Methodological Quality Assessment Research Articles

The Current Role of Imaging in the Diagnosis of Inflammatory Bowel Disease and Detection of Its Complications: A Systematic Review.

Inflammatory bowel disease (IBD) encompasses complex gastrointestinal (GI) conditions, primarily Crohn's disease (CD) and ulcerative colitis (UC), requiring precise imaging for effective diagnosis and management of complications. This systematic review aimed to evaluatethe current role of imaging modalities in diagnosing IBD and detecting related complications. Thereview adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a literature search using text words and controlled vocabulary applying Boolean operators "AND," "OR," with various combinations on databases such as PubMed, Embase, and Cochrane Library. The search targeted open-access articles involving humans, with full-text available, and published in the English Language from 2005 to 2024. The quality of the included studies was assessed using the Cochrane Risk-of-Bias (RoB) checklist. Our search process identified 127 recordsfrom Cochrane (39), Embase (29), and PubMed (59). After removing 98 irrelevant records, 29 underwent further screening. Five were excluded as they involved irrelevant problems or outcomes, leaving us with 24 reports with full text, all of which were accessible. Following the eligibility assessment, two more reports were excluded due to inaccessibility, and 22 studies were included in the final analysis. The risk of bias and methodological quality assessment revealed that out of 22 studies analyzed, five (23%) had a high risk of bias, while 13 (59%) were classified as moderate risk, and four (18%) showed low risk. This distribution highlights a predominance of moderate-risk studies in research on imaging in IBD, emphasizing the need for enhanced study designs in future investigations. Our findings revealed the varying effectiveness of imaging modalities in diagnosing complications of CD and UC. Magnetic resonance enterography (MRE) stands out as the preferred method for CD due to its high sensitivity and noninvasive nature. In contrast, colonoscopy remains the gold standard for UC, providing direct visualization of mucosal lesions. While techniques like ultrasound and capsule endoscopy offer valuable insights, they havelimitations that may affect their utility in certain cases.

Concordance between humans and GPT-4 in appraising the methodological quality of case reports and case series using the Murad tool

BackgroundAssessing the methodological quality of case reports and case series is challenging due to human judgment variability and time constraints. We evaluated the agreement in judgments between human reviewers and GPT-4 when applying a standard methodological quality assessment tool designed for case reports and series.MethodsWe searched Scopus for systematic reviews published in 2023–2024 that cited the appraisal tool by Murad et al. A GPT-4 based agent was developed to assess the methodological quality using the 8 signaling questions of the tool. Observed agreement and agreement coefficient were estimated comparing published judgments of human reviewers to GPT-4 assessment.ResultsWe included 797 case reports and series. The observed agreement ranged between 41.91% and 80.93% across the eight questions (agreement coefficient ranged from 25.39 to 79.72%). The lowest agreement was noted in the first signaling question about selection of cases. The agreement was similar in articles published in journals with impact factor < 5 vs. ≥ 5, and when excluding systematic reviews that did not use 3 causality questions. Repeating the analysis using the same prompts demonstrated high agreement between the two GPT-4 attempts except for the first question about selection of cases.ConclusionsThe study demonstrates a moderate agreement between GPT-4 and human reviewers in assessing the methodological quality of case series and reports using the Murad tool. The current performance of GPT-4 seems promising but unlikely to be sufficient for the rigor of a systematic review and pairing the model with a human reviewer is required.

Effectiveness of Non-Pharmacological Interventions for Spasticity Management in Multiple Sclerosis: A Systematic Review.

