘gold standard’ for evaluating the effectiveness of health interventions. Trial recruitment is notoriously difficult, with approximately 57% of publicly funded RCTs not meeting recruitment target sample sizes. Trainee involvement can be crucial for large scale clinical studies. However, there remains limited knowledge about methods in which trainee collaboration can assist studies in achieving their aims. The Sunflower Study is the UKs largest surgical RCT and is unique in piloting the establishment of a Trainee Executive Group (TEG). Here we explore the outputs of the TEG and its impact on the study. Method The TEG consists of five trainee representatives of different training grades and research backgrounds, all appointed via national selection. The TEG held regular virtual meetings seeking to understand trainee perspectives on RCTs recruitment, champion and disseminate examples of good recruitment, indentify recruitment barriers, optimise The Sunflower Study's social media presence and update digital resources via a trainee section on its website. The TEG also established a network of regional representatives with the purpose of connecting neighbouring recruitment sites with one another, disseminating knowledge at a local level, sharing recruitment tips and encouraging local/national competition. All of these strategies aimed to ultimately boost patient recruitment. Results The regional representative network assisted with setting up a new recruitment site, who have since remained a top recruiter. The TEGs establishment saw the highest number of trainees attend the study's yearly ‘Investigators' Meeting’. The TEGs engagement with the study’s social media led to an increase in follower numbers and consistently maintained high tweet impressions. The Sunflower Study is affiliated with the NIHR API scheme and has 165 collaborators registered with the scheme - the highest of any UK study. Through this, trainees are able to develop leadership, communication and research skills; as well as gain competencies required for CCT. Conclusion The implementation of the TEG illustrates how innovative strategies can be utilised to actively involve trainees in research. Following the establishment of the TEG, new sites participated in the study, the study's social media impact increased and trainee engagement was optimised. The TEG also encouraged trainees' future involvement with research through the API scheme. In the post-COVID-19 era, collaborative studies have proven their role in providing high impact quality research. Future studies could foster the TEG model, with an appointed trainee leadership team focusing on maximising trainee output, providing benefits not only for the trainees themselves, but also recruitment sites and studies overall.

Therapeutic climbing in inpatient rehabilitation

Abstract: Background: Therapeutic climbing (TC) has been increasingly implemented in the context of mental health care, with promising effects. While most evaluation studies focus on symptom reduction, the specific elements and mechanisms that make climbing effective compared to other therapeutic sports remain unclear. This study explores the subjective experiences of participants of a climbing therapy program in order to explore the underlying processes and the subjectively perceived effects. Method: The study took place at an inpatient rehabilitation facility in southern Germany, where a weekly group TC program was part of the treatment for individuals with mental disorders. Data from 265 participants with ICD-10 mental disorders collected between 2010 and 2022 was analyzed via questionnaires quantitatively assessing physical, psychological, and social improvements with rating items. Additionally open answers on subjectively relevant psychological experiences were analyzed using a qualitative content analysis. Results: Climbing therapy was generally perceived as relevant to their rehabilitation and rated as influential in terms of improving physical and psychological condition as well as sociability. The qualitative analysis identified five main categories being “Successful coping and positive mood”, “Challenge and coping strategies”, “Self-reflection and self-perception”, “Social experiences and belaying” and “Letting go of worries and being in the moment”. Conclusion: The results support previous findings on the benefits of TC and highlight its relevance as a therapeutic tool. Participants with mental disorders reported various positive experiences, emphasizing the unique demands, motivational aspects and social context of climbing. Further high-quality research is needed to compare climbing’s potential with other therapeutic sports across different target groups.

