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98 Intracorporeal Versus Extracorporeal Anastomosis in Laparoscopic Right Hemicolectomy: Meta-Analysis of Randomised Controlled Trials

Abstract Aim To evaluate comparative outcomes of intracorporeal (ICA) and extracorporeal (ECA) anastomosis in laparoscopic right hemicolectomy. Method We conducted a systematic search of electronic databases and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Overall perioperative morbidity, anastomotic leak, surgical site infection (SSI), paralytic ileus, bleeding, postoperative pain within 5 days, conversion to an open procedure, length of incision and procedure time were the evaluated outcome parameters. Combined overall effect sizes were calculated using random-effects models. Results We identified 4 randomised controlled trials reporting a total of 399 patients evaluating outcomes of ICA (n = 199) and ECA (n = 200) in laparoscopic right hemicolectomy. The ICA was associated with significantly shorter length of incision (MD:-1.82, P < 0.00001), lower postoperative pain score on day 2 (MD:-0.69, P = 0.0007), day 3 (MD:-0.80, P = 0.02), day 4 (MD:-0.83, P = 0.01) and day 5 (MD:-0.49, P < 0.00001) when compared to ECA. Moreover, it was associated with significantly shorter length of hospital stay (MD:-0.27, p = 0.03). However, there was no significant difference in overall perioperative morbidity (RR:0.79, P = 0.47), anastomotic leak (RR:1.29, P = 0.65), SSI (RR:0.61, P = 0.42), bleeding (RR:0.70, P = 0.71), ileus (RR:0.60, P = 0.45), conversion to open (RD:-0.02, P = 0.45), number of harvested lymph nodes (MD:0.82, p = 0.06), and procedure time (MD:16.04, p = 0.06) between two groups. Conclusions The meta-analysis of level 1 evidence demonstrated that ICA and ECA have comparable perioperative outcomes in laparoscopic right colectomy although the former may be associated with less postoperative pain probably due to shorter incision length.

Design for healthy ageing – the relationship between design, well-being, and quality of life: a review

ABSTRACT Although people are living longer, well-being and quality of life (QoL) are not guaranteed. The built environment is recognized as influencing health outcomes across lifespans. This narrative review takes a cross-disciplinary approach to understand the current evidence of the relationship between design, healthy ageing and QoL. Diverse methods were used to search for relevant literature, including database, and reference list search. Sixty-five papers were deemed relevant and included in this review. Seven main themes emerged through inductive thematic analysis. The extracted literature suggests there is good evidence for the role of biophilia, and indoor environmental quality; emerging evidence for technology, wayfinding, and opportunities for social interactions; but limited evidence for safety/security and adaptability/fit. One significant consideration for healthy ageing was older adults maintaining agency in their lives, including the ability to exert control over their environment in order to support healthy ageing. Design decisions have a significant impact on the health and well-being of older adults, but these decisions are often made in the absence of strong scientific evidence. This review sets out to assist decision-makers to consider design principles that support healthy ageing.

Psychological impacts and online interventions of social isolation amongst older adults during COVID-19 pandemic: Ascoping review.

AimTo summarise the psychological impacts of social isolation amongst older adults during COVID‐19 and review the benefits and limitations of online interventions used to combat social isolation.DesignA scoping review was performed.Data SourcesA systematic search was performed from October 2020 to January 2021 in seven electronic databases: China National Knowledge Infrastructure (CNKI), PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Cochrane Library and Web of Science. A hand search of the reference lists of included papers and WHO publications was performed. Grey literature search was carried out from Scopus, ProQuest Dissertation and Google Scholar.Review MethodsStudies were screened, appraised and extracted independently by two reviewers. Thematic analysis was used to synthesise data, which were presented in a descriptive manner and organised into categories and themes.ResultsTotally, 33 studies were included. Four themes and eight sub‐themes emerged: (1) negative impacts and experiences of older adults during social isolation, (2) adopting coping behaviours in the midst of COVID‐19, (3) online interventions to combat the consequences of social isolation, (4) barriers to online intervention.ConclusionThe COVID‐19 pandemic has taken an emotional toll on older adults’ psychological wellbeing and has highlighted the untapped strengths of older adults facing isolation. Online interventions, which could be a new normal in the COVID era, were beneficial in combating social isolation. Strategies by various stakeholders were recommended to tackle the barriers of online interventions.ImpactWith the COVID‐19 pandemic still in progress, this review provides insights on the psychological impacts of social isolation amongst older adults. Nurses in the community and long‐term care facilities could adopt strategies and online intervention to better support the older adults, contribute to a stronger COVID‐19 response and support system, and an overall better road to recovery from this crisis.

