Performed Quality Assessment Research Articles

Lessons Learned from Managing Millions of Records to Create the World Flora Online

In 2013, the World Flora Online (WFO) Consortium Council decided to use version 1.1 of the The Plant List (TPL) to initially populate the WFO taxonomic backbone. TPL is a collaboration between the Royal Botanic Gardens, Kew, Missouri Botanical Garden and other stakeholders to create a comprehensive list of Vascular plant (flowering plants, conifers, ferns and their allies) and of Bryophytes (mosses and liverworts). By combining multiple checklist held by these institutions, TPL 1.1 contained 1,064,035 scientific plant names of species rank, 350,699 of which were accepted species names. TPL provides the Accepted Latin names linked to Synonyms by which that species has been known. It also includes Unresolved names for which the contributing data sources did not contain sufficient evidence to decide whether they were Accepted or Synonyms. Fortunately, TPL keeps track of the provenance of names and links back to the International Plant Names Index (IPNI) repository. This provenance trace has proven crucial when giving proper credit, as well as implementing a reliable curating process in WFO that supports the incorporation of potential new content, updates and further improvements contributed by the source. We will see some examples in WFO where duplication of names is originated from combining different providers and different sources, but also cases where duplication was caused within the same provider and even within a single source. The WFO Council also decided to adopt the software used by eMonocot.org to display and harvest the information of plants. This decision made it possible to take advantage of the efforts previously done by the Monocots group in using already defined standards and existing tools to create and validate the input files harvested. Unfortunately, no technical documentation nor support was available for the eMonocot software and adapting the software code was not an option then. Therefore, a process of reverse engineering was implemented to determine what input was expected, which harvested values were actually stored in the database and what impact, if any, they could have on the Portal function. For example, the eMonocot software always harvests content under a particular hierarchy where an authority, in this case corresponding to a family taxon, holds ownership of the taxa underneath. We will explain how this may become an issue when incorporating new endemic taxa. To ensure a convenient quality control, processes of validation and data curation were implemented. WFO assigns a unique ID to each name in its taxonomic backbone. The guarantee of uniqueness and permanence of such IDs is essential to support a process of cumulative improvement. To obtain this ID, a tool that matches Names was developed, allowing providers to contribute revisions to the taxonomy and descriptive content associated to a taxon. The origin of changes needs to be considered when tracing and correcting errors, implementing modifications or rolling back them later. A report about the result of requested changes in the taxonomy needs to be approved by the provider before any actual change is implemented in the taxonomic backbone. Programmatically, any process that performs quality assessment or makes data modifications must be implemented as parameterized algorithms to allow replication of the process whenever new or updated data is available from the source. Single-use scripts are quick but not very scalable. Finally, having defined a schema to use when providing content doesn’t necessarily imply that the values provided in each field are correct. Even with standardized values, the semantics associated could cause unforeseen behavior in the process implemented by the software. When possible, an additional step was required to convert harvested data from different localized vocabularies for standardized fields. Examples in Portuguese and Turkish will be given.

A Comprehensive Review of Power Quality Issues and Measurement for Grid-Integrated Wind Turbines

Background: Renewable energy generation using wind energy has emerged worldwide and has opened up significant new markets in electrical power generation. However, different factors that affect power quality performance of Wind Turbine (WT) applications such as wind speed fluctuation and use of power electronic based devices have been presented due to the rapid increase of WT installations. Methods: Accordingly, it is worth to measure, assess and evaluate the quality of the generated power of these WTs in order to ensure their compliance with the grid-integration conditions. In this work, first, a general classification of WTs and their operating principle is reviewed. Because variable speed WTs are frequently used in today’s power systems, much attention was paid to this type of turbines. Second, the various power quality aspects caused due to the integration of the wind energy systems into the grid were presented and discussed. Flickers, harmonic distortion, response to voltage dip, active power, and reactive power requirements, fault-ride through and short-circuit current contribution were the addressed power quality problems. Results: Further, the study pointed out the need for a unified evaluation process to assess the power quality performance of the grid-connected wind systems. Conclusion: Also, it was concluded that success in integrating more wind energy systems hinges on accurate power quality performance assessment.

