Original Research Reports Research Articles

Comparison of Instructions to Authors and Reporting of Ethics Components in Selected African Biomedical Journals: 2008 and 2017.

Journal editors instruct authors to describe human participant protections in original research reports. However, little is known about African biomedical journal authors' adherence to such journal editors' instructions. This study investigated changes in editors' instructions to authors and authors' reporting of research ethics information in selected African biomedical journals between 2008 and 2017. Twelve selected journal websites and online articles were reviewed in Eastern, Southern, and Western African [ESWA] countries. A pre-tested schema and a checklist were used to collect data from journal websites and articles published in 2008 and 2017, and the data were analysed using descriptive and inferential statistics. Half of the journals requested prospective authors to disclose ethics approval and related issues in their manuscripts between 2008 and 2017. There was a significant increase in instructions to authors regarding information on the protection of research participants within this period; more authors complied with these requirements in 2017 than in 2007.

Social impacts experienced by women with HIV and infertility in sub-Saharan Africa: A scoping review.

In Sub-Saharan Africa (SSA), HIV (Human Immunodeficiency Virus) prevalence among reproductive-aged women remains high, and infertility among these women is common. The social consequences for these women are yet to be explored. This scoping review summarises the social consequences of living with HIV and infertility for SSA women. This scoping review of published peer-reviewed literature focused on the intersection of infertility and living with HIV among women in SSA. We followed the PRISMA guidelines for scoping reviews. We searched PubMed, Web of Science and SCOPUS and included all original research reports which met the inclusion criteria; women in Sub-Saharan Africa, living with HIV, and infertility. Fourteen papers met the inclusion criteria. Both HIV diagnosis and infertility were reported as stigmatising experiences for women who desire to have children. The stigma of infertility had a greater negative impact on women than that of an HIV diagnosis. Familial, community support, and medical intervention were perceived vital to ensure women feel de-stigmatised and in control of their future, even without children. This is the first review demonstrating the social consequences of HIV and infertility on SSA women. Further research and interventions are needed to reduce the social consequences of infertility within SSA.

Faculty Development Needs and Approaches to Support Course Examination Development in Nursing Programs: An Integrative Review.

Many nursing faculty lack formal training in item writing and test construction. This integrative review synthesizes the evidence to gain a comprehensive understanding of the developmental needs and interventions employed to help nursing faculty gain skills to develop course examinations. Original research and non-research reports published since 2012 were included. Independent quality appraisals were completed based on the Johns Hopkins Nursing Evidence-based Practice Model. Data were analyzed using the constant comparison method. Nineteen reports met inclusion criteria. Themes related to test development skills were standards support practice, educational preparation, evolving technologies, and writing for clarity. Themes related to faculty development were continuous improvement, professional development plans, peer and expert collaboration, and up-to-date resources. Nursing programs need to establish methods to ensure faculty use best practices and are competent in test development. Nursing needs future research to understand optimal faculty development approaches.

Regional hospice and palliative care networks worldwide: scoping review

BackgroundRegional hospice and palliative care networks (RHPCNs) are increasingly being established to improve integrative care for patients with life-limiting illnesses. This scoping review aimed at identifying and synthesising international literature...

Private practice dietetics: A scoping review of the literature.

Private practice is one of the most rapidly growing, but under-researched employment sectors for graduate dietitians in Australia, limiting evidence-based workforce development. This scoping review examines existing international literature to gain an understanding of the current private practice workforce size, distribution, demography and workforce development considerations, including competencies, supply and demand, remuneration and professional development activities. The databases MEDLINE, EMBASE, CINAHL, EMCARE, PsycInfo (Ovid) and grey literature were systematically searched in August 2023 using key search terms to identify studies for inclusion. Articles were included if they related to private practice dietetics and described an aspect of workforce. Original research, government and organisational reports,statements of practice and websites providing governmental or organisational statistics were included. A directed content analysis and qualitative constant comparison technique were used to deductively map intelligence sources against a workforce development framework. A gap analysis was also conducted to provide a focus for future workforce development research. A total of 72 peer-reviewed and grey literature sources were included, with 65% of the studies being Australian-based publications. Private practice dietetics research interest has increased in the last decade. Despite a breadth of published sources, this review found little published data on workforce size, distribution, demography, supply, demand, continued professional development and remuneration, indicating a significant gap in the evidence base. Existing literature focuses on workforce challenges and barriers, the work of private practice dietitians, with limited exploration of competency requirements for graduate private practitioners. The literature on the private practice dietetics workforce is lacking worldwide, which constrains evidenced-based workforce development initiatives. Workforce development research across all workforce aspects is warranted to address current evidence gaps.

