Standardized Outcome Measures Research Articles

Development of a standard set of key work-related outcomes for use in practice for patients with cardiovascular disease: a modified Delphi study

BackgroundTo facilitate the maintenance or resumption of participation in work for patients with cardiovascular disease (CVD), there is a need for high-quality work-focused healthcare. According to the concept of value-based healthcare, quality of care can be enhanced by understanding the outcomes that matter most to patients. However, a major challenge in assessing quality of work-focused healthcare in practice is the lack of consensus on which work-related outcomes should be measured.ObjectiveThe objective of this study was to identify a standard set of key work-related outcomes for patients with CVD to be used in practice of work-focused healthcare in the Netherlands, including standardised outcome measures and associated case mix factors. This standard set is intended to assist occupational and other health professionals in delivering work-focused healthcare that meets a patient’s individual needs regarding work participation, and to enhance patients’ engagement in their own work-focused care process.MethodsA 2-round RAND-modified Delphi process was conducted. The process included literature searches, consecutive research team meetings, and several meetings and rounds of voting by a working group. The working group consisted of patients with CVD (n = 6) and health professionals representing different stakeholders (n = 11) involved in work-focused healthcare for this patient population in the Netherlands. Consensus was reached over four phases: (1) establishing the scope of the standard set and defining the population, (2) prioritising and defining the outcome domains, (3) selecting the outcome measures for the most important domains, including clinical data and patient-reported data, and (4) selecting and defining case mix factors.ResultsA 23-item patient-reported questionnaire was developed, called the Value@WORK-Q23, including questions on nine work-related outcome domains considered most important for patients with CVD: (1) work participation, (2) physical work ability, (3) mental work ability, (4) suitable work, (5) support from the work environment, (6) flexibility of the work environment, (7) communication with the patient, (8) person-centredness, and (9) interdisciplinary communication. In addition, nine case mix variables was selected, comprising demographic-, disease-, and work factors.ConclusionsThe Value@WORK-Q23 provides guidance on measuring the most important work-related outcomes for patients with CVD. Using this work-related set in practice, in addition to existing disease-specific standard sets for CVD may facilitate the provision of high-value work-focused healthcare for this patient population.

Understanding Strategies to Reduce the Impact of Non-urgent Visits to the Pediatric Emergency Department: A Scoping Review.

The pediatric emergency department (PED) is increasingly being used for non-urgent reasons. This impacts PED input and throughput, and contributes to overcrowding. To identify solutions, it is essential to identify and describe the approaches that have been trialed. We completed a scoping review to identify and then describe the design and outcomes of all initiatives undertaken to reduce the impact of non-urgent visits on the PED. We searched 4 databases (MEDLINE, EMBASE, EBM, and CINAHL) to identify research published from the database inception until March 31, 2024. Studies met our inclusion criteria if they focused on the pediatric ED, defined non-urgent visits, described an intervention (hypothesizing it would reduce the impact of non-urgent visits on the PED), and reported on the interventions impact. The title and abstract of each study were independently screened for inclusion by 2 reviewers (E.Q., K.N.), and disagreements were resolved by deliberation until consensus was achieved. This process was then repeated for the full text of all articles. In total, we screened 11,600 articles and 20 were included. Nine interventions focused on PED input, 10 on PED throughput, and 1 on both PED input and throughput. Definitions of non-urgent visits and outcomes measures used to assess the effectiveness of an intervention differed between studies. Three types of strategies employed to reduce the impact of non-urgent visits on the PED were identified, these include (1) engaging nonpediatric emergency medicine clinicians by including them into the PED or connecting non-urgent patients to community locations for care, (2) reorganizing PED operations in anticipation of non-urgent visits, and (3) providing education to prevent future non-urgent visits. Consistent definitions of non-urgent visits and standardized outcome measures may allow for more precise comparisons between studies. We identify 3 commonly employed strategies that may help reduce the impact of non-urgent visits on the PED.

Interventions to reduce burnout in emergency medicine: a national inventory of the Canadian experience to support global implementation of wellness initiatives.

