Methodological Items Research Articles

Greater return to sports after anterior cruciate ligament reconstruction combined with anterolateral ligament reconstruction compared with anterior cruciate ligament reconstruction alone: A systematic review and meta-analysis.

This study aimed to compare the return to sports, return to competition, Tegner score and anterior cruciate ligament-return to sports injury (ACL-RSI) scores between patients who underwent ACL reconstruction (ACLR) combined with anterolateral ligament reconstruction (ALLR) and those who underwent ACLR alone. Two independent reviewers conducted a literature search in PubMed (MEDLINE), EMBASE, Google Scholar and the Cochrane Library in July 2024, followed by data extraction and quality assessment. This study followed the Preferred Reporting Items for Systematic Reviews and meta-analysis guidelines. The return to sports rate, return to competition rate, Tegner score and ACL-RSI score were compared between patients who underwent primary ACLR with ALLR and those who underwent isolated primary or revision ACLR. The methodological quality of the included studies was assessed via the Cochrane risk-of-bias tool and methodological items for nonrandomized studies. In total, 12,139 studies were screened, and 14 (four randomized controlled trials and 10 nonrandomized studies) studies were ultimately evaluated. Compared with isolated ACLR, ACLR combined with ALLR resulted in a higher rate of return to sports and competition. Nevertheless, no significant differences were found in the Tegner score or ACL-RSI score between the two groups. Patients who underwent ACLR in combination with ALLR had higher rates of return to sports and competition, but their Tegner activity and ACL-RSI scores were similar to those of patients who underwent ACLR alone. This finding may assist surgeons in making decisions when treating patients undergoing ACLR, especially athletes. Level III.

Incidence of Avascular Necrosis of the Femoral Head Post Hip Reduction Surgery in Children With Cerebral Palsy.

Avascular necrosis (AVN) of the femoral head confers a risk of morbidity amongst cerebral palsy (CP) patients. Meanwhile, the proportion who develop AVN posthip reduction surgery is unclear, and the risk factors are not established. To estimate the incidence and risk factors for AVN post hip reduction surgery in CP patients, we reviewed and analysed literature from Medline, Embase, and Web of Science repositories between January 1, 1990, and August 31, 2024. The included publications were reviewed for the incidence and risk factors in this cohort of patients. Findings were appraised using the methodological index for non-randomised studies, and scores and results were descriptively analysed. Given the marked heterogeneity of retrieved data, results were reported as standardised values, including the mean weighted incidence rate. A total of 1619 hip reduction surgeries were performed on 1045 CP patients across 12 retrospective studies with 424 cases of AVN. The mean age at surgery ranged from 7.3 to 16.2 across studies. The mean incidence was 0.482% ± 0.06945 per person-year. Most patients were in gross motor function classification system V, with a preoperative mean Reimers index of 54.11-80%. The average methodological items for non-randomised studies score was 10.08/16 ± 0.28 for all studies (n=12). AVN has a definite relationship with hip reductionsurgery. The low methodological quality of reviewed studies informs the need for well-designed prospective randomised controlled studies to understand the mechanics of this relationship in terms of age of surgery and Reimers hip migration index, guide surgical timing, and patient selection.

Patient safety climate research in primary care dentistry: A systematic scoping review.

Patient safety climate constitutes an important element for quality improvement. Its current evidence base has been generated in hospital settings in developed countries. Studies in dentistry are limited. To systematically explore the evidence regarding assessing patient safety climate in dentistry. We developed a search strategy to explore MEDLINE, SCOPUS, and Web of Science databases from January 1st, 2002, to December 31st, 2022, to include observational studies on patient safety culture or patient safety climate assessment. Methodological features and item data concerning the dimensions employed for assessment were extracted and thematically analyzed. Reported scores were also collected. Nine articles out of 5584 were included in this study. Most studies were generated from high-income economies. Our analysis revealed methodological variations. Non-randomized samples were employed (ranging from 139 to 656 participants), and response rates varied from 28% to 93.7%. Three types of measurement instruments have been adapted to assess patient safety climate. These mainly consisted of replacing words or rewording sentences. Only one study employed an instrument previously validated through psychometric methods. In general, patient safety climate levels were either low or neutral. Only one study reported scores equal to or greater than 75. Despite diverse assessment tools, our two-decade analysis reveals a lag compared with medicine, resulting in methodological variations for assessing patient safety climate. Collaboration is vital to elevate standards, prioritize patient safety across oral healthcare services, and advocate for integrating safety climate into local and national quality and patient safety strategies.

