Lower Quality Scores Research Articles

Ex vivo comparison of full-thickness biopsy techniques in the equine small intestine.

To compare the practicability and tissue sample quality between different intestinal biopsy techniques. Experimental, randomized ex vivo study. Small intestine of nine horses. Four different biopsy techniques were evaluated in the aboral jejunum and the ileum within 1 h after euthanasia. One segment was used as control (C), and the applied techniques included an 8 mm biopsy punch (BP), transverse wedge resection (TW), longitudinal wedge resection with transverse closure (LW) and a longitudinal sample using Eppendorfer biopsy forceps (EF). Defects were closed using a single-layer continuous Lembert pattern. Duration of the procedure, intestinal diameter, contamination, and bursting pressure were determined. The quality of the obtained tissue samples for histological assessment was evaluated using a semiquantitative score. The jejunal and ileal samples were analyzed separately. All biopsy procedures including defect closure were completed within 5 min, with shorter closure times for BP (p = .03). Minimal contamination could be noted in 1/8 TW and 2/8 LW cases, without significant differences between the groups. Longitudinal closure techniques (BP, EF) showed more constriction than transverse closures (TW, LW) (p < .05). Bursting pressure was >75 mmHg in all cases. Technique BP showed significantly lower biopsy quality scores (p = .009). The tested biopsy techniques could all be applied effectively within a reasonable time frame, yet the biopsy punch was associated with significant artifacts and risk of missing mucosa. The findings provide insights into the possible advantages and limitations of the different techniques and alert the surgeon to potential issues with the quality of the tissue sample.

Coffee Consumption and Sleep Quality: A Cross-Sectional Study among Saudi Adults

Background: Caffeine is one of the most commonly consumed stimulants in Saudi Arabia. We aim to examine the relationship between caffeine consumption and sleep quality among individuals residing in Saudi Arabia. Methods: This is a cross-sectional study using the Pittsburgh Sleep Quality Index (PSQI). Data was collected through social media platforms such as WhatsApp, Twitter, LinkedIn, and Facebook. The study included adults 18 years and older who reside in Saudi Arabia. Descriptive statistics were performed to examine the population characteristics, and the logistic regression model was used to examine the association between caffeine consumption and sleep quality. Results: A total of 636 respondents participated in the study. Nine out of ten respondents reported consuming caffeine (90%). The respondents were predominately aged 30 to 44 (52.04%), females (63.11%), married (62.89%), and overweight/obese (60.47%). Around two-thirds were Saudi nationals (69.68%). More than half of the respondents reported a good quality sleep score (56.88%). In multivariate analysis adjusted for potential confounders, body mass index was the only statistically significant demographic predictor for sleep quality. Overweight/obese respondents had a statistically significantly lower sleep quality score mean than non-overweight/obese respondents (coefficient -0.48; P-value 0.05). Conclusion: Caffeine consumption was highly prevalent among Saudis; however, it was not associated with poor sleep quality. On the contrary, those with high body mass index, particularly in obese individuals, were significantly associated with poor sleep quality. Caffeine consumers have to monitor their caffeine consumption carefully and set a daily consumption limit for themselves.

The optimal measurement method considering reliability and validity in the anterior knee laxity of anterior cruciate ligament tears.

To seek an optimal measurement method with high reliability and high validity for evaluation of the anterior knee laxity on stress radiographs and comparing the translation values to those of KT-2000 arthrometer. Anterior knee laxity in 77 patients was measured preoperatively using the TelosTM and the KT-2000 arthrometer. Side-to-side difference measurements were taken using three conventional measuring methods and one proposed method (Modified Lateral). The knee position on the stress radiograph was evaluated and scored based on the stress radiograph qualifying criteria depending on stress film correctiveness. Intraclass correlation coefficients were analyzed to evaluate the reliability of the measurement methods and were compared between high (Group H) and low (Group L) radiograph quality score groups for each method. Validity was assessed by comparing the KT-2000 and the TelosTM using Pearson correlation (r value). The Modified Lateral method showed the best Intraclass Correlation Coefficients (ICCs), followed by Center to Center, and Medial to Medial and Lateral to Lateral methods without considering the quality of Telos. In the comparison between groups based on Telos quality for intra-rater reliability, the Medial to Medial (MM) method demonstrated the best reliability in both groups (MM: ICCs, Group H = 0.942, Group L = 0.917, P = 0.693). As for inter-rater reliability, the Modified Lateral (ML) method exhibited the best reliability in both groups (ML: ICCs, Group H = 0.923, Group L = 0.882, P = 0.547). The value measured using the ML method in Telos showed the highest correlation coefficient with the KT-2000 measured value in both groups H and L. There were no statistically significant differences among the correlation coefficient values. The Modified Lateral method is recommended for its high reliability, taking into account the differences in bilateral knee positions and anatomical discriminability on stress radiographs when evaluating anterior knee translation with Telos. It also best reflected the KT-2000 arthrometer. Case Series, Level IV.