Burnout in healthcare workers is a global issue, with Emergency Medicine (EM) particularly impacted. Many countries have tried implementing wellness initiatives to reduce burnout and improve wellness. This paper summarizes interventions implemented in Canada to-date with the aim of supporting the design of wellness interventions in EDs globally. A systematic review and a grey literature search were completed in November 2023. Original studies in both English and French that included the implementation and evaluation of a wellness intervention in EDs in Canada were included. The study design, content of the intervention, target population, and outcomes were extracted and narratively analyzed. 13 studies were included. Each implemented a unique wellness intervention for EDs. All three studies (3/3, 100%) that included a structured wellness curriculum demonstrated significant improvement in burnout as measured by the Maslach Burnout Inventory, physical health (PCS-8), and Brief Resident Wellness Profile (BRWP). Other interventions included Ice Cream Rounds, therapy dogs, changing the duration of night shifts, and sessions on resilience and self-care. Our Canada-wide analysis of wellness interventions identified initiatives geared towards trainees, staff, or entire ED workface groups. Examples include educational programs, dedicated sessions for compassion literacy and resilience, critical events debriefing, and optimizing shift schedules. Structured wellness curriculums seem to be effective, and this area warrants further study. Moreover, we identify a need for global collaboration to build wellness programs and for more easily translatable standardized outcome measures for assessing the efficacy of wellness programs in EM.

Modern surgical treatments for lymphedema.

Lymphedema occurs when the lymphatic system is malformed, leaking or is damaged by infection or cancer treatment. Enlarged extremities due to extensive fluid retention and adipose tissue deposition, recurrent cellulitis, and the requirement for hard-to-wear compression garments lead to impaired limb function and decreased quality of life. This narrative review aims to elucidate classification, diagnostic tools, and conservative management strategies leading the path to patient selection for microsurgical reconstructive procedures or volume reduction procedures. The surgical approaches include reconstructive procedures such as lymphaticovenous anastomosis (LVA) and lymph node transfer and reductive procedures, mainly liposuction and occasionally excisional surgery. Comparing the efficacy of lymphedema surgeries is fully dependent on standardized and reproducible outcome measures. A growing body of knowledge has evolved pointing to the benefits of reconstructive microsurgery of the lymphatic system with or without surgical volume reduction. Tissue engineering and stem cell research leads the way for new approaches. However, several questions remain emphasizing the research needs. Ongoing multicentre trials aiming to elucidate the efficacy and accessibility of surgical treatments for this condition are on their way.

Can nudge interventions targeting healthy food purchases in real-world grocery stores reduce diet-related health disparities? A pooled analysis of four controlled trials

BackgroundHealthy food nudges may be more, or especially, effective among groups experiencing socioeconomic disadvantage. We investigated the modifying role of socioeconomic and demographic characteristics in the effectiveness of nudge interventions targeting healthy foods in real-world grocery store settings on food purchasing patterns.MethodsWe pooled individual participant data from multiple trials. Eligible trials were identified via a PubMed search and selected based on having a controlled real-world design, testing a nudging intervention promoting healthy purchases, while collecting participants’ sociodemographic and purchasing data. Out of four eligible trials, three had longitudinal measurements, one consisted of a single time point, two were randomised and two were not. Applied nudges consisted of a combination of placement nudges (focussing on availability or positioning) and property nudges (presentation and/or information). Harmonised data included dichotomised socioeconomic and demographic variables and the percentage of purchased fruits and vegetables of total purchases. Multilevel meta-regression based on linear mixed-effects models were used to explore modifying effects using two approaches: longitudinal and cross-sectional analyses.ResultsThe analytical sample in the longitudinal analysis comprised of 638 participants, who were predominantly female (76.3%), had a lower education attainment (67.7%), and a mean age of 46.6 years (SD 13.5). These characteristics were similar in the cross-sectional analysis (n = 855). Compared to control group participants, there was no main effect of healthy food nudges on the percentage of fruit and vegetable purchases by intervention group participants in the longitudinal analysis (β = 0.00; 95%CI -0.03, 0.09). This main effect was not modified by educational attainment (βgroup*higher education = -0.06; -0.40, 0.02), sex (βgroup*females = 0.13; -0.00, 0.61) nor age (βgroup*older adults = -0.05; -0.39, 0.02). Results from the cross-sectional analysis were comparable.ConclusionsThis pooled analyses of four controlled trials did not find evidence supporting the hypothesis that grocery store nudge interventions of healthy foods work more effectively among groups experiencing socioeconomic disadvantage. Future studies are needed to address the identified limitations through rigorous trial design using comprehensive interventional strategies, standardised outcome measures, while also evaluating context-specific approaches. Such insights will help to better understand the equity of nudging interventions in grocery store settings and the potential for reducing diet-related health disparities.Trial registrationsThe trial of Ayala et al. (2022) was retrospectively registered at ClinicalTrials.gov (NCT01475526; at 14 November 2011, https://clinicaltrials.gov/study/NCT01475526), the of Huitink et al. (2020) was retrospectively registered in the ISRCTN registry (ISRCTN39440735; at 5 September 2018, https://doi.org/10.1186/ISRCTN39440735), the of Vogel et al. (2024) was retrospectively registered at ClinicalTrials.gov (NCT03518151; at 24 April 2018, https://clinicaltrials.gov/study/NCT03518151), and finally of Stuber et al. (2024) was registered in the Dutch Trial Register (ID NL7064, at 30 May 2018, https://www.onderzoekmetmensen.nl/en/trial/20990).