Efficacy of 4% articaine vs 2% lidocaine in mandibular and maxillary block and infiltration anaesthesia in patients with irreversible pulpitis: a systematic review and meta-analysis.

ObjectiveThe goal of this systematic review and meta-analysis is to determine the performance of 4% Articaine vs. 2% Lidocaine for mandibular and maxillary block and infiltration anaesthesia in patients with irreversible pulpitis (IP).MethodsPubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Google Scholar, and Open Gray were used to conduct a thorough literature search. A manual search of the reference lists of the publications found was also carried out. Two reviewers critically evaluated the papers for inclusion and exclusion criteria, and data extraction was done on the selected publications. The Cochrane Collaboration Tool and the Minors checklist were used to assess the quality of the selected studies for randomised controlled trials (RCTs) and non-randomised studies, respectively. The RevMan software was used to perform a meta-analysis of the pooled data and subgroups according to the technique of anaesthetic solution delivery, as well as a sensitivity analysis (P < 0.05).ResultsA total of twenty-six papers were included in the qualitative synthesis, with twenty-two of them being included in the meta-analysis. There were fifteen studies with a low potential for bias, three with a moderate potential for bias, and seven with a high potential for bias. The combined results of the 19 trials in the tooth level unit revealed that 4% articaine had a success rate 1.37 times greater than 2% lidocaine for mandibular teeth (RR, 1.37; 95% CI [1.17–1.62]; P = 0.0002). For the maxillary buccal infiltration method, the combined results from the three trials revealed that 4% articaine resulted in a success rate 1.06 times greater than 2% lidocaine (RR, 1.06; 95% CI [0.95–1.2]; P = 0.3). Excluding subgroups with a single study in sensitivity analysis for mandibular teeth revealed a substantial improvement in the success rate of the articaine group in treating IP when compared to the lidocaine group.ConclusionThe findings of this meta-analysis back up the claim that articaine is more effective than lidocaine in providing anaesthesia in patients with IP. PROSPERO Registration No.: CRD42020204606 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020204606).

Primary Extracranial Meningiomas of the Head and Neck.

Meningiomas represent the most common benign histological tumor of the central nervous system. Usually, meningiomas are intracranial, showing a typical dural tail sign on brain MRI with Gadolinium, but occasionally they can infiltrate the skull or be sited extracranially. We present a systematic review of the literature on extracranial meningiomas of the head and neck, along with an emblematic case of primary extracranial meningioma (PEM), which provides further insights into PEM management. A literature search according to the PRISMA statement was conducted from 1979 to June 2021 using PubMed, Web of Science, Google Scholar, and Scopus databases, searching for relevant Mesh terms (primary extracranial meningioma) AND (head OR neck). Data for all patients were recorded when available, including age, sex, localization, histological grading, treatment, possible recurrence, and outcome. A total of 83 published studies were identified through PubMed, Google Scholar, and Scopus databases, together with additional references list searches from 1979 to date. A total of 49 papers were excluded, and 34 manuscripts were considered for this systematic review, including 213 patients. We also reported a case of a 45-year-old male with an extracranial neck psammomatous meningioma with sizes of 4 cm × 3 cm × 2 cm. Furthermore, whole-body 68Ga-DOTATOC PET/CT was performed, excluding tumor spread to other areas. Surgical resection of the tumor was accomplished, as well as skin flap reconstruction, obtaining radical removal and satisfying wound healing. PEMs could suggest an infiltrative and aggressive behavior, which has never found a histopathological correlation with a malignancy (low Ki-67, <5%). Whole-body 68Ga-DOTATOC PET/CT should be considered in the patient’s global assessment. Surgical removal is a resolutive treatment, and the examination of frozen sections can confirm the benignity of the lesion, reducing the extension of the removal of healthy tissue surrounding the tumor.

