MEDLINE Index Research Articles

Divergences between healthcare-associated infection administrative data and active surveillance data in Canada.

Although Canada has both a national active surveillance system and administrative data for the passive surveillance of healthcare-associated infections (HAI), both have identified strengths and weaknesses in their data collection and reporting. Active and passive surveillance work independently, resulting in results that diverge at times. To understand the divergences between administrative health data and active surveillance data, a scoping review was performed. Medline, Embase and Cumulative Index to Nursing and Allied Health Literature along with grey literature were searched for studies in English and French that evaluated the use of administrative data, alone or in comparison with traditional surveillance, in Canada between 1995 and November 2, 2020. After extracting relevant information from selected articles, a descriptive summary of findings was provided with suggestions for the improvement of surveillance systems to optimize the overall data quality. Sixteen articles met the inclusion criteria, including twelve observational studies and four systematic reviews. Studies showed that using a single source of administrative data was not accurate for HAI surveillance when compared with traditional active surveillance; however, combining different sources of data or combining administrative with active surveillance data improved accuracy. Electronic surveillance systems can also enhance surveillance by improving the ability to detect potential HAIs. Although active surveillance of HAIs produced the most accurate results and remains the gold-standard, the integration between active and passive surveillance data can be optimized. Administrative data can be used to enhance traditional active surveillance. Future studies are needed to evaluate the feasibility and benefits of potential solutions presented for the use of administrative data for HAI surveillance and reporting in Canada.

Nurse staffing and patient care outcomes: protocol for an umbrella review to identify evidence gaps for low and middle-income countries in global literature

Background: Adequate staffing is key to the delivery of nursing care and thus to improved inpatient and health service outcomes. Several systematic reviews have addressed the relationship between nurse staffing and these outcomes. Most primary studies within each systematic review are likely to be from high-income countries which have different practice contexts to low and middle-income countries (LMICs), although this has not been formally examined. We propose conducting an umbrella review to characterise the existing evidence linking nurse staffing to key outcomes and explicitly aim to identify evidence gaps in nurse staffing research in LMICs. Methods and analysis: This protocol was developed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P). Literature searching will be conducted across Ovid Medline, Embase and EBSCO Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Two independent reviewers will conduct searching and data abstraction and discordance will be handled by discussion between both parties. The risk of bias of the individual studies will be performed using the AMSTAR-2 . Ethics and dissemination: Ethical permission is not required for this review as we will make use of already published data. We aim to publish the findings of our review in peer-reviewed journals. PROSPERO registration number: CRD42021286908

A systematic review article Exposure to cement dust and respiratory health for communities residing near cement factories: A systematic review of the literature.

Objective: To examine the strength of evidence through systematic review of published literature on the association between effects of exposure to cement dust on respiratory health of communities residing near cement plants. Design and data sources: A systematic search and review of observational studies in Medline, Embase, and Cumulative Index to Nursing and allied Health Literature (CINAHL), and other sources was conducted. Eligibility criteria: Peer reviewed articles, published from 1996 to 2022 that investigated effects of exposure to cement dust on human respiratory health (pulmonary functions and symptoms) were included. The studies must have been conducted in communities residing near a cement factory; were original research and written in English. The search key words were: cement, cement dust, cement dust exposure, respiratory health, cement respiratory health effect, cement dust exposure respiratory effect, cement pulmonary function, and cement dust pulmonary health. Results: 443 studies were retrieved and screened. Only 12 of these met the inclusion criteria. The majority of studies were assessed as being of moderate quality; seven of these studies were cross sectional study design and only five studies performed actual measurement of ambient concentration of particulate matter (PM) while the rest assumed high exposure levels based on other studies’ findings. Furthermore, all the five studies that measured exposure used environmental monitoring rather than more precise methods of measuring personal exposure. Most studies reported higher levels of PM2.5 and PM10 in the exposed compared to the controls and demonstrated a statistically significant difference in the prevalence of respiratory symptoms and reduced pulmonary functions or some degree of association. Conclusion: This review shows that despite showing some degree of association between exposure to cement dust and respiratory ill health, the existing evidence is insufficient to draw firm conclusion mainly because the studies were of low quality. To improve the quality of evidence, future studies should include panel studies, personal monitoring of the exposure, source apportionment and chemical characterisation coupled with using standardized measurement tools for exposure and outcome at predetermined intervals

Evaluation of environmental assessment tools for settings for individuals living with dementia.