This systematic review aims to determine the effectiveness of non-pharmacological interventions for the management of spasticity in people with multiple sclerosis (pwMS). A comprehensive literature search in health science databases (MEDLINE, Embase, CENTRAL, CINHAL) was performed to identify randomized controlled trials (RCTs) (up to April 2024). Manual searching in journals and screening of the reference lists of identified studies were conducted. Two authors independently selected the studies, assessed the methodological quality, and summarized the evidence. A meta-analysis was not feasible due to the methodological, clinical, and statistical diversity of the included studies. Overall, 32 RCTs (n=1,481 participants) investigated various types of non-pharmacological interventions including: physical activity, transcranial magnetic stimulation (intermittent theta burst stimulation [iTBS], repetitive transcranial magnetic stimulation [rTMS]), electromagnetic therapy, transcutaneous electrical nerve stimulation, vibration therapy, shock wave therapy, self-management educational programs, and acupuncture. All studies scored 'low' on the methodological quality assessment, implying a high risk of bias. The findings suggest 'moderate to low certainty' evidence for physical activity programs used in isolation or combination with other interventions (pharmacological or non-pharmacological), and for iTBS/rTMS with or without adjuvant exercise therapy in improving spasticity in adults with MS. There is 'very low certainty' evidence supporting the use of other modalities for treating spasticity in this population. Despite a wide range of non-pharmacological interventions used for the management of spasticity in pwMS, there is a lack of conclusive evidence for many. More robust trials with larger sample sizes and longer-term follow-ups are needed to build evidence for these interventions.

Systematic review of the literature about immunogenity and antibodies persistance of Tdap vaccination

Abstract Introduction In industrialized countries, routine use of pertussis vaccines has shifted the burden of pertussis disease from children to infants, adolescents and adults, leading to the necessity of booster doses. Materials and methods We prepared the review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) with the aim of a) to describe the immunogenity of the main available vaccines for adolescents and adults b) to describe antibodies persistance after immunization with the main vaccines available in childhood and adults and, also, possible co-administration and c) to identify the gold standard for adolescent and adult immunizations. Results Of 6906 records identified, after removing duplicate records, 12 RCT were included (people aged 11-73): of these 7 studies had only 1 control group, 4 studies had 2 control group and 1 had 5 control group; moreover, of the 12 studies included only 2 regarding co-administration and all were about immunogenity. 9 out 12 studies had a Jadad score above 3 points and 10 out 12 meet the criteria of Cocrane Back Review Group Criteria List for Methodological Quality Assessment. Discussion and conclusions We found a limited number of good-quality RCTs investigating our object. The five component vaccines, although containing a lower dosage of antigen, are found to be more effective than one components vaccines for prevention. Evidences support the use of 5- components vaccines for booster sessions in adolescence and adulthood. Key messages • Although 3-component and 5-component vaccines contain a lower dose of antigen, they are more effective than 1-component vaccines in the prevention of diphtheria-tetanus and Bordetella pertussis. • The robustness of the data and the analytical tests support the use of vaccines with reduced antigen concentration for decennial booster sessions in adolescence and adulthood.

"I didn't really fit into any boxes": understanding the experiences of women affected by cancer in pregnancy and up to one-year postpartum-a mixed-method systematic review.

Little is known about women's experiences of cancer during pregnancy and up to one-year postpartum. As the incidence of gestational cancer rises parallel to increasing rates of early onset cancers there is an imperative need to understand their experiences. The aim of this research is to understand women's experiences of gestational cancer during pregnancy and up to one-year postpartum. This systematic integrative review followed the JBI methodology for mixed method systematic reviews (MMSR) which integrates empirical data from qualitative and quantitative primary studies. The search strategy included electronic databases, APA PsycINFO, CINHAL, Medline, Scopus, and the Web of Science Core Collection. The review has been reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive methodological quality assessment was undertaken using the Mixed Methods Appraisal Tool (MMAT). Thirteen studies were included, reporting on the experiences of 266 women. The findings represented the women's insight on the psychological impact of their gestational cancer, the impact on women's identity as a mother and a patient, and women's experiences of complex care. Gestational cancer reflects an emerging focus of clinical practice and an opportunity for much needed new research to explore woman-centered care exploring supportive care needs and models of maternity care. Women's experiences indicate that services are under-resourced to address the holistic and integrated supportive care needs of women affected by cancer across both maternity and cancer care teams.

Smart Home Technologies for Enhancing Independence of Living and Reducing Care Dependence in Older Adults: A Systematic Review.