Intraoperative Methadone Use in Cardiac Surgery: A Systematic Review.

To investigate the effects of intraoperative methadone in comparison with those of standard-of-care intraoperative opioids, such as fentanyl and morphine, on pain scores, opioid consumption, and adverse effects in adults undergoing cardiothoracic surgery. The literature was reviewed in PubMed, Embase, Cochrane Library, and Google Scholar, followed by a manual search of the reference lists of the identified articles. Search terms included a combination of "intraoperative methadone," "methadone," and "cardiac surgery." Our review includes four studies published between 2011 and 2020. Quality assessment of the studies was performed. The initial search identified 715 articles, from which 461 duplicates were removed and 236 were eliminated on the basis of inclusion and exclusion criteria. Eighteen articles underwent full-text review. Four studies evaluating a total of 435 patients with various cardiothoracic procedures were included in this review. We found that intraoperative methadone decreased acute postoperative pain and reduced postoperative opioid consumption in the first 24 postoperative hours in patients who received 0.1-0.3 mg/kg intraoperative methadone in comparison with morphine and fentanyl. No difference was found in adverse effects between the groups. Quality assessment of the studies showed a low risk of bias in three of the randomized controlled trials and a high risk of bias in the retrospective review because of the baseline confounding bias in the study design. Intraoperative methadone use reduces acute postoperative pain and lowers opioid consumption in comparison with morphine and fentanyl. Initial results suggest that methadone may be an equivalent opioid to be administered during cardiothoracic procedures to reduce acute postsurgical pain, though further research is warranted.

Patient-Reported Outcome Measures for Pediatric Patients With Sport-Related Injuries: A Systematic Review.

Despite a call to incorporate patient-reported outcome measures (PROMs) into all aspects of health care, little is known about which instruments are best suited for a pediatric patient population with sport-related injury. The objective of this article was to perform a systematic review of the currently available evidence to determine which PROMs were used for pediatric patients with sport-related injuries and identify the associated psychometric properties and considerations for clinical utility. We conducted a literature search for articles on PROMs used in the pediatric population through electronic databases and a manual search of reference lists and authors between from inception to 2020. Articles were grouped based on the PROM(s) included, and considerations for clinical utility and psychometric properties were extracted from each article. Thirty-nine articles were included in this review, from which 22 PROMs were identified: 12 PROMs were developed specifically for the pediatric population, 4 were modified versions of an adult scale, and 6 were adult measures used in a pediatric population. Of the PROMs included in this review, the Oxford Ankle Foot Questionnaire for Children and the Pediatric Quality of Life Inventory were the most comprehensive in their development and assessment. Several outcome measures used for pediatric patients had missing or inadequate measurement properties and considerations for clinical utility, particularly in regard to readability, responsiveness, and interpretability. Clinicians and researchers should consider a measure's feasibility, acceptability, appropriateness, and psychometric properties when selecting a PROM for use with the pediatric population.

Shift work and health outcomes: an umbrella review of systematic reviews and meta-analyses of epidemiological studies.

Shift work is commonly increasing, and some physiological changes occur as workers sleep less and their circadian rhythms are disrupted. This umbrella review not only summarizes the evidence but also evaluates the validity of the associations of shift work with different health outcomes. We searched the MEDLINE, Web of Science, and Embase databases from their inception to April 25, 2020. For each systematic review and/or meta-analysis, we estimated the summary effect size, the 95% confidence interval, the 95% prediction interval, the between-study heterogeneity, evidence of small-study effects, and evidence of excess-significance bias. Eight eligible systematic reviews and meta-analyses were identified, providing data on 16 associations. We observed highly suggestive evidence for associations between shift work and myocardial infarction (having ever vs having never done shift work) and diabetes mellitus incidence (per 5-year increment in shift work). Furthermore, we observed suggestive evidence for an association between shift work and diabetes mellitus incidence (having ever vs having never done shift work). Two health outcomes, including prostate cancer incidence (having ever vs having never done shift work and rotating night shift work vs daytime work) and colorectal cancer incidence (longest vs shortest shift work time), were only supported by weak evidence. This umbrella review found that shift work was associated with several health outcomes with different levels of evidence. Associations for myocardial infarction and diabetes mellitus incidence were supported by highly suggestive evidence. Registry: PROSPERO; Identifier: CRD42020188537. Wu Q-J, Sun H, Wen Z-Y, etal. Shift work and health outcomes: an umbrella review of systematic reviews and meta-analyses of epidemiological studies. J Clin Sleep Med. 2022;18(2):653-662.