IntroductionThe overarching goal of research on physical settings for individuals living with dementia is to identify associations between designed features within the built environment and outcomes of interest. Over the past three decades numerous environmental assessment tools have been developed in several countries, responding to a changing set of care industry values that increasingly prioritize a holistic, quality‐of‐life–driven person‐centered care (PCC) model over a biomedical approach to long‐term care (LTC) provision. This article reviews the diversity, constructs, strengths, and limitations of existing environmental assessment tools and identifies gaps for future tool development.MethodsA systematic literature search was conducted using four databases (Medline, CINAHL, PsycInfo, and Avery Index) and terms related to health‐care environments and assessment tools.ResultsA total of 13 environmental assessment tools for people living with dementia within shared residential settings were identified. Evaluation of the environmental assessment tools includes a synthesis of published data for each tool's reliability, validity, ease of use, interpretability, strengths and weaknesses, as well as a comparison of various tool characteristics including date of development, country of origin, applicable care setting(s), number and variety of measures and underlying constructs, format, and descriptive versus evaluative content.DiscussionWhile the shift to person‐centered values encompasses all aspects of care and care settings, the majority of person‐centered definitions exclude the important role of the designed, physical environment. However, this review of environmental assessment tools clearly demonstrates that newer tools are embracing the full array of PCC values. In the United States, this is shown in the shift from tools designed to assess segregated dementia care settings to tools that integrate the needs and preferences both of individuals living with and without dementia. Next‐generation tools need to specifically address the household model of design.Highlights The overarching goal of research on physical settings for individuals living with dementia is to identify associations between designed features within the built environment and outcomes of interest.A systematic literature search identified a total of 13 environmental assessment tools for people living with dementia within shared residential settings; these tools were then described and evaluated based on reliability, validity, ease of use, interpretability, strengths, and weaknesses.This review of environmental assessment tools clearly demonstrates that newer tools are embracing the full array of person‐centered care values.

Nurse staffing and patient care outcomes: protocol for an umbrella review to identify evidence gaps for low and middle-income countries.

Background: Adequate staffing is key to the delivery of nursing care and thus to improved inpatient and health service outcomes. Several systematic reviews have addressed the relationship between nurse staffing and these outcomes. Most primary studies within each systematic review are likely to be from high-income countries which have different practice contexts to low and middle-income countries (LMICs), although this has not been formally examined. We propose conducting an umbrella review to characterise the existing evidence linking nurse staffing to key outcomes and explicitly aim to identify evidence gaps in nurse staffing research in LMICs. Methods and analysis: This protocol was developed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P). Literature searching will be conducted across Ovid Medline, Embase and EBSCO Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Two independent reviewers will conduct searching and data abstraction and discordance will be handled by discussion between both parties. The risk of bias of the individual studies will be performed using the AMSTAR-2 . Ethics and dissemination: Ethical permission is not required for this review as we will make use of already published data. We aim to publish the findings of our review in peer-reviewed journals. PROSPERO registration number: CRD42021286908.