Current Trends in Deep Plane Neck Lifting: A Systematic Review.

The aging neck is a prevalent aesthetic concern, with over 160,000 neck procedures performed in 2020. It is characterized by increased soft tissue laxity and displacement of cervical structures. While nonsurgical interventions like cryoablation and laser resurfacing show promise, their variable responses highlight the necessity for surgical solutions. Traditional neck lifts address superficial structures but often neglect the subplatysmal plane. Recently, deep plane neck lifts have gained attention for addressing deeper anatomical structures. This paper systematically reviews the literature on subplatysmal modifications in cervicoplasty, aiming to clarify the risks and benefits of these evolving surgical techniques. On February 20, 2024, a systematic review adhering to Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 guidelines was performed. MEDLINE, PubMed, Cochrane, and Scopus databases were searched for terms related to neck rejuvenation. Independent reviewers screened titles, abstracts, and full texts, including all relevant studies. Data extracted included patient numbers, procedures, outcomes, and complications. From an initial 771 articles, 57 studies encompassing 8648 patients met inclusion criteria. The most commonly altered anatomical structures during "deep plane" neck lift (DPNL) were the submandibular gland (69.9%), digastric muscles (58.6%), and subplatysmal fat (48.6%). Postoperative complications were reported in 59.6% of studies, with nerve palsy (0.2%-12%) and hematoma (0.2%-4%) being most common. Aesthetic outcomes were less frequently reported (56% of studies); patient satisfaction ranged from 81.6% to 98.6%, while objective measures were reported in only 12% of studies. Recent surveys indicate a growing concern over excess laxity under the chin, with patients increasingly seeking neck rejuvenation. Our review found that DPNL techniques vary widely, with the submandibular gland and digastric muscles being the most frequently altered structures. Despite a general lack of standardized outcome measures, patient satisfaction was high. However, DPNL showed a higher rate of postoperative nerve palsy compared to traditional neck lift. Overall, while DPNL demonstrates potential aesthetic benefits, the increased risk necessitates thorough patient counseling and further studies for standardization and comparison.

Exploring Music-Based Interventions for Executive Functioning and Emotional Well-Being in Stroke Rehabilitation: A Scoping Review

Purpose: Stroke is one of the leading causes of disability with life-long implications requiring assessment and treatment of several functional domains. This review identifies the results from research into music-based interventions (MBIs), including music therapy (MT), for executive functions (EFs) and emotional well-being (EWB) in adults with stroke and highlights opportunities for clinical practice and future research. Methods: APA PsycInfo (EBSCOhost), and CINAHL (EBSCOhost) were searched, in addition to grey literature. Results: A total of 49 studies were included and encompassed experimental, analytic, and descriptive observational studies, and case reports, involving a total of 1663 participants. In total, 32 studies included MT interventions, and 17 were MBIs. EFs were an outcome in 20.41%, and EWB in 61.22% of studies, for which active interventions were the most utilized. Overall, 73.47% of the studies reported positive results. Conclusions: This scoping review indicates that music interventions can be beneficial for the improvement of different aspects of EFs and EWB at different stages of stroke recovery. Further research may benefit clinical practice by including standardized protocols, outcome and self-reported measures, and brain imaging data to determine the effects of interventions and support evidence-based decisions for treatment policies for stroke survivors.

