Tool For Risk Research Articles

A simulation study to quantitatively assess the performance of electronic prescribing systems in English NHS Hospital Trusts

Prescribing errors are a source of preventable harm in healthcare, which may be mitigated using Electronic Prescribing (EP) systems. Anyone who routinely prescribes medication could benefit from digitally assisted automated checks to identify whether a prescription should potentially not be allowed (e.g. drug allergy). National Health Service (NHS) Trusts have implemented a range of EP systems; however, their performance has not hitherto been evaluated. We developed the web-based Electronic Prescribing Risk and Safety Evaluation (ePRaSE) tool, which comprises a bank of prescribing scenarios to evaluate the performance of EP systems. We solicited ePRaSE testing: 68 pharmacists from across 45 English NHS Trusts, utilising 13 different EP systems volunteered for the study. We found considerable variability in mitigation performance (systems correctly identifying risk of error when prescribing) across both NHS Trusts and EP systems. Moreover, we found that mitigation performance varied considerably across NHS Trusts using the same EP system, strongly suggesting there are opportunities to optimise performance within systems. The ePRaSE tool is effective in identifying variability in risk management between NHS Trusts and EP systems. Wider use of this tool may facilitate improvements in EP system configurations, thus minimising potential harm from prescribing errors.

Protective effect of resveratrol on retinal damage in glaucoma: a systematic review and meta-analysis of preclinical studies

IntroductionResveratrol, a polyphenolic compound commonly found in natural plants and fruits, exhibits potential in preventing optic nerve damage in glaucoma, as indicated by several animal studies. However, there is presently a dearth of relevant evidence available for comprehensive summarization.MethodsIn this study, we conducted an extensive search across 7 electronic databases, encompassing all pertinent animal studies for a systematic review and meta-analysis. Methodological quality was evaluated using SYRCLE’s bias risk tool, with statistical analysis performed using Stata 17.0. The primary outcome measures included the survival of retinal ganglion cells and retinal thickness.ResultsThe comprehensive analysis of the 30 included studies revealed that resveratrol can enhance the expression of Sirtuin 1(SIRT1) protein in retinal tissue (SMD: 3.00, 95% CI: 2.46, 3.53, P = 0.095), boost the survival rate of retinal ganglion cells (SMD: 4.33, 95% CI: 3.28, 5.38, P < 0.05), decelerate the thinning of retinal thickness (SMD: 4.26, 95% CI: 2.77, 5.75, P < 0.05), and enhance visual function. Its potential mechanism of action may involve the suppression of pro-inflammatory cytokine levels and cell apoptosis.DiscussionResveratrol emerges as a promising agent for mitigating glaucoma-related retinal damage. However, given that the animal research models utilized in the study may not fully reflect the intricate scenarios of multiple coexisting diseases in clinical settings, and the administration methods in animal models may differ from those in clinical practice, future studies should aim to provide higher levels of evidence to facilitate the clinical translation of these findings.Systematic Review Registration:identifier [CRD42024535673].

Automated Volumetric Milling Area Planning for Acoustic Neuroma Surgery via Evolutionary Multi-Objective Optimization

Mastoidectomy is critical in acoustic neuroma surgery, where precise planning of the bone milling area is essential for surgical navigation. The complexity of representing the irregular volumetric area and the presence of high-risk structures (e.g., blood vessels and nerves) complicate this task. In order to determine the bone area to mill using preoperative CT images automatically, we propose an automated planning method using evolutionary multi-objective optimization for safer and more efficient milling plans. High-resolution segmentation of the adjacent risk structures is performed on preoperative CT images with a template-based approach. The maximum milling area is defined based on constraints from the risk structures and tool dimensions. Deformation fields are used to simplify the volumetric area into limited continuous parameters suitable for optimization. Finally, a multi-objective optimization algorithm is used to achieve a Pareto-optimal design. Compared with manual planning on six volumes, our method reduced the potential damage to the scala vestibuli by 29.8%, improved the milling boundary smoothness by 78.3%, and increased target accessibility by 26.4%. Assessment by surgeons confirmed the clinical feasibility of the generated plans. In summary, this study presents a parameterization approach to irregular volumetric regions, enabling automated milling area planning through optimization techniques that ensure safety and feasibility. This method is also adaptable to various volumetric planning scenarios.