To systematically review the potential of smart home technology to enhance the independence of older adults and reduce their dependence on care. Additionally, it sought to examine the positive impacts of such technology on their golden years. A systematic review based on Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The search was conducted on 8 April 2024. Peer-reviewed studies in PubMed, Embase, Web of Science, IEEE Xplore, Scopus, The Cochrane Library, CINAHL, CNKI, WANFANG DATA and VIP from 1 January 2000 to 8 April 2024 were searched. The methodological quality assessment used the Mixed Methods Appraisal Tool (MMAT). Positive findings relevant to this study were extracted from the literature and analysed using thematic synthesis. After meticulously examining 3404 studies, we identified 21 relevant sources for in-depth analysis, including qualitative studies (n = 10), experimental studies (n = 9) and mixed method studies (n = 2). These sources were grouped into five core themes based on the pivotal role of smart home technologies in enabling ageing in place: daily monitoring, assisted living activities, life reminders, functional improvement and emotional companionship. The study found that smart home technology offers numerous benefits to the lives of older adults, including increased independence, psychological support, improved cognitive functioning, enhanced self-management, increased mobility, support for caregivers, promoted social engagement and enhanced quality of life. Smart home technology can enhance the independence of older adults' lives, reduce their dependence on care, alleviate the burden on caregivers and promote home-based elderly care. This systematic review contributes to understanding the capability of smart home technology to promote elderly care at home and help better utilise smart home technology to benefit older adults. Older adults and their caregivers should be encouraged to adopt this technology to improve older adults' quality of life. No patient or public contribution.

First-Trimester Prediction Models Based on Maternal Characteristics for Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis.

Early risk stratification can facilitate timely interventions for adverse pregnancy outcomes, including preeclampsia (PE), small-for-gestational-age neonates (SGA), spontaneous preterm birth (sPTB) and gestational diabetes mellitus (GDM). To perform a systematic review and meta-analysis of first-trimester prediction models for adverse pregnancy outcomes. The PubMed database was searched until 6 June 2024. First-trimester prediction models based on maternal characteristics were included. Articles reporting on prediction models that comprised biochemical or ultrasound markers were excluded. Two authors identified articles, extracted data and assessed risk of bias and applicability using PROBAST. A total of 77 articles were included, comprising 30 developed models for PE, 15 for SGA, 11 for sPTB and 35 for GDM. Discriminatory performance in terms of median area under the curve (AUC) of these models was 0.75 [IQR 0.69-0.78] for PE models, 0.62 [0.60-0.71] for SGA models of nulliparous women, 0.74 [0.72-0.74] for SGA models of multiparous women, 0.65 [0.61-0.67] for sPTB models of nulliparous women, 0.71 [0.68-0.74] for sPTB models of multiparous women and 0.71 [0.67-0.76] for GDM models. Internal validation was performed in 40/91 (43.9%) of the models. Model calibration was reported in 21/91 (23.1%) models. External validation was performed a total of 96 times in 45/91 (49.5%) of the models. High risk of bias was observed in 94.5% of the developed models and in 58.3% of the external validations. Multiple first-trimester prediction models are available, but almost all suffer from high risk of bias, and internal and external validations were often not performed. Hence, methodological quality improvement and assessment of the clinical utility are needed.

Self-directed learning and the student learning experience in undergraduate clinical science programs: a scoping review.

Health professional organisations are increasingly promoting the use of self-directed learning. Furthermore, the rapidly evolving field of healthcare has meant that there is greater emphasis within tertiary education for students to become self-directed learners and possess the skills to engage in life-long learning. The aim of this scoping review was to explore the drivers that improve the student learning experience, in undergraduate clinical science programs that utilise self-directed learning. The Joanna Briggs Institute Scoping Review Methodology guided this study. The electronic databases MEDLINE, Embase, Emcare, Scopus and ERIC were comprehensively searched in April 2022 and re-run August 2023, for peer-reviewed research articles published in English. The original search was developed in MEDLINE and then adapted to each database. Following the Joanna Briggs Scoping Review methodology, articles were screened first by title and abstract and then by full text. Included articles were assessment for methodological quality. The search strategy yielded 2209 articles for screening. 19 met the inclusion criteria. Five key factors were identified which improve the student learning experience in self-directed learning: (i) curricular elements; (ii) educator influence; (iii) impact of peers, (iv) environment; and (v) clinical placement experiences. There are many curricular, environmental, and external factors which can improve the student learning experience in programs that utilise self-directed learning. Greater understanding of these factors will allow educators within clinical science programs to implement self-directed learning strategies more effectively within curriculum.