Performance and Emission Quality Assessment in a Diesel Engine of Straight Castor and Sunflower Vegetable Oils, in Diesel/Gasoline/Oil Triple Blends

This research evaluates the possibility of using straight oils such as castor oil, which is not suitable for food use, and sunflower oil, used as a standard reference for waste cooking oils, in blends with gasoline as second-generation biofuels. To this end, a study of the rheological properties of biofuels obtained from these double blends has been carried out. The aim is to take advantage of the different properties of gasoline, i.e., its low viscosity and its high energy density to obtain blends whose rheological properties allow the substitution of fossil diesel in high extent. The incorporation of fossil diesel to these gasoline/oil mixtures produces diesel/gasoline/oil triple blends, which exhibited the suitable rheological properties to be able to operate in conventional diesel engines. Therefore, the behavior of these blends has been evaluated in a conventional diesel engine, operating as an electricity generator. The triple blends allow the substitution of fossil diesel up to 40% with sunflower oil, and up to 25% with castor oil, with excellent power results achieved for blends in which diesel is substituted up to 40%, and also in fuel consumption at high demand in comparison to conventional fossil diesel. Besides, a significant reduction in the emission of pollutants has also been obtained with these triple blends.

Monitoring the strength development of alkali-activated materials using an ultrasonic cement analyzer

The ultrasonic cement analyzer (UCA) is used as an aid to develop new cement formulations or perform quality assessment on existing formulations prior to on-site application. The non-destructive UCA technique monitors the strength development of cements by measuring the time required for ultrasonic waves to travel through the cement sample and predicting the strength using empirical correlations, which were developed for ordinary Portland cement slurries. Unfortunately, these empirical correlations cannot be used to accurately predict the strength development for fly ash-based alkali activated materials (AAMs), which are a viable alternative to ordinary Portland cement slurries for oil-well cementing applications. Therefore, a new empirical correlation linking the transit time (i.e. the time required for ultrasonic waves to travel through a unit length of the cement sample) to the compressive strength of fly ash-based AAMs was developed in this study.Class F fly ash was activated by four different alkaline solutions, two sodium hydroxide solutions with 6M and 8M concentrations and two sodium silicate solutions with SiO2/Na2O weight ratio of 0.12 and sodium concentration of 6M and 8M, to produce 4 different slurries which were cured under downhole conditions. 50 mm cubes were crushed to determine the compressive strength of these AAMs after 18, 24, 48, and 72 h of curing. UCA testing was conducted to measure the transit time up to 72 h of curing. Linear regression was performed to develop a correlation linking the measured compressive strength to the measured transit time and AAM mix design parameters.One-way ANOVA analysis revealed that the change in transit time, the concentration of sodium in the activator solution, the SiO2/Na2O weight ratio of the activator solution, and the CaO content of the FA were all significant in predicting the compressive strength of the resulting AAM. The proposed model is applicable for AAMs prepared using Class F fly ash and sodium hydroxide/silicate activating solution with sodium concentration and SiO2/Na2O weight ratio ranging between 6M and 8M and 0 and 0.12, respectively.

Effect of Imaging Surveillance After Endovascular Aneurysm Repair on Reinterventions and Mortality: A Systematic Review and Meta-analysis

Purpose: To study the effects of imaging surveillance after endovascular aortic repair (EVAR) on reintervention and mortality. Materials and Methods: A systematic review was conducted comparing complication rates in EVAR patients compliant with the imaging surveillance protocol vs partially or noncompliant patients. Two authors independently selected articles and performed quality assessment and data extraction. Risk differences for reintervention and mortality between compliant and partially/noncompliant patients were meta-analyzed. The pooled risk difference (RD) is reported with the 95% confidence interval (CI). The review protocol is registered at Prospero (CRD42017080494). Results: A total of 11 cohort studies involving 21,838 patients were included. Studies differed in imaging, their surveillance protocols, and definitions of compliance subgroups. Median follow-up was 31.7 months (interquartile range 29.8, 49.3). The overall reintervention rate was 5%, while the overall mortality was 31%. The RD for the reintervention rate was 4% (95% CI 1% to 7%) in favor of partial/noncompliance [number needed to harm 25 (95% CI 14 to 100)], while mortality showed a nonsignificant RD of 12% (95% CI −2% to 26%) in favor of partial/noncompliance. Two studies reported that 41% to 53% of reinterventions were performed for complications detected through imaging surveillance; the other events were detected through patient symptoms. Conclusion: Patients who are compliant with imaging surveillance appear to undergo more reinterventions than those who are partially or noncompliant. However, imaging surveillance does not seem to protect against mortality. This suggests that the recommended yearly imaging surveillance may not be beneficial for all EVAR patients.