The ORIGINS Project: A Cross-Sectional Analysis of the Nutrition Profile of Pregnant Women in a Longitudinal Birth Cohort.

Pregnancy is an opportunistic time for dietary intake to influence future disease susceptibility in offspring later in life. The ORIGINS Project was established to identify the factors that contribute to 'a healthy start to life' through a focus supporting childhood health and preventing disease (including non-communicable diseases). We aim to describe the dietary intakes of pregnant women in this cohort and to compare these to the Nutrient Reference Values (NRVs) and Australian Recommended Food Score (ARFS). The usual food and nutrient intakes of women were collected using the Australian Eating Survey (AES), a semi-quantitative food frequency questionnaire (FFQ). A total of 374 women completed the AES FFQ at both 20 weeks and 36 weeks of gestation between December 2016 and January 2023. Macronutrient, micronutrient, and food group intake were explored using descriptive statistics. Overall, it was found that the energy contribution from carbohydrates was low, while that from fat and saturated fat was high; participants were not meeting the recommendations for several key micronutrients (calcium, iron, iodine, and folate); and they had low diet quality scores for all food groups. These findings suggest that despite the ongoing promotion of healthy eating during pregnancy, further exploration into why dietary guidelines during pregnancy are not being adhered to is warranted.

Impact of Anxiety, Depression, and Coping Strategies on Health-Related Quality of Life in Patients with Cystic Fibrosis.

With the significant increase in the life expectancy of cystic fibrosis (CF) patients, many individuals now reach adulthood and develop specific coping strategies to maintain their physical and mental well-being. This study aims to evaluate coping styles and their relationship with mental health and Health-Related Quality of Life (H-RQoL) in adult CF patients. Thirty adult CF patients completed the Hospital Anxiety and Depression Scale to assess anxiety and depression, the Cystic Fibrosis Questionnaire-Revised to evaluate quality of life, and the Brief Coping Orientation to Problems Experienced questionnaire to assess coping strategies. Twelve individuals (40%) met the diagnostic criteria for being at risk of experiencing anxiety and/or depression. Anxiety risk group exhibited lower life quality scores in the domains of vitality, emotional functioning, and role limitations (P = .027, P = .001, and P = .001, respectively). Patients reporting depressive symptoms had lower scores in emotional functioning and role limitations domains of quality of life (P = .005 and P = .018, respectively). Multivariate analysis indicated that depression and anxiety scores were significant predictors of emotional quality of life. In terms of coping strategies, "acceptance" was the most commonly preferred, while "substance use" was the least preferred strategy among all participants. Patients at risk of anxiety and/or depression often chose "avoidance" as their coping strategy. Anxiety and depressive symptoms are prevalent and associated with poorer H-RQoL in adult CF patients. These patients preferred to employ giving up strategy when dealing with the disease. Therefore, it is essential to screen adult CF patients for mental health risks and to work on improving their coping strategies.

Patients With Shoulder Labral Tears Search the Internet to Understand Their Diagnoses and Treatment Options

PurposeTo analyze the most frequently searched questions associated with shoulder labral pathology and to evaluate the source type availability and quality. MethodsCommon shoulder labral pathology related search terms were entered into Google and the suggested frequently asked questions were compiled and categorized. Suggested sources were also recorded, categorized, and scored for quality of information utilizing Journal of the American Medical Association (JAMA) benchmark criteria. Statistical analysis was performed to compare the types of questions and their associated sources, as well as the quality of sources. ResultsFive-hundred and thirteen questions and 170 sources were identified and categorized. The most popular topics were Diagnosis/Evaluation (21.5%) and Indications/Management (21.1%.). The most common website types were Academic (27.9%), Commercial (25.2%), and Medical Practice (22.5%). Multiple statistically significant associations were found between specific question categories and their associated source types. The average JAMA quality score for all sources was 1.56 and medical websites had significantly lower quality scores than non-medical sites (1.05 vs 2.12, p<0.001). ConclusionPatients searching the internet for information regarding shoulder labral pathology often look for facts regarding the management of their condition. They use various source types to understand their conditions, with government sources being the highest quality, while medical sites showed statistically lower quality. Across the spectrum of questions, the quality of readily available resources varies substantially.