1274The application of simulation to quantifying the influence of bias in reproductive and perinatal epidemiology

Abstract Background Establishing causal effects in reproductive and perinatal epidemiology is challenging due to the many selection and attrition processes from preconception to the postnatal period. Further challenging, is the potential for the misclassification of exposures, outcomes and confounders, contributing to measurement error. The application of simulation enables the illustration and quantification of the magnitude of various types of bias commonly found in observational studies. Methods A systematic search was conducted in PubMed, Medline, Embase, CINAHL and Scopus in August 2020. A gray literature search of Google and Google Scholar, followed by a search of the reference lists of included studies, was undertaken. Results Thirty-nine studies, covering information (n = 14), selection (n = 14), confounding (n = 9), protection (n = 1), and attenuation bias (n = 1) were identified. The methods of simulating data and reporting of results varied, with more recent studies including causal diagrams. Few studies included code for replication. Although there has been an increasing application of simulation in reproductive and perinatal epidemiology since 2015, overall this remains an underexplored area. Conclusions The studies demonstrated effectiveness in the quantification of multiple types of bias using simulation. The limited use implies that further effort is required to increase knowledge of the application of simulation, which will thereby improve causal interpretation in reproductive and perinatal studies. Key messages Practical guidance for researchers is required in the development, analysis and reporting of simulation methods for the quantification of bias.

Are adjunctive therapies effective in reducing gingivitis and plaque?

Data sources PubMed, CENTRAL, Scopus and Cochrane electronic databases were used as the data sources for the systematic review. All randomised control trials that reviewed antiseptics published up to and including 26 February 2019 were included. A manual search of reference lists of the selected studies was conducted, including information from previous systematic reviews conducted by the same authors.Study selection Two trained and calibrated reviewers screened titles and abstracts that investigated the efficacy of adjuncts to mechanical plaque control, in systematically healthy patients aged 18 years or older with dental plaque biofilm-induced gingivitis, in an intact periodontium (GP) or in patients previously treated for periodontitis with gingival inflammation (PP_GI). Studies with at least one test group and a control group were included, where changes from baseline up to six months in gingival or bleeding indices was the primary outcome.Data extraction and synthesis Data was extracted by three reviewers and reported outcomes extracted at baseline, six months and the longest to follow-up visit. Meta-analysis was conducted for six-month data on antiseptics investigating gingival indices, bleeding indices and plaque indices. Studies were compared via mean treatment effect, calculated for baseline to six months, and analysed using weighted mean differences (WMD) or standardised mean differences (SMD). Statistical heterogeneity was assessed using Cochran's Q and I squared statistic. Study-specific estimates were pooled using the random-effect model and meta-regression analysis performed. Sensitivity analysis was performed to assess the contribution of each study to the evidence and Begg's rank correlation test utilised to assess publication bias.Results Following screening of 1,101 articles, 70 were included in quantitative synthesis. Adjuncts yielded statistically significant reductions in gingival index, plaque index and plaque. Meta-regression analysis showed use of mouth rinses resulted in greater reductions in plaque when compared with dentifrices, whereas antiseptic agents were similarly effective in reducing gingivitis in plaque in patients with GP and PP_GI.Conclusions Based on the present evidence, adjunctive antiseptics in mouth rinses and dentifrices demonstrate statistically significant reductions in gingival, bleeding and plaque indices, when used in adjunct to mechanical plaque control. Clinical significance must be interpreted with caution due to the heterogeneity among studies included and significant publication bias.

Are ceramic implant-supported single crowns clinically better than metal-ceramic implant-supported single crowns?