Problematic issues of regulatory support of training and performance of non-staff healthcare professionals of the Disaster Medicine Service of the Ministry of Defense of the Russian Federation

Relevance. The available unique experience of elimination of medical and sanitary consequences of emergency situations of natural, technogenic and social nature proves that the effectiveness of rendering medical care within or on the border of emergency area depends on timely arrival and actions of non-staff healthcare professionals of the All-Russian service for disaster medicine – crews for specialized medical care, physician-and-nurse crews. Directly during training and practical activities non-staff healthcare professionals face problematic issues affecting their readiness and quick response.Intention. To define the most significant problematic issues influencing work of non-staff healthcare professionals of the Service for disaster medicine of the Ministry of Defense of the Russian Federation on elimination of medical and sanitary consequences of emergency situations.Methodology. Content analysis of the facts and trends in the documents regulating activities of non-staff healthcare professionals of emergency formations was performed. Non-staff physicians were surveyed on problematic issues of training, practical activities and professional competence and importance of these issues ranked: “not important” – 1, “important” – 2, “very important” – 3 with assigning respective points.Results and Discussion. In the military-medical organizations of the central subordination, including the Kirov Military Medical Academy, emergency formations of Service for disaster medicine of the Ministry of Defense of the Russian Federation exist to strengthen (special-purpose) medical groups and medical institutions responsible for admitting casualties from emergency areas. An “average portrait” of a non-staff healthcare professional was as follows: male surgeon of 38.7±1.1 after a clinical internship, with an academic degree and experience in subject domain of 13.4 years. He has served (worked) at the Kirov Military Medical Academy and carried out functional duties on a constant basis, with experience more than two years as a part of physician-nurse or specialized medical care (thoracoabdominal) crew, with sufficient experience in elimination of medical and sanitary consequences of emergencies. At the same time during training and practical activities he faces a number of issues, such as labor relations and quality assessment of performance during elimination of medical and sanitary consequences of emergency situations, unsatisfactory resource and organizational support and also low readiness of all the non-staff members of the crew.Conclusion. Besides problematic issues of labor relations in emergency formations, the factors influencing training, performance and professional competence of non-staff healthcare professionals were defined, i.e. special equipment for medical evacuation (sanitary aviation); unsatisfactory facilities intended for elimination of medical and sanitary consequences of emergencies; medical equipment in emergency areas. As a result of the analysis, all the problematic issues were limited to 3 fundamental internal (hidden) factors influencing training, performance and professional competence of healthcare professionals at the Kirov Military Medical Academy: “Basic resources” (22.05%), “Shortcomings in daily activities” (11.9%), “Readiness for actions” (10.4%). To minimize the specified problematic issues, various (alternative) options are suggested.

Effects of Intratympanic Gentamicin and Intratympanic Glucocorticoids in Ménière’s Disease: A Network Meta-Analysis of Randomized, Controlled Trials