Effectiveness of Cognitive Remediation Interventions for Schizophrenia in Asian Population: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background: Cognitive deficits are an integral part of schizophrenia, with negatively impacting functionality. Current treatments, primarily pharmacological, do not adequately address these cognitive impairments. Cognitive remediation (CR) interventions, designed to improve cognitive functions, have shown promising outcomes. However, most research has been conducted in western contexts, necessitating a review of CR effectiveness in the Asian populations. This systematic review aims to provide comprehensive update on the effectiveness of CR interventions in improving cognition among individuals with schizophrenia in Asian countries. The meta-analysis aims to synthesize and summarize the relevant CR studies to obtain a pooled estimate of effectiveness. Methods: A systematic search of three databases, PubMed, Ovid MEDLINE, and EMBASE, was conducted from the date of inception to March 19, 2024, for eligible records using prespecified search criteria. Primary studies with a randomized controlled trial (RCT) design, conducted on individuals aged 18–65 years, diagnosed with schizophrenia in Asian countries, comparing CR interventions with other non-pharmacological interventions or treatment as usual, reporting cognitive outcomes, using standardized tools, and published in English were included in the study. The review excluded unpublished RCTs, low-quality studies, open-label studies, cohort studies, studies focusing on noncognitive outcomes, and those lacking a clear comparison arm. The quality of the studies was assessed using the Cochrane risk of bias 2 (RoB2) tool by two independent reviewers. Meta-analyses were performed using R version 4.3.0 software using meta package to synthesize the overall impact of CR interventions on cognitive outcomes. Results and Discussion: This systematic review included 17 studies with 1272 participants, conducted in China, Japan, Hong Kong, Taiwan, Iran, Korea, and Singapore. The interventions varied in type and format. These were delivered through group and individual sessions, both in-person and computer-based, with varied duration. Quality assessment done with RoB2 tool indicated high-risk concerns in 14 of the studies. The meta-analysis of four studies on composite cognitive scores using the brief assessment of cognition in schizophrenia showed a significant positive effect of CR interventions (standardized mean difference [SMD] = 0.89, 95% confidence interval [CI]: 0.35 to 1.43). For executive functioning, the meta-analysis of three studies indicated no significant improvement (SMD = 0.75, 95% CI: −0.11 to 1.61). Conclusion: CR is an effective intervention for improving cognitive functions in individuals with schizophrenia in Asia based on the meta-analysis conducted, akin to evidence from western countries. However, quality concerns and high heterogeneity among the included studies underscore the need for standardized protocols and uniform outcome measures to enhance the reliability of future research.

Efficacy and Safety of Antiepileptic Drugs in the Management of Behavioral Issues in Autism Spectrum Disorders: A Systematic Review and Meta-analysis

Background: Autism spectrum disorder (ASD) is often accompanied by comorbidities such as epilepsy and behavioral problems. The interplay between epilepsy, behavior, and language suggests a potential role for antiepileptic drugs (AEDs) in managing ASD-related behavioral issues. Despite some preliminary studies indicating possible benefits, the evidence remains inconclusive. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of AEDs in managing behavioral issues in individuals with ASD. Methodology: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a comprehensive search across multiple databases (PubMed, Ovid MEDLINE, Cochrane Library, Web of Science, and others) for double-blind, placebo-controlled randomized controlled trials (RCTs) published in English. Inclusion criteria focused on individuals with ASD exhibiting behavioral problems, with or without EEG abnormalities, treated with AEDs. Data extraction and quality assessment were performed by two independent reviewers. The primary outcome was focused on investigating the efficacy of AEDs in improving behavioral symptoms, predominantly irritability, and aggression. We also investigated the safety profiles of the AEDs. Results: Seven RCTs met the inclusion criteria, involving AEDs such as valproate, levetiracetam, and topiramate. Two RCTs were excluded due to incompatible outcome measures. Meta-analysis of the remaining five RCTs showed no significant difference in the reduction of aggression and irritability between AEDs and placebo, with high heterogeneity (I2 = 93%). Sensitivity analysis confirmed the nonsignificance and high heterogeneity (I2 = 87%). Adverse effects commonly reported included insomnia and weight gain. Conclusion: This meta-analysis found no significant benefit of AEDs in managing behavioral symptoms of ASD compared to placebo, consistent with previous findings. The high heterogeneity and methodological limitations highlight the need for more robust and larger-scale studies. Future research should consider the role of electroencephalography abnormalities and standardize outcome measures to better evaluate the potential of AEDs in this population or in a specific subgroup of ASD.

Comparative Outcomes Between Surgical and Conservative Management of Mallet Thumb: A Systematic Review and Pooled Analysis.