Abstract P365: Systematic Review of Self-Management Interventions for Black Women With Cardiovascular Risk Factors

Background: Cardiovascular disease (CVD) is the leading cause of death among Black women, and when compared to their non-Hispanic White counterparts, they are about 50% more likely to have uncontrolled high blood pressure (BP). The disproportionate burden of CVD in Black women highlights the need for CVD prevention programs in this population. The present systematic literature review assessed the efficacy of self-management interventions for Black women with CVD risk factors. Hypothesis: Self-management interventions that target more than one health practice, when administered to Black women with CVD risk factors, will decrease CVD risk and improve clinical outcomes. Methods: Searches were run on PubMed, Cochrane, CINAHL, and PsycINFO databases based on the following inclusion criteria: papers written from September 22, 2018; English language; US studies only; original research reports; prospective clinical trials; cardiovascular health promotion/self-management interventions that target at least two health practices (individual or group, in-person or remotely delivered, or person-person synchronous); primary prevention; comorbid conditions without a cardiovascular event; at least one patient level outcome (self-reported or biological); Black women at least 18 years of age only. Data extraction included participant demographics; intervention characteristics; self-management/health behavior domains; research design; and study outcomes. Results: Of the 1041 abstracts screened (262 duplicates removed), 87 full-text articles were screened, and 11 papers from 10 unique trials (N= 1,635) were chosen for inclusion. Intervention durations ranged from 5-weeks to 12-months, with a frequency of intervention dose ranging from daily contact to bi-weekly meetings. Of the 10 unique trials, the majority targeted physical activity (n=8), nutrition (n=5), weight loss (n=3), health knowledge (n=2), and BP control (n=2). Interventions were mostly offered in groups (n=9), and some included individual components (n=2). Nine of the eleven papers reported statistically significant improvements in CVD risk factors including weight loss (n=6), physical activity (n=2), BP control (n=2), waist circumference (n=1), and depression (n=1). Few papers (N=1) addressed mental health, and none addressed other social determinants of health. Conclusions: Evidence to date indicates that self-management interventions are not only feasible but also appear to improve CVD risk factors and clinical outcomes in Black women with CVD risk. Future research should assess best practices for the implementation of culturally informed CVD risk prevention programs in underserved populations. Further intervention development should focus on the influence that social determinants of health such as discrimination, stress, and mental health may have on self-management and CVD risk in this population.

Telepharmacy Implementation to Support Pharmaceutical Care Services during the COVID-19 Pandemic: A Scoping Review.

Telepharmacy was effectively applied for remote pharmaceutical care during the COVID-19 pandemic. To determine the implementation of telepharmacy services to support pharmacists in providing pharmaceutical care during the pandemic. Seven electronic databases were searched from inception to June 2021: PubMed, Ovid MEDLINE, Excerpta Medica database (Embase), Web of Science, Proquest, Scopus, and the Cochrane Database of Systematic Reviews. The review followed PRISMA guidelines and was registered with the PROSPERO registry of systematic reviews. Reports of original research investigating the implementation of telepharmacy during the COVID-19 pandemic were retrieved. Researchers screened the title and abstract of each article, and then evaluated the full text of eligible articles to identify studies that met the inclusion criteria. Pharmacists' responsibilities and actions were classified in relation to the International Pharmaceutical Federation guideline for managing the COVID-19 pandemic. Extracted data included study characteristics, pharmacists' interventions delivered through a telepharmacy system, and the benefits of telepharmacy implementation. The database search yielded 1400 articles. After removal of duplicates and articles not meeting the specific inclusion criteria (n = 1381), a total of 19 relevant original research articles were reviewed. According to these studies, telepharmacy was used to perform remote medication review and optimization, assess medication adherence, dispense and deliver medications, educate and counsel patients, promote disease prevention, collaborate with health care providers, and monitor treatment outcomes. This study highlighted the use of telepharmacy services to support pharmacists' activities during the COVID-19 pandemic. Randomized clinical trials are needed to investigate the long-term efficacy and cost-effectiveness of telepharmacy services.