Exploring participants’ characteristics and self-assessed readiness to conduct clinical trials in general practice – baseline analysis of the RaPHaeL practice-based research network

Background Primary care is integral to healthcare systems extending beyond traditional illness management to include preventive care, chronic disease management, and health promotion. Practice-based research networks (PBRNs) have emerged as essential infrastructures for conducting clinical research in primary care. This study explores the establishment of the ‘Research-Practices Halle-Leipzig’ (RaPHaeL) PBRN in Germany, evaluating the characteristics and research readiness of participating practices. Methods A cross-sectional survey (MORNING II) was conducted among all general practitioners (GPs) joining the RaPHaeL PBRN, assessing socio-demographic characteristics, practice infrastructure, and research readiness. After a descriptive analysis, we compared data with a previous study (MORNING) to examine potential differences between PBRN participants and non-participants. We developed a research readiness score (RRS) to quantify practices’ ability to perform clinical research subtasks. Results The response rate was 97.1% and our participants were often male, involved in undergraduate education, generally interested in research or had previous research experiences. However, they differed widely in age and size, staff structure, and patient demographics of their practices. Initially, around two-thirds of the practices were not sufficiently prepared to conduct clinical trials (self-assessed feasibility of relevant subtasks). If further research and documentation tasks are required, patient recruitment estimations are lower than for patient identification and information. Conclusion This study highlights the variability in research readiness among GP practices and shows the need for targeted training. By systematically assessing and enhancing research capabilities of participating GPs, PBRNs can facilitate high-quality clinical research in primary care to improve patient outcomes and healthcare delivery.

Interpretation of the CDISC therapeutic area user guide for traditional Chinese medicine- acupuncture

Improving research data quality is a crucial aspect of high-quality clinical research of acupuncture and moxibustion. The Clinical Data Interchange Standards Consortium (CDISC) has developed a series of standards to support the collection, tabulation, and analysis of clinical research data. To enhance the efficiency and quality of clinical research in acupuncture, as well as to facilitate the integration, sharing, and secondary analysis of data from multiple similar studies, CDISC has developed and released the CDISC therapeutic area user guide for traditional Chinese medicine acupuncture (TAUG-TCM-Acupuncture). This paper introduced the TAUG-TCM-Acupuncture, including relevant concepts, main content, and its application in clinical research of acupuncture, with illustrative examples.

Exploring the Nature-Creativity Connection Across Different Settings: A Scoping Review

AbstractThe widespread benefits of creativity have become more salient in recent years. This has led to scholarly interest in finding ways to foster creativity. Nature immersion may be one way to enhance creativity, particularly as many individuals involved in creative pursuits have found nature to be a source of inspiration and a haven for restoration. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for scoping reviews and the PRISMA-ScR 22 item checklist, we conducted a scoping review to examine the evidence on the relationship between nature and creativity as well as any underlying mechanisms facilitating this relationship. A scoping review was deemed appropriate given the infancy of the topic and the need to understand the broad landscape. Our aim was to present a range of interdisciplinary applications of nature interventions on different types of creative performance. We found 45 publications exploring the relationship between nature and creativity, with the majority (n = 36, 80%) published within the past seven years. Overall, the quantitative studies in our scoping review provided evidence of a significant positive relationship, or effect, between nature and creativity. These relationships held across various types of nature including for wilderness, rural and urban settings, as well as in different applications of creativity such as in the arts, workplace, education, and laboratory conditions. Qualitative and case study research also supported the positive relationship between nature and creativity including in diverse nature settings and in different applications such as in visual arts, design, writing, music, free play in kindergartens, and work. Qualitative studies highlighted potential mechanisms behind this relationship, including time in solitude, appreciation of impermanence, relaxation and inspiration, and disconnection from technology. Moreover, the degree of exposure to nature may be an important consideration for creative performance with more immersive, real-life experiences typical of outdoor nature, tending to be more effective than indoor spaces with window views or indoor plants. These preliminary findings suggest that more opportunities to connect with nature, especially in the outdoors, may help to stimulate creativity in a wide range of settings including education, the creative arts, and workplaces, although more high-quality research examining the sustained effects of nature on creativity is needed.

Towards the year 2049: The next 25 years of occupational health and safety research.