Comparative analysis of the leprosy detection rate regarding its clinical spectrum through PCR using the 16S rRNA gene: a scientometrics and meta-analysis.

Leprosy is a chronic and disabling infectious disease caused by Mycobacterium leprae. It has a wide clinical spectrum and is operationally classified into paucibacillary (PB) and multibacillary (MB) cases. There is evidence that the 16S rRNA gene can be used in Polymerase Chain Reaction (PCR) for complementary detection with high sensitivity and specificity. However, there is no literature convention on its diagnostic correspondence regarding the particular operational classification of the disease. This study aimed to correlate, through a meta-analysis, the detection rate of leprosy between the PCR method with the 16S rRNA gene in the clinical forms PB and MB in relation to confirmed cases. This is a systematic review and meta-analysis study conducted according to the PRISMA 2020 guidelines, using the search descriptors with "AND": "Leprosy"; "Polymerase Chain Reaction"; "16S rRNA" in the PUBMED, SciELO, LILACS, and Science Direct databases. The search was limited to original observational articles in Portuguese, English, or Spanish, with no defined time frame. The methodological quality assessment of the selected articles was performed using the JBI checklists. A scientometric approach to the article using used the VOS Viewer and Scimago Graphica software. The meta-analysis was conducted using Comprehensive Meta-Analyses software, under Pearson's Correlation effect test and fixed effect model and subgroup analysis concerning the type of sample analyzed. The study was significant from the perspective of the paucibacillary group (Clinical biopsy: -0.45 [95% CI= -0.63 - -0.22], p < 0.001/ Slit smear skin: -0.52 [95% CI= -0.65 - -0.36], p < 0.001 / Overall: -0.50 [95% CI= -0.61 - -0.37], p < 0.001). The PCR diagnostic method for the16S rRNAgene ofM. lepraehas low viability and diagnostic sensitivity in both clinical biopsy samples and leprosy skin smears. This implies little validation of it as a PCR target gene for diagnosing the disease, highlighting limitations in the actual technique. https://www.crd.york.ac.uk/prospero/, identifier CRD42024588790.

Comparative Efficacy of Interlocking Intramedullary Nails and Percutaneous Plate Implantation in the Treatment of Femoral Shaft Fractures: A Meta-Analysis.

Interlocking intramedullary nailing and percutaneous plate implantation are commonly used techniques in the treatment of femoral shaft fractures. This study aimed to determine the most appropriate and effective treatment strategy between interlocking intramedullary nails and percutaneous plate implantation by analyzing and summarizing the available evidence. Relevant articles published from the date of database construction in PubMed, Embase, Web of Science, and Cochrane to 2024 were searched and downloaded according to PRISMA 2020. These studies were screened following pre-established inclusion criteria, and the data were extracted. Methodological quality assessment for retrospective studies was performed using the Newcastle-Ottawa Scale, whereas Review Manager Software was used for methodological quality assessment of randomized controlled trials (RCTs) and statistical analysis. Only 13 studies containing 1061 patients were included in the meta-analysis. Femoral shaft fractures treated with interlocking intramedullary nailing had shorter operative and fluoroscopic time and less estimated blood loss. Pediatric patients treated with interlocking intramedullary nails had less estimated blood loss and shorter healing time. Interlocking intramedullary nailing group in the retrospective study was associated with shorter operative time and less blood loss, whereas, in the randomized controlled trial (RCT) study, it was associated with less blood loss and shorter healing time. Interlocking intramedullary nailing is more advantageous in treating femoral shaft fractures and is a more appropriate option for treating femoral shaft fractures in pediatric patients. PROSPERO: CRD42024564563.