Development and validation of a risk prediction model for acute kidney injury in coronary artery disease

BackgroundAcute Kidney Injury (AKI) is a sudden and often reversible condition characterized by rapid kidney function reduction, posing significant risks to coronary artery disease (CAD) patients. This study focuses on developing accurate predictive models to improve the early detection and prognosis of AKI in CAD patients.MethodsWe used Electronic Health Records (EHRs) from a nationwide CAD registry including 54 429 patients. Initially, univariate analysis identified potential predictors. Subsequently, a stepwise multivariate logistic model integrated clinical significance and data distribution. To refine predictor selection, we applied a random forest algorithm. The top 10 variables, including admission to the surgical department, EGFR, hemoglobin, and others, were incorporated into a logistic regression-based prediction model. Model performance was assessed using the area under the curve (AUC) and calibration analysis, and a nomogram was developed for practical application.ResultsDuring hospitalization, 2,112 (3.88%) patients in the overall population of both the development and validation groups experienced AKI within 30 days. The final prediction model exhibited strong discrimination with an AUC of 0.867 (95% CI: 0.858 to 0.876) and well calibration capability in both the development and validation groups. Key predictors included surgical department admission, eGFR, hemoglobin, chronic kidney disease history, male sex, white blood cell count, age, left ventricular ejection fraction, acute myocardial infarction at admission, and congestive heart failure history. Bootstrap resampling confirmed model stability (Harrell's optimism-correct AUC = 0.866). The nomogram provided a practical tool for AKI risk assessment.ConclusionThis study introduced a refined AKI risk prediction model for CAD patients. This model showed adaptability to subgroups and held the potential for early AKI alerts and personalized interventions, thereby enhancing patient care.

Lipid Accumulation Product Outperforms BMI and Waist Circumference in Metabolic Disorders.

Background and Objective: Obesity is a global health issue intricately linked to metabolic syndrome (MetS), insulin resistance, and dyslipidemia. Anthropometric indices, particularly those measuring central obesity, have emerged as more reliable predictors of these metabolic disorders than general obesity indices such as body mass index (BMI). However, the relative predictive power of these indices remains debated, particularly across sexes. This study aimed to evaluate the discriminative performance of various anthropometric measures, including lipid accumulation product (LAP), BMI, waist circumference (WC), and visceral adiposity index (VAI), in predicting insulin sensitivity, β-cell function, MetS, and dyslipidemia using National Health and Nutritional Evaluation Survey III (NHANES III) data. Methods: A cross-sectional analysis of 3,706 adults from the NHANES III database was conducted. Anthropometric indices were compared against insulin sensitivity Homeostasis Model Assessment (HOMA)-S, β-cell function (HOMA-B), metabolic syndrome (MetS) status, and dyslipidemia. Receiver-operating characteristic (ROC) curves and linear regression models were used to identify thresholds for predicting metabolic abnormalities. Results: LAP emerged as the most discriminative index across all outcomes, outperforming BMI and WC, particularly in predicting insulin sensitivity and β-cell function in males. In females, BMI was superior in predicting β-cell function. VAI demonstrated the strongest association with dyslipidemia but was less effective in predicting insulin resistance. Conclusion: LAP significantly outperforms conventional anthropometric indices in identifying insulin resistance and MetS, highlighting its potential as a screening tool for cardiometabolic risk. Gender differences in the predictive abilities of these measures suggest that BMI may retain value in assessing β-cell function in females. VAI should be considered when screening for dyslipidemia but is less effective for insulin resistance.

Evaluating the Exposome Score for Schizophrenia in a Transdiagnostic Psychosis Cohort: Associations With Psychosis Risk, Symptom Severity, and Personality Traits.