In this discussion paper, we close our 2024 series reflecting on the successes, failures, and promises of occupational health and safety research in celebration of the 50th anniversary of the Scandinavian Journal of Work, Environment & Health (SJWEH). This paper aims to elaborate on the future of our research field. We conducted a narrative review of lessons learned in the series, examining insights gained and key takeaways. Additionally, we explored the current and anticipated agendas of major institutions, including the World Health Organization and the European Union, on occupational health and safety, as well as potential developments in the academic publishing industry. Occupational health and safety research has significantly evolved over the last 50 years, emphasizing longitudinal study designs, enriching observational data with registry-based information, and expanding the scope of hazardous determinants impacting workers` health. Novel statistical approaches have further enabled researchers to address complex associations, such as mediation effects, and to strengthen causal inference in observational studies. At the same time, the publishing business is changing rapidly, with artificial intelligence poised to reshape both research practices and the landscape of academic publishing. In the changing landscape of research and academic publishing, our goal is for SJWEH to continue to be a leading source of high-quality research dedicated to protecting and improving workers' health. We are curious and excited to see where all these current and anticipated changes will lead in the years to come.

Residential medication management reviews: a call for improved collaboration and systems integration in aged care

Purpose Residential Medication Management Reviews (RMMR) are a key component of safe, high-quality aged care service delivery. The RMMR is an interdisciplinary approach to medication management that relies on collaboration, communication and integration of systems. Acting as an improvement opportunity, the purpose of this paper is to present findings from a regional study, aimed at assessing the impact of RMMR on falls and hospital admissions and identifies barriers to impactful research in this area. Design/methodology/approach A three-year retrospective quantitative longitudinal practice audit was conducted in a regional state-managed high-care residential facility in Queensland, Australia. Data was collected pre-RMMR and six months post-RMMR. Findings The data collected was insufficient to achieve statistical significance or demonstrate the impact of RMMR on health outcomes. Factors impeding the research included limited ability to collect the data due to the lack of integration of information systems and limited stakeholder engagement resulting in poor recruitment. This highlights the need for improvement in RMMR processes and practices, and indeed wider research collaboration in the aged care sector. Research limitations/implications Thís paper acts as a call to action to improve research and interprofessional collaboration in Australian aged care. Originality/value The aged care industry needs high-quality research to drive practice improvement and collaborative care and service delivery. This paper advocates for improvements in the aged care sector with respect to research engagement and communication pathways between service providers. Advancement in systems integration for information sharing, recruitment of participants and stakeholder engagement will support evidence-based practice and process change.

Beyond diagnosis: maximizing the role of medical thoracoscopy in pleural disease treatment.

Medical thoracoscopy has been extensively utilized in the diagnosis of pleural disease, yet its potential therapeutic applications remain underutilized. This article presents a comprehensive overview of the various uses of medical thoracoscopy in managing pleural diseases. It has been employed to facilitate thoracic drainage and reduce hospitalization duration of patients with complicated parapneumonic effusions and empyema. Additionally, medical thoracoscopic occlusion therapy can be used for bronchoscopic closure and refractory pneumothorax. However, there is currently a lack of standardized protocols for utilizing medical thoracoscopy to reduce the volume of giant emphysematous bullae. Furthermore, medical thoracoscopy allows for pleurodesis or photodynamic therapy in patients with malignant pleural effusion. Nevertheless, further high-quality clinical research is needed to validate these findings.

Research Situation, Hotspots, and Global Trends in Laser Treatment of Acne Scars: A Bibliometric Analysis of Related Research From 2014 to 2024.