Potential misinformation in websites on carpal tunnel syndrome

ObjectiveWe sought to evaluate the potential reinforcement of misconceptions in websites discussing carpal tunnel syndrome (CTS). MethodsAfter removing all cookies to limit personalization, we entered “carpal tunnel syndrome” into five search engines and collected the first 50 results displayed for each search. For each of the 105 unique websites, we recorded publication date, author background, and number of views. The prevalence of potential reinforcement and/or reorientation of misconceptions for each website was then scored using a rubric based on our interpretation of the best current evidence regarding CTS. The informational quality of websites was graded with the DISCERN instrument, a validated tool for assessing online health information. ResultsEvery website contained at least one potentially misleading statement in our opinion. The most common misconceptions reference “excessive motion” and “inflammation.” Greater potential reinforcement of misinformation about CTS was associated with fewer page views and lower informational quality scores. ConclusionsKeeping in mind that this analysis is based on our interpretation of current best evidence, potential misinformation on websites addressing CTS is common and has the potential to increase symptom intensity and magnitude of incapability via reinforcement of unhelpful thoughts regarding symptoms. InnovationThe prevalence of patient-directed health information that can increase discomfort and incapability by reinforcing common unhelpful thoughts supports the need for innovations in how we develop, oversee, and evolve healthy online material.

Low Global Diet Quality Score (GDQS) Among Adolescents in Vietnam Is Due to Inadequate Consumption of Fruits and Vegetables Rather Than High Consumption of Unhealthy Foods

Low Global Diet Quality Score (GDQS) Among Adolescents in Vietnam Is Due to Inadequate Consumption of Fruits and Vegetables Rather Than High Consumption of Unhealthy Foods

Poor sleep quality contributes to occurrence of posttraumatic stress disorder in trauma patients

To evaluate the impact of poor sleep quality on occurrence of post-traumatic stress disorder (PTSD) in trauma patients. We prospectively recruited 256 trauma patients hospitalized in 4 general hospitals in Zunyi during the period from October, 2021 to November, 2022, and 226 of the participants completed the PTSD survey and assessment. The patients' sleep quality within a month before trauma was estimated using Pittsburgh Sleep Quality Index (PSQI), and their sleep quality within 7 days after admission was monitored by smart bracelet sleep monitoring; the PTSD Checklist-Civilian Version (PCL-C) was used to detect the occurrence of PTSD during the follow-up. The detection rate of PTSD in the patients was 19.47% at 1 month and 17.61% at 3 months after trauma. The patients who developed PTSD had poorer sleep quality before the trauma, as shown by significantly higher PSQI scale scores (P < 0.001), than those without PTSD, and they showed a sleep abnormality rate as high as 72.73% prior to PTSD onset. Within 7 days after admission, the patients developing PTSD had lower sleep quality scores with more frequent night awakenings (P < 0.05). A 1 month and 3 months after trauma, the patients with PTSD had significantly higher PSQI scores than those without PTSD (P < 0.05). PTSD is more likely to occur in trauma patients with poor sleep quality before trauma.

Improving quality of care by standardising patient data collection in electronic medical records in an oncology department in Spain

BackgroundEvaluation of quality of care in oncology is key in ensuring patients receive adequate treatment. American Society of Clinical Oncology’s (ASCO) Quality Oncology Practice Initiative (QOPI) Certification Program (QCP) is...