Carbon footprint of healthcare systems: a systematic review of evidence and methods

ObjectiveGiven the demand for net-zero healthcare, the carbon footprint (CF) of healthcare systems has attracted increasing interest in research in recent years. This systematic review investigates the results and methodological...

What is the rate of occult nodal metastasis in squamous cell carcinomas of the sinonasal tract? A systematic review.

The role of elective neck dissection (END) in the management of clinical N0 (cN0) squamous cell carcinomas (SCC) of the sinonasal tract is unclear. In this systematic review, we evaluate the risk of occult nodal metastasis in sinonasal SCCs with cN0M0 tumors to support clinical decision making. A literature search was conducted in the following three electronic databases: Medline/PubMed, ScienceDirect, and Google Scholar. Articles were assessed for eligibility in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Two independent authors extracted the data. The Methodological Items for Non-Randomized Studies (MINORS) tool was used for the assessment of biases of each included study. Our systematic review included six studies that met the inclusion criteria, all retrospective in design. The rate of histologically proven metastasis of sinonasal SCC to the clinically negative neck is 12.5%. Almost half of the positive cases are pathologically staged as N2 (6.5%). Our systematic review provides the rate of sinonasal SCC occult metastasis to the neck so that the surgeons can discuss with patients the risks and possible merits of adding an elective neck management in the surgical plan.

Total hip arthroplasty in patients with common pediatric hip orthopedic pathology.

Literature regarding total hip arthroplasty for pediatric hip diseases is scarce. This review aims to portray the various orthopedic conditions of childhood that can lead to significant impairment of the hip joint and, ultimately, to total hip arthroplasty in adolescence and adulthood. In total, 61 out of 3666 articles were selected according to (1) the diagnosis of one of the 12 pediatric hip pathologies (Legg-Perthes-Calvé disease, developmental dysplasia of the hip, slipped capital femoral epiphysis, neuromuscular hip dysplasia, post-traumatic avascular necrosis of the proximal femur, juvenile rheumatoid arthritis, achondroplasia, spondyloepiphyseal dysplasia, mucopolysaccharidosis, mucolipidosis, hip infections, and tumors) that required total hip arthroplasty; (2) minimum follow-up of 16 months; (3) assessed outcome with a clinical or radiologic score; (4) Methodological Items for Non-Randomized Studies quality score of 9 or higher. The following information for each pathology was retrieved: mean age at total hip arthroplasty, reason for total hip arthroplasty, type of total hip arthroplasty, surgical technique, mean follow-up, and outcomes. Overall, the mean age at total hip arthroplasty for pediatric hip disease is in the sixth and seventh decade, except for tumors and skeletal dysplasias. The reason for performing total hip arthroplasty is often osteoarthrosis and abnormal anatomy. Prosthesis types change based on patient's conditions and technological advances; custom-made implants are used for tumors, juvenile rheumatoid arthritis, and skeletal dysplasias; for other diseases, the most frequent are modular cementless implants. Outcomes are generally good, and all studies portray functional and pain improvements. Total hip arthroplasty is performed more frequently than in the past in patients with pediatric hip pathologies; it enhances patients' quality of life by reducing pain and improving function. However, revision rate in these patients is not negligible.

Periprosthetic Distal Femoral Fractures Around a Total Knee Arthroplasty: a Meta-analysis Comparing Locking compression Plating and Retrograde Intramedullary Nailing.