Backgroud: Controversies exist in choosing Intratympanic gentamicin or intratympanic glucocorticoids for Meniere’s disease. Methods: To assess the treatment effects and safety among intratympanic gentamicin, glucocorticoids and placebo therapy in Meniere disease. Electronic searches in PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, MEDLINE, BIOSIS Previews, Embase, CINAHL, ClinicalTrials.gov and the European Union Clinical Trials Register were conducted from inception until March 2019. All randomized controlled trials of intratympanic gentamicin or glucocorticoids for Meniere’s disease, compared with each other or placebo therapy, were considered for this review. Two independent reviewers extracted study data and performed quality assessment using the Cochrane Risk of Bias Tool. Network meta-analysis on vertigo control, function level scales (FLS), hearing outcomes and tinnitus handicap inventory (THI) were calculated with a Bayesian approach using the R package netmeta (version:3.5.2). The quality of primary outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Findings: 10 studies of RCTs (455 patients) met inclusion criteria as described. Pooled results indicated significant advantage of intratympanic gentamicin and glucocorticoids over placebo treatments in vertigo control (gentamicin vs placebo: risk rate, RR, 2.56; 95%CI, 1.18 to 5.54; glucocorticoids vs placebo: RR, 3.02; 95%CI, 1.36 to 6.73). The comparison between gentamicin and glucocorticoids did not show a statistically significant result (RR 0.85; 95%CI, 0.69 to 1.03). FLS also showed improvements in intratympanic therapies over placebo. For PTA and SDS, intratympanic glucocorticoids showed better hearing protective results than gentamicin (change of PTA, MD, -6.48 dB; 95%CI, -11.84 dB to -1.13 dB; change of SDS, MD 7.69%; 95%CI, 0.83% to 14.55%),but no statistical significance in comparisons with placebo. No difference was found in THI among three approaches. Interpretation: Intratympanic gentamicin and glucocorticoids are two effective approaches to control vertigo symptoms for Meniere’s disease. Compared with gentamicin, glucocorticoids showed a potentially better hearing protective role, and intratympanic gentamicin therapy was not associated with high risk of hearing loss than placebo. Funding Statement: The authors have no funding to disclose. Declaration of Interests: The authors have no financial relationships, or conflicts of interest to disclose. Ethics Approval Statement: This research was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions, and the PRISMA extension statement for reporting of systematic reviews incorporating NMA of health care interventions. The pre-specified protocol of this systematic review has been registered in November 2018 (PROSPERO Identifier: CRD42018114389).

Energy and quality performance assessment of emerging and conventional food preservation technologies

The energy performance of emerging food pasteurisation technologies (high pressure processing, microwave volumetric heating, ohmic heating) are evaluated to establish whether they can offer significant reductions in energy consumption and overall carbon emissions, relative to conventional processes, while delivering equivalent microbiological lethality, nutritional and organoleptic quality under commercially-representative processing conditions. Product quality (vitamin C and flavour compounds) data have been collected using established analytical and instrumental methods to benchmark achievable product quality improvements. The results show that for maintaining the raw product quality, the emerging electro-technologies are more energy- and primary resource-efficient, subject to identified operating parameters.

Socio-Economic Indicators for Performance Evaluation and Quality Assessment: Statistical Methods and Applications

Socio-Economic Indicators for Performance Evaluation and Quality Assessment: Statistical Methods and Applications

Assessment of Image Quality and Dosimetric Performance of CT Simulators

BackgroundCT simulator for radiation therapy aims to produce high-quality images for dose calculation and delineation of target and organs at risk in the process of treatment planning. Selection of CT imaging protocols that achieve a desired image quality while minimizing patient dose depends on technical CT parameters and their relationship with image quality and radiation dose. For similar imaging protocols using comparable technical CT parameters, there are also variations in image quality metrics between different CT simulator models. Understanding the relationship and variation is important for selecting appropriate imaging protocol and standardizing QC process. Here, we proposed an automated method to determine the relationship between image quality and radiation dose for various CT technical parameters. Material and MethodThe impact of scan parameters on various aspects of image quality and volumetric CT dose index for a Philips Brilliance Big Bore and a Toshiba Aquilion One CT scanners were determined by using commercial phantom and automated image quality analysis software and cylindrical radiation dose phantom. Results and DiscussionBoth scanners had very similar and satisfactory performance based on the diagnostic acceptance criteria recommended by ACR, International Atomic Energy Agency, and American Association of Physicists in Medicine. However, our results showed a compromise between different image quality components such as low-contrast and spatial resolution with the change of scanning parameters and revealed variations between the two scanners on their image quality performance. Measurement using a generic phantom and analysis by automated software was unbiased and efficient. ConclusionThis method provides information that can be used as a baseline for CT scanner image quality and dosimetric QC for different CT scanner models in a given institution or across sites.