While mallet finger remains a relatively common injury of the hand, mallet thumb is much rarer in occurrence. Mallet thumb management has been noted infrequently within the literature and reliable evidence regarding the most effective method of management remains absent. The aim of this review is to assess the quality of literature that exists pertaining to mallet thumb to determine whether conservative or surgical management is superior. A search was completed in February 2023 of Ovid Medline, Embase, CINAHL, and SPORTDiscus with no limitation on study type, and date of publication. Comparative outcomes of thumb interphalangeal (IP) joint range of motion, tip, lateral pinch and grip strength, complications, outcome measure scores, and follow-up period were recorded. We assessed 103 mallet thumbs (51 surgically and 52 conservatively managed) across the 23 studies of low to moderate quality based on the Structured Effectiveness Quality Evaluation Scale. The authors adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. While recommendations remain weak due to low quality of evidence, our review found a lower complication rate and higher IP joint flexion in thumbs managed conservatively. These findings demonstrate a need for future research to shift toward ensuring standardized patient-rated outcome measures are utilized and functional outcomes are included in research planning and operationalization in order to contextualize clinical outcomes.

OUTCOME MEASURES FOR CERVICOGENIC DIZZINESS: A META ANALYSIS.

Background: Cervicogenic dizziness (CGD) is a complex condition characterized by dizziness arising from cervical spine disorders. It affects approximately 40% of patients with chronic neck pain and can significantly impact daily activities, quality of life, and mental health. The involvement of cervical structure in vestibular function highlights the need for effective assessment tools. Outcome measures play a crucial role in diagnosing CGD, evaluating treatment effectiveness, and improving patient outcomes. This evolved, focusing on both subjective and objective assessments, including symptom questionnaires, functional scales, and vestibular function tests. Standardized outcome measures are essential for clinical making and guideline development. Objective: The objective of the study is to systematically evaluate and compare the reliability, validity and sensitivity data of various outcome measures of cervicogenic dizziness. Method: The systemic data were searched using PubMed, Scopus, Google scholar, Science direct, PEDro, Cochrane library to identify studies published from the year 2001 up to 2023. Study selection is reported according to PRISMA guidelines. A total of 50 review articles were collected on outcome measures for Cervicogenic Dizziness (CGD). Data extraction included Research, Evidence based study, Literature, Systematic reviews and Meta-analysis articles. Result: This meta-analysis states that outcomes measures for Cervicogenic Dizziness (CGD) show a highly significant difference. Conclusion: After analysis of various articles, it was concluded that diagnosing patients with outcome measures for Cervicogenic Dizziness shows highly significant and improving health care efficiency. This study identified reliable and valid outcome measures for assessing Cervicogenic Dizziness (CGD). Implication: This study findings have significant implication for clinical practice, research, and policy, enhancing diagnosis, treatment and patient outcomes, standardized use of validated outcome measures will inform evidence – based guidelines for Cervicogenic Dizziness.

Assessing the Efficacy of Acupuncture in the Treatment of Olfactory Dysfunction: A Systematic Review.

This article seeks to systematically review existing literature on the use of acupuncture in treating olfactory dysfunction in order to better understand the methodology and efficacy of this alternative treatment modality. A comprehensive search of PubMed, Cochrane Library, Embase, Web of Science, and Google Scholar was conducted. The review was conducted by 2 independent reviewers that authored this article. Inclusion criteria included all studies analyzing the efficacy of acupuncture for treatment of olfactory dysfunction. Articles were excluded if they were duplicates, opinion or review papers, incomplete or unavailable papers, or if they were in a language other than English. The review found 10 articles matching the inclusion criteria that overall showed a positive improvement in olfactory dysfunction after acupuncture intervention in multiple settings. Challenges highlighted in this review include variability in acupuncture protocols, such as differences in point selection, session frequency, and overall treatment duration, as well as the lack of standardized outcome measures for assessing olfactory function. This systematic review suggests acupuncture may have therapeutic effect on improvement of olfactory function across various types of olfactory disorders, most notably seen in post-viral anosmia. Given the variability in acupuncture protocols and lack of standardized outcome measures, there is a need for further research with standardized methods and larger sample sizes. Olfactory dysfunction is fundamentally a quality-of-life issue; advancing research could solidify acupuncture as a valuable and cost-effective addition to treatment plans, optimizing patient well-being.

Low Lesion Clearance Rates in Neurocysticercosis: Is It Time to Review Guidelines?