Impact of Peroxisome Proliferator-Activated Receptor Agonists on Myosteatosis in the Context of Metabolic Dysfunction-Associated Steatotic Liver Disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD), and more specifically steatohepatitis may be associated with fat infiltration of skeletal muscles which is known as myosteatosis. Pan-peroxisome proliferator-activated receptor (PPAR) agonists have been shown to promote metabolic dysfunction-associated steatohepatitis (MASH) remission. However, the effect of PPAR agonists on myosteatosis remains to be determined. The aim of this review is to evaluate the effect that PPAR agonists alone or in combination, have on myosteatosis in the context of MASLD. Original research reports concerning the impact of PPAR agonists on muscle fat in MASLD were screened from PUBMED and EMBASE databases following the PRISMA methodology. Eleven original manuscripts were included in this review. Two preclinical studies assessed the impact of the PPARα agonist on fat content in the quadriceps muscle and the liver by extracting triglycerides in rats fed a high-fat diet and in insulin-resistant mice. Both models showed muscle and liver triglyceride content reduction using WY14643. Fenofibrate had no significant impact on soleus intramyocellular lipids or liver fat content in insulin-resistant subjects based on proton magnetic resonance spectroscopy. Treatment with PPARδ agonists increased the expression of genes involved in fatty acid oxidation in two studies on muscle cell culture. PPARγ agonists were investigated in two preclinical studies and one clinical study using spectroscopy and computed tomography respectively. In the first preclinical study in Zucker diabetic fatty rats, rosiglitazone reduced muscle lipids and hepatic steatosis. In a second preclinical study using the same animal model, pioglitazone reduced tibialis anterior intramyocellular lipids. In contrast, computed tomography analyses in patients with type 2 diabetes revealed a surface area increase of low-density muscles (suggesting an increase in muscle fat content) after a one-year treatment with rosiglitazone. Varying combinations of PPAR agonists (cevoglitazar, fenofibrate/pioglitazone and muraglitazar) were evaluated in two preclinical studies and one clinical study. In rats, these treatments showed variable results for muscle and liver depending on the combinations studied. In type 2 diabetic patients, treatment with muraglitazar (a PPARα/γ agonist) reduced the intramyocellular lipid content of tibialis anterior as well as liver fat content following spectroscopy assessment. The combination of different PPAR agonists could have a positive impact on reducing myosteatosis, in addition to their effect on the liver. Some discrepancies could be explained by the different techniques used to assess muscle lipid content, the muscles assessed and the possible adipogenic effect of PPARγ agonists. Further clinical research is needed to fully assess the efficacy of these treatments on both MASLD progression and associated myosteatosis.

Acknowledgment to Reviewers

MedLiber of Regenerative Medicine successfully launched in 2023. Between September 15, 2023, and June 30, 2024, we published a total of 9 articles, including original research, reviews, and case reports. We extend our heartfelt gratitude to our reviewers for their valuable feedback and comments.