Missed nursing care in acute care hospital settings in low-middle income countries: a systematic review protocol

Background: Missed nursing care (care left undone or task incompletion) is viewed as an important early predictor of adverse patient care outcomes and is a useful indicator to determine the quality of patient care. Available systematic reviews on missed nursing care are based mainly on primary studies from developed countries, and there is limited evidence on missed nursing care from low-middle income countries (LMICs). We propose conducting a systematic review to identify the magnitude of missed nursing care and document factors and reasons associated with this phenomenon in LMIC settings.Methods and analysis: This protocol was developed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P). We will conduct literature searching across the Ovid Medline, Embase and EBSCO Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, from inception to 2021. Two independent reviewers will conduct searches and data abstraction, and discordance will be handled by discussion between both parties. The risk of bias of the individual studies will be determined using the Newcastle-Ottawa Scale (NOS).Ethics and dissemination: Ethical permission is not required for this review as we will make use of already published data. We aim to publish the findings of our review in peer-reviewed journalsPROSPERO registration number:CRD42021286897 (27thOctober 2021)

Smartphone-based fundus imaging: applications and adapters

Smartphone-based fundus imaging (SBFI) is an innovative and low-cost alternative for color fundus photography. Since the first reports on this topic more than 10years ago alarge number of studies on different adapters and clinical applications have been published. The aim of this review article is to provide an overview on the development of SBFI and adapters and clinical applications published so far. Aliterature search was performed using the MEDLINE and Science Citation Index Expanded databases without time restrictions. Overall, 11 adapters were included and compared in terms of exemplary image material, field of view, acquisition costs, weight, software, application range, smartphone compatibility and certification. Previously published SBFI applications are screening for diabetic retinopathy, glaucoma and retinopathy of prematurity as well as the application in emergency medicine, pediatrics and medical education/teaching. Image quality of conventional retinal cameras is in general superior to SBFI. First approaches on automatic detection of diabetic retinopathy through SBFI are promising and the use of automatic image processing algorithms enables the generation of wide-field image montages. SBFI is aversatile, mobile, low-cost alternative to conventional equipment for color fundus photography. In addition, it facilitates the delegation of ophthalmological examinations to assistance personnel in telemedical settings, could simplify retinal documentation, improve teaching, and improve ophthalmological care, particularly in countries with low and middle incomes.

Out-of-pocket expenses related to aging in place for frail older people: a scoping review.

ABSTRACTObjective:The objective of this scoping review was to map and describe the available evidence reporting out-of-pocket expenses related to aging in place for older people with frailty and their caregivers.Introduction:As the global population ages, there has been increasing attention on supporting older people to live at home in the community as they experience health and functional changes. Older people with frailty often require a variety of supports and services to live in the community, yet the out-of-pockets costs associated with these resources are often not accounted for in health and social care literature.Inclusion criteria:Sources that reported on the financial expenses incurred by older people (60 years or older) with frailty living in the community, or on the expenses incurred by their family and friend caregivers, were eligible for inclusion in the review.Methods:We searched for published and unpublished (ie, policy papers, theses, and dissertations) studies written in English or French between 2001 and 2019. The following databases were searched: CINAHL, MEDLINE, Scopus, Embase, PsycINFO, Sociological s, and Public Affairs Index. We also searched for gray literature in a selection of websites and digital repositories. JBI scoping review methodology was used, and we consulted with a patient and family advisory group to support the relevance of the review.Results:A total of 42 sources were included in the review, including two policy papers and 40 research papers. The majority of the papers were from the United States (n = 18), with others from Canada (n = 6), the United Kingdom (n = 3), Japan (n = 2), and one each from Australia, Brazil, China, Denmark, Israel, Italy, The Netherlands, Poland, Portugal, Singapore, South Korea, Taiwan, and Turkey. The included research studies used various research designs, including cross-sectional (n = 18), qualitative (n = 15), randomized controlled trials (n = 2), longitudinal (n = 2), cost effectiveness (n = 1), quasi-experimental (n = 1), and mixed methods (n = 1). The included sources used the term “frailty” inconsistently and used various methods to demonstrate frailty. Categories of out-of-pocket expenses found in the literature included home care, medication, cleaning and laundry, food, transportation, medical equipment, respite, assistive devices, home modifications, and insurance. Five sources reported on out-of-pocket expenses associated with people who were frail and had dementia, and seven reported on the out-of-pocket expenses for caregivers of people with frailty. While seven articles reported on specific programs, there was very little consistency in how out-of-pocket expenses were used as outcome measures. Several studies used measures of combined out-of-pocket expenses, but there was no standard approach to reporting aggregate out-of-pocket expenses.Conclusions:Contextual factors are important to the experiences of out-of-pocket spending for older people with frailty. There is a need to develop a standardized approach to measuring out-of-pocket expenses in order to support further synthesis of the literature. We suggest a measure of out-of-pocket spending as a percentage of family income. The review supports education for health care providers to assess the out-of-pocket spending of community-dwelling older people with frailty and their caregivers. Health care providers should also be aware of the local policies and resources that are available to help older people with frailty address their out-of-pocket spending.