The number of total knee replacements (TKRs) performed per year has been increasing annually and it is estimated that by 2030 demand would reach 3.48 million procedures per year in the United States Of America. The prevalence of periprosthetic fractures (PPFs) around TKRs has followed this trend with incidences ranging from 0.3% to 3.5%. Distal femoral PPFs are associated with significant morbidity and mortality. When there is sufficient bone stock in the distal femur and a fracture pattern conducive to fixation, locking compression plating (LCP) and retrograde intramedullary nailing (RIMN) are commonly used fixation strategies. Conversely, in situations with loosening and deficient bone stock, a salvage procedure such as a distal femoral replacement is recognized as an alternative. This meta-analysis investigates the rates of non-union, re-operation, infection, and mortality for LCPs and RIMNs when performed for distal femoral PPFs fractures around TKRs. A search was conducted to identify articles relevant to the management of distal femoral PPFs around TKRs in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Articles meeting the inclusion criteria were then assessed for methodological quality using the methodological items for non-randomised studies (MINORS) criteria. Articles were reviewed, and data were compiled into tables for analysis. 10 articles met the inclusion criteria, reporting on 528 PPFs. The overall incidence of complications was: non-union 9.4%, re-operation 12.9%, infection 2.4%, and mortality 5.5%. This meta-analysis found no significant differences between RIMN and LCP in rates of non-union (9.2% vs 9.6%) re-operation (15.1% vs 11.3%), infection (2.1% vs 2.6%), and mortality (6.0% vs 5.2%), respectively. This meta-analysis demonstrated no significant difference in rates of non-union, re-operation, infection, and mortality between RIMN and LCP and both remain valid surgical treatment options.

Both gastrocnemius aponeurosis flaps and semitendinosus tendon grafts are effective in the treatment of chronic Achilles tendon ruptures – a systematic review

IntroductionA chronic Achilles tendon rupture (ATR) is defined as an ATR that has been left untreated for more than four weeks following rupture. This systematic review aims to summarize the outcomes of chronic ATR treated using either a gastrocnemius aponeurosis flap or semitendinosus tendon graft.MethodsA systematic search was conducted in three databases (PubMed, Scopus and Cochrane), for studies describing outcomes after surgical treatment of chronic ATR using gastrocnemius aponeurosis flaps or semitendinosus tendon grafts with more than 10 patients included. The studies were assessed for quality and risk of bias using the Methodological Items used to assess risk of bias in Non-Randomized Studies (MINORS).ResultsOut of the 818 studies identified with the initial search, a total of 36 studies with 763 individual patients were included in this systematic review. Gastrocnemius aponeurosis flap was used in 21 and semitendinosus tendon graft was used in 13 of the studies. The mean (SD) postoperative Achilles tendon Total Rupture Score (ATRS) for patients treated with a gastrocnemius aponeurosis flap was 83 (14) points and the mean (SD) American Orthopaedic Foot and Ankle Score (AOFAS) was 96 (1.7) points compared with ATRS 88 (6.9) points and AOFAS 92 (5.6) points for patients treated with a semitendinosus tendon graft. The included studies generally had low-quality according to MINORS, with a median of 8 (range 2–13) for all studies.ConclusionBoth gastrocnemius aponeurosis flaps and semitendinosus tendon grafts give acceptable results with minimal complications and are valid methods for treating chronic ATR. The main difference is more wound healing complications in patients treated with a gastrocnemius aponeurosis flap and more sural nerve injuries in patients treated with a semitendinosus grafts. The current literature on the subject is of mainly low quality and the absence of a patient-related outcome measure validated for chronic ATR makes comparisons between studies difficult.Level of evidenceLevel IV.

Reverse triage: a systematic review of the literature

BackgroundMany techniques to increase hospital surge capacity in the case of a mass casualty incident (MCI) have already been studied, but a new technique, reverse triage, has gained attention. The objective of this systematic review is to provide a comprehensive literature overview regarding the use of the reverse triage principle in emergency and disaster medicine.MethodsA systematic literature review was carried out adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Publications up to May 2023 in the Medline, Embase, CENTRAL, CINAHL, and Web of Science databases were considered. The risk of bias was assessed using the Methodological Items for Non-Randomized Studies, the Risk of Bias Assessment Tool for Systematic Reviews, and Johanna Briggs Institute tools for observational, systematic reviews, and expert opinions respectively.ResultsThe initial search identified 21,259 unique records, of which 16 were included, consisting of 2 reviews, 5 expert opinions, and 9 observational studies. Across studies, an overall surge capacity of 20–30% could be achieved by implementing reverse triage and even more when combined with other strategies. Furthermore, the American framework that comprehended a safe discharge protocol for inpatients is being used in the development of new reverse triage discharge protocols. The risk of developing a complication (adverse event) due to early discharge is rather low.DiscussionDue to the heterogeneity of the included studies, the interpretation of the results should be taken with caution. The most prominent differences were related to study size, university affiliation, health care system, and patient characteristics. Nevertheless, implementing the reverse triage principle in MCIs to guide early discharge of adult inpatients can create additional surge capacity with a minor occurrence of adverse events. A final assessment by a multidisciplinary discharge team (nurses and physicians) remains crucial.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022294136, identifier: CRD42022294136.