The standard treatment guidelines of neurocysticercosis have been described as per computed tomography (CT)-based studies. We aimed to prospectively study if posttreatment magnetic resonance imaging (MRI) clearance rates of neurocysticercosis were like those reported in literature using CT. A prospective observational study in newly diagnosed children with neurocysticercosis was undertaken. Children were treated with antihelminthics and steroids and followed up after 6 months. The primary objective was to study the proportion of children with single-lesion neurocysticercosis who were in radiologic resolution at 6 months and clinical remission (seizure-free for the preceding 3 months). Eighty of 128 consecutive children screened were included (single lesion, 65; multiple lesions, 15). Seventy-two children were evaluated at 6 months. Seizure recurrence was seen in 5 (6.2%). Brain MRI showed an overall clearance of lesions in 10 (14%) children. In the children with single-lesion neurocysticercosis (65), 59 were followed up at 6 months, and lesions resolved in 9 (15.3%, 95% confidence interval of 6.1-24.4). In children with single-lesion neurocysticercosis treated with antihelminthics and corticosteroids, the lesion resolution rate is only 15% at 6 months. Thus, there is a need to review old recommendations and use MRI as a standard outcome measure.

Anesthetic Techniques for Type-1 (Medialization) Thyroplasty: A Scoping Review

ObjectiveTo explore different anesthesia techniques for medialization thyroplasty and determine how these anesthesia techniques may influence patient safety, patient experience, and surgical outcomes during medialization thyroplasty in adult patients. Data SourcesA comprehensive librarian-designed strategy was used to search EMBASE, MEDLINE, and Web of Science for English language studies from database inception to July 2023. The study was registered on Open Science Framework (10.17605/OSF.IO/R3BV2). Review MethodsStudy selection was independently performed by two investigators for all English language studies of adult patients investigating anesthetic techniques for medialization thyroplasty with a minimum of 5 patients. Surgical outcomes (voice, perioperative complications, swallowing), healthcare resource utilization metrics (operating time, length of stay), and patient-reported outcomes measures (PROMs) were analyzed. Study quality was assessed with the Oxford Levels of Evidence tool. ResultsFrom 354 articles, 28 studies were included. The most common anesthetic techniques were combined procedural sedation and local anesthesia (13/28[46%]), local anesthesia alone (8/28 [29%]), and general anesthesia (GA) (7/28 [25%]). Six (6) studies (21%) reported intraoperative complications (e.g., desaturation), and 8 (29%) studies reported postoperative complications (e.g., airway obstruction). Voice outcomes were assessed in 14 (50%) studies. PROMs, including Voice Handicap Index (3/28 [11%]) were less commonly assessed. Intraoperative fiberoptic visualization was utilized in 8 (29%) studies. Only one study assessed swallowing. Only two studies compared outcomes between anesthetic techniques. The median Oxford Level of Evidence was 4. ConclusionMedialization thyroplasty is performed under local anesthetic alone, with combined procedural sedation, and local anesthetic or with GA, with diverse approaches to airway management and minimal perioperative complications. Future research using standardised outcome measures is warranted due to the current paucity in the literature.

Understanding the role of machine learning in predicting progression of osteoarthritis.

Machine learning (ML), a branch of artificial intelligence that uses algorithms to learn from data and make predictions, offers a pathway towards more personalized and tailored surgical treatments. This approach is particularly relevant to prevalent joint diseases such as osteoarthritis (OA). In contrast to end-stage disease, where joint arthroplasty provides excellent results, early stages of OA currently lack effective therapies to halt or reverse progression. Accurate prediction of OA progression is crucial if timely interventions are to be developed, to enhance patient care and optimize the design of clinical trials. A systematic review was conducted in accordance with PRISMA guidelines. We searched MEDLINE and Embase on 5 May 2024 for studies utilizing ML to predict OA progression. Titles and abstracts were independently screened, followed by full-text reviews for studies that met the eligibility criteria. Key information was extracted and synthesized for analysis, including types of data (such as clinical, radiological, or biochemical), definitions of OA progression, ML algorithms, validation methods, and outcome measures. Out of 1,160 studies initially identified, 39 were included. Most studies (85%) were published between 2020 and 2024, with 82% using publicly available datasets, primarily the Osteoarthritis Initiative. ML methods were predominantly supervised, with significant variability in the definitions of OA progression: most studies focused on structural changes (59%), while fewer addressed pain progression or both. Deep learning was used in 44% of studies, while automated ML was used in 5%. There was a lack of standardization in evaluation metrics and limited external validation. Interpretability was explored in 54% of studies, primarily using SHapley Additive exPlanations. Our systematic review demonstrates the feasibility of ML models in predicting OA progression, but also uncovers critical limitations that currently restrict their clinical applicability. Future priorities should include diversifying data sources, standardizing outcome measures, enforcing rigorous validation, and integrating more sophisticated algorithms. This paradigm shift from predictive modelling to actionable clinical tools has the potential to transform patient care and disease management in orthopaedic practice.