A scoping review of nontechnical skill assessment tools to evaluate trauma team performance.

The objective of this scoping review was to identify assessment tools of trauma team performance (outside of technical skills) and assess the validity and reliability of each tool in assessing trauma team performance. We searched Embase, Cochrane Library, Web of Science, Ovid Medline, and Cumulative Index to Nursing and Allied Health Literature from inception to June 1, 2021. English studies that evaluated trauma team performance using nontechnical skill assessment tools in a simulation or real-world setting were included. Studies were assessed by two independent reviewers for meeting inclusion/exclusion criteria. Data regarding team assessment tools were extracted and synthesized into behavior domains. Each tool was then assessed for validity and reliability. The literature search returned 4,215 articles with 29 meeting inclusion criteria. Our search identified 12 trauma team performance assessment tools. Most studies were conducted in the United States (n = 20 [69%]). Twenty studies (69%) assessed trauma team performance in a simulation setting; Team Emergency Assessment Measure (TEAM) and Trauma Nontechnical Skills Scale (T-NOTECHS) were the only tools to be applied in a simulation and real-world setting. Most studies assessed trauma team performance using video review technology (n = 17 [59%]). Five overarching themes were designed to encompass behavioral domains captured across the 12 tools: (1) Leadership, (2) Communication, (3) Teamwork, (4) Assessment, and (5) Situation Awareness. The reliability and validity of T-NOTECHS were investigated by the greatest number of studies (n = 13); however, TEAM had the most robust evidence of reliability and validity. We identified 12 trauma team performance tools that assessed nontechnical skills to varying degrees. Trauma Nontechnical Skills Scale and TEAM tools had the most evidence to support their reliability and validity. Considering the limited research in the impact of trauma team performance on patient outcomes, future studies could use video review technology in authentic trauma cases to further study this important relationship. Systematic reviews and meta-analyses, level IV.

Statistical estimation of wear in permanent teeth: A systematic review

An up to date quantitative assessment of the prevalence of tooth wear (with dentine exposure) in permanent dentition is lacking. The purpose of this systematic review was to synthesize clinical studies and research related to tooth wear in order to derive an overall estimate of the prevalence of tooth wear in permanent dentition. The eligibility criteria used in his work included population-based studies that reported the prevalence of tooth wear in permanent teeth of both adolescents and adults aged 12–80-year-old. Following the eligibility criteria, an electronic search of databases- Medline, Scopus, Embase and Science Citation Index and Biosis (Web of Science)-were performed from 1984 to 2020. Data regarding the sample size, geographical locations, year of publication, age etc. were extracted from each study and the overall estimated prevalence of tooth wear was determined. Meta-regression analysis was used to determine the source of heterogeneity in the studies while Bhattacharyya Distance (BD) was deployed to investigate the relationship within the source of the heterogeneity. The search strategy identified 4205 studies and after removal of duplicates (959), title and abstract screening (3206) and full-text reading (60), 22 studies comprising of total 20,112 subjects were included in the systematic review. The overall estimated prevalence of the tooth wear was 38% (95% CI: 31–46%), the subgroup meta-analysis revealed that continents (region) of publications was responsible for the variability of the prevalence of tooth wear within the included studies with Europe having the least prevalence rate. Bhattacharyya Distance (BD) highlighted that studies from Africa were remarkably different from other studies, whereas studies from Europe, America and Asia share some similarities. We showed that the prevalence of tooth wear with dentin exposure was 38%, with significant heterogeneity between the included studies, and the variability depends mostly on the geographical location of the studies. The results of this study can be used as an information guide by clinicians and policymakers to know the global tooth wear prevalence; can be used as a conductor in formulating policies that will help in reducing the tooth wears.