Differences in the Development of Language and Social Independence in Children with Speech Delay and Sensorineural Hearing Loss based on Age of Early Intervention and Duration of Auditory Verbal Therapy

Highlights :1. This original research report provides information to the public about the importance of early detection, the use of hearing technology and the advantages of Auditory Verbal Therapy in delayed speech children with sensorineural hearing loss, where this therapy makes it easier for children to achieve language development on par with other children their age.2. Auditory Verbal Therapy as part of the process of learning to speak and hear deaf children is still quite new and unfamiliar among the community, so based on this study it can be seen that AVT has a positive impact on child development. AbstractSpeech delay with sensorineural hearing loss is a delay in a child's speech process compared to normal children of the same age, mostly caused by hearing loss. It can give may affect the development of language and social independence of children. Auditory Verbal Therapy (AVT) as early intervention maximizes the use of residual hearing with hearing aids or a cochlear implant for sound detection. Therapy that is routinely and periodically conducted may affect language development to support children's independence. This study aims to analyze differences in the development of language and social independence of children with delayed speech and sensorineural hearing loss based on the age of early intervention and duration of auditory verbal therapy. This study used an analytical-observational study design with a cross-sectional approach. The samples were obtained by total sampling from all children who underwent routine AVT once a week at the Aurica Surabaya Foundation, with a total sample of 29 children. The instrument used Developmental Pre-Screening Questionnaire. Method of data analysis was bivariate analysis with the Chi-Square (p-value) proportions different test using SPSS . The results regarding language development based on the age of early intervention and the duration of AVT obtained p = value 0.013 (p < 0.05) and p = 0.019 (p < 0.05), while the results of the chi-square test analysis of the development of social independence based on the age of early intervention and duration of AVT obtained p value = 0.229 (p > 0.05) and p-value = 0.111 (p > 0.05). In conclusion, there was a difference between language development based on the age of early intervention and the duration of AVT, but no difference was found between the development of social independence based on the age of early intervention and the duration of AVT.

Lymphocyte Cell Expressions and SARS-COV-2 Antibody Titers in Healthy Donors’ Blood at an Indonesian Blood Transfusion Center (UTD PMI Surabaya)

Highlights: 1. There was no relationship between total lymphocyte count and antibody titers against SARS-CoV-2.2. This original research report offers information on the several blood test result after getting COVID-19vaccines and provides data that the public may use as scientific evidence to the further research. Abstract SARS-CoV-2 is a virus that infects the respiratory tract and attacks the respiratory mucosa and epithelial cells.Lymphocytes are a subset of agranulocyte leukocytes that have a role in the immune response to pathogenicmicroorganisms' attacks. The number of lymphocytes will increase if a virus causes an infection. An antibody is aprotective protein produced by the body's immune system in response to the presence of an antigen. Antibodies bind and inactivate foreign substances so that the replication of pathogens can be prevented and destroyed. This mechanism can be expressed through the total number of lymphocyte cells. The objective of this study was to define the relationship between the number of lymphocytes and antibody titers against SARS-CoV-2. The type of research used was analytic observational with a cross-sectional approach using quantitative analysis methods and a purposive sampling method for sampling. The samples used were 30 donor blood samples from UTD PMI Surabaya. This research was conducted in May 2022 at the Hematology Laboratory, Department of Medical Laboratory Technology, Poltekkes, Ministry of Health, Surabaya, to examine the number of lymphocyte cells using the flowcytometry method and the Immunoserology Laboratory of the Surabaya Health Laboratory Center for antibody titer examination using the ELISA (Enzyme-Linked Immuno Sorbent Assay) method. The study showed an average lymphocyte level of 2.2633 x 103/µl and an average antibody titer value expressed in OD of 0.2197. Data analysis using Spearman's rank correlation statistical test revealed p = 0.262 0.005. It showed no relationship between total lymphocyte count and antibody titers against SARS-CoV-2

Young children and music: Views from varied perspectives

This issue is comprised of three original research reports as well as one theoretical article. Article topics include the relationship between vocal pitch matching and academic performance, empathic creativity during child–adult play episodes, encouraging vocal play among generalist teachers’ engagement with children, and redefining a teacher education approach to emphasize musical process over product and increased teacher reflection. The editorial highlights the value of inter- and transdisciplinary work pertaining to young children and music, and encourages authors from a broad array of professions to submit their work to the journal.