An Assessment of Water Quality and Pollution Sources in a Source Region of Northwest China

China prioritizes ensuring drinking water safety, particularly in the water-scarce northwest region. This study, utilizing water quality data from 52 village and town water sources since August 2022, assesses water quality, with a specific focus on key indicators related to organic pollution sources. This study provides a scientific foundation for enhancing water quality in these sources. Employing category factor analysis for classification and grading, principal component analysis for qualitative analysis of key evaluation indicators, and the absolute principal component linear regression equation for quantitative calculation of pollution sources, this study reveals that all 52 water sources meet quality standards. Principal component analysis categorizes pollution sources as diverse types of organic compounds in surface water. Source analysis calculations highlight decay-type organic substances as major contributors to increased water color and permanganate index, with pollution contribution rates of 54.78% and 31.31%, respectively. Fecal-type organic substances dominate the increase in dissolved total solids and total coliforms, with pollution contribution rates of 56.65% and 40.16%, respectively. Additionally, high-molecular-weight organic substances exhibit lower concentrations in the water. This article presents a systematic water quality assessment methodology, which is used for the first time to qualitatively assess the types of water sources and to quantitatively trace specific sources of organic pollution in source water in northwest China. This systematic study’s results, involving initial assessment followed by traceability, recommend the adoption of a simple contact filtration and disinfection process to enhance water quality in the region.

Percutaneous Electrical Stimulation Improves Chronic Knee Pain and Function. A Systematic Review and Meta-analyses.

The aim of this systematic review and meta-analysis was to evaluate the effectiveness of the percutaneous electrical stimulation in the modulation of pain and its implication in the function of patients with a painful knee condition. A search was conducted from database inception to September 2023 across PubMed, Web of Science and Scopus databases. Randomized controlled trials were included. Two reviewers performed independent data extraction and methodologic quality assessment of the studies. Study quality was assessed using the PEDro scale and the risk of bias was evaluated with the Cochrane Assessment tool. Eight studies were included. A significant statistical effect was found (P<0.001) for reducing pain and improving function after treatment. Additionally, a significant statistical effect was presented for reducing pain (P=0.009) and improving function (P<0.001) after follow-up. The risk of bias was low. This review showed a positive effect of applying the percutaneous electrical stimulation reducing pain and improving function in adults with a painful knee.

Automated assessment of task-based performance of digital mammography and tomosynthesis systems using an anthropomorphic breast phantom and deep learning-based scoring.

Conventional metrics used for assessing digital mammography (DM) and digital breast tomosynthesis (DBT) image quality, including noise, spatial resolution, and detective quantum efficiency, do not necessarily predict how well the system will perform in a clinical task. A number of existing phantom-based methods have their own limitations, such as unrealistic uniform backgrounds, subjective scoring using humans, and regular signal patterns unrepresentative of common clinical findings. We attempted to address this problem with a realistic breast phantom with random hydroxyapatite microcalcifications and semi-automated deep learning-based image scoring. Our goal was to develop a methodology for objective task-based assessment of image quality for tomosynthesis and DM systems, which includes an anthropomorphic phantom, a detection task (microcalcification clusters), and automated performance evaluation using a convolutional neural network. Experimental 2D and pseudo-3D mammograms of an anthropomorphic inkjet-printed breast phantom with inserted microcalcification clusters were collected on clinical mammography systems to train a signal-present/signal-absent image classifier based on Resnet-18 architecture. In a separate validation study using simulations, this Resnet-18 classifier was shown to approach the performance of an ideal observer. Microcalcification detection performance was evaluated as a function of four dose levels using receiver operating characteristic (ROC) analysis [i.e., area under the ROC curve (AUC)]. To demonstrate the use of this evaluation approach for assessing different technologies, the method was applied to two different mammography systems, as well as to mammograms with re-binned pixels emulating a lower-resolution X-ray detector. Microcalcification detectability, as assessed by the deep learning classifier, was observed to vary with the exposure incident on the breast phantom for both DM and tomosynthesis. At full dose, experimental AUC was 0.96 (for DM) and 0.95 (for DBT), whereas at half dose, it dropped to 0.85 and 0.71, respectively. AUC performance on DM was significantly decreased with an effective larger pixel size obtained with re-binning. The task-based assessment approach also showed the superiority of a newer mammography system compared with an older system. An objective task-based methodology for assessing the image quality of mammography and tomosynthesis systems is proposed. Possible uses for this tool could be quality control, acceptance, and constancy testing, assessing the safety and effectiveness of new technology for regulatory submissions, and system optimization. The results from this study showed that the proposed evaluation method using a deep learning model observer can track differences in microcalcification signal detectability with varied exposure conditions.