A review of interventions for noncommunicable diseases in humanitarian emergencies in low- and middle-income countries.

Noncommunicable diseases (NCDs) are of increasing prevalence in low- and middle-income countries (LMICs), affected by disasters. Humanitarian actors are increasingly confronted with how to effectively manage NCDs, yet primary focus on this topic is lacking. We conducted a systematic review on the effects of disasters on NCDs in LMICs. Key interventions were identified, and their effects on populations in disaster settings were reviewed. We electronically searched Medline, PubMed, Global Health, and Social Science Citation Index. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. Eligible articles incorporated core intervention components as defined by the United States Department of Health and Human Services. Key intervention components including target population, phase of crisis, and measured outcomes were extracted and synthesized using a thematic analysis approach. The full systematic review is registered at PROSPERO (CRD42018088769). Of the 4,430 identified citations, we identified seven eligible studies. Studies reported on the response (n = 4) and recovery (n = 3) phases of disaster, with no studies reporting on the mitigation or preparedness phases. Successful interventions conducted predeployment risk assessments, performed training and capacity building for healthcare workers, worked in close cooperation with local health services, evaluated individual needs of subpopulations, promoted task shifting between humanitarian and development actors, and adopted flexibility in guideline -implementation. This review highlights the limited quantity and quality of evidence on interventions designed to address NCDs in humanitarian emergencies, with a particular paucity of studies addressing the mitigation and preparedness phases of disaster. While several challenges to NCD management such as insecurity and fluid movement of refugees create inherent challenges to NCD management in disasters, the lack of knowledge and training in NCD management among healthcare providers and the absence of basic medications and supplies for NCD management highlighted in this review are amenable to further intervention.

Hepatology Communications Achieves First Impact Factor and MEDLINE Indexing

Hepatology Communications Achieves First Impact Factor and MEDLINE Indexing

Factors Associated with the Development, Progression, and Outcome of Dupuytren Disease Treatment: A Systematic Review.

The factors typically considered to be associated with Dupuytren disease have been described, such as those in the "Dupuytren diathesis." However, the quality of studies describing them has not been appraised. This systematic review aimed to analyze the evidence for all factors investigated for potential association with the development, progression, outcome of treatment, or recurrence of Dupuytren disease. A systematic review of the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature databases was conducted using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant methodology up to September of 2019. Articles were screened in duplicate. Prognostic studies were quality assessed using the Quality in Prognosis Study tool. This study identified 2301 records; 51 met full inclusion criteria reporting data related to 54,491 patients with Dupuytren disease. In total, 46 candidate factors associated with the development of Dupuytren disease were identified. There was inconsistent evidence between the association of Dupuytren disease and the presence of "classic" diathesis factors. The quality of included studies varied, and the generalizability of studies was low. There was little evidence describing the factors associated with functional outcome. This systematic review challenges conventional notions of diathesis factors. Traditional diathesis factors are associated with disease development and recurrence, although they are not significantly associated with poor outcome following intervention based on the current evidence.