Data sources Data was collected from six databases (Medline, Embase, Web of Science, The Cochrane Central Register of Controlled Trials [CENTRAL], China National Knowledge Infrastructure [CNKI] and Chinese Biomedical Literature Database). Studies published in English and Chinese languages comparing ceramic and metal-ceramic implant-supported fixed dental prostheses (FDPs) were searched. The literature search was performed on studies published until 2018. Manual search of the reference lists of the identified articles was also performed to find related review articles and studies.Study selection Randomised controlled trials (RCTs), prospective and retrospective cohort studies involving the comparison of ceramic and metal-ceramic implant-supported FDPs were selected using the PICOS model for the meta-analysis. For ceramic and metal-ceramic single crowns, the survival rate, marginal adaptation, marginal bone loss, pocket probing depth, crown colour match and mucosal discolouration were assessed. The authors also included studies on survival rate of implant-supported fixed partial dental prostheses (FPDPs) in this meta-analysis.Data extraction and synthesis Two investigators independently screened the articles from the literature search and extracted and analysed data from the included studies. The quality of the included RCTs were assessed using the Cochrane collaboration tool for assessment of risk of bias. For the selected non-randomised studies, the quality and risk of bias were assessed using the Newcastle-Ottawa scale. Twenty studies were included in data synthesis.Results Of the selected 20 studies, ten were RCTs and ten were prospective or retrospective cohort studies.Conclusions The results of this study can be useful to clinicians in making decisions between ceramic and metal-ceramic implant-supported single crowns. This study concluded that the ceramic implant-supported single crown has better crown colour match over a metal-ceramic single crown, but poorer marginal adaptation, and there was no difference observed in other parameters studied (survival rate, marginal bone loss, pocket probing depth and mucosal discolouration). The conclusions on survival rate of implant-supported FPDPs needs to be further evaluated with RCTs with larger samples.

Impact of arteriovenous fistulas versus arteriovenous grafts on vascular access performance in haemodialysis patients: A systematic review and meta-analysis.

Controversy exists regarding the best-performing vascular access type for patients undergoing haemodialysis. We aimed to compare outcomes of starting dialysis on arteriovenous fistulas (AVFs) versus arteriovenous grafts (AVGs) in haemodialysis patients. We conducted a systematic search of multiple electronic information sources and bibliographic reference lists. The following outcome parameters were evaluated at 1, 2 and 5years: primary failure, defined as access never used for dialysis; primary patency, defined as intervention-free access survival; primary-assisted patency, defined as uninterrupted access survival with interventions; and secondary patency, defined as cumulative access survival. We identified 15 comparative studies reporting a total of 118,434 patients who initiated haemodialysis with AVF (n = 95,143) or AVG (n = 23,291). Our analysis demonstrated that AVF was associated with significantly higher primary failure rate (OR: 2.05, p = .0005) but significantly higher rate of primary patency at 1year (OR: 1.91, p < .00001), at 2years (OR: 2.52, p < .00001) and at 5years (OR: 2.59, p < .00001); and primary-assisted patency at 1year (OR: 1.71, p < .00001), at 2years (OR: 2.13, p < .00001) and 5years (OR: 2.79, p < .00001). There was no significant difference in secondary patency at 1year (OR: 1.08, p < .00001) but AVF had better secondary patency at 2years (OR: 1.26, p < .00001) and 5years (OR: 1.60, p < .00001) than AVG. The meta-analysis of best available comparative evidence (Level 2) demonstrated that AVFs may be associated with significantly higher primary failure rate but higher primary patency, primary-assisted patency and secondary patency at 1, 2 and 5years compared to AVGs. However, the available evidence is subject to significant selection bias and confounding by indication.