QOL-31. NEUROPSYCHOLOGICAL FUNCTIONING AND QUALITY OF LIFE IN INFANT AT/RT SURVIVORS: FOCUS ON FLUID INTELLIGENCE AND VISUAL PROCESSING

Abstract BACKGROUND Understanding the long-term cognitive sequelae in infant brain tumor survivors remains incomplete, particularly regarding the impact of tumor type, multimodal treatment, and other patient-related factors. This retrospective analysis explores neuropsychological and quality of survival (QoS) outcomes in survivors of atypical teratoid/rhabdoid tumors (AT/RT) and extracranial malignant rhabdoid tumors of soft tissues (eMRT) and kidneys (RTK), all treated within the same framework. Neuropsychological data from children with AT/RT were compared to data from children with non-irradiated low-grade glioma (LGG). METHODS Patients (0 - 36 months at diagnosis) underwent various treatments, including radio-chemotherapy for AT/RT (n = 13) and eMRT/RTK (n = 7), chemotherapy only for LGG (n = 4) and eMRT/RTK (n = 1), or observation for LGG (n = 11). Neuropsychological evaluations were conducted at a median of 6.8 years (AT/RT), 6.6 years (eMRT/RTK), and 5.2 years (LGG) post-diagnosis. RESULTS Impairments were observed for all tumour types. Patients with AT/RT exhibited impairments in fluid intelligence (p =.041; d = 1.11) and visual processing (p =.001; d = 2.09) when compared to LGG-patients. Both groups demonstrated deficits in psychomotor speed and attention abilities (p &amp;lt;.001–.019; d = 0.79–1.90). Diagnosis significantly predicted cognitive outcomes, whereas gender and age-related variables did not. QoS outcomes for all rhabdoid patients indicated lower scores in psychosocial functioning (p =.023; d = 0.78) and quality of life (p =.006; d = 0.79) compared to healthy controls. CONCLUSIONS Infant rhabdoid tumor survivors experience cognitive and quality-of-life sequelae. Patients with AT/RT are especially vulnerable to impairments in fluid intelligence and visual processing, while infant LGG-patients without radiotherapy demonstrated comparable deficits in psychomotor and attention abilities. Close monitoring of neuropsychological and quality of life outcomes is crucial for early onset and multimodal treatment.

Assessing the accessibility and quality of mobile health applications for the treatment of obesity in the German healthcare market.

Overweight and obesity are among the most prevalent health problems worldwide leading to various diseases and having a significant impact on the healthcare system. In Germany, the prevalence of obesity among adults is 19%. Mobile health applications offer a new approach to treatment and prevention and have been proven effective in previous studies. However, it is essential to investigate the availability and quality of these digital applications. The aim of this systematic assessment is to evaluate the accessibility and quality of digital health applications in German language designed to treat obesity. In January 2024, a systematic search for mobile health applications was conducted on both the Google Play Store and Apple App Store. Just those apps available in German for both iOS and Android were considered acceptable. The German Mobile Application Rating Scale (MARS-G) was used to assess the quality of the apps. The content of mobile health applications was evaluated using the guideline from the German Obesity Society for the treatment of obesity. The characteristics of the apps were summarized and presented, and the results were analyzed using descriptive statistics and presented in tables. After screening, ten apps were included in the review. The apps varied in terms of calorie tracking, individual workout plans, educational aspects, nutritional plans, and exercises for behavioral change. On average, 6.4 out of 12 items of the German Obesity guideline recommendations were fulfilled. The MARS score (possible range from 1-5) reached a mean of 3.39 (SD = 0.39). The section "Engagement" had the lowest quality score with a mean of 3.14 (SD = 0.57), while the section "Aesthetics" achieved the highest mean of 3.57 (SD = 0.52). Most German mobile health applications for managing obesity meet some guideline recommendations. They demonstrate adequate to good quality according to the MARS score. Assessing the quality of mobile health applications can be challenging for patients, despite being easily accessible and low-threshold. However, such digital health applications, reimbursed by the German SHI, offer evidence-based information, even if access can be associated with higher hurdles.