Team-based learning in health professions education: an umbrella review

BackgroundTeam-Based Learning (TBL) has garnered considerable attention in education research. To consolidate the existing evidence, we conducted an umbrella review with four objectives: (a) to identify TBL review characteristics, (b) to synthesize findings from previous reviews regarding TBL effectiveness and outcomes, (c) to determine which student groups benefit most, and (d) to identify the most and least researched elements.MethodsThe Joanna Briggs Institute (JBI) methodology was followed: [1] Search strategy and literature search [2] Screening and Study Selection [3] Assessment of methodological quality [4] Data collection, and [5] Data summary. We utilized Endnote, Excel, and MAXQDA for efficient project management and analyzing data.ResultsAnalyzing twenty-three reviews spanning from 2013 to 2024, we found a peak in TBL research in 2022 including more than 312 unique primary studies involving more than 63,987 participants. Notably, the United States and China accounted for over 61% of the total primary articles focused on students from medicine, nursing, pharmacy, and dentistry. Evidence supports the superiority of TBL in enhancing cognitive outcomes. However, findings related to retention are mixed. Insufficient evidence exists to draw robust conclusions when comparing TBL with other active learning methods. TBL demonstrates favorable outcomes in terms of clinical performance and engagement. Non-technical skills show mixed results. Notably, TBL positively impacts self-study, learning ability, decision-making, and emotional intelligence. Faculty experiences reveal an initial increase in workload, but generally hold positive attitude. Faculty development remain limited in duration and scope. Freshmen, academically weaker students, undergraduates, Chinese female students, and nursing students appear to benefit most from TBL. Team formation and size are the most frequently studied elements.ConclusionTBL holds promise for improving learning outcomes, but ongoing investigation is essential to maximize its impact in diverse educational contexts. This umbrella review underscores the need for further research in specific areas i.e. effective pre-class learning methods and faculty workload.

A systematic review of the effect of sandplay therapy on social communication deficits in children with autism spectrum disorder.

To explore the efficacy of sandplay therapy in intervening social communication deficits in children with autism spectrum disorders (ASD), and whether this efficacy is influenced by the age of the children and the dosage of sandplay therapy intervention. Following the PICOS principle, randomized controlled trials (RCTs) related to sandplay therapy for social communication deficits in ASD children were retrieved from seven databases: PubMed, WOS, The Cochrane Library, Embase, CNKI, Wanfang, and VIP, from the inception of each database to November 10, 2023. Two experimenters independently conducted study screening and excluded studies with concomitant diseases, incomplete data, unextractable data, and non-randomized controlled trials. The PEDro scale was used for methodological quality assessment, and the GRADEprofiler method was employed to evaluate the quality of evidence. Stata17 software was used for meta-analysis, subgroup analysis, sensitivity analysis, and publication bias testing. The standardized mean difference (SMD) and 95% confidence interval (CI) were used as the effect statistics. A total of 12 RCTs (791 cases) were included. Sandplay therapy had a positive impact on the social communication deficits of ASD children [SMD = -1.42, 95%CI (-1.79, -1.04), P < 0.001]. Subgroup analysis revealed that sandplay therapy administered during the early school age (449 cases, SMD = -1.44, P < 0.05), for a duration of 22-28 weeks (208 cases, SMD = 1.69, P < 0.05), and with a frequency of once per week (218 cases, SMD = -1.67, P < 0.05) was most effective in improving on social communication deficits of ASD children. The quality of evidence in this study was rated as high, with good methodological quality, including 12 studies with better quality and no detection of bias risk. The study had high heterogeneity, which was attributed to the measurement tools and intervention duration through subgroup analysis, with no inconsistency found. Additionally, no downgrade factors related to imprecision, publication bias, or indirectness were identified. In conclusion, sandplay therapy is an effective measure to improve social communication deficits in children with ASD, and current evidence recommends early intervention using an individual sandplay therapy or integrated sandplay therapy intervention program once a week for 22-28 weeks, which can serve as evidence-based clinical guidance. www.crd.york.ac.uk, identifier (CRD420234821750).