Synthesis, Performance and Emission Quality Assessment of Ecodiesel from Castor Oil in Diesel/Biofuel/Alcohol Triple Blends in a Diesel Engine

This research aims to promote the use of second-generation biofuels based mainly on Castor oil, which is not adequate for food use, and Sunflower oil as a standard reference for recycled oils. They have been applied in the production of Ecodiesel, a biofuel that integrates glycerol as monoglyceride, employing sodium methoxide as homogeneous catalyst and ethanol as solvent, but operating in milder conditions than in the synthesis of conventional biodiesel in order to obtain a kinetic control of the selective transesterification. The behavior of biofuels has been evaluated in a conventional diesel engine, operating as an electricity generator. The contamination degree was also evaluated from the opacity values of the generated smokes. The different biofuels here studied have practically no differences in the behavior with respect to the power generated, although a small increase in the fuel consumption was obtained in some cases. However, with the biofuels employed, a significant reduction, up to 40%, in the emission of pollutants is obtained, mainly with the blend diesel/castor oil/alcohol. Besides, it is found that pure Castor oil can be employed directly as biofuel in triple blends diesel/biofuel/alcohol, exhibiting results that are very close to those obtained using biodiesel or Ecodiesel.

Compliance verification and probabilistic analysis of state-wide power quality monitoring data

This paper introduces the implementation and data analysis associated with a state-wide power quality monitoring and analysis system in China. Corporation specifications on power quality monitors as well as on communication protocols are formulated for data transmission. Big data platform and related technologies are utilized for data storage and computation. Compliance verification analysis and a power quality performance assessment are conducted, and a visualization tool for result presentation is finally presented.

Outcomes after toxic alcohol poisoning: a systematic review protocol

BackgroundToxic alcohols have been implicated in accidental ingestions and intentional exposures. Recognition of toxic alcohol poisoning is challenging. The main treatment modalities include antidotes with alcohol dehydrogenase inhibitors and dialysis. Current guidelines exist for both methanol and ethylene glycol intoxication. However, treatment consensus related to other toxic alcohols is limited. Furthermore, uncertainties regarding thresholds for when to initiate antidotes and dialysis persist. As a consequence, variations exist in the interventions utilized for management of all toxic alcohol poisonings. To our knowledge, no prior systematic review of clinical outcomes of toxic alcohols exists. The objective of this study is to summarize existing evidence on short- and long-term outcomes of patients following toxic alcohol poisonings, including methanol, ethylene glycol, isopropanol, propylene glycol, and diethylene glycol.MethodsA literature search in PubMed, MEDLINE, and EMBASE will be performed based on pre-determined criteria. There will be no restrictions on publication dates or languages. The search will be supplemented by manual scan of bibliographies of eligible studies and gray literature assessment. Observational studies and clinical trials will be included in this review. Once eligible studies have been selected based on pre-specified criteria, two investigators will extract relevant data independently and perform quality assessment per validated tools. A pooled analysis of mortality and short- and long-term secondary outcomes will be performed. Pre-specified subgroup analyses will be performed according to the type of toxic alcohol intoxication, mode of renal replacement therapy, and medical interventions received. A meta-analysis will be performed if three or more studies with similar populations, type of toxic alcohol poisoning, and outcome measures, as well as adequate quality, are identified. This review will be reported according to the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Statement.DiscussionThis systematic review aims to synthesize current evidence in the short- and long-term outcomes of post-toxic alcohol poisoning. The results will enhance the understanding of patient morbidity and mortality after toxic alcohol poisoning, help inform uniform concrete management guideline development, identify gaps in the current state of knowledge, and provide evidence to help implement post-treatment follow-up.Systematic review registrationPROSPERO CRD42018101955

Role of diffusional kurtosis imaging in grading of brain gliomas: a protocol for systematic review and meta-analysis

IntroductionCentral nervous system (CNS) gliomas are the most common primary intra-axial brain tumours and pose variable treatment response according to their grade, therefore, precise staging is mandatory. Histopathological analysis of...

A Systematic Review of the Quality and Utility of Observer-Based Instruments for Assessing Medical Professionalism.

Professionalism, which encompasses behavioral, ethical, and related domains, is a core competency of medical practice. While observer-based instruments to assess medical professionalism are available, information on their psychometric properties and utility is limited. We systematically reviewed the psychometric properties and utility of existing observer-based instruments for assessing professionalism in medical trainees. After selecting eligible studies, we employed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria to score study methodological quality. We identified eligible instruments and performed quality assessment of psychometric properties for each selected instrument. We scored the utility of each instrument based on the ability to distinguish performance levels over time, availability of objective scoring criteria, validity evidence in medical students and residents, and instrument length. Ten instruments from 16 studies met criteria for consideration, with studies having acceptable methodological quality. Psychometric properties were variably assessed. Among 10 instruments, the Education Outcomes Service (EOS) group questionnaire and Professionalism Mini-Evaluation Exercise (P-MEX) possessed the best psychometric properties, with the P-MEX scoring higher on utility than the EOS group questionnaire. We identified 2 instruments with best psychometric properties, with 1 also showing acceptable utility for assessing professionalism in trainees. The P-MEX may be an option for program directors to adopt as an observer-based instrument for formative assessment of medical professionalism. Further studies of the 2 instruments to aggregate additional validity evidence is recommended, particularly in the domain of content validity before they are used in specific cultural settings and in summative assessments.

Abstract 17059: Re-Use of Clinical Trial Data From the NHLBI Data Repository (BioLINCC) for Patient-Level Meta-Analyses of Cardiovascular Outcomes: Challenges and Opportunities

Introduction: An objective of the Meta-AnalyTical Interagency Group (MATIG) is to conduct patient-level meta-analyses of cardiovascular outcomes using data from publicly available repositories. We describe challenges with data re-use from a seminal trial, provide a systematic approach to identify and curate data elements for hypothesis generation, and establish stackable trials to support these analyses. Methods: We used data from the ACCORD trial to assess risk factors and their gender specific differences for the event of hospitalization or death due to heart failure (hdHF), in patients with type 2 diabetes*. We identified the data elements needed to answer the research questions, reviewed the trial protocol to verify definitions, extracted patient-level data, performed quality assessment and statistical analysis. The results showed a gender difference in the effect of intensive vs. standard glucose-lowering therapy on hdHF. To validate the findings, we sought additional trials in BioLINCC to develop a compendium for meta-analysis, and repeated these steps for each trial. Results: Challenges for reusing the ACCORD trial included access to complete patient-level data and metadata. The compendium, developed to evaluate the stackability** of data across trials, identified differences in trial designs, patient populations, study interventions, and data elements that may impact the feasibility and interpretation of meta-analysis. An example of compendium components is shown in Table 1. Conclusion: High-quality metadata facilitate re-use of trial repository data. This compendium standardizes common data elements for gender, racial and age-group specific outcome assessment in major clinical trials. It provides the framework to assess the fitness of trials for patient-level meta-analyses. Efforts are underway by MATIG to expand the compendium to include risk factors and major cardiovascular outcomes across multiple large trials for meta-analysis.

Gene therapy for peripheral arterial disease.

Reason for Withdrawal This protocol was withdrawn from the Cochrane Library from Issue 3, 2015 as no progress had been made towards the review. To view the published versions of this article, please click the ‘Version History' tab. To view the published versions of this article, please click the 'Other versions' tab.

AIRCRAFT ACCIDENT EVALUATION USING QUALITY ASSESSEMENT TOOLS

The case study is focused on the application of principal quality tools in a fourth generation jet fighter to evaluate a maintenance activity in an accident investigation process. The paper assesses aircraft engineers’ performance on checking aircraft tyre inflation pressure before the aircraft’s flight. Process evaluation is organized by the application of fundamental quality tools in order to provide vital information regarding the level of control. The methodology combines the benefits of statistical quality control, root cause determination, and preventive actions, to eliminate maintenance discrepancy in the future. The methodology revealed an approach to generate useful safety metrics from incident reporting data. Furthermore, this study pointed out the significance of participation at all technician levels for the successful implementation of Total Quality Management (TQM). Also, it discusses the value of TQM in aviation and suggests that continuous improvement is still needed. The paper is based on practical work being undertaken in a military squadron and, therefore, is demonstrated to be practical in an aviation environment. This study would encourage aviation personnel to rely on TQM methods for performing quality assessment monitoring and achieving continuous improvement.

Photodynamic therapy for symptomatic oral lichen planus.

Data sourcesMEDLINE/PubMed, Scopus and ISI Web of knowledge, from date of inception up to July 2017. Hand searching of the reference lists of the included studies was performed.Study selectionRandomised (RCT) and non-randomised (n-RCT) controlled trials and controlled and comparative studies were included in patients more than 18 years old diagnosed with symptomatic oral lichen planus, histopathologically confirmed, on the use of photodynamic therapy (PDT) compared with corticosteroids, published in English.Data extraction and synthesisTwo authors independently assessed for inclusion and performed quality assessment of the included studies following the CONSORT statement followed by the overall estimation of the risk of bias. Data extraction was also done independently by two authors. The primary outcome was the effect of PDT on pain and clinical improvement.ResultsFive studies were included: three RCTs and two n-RCTs having between eight and 30 participants. Two studies used diode laser and three used light emitting diode (LED) and the duration of the radiation ranged between 30 seconds to ten minutes. Each study used a unique corticosteroid agent. Three studies used methylene blue, one toluidine blue and one 5-aminolevulinic acid as photosensitiser agent. Follow-up was between one and three months. The authors presented the results as a narrative review.ConclusionsThe limited present evidence suggests that PDT is an effective treatment option for the management of OLP by reduction in pain, burning and decrease in the size of the lesions.

CATHETER ABLATION OF ATRIAL FIBRILLATION IN HEART FAILURE WITH REDUCED EJECTION FRACTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

There is growing evidence that Atrial Fibrillation (AF) ablation may result in improved outcomes in select patients with AF and heart failure with reduced ejection fraction (HFrEF). The objective of this study was to examine the impact of AF ablation on mortality, hospitalization rate, left ventricular ejection fraction (LVEF), and quality of life in patients with HFrEF, compared to contemporary alternative treatment modalities. We conducted a systematic review and meta-analysis of trials that randomized patients with HFrEF (LVEF ≤40%) to an AF ablation arm or an alternative treatment modality (medical rate control, medical rhythm control, AV node ablation with biventricular pacing). Two independent reviewers extracted study data and performed quality assessments using Grading of Recommendations and the Cochrane Risk Bias Tool. We reported changes on the following outcomes: mortality, heart failure (HF) hospitalization rate, LVEF improvement, quality of life as measured by the Minnesota living with heart failure questionnaire (MLHFQ), six-minute walk test (6MWT), procedural efficacy, and complication rate per procedure. 2009 unique records were identified and screened, and 12 were selected for full text review. Ultimately, seven moderate to high quality randomized controlled trials with 856 patients met inclusion criteria. Four studies used medical rate control as a comparator group, while the three remaining studies used medical rhythm control, either medical rate or rhythm control, and AV node ablation with biventricular pacing, respectively. There were significantly reduced rates of HF-related hospitalization (RR 0.58; CI 0.46,0.74; p<0.001) and all-cause mortality (RR 0.51; CI 0.35,0.75; p<0.001) with AF ablation. Additionally, there was improvement in LVEF (mean difference 7.6%; CI 3.9,11.3; p<0.001) with AF ablation compared to alternative therapies. AF ablation was superior in enhancing quality of life based on MLHFQ scores (mean difference -9.8 points; CI -15, -4.5; p<0.001), and there was a greater reduction in BNP levels post-AF ablation compared to other modalities (mean difference -138.1pg/ml; CI -223, -53; p=0.001). There were 50 procedural complications in a total of 555 ablation procedures performed, culminating in a complication rate of 9.0%. The pooled mean procedural efficacy for the first and final ablations were 61.2% and 74.4%, respectively. In selected patients with AF and HFrEF, AF ablation is associated with a substantial improvement in mortality, HF-hospitalization rate, left ventricular function, and quality of life. Consideration should be given for referral of these patients for assessment of AF ablation candidacy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)