Interventions and guidelines for promoting maternal and child health in the interconception period: a literature and policy review

BackgroundInterconception is defined as the period of time between pregnancies or the first 24 months post partum. During interconception, visits for maternal and child health offer the opportunity for parents to be engaged with health messages, and the health-care professionals involved are more easily identifiable than in the preconception period. Beneficial outcomes, such as improved weight management and nutritional intake, might be reached in a shorter timescale in the interconception period than in the preconception period. We aimed to synthesise articles and guidelines on interconception care to develop recommendations for research, public health policy, and practice. MethodsIn this literature review and policy analysis, we searched four academic databases (Cochrane library, Embase, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature), using MeSH and free-text terms (including but not limited to “interconception”, “post-partum”, “nutrition”, “diet”, and “primary care”), for reviews published in English on nutrition for parents in the interconception and post-partum period between Jan 1, 2010, and Jan 21, 2021. Outcomes related to maternal nutrition and weight management were considered. A scoping search on interconception pilot studies and a review of guidelines published by UK public health organisations and government agencies were also conducted online. Strength of evidence was assessed for review articles by two reviewers using Health Evidence guidelines developed by McMaster University, Canada. Findings were analysed as a narrative synthesis. FindingsWe included 47 documents from a scoping search of grey literature and websites, 29 full-text review articles (after screening 1780 titles and abstracts), and six pilot studies from our database search on interconception and post-partum care. 535 (30%) of 1780 titles and abstracts, and 23 (33%) of 70 full-text papers, were double-screened by another reviewer to ensure consistency. Most reviews were of strong quality (20 [69%]), followed by moderate (seven [24%]), and weak (two [7%]). Interconception care opportunities for parents include the post-partum period, family planning, routine practice, and risk assessment. Various stakeholders have a role in interconception care including general practitioners, health visitors, dieticians, nutritionists, health psychologists, community groups, local authorities, and charities. The guidelines advise increased utilisation of existing community-based services. InterpretationInterconception offers an opportunity for health-care professionals to promote maternal health through routine appointments, but training in communication skills based on empowering behaviour-change principles will be required. Risk assessments should be conducted on the basis of previous pregnancy outcomes—eg, follow-up care following gestational diabetes. Although we found little evidence on interventions in the interconception period, this review provides recommendations for UK health-care systems that could improve life-course health for mothers and potentially their offspring—eg, by reducing childhood obesity. FundingRANK Foundation and Public Policy Southampton.

Estimating the health impact of individual's dietary change across multiple physiological outcomes: a conceptual and simulation model

BackgroundInterventions to improve the food environment are often implemented at the population level. The health effects of these interventions can be difficult to observe but can be predicted by models. Prediction models require evidence from multiple sources if changes to diet affect sodium, fat, and carbohydrate consumption. We aimed to develop a model to estimate how multidimensional changes in individuals' diets affect metabolic risk factors. MethodsWe developed an evidence review to identify mathematical models describing relationships between calories and weight in adults, and systematic reviews estimating relationships between fats, carbohydrates, and sodium on systolic blood pressure (SBP), cholesterol, and HbA1c from randomised controlled trials. We searched the MEDLINE, Embase, Cochrane Library, and Science Citation Index databases for peer-reviewed systematic reviews published in English between 1946 and May 26, 2020 using keywords for metabolic risks and nutrients . A systems map combining the School for Public Health Research (SPHR) Diabetes Prevention model, background literature, and dietary public health policies was used to develop the review protocol. Data extracted from the review were used to develop a conceptual map to illustrate the causal relationships between dietary measures and metabolic risk factors, including the effects of food substitutions (carbohydrates vs fats). The map was discussed with two senior lecturers in nutrition to identify evidence gaps and additional evidence. The map was programmed into a deterministic simulation in R to estimate how changes in diet affect metabolic risk factors. FindingsWe estimated that reducing calorie intake by 50 kcal per day would reduce population mean weight by 1·3 kg over 12 months. Reducing sodium intake by 1 g per day would decrease population mean SBP by 0·212 mm Hg. Increasing fibre intake by 1 g per day would decrease SBP by 0·200 mm Hg over 12 months, with marginal decreases in weight, HbA1c, and LDL cholesterol. Substituting carbohydrates for polyunsaturated fat (2·5% of energy) would decrease population mean total cholesterol by 0·12 mmol/L over 12 months, with marginal reductions in SBP and weight. InterpretationThis study provides a tool to estimate effects of dietary changes on individual physiological indicators of health. The research will be most beneficial to extrapolate health effects of population-level food interventions, including those leading to multiple, and possibly, competing nutritional effects. FundingNational Institute for Health Research School for Public Health Research (grant reference number PD-SPH-2015).