Prevalence and Antimicrobial-Resistant Features of Shigella Species in East Africa from 2015-2022: A Systematic Review and Meta-Analysis.

Shigellosis is the most common cause of epidemic dysentery found worldwide, particularly in developing countries, where it causes infant diarrhea and mortality. The prevalence of Shigella species resistant to commonly used antimicrobial drugs has steadily increased. The purpose of this review is to describe the prevalence and antimicrobial resistance (AMR) characteristics of Shigella species in East Africa between 2015 and 2022. Studies were identified using a computerized search of Medline/PubMed, Google Scholar, and Web of Science databases, with a detailed search strategy and cross-checking of reference lists for studies published between 2015 and 2022. Articles presenting data on prevalence and AMR, accessibility of the full-length article, and publication dates between 2015 and 2022 were the eligibility criteria for inclusion in the review. Original research reports written in English were considered. The heterogeneities of the studies were examined, and a meta-analysis was performed to estimate the pooled prevalence and AMR using a random effects model. The pooled prevalence of Shigella species in East Africa was 6.2% (95% CI -0.20-12.60), according to an analysis of 22 studies. Shigella species prevalence was 4.0% in Ethiopia, 14.6% in Kenya, 0.7% in Sudan, 5.2% in South Sudan, and 20.6% in Somalia. The association of Shigella infection significantly varied among the countries (p = 0.01). Among the antibiotics tested, most Shigella isolates were susceptible to ciprofloxacin, norfloxacin, nalidixic acid, and ceftriaxone. Despite the fact that the reports varied in study sites and time, Shigella species were resistant to tetracycline, ampicillin, amoxicillin, chloramphenicol, and co-trimoxazole. The pooled estimate indicates high burden of Shigella infection in East Africa, as well as a high proportion of drug resistance pattern to tetracycline, ampicillin, chloramphenicol, and amoxicillin. Therefore, initiating and scale-up of performing drug susceptibility test for each shigellosis case need to be considered and strengthened.

Management of Oral Candidiasis in People Living With HIV

Background: The incidence of HIV/AIDS has increased significantly over the last decade, both globally and in Indonesia. In this situation, the patient has severe impairment in their cellular immunity, making them susceptible to various kinds of opportunistic infections. Oral candidiasis is the most common oral lesion related to HIV/AIDS. Oral candidiasis in people living with HIV (PLHIV) needs to be treated because it can evolve into a systemic infection through the lymphatic system that attacks vital organs. Objective: To know the management of oral candidiasis in PLHIV. Methods: A web-based search was performed via the PubMed, ScienceDirect, and Google Scholar database. Original research and case reports (2018–2023) published in the English language were included to appraise various topics. The number of articles included in the review amounted to 9 articles. Literature Study: Management of patients with oral candidiasis in PLHIV by eliminating predisposing factors, improving oral hygiene, and administering antifungal drugs such as topical agents and/or systemic triazoles. Discussion: In cases of oral candidiasis associated with immunodeficient individuals, topical agents may not be effective in such cases, hence triazole systemic administration is necessary. Oral candidiasis in PLHIV is less responsive to polyene antifungal drugs (nystatin and amphotericin B). Conclusions: Management of oral candidiasis in PLHIV sufferers are eliminating predisposing factors, Improving oral hygiene and stopping habits that can worsen the patient's oral hygiene, administration fluconazole antifungal drugs, giving chlorhexidine gluconate mouthwash, and antiretroviral (ARV) treatment.

Pediatric pulmonology year in review 2022: Sleep medicine.

Pediatric pulmonology publishes original research, review articles, and case reports on a wide variety of pediatric respiratory disorders. In this article, we summarized the past year's publications in sleep medicine and reviewed selected literature from other journals in this field. We focused on original research articles exploring aspects of sleep-disordered breathing in patients with underlying conditions such as asthma, neuromuscular disorders, and Down syndrome. We also explored sleep-disordered breathing risk factors, monitoring, diagnosis, and treatment; and included recent recommendations for drug-induced sleep endoscopy and ways to monitor and improve PAP adherence remotely.