The Effects of Blood Glucose Control in the Operative Spine Patient: A Systematic Review.

To our knowledge, this is the first systematic review to evaluate the available literature on the effects of perioperative serum glucose (SG) on outcomes for patients undergoing spine surgery. This review will add insight into how the perioperative management of SG affects the outcomes of patients undergoing spine surgery. Three databases were used in this review including Embase, PubMed, and Cochrane Library. The searches were from 2012 to 2022 and included the terms "spine surgery" and "glucose level" to identify studies that demonstrated a correlation between glucose level and postoperative outcomes. Pediatric studies, those that did not specify spine surgical outcomes related to glucose levels, and non-English studies were excluded. The methodological items for nonrandomized studies score was used to assess risk of bias in the included studies. This review included a total of 9 cohort studies, both prospective and retrospective, encompassing a total of 431,156 subjects. Seven of the 9 studies reported an increased overall complication rate among patients with diabetes or with higher SG levels, and 4 studies demonstrated an increased infection rate among this population. Two studies reported an association between decreased SG levels and improved neurological recovery when a deficit was present preoperatively, and 1 of the studies found that this association was statistically significant. Limitations of this review include lack of standardization regarding type of surgery, location of the spine, and level of evidence. Most of the current literature suggests that elevated SG levels in patients undergoing spine surgery likely leads to higher complication rates and may lead to increased infection rates, and this review reinforced the current evidence. Additionally, perioperative SG levels may be associated with the extent of neurological recovery after surgery, but further investigation may be warranted. This review adds to the current body of evidence regarding perioperative SG levels and its association with complications.

The benefit and risk of PD-1/PD-L1 inhibitors plus anti-angiogenic agents as second or later-line treatment for patients with advanced non-small-cell lung cancer: a systematic review and single-arm meta-analysis of prospective clinical trials.

Previous studies revealed that Programmed cell death protein 1 (PD-1)/Programmed cell death-Ligand protein 1 (PD-L1) inhibitors plus anti-angiogenic agents had extensive anti-tumor activities. However, almost all studies on the efficacy and safety of PD-1/PD-L1 inhibitors plus anti-angiogenic agents as second or later-line treatment for patients with advanced non-small cell lung cancer are non-randomized controlled trials with small sample sizes, which might lead to a lack of effective metrics to assess the effectiveness and safety of the therapeutic regimen. Here, this meta-analysis aimed to evaluate the efficacy and safety of PD-1/PD-L1 inhibitors plus anti-angiogenic agents as second or later-line treatment for patients with advanced non-small cell lung cancer. A single-arm meta-analysis was performed, and published literature from PubMed, Web of Science and Embase databases as of January 13, 2023, was systematically retrieved. We used the Cochrane risk of bias tool and methodological index for non-randomized studies (MINORS) Methodological items to evaluate the quality of eligible clinical trials. Outcomes including overall response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and adverse events (AEs) were extracted for further analysis. The random effect model is used to calculate the pooled parameters. 19 studies (16 were non-comparative single-arm clinical trials and 3 were randomized controlled trials) were enrolled in this meta-analysis. In terms of tumor response, the pooled ORR and DCR were 22.4% (95% CI, 16.6-28.1%) and 76.8% (95% CI, 72.6-81.1%), respectively. With regard to survival analysis, the pooled PFS and OS were 5.20 (95% CI, 4.46-5.93) months and 14.09 (95% CI, 13.20-14.97) months, respectively. The pooled grade ≥3 adverse effect (AE) rate was 47.6% (95% CI, 33.1-62.0%). PD-1/PD-L1 inhibitors plus anti-angiogenic agents has promising efficacy and safety as second or later-line treatment in patients with advanced non-small cell lung cancer. https://www.crd.york.ac.uk/prospero/, identifier CRD42023407559.

Radiomics-Based Analysis in the Prediction of Occult Lymph Node Metastases in Patients with Oral Cancer: A Systematic Review.