BANK TECHNICAL EFFICIENCY OF COUNTRY GROUPS: A META-REGRESSION ANALYSIS

Purpose- This study endeavors to examine studies using Data Envelopment Analysis in calculating the banking sector efficiency across country groups and to determine the factors affecting their technical efficiency through meta-regression analysis. Methodology- As of November 22, 2023, relevant works were systematically reviewed using Web of Science, Scopus, and Google Scholar. The literature review employed a comprehensive search encompassing all files with the keywords such as ‘‘technical efficiency (All Field) AND bank (All Field)’’. The research process adhered to the PRISMA guidelines. This study reviewed all studies published between 1932 and 2023 identifying 64599 studies in the initial scan by the author. The author independently scrutinized the titles, abstracts, keywords, text, and references of all manuscripts to mitigate selection bias and reveal whether eligibility criteria were met. Exclusions from the scope encompassed duplicate downloads, papers, books and book chapters, together with studies having low quality scores, no full-text versions, and those that are irrelevant to the subject. Findings- The results of meta-regression analysis revealed that the data collection year of the studies and the income groups of the countries did not have an impact on the mean technical efficiency. The number of banks, number of observations, publication year, and number of countries were statistically significant on the mean technical efficiency estimate. Conclusion- The study further standardized variables and methodological assumptions used in bank sector efficiency studies within country groups through meta-regression analysis. Empirical findings in the literature were combined. This study enhances accessibility to the existing body of knowledge for researchers in the field

Malassezia specific IgE in head and neck dermatitis of eczema: A systematic review &amp; meta‐analysis

AbstractHead and neck atopic dermatitis (HNAD) is a subtype of atopic dermatitis (AD), a common inflammatory skin condition with a distinctive clinical appearance. Malassezia spp., a predominant skin yeast, is considered to exacerbate HNAD. In this study, we investigate the prevalence of Malassezia‐specific IgE among HNAD patients. A comprehensive search was performed for observational studies analysing the association between Malassezia‐specific IgE and HNAD. This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta‐Analyses 2020 checklist and quality was assessed via the Newcastle‐Ottawa Quality Assessment Scale (NOS). Fourteen observational studies (840 patients) were included in the analysis. 58% of HNAD patients were male (95% CI: 45.2–69.7). Overall prevalence of Malassezia‐specific IgE among HNAD patients was 79.3% (95% CI: 57.5–91.5). Prevalence of Malassezia‐specific IgE among HNAD patients varied significantly between geographical regions (p = 0.0441), with 88% in non‐Asian regions (95% CI: 61.06–97.17) and 54.73% in Asian regions (95% CI: 34.36–73.63). Malassezia‐specific IgE prevalence among HNAD patients varied significantly among studies of higher and lower NOS quality score (p = 0.0386), with 95.42% in studies with NOS ≥7 (95% CI: 63.54–99.60) and 58.05% in studies with NOS &lt;7 (95% CI: 41.44–73.01). Malassezia‐specific IgE prevalence among HNAD patients did not vary significantly between more and less predominant Malassezia species (p = 0.1048). Malassezia spp. plays a crucial role in the pathogenesis of HNAD, and IgE anti‐Malassezia antibodies appeared to be a common marker for HNAD. Understanding the pathophysiology of Malassezia in HNAD can help develop more targeted therapeutic approaches in managing AD.

Parent, Physician, and Therapist Experience of In-Person, Hybrid, and All-Virtual Models of Physiatry Care for Children with Special Health Care Needs

ObjectiveThe purpose of this study was to compare three models of pediatric physiatry care (in-person, hybrid, and all-virtual) in terms of parent experience and physician- and therapist-reported quality of care. We hypothesized that the all-virtual model would have lower parent experience scores and lower quality scores compared with the other two models of care. MethodsWe designed a convergent parallel mixed methods study incorporating a cluster-randomized crossover design. Quantitative data included surveys of parents, physicians, and therapists after visits to 13 medical therapy units in Northern California between January 2020 and January 2022. Qualitative data were collected in six focus groups with parents, physicians, and therapists. ResultsA total of 2455 visits were completed for 1281 unique children during the study period, including 507 in-person visits, 246 hybrid visits, and 1702 all-virtual visits. There were no differences in parent experience scores between the three models of care. Physicians and therapists rated all-virtual visits significantly lower in terms of quality of care, parent education, and physical exam, compared with the other two models of care, but qualitative results highlighted specific instances where all-virtual visits could be useful. ConclusionsOur findings suggest that parents, therapists, and physicians find a hybrid virtual model is an acceptable model of care that maintains the quality of care and facilitates parent education. All-virtual models may be appropriate for specific circumstances but are perceived as lower quality. Research exploring implementation of these models would be valuable for providing practical guidance in the future.

Continuous subcutaneous insulin infusion versus multiple daily injection therapy in pregnant women with type 1 diabetes.