The Role of WHO Surgical Checklists in Reducing Postoperative Adverse Outcomes: A Systematic Review.

Surgical safety remains a critical aspect of modern healthcare, particularly as the number of surgical procedures continues to rise, placing greater demands on resources and increasing the potential for errors. In response to this challenge, various mitigation strategies have been implemented to improve operative outcomes. One such strategy, introduced by the WHO in 2008, is the Surgical Safety Checklist. Despite its widespread adoption globally, its acceptance remains limited in developing countries. This systematic review aimed to evaluate the impact of the WHO Surgical Safety Checklist, specifically the sign-in, time-out, and sign-out components, on reducing post-operative adverse effects in surgical patients. A single-step search strategy was employed across multiple databases, including Medline, CINAHL, Embase, Cochrane Database, ProQuest, Index Copernicus, Google Scholar, and Scopus. Additionally, reference lists of identified reports and articles were manually searched to identify further relevant studies. Only studies published in English before September 2022 that focused exclusively on the WHO Surgical Safety Checklist were included. Studies on other checklists or those with confounding factors, such as international surgical outcomes studies, were excluded from this analysis. After screening 17,821 publications based on their titles and abstracts, 93 studies met the initial inclusion criteria and underwent full retrieval and assessment for methodological quality. Ultimately, 13 studies were deemed of sufficient quality to be included in the review. Among these, 10 studies reported outcomes related to complication rates, with nine of them demonstrating a decrease in complication rates following checklist implementation. Similarly, 13 studies reported outcomes related to mortality rates, with 12 reporting a decrease in mortality rates associated with checklist use. In conclusion, the application of the WHO Surgical Safety Checklist has been shown to improve surgical outcomes by reducing post-operative adverse effects, including mortality and complication rates. However, further research is warranted to assess the checklist's impact on the quality of life of surgical patients, which would contribute to enhancing its overall acceptability. Continued investigation into these areas will help further strengthen the evidence supporting the widespread adoption and effective implementation of the WHO Surgical Safety Checklist across diverse healthcare settings globally.

Developing a real-time compaction quality assessment methodology for subgrade based on semi-supervised co-training

The current intelligent methodologies for real-time evaluation of subgrade compaction quality predominantly rely on supervised machine learning algorithms. However, the scarcity of sand cone test significantly impedes model performance, thereby severely limiting the applicability of intelligent subgrade compaction. This paper proposes a semi-supervised co-training algorithm for real-time evaluation of subgrade compactness during the construction procedure, leveraging unlabeled data to enhance the model performance. Based on the compaction datasets from various subgrade scenarios, the proposed PSO-XGB-Co-training KNN-PLS (PSO-XGB-CoKP) algorithm is utilized to train the unlabeled data, boasting a 20.4% reduction in Mean Squared Error (MSE). The semi-supervised co-training algorithm is modified by employing different regressors as co-trained sub-models and increasing the number of regressors. The model is optimized by levering the accuracy and computational cost, and an optimal data augmentation volume is recommended through the sensitivity study. This study provides an alternative approach for leveraging unbalanced and small-sample datasets to develop a reliable intelligent methodology for evaluating subgrade compaction quality in engineering practice.

Patient-reported outcome measures and physical function following head and neck lymphedema - a systematic review.

Head and neck cancer (HNC) treatments often lead to significant morbidity, including lymphedema. This systematic review aims to comprehensively explore the prevalence and impact of head and neck lymphedema (HNL) following treatment. A systematic literature search was conducted up to September 2023. Studies evaluating HNL prevalence, associated factors, impact, patient-reported outcomes (PROMs), and physical assessments were included. Methodological quality assessment was performed, and data were synthesised narratively. Twelve studies met the inclusion criteria, with methodological quality ranging from moderate to high. Internal lymphedema prevalence was consistently higher than external lymphedema, with varying rates attributed to treatment modalities and assessment methods. PROMs such as the Lymphedema Symptom Intensity and Distress-Head and Neck and physical assessments including Patterson's Rating Scale were commonly utilised. HNL significantly impacted quality of life and physical function, with reported symptoms including discomfort, tightness, swallowing difficulties, and psychological distress. HNL is a common sequela of HNC treatment with significant implications for individuals' QoL. Standardised assessment protocols and tailored interventions are needed to address the needs of individuals with HNL and improve overall outcomes. This systematic review highlights a significant prevalence of lymphedema, particularly internal lymphedema in the larynx and pharynx, following treatment. Swallowing difficulties, nutritional issues, anxiety, depression, and body image concerns were associated with both internal and external lymphedema. The impact on quality of life is substantial, with survivors experiencing physical symptoms and psychosocial challenges, emphasising the importance of integrated care approaches tailored to both aspects of well-being.