Investigations of causal pathways for psychosis can be guided by the identification of environmental risk factors. A recently developed composite risk tool, the exposome score for schizophrenia (ES-SCZ), which controls for intercorrelations between risk factors, has shown fair to good performance. We tested the transdiagnostic psychosis classifier performance of the ES-SCZ with the Bipolar-Schizophrenia Network for Intermedial Phenotypes data and examined its relationship with clinical-level outcomes. We computed the case-control classifier performance for the ES-SCZ from cross-sectional data on 1055 volunteers with psychotic diagnoses (schizophrenia, schizoaffective, bipolar psychosis) and 510 controls. Multivariate regression models were used to control for the correlations between outcomes and to correct for the effects of age, sex, and family socioeconomic status across outcomes. We estimated association for the ES-SCZ with psychosis and mood symptom severity, the 5-factor model of personality, and function across biologically defined biotypes, traditional diagnostic categories, and controls. ES-SCZ classifier performance for psychosis was fair to good. ES-SCZ associations with personality factor scores were qualitatively similar between psychosis groups and controls with decreased conscientiousness and agreeableness and increased neuroticism. The patterns of associations between ES-SCZ and symptoms differed across biotypes and diagnoses. Biotype 3 and bipolar disorder had consistent within-group associations where greater exposome score predicted more severe symptoms and worse function. ES-SCZ performance was consistent with previous reports in this transdiagnostic psychosis sample (adjusted odds ratio: 3.331 [2.834, 3.915], P < .001; area under the curve: 0.762 [0.735, 0.789]). Individual differences in ES-SCZ magnitude may be useful for investigating causal pathways between developmentally relevant exposures and symptomatic expression of psychosis.

Emergency and postoperative access to critical and enhanced care: a multicentre prospective observational study.

The ability to admit patients to enhanced or critical care may be limited by bed availability. In a network with low provision of critical and enhanced care beds, we aimed to assess the proportion of patients having surgery with moderate (1%-< 5%) or high (≥ 5%) predicted risk of 30-day postoperative mortality and their postoperative care location. We also aimed to study referral and admission outcomes to critical care. This prospective, 7-day observational study was conducted across 19 acute hospital sites within the South West Critical Care Network. All adult inpatients having a procedure under the care of an anaesthetist (excluding cardiac and obstetric procedures) had a surgical outcome risk tool score calculated retrospectively, and their postoperative destination captured. Synchronously, all critical care referrals, admissions and refusal decisions were captured, along with critical care bed capacity. Of 2222 eligible patients, 1728 (78%) were captured. Retrospective surgical outcome risk tool score calculation revealed 1060 (61%) patients had a low, 418 (24%) a moderate and 250 (15%) a high risk of postoperative mortality. In patients with a moderate predicted risk of postoperative morbidity, 72/418 (17%) received enhanced or critical care and 64/249 (26%) patients with a high predicted risk received critical care. All critical care referral and admission activity was captured; in total, 263/680 (39%) of patients referred were admitted to critical care. Referrals to critical care exceeded the available level 3-equivalent beds on 79% of occasions. These data describe constraints in access to postoperative and emergency enhanced/critical care in the south-west of England. There is poor compliance with national guidance regarding the postoperative care location of patients with a moderate or high risk of postoperative mortality.

PRP Injections for the Treatment of Knee Osteoarthritis: The Improvement Is Clinically Significant and Influenced by Platelet Concentration: A Meta-analysis of Randomized Controlled Trials