Tumor extension and metastatic cervical lymph nodes' (LNs) number and dimensions are major prognostic factors in patients with oral squamous cell carcinoma (OSCC). Radiomics-based models are being integrated into clinical practice in the prediction of LN status prior to surgery in order to optimize the treatment, yet their value is still debated. A systematic review of the literature was conducted according to the PRISMA guideline. Baseline study characteristics, and methodological items were extracted and summarized. A total of 10 retrospective studies were included into the present study, each of them exploiting a single imaging modality. Data from a cohort of 1489 patients were analyzed: the highest AUC value was 99.5%, ACC ranges from 68% to 97.5%, and sensibility and specificity were over 0.65 and 0.70, respectively. Radiomics may be a noninvasive tool to predict occult LN metastases (LNM) in OSCC patients prior to treatment; further prospective studies are warranted to create a reproducible and reliable method for the detection of LNM in OSCC.

What are the best practices for End-of-Life Vehicle management – A practical assessment of estimates, perceptions and policies

PurposeThe primary purpose of the present research is to assess the people's awareness level of End-of-Life Vehicle (ELV) management in India. The study proposes to estimate the projected annual demand for the new ELVs over 15 years from 2020–2035 and assess the growth rate in new annual ELVs.Design/methodology/approachEmploying a mixed method study, the authors obtained secondary data from the annual reports from the Society of Indian Automobile Manufacturers (SIAM). In Study 1, the authors employed log-linear regression and compounded annual growth rate (CAGR) to compute the growth rates for these projections. After that, the authors collected the primary data of vehicle users (n = 920) using survey methodology, both open and closed-ended items completed the test battery (Study 2A and 2B). While open-ended items were analyzed qualitatively, the closed-ended items were analyzed quantitatively.FindingsThe estimation of annual ELV estimates and their cumulative figures over 15 years determined the market size in the future, outlining the importance of ELV management. The qualitative approach helped deduce the people's most prominent sentiments regarding decommissioning and the ELV management process. From the primary analysis, the authors concluded that people perceived the ELV management process positively; however, there are areas where the government's specific attention is warranted.Originality/valueIn this study, the authors have outlined how specific measures in ELV management can result in a sustainable circular economy. Additionally, the authors have designed a test battery to understand people's perception, which is first of its kind effort to understand what people think about ELV management. Studies globally considering people's perception of ELV can employ the test battery designed for this study. Additionally, countries that have ELV management in nascent stages can refer to India's experience with ELV management and the related people's perception.

Smoking Cessation Interventions for Chinese American Smokers: A Systematic Review and Meta-Analysis.

Smoking cessation interventions are important for decreasing lung cancer mortality rate among Chinese Americans. This study aims to investigate and summarize the intervention methods focusing on smoking cessation among Chinese Americans and to compare the effects of intervention methods on the smoking cessation rates. A systematic review and meta-analysis design was used in this study. Keyword searching was conducted in August 2021 on PubMed, Google Scholar, PsycINFO, and CINAHL. The methodological quality of each study was assessed using the PEDro scale or The Methodological item for non-randomized studies (MINORS). The Review Manager Version 5.4 software was used to conduct the meta-analysis. Random effect model and subgroup analysis were applied in the analysis. Twenty and 11 studies were included in the systematic review and meta-analysis, respectively. Of the 20 studies, 8 were randomized control studies, 9 were pre-post single group intervention studies, 1 was retrospective analysis for an intervention study, 1 was a baseline data analysis from a cluster randomized trial, 1 was a feasibility intervention study. Results showed that compared to the control group, the group that received interventions on smoking cessation had a significantly increased smoking cessation rate (OR, 3.76; 95% CI, 1.72-8.21; P=0.0009). Subgroup analysis showed individual-based (OR, 5.88) NRT outreach interventions (OR, 3.80) conducted in person (OR, 2.53) with smokers (OR, 6.64) seemed to be more effective to increase smoking cessation rates among Chinese Americans compared with group-based, telephone counseling, indirect remote interventions conducted among Chinese American smokers and their non-smoke family members. Individual-based NRT outreach interventions conducted in person with smokers is an effective way to increase smoking cessation rates among Chinese Americans. More culturally sensitive and effective interventions are needed to help Chinese American smokers to quit smoking.

Quality of life after mastoid surgery. Is there a real benefit to preserving the posterior wall of the external auditory canal? A systematic review and meta-analysis.