Evaluating Educational Patterns and Methods in Infant Sleep Care: Trends, Effectiveness, and Impact in Home Settings-A Systematic Review.

Sleep care is crucial for the health and development of infants, with proper sleep patterns reducing the risk of sudden infant death syndrome (SIDS) and other sleep-related incidents. Educational interventions targeting caregivers are essential in promoting safe sleep practices. This systematic review adhered to PRISMA guidelines, searching databases such as PubMed, MEDLINE, Scopus, and the Cochrane Library. Inclusion criteria focused on studies involving home-based interventions for infants aged 0-12 months, including parental education and behavioral interventions. Exclusion criteria included studies in clinical settings and non-peer-reviewed articles. Data extraction and synthesis were performed by two independent reviewers, using a narrative approach to categorize interventions and outcomes. Twenty-three studies met the inclusion criteria. Key findings indicate that home-based educational interventions, including hospital-based programs, home visits, and mobile health technologies, significantly improve parental knowledge and adherence to safe sleep practices. These interventions also enhance parental satisfaction and contribute positively to infant health outcomes. Educational interventions have demonstrated effectiveness in promoting safe sleep practices among caregivers, particularly in home settings. These interventions, including hospital-based programs, home visits, and digital tools, improve parental knowledge, adherence to guidelines, and overall satisfaction. The impact is evident in the reduction of unsafe sleep behaviors and enhanced infant health outcomes. However, variability in the intervention methods and delivery, cultural contexts, and geographic focus suggest a need for more tailored, long-term, and comprehensive studies. Future research should standardize outcome measures and assess the sustained impact of these educational strategies on infant sleep patterns and caregiver practices over time. This will provide deeper insights into the trends and long-term effectiveness of educational patterns and methods in diverse home environments.

Effects of Sodium-Glucose Cotransporter-2 (SGLT-2) Inhibitors on Health-Related Quality of Life and Exercise Capacity in Heart Failure Patients With a Preserved Ejection Fraction: A Scoping Review.

This scoping review examines the effects of sodium-glucose cotransporter-2 (SGLT-2) inhibitors on health-related quality of life (HRQoL) and exercise capacity in heart failure patients with preserved ejection fraction (HFpEF). Five randomized controlled trials were analyzed, revealing consistent improvements in HRQoL metrics, such as the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and exercise capacity, measured by the six-minute walk distance (6MWD). The findings suggest that SGLT-2 inhibitors significantly enhance physical functioning and overall well-being in HFpEF patients. These benefits align with existing literature on SGLT-2 inhibitors' efficacy in heart failure with reduced ejection fraction (HFrEF), indicating broader applicability across heart failure phenotypes. However, the review highlights the need for long-term studies to confirm sustained benefits and further investigate the underlying mechanisms. Methodological improvements, such as standardized outcome measures, are also recommended to enhance future research robustness. Clinically, these findings advocate for incorporating SGLT-2 inhibitors into HFpEF management strategies, emphasizing their potential to improve patient outcomes and quality of life. Future research should focus on diverse patient populations and long-term effects to optimize the therapeutic use of SGLT-2 inhibitors in HFpEF.

What impact does urinary and anal incontinence have on a woman’s quality of life?