Effects of pelvic floor muscle training (PFMT) on the sexual function of climacteric women: a systematic review protocol

Introduction Climacteric period signifies a transitional phase characterized by ovarian failure and a decline in estrogen levels, leading to various urogynecological alterations, including potential sexual dysfunctions. Among these, pelvic floor muscle (PFM) function plays a pivotal role in female sexual function. This study aims to evaluate the efficacy of pelvic floor muscle training (PFMT) on the sexual function of climacteric women. Methods Experimental or quasi-experimental studies published in peer-reviewed journals, assessing the sexual function of perimenopausal women with PFMT as an intervention, will be included. Studies conducted in institutionalized populations or with neurological and cognitive diseases will be excluded. This systematic review protocol follows the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The searches will be carried out in the Pubmed, LILACS (Latin American and Caribbean Literature on Health Sciences), Scopus, Web of Science, and PEDro, using the Search equation: climacteric women/menopause and PFMT and (sexual function or sexual dysfunction). The assessment of methodological quality will be carried out using the Pedro and GRADE scale, which will involve two independent researchers to evaluate the criteria. A third researcher will resolve discrepancies. Ethics and disclosure Ethical approval is not required as this is a secondary data study. This systematic review began in April 2024 and all steps are expected to be completed by November 2024. PROSPERO registration number CRD42024534297

Mentorship in health research institutions in Africa: A systematic review of approaches, benefits, successes, gaps and challenges.

In Africa, where the burden of diseases is disproportionately high, significant challenges arise from a shortage of skilled researchers, lack of research funding, and limited mentorship opportunities. The continent faces a substantial gap in research output largely attributed to the dearth of mentorship opportunities for early career researchers. To explore existing mentorship approaches, identify challenges, gaps, successes, and benefits, and provide insights for strengthening mentorship programs in African health research institutions. We registered the review protocol on the International Prospective Register of Systematic Reviews [CRD42021285018] and searched six electronic databases-EMBASE, AJOL, Web of Science, PubMed, DOAJ, and JSTOR from inception to 10 November 2023, for studies published in English reporting on approaches of mentorship in health research in African countries. We also searched grey literature repositories, institutional websites, and reference lists of included studies for additional literature. Two independent reviewers conducted screening of titles and abstracts of identified studies, full-text screening, assessment of methodological quality, and data extraction. We assessed study quality against the Mixed Methods Appraisal Tool (MMAT). We resolved any disagreements through discussion and consensus. We employed a narrative approach to synthesize the findings. We retrieved 1799 articles and after screening, included 21 studies in the review. The reviewers identified 20 mentorship programs for health researchers (N = 1198) in 12 African countries mostly focusing on early-career researchers and junior faculty members. A few included mid-career and senior researchers. We categorized the programs under three key mentoring approaches: international collaborative programs, regional and in-country collaborations, and specialized capacity-building initiatives. Our review highlighted the following successes and benefits of health research mentorship programs: the establishment of collaborations and partnerships, development of research programs and capacities, improvement of individual skills and confidence, increased publications, and successful grant applications. The gaps identified were limited funding, lack of a mentorship culture, negative attitudes towards research careers, and lack of prioritization of research mentorship. Our review highlights a diverse landscape of health research mentorship aspects predominantly targeting early career researchers and heavily driven by the North. There is a need for locally driven mentorship initiatives in Africa to strengthen mentorship to advance health research in the region. PROSPERO registration number: CRD42021285018.