ObjectiveCanal wall up (CWU) and canal wall down (CWD) mastoidectomies represent the most common cholesteatoma surgical techniques. In this meta-analysis, we compare the postoperative quality of life (QoL) in patients treated with either CWU or CWD mastoidectomy. MethodsA literature search was conducted in the following three electronic databases: Medline/PubMed, ScienceDirect, and Google Scholar. Articles were assessed for eligibility in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and data were extracted independently by two authors. Biases assessment was conducted for each study according to the Methodological Items for Non-Randomized Studies (MINORS) tool. Meta-analysis was performed for postoperative QoL following CWU versus CWD mastoidectomy. ResultsOur systematic review included four studies that met the inclusion criteria, three prospective cohort studies, and one retrospective cohort study. The meta-analysis did not favor treatment with one of the two surgical techniques. Postoperative QoL did not show a statistically significant difference between CWU and CWD mastoidectomies (p>0.05). ConclusionOur systematic review and meta-analysis results indicate that QoL is not statistically significantly better among patients who underwent CWU mastoidectomies when compared with CWD. The trend of selecting CWU over CWD mastoidectomies in selected cases - for QoL purposes - is not always based on evidence-based data. The statistically insignificant difference between the two surgical techniques suggests that an initial more radical approach might prevent patients from further surgeries, without affecting postoperative QoL.

Reporting quality was suboptimal in a systematic review of randomized controlled trials with adaptive designs

ObjectiveThe study was conducted to evaluate the reporting quality of randomized controlled trials (RCTs) that use an adaptive design (AD) based on the 2020 AD Consolidated Standards for Reporting Trials 2010 extension (ACE) guidelines and identify factors associated with better reporting quality. Study Design and SettingPubMed, Embase, Cochrane, Web of Science, and Google Scholar were searched until November 1, 2022. Multivariable linear regression analysis was performed to investigate potential predictors. ResultsIn total, 109 RCTs were included in our study. The mean compliance rate for the ACE checklist items was 69.75% ± 16.02. Key methodological items including allocation concealment and its implementations were poorly reported. There was also suboptimal reporting of checklist items related to the conduct of interim analyzes. Multivariable regression analysis showed better reporting quality with trial registration, nonindustry affiliation (first author), a sample size of >100, general medical journal type, publication date (≥2020), funding, and disclosure of the number of interim analyzes. ConclusionOur study showed that RCTs with AD had suboptimal reporting of 2020 ACE checklist items, particularly AD-specific items. Following the development of ACE guidelines, stricter adherence to the ACE guideline is necessary to improve their reporting quality. Pre-ACE and post-ACE adherence comparisons can be conducted in the future.

Scientific production in accounting in Brazil: analysis with doctoral theses

Contextualization: The increase in scientific research in accounting that has taken place in Brazil in recent years involves the increase in postgraduate courses. In this way, it is pertinent to verify the progress in accounting research through the doctoral theses defended. Gap: The originality of the research lies in the identification, amplitude and period covered, as well as in the analysis of the methodological items used in the doctoral theses in accounting. Purpose: To present a survey of the characteristics of doctoral theses in accounting defended between the years 2012 to 2016 in Brazil. Methodology: As for the methodology, a bibliometric analysis was carried out through the technique of meta-analysis, in 147 theses published by graduate programs in accounting. Results: The main results were: (1) the thematic area most addressed in the theses was financial accounting; (2) there is a predominance of male doctoral students; (3) in relation to the methodology, the most used type of research is descriptive and the procedure is documentary; (4) regarding the methodological approach, the predominance is quantitative studies, with the main technique used for descriptive statistics; and (5) the Agency and Contingency Theories were the ones that most substantiated the studies developed. Conclusion: There was an evolution in the researched subjects within the accounting area, mainly due to the amount of theories used, it was noticed through the meta-analysis that the management accounting area has been evolving.

Risk factors for mortality in COVID-19 patients in sub-Saharan Africa: A systematic review and meta-analysis.