Acne vulgaris is a chronic inflammatory skin condition, commonly resulting in acne scars. Treating acne scars remains a significant challenge in dermatology. With advancements in laser technology, its clinical use for treating acne scars has been increasing annually. However, bibliometric analysis on laser treatment for acne scars is lacking. This study aims to use bibliometrics to comprehensively understand the development trends and research hotspots in laser treatment for acne scars. Using "acne scar" and "laser" as search terms, literature on laser treatment of acne scars from 2014 to 2024 was retrieved from the Web of Science Core Collection (WoSCC) database. The literature data were visualized using VOSviewers, CiteSpace, and R software, generating maps of countries, research institutions, authors, journals, references, and keywords. The analysis included 536 articles from 46 countries, with the United States and China leading in publications. Publications focusing on laser treatment of acne scars exhibit a consistent growth trend annually. Key research institutions include Mahidol University in Thailand, Cairo University in Egypt, and Hallym University in South Korea. The "Journal of Cosmetic Dermatology" had the highest number of articles in this field, while "Dermatologic Surgery" was the most cited publication. These publications involved contributions from 2135 authors, with Professor Manuskiatti Woraphong from Mahidol University in Thailand being the most prolific author in this field. Research on the efficacy of laser treatment for acne scars is a major focus in this field. Among the different types of lasers, CO2 lasers are the most commonly used. Emerging research focuses include therapies such as platelet-rich plasma, picosecond laser, trichloroacetic acid, and burn scar. Treatment efficacy is the primary focus of research in the field of laser treatment for acne scars. Platelet-rich plasma, and novel picosecond lasers, have emerged as hot topics and trends in this research field. However, it is important to note that the impact factors of journals publishing in this field are currently low. Therefore, clinicians must consider and explore strategies for publishing high-quality clinical research in the future.

A new trial monitoring plan (TMP) template for clinical trials: output from a Delphi process

BackgroundMonitoring is a crucial part of trial conduct and ensures that participants’ data is fairly represented, and future healthcare information is enhanced. This project aims to improve trial monitoring by creating a trial monitoring plan (TMP) template with input from individuals experienced in monitoring clinical trials.MethodsA review of monitoring plans received from UK Clinical Research Collaboration (UKCRC) registered clinical trials units (CTU)s created the basis for a preliminary TMP template and a Delphi survey. The TMP template was finalised after 2 rounds of a Delphi survey and a two-part consensus meeting including trialists with experience and expertise in monitoring clinical trials.ResultsWe received 31 monitoring plans from UKCRC-registered CTUs and reviewed over 800 monitoring items for inclusion in a TMP template, selecting items based on guidelines such as Good Clinical Practice (GCP) and our monitoring experiences. For certain items, further expert input was required. A total of 66 items were chosen for a Delphi survey involving 47 participants from 25 UK CTUs and industry. After the first round, all 66 items were retained, and six additional items were suggested by Delphi participants. In the second round, 37 items reached consensus for inclusion in the TMP template. The Delphi process was followed by a consensus meeting with 9 participants from 9 UK CTUs and industry. Participants in the consensus meeting voted on the 32 further items that had not reached the definition of consensus within the Delphi, regarding each item’s inclusion in or exclusion from the TMP template. The voting resulted in 18 items being excluded, leaving 14 items to be included in the TMP template. The process overall resulted in a standardised TMP template with input from many individuals with interest, experience, or expertise in monitoring clinical trials.ConclusionA TMP template was developed building on the currently used monitoring plans and with input from those experienced in clinical trial monitoring. Using a centrally developed good quality TMP template should contribute towards maintaining consistency in monitoring standards across all CTUs, resulting in higher research quality and improved quality assurance. Its use should provide reassurance to participants that their participation is carefully monitored to ensure that their data or any samples provided are treated with confidentiality, integrity, and respect and that their rights and well-being are protected.