Does early acne intervention provide more than just a reduction in the incidence of scars? A review of the literature

Background: It is well established that early intervention in acne treatment reduces the incidence of scars. The purpose of this paper was to identify if early intervention in acne management also provides a cost benefit to the patient, reduces relapse rates or lessens the requirement for the treatment of acne scars. Method: A systematic search of The Cochrane Library, MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was performed independently by one reviewer using predefined criteria. Results: Seven articles were identified from the literature – one systematic review, one review article and five expert opinion articles. Although data supports early intervention in acne management, no articles identified whether a cost benefit was also provided, if there was a reduction in the relapse rates or if there was a decreased requirement for the treatment of acne scars. Conclusions: This review identifies an overall lack of published data regarding multiple outcomes for early intervention in acne and allows for the possible identification of areas where primary research would be beneficial.

244 Traumatic Brain Injury Related Paediatric Mortality and Morbidity in Low- And Middle-Income Countries: A Systematic Review and Meta-Analysis

Abstract Aim Three million cases of paediatric traumatic brain injury (pTBI) occur annually, the majority of which occur in low-and-middle-income countries (LMICs). However, there is a paucity of data on the outcomes of pTBI available. We aimed to systematically review and synthesise the reported morbidity and mortality from pTBI in the published literature about LMICs. Method A systematic review and meta-analysis were conducted. MEDLINE, EMBASE, Global Health, and Global Index Medicus were searched for relevant articles from January 2000 to May 2020. Observational or experimental studies on pTBI (individuals between the ages of 0 to 16 years) in LMICs were included. Morbidity data were descriptively analysed, and a random-effects model was used to pool mortality rates. PROSPERO ID: CRD42020171276. Results We included 145 studies from 38 countries representing 174073 patients with pTBI. Males were twice (95% CI: 1.6 – 2.4) as likely to have a pTBI than females. Where available, mild TBI represented ≥ 60% of all pTBI cases in most reports (n = 24/43, 56%). The commonest cited cause of pTBI was road traffic accidents (n = 16643/43083, 39%), followed by falls (n = 10927/43083, 25%). 4385 patients (n = 4385/18092, 24%) had a reduction from normal function on discharge. On average, there were 6.7 deaths per 100 cases of pTBI. Conclusions Only 38 LMICs have published data on the volume and burden of pTBI in their country. Limited data available suggests that young male children are at a high-risk of pTBIs in LMICs, particularly from road traffic accidents.

Application of Human Adipose-Derived Stem cells for Bone Regeneration of the Skull in Humans.

Archeological archives report cranioplasty as 1 of the oldest surgical procedures; however, it was not until the last century that true advances have been made. Alternative approaches are necessary to achieve optimal closure of the defect with fewer adverse effects. We aim to evaluate the use of human adipose-derived stem cells (hADSCs) alone or seeded in scaffolds as the main treatment for cranial bone defects and to assess human patient outcomes. A systematic review was performed by querying PubMed, Ovid MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature databases with the MeSH terms: "adipose-derived stem cells," "cranial bone defect," "stromal vascular factor," "fat grafting," as well as synonyms in combinations determined by our search strategy. We included human models that used hADSCs as primary therapy. We excluded studies in languages other than English. One hundred ninety-four studies were identified after removal of duplicates. Four articles that used hADSCs as the main therapy to treat calvarial defects in humans were included. One article applied the cell therapy alone, and 3 used β-tricalcium phosphate granules as a scaffold to seed the hADSCs. Bone regeneration was reached in a short and intermediate period using autologous hADSCs in humans with no major adverse effects in all 4 articles included. A long-term follow-up study (6 years) exhibited late infections and reabsorption of the β-tricalcium phosphate scaffold seeded with hADSCs.