Mortality rates of coronavirus-2019 (COVID-19) disease continue to increase worldwide and in Africa. In this study, we aimed to summarize the available results on the association between sociodemographic, clinical, biological, and comorbidity factors and the risk of mortality due to COVID-19 in sub-Saharan Africa. We followed the PRISMA checklist (S1 Checklist). We searched PubMed, Google Scholar, and European PMC between January 1, 2020, and September 23, 2021. We included observational studies with Subjects had to be laboratory-confirmed COVID-19 patients; had to report risk factors or predictors of mortality in COVID-19 patients, Studies had to be published in English, include multivariate analysis, and be conducted in the sub-Saharan region. Exclusion criteria included case reports, review articles, commentaries, errata, protocols, abstracts, reports, letters to the editor, and repeat studies. The methodological quality of the studies included in this meta-analysis was assessed using the methodological items for nonrandomized studies (MINORS). Pooled hazard ratios (HR) or odds ratios (OR) and 95% confidence intervals (CI) were calculated separately to identify mortality risk. In addition, publication bias and subgroup analysis were assessed. Twelve studies with a total of 43598 patients met the inclusion criteria. The outcomes of interest were mortality. The results of the analysis showed that the pooled prevalence of mortality in COVID-19 patients was 4.8%. Older people showed an increased risk of mortality from SARS-Cov-2. The pooled hazard ratio (pHR) and odds ratio (pOR) were 9.01 (95% CI; 6.30-11.71) and 1.04 (95% CI; 1.02-1.06), respectively. A significant association was found between COVID-19 mortality and men (pOR = 1.52; 95% CI 1.04-2). In addition, the risk of mortality in patients hospitalized with COVID-19 infection was strongly influenced by chronic kidney disease (CKD), hypertension, severe or critical infection on admission, cough, and dyspnea. The major limitations of the present study are that the data in the meta-analysis came mainly from studies that were published, which may lead to publication bias, and that the causal relationship between risk factors and poor outcome in patients with COVID-19 cannot be confirmed because of the inherent limitations of the observational study. Advanced age, male sex, CKD, hypertension, severe or critical condition on admission, cough, and dyspnea are clinical risk factors for fatal outcomes associated with coronavirus. These findings could be used for research, control, and prevention of the disease and could help providers take appropriate measures and improve clinical outcomes in these patients.

Ability of Delta Radiomics to Predict a Complete Pathological Response in Patients with Loco-Regional Rectal Cancer Addressed to Neoadjuvant Chemo-Radiation and Surgery.

Simple SummaryThe present study aimed to investigate the possible use of MRI delta texture analysis (D-TA) in order to predict the extent of pathological response in patients with locally advanced rectal cancer addressed to neoadjuvant chemo-radiotherapy (C-RT) followed by surgery. We found that D-TA may really predict the frequency of pCR in this patient setting and, thus, it may be investigated as a potential item to identify candidate patients who may benefit from an aggressive radical surgery.We performed a pilot study to evaluate the use of MRI delta texture analysis (D-TA) as a methodological item able to predict the frequency of complete pathological responses and, consequently, the outcome of patients with locally advanced rectal cancer addressed to neoadjuvant chemoradiotherapy (C-RT) and subsequently, to radical surgery. In particular, we carried out a retrospective analysis including 100 patients with locally advanced rectal adenocarcinoma who received C-RT and then radical surgery in three different oncological institutions between January 2013 and December 2019. Our experimental design was focused on the evaluation of the gross tumor volume (GTV) at baseline and after C-RT by means of MRI, which was contoured on T2, DWI, and ADC sequences. Multiple texture parameters were extracted by using a LifeX Software, while D-TA was calculated as percentage of variations in the two time points. Both univariate and multivariate analysis (logistic regression) were, therefore, carried out in order to correlate the above-mentioned TA parameters with the frequency of pathological responses in the examined patients’ population focusing on the detection of complete pathological response (pCR, with no viable cancer cells: TRG 1) as main statistical endpoint. ROC curves were performed on three different datasets considering that on the 21 patients, only 21% achieved an actual pCR. In our training dataset series, pCR frequency significantly correlated with ADC GLCM-Entropy only, when univariate and binary logistic analysis were performed (AUC for pCR was 0.87). A confirmative binary logistic regression analysis was then repeated in the two remaining validation datasets (AUC for pCR was 0.92 and 0.88, respectively). Overall, these results support the hypothesis that D-TA may have a significant predictive value in detecting the occurrence of pCR in our patient series. If confirmed in prospective and multicenter trials, these results may have a critical role in the selection of patients with locally advanced rectal cancer who may benefit form radical surgery after neoadjuvant chemoradiotherapy.

Design and methodological characteristics of studies using observational routinely collected health data for investigating the link between cancer and neurodegenerative diseases: protocol for a meta-research study

IntroductionHealth services generate large amounts of routine health data (eg, administrative databases, disease registries and electronic health records), which have important secondary uses for research. Increases in the availability and...