COVID-19 Disease Severity and Blood Test Results in Unvaccinated and Vaccinated Patients at Bhayangkara Hospital, Denpasar, Indonesia

Highlights: This original research report on the differences in disease severity and blood test results between unvaccinated and vaccinated COVID-19 patients is quite novel, as the COVID-19 pandemic was still happening when this study was carried out. This original research report offers information on the advantages of the COVID-19 vaccines and provides data that the public may use as scientific evidence to counter hoaxes. Abstract The COVID-19 pandemic caused by SARS-CoV-2 is an unprecedented event in human history. Vaccines are a safe, long-term solution for addressing the COVID-19 pandemic. This study aimed to investigate the differences in disease severity and blood test results between unvaccinated and vaccinated COVID-19 patients. This study used an analytical observational method with purposive sampling. A total of 90 COVID-19 patients at Bhayangkara Hospital, Denpasar, Indonesia, were divided into three groups: unvaccinated group (V0), two-dose vaccinated group (Vp), and three-dose vaccinated group (Vb). Primary data were collected from July to December 2022, while secondary data were collected from January 2021 to June 2022. The data were analyzed using the Kruskal-Wallis test followed by the Mann-Whitney test, as well as one-way ANOVA test followed by Tukey's honestly significant difference (HSD) test with a confidence interval (CI) of 95% and α of 5%. The results revealed significant differences in disease severity (p<0.001). V0 had a higher percentage of severe (36.7%) and critical (6.7%) symptoms than Vp (severe=10.0%; critical, n=0) and Vb (severe and critical, n=0). The follow-up tests revealed significant differences in disease severity between V0 and Vp (p<0.001), V0 and Vb (p<0.001), as well as Vp and Vb (p=0.001). Blood test results revealed significant differences in lymphocytes (p=0.005), monocytes (p<0.001), monocyte-to-lymphocyte ratio (MLR) (p<0.001), and eosinophils (p=0.037). The follow-up tests revealed significant differences in these four indicators between V0 and Vb, in all parameters except for lymphocytes between V0 and Vp, and in lymphocytes only between Vp vs Vb. In conclusion, unvaccinated patients had a higher percentage of severe and critical symptoms than vaccinated patients. The blood test results revealed significant differences in lymphocytes, monocytes, MLR, and eosinophils. Unvaccinated patients had lower lymphocyte counts, higher MLR levels, and higher monocyte counts than vaccinated patients.

Early Career Publication Trajectory of Male Infertility Fellows During and After Fellowship.

Improving evidence-based medicine through research contribution is an important aspect of fellowship training. Prior studies have investigated the research activity of urology fellows during and after fellowship. The main objective of this study was to specifically explore the publication productivity of male infertility fellows both during fellowship and in the first 5 years afterwards. The 19 fellowship program directors from the Society for the Study of Male Reproduction were asked to share a list of fellows from 2004 to 2019. Publications from 87 fellows at 12 programs were analyzed. PubMed® was utilized to search for peer-reviewed publications for each fellow during their fellowship and in the first 5 years afterwards. Each publication was classified by publication type (original research, review article, editorial comment, or case report), topic (fertility, testosterone, or other), and author type (sole, first, middle, or last author). Some 87 male infertility fellows were analyzed, and a total of 1608 peer-reviewed publications were identified. Some 662 total publications (41.2%) were written on the topic of fertility during fellowship and in the first 5 years afterwards. Some 554 (34.5%) publications were completed during fellowship, 178 (11.1%) in year 1, 164 (10.2%) in year 2, 220 (13.7%) in year 3, 269 (16.7%) in year 4, and 223 (13.9%) in year 5. The mean number of publications during fellowship was 6.37 (range 0-57). Means for years 1-5 after fellowship were 2.12, 1.95, 2.65, 3.36, and 2.97, respectively. After fellowship, 25.3% of the fellows did not publish again. A significant difference was detected between the group mean number of publications (analysis of variance, ANOVA - p = 0.0001) during fellowship and the 5 years afterwards. There was no significant difference between the group mean number of publications between the 1st and 5th years post-fellowship (ANOVA - p = 0.5919). As anticipated, male infertility fellows were most productive during fellowship, with relatively stable research production thereafter. Thus, early career support and mentorship remain important to the future academic success of fellows. Future investigation of the relationship between male infertility fellow characteristics and the pursuit of an academic career is warranted.