Factors affecting use of magnesium sulphate for pre‐eclampsia or eclampsia: a qualitative evidence synthesis

BackgroundHypertensive disorders account for 14% of global maternal deaths. Magnesium sulphate (MgSO4) is recommended for prevention and treatment of pre‐eclampsia/eclampsia. However, MgSO4 remains underused, particularly in low‐ and middle‐income countries (LMICs).ObjectiveThis qualitative evidence synthesis explores perceptions and experiences of healthcare providers, administrators and policy‐makers regarding factors affecting use of MgSO4 to prevent or treat pre‐eclampsia/eclampsia.Search strategyWe searched MEDLINE, EMBASE, Emcare, CINAHL, Global Health and Global Index Medicus, and grey literature for studies published between January 1995 and June 2021.Selection criteriaPrimary qualitative and mixed‐methods studies on factors affecting use of MgSO4 in healthcare settings, from the perspectives of healthcare providers, administrators and policy‐makers, were eligible for inclusion.Data collection and analysisWe applied a thematic synthesis approach to analysis, using COM‐B behaviour change theory to map factors affecting appropriate use of MgSO4.Main resultsWe included 22 studies, predominantly from LMICs. Key themes included provider competence and confidence administering MgSO4 (attitudes and beliefs, complexities of administering, knowledge and experience), capability of health systems to ensure MgSO4 availability at point of use (availability, resourcing and pathways to care) and knowledge translation (dissemination of research and recommendations). Within each COM‐B domain, we mapped facilitators and barriers to physical and psychological capability, physical and social opportunity, and how the interplay between these domains influences motivation.ConclusionsThese findings can inform policy and guideline development and improve implementation of MgSO4 in clinical care. Such action is needed to ensure this life‐saving treatment is widely available and appropriately used.Tweetable abstractGlobal qualitative review identifies factors affecting underutilisation of MgSO4 for pre‐eclampsia and eclampsia.

11.13 Predictors, Moderators, and Mediators in RCTs for the Treatment of Adolescent Depression: A Scoping Review

Evidence-based treatments for depression in adolescents have limited benefits. Discovering who best responds to which treatment and understanding the mechanisms of response can help optimize resources and clinical outcomes. Accordingly, this scoping review aimed to comprehensively map out the study of predictors, moderators, and mediators (PMMs) of outcome in RCTs in the treatment of adolescent depression. We applied a planned search strategy to the following databases: MEDLINE, Embase, APA PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), from inception to February 2020. We included publications testing PMMs of depression symptom severity in the context of RCTs for the treatment of depression in adolescents (aged 13 to 17 years). In duplicate, we extracted variables tested as PMMs, grouped PMM variables into domains, coded analyses as univariate/multivariate, and coded reported results as significant/nonsignificant. Our search yielded 79 publications that tested at least 1 variable as a PMM of outcome across 33 RCTs. The variable domains most commonly studied as baseline predictors included sex (N = 12 RCTs), age (N = 9), race (N = 6), socioeconomic status (N = 5), severity (N = 13), anxiety (N = 10), overall psychopathology (N = 7), suicidal ideation (N = 6), hopelessness (N = 5), general functioning (N = 7), family functioning (N = 6), and history of trauma (N = 5). The domain most commonly tested as a postbaseline predictor was therapy attendance (N = 10). Domains frequently tested as moderators included: sex (N = 13), age (N = 11), race (N = 6), severity (N = 9), anxiety (N = 6), family functioning (N = 6), general functioning (N = 5), and history of trauma (N = 5). The results of mediator analyses were only reported in 4 RCTs. The reported significance of results was generally mixed across trials, and the most consistent finding was that baseline symptom severity was found to be a predictor, with 9 of 13 RCTs reporting significance on at least 1 multivariate analysis. Across RCTs for the treatment of adolescent depression, published PMM analyses have reported mixed results. Our findings can be used to inform the selection of variables for more focused study designs (eg, individual patient data meta-analyses) needed to further understand how these variables can be best used to optimize treatment for adolescents with depression.