The study aimed to compare glycemic control and pregnancy outcomes in women with type 1 diabetes mellitus (T1DM) using multiple daily injection therapy (MDI) and continuous subcutaneous insulin infusion (CSII) and to compare outcomes of women treated with long-acting insulin or neutral protamine Hagedorn (NPH). This multicenter prospective cohort study involved women with pregestational T1DM treated with MDI and CSII. Primary outcome was glycated hemoglobin (HbA1c) before and during pregnancy. Secondary outcomes included maternal and neonatal outcomes and quality of life. Of the 121 studied women, the average age was 28.48 years, and the average body mass index was 21.29 kg/m2 at conception and 26.32 kg/m2 at delivery. Of the studied women, 78.51% had planned pregnancy. Women treated with MDI and CSII had comparable HbA1c before pregnancy or in the first and second trimesters. In the third trimester, women on CSII therapy had significantly lower HbA1c (6.07 ± 0.62 vs 6.20 ± 0.88%, p = .017), higher HbA1c on-target rate (71.43% vs 64.62%, p = .030), and greater decline of HbA1c from preconception to the third trimester (-0.65 vs -0.30%, p = .047). Fewer daily insulin requirements were observed in those used CSII compared with MDI-treated women (0.60 ± 0.22 vs 0.73 ± 0.25 U/kg/day, p = .004). Newborns born of mothers treated with the CSII method were more likely to have neonatal jaundice (adjusted odds ratio [OR] 2.76, 95% confidence interval [CI] 1.16-6.57) and neonatal intensive care unit (adjusted OR 3.73, 95%CI 1.24-11.16), and women on CSII had lower scores in patient-reported quality of life (p = .045). In the MDI group, those receiving long-acting insulin had nonsignificant lower HbA1c and higher HbA1c on-target rate in the second and third trimesters, compared with those treated with NPH. Insulin pump users may achieve better glycemic control than multiple daily insulin injections, which did not substantially improve pregnancy outcome.

Role of Healthy Lifestyle and Diet Quality in the Development of Colorectal Cancer in the Adult Population in the Kurdistan Region: A Case-Control Study.

Background The incidence of colorectal cancer (CRC) is increasing in developing countries. The factorscontributing to the risk of CRC are not known in developing countries. Therefore, this study aimed to explore the role of a healthy lifestyle on CRC in the adult population in the Kurdistan Region of Iraq. Methodology In this case-control investigation, patients previously diagnosed with CRC were included as cases (n = 84) and the healthy adult population as healthy controls (n = 87). The patients were selected from the Gastroenterology Unit of Azadi Teaching Hospital and Emergency Teaching Hospital. The healthy controls were selected from the caregivers of patients who met the eligibility criteria. Results Individuals with a history of chronic disease (63.08% vs. 40.52%; p = 0.0043), a history of hypertension (71.74% vs. 40.80%; p = 0.0003), and a history of inflammatory bowel disease (IBD) (59.42% vs. 42.16%; p = 0.0267) had a significantly higher prevalence of CRC compared to healthy controls. CRC patients had significantly lower diet quality scores than healthy controls (36.27 vs. 37.83; p = 0.0002). The study showed that CRC patients had a significantly lower lifestyle index score compared to healthy controls (10.20 vs. 11.69; p = 0.0002). In addition, CRC patients had lower scores for diet (0.42 vs. 1.00; p < 0.0001), smoking (2.92 vs. 4.0; p < 0.0001), and physical activity (1.02 vs. 1.70; p < 0.0001) compared to healthy controls. However, CRC patients and healthy controls had similar alcohol index scores (5.0 vs. 530; p = 1.000) and body mass index (1.04 vs. 1.01; p = 0.8982). Conclusions This study showed that CRC was associated with having a history of bad diet quality and unhealthy lifestyles. In addition, a history of chronic diseases, hypertension, and IBD was associated with the risk of CRC.

A Systematic Review of the Gonadotoxicity of Osteosarcoma and Ewing's Sarcoma Chemotherapies in Postpubertal Females and Males.