The impact of pelvic floor dysfunction is often far-reaching, and can have a devastating impact on women’s lives. In the past 50 years, the concept of quality of life (QOL) has been increasingly used, but despite acceptance that relevant data are an important metric, there is little mention of it within the available pelvic-health-related grey literature. Therefore, this literature review looks at the published evidence to evaluate the impact that urinary incontinence (UI) and anal incontinence (AI) have on a woman’s QOL. A systematic search was conducted that involved MEDLINE, CINAHL, AMED, Google Scholar, pertinent grey literature and a hand-search of reference lists in relevant papers published in the English language between 2012 and 2022. The inclusion criteria were limited to two elements of pelvic health, i.e. UI and AI, because these are common, definable symptoms, and articles tend to focus on condition-specific, health-related QOL. The literature search was also limited to “titles only” because of the high-volume return rate when “abstract and title” was employed. Among the 418 papers initially identified, five met the eligibility criteria: three were specific to UI; and two focused on AI as a result of obstetric anal sphincter injuries and its impact on QOL. The literature review identified three themes: QOL is negatively affected by UI and AI; UI and AI have a negative impact across the different domains of QoL; and finally, there are geographical variations in UI and AI. It also offered some insight into the risk factors for and the prevalence of UI and AI that was in keeping with current literature. Continence is considered to be among the most basic of needs. These findings support the perception that UI and AI are both prevalent, and have a myriad of far-reaching consequences that negatively impact QOL. The results of this literature review demonstrate that there is a clear need for QOL measures in pelvic health research. However, there is also a need for standardized outcome measures to allow for a greater depth of synthesis, and where possible, meta-analysis. Future research needs to ensure that geographical and ethnicity data are considered and accurately reported in order to gain deeper insights and address known health inequalities. In line with current thinking, health professionals and women themselves should be made aware of the prevalence of and known risk factors for UI and AI so that they can focus on prevention and early recognition to optimize lifelong pelvic health.

Voluntary wheel-running exercise improvement of anxiety or depressive symptoms in different models of depression.

The effects of voluntary wheel-running exercise in different rodent models of depression remain unclear, and further research is needed to fully understand the mechanisms underlying these effects. Therefore, this systematic review aimed to evaluate the currently available findings on whether voluntary wheel-running exercise can alleviate depressive symptoms in five different rodent models of depression. The findings of the comprehensive meta-analysis imply that engaging in voluntary wheel-running exercise has a beneficial effect on alleviating depressive symptoms in rodent models that simulate depression. While further research is needed to fully understand the mechanisms and limitations of this intervention future research should aim to conduct larger. Well-designed studies that use standardized protocols and outcome measures. This would help to reduce heterogeneity between studies and improve the overall quality of the evidence base. Additionally, studies should explore the potential mechanisms of action of voluntary wheel-running exercise in treating depression, such as changes in neurotransmitter levels, neuroplasticity, and inflammation. The results suggest that it may hold promise as an adjunctive therapy for depression.

Defining a core outcome set for hypermobility spectrum disorders and hypermobile Ehlers-Danlos syndrome: A Delphi consensus study

The reported prevalence of hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos Syndrome (hEDS) is unclear due to complex presentations and lack of awareness amongst professionals, contributing to diagnostic and management uncertainties. Standardising an outcome measure to assess symptoms most important to patients should help determine the impact of interventions. This Delphi study aims to reach a consensus with stakeholders on the core outcome set for children and adults with HSD/hEDS. A three-round modified Delphi consensus study with a follow-up consensus meeting was used. Stakeholder groups consisted of (1) individuals with HSD/hEDS; (2) family/friends/carers and (3) healthcare professionals. Participants could belong to more than one stakeholder group. They rated 74 symptoms using a 9-point Likert scale: 1 “not important to 9 “critically important”. Symptoms achieving a consensus rating of ≥ 70.0% critical importance across all groups were included. In Round 1, 766 responses were received from 600 participants, reducing to 566 responses from 438 participants by Round 3, with 53 participating in the consensus meeting. Overall, 30 symptoms met the ≥ 70.0% critically important threshold to be included in the final core outcome set. These were categorised under the specialties of musculoskeletal and orthopaedics, social, pain, gynaecology and urology, negative affect, neurological, gastrointestinal and “other”. This study is the first to identify by consensus the core outcome set to be measured for patients with HSD/hEDS. The importance of these outcomes was confirmed by individuals living with the condition, their family, friends, carers and relevant healthcare professionals. Trial registration: IRAS ID: 326,855; East Midlands — Leicester South REC (reference: 23/EM/0143); Protocol registered with the COMET Initiative. Key Points• There is a lack of standardised outcome measure for HSD/hEDS research studies due to the heterogeneity of symptom presentations.• Symptoms across musculoskeletal and orthopaedics, social, pain, gynaecology and urology, negative affect, neurological, gastrointestinal and “other” specialties were identified as the core outcome set defined as ≥ 70.0% critically important to measure for individuals with HSD/hEDS.• There were a significant number of symptoms, widely recognised in the literature to be comorbid to HSD/hEDS, that reached a critical importance threshold of 50.0–69.9%, restricting the core outcome set to only those that met 70% or above may be limiting.