Evaluating MPI resource usage summary statistics

The Message Passing Interface (MPI) remains the dominant programming model for scientific applications running on today’s high-performance computing (HPC) systems. This dominance stems from MPI’s powerful semantics for inter-process communication that has enabled scientists to write applications for simulating important physical phenomena. MPI does not, however, specify how messages and synchronization should be carried out. Those details are typically dependent on low-level architecture details and the message characteristics of the application. Therefore, analyzing an application’s MPI resource usage is critical to tuning MPI’s performance on a particular platform. The result of this analysis is typically a discussion of the mean message sizes, queue search lengths and message arrival times for a workload or set of workloads. While a discussion of the arithmetic mean in MPI resource usage might be the most intuitive summary statistic, it is not always the most accurate in terms of representing the underlying data. In this paper, we analyze MPI resource usage for a number of key MPI workloads using an existing MPI trace collector and discrete-event simulator. Our analysis demonstrates that the average, while easy and efficient to calculate, is a useful metric for characterizing latency and bandwidth measurements, but may not be a good representation of application message sizes, match list search depths, or MPI inter-operation times. Additionally, we show that the median and mode are superior choices in many cases. We also observe that the arithmetic mean is not the best representation of central tendency for data that are drawn from distributions that are multi-modal or have heavy tails. The results and analysis of our work provide valuable guidance on how we, as a community, should discuss and analyze MPI resource usage data for scientific applications.

Incidence of spontaneous bacterial peritonitis among asymptomatic cirrhosis patients undergoing outpatient paracentesis: a systematic review and meta-analysis.

Spontaneous bacterial peritonitis (SBP) is a common complication of decompensated cirrhosis with high morbidity and mortality rate. There is a paucity of evidence regarding the incidence of SBP in asymptomatic liver cirrhosis patients undergoing routine out-patient large-volume paracentesis (LVP). The aim of this study was to perform a systematic review and meta-analysis to determine the incidence of SBP among asymptomatic decompensated cirrhosis patients undergoing routine outpatient LVP. A systematic search of Ovid Medline, Embase, Web of Science and CENTRAL electronic databases was performed in January 2021, along with a manual search of reference lists of retrieved articles. Data were extracted to determine the incidence of SBP [polymorphonuclear cells (PMNs) greater than 250 PMNs/mm3 with or without positive culture] and the incidence of all positive paracentesis (SBP or bacterascites-positive ascitic culture but no elevation in PMNs). A total of 504 studies were retrieved with 16 studies being included in the review. A total of 1532 patients were included with a total of 4016 paracentesis performed. The incidence of a positive paracentesis (SBP and/or bacterascitis) was 4% [95% confidence interval (CI), 3-6%]. However, the incidence of definite SBP was 2% (95% CI, 1-3%). The incidence of SBP in asymptomatic outpatients with decompensated cirrhosis requiring LVP is low. The benefit of routine analysis of all paracentesis samples in this population is questionable. Further studies are required to determine the cost-effectiveness of routine analysis and to determine if certain subgroups are at higher risk of SBP that require routine analysis.

Is there a link between the use of benzodiazepines and related drugs and dementia? A systematic review of reviews.

Benzodiazepines (BZDs) and related drugs (BZRDs) are commonly used to treat diverse psychiatric disorders due to their anxiolytic, hypnotic and sedative properties, despite their known associated side effects, including acute consequences on cognition. Recently, some studies have also suggested that long-term cognitive effects may coexist, as the increased risk of cognitive decline and dementia. This review aims to appraise and summarise published synthesis studies on the risk of dementia development due to BZDs/BZRDs use. A comprehensive systematic search was carried out in PubMed, Web of Science, Cochrane Library and Epistemonikos databases. Grey literature and hand search of the studies' reference lists were undertaken. Meta-analysis, systematic and non-systematic reviews were included. Neither language nor date restrictions were applied. Search results other than synthesis studies were excluded. The methodological quality of the included reviews was analysed with AMSTAR-2 and SANRA tools. Overall, 877 records were initially retrieved and 15 complied with the inclusion criteria. From these, five were systematic reviews with meta-analysis, two were systematic reviews and eight were non-systematic reviews. Most of the primary studies included in the analysed reviews found an association between BZDs/BZRDs use and subsequent dementia, with meta-analysis studies reporting an increased risk for users (ORs ranging from 1.38 to 1.78). However, the considerable clinical and methodological heterogeneity of the primary studies makes it difficult to establish a causal relationship. Although hampered by the heterogeneity between the studies, the present findings suggest an association between BZDs/BZRDs use and increased risk of dementia in older adults.