Background: Platelet-rich plasma (PRP) has emerged as a promising therapeutic intervention for knee osteoarthritis (OA), attracting substantial clinical and research attention. However, the clinical relevance of the treatment benefit remains controversial. Purpose: To evaluate the effectiveness of PRP compared with placebo in patients with knee OA in terms of minimal clinically important difference (MCID) and to investigate the possible influence of platelet concentration on the clinical outcome. Study Design: Meta-analysis. Level of evidence 1. Methods: The search was conducted on 5 databases (PubMed, Cochrane Library, Scopus, Embase, Web of Science) using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were randomized controlled trials comparing PRP and placebo injections to treat knee OA, written in the English language, with no time limitation. The effects were quantified at 1-, 3-, 6-, and 12-month follow-up points. Visual analog scale (VAS) for pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used, with subanalyses based on platelet concentration performed using a 1,000,000 ± 20% platelets/µL cutoff. The MCID values (VAS, 1.37; WOMAC, 6.4) were used to interpret clinical improvement. The articles’ quality was assessed using the Revised Tool for Risk of Bias in Randomized Trials and the Grading of Recommendations Assessment, Development and Evaluation guidelines. Results: Among the 5499 articles retrieved, 18 randomized controlled trials (1995 patients) were included. PRP presented statistically superior improvements in VAS and WOMAC scores compared with placebo at all follow-up points, exceeding the MCID at 3- and 6-month follow-up points for VAS and at all follow-up points for WOMAC. The subanalysis based on platelet concentration showed that high-platelet PRP provided clinically significant pain relief with the improvement exceeding the MCID compared with placebo at 3-, 6-, and 12-month follow-up points. In contrast, low-platelet PRP failed to offer a clinically perceivable benefit in terms of VAS score. WOMAC results showed that both products provided a clinically significant improvement at 3 and 6 months of follow-up. This benefit was maintained up to the 12-month follow-up in the high-platelet group but not in the low-platelet group, where the improvement compared with placebo did not reach statistical significance. Conclusion: This meta-analysis showed that PRP offered clinically relevant functional improvement at 1-, 3-, 6-, and 12-month follow-up points and pain relief at 3- and 6-month follow-up points compared with placebo for the treatment of knee OA. Platelet concentration was found to influence treatment efficacy, with high-platelet PRP providing superior pain relief and more durable functional improvement compared with low-platelet PRP.

Dual task iTUG to investigate increased fall risk among older adults with bilateral hearing loss.

To investigate fall risk among older adults with bilateral sensorineural hearing loss (BHL) by comparing single task (ST) and dual task (DT) performance on the instrumented "Timed Up & Go" test (iTUG). The TUG is a well-validated clinical tool for fall risk; addition of wireless sensors increases the test's sensitivity and allows for subcomponent analysis. Adults with audiometrically confirmed normal hearing or BHL were prospectively recruited and screened for visual, musculoskeletal, neurologic, or vestibular pathology and Dizziness Handicap Inventory (DHI)<10. Total and sub-component iTUG data in the ST and DT condition (serial subtraction) was collected. 35 adults (50-78years) were included: 20 (mean 69years) with BHL and 15 controls (mean age 63years). Total iTUG duration did not differ between groups in either the ST or DT condition. In sit-to-stand, BHL were significantly slower than controls (p<0.03) in both ST and DT conditions. In the final subcomponent (stand-to-sit), a significant interaction was observed such that the BHL group were significantly slower with DT compared to the control group. BHL performed slower on sub-component analysis of the iTUG compared with age-matched normal hearing controls. Slower times on the final iTUG phase for BHL may suggest a lower threshold for attentional capacity that may be cumulative. Further investigation into the impact of treatment (including amplification and training) is warranted.

Simplifying coronary artery disease risk stratification: development and validation of a questionnaire-based alternative comparable to clinical risk tools.