Gender Gap: A Call for Women Leaders.

An original clinical research report and accompanying editorial in this issue of Anesthesia & Analgesia directly address a reality that deserves our undivided attention: a stark disparity continues to exist between men and women in leadership roles in academic anesthesiology. Basile et al identified 26 women in our field who have successfully achieved leadership positions. These leaders participated in structured interviews to ascertain whether there were specific factors common to women in leadership in anesthesiology, and how they obtained these positions. Four themes related to career development for these women were identified. Personality traits such as perseverance and adaptability were common among these women. Many of these individuals completed leadership courses and received early mentorship. As well, a major obstacle for these women was overcoming workplace bias and competing family obligations. Finally, leadership acquisition required self-promotion and sponsorship. The attributes of the interviewees are illustrated above. The reader is strongly encouraged to review the cited article and editorial for an in-depth understanding of the concepts summarized in this infographic.

Parameters associated with successful weaning of veno-arterial extracorporeal membrane oxygenation: a systematic review

PurposeVeno-arterial (VA) extracorporeal membrane oxygenation (ECMO) can be used to restore organ perfusion in patients with cardiogenic shock until native heart recovery occurs. It may be challenging, however, to determine when patients can be weaned successfully from ECMO—surviving without requiring further mechanical support or heart transplant. We aimed to systematically review the medical literature to determine the biomarkers, hemodynamic and echocardiographic parameters associated with successful weaning of VA-ECMO in adults with cardiogenic shock and to present an evidence-based weaning algorithm incorporating key findings.MethodWe systematically searched PubMed, Embase, ProQuest, Google Scholars, Web of Science and the Grey literature for pertinent original research reports. We excluded studies limited to extracorporeal cardiopulmonary resuscitation (ECPR) as the neurological prognosis may significantly alter the decision-making process surrounding the device removal in this patient population. Studies with a mixed population of VA-ECMO for cardiogenic shock or cardiac arrest were included. We excluded studies limited to patients in which ECMO was only used as a bridge to VAD or heart transplant, as such patients are, by definition, never “successfully weaned.” We used the Risk of Bias Assessment tool for Non-Randomized Studies. The study was registered on the International prospective register of systematic reviews (PROSPERO CRD42020178641).ResultsWe screened 14,578 records and included 47 that met our pre-specified criteria. Signs of lower initial severity of shock and myocardial injury, early recovery of systemic perfusion, left and right ventricular recovery, hemodynamic and echocardiographic stability during flow reduction trial and/or pump-controlled retrograde trial off predicted successful weaning. The most widely used parameter was the left ventricular outflow tract velocity time integral, an indicator of stroke volume. Most studies had a moderate or high risk of bias. Heterogeneity in methods, timing, and conditions of measurements precluded any meta-analysis.ConclusionsIn adult patients on VA-ECMO for cardiogenic shock, multiple biomarkers, hemodynamic and echocardiographic parameters may be used to track resolution of systemic hypoperfusion and myocardial recovery in order to identify patients that can be successfully weaned.Graphical

Conceptualizing childhood in scholarship and discourse

This issue contains two original research reports, as well as the three keynote addresses delivered at the 10th Conference of the European Network of Music Educators and Researchers of Young Children (EuNet MERYC), which took place in February 2022. This editorial includes a discussion of how childhood appears to be conceptualized within this scholarship and how this conceptualization may contrast persistent deficit views of children. Recent US political discourse regarding children and education is cited as an example of such a deficit perspective on childhood.