A scoping review of registry captured indicators for evaluating quality of critical care in ICU

BackgroundExcess morbidity and mortality following critical illness is increasingly attributed to potentially avoidable complications occurring as a result of complex ICU management (Berenholtz et al., J Crit Care 17:1-2, 2002; De Vos et al., J Crit Care 22:267-74, 2007; Zimmerman J Crit Care 1:12-5, 2002). Routine measurement of quality indicators (QIs) through an Electronic Health Record (EHR) or registries are increasingly used to benchmark care and evaluate improvement interventions. However, existing indicators of quality for intensive care are derived almost exclusively from relatively narrow subsets of ICU patients from high-income healthcare systems. The aim of this scoping review is to systematically review the literature on QIs for evaluating critical care, identify QIs, map their definitions, evidence base, and describe the variances in measurement, and both the reported advantages and challenges of implementation.MethodWe searched MEDLINE, EMBASE, CINAHL, and the Cochrane libraries from the earliest available date through to January 2019. To increase the sensitivity of the search, grey literature and reference lists were reviewed. Minimum inclusion criteria were a description of one or more QIs designed to evaluate care for patients in ICU captured through a registry platform or EHR adapted for quality of care surveillance.ResultsThe search identified 4780 citations. Review of abstracts led to retrieval of 276 full-text articles, of which 123 articles were accepted. Fifty-one unique QIs in ICU were classified using the three components of health care quality proposed by the High Quality Health Systems (HQSS) framework. Adverse events including hospital acquired infections (13.7%), hospital processes (54.9%), and outcomes (31.4%) were the most common QIs identified. Patient reported outcome QIs accounted for less than 6%. Barriers to the implementation of QIs were described in 35.7% of articles and divided into operational barriers (51%) and acceptability barriers (49%).ConclusionsDespite the complexity and risk associated with ICU care, there are only a small number of operational indicators used. Future selection of QIs would benefit from a stakeholder-driven approach, whereby the values of patients and communities and the priorities for actionable improvement as perceived by healthcare providers are prioritized and include greater focus on measuring discriminable processes of care.

Mental health training for Australian undergraduate paramedic science students: a review

PurposeThis paper aims to present the current state of evidence regarding the mental health literacy of paramedics and student paramedics and whether mental health literacy affects the care that paramedics provide to their patients with mental illness.Design/methodology/approachEmbase, PubMed, Medline and Google Scholar were searched for recent (2010–2020) English language published articles using the key phrases paramedic AND/OR ambulance AND mental health AND mental health literacy. Additional searches of the reference lists of included articles were undertaken. A descriptive thematic analysis was used to arrive at a narrative synthesis of the study findings.FindingsThe emergency medical services system has taken a primary role in the care of patients with mental illness but has limited capacity for non-emergency psychosocial situations. Negative and judgemental attitudes amongst paramedics towards patients with mental illness is a significant issue and remains a barrier to patients seeking medical care for mental illness. Improved care provision and patient engagement might result from specific education aimed to better enhance paramedics’ mental health literacy.Originality/valueThis literature review provides insights into the current practice of mental health training for Australian undergraduate paramedic science students and the implications for patient care. Recommendations for educational strategies are provided.

Compilation and Dissemination of Lithuanian Paremias: Contemporary Resources

The Collection of Lithuanian Proverbs and Proverbial Phrases built by the Institute of Lithuanian Literature and Folklore in Vilnius presents a thorough view of the corpus of traditional paremias. A larger part of the Collection consists of archival data, another one – of paremias collected from written sources.Archival data – that is paremias mostly from the Lithuanian Folklore Archive (LTR), Lithuanian Scientific Society’s Archive (LMD). These texts are mainly samples of the spoken language and dialects. The oldest archive collections are from the 19th century. Another large part of Lithuanian paremias compilation consists of texts collected from written sources. It is worth to mention, that we have around 1500 proverbs from the period of the 16th to the 18th centuries.The collection is accessible through three resources: they are the Card Index, the publication “Lithuanian Proverbs and Proverbial Phrases” (LPP), and The Electronic Compilation of Proverbs and Proverbial Phrases (eLPP).The Card Index was the first organized and systematized resource of Lithuanian paremias and served as the base for LPP and eLPP. The Card Index was created in 1970–1990 following the initiative of professor Kazys Grigas, who was also the author of the system of it. There are around 50 000 proverb types and more than 200 000 variant texts in the Card Index.At the end of the 20th century, LPP was started to be compiled. There have been three volumes published until now (Vol. 1 – 2000, Vol. 2 – 2008, Vol. 3 – 2019). LPP presents carefully sorted data without duplicates, copies, and fakes, and it has some additional data: Lithuanian paremias equivalents (in Latvian, Polish, German, English, Latin, and Russian) and type titles’ translations into English, German, and Russian.In 1998, eLPP was started and in 2018, after receiving funding from the Lithuanian Research Council (LMTLT), the database was updated. Now, the database also has an English version. eLPP includes the Card Index’ data and LPP data as well, with an exception of paremias variants. Due to the recently observed rising need to find an explanation of a saying, the category “Interpretation” has been introduced. The newly programmed search engine now contains functions of a simple search, advanced search, and selection lists. The database address is http://archyvas.llti.lt/elpp/lt, an email for comments and questions is patarles@llti.lt.