Coronary artery disease (CAD) comprises one of the leading causes of morbidity and mortality both in the European population and globally. All established clinical risk stratification scores and models require blood lipids and physical measurements. The latest reports of the European Commission suggest that attracting health professionals to collect these data can be challenging, both from a logistic and cost perspective, which limits the usefulness of established models and makes them unsuitable for population-wide screening in resource-limited settings, i.e., rural areas. Therefore, the aim of this study was to develop and externally validate a questionnaire-based risk stratification model on a population scale at minimal cost, i.e., the Questionnaire-Based Evaluation for Estimating Coronary Artery Disease (QUES-CAD) to stratify the 10-year incidence of coronary artery disease. Cox proportional hazards (CoxPH) and Cox gradient boosting (CoxGBT) models were trained with 10-fold cross-validation using combinations of ten questionnaire variables on the White population of the UK Biobank (n=448,818) and internally validated the models in all ethnic minorities (n=27,433). The Lifelines cohort was employed as an independent external validation population (n=97,770). Additionally, we compared QUES-CAD's performance, containing only questionnaire variables, to clinically established risk prediction tools, i.e., Framingham Coronary Heart Disease Risk Score, American College of Cardiology/American Heart Association pooled cohort equation, World Health Organization cardiovascular disease risk charts, and Systematic Coronary Risk Estimation 2 (SCORE2). We conducted partial log-likelihood ratio (PLR) tests and C-index comparisons between QUES-CAD and established clinical prediction models. In the external validation set, QUES-CAD exhibited C-index values of CoxPH: 0.692 (95% Confidence Interval [CI]: 0.673-0.71) and CoxGBT: 0.699 (95% CI: 0.681-0.717) for the male population and CoxPH: 0.771 (95% CI: 0.748-0.794) and CoxGBT: 0.759 (95% CI: 0.736-0.783) for the female population. The addition of measurement-based variables and variables that require a prior medical examination (i.e., insulin use, number of treatments/medications taken, prevalent cardiovascular disease [other than CAD, and stroke diagnosed by a doctor]) and the further addition of biomarkers/other measurements (i.e., high-density lipoprotein [HDL] cholesterol, total cholesterol, and glycated haemoglobin) did not significantly improve QUES-CAD's performance in most instances. C-index comparisons and PLR tests showed that QUES-CAD performs and fits the data at least as well as the clinical prediction models. QUES-CAD performs comparably to established clinical prediction models and enables a population-wide identification of high-risk individuals for CAD. The model developed and validated herein relies solely on ten questionnaire variables, overcoming the limitations of existing models that depend on physical measurements or biomarkers. University Medical Center Groningen.

MSC-Derived Extracellular Vesicles Against Pulmonary Fibrosis of Rodent Model: A Meta-Analysis.

Pulmonary fibrosis (PF) is a fatal disease distinguished by structural destruction and dysfunction, accompanied by continuous accumulation of fibroblasts, which eventually leads to lung failure. Preclinical studies have shown that the administration of mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) may be a safe and effective treatment for PF. The purpose of our meta-analysis is to evaluate the efficacy of MSC-EVs therapy and identify therapeutic aspects related to PF. Our study (up to April 6, 2022) identified English and Chinese, preclinical, controlled, and in vivo studies to examine the application of MSC-EVs in the treatment of PF. The risk of bias (ROB) is assessed using the SYRCLE bias risk tool. The primary outcomes include collagen content, α-smooth muscle actin (α-SMA), hydroxyproline (HYP) content, and transforming growth factor-β1 (TGF-β1). Thirteen studies were included in this meta-analysis. Ten studies evaluated the collagen content, five studies evaluated the α-SMA, five studies evaluated the HYP content, and six studies evaluated the TGF-β1. Compared to the control group, MSC-EVs therapy was associated with a significant reduction of collagen accumulation, α-SMA, HYP content, and TGF-β1. The administration of MSC-EVs is beneficial for the treatment of rodent PF models. However, the safety and effectiveness of the application in human PF diseases have yet to be confirmed. The application of MSC-EVs in the treatment of PF needs to be further standardized in terms of source, route of administration, and culture method.

Polygenic Score Approach to Predicting Risk of Metabolic Syndrome

Background/Objectives: Metabolic syndrome (MetS) is a complex condition linking obesity, diabetes, and hypertension, representing a major challenge in clinical care. Its rising global prevalence, driven by urbanization, sedentary lifestyles, and dietary changes, underscores the need for effective management. This study aims to explore the genetic mechanisms behind MetS, including adiposity, inflammation, neurotransmitters, and β-cell function, to develop a prognostic tool for MetS risk. Methods: We genotyped 40 genetic variants across these pathways in 279 MetS patients and 397 healthy individuals. Using logistic regression, we evaluated the prognostic capability of a polygenic score model for MetS risk, both independently and with other factors like sex and age. Results: Logistic regression analysis identified 18 genetic variants significantly associated with MetS. The optimal predictive model used polygenic scores calculated with weights assigned to the 18 loci (AUC 82.5%, 95% CI 79.4–85.6%), with age and sex providing a minimal, non-significant improvement (AUC 83.3%, 95% CI 80.2–86.3%). The addition of the polygenic score significantly improved net reclassification (NRI = 1.03%, p = 3.42 × 10−50). Including all 40 variants did not enhance prediction (NRI = −0.11, p = 0.507). Conclusions: Polygenic scores could aid in predicting MetS risk and health outcomes, emphasizing the need for diagnostic tools tailored to specific populations. Additional research is warranted to corroborate these conclusions and explore the molecular mechanisms of MetS.

Validation of a High Bleeding Risk Definition in Cancer Patients undergoing Percutaneous Coronary Intervention.

Due to the absence of validated bleeding risk tools in cancer patients undergoing percutaneous coronary intervention (PCI), we aimed to validate an adapted version of the Academic Research Consortium (ARC) High Bleeding Risk (HBR) criteria. Consecutive patients with active or remission cancer undergoing PCI between 2012 and 2022 at Mount Sinai Hospital (New York, USA) were included. Patients were considered at HBR if they met at least one of the major ARC-HBR criteria, other than cancer, or two minor criteria.The primary endpoint was a composite of periprocedural in-hospital or post-discharge bleeding at 1 year. The key secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE), including death, myocardial infarction, or stroke. Of the 2,007 cancer patients included in this study, 1,142 (56.9%) were classified as HBR. Moderate to severe anemia was the most prevalent major HBR criterion (35%). At 1 year, the incidence of bleeding was significantly higher in HBR compared to non-HBR patients (10.9% vs. 3.9%, adj. HR: 2.36, 95% CI: 1.57-3.53, p<0.001), mainly driven by higher periprocedural bleeding. Similarly, HBR patients were at higher risk of MACCE (11.0% vs. 3.2%, adj. HR: 2.78, 95% CI: 1.72-4.47, p<0.001) and death (8.8% vs. 2.2%, adj. HR: 3.28, 95% CI: 1.87-5.77, p<0.001) than non-HBR patients. An adapted version of the ARC-HBR criteria, in which cancer is not a major criterion, effectively delineates cancer patients undergoing PCI who are at HBR. Cancer patients at HBR according to this definition also exhibited a higher mortality risk. .

Incorporating Training Prescription from a Countermovement Jump-based Algorithm Does Not Improve Jump Performance

Countermovement jump (CMJ) testing is a commonly used, effective tool for monitoring performance, neuromuscular fatigue, and injury risk. Force plates can provide information about jump performance including power, explosiveness, and interlimb asymmetry. Embedded human performance (HP) teams focus on preparing military personnel to meet the physical demands of their occupations, and with the implementation of CMJ monitoring; they can work towards eliminating the risk of musculoskeletal injuries (MSKI). The purpose of this study was twofold: 1) Determine whether the intervention exercises prescribed by Sparta Science training program changed an individual’s jump performance over a 10-week training program and 2) Evaluate how Sparta strength training recommendations impacted other performance metrics over the training program. This study included 31 active-duty Air Force personnel who completed a 10-week, concurrent training program with pre- and post-testing. Sparta jump height increased by 2.11 centimeters on average. Lower body anaerobic capacity improved as evidenced by significant lower body wingate relative (W/kg) (p=0.022) and absolute power (W) (p=0.045) increases from pre- to post-testing. The results of this study indicated that practitioners are not likely to achieve optimal results for either injury risk or jump performance by following Sparta’s training suggestions. Instead, these results indicate that the appropriate training program recommendations include focus on the specific needs of an individual, to include strength, power, and force-developing exercises to elicit optimal jump and performance metric outcomes.

Major clinical approaches to endodontic treatment in the treatment scenario of patients with head and neck cancer: a systematic review

Introduction: In the context of endodontic treatments and cancer, head and neck squamous cell carcinoma is the 6th most common form of cancer in the world, with more than 400,000 deaths annually. The great challenge is endodontic treatment after radiotherapy processes. Furthermore, the promising applications of exosomes in targeted therapy and we propose future directions for the use of exosomes in clinical and endodontic treatment. Objective: The present study developed a systematic review to elucidate the main clinical approaches to endodontic treatment in the treatment scenario of patients with head and neck cancer. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from July to September 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 124 articles were found, 35 articles were evaluated in full and 20 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=89.2%&lt;50%. It was concluded that biomechanical preparation using a reciprocating system and 2.5% NaOCl in irradiated teeth demonstrated efficacy in reducing endodontic contaminants. Moreover, Ca(OH)2 as intracanal medication should be performed in irradiated patients with infected root canals. Also, radiotherapy causes changes in pulp behavior patterns in the short term; however, recovery and return to mean values occur after long periods. The probiotic SsK12 significantly reduced the incidence, onset, and duration of severe oral mucositis with a good safety profile. Artificial intelligence has valuable applications in the field of modern endodontics with promising results, especially in endodontic treatments in patients with head and neck cancer.

Major clinical findings on the types of impressions used in implant-supported prostheses: a systematic review

Introduction: The key to obtaining perfect prostheses depends on the passive fit between its connector and the implant itself. The compromised fit between the contact surfaces of implant-supported prostheses creates uncontrolled stresses in the components and peri-implant tissues, evoking biological and mechanical complications. Objective: It was to review the scientific literature on the types of impression used in implant prostheses. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from July to August 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 111 articles were found, and 44 articles were evaluated in full, and 23 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 06 studies with a high risk of bias and 31 studies that did not meet GRADE. Minimizing contraction appears to be the most important factor in ensuring an accurate impression for this technique. Digital printing has achieved high patient acceptance, reduces possible impression and master mold errors, reduces time in the chair, provides a three-dimensional image of the preparation, and ease of communication between the clinician and the laboratory. However, there is a dearth of scientific data regarding implant fingerprints and their accuracy. Research on implant fingerprinting has been limited to a few in vitro studies and case reports.

Effectiveness of Leisure-Focused Occupational Therapy Interventions in Middle-Aged and Older People with Mild Cognitive Impairment: A Systematic Review.

Background/Objectives: This systematic review aimed to evaluate and synthesize scientific evidence on occupational therapy (OT) interventions focused on leisure activities to improve activities of daily living (ADLs) and cognitive function in middle-aged and older people with mild cognitive impairment (MCI). Methods: A systematic review was carried out following the guidelines established by the PRISMA statement. The study was registered in the PROSPERO database. Four databases were used for the literature search process (Scopus, Web of Science, Medline/PubMed, ScienceDirect), and selected results were assessed using standard tools for risk of bias and certainty of evidence with GRADEpro. Results: Of 169 records identified in the databases, 7 studies with a total of 620 middle-aged and older people (44.9% female) with a mean age of 77.5 years were analyzed using the PICOS format. The meta-analysis of the Mini-Mental State Examination (MMSE) revealed no significant improvements in cognitive function (p > 0.05). Individual studies reported varied results on ADL among people with MCI, with some demonstrating significant improvements following leisure interventions, while others found no notable differences between groups (p > 0.05). Conclusions: OT interventions did not significantly improve MMSE of the overall cognitive function and ADL performance in middle-aged and older people with MCI. Therefore, further studies detailing the dosage of interventions are needed.

Complications and blood loss after invasive treatments for small renal masses: A systematic review.

This systematic review and meta-analysis provides estimates of major complications and blood loss for open partial nephrectomy, conventional laparoscopic partial nephrectomy, and robot-assisted partial nephrectomy. Additionally, it outlines the incidence of major complications associated with percutaneous thermal ablation in patients with small renal masses. We searched MEDLINE, EMBASE, and CINAHL from inception to the end of July 2023. We supplemented the electronic search with a hand search of references in the included studies and suggestions from two content experts. We used random effect meta-analysis to obtain pooled estimates of major complications and blood loss. We used the QUIPS tool for risk of bias assessment and applied a prognosis approach to rate the quality of evidence using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) framework. We included 65 eligible studies that provided pooled estimates of major complications after open partial nephrectomy of 5.4% (95% confidence interval [CI] 2.9-9.9