Data on gonadotoxicity of chemotherapies are essential to better counsel young females and males about the risk of infertility and to better indicate fertility preservation measures before cancer therapies. However, such data have not recently been reviewed for bone cancer. Therefore, a systematic literature search was conducted considering papers published since 2000. This study is part of the FertiTOX® project, which aims to improve the lack of data regarding gonadotoxicity of cancer therapies to enable more accurate counseling regarding fertility preservation. Only relapse-free women and men were included. Gonadotoxic therapy-induced suspected infertility was defined as very low anti-mullerian hormone, high gonadotropin concentration, amenorrhea, oligomenorrhea, azoospermia, or oligozoospermia. The quality of the individual studies was assessed using the Newcastle-Ottawa Scale (NOS). In total, 11 out of 831 studies were included in the review. Suspected infertility was found in 10/190 (5.1%, range 0%-66%) of female patients with osteosarcoma (six studies), in 24/46 (52.2%, range 46%-100%) of male patients with osteosarcoma (three studies), in 18/138 (13.0%, range 3%-18%) of female patients with Ewing's sarcoma (three studies), and in 34/38 (89.5%) of male patients with Ewing's sarcoma (one study). A risk calculation in relation to specific chemotherapies was not possible. Risk of suspected infertility tends to be higher in Ewing's sarcoma in which all patients received chemotherapies with alkylating agents. Two of the 11 included studies received a high NOS quality score, whereas the remaining nine studies received a low quality score, mainly because of the lack of a comparator group. Published data are too limited for precise estimation of the gonadotoxicity. However, data indicate clinically relevant risk for infertility, supporting counseling patients before chemotherapy about fertility preservation measures.

Non-pharmacological Management of Hypertension in Arab Countries: A Scoping Review

Background: Non-pharmacological interventions, such as healthy dietary approaches and physical activity, have always been a crucial part of hypertension (HTN) control in clinical practice. These non-pharmacological interventions, however, have never been reviewed in the literature of Arab countries. This review has quantified and evaluated non-pharmacological interventional studies conducted in Arab countries until 2023. Methods: Medline, Web of Science, PubMed, the Cochrane Library, Embase, Science Direct, Scopus, ERIC, ProQuest, Springer, Google Scholar, and CINAHL were explored from database inception until September 2023. Articles of relevance were screened based on their titles and abstracts for selection criteria. Eligible studies were reviewed, and information was retrieved. Jadad scores and the Downs and Black checklist were used to evaluate randomized controlled trials (RCTs) and quasi-experimental studies, respectively. Results: A total of 12 RCTs and 5 quasi-experimental studies met the selection criteria. The studied interventions were eHealth applications, educational programs, wet cupping, physical exercise, adherence therapy, green tea, lifestyle interventions, dietary approaches to stop HTN, motivational interviewing, and cold hibiscus beverages. The most commonly used outcome measure was blood pressure. Nine studies scored high quality. The low and neutral quality scores were mainly due to loss of blindness, poor reporting of participants’ characteristics, loss of follow-up, and failure to account for potential confounders. Conclusion: There is a scarcity of HTN non-pharmacological interventional studies, aside from the low or modest quality of nearly 50% of them. Hence, it is recommended that further high-quality interventional studies focus on the areas of dietary approaches (especially DASH), exercise, theory-based education, and behavioral counseling in Arab countries.

Hospice providers serving assisted living residents: Association of higher volume with lower quality.

Assisted living (AL) community caregivers are known to report lower quality of hospice care. However, little is known about hospice providers serving AL residents and factors that may contribute to, and explain, differences in quality. We examined the association between hospice providers' AL patient-day volume and their quality ratings based on Hospice Item Set (HIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Surveys. This cross-sectional study employed information from the Medicare Compare website and Medicare claims data. Medicare-eligible AL residents were identified using previously validated methods and merged with hospice claims. Linear probability models adjusting for county fixed effects were used to examine the association between hospice provider AL volume, measured as the share of annual hospice patient days from AL residents, and quality measures obtained from HIS and CAHPS. Models controlled for hospice providers' profit status and daily patient census. Higher AL-volume hospice providers were 7 percentage points more likely to have caregivers reporting lower median scores on domains of pain assessment, dyspnea treatment, and emotional support. Their caregivers also reported lower scores in team communications and training family to provide care. Higher AL-volume hospice providers also were 5 percentage points less likely to get higher aggregated scores from all CAHPS domains and 7 percentage points less likely to have higher HIS composite scores. Hospice providers serving higher volumes of AL patient days had lower quality scores. In order to identify targeted opportunities for quality improvement, research is needed to understand why lower quality providers are concentrated in the AL market.