Factors influencing cervical cancer screening practice among female health workers in Nigeria: A systematic review.

BackgroundCervical cancer is the most prevalent gynaecologic cancer in Nigeria. Despite being largely preventable through screening, cervical cancer is the second leading cause of cancer morbidity and mortality in Nigeria. To reduce the burden of cervical cancer in Nigeria, female health workers (FHWs) are expected to play an influential role in leading screening uptake and promoting access to cervical cancer education and screening.AimThe aim of this systematic review is to assess the factors influencing cervical cancer screening (CCS) practice among FHWs in Nigeria.MethodsWe conducted a systematic literature search across six (6) electronic databases namely MEDLINE, Embase, Scopus, African Index Medicus, CINAHL, and Web of Science between May 2020 and October 2020. Reference list and grey literature search were conducted to complement database search. Four reviewers screened 3171 citations against the inclusion criteria and critically appraised the quality of eligible studies. Narrative synthesis was used in summarising data from included studies.ResultsOverall, 15 studies met the inclusion criteria and were all quantitative cross‐sectional studies. Included studies sampled a total of 3392 FHWs in Nigeria. FHWs had a high level of knowledge and positive attitude towards CCS. However, CCS uptake was poor. Predominant barriers to CCS uptake were the cost of screening, fear of positive results, lack of test awareness, reluctance to screen, low‐risk perception, and lack of time. In contrast, being married, increasing age, awareness of screening methods, and physician recommendation were the most documented facilitators.ConclusionThis study revealed that a complex interplay of socioeconomic, structural, and individual factors influences CCS among FHWs in Nigeria. Therefore, implementing holistic interventions targeting both health system factors such as cost of screening and infrastructure and individual factors such as low‐risk perception and fear of positive result affecting FHWs in Nigeria is critical to reducing the burden of cervical cancer.

Accessibility and effectiveness of mechanical thrombectomy for ischaemic stroke in Latin American countries: a rapid review of the literature

Introduction. Stroke constitutes a major cause of death and disability in Latin America. Although the number of stroke survivors has increased in recent decades, a small proportion receives the appropriate treatment. Mechanical thrombectomy (MT) revolutionised stroke management by treating patients within a 24-hour window period, compared to the usual 4.5 hours with intravenous recombinant tissue plasminogen activator (IV rtPA). Objective. To evaluate the current status of mechanical thrombectomy in Latin American countries regarding availability, accessibility, effectiveness, and cost-utility. Methods. A rapid review of the literature was performed by identifying papers published in MEDLINE in English or Spanish from 2015 to current. Reference list search complemented the database research. Included studies were randomised controlled trials and observational studies. Data extraction was performed by one reviewer, and data synthesis was performed following the SWIM guidelines. Results. 10 studies were included. Only one study was a randomised controlled trial. Studies reported that MT is available in Latin American countries. The proportion of treated patients varied from 3% to 19.9%. Recanalisation rates were above 69% in all studies, while functional independence (mRS 0-2) varied from 25% to 50%. Financial barriers were considered as the main limiting factor to access MT. No study realised a cost-utility analysis. Conclusion. Evidence of the efficacy and effectiveness of MT and its main barriers to access is consistent among Latin American countries. Further research is needed, mainly from a robust economic analysis, to evaluate the economic impact of MT.