Maggots in Medicine: A Narrative Review Discussing the Barriers to Maggot Debridement Therapy and Its Utilisation in the Treatment of Chronic Wounds

Background: There is currently no standardised guidance that supports any particular method of debridement. Maggot debridement therapy (MDT) is often used as a last-resort therapy over more conventional treatments, despite mounting evidence of its benefits. Objectives: This review aimed to critically analyse the systemic and individual barriers to MDT implementation and utilisation. As the primary providers of wound care, discussions are primarily focused on nursing care. Search strategy: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to conduct a literature search of the studies published between 2012 and 2022 across four databases: CINAHL, Cochrane, British Nursing Index and PubMed. The keywords used for this search were based on the PICO (Population, Intervention, Comparison, Outcome) framework. Twenty-three main articles met the inclusion criteria. All the studies were quality appraised using a risk of bias tool and data were extracted using a predesigned form. The evidence base of the four main themes were discussed: (1) effectiveness of MDT compared to conventional treatments, (2) perceptions and stigma, (3) cost, training and accessibility and (4) side-effects. Conclusions: The findings of this review suggest that MDT is an underused and potentially very effective method of debridement compared to conventional treatments. The identified barriers could be mitigated with relatively low-cost solutions. More high-quality research is needed across all the barriers.

Emotion dysregulation in autism: Severity and correlates in early childhood.

Emotion dysregulation (ED) is common and severe in older autistic youth, but is rarely the focus of early autism screening or intervention. Moreover, research characterizing ED in the preschool years (when autism is typically diagnosed) is limited. This study aimed to characterize ED in autistic children by examining (1) prevalence and severity of ED as compared to children without an autism diagnosis; and (2) correlates of ED in autistic children. A sample of 1864 parents (Mean child age = 4.21 years, SD = 1.16 years; 37% female) of 2-5 year-old children with (1) autism; (2) developmental concerns, but no autism; and (3) no developmental concerns or autism completed measures via an online questionnaire. ED was measured using the Emotion Dysregulation Inventory-Young Child, a parent report measure characterizing ED across two dimensions: Reactivity (fast, intense emotional reactions) and dysphoria (low positive affect, sadness, unease). Autistic preschoolers, compared to peers without developmental concerns, had more severe ED (+1.12 SD for reactivity; +0.60 SD for dysphoria) and were nearly four and three times more likely to have clinically significant reactivity and dysphoria, respectively. Autistic traits, sleep problems, speaking ability, and parent depression were the strongest correlates of ED in the autism sample. While more work is needed to establish the prevalence, severity, and correlates of ED in young autistic children, this study represents an important first step. Results highlight a critical need for more high-quality research in this area as well as the potential value of screening and intervention for ED in young autistic children.

Is robot-assisted pedicle screw placement really superior to conventional surgery? An overview of systematic reviews and meta-analyses.

Over the past two decades, modern spine surgery has become increasingly intellectualized and minimally invasive. However, whether using robots in spine surgery results in more accurate pedicle screw placement remains a topic of debate. This study aimed to evaluate the certainty and quality of the available evidence on the efficacy of robot-assisted pedicle screw placement. We performed an overview of reviews including systematic reviews (SRs) and meta-analyses (MAs) regarding the accuracy of robot-assisted pedicle screw placement. Regarding the SRs/MAs, five electronic databases were searched from inception to 28 April 2023. There were no restrictions on the language or population. The quality and certainty of the evidence were evaluated with PRISMA, AMSTAR-2, ROBIS, Veritas plot, and GRADE tools. Fifteen SRs/MAs were analyzed. The findings indicated that the accuracy of pedicle screw placement in the robot-assisted group was not superior to that in the freehand group. All the SRs/MAs were of low or critically low quality. The main reasons for this include missing data, lack of transparency, lack of sensitivity analysis, and measurement of heterogeneity in the included studies, registration of reporting protocols, and deficiencies in the study inclusion methods and selection criteria. While there is potential for robot-assisted pedicle screw placement to offer superior accuracy compared to conventional surgery, the current evidence is limited by methodological shortcomings. The quality of the studies analyzed was insufficient to provide a robust basis for developing clinical guidelines. Further high-quality research is necessary to confirm the benefits and establish clearer recommendations.