Population, Intervention, Comparison, Outcome Research Articles

2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective.

To develop evidence-based consensus recommendations for the optimal timing of hip and knee arthroplasty to improve patient-important outcomes including, but not limited to, pain, function, infection, hospitalization, and death at 1 year for patients with symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis of the hip or knee who have previously attempted nonoperative therapy, and for whom nonoperative therapy was ineffective, and who have chosen to undergo elective hip or knee arthroplasty (collectively referred to as TJA). We developed 13 clinically relevant population, intervention, comparator, outcomes (PICO) questions. After a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the quality of evidence (high, moderate, low, or very low), and evidence tables were created. A Voting Panel, including 13 physicians and patients, discussed the PICO questions until consensus was achieved on the direction (for/against) and strength (strong/conditional) of the recommendations. The panel conditionally recommended against delaying TJA to pursue additional nonoperative treatment including physical therapy, nonsteroidal antiinflammatory drugs, ambulatory aids, and intraarticular injections. It conditionally recommended delaying TJA for nicotine reduction or cessation. The panel conditionally recommended delay for better glycemic control for patients who have diabetes mellitus, although no specific measure or level was identified. There was consensus that obesity by itself was not a reason for delay, but that weight loss should be strongly encouraged, and the increase in operative risk should be discussed. The panel conditionally recommended against delay in patients who have severe deformity or bone loss, or in patients who have a neuropathic joint. Evidence for all recommendations was graded as low or very low quality. This guideline provides evidence-based recommendations regarding the optimal timing of TJA in patients who have symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis for whom nonoperative therapy was ineffective to improve patient-important outcomes, including pain, function, infection, hospitalization, and death at 1 year. We acknowledge that the evidence is of low quality primarily due to indirectness and hope future research will allow for further refinement of the recommendations.

2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective.

To develop evidence-based consensus recommendations for the optimal timing of hip and knee arthroplasty to improve patient-important outcomes including, but not limited to, pain, function, infection, hospitalization, and death at 1 year for patients with symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis of the hip or knee who have previously attempted nonoperative therapy, and for whom nonoperative therapy was ineffective, and who have chosen to undergo elective hip or knee arthroplasty (collectively referred to as TJA). We developed 13 clinically relevant population, intervention, comparator, outcomes (PICO) questions. After a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the quality of evidence (high, moderate, low, or very low), and evidence tables were created. A Voting Panel, including 13 physicians and patients, discussed the PICO questions until consensus was achieved on the direction (for/against) and strength (strong/conditional) of the recommendations. The panel conditionally recommended against delaying TJA to pursue additional nonoperative treatment including physical therapy, nonsteroidal antiinflammatory drugs, ambulatory aids, and intraarticular injections. It conditionally recommended delaying TJA for nicotine reduction or cessation. The panel conditionally recommended delay for better glycemic control for patients who have diabetes mellitus, although no specific measure or level was identified. There was consensus that obesity by itself was not a reason for delay, but that weight loss should be strongly encouraged, and the increase in operative risk should be discussed. The panel conditionally recommended against delay in patients who have severe deformity or bone loss, or in patients who have a neuropathic joint. Evidence for all recommendations was graded as low or very low quality. This guideline provides evidence-based recommendations regarding the optimal timing of TJA in patients who have symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis for whom nonoperative therapy was ineffective to improve patient-important outcomes, including pain, function, infection, hospitalization, and death at 1 year. We acknowledge that the evidence is of low quality primarily due to indirectness and hope future research will allow for further refinement of the recommendations.

Is day-case surgery feasible for laser endoscopic enucleation of the prostate? A systematic review

PurposeLaser endoscopic enucleation of the prostate (EEP) for benign prostatic obstruction has become increasingly prevalent worldwide. Considering the medical cost-savings and concomitantly fewer nosocomial infections, the feasibility of same-day postoperative discharge of patients who have undergone laser EEP in terms of its safety and effectiveness has become a subject matter of growing interest. We aimed to review those studies focussing on day-case surgery (DCS) in patients undergoing laser EEP.MethodsA systematic search was conducted using PubMed-MEDLINE and Web of Science databases until October 2022 with the following search terms: “same day discharge AND laser enucleation of the prostate”, “day-case AND laser enucleation of the prostate”, “same day surgery AND laser enucleation of the prostate” and “one day surgery AND laser enucleation of the prostate” by combining PICO (population, intervention, comparison, outcome) terms. We identified 15 eligible studies.ResultsWhile 14 of the studies focussed on holmium laser EEP, one focused on thulium laser vapoenucleation of the prostate. We observed an improvement in functional parameters in all studies we reviewed, and DCS success and readmission rates ranged between 35.3–100% and 0–17.8%, respectively. The complication rates varied between 0 and 36.7%, most of the complicatons were Clavien-Dindo (CD) I and II. CD ≥ III complications did not significantly differ between same day discharge (SDD) and non-SDD groups in the studies.ConclusionLaser EEP is feasible and promising DCS treatment option delivering improved functional parameters compared to baseline values, and lower perioperative complication and readmission rates in certain patients.

Risk Prediction Models for Peri-Operative Mortality in Patients Undergoing Major Vascular Surgery with Particular Focus on Ruptured Abdominal Aortic Aneurysms: A Scoping Review.

The present scoping review aims to describe and analyze available clinical data on the most commonly reported risk prediction indices in vascular surgery for perioperative mortality, with a particular focus on ruptured abdominal aortic aneurysm (rAAA). A scoping review following the PRISMA Protocols Extension for Scoping Reviews was performed. Available full-text studies published in English in PubMed, Cochrane and EMBASE databases (last queried, 30 March 2023) were systematically reviewed and analyzed. The Population, Intervention, Comparison, Outcome (PICO) framework used to construct the search strings was the following: in patients with aortic pathologies, in particular rAAA (population), undergoing open or endovascular surgery (intervention), what different risk prediction models exist (comparison), and how well do they predict post-operative mortality (outcomes)? The literature search and screening of all relevant abstracts revealed a total of 56 studies in the final qualitative synthesis. The main findings of the scoping review, grouped by the risk score that was investigated in the original studies, were synthetized without performing any formal meta-analysis. A total of nine risk scores for major vascular surgery or elective AAA, and 10 scores focusing on rAAA, were identified. Whilst there were several validation studies suggesting that most risk scores performed adequately in the setting of rAAA, none reached 100% accuracy. The Glasgow aneurysm score, ERAS and Vancouver score risk scores were more frequently included in validation studies and were more often used in secondary studies. Unfortunately, the published literature presents a heterogenicity of results in the validation studies comparing the different risk scores. To date, no risk score has been endorsed by any of the vascular surgery societies. The use of risk scores in any complex surgery can have multiple advantages, especially when dealing with emergent cases, since they can inform perioperative decision making, patient and family discussions, and post hoc case-mix adjustments. Although a variety of different rAAA risk prediction tools have been published to date, none are superior to others based on this review. The heterogeneity of the variables used in the different scores impairs comparative analysis which represents a major limitation to understanding which risk score may be the "best" in contemporary practice. Future developments in artificial intelligence may further assist surgical decision making in predicting post-operative adverse events.

Dietary Interventions in Heart Failure with Preserved Ejection Fraction (HFpEF): a systematic scoping review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Evelyn Trust. Background Pharmacotherapies have improved outcomes for patients with Heart Failure with reduced Ejection Fraction (HFrEF), but less so for patients with HFpEF. Limited treatments results in substantial burden at personal, clinical and economic levels. Diet has been implicated in the pathogenesis and prognosis of HFpEF, as such, dietary manipulation has the potential to be a useful management strategy. Purpose The aim of the scoping review was to establish which nutritional interventions have so far been tested in patients with HFpEF and establish how the dietary manipulation was achieved. The aim of the meta-analysis was to quantify the effects of interventions tested to determine whether there is evidence to support specific dietary recommendations in patients with HFpEF. Methods Key word searches were performed in five bibliographic databases to identify randomised or controlled studies of dietary interventions conducted in HFpEF or mixed heart failure (HF) samples. Study characteristics were summarised according to PICO (population, intervention, comparator, outcome) categories and intervention complexity was assessed. Studies included in the meta-analysis were appraised for bias and the quality of the body of evidence was assessed via the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework. Results Twenty-five different interventions reported across 31 papers were identified. Only ten (40%) were conducted exclusively in HFpEF subjects. Studies employing highly tailored prescribed methods were most common (n=12, 48%). Dietary supplementation (n=10, 40%) and dietary pattern manipulations (n=3, 12%) were less represented. Seventeen studies were considered for meta-analysis; all but one were judged to be at high risk of bias. There was moderate quality evidence that caloric restriction led to clinically meaningful improvements in blood pressure and body weight. There was moderate quality evidence carbohydrate restriction resulted in meaningful reductions in blood pressure. There was very low quality evidence protein supplementation improved blood pressure and body weight and moderate quality evidence for clinically meaningful improvements in function. Conclusions Very few dietary interventions have been tested in HFpEF specifically. Most interventions tested were complex at the patient level, which may not be suitable for the older, multi-morbid patients who typify HFpEF. Results of meta-analyses performed were not of sufficient quality to make generalised conclusions. Some interventions delivered clinically meaningful changes that may be important to patients, therefore, clinicians could draw on these findings to inform personalised care plans and treatment goals.

Explaining factors affecting the participation of nongovernmental organizations (NGOs) in disaster management: A systematic review.

Numerous disasters have occurred over the recent years. Moreover, there has been a considerable rise in the number of victims, injured people, and damages caused by disasters worldwide. Governments cannot meet needs alone due to the complicated nature of crises and accidents. Therefore, nongovernmental organizations (NGOs) and communities must assist the states during disasters. The present study aimed to derive the factors affecting the participation of NGOs in disaster management using a systematic review in 2022. This systematic review was done using ISI, Science Direct, Scopus, PubMed/MEDLINE, ProQuest, and Cochran Library based on the preferred reporting items for systematic reviews (PRISMA) standard from January 1, 2000 to December 31, 2021. The articles were selected based on the search keywords (population, intervention, comparison, outcome (PICO)). After studying the titles, abstracts, and full texts of the articles, the factors affecting the participation of NGOs in disaster management were derived. The final assessment was done on 13 articles. Cooperation and coordination with other organizations, education, communication between NGOs, social empowerment, access to adequate references, and flexibility were the criteria with the highest frequency. As multiple NGOs take part in responding to disasters and performing relief operations, establishing a unified command and supervision system for effective coordination and collaborations among NGOs and other stakeholders is highly suggested. Further research is needed to develop a -measurement tool for assessing the effectiveness of NGOs' activities during disasters.

The sequential approach in eating disorders: A scoping systematic review.

The sequential model has been defined as an intensive, two-stage approach that comprises administering two types of treatment consecutively to improve treatment outcomes in cases of non-optimal or absence of treatment response. A psychiatric population that would potentially benefit from the application of the sequential model is the eating disorders (EDs) population. The current scoping review aimed to explore the emerging literature on the application of sequential treatments in EDs. Using PRISMA and Population intervention comparison outcomes study guidelines, Pubmed and PsycINFO were systematically searched for studies which applied temporally sequential treatments in patients diagnosed with EDs from inception to April 2022 using a combination of keywords. Studies utilising combined or integrated approaches were excluded. A total of 12 studies were selected and reviewed. Studies included Bulimia Nervosa, Binge Eating Disorder (BED), or mixed ED samples with a majority of female patients. No studies on AN samples were identified. The majority of studies contained a Cognitive-Behavioural Therapy module of treatment, were conducted on BED patients, were in outpatient settings, and included a group format in one or more treatment conditions. Studies varied in number of comparison groups and study design. Secondary and sequentially applied treatment modules were consistent with treatment recommendations of clinical guidelines. The available data on sequential treatments in EDs is scarce and exhibits methodological limitations that should be addressed in future studies. Definition of sequential treatments in EDs should be further developed to guide robust clinical research and improve empirical support of sequential treatment for complex ED cases and for non-optimal ED treatment response.

Periodic Medical Examination: A Systematic Review

A periodic medical examination is also referred to as a health screening, an annual health checkup, a preventive health check or a general health checkup. This study aimed to conduct a systematic review in order to identify the techniques, their origin, and conceptual foundation, as well as the instruments or items that were utilised in evaluating views about periodic medical examinations. Three databases were searched using the PRISMA checklist for publication searches from inception to April 2019. Some of the PICO (population, intervention, comparison, outcome) acronym selection criteria that were looked for included: focusing on general health check-ups and involving adults; and is published in peer-reviewed journals from inception to April 2019, with full-text papers available in English. Of the 2,445 articles identified, 340 were examined, and only 15 were finally included in this review. One study used a mixed method and another two qualitative methods, while the rest were quantitative in nature. The Mixed Method Appraisal Tool (MMAT) was used to evaluate the overall quality of each item that was kept. A multi-factorial impact on periodic medical examination is seen in the practice of periodic medical examination. Lack of awareness, self-practice, and compliance with suggestions from healthcare experts might be responsible. As a medical examination is the initial step of a healthcare intervention, action taken at this stage may help in management later, thus maximising the advantages of health check-ups. In order to get the full benefits of periodic health checks, a wide variety of techniques will be required.

P-383 The risks and opportunities of building a family at an advanced parental age: A systematic review

Abstract Study question What empirical evidence exists on the well-being and psycho-social health of couples who become parents at an advanced age and their children? Summary answer Empirical evidence mostly focus on the well-being and psycho-social health of offspring (psychotic disorders, (neuro-)developmental disorders) and only little knowledge exists about their parents’ well-being. What is known already In many societies, people tend to have children at an increasingly advanced age and there is increasing attention in the medical literature towards the consequences of this trend. This systematic review is the first one to critically synthesize the existing empirical literature on the psycho-social health and well-being of parents who had their children from the age 40 onwards and their offspring. Study design, size, duration We conducted a Systematic Review and registered its protocol in Prospero (CRD42022304564). The search strategy was designed based on a Population-Context-Outcome (PCO) structure, an adaptation of the traditional Population-Intervention-Comparison-Outcome (PICO) scheme to fit the specific aims of our study. The search was conducted in six electronic databases (namely Pubmed incl. MEDLINE, Embase, Scopus, PsycInfo, CINAHL and SocINDEX) and was limited to include empirical studies published between 01.01.2000 and 31.12.2021. Participants/materials, setting, methods Studies included are empirical studies – qualitative or quantitative – where subjects were children born to 40+ parents and their parents. Studies either examined the well-being and psycho-social health of parents and/or their children or focused on the social and ethical discussions surrounding risk and benefits of advanced parental age for parents and/or the offspring. Main results and the role of chance 5’403 articles were identified, leaving 2’543 after the removal of duplicates and 98 after the screening of titles and abstracts to be included for a full-text screening. Thereafter another 30 additional articles were excluded because they did not fulfil the inclusion criteria. Simultaneously, citation searching brought up 10 additional articles to include, of which 4 were in line with the defined inclusion criteria, leading to 69 total articles included in the final sample of the present systematic review. The key results concern four aspects relevant for the research question: (1) studies show discrepancies in defining who is a parent of advanced parental age (APA); (2) there is an imbalance in the empirical evidence produced for different participant groups (e.g. mothers, fathers, offspring); (3) aspects of wellbeing (e.g. psychotic disorders, (neuro-)developmental disorders, general well-being) discussed for the specific participant group studied; and (4) a narrative synthesis of the advantages and disadvantages related to psycho-social health and wellbeing for the specific participant group. Limitations, reasons for caution Only empirical studies in English, published between 01.01.2000 and 31.12.2021 were included in this review. Also, the review focuses only on empirical evidence produced in studies where parents were 40 years or older at the time of birth. Wider implications of the findings There are many aspects of the well-being of children born by older parents which remain unknown, thus requiring more research (esp. on psychosocial wellbeing of children) to understand the (non-medico-somatic) risks and benefits of becoming parents at an older age and designing evidence-informed policies. Trial registration number Not applicable

Polymerization Cycle and Occlusal Vertical Dimension of Complete Dentures: Systematic Review and Meta-Analysis

The aim of this systematic review and meta-analysis was to assess the influence of the polymerization cycle on the occlusal vertical dimension (OVD) of complete dentures. This review was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The PICO (Population, Intervention, Comparison, Outcome) question evaluated was “Does the microwave polymerization cycle influence the occlusal vertical dimension of complete dentures when compared to conventional water bath polymerization?”. The literature search was conducted in the PubMed/MEDLINE, Web of Science, and Scopus databases for relevant articles published up to March 2023. In vitro studies involving OVD measurement from complete dentures polymerized with different polymerization methods were included. The risk of bias was analyzed using the Critical Appraisal Checklist for Quasi-Experimental Studies (non-randomized experimental studies) from the Joanna Briggs Institute (JBI). The meta-analysis was based on the inverse variance (IV) methods with mean difference (MD) for OVD evaluation between techniques. Five articles were included in the qualitative and quantitative analysis. A total of 222 complete dentures were evaluated. In the polymerization cycles, microwave cycles with 90 W to 810 W between 3-5 minutes and conventional water bath cycles between 9-12 hours (long cycles) and 3-4 hours (short cycles) were used. In a quantitative analysis of polymerization methods, no statistically significant difference was found between water bath and microwave techniques [p = 0.99; MD: -0.00; CI = -0,26-0,26]. The current meta-analysis can be concluded that both techniques can be used to polymerization of complete dentures without significant clinical changes in the OVD.

Characterization of controlled trials on probiotic supplementation to dairy calves: A scoping review

The objective of this scoping review was to identify, describe, and characterize the literature on probiotic supplementation in dairy calves. Eligible studies were nonrandomized, quasi-randomized and randomized controlled trials in English, Spanish, or Portuguese that evaluated the effect of probiotic supplementation on growth and health of dairy calves. The search strategies were based on a modification of the PICO (Population, Intervention, Comparator, Outcome) framework and used synonyms and words related to "dairy calves" (population), "probiotics" (intervention), and "growth and health measurements" (outcomes). No restrictions for publication year or language were applied. Searches were conducted in Biosis, CAB Abstracts, Medline, Scopus, and the Dissertations and Theses Database. In total, the search identified 4,467 records, of which 103 studies (110 controlled trials) met the inclusion criteria. The studies were published between 1980 and 2021 and originated from 28 countries. Trials were randomized (80.0%), nonrandomized (16.4%), and quasi-randomized (3.6%), ranging in sample size from 5 to 1,801 dairy calves (mode = 24; average = 64). Enrolled calves were frequently Holstein (74.5%), males (43.6%), and younger than 15 d at the beginning of probiotic supplementation (71.8%). Often, trials were conducted in research facilities (47.3%). Trials evaluated probiotics with single or multiple species of the same genus: Lactobacillus (26.4%), Saccharomyces (15.4%), Bacillus (10.0%), Enterococcus (3.6%), or multiple species of various genera (31.8%). Eight trials did not report the probiotic species used. Lactobacillus acidophilus and Enterococcus faecium were the species most supplemented to calves. The duration of probiotic supplementation ranged from 1 to 462 d (mode = 56; average = 50). In trials with a constant dose, it ranged from 4.0 × 106 to 3.7 × 1011 cfu/calf per day. Most probiotics were administered mixed solely into feed (88.5%; whole milk, milk replacer, starter, or total mixed ration) and less frequently orally as a drench or oral paste (7.9%). Most trials evaluated weight gain (88.2%) as a growth indicator and fecal consistency score (64.5%) as a health indicator. Our scoping review summarizes the breadth of controlled trials evaluating probiotic supplementation in dairy calves. Differences in intervention design (mode of probiotic administration, dose, and duration of probiotic supplementation) and outcomes evaluation (type and methods) justify future efforts toward standardized guidelines in clinical trials.

HPR44 Evolving PICO Characteristics in the Early Oncology Treatment Lifecycle: Differences from Trials to Treatment Guidelines

Under the new European health technology assessment (HTA) legislation, European countries will largely need to agree on the PICO (population, intervention, comparator, outcome) elements in HTA assessments. Additionally, cross-stakeholder alignment grows in importance due to our ever-evolving healthcare landscape, such as smaller populations and increasingly advanced products. The PICO therefore becomes more subject to variation among decision-makers. This study assessed how the PICO elements evolve over the early treatment lifecycle of oncology drugs and align between stakeholders on a global level.

HTA57 Quantifying Heterogeneity within and between Treatment Guidelines for Type 2 Diabetes: Potential Implications for EU-Wide Health Technology Assessment

By 2030, the European Union (EU) will require manufacturers to submit a Joint Clinical Assessment (JCA) dossier for new therapies, aiming to harmonize health technology assessment across the EU. This will require all 27 member states to define relevant PICO (population, intervention, comparator, outcome) requirements. In type 2 diabetes (T2D), step-wise intensification is often required to maintain glycemic control, with recommendations at each therapy line creating branched treatment pathways. This review quantifies the heterogeneity in managing T2D in EU guidelines and the implications for the JCA process.

Family Centered Empowerment Model Efektif Meningkatkan Mekanisme Koping Orang Tua dalam Merawat Anak Penyakit Kronis

This study aims to find evidence of the clinical efficacy of the Family Centered Empowerment Model (FCEM) care concept to improve parents' coping mechanisms in caring for children with chronic illnesses. The method used is a systematic review based on guidelines from Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA), which includes e-resources from ProQuest, Science Direct, Scopus, PubMed, and EBSCOhost from 2012 – 2022. Articles included in the systematic review This was made based on the Population Intervention Comparison Outcome Study (PICOS) with a design for (P) Parents/caregivers of children with chronic disease, (I) Concept of Family-Centered Empowerment Model (FCEM) care, (C) There is no comparison intervention, and ( O) Improving coping mechanisms for caring for children with chronic illnesses. The results showed that from 552 articles filtered into eight themes, data found that FCEM can improve parents' coping mechanisms in caring for children with chronic illnesses. In conclusion, FCEM care effectively improves parents' coping mechanisms for children with chronic diseases.
 
 Keywords: Family-Centered Empowerment Model, Chronic Disease, Coping Mechanism

Assessing Equity of Access to Proton Beam Therapy: A Literature Review

Proton beam therapy (PBT) is one of the most advanced radiotherapy technologies, with growing evidence to support its use in specific clinical scenarios and exponential growth of demand and capacity worldwide over the past few decades. However, geographical inequalities persist in the distribution of PBT centres, which translate into variations in access and use of this technology. The aim of this work was to look at the factors that contribute to these inequalities, to help raise awareness among stakeholders, governments and policy makers. A literature search was conducted using the Population, Intervention, Comparison, Outcomes (PICO) criteria. The same search strategy was run in Embase and Medline and identified 242 records, which were screened for manual review. Of these, 24 were deemed relevant and were included in this analysis. Most of the 24 publications included in this review originated from the USA (22/24) and involved paediatric patients, teenagers and young adults (61% for children and/or teenagers and young adults versus 39% for adults). The most reported indicator of disparity was socioeconomic status (16/24), followed by geographical location (13/24). All the studies evaluated in this review showed disparities in the access to PBT. As paediatric patients make up a significant proportion of the PBT-eligible patients, equity of access to PBT also raises ethical considerations. Therefore, further research is needed into the equity of access to PBT to reduce the care gap.

Guidelines on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes mellitus (IWGDF 2023).

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This is the first guideline on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes published by the IWGDF. We followed the GRADE Methodology to devise clinical questions in the PACO (Population, Assessment, Comparison, Outcome) and PICO (Population, Intervention, Comparison, Outcome) format, conducted a systematic review of the medical literature, and developed recommendations with the rationale. The recommendations are based on the evidence from our systematic review, expert opinion when evidence was not available, and also taking into account weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to an intervention. We here present the 2023 Guidelines on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes mellitus and also suggest key future topics of research.

Guidelines for the Neurocritical Care Management of Aneurysmal Subarachnoid Hemorrhage.

The neurointensive care management of patients with aneurysmal subarachnoid hemorrhage (aSAH) is one of the most critical components contributing to short-term and long-term patient outcomes. Previous recommendations for the medical management of aSAH comprehensively summarized the evidence based on consensus conference held in 2011. In this report, we provide updated recommendations based on appraisal of the literature using the Grading of Recommendations Assessment, Development, and Evaluation methodology. The Population/Intervention/Comparator/Outcome (PICO) questions relevant to the medical management of aSAH were prioritized by consensus from the panel members. The panel used a custom-designed survey instrument to prioritize clinically relevant outcomes specific to each PICO question. To be included, the study design qualifying criteria were as follows: prospective randomized controlled trials (RCTs), prospective or retrospective observational studies, case-control studies, case series with a sample larger than 20 patients, meta-analyses, restricted to human study participants. Panel members first screened titles and abstracts, and subsequently full text review of selected reports. Data were abstracted in duplicate from reports meeting inclusion criteria. Panelists used the Grading of Recommendations Assessment, Development, and Evaluation Risk of Bias tool for assessment of RCTs and the "Risk of Bias In Nonrandomized Studies - of Interventions" tool for assessment of observational studies. The summary of the evidence for each PICO was presented to the full panel, and then the panel voted on the recommendations. The initial search retrieved 15,107 unique publications, and 74 were included for data abstraction. Several RCTs were conducted to test pharmacological interventions, and we found that the quality of evidence for nonpharmacological questions was consistently poor. Five PICO questions were supported by strong recommendations, one PICO question was supported by conditional recommendations, and six PICO questions did not have sufficient evidence to provide a recommendation. These guidelines provide recommendations for or against interventions proven to be effective, ineffective, or harmful in the medical management of patients with aSAH based on a rigorous review of the available literature. They also serve to highlight gaps in knowledge that should guide future research priorities. Despite improvements in the outcomes of patients with aSAH over time, many important clinical questions remain unanswered.

Evaluating the Effectiveness of Return-to-Work Interventions for Individuals with Work-Related Mental Health Conditions: A Systematic Review and Meta-Analysis.

The workplace is a vital setting to support positive mental health. Mental health conditions in the workforce contribute to decreased work engagement and participation. There is existing literature on return-to-work (RTW) interventions for individuals with work-related mental health conditions, however, there lacks consensus on their effectiveness. Therefore, the primary aim of this systematic review was to synthesize the literature and evaluate the effectiveness of return-to-work interventions on return-to-work rates, quality of life, and psychological wellbeing for individuals with work-related mental health conditions. Selected articles were organized and identified using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and the Population/Intervention/Comparison/Outcome (PICO) framework. Quality assessment of the included studies was completed using the Critical Appraisal Skills Programme randomized controlled trials checklist and the Joanna Briggs Institute quasi-experimental studies checklist. A random effects meta-analysis model was performed using DerSimonian-Laird weighting to calculate standard mean difference and risk ratios to assess the impact of RTW interventions on return-to-work rates, absenteeism, stress symptoms, depression symptoms, and quality of life. A total of 28 out of 26,153 articles met the inclusion criteria. Diagnoses for participants in the studies ranged from work-related stress to work-related PTSD following exposure to a psychologically traumatizing event in the workplace. No significant differences were found for the meta-analyses examining return-to-work rates, absenteeism, depression, stress, and quality of life. The most effective interventions were found to be a multi-domain intervention (67% of participants RTW full time) and a health-focused intervention (85% RTW rate). Future research may consider establishing effective interventions to develop programs or policies supporting the RTW of employees and promote mental well-being among employees experiencing work-related mental health conditions.

How to apply evidence-based practice to the use of artificial intelligence in radiology (EBRAI) using the data algorithm training output (DATO) method.

As the number of radiology artificial intelligence (AI) papers increases, there are new challenges for reviewing the AI literature as well as differences to be aware of, for those familiar with the clinical radiology literature. We aim to introduce a tool to aid in this process. In evidence-based practise (EBP), you must Ask, Search, Appraise, Apply and Evaluate to come to an evidence-based decision. The bottom-up evidence-based radiology (EBR) method allows for a systematic way of choosing the correct radiological investigation or treatment. Just as the population intervention comparison outcome (PICO) method is an established means of asking an answerable question; herein, we introduce the data algorithm training output (DATO) method to complement PICO by considering Data, Algorithm, Training and Output in the use of AI to answer the question. We illustrate the DATO method with a worked example concerning bone age assessment from skeletal radiographs. After a systematic search, 17 bone age estimation papers (5 of which externally validated their results) were appraised. The paper with the best DATO metrics found that an ensemble model combining uncorrelated, high performing simple models should achieve error rates comparable to human performance. Considering DATO in the application of EBR to AI is a simple systematic approach to this potentially daunting subject. The growth of AI in radiology means that radiologists and related professionals now need to be able to review not only clinical radiological literature but also research using AI methods. Considering Data, Algorithm, Training and Output in the application of EBR to AI is a simple systematic approach to this potentially daunting subject.

Suicide prevention program (SPP) in South Asian Countries: A protocol for systematic review

Introduction: Every year, over 703,000 individuals lose their life by suicide and many individuals attempt suicide. Suicide occurs in all age groups and is the fourth major cause of death among 15–29-year-olds globally in 2019. A suicide prevention program (SPP) is a capacity-building program that helps gatekeepers to identify the risk of suicide. The objective of the review is to determine the effectiveness of SPP on the improvement of knowledge, attitude, and gatekeeper behaviour among gatekeepers in South Asian countries. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PICO (Population, Intervention, Comparison, Outcome) format will be followed in this review. This review will include all interventional studies that provided a suicide prevention program to the gatekeepers as an intervention. The full-text articles will be included from the following databases, Scopus, PubMed (MEDLINE), Cochrane, PsycINFO, Web of Science, and CINAHL, published in peer-reviewed, indexed, and English language journals from the date of inception to 2022. A grey literature search and hand-search of reference lists of the included studies will also be done. A search strategy will be developed using keywords and MeSH terms for each database. Cochrane ROB-2 tool, JBI Critical Appraisal Checklist, Critical Appraisal Skills Program (CASP), and Mixed Methods Appraisal Tool (MMAT) will be used to evaluate the quality of individual studies. Analysis of the data will be done using narrative synthesis. Conclusions: This review will provide information on knowledge, attitude, and gatekeeper behaviour toward suicide prevention in college students and will be helpful for the prevention of suicide. Therefore, the authors plan to publish the review outcome through a peer-reviewed journal. Registration: The review is registered in PROSPERO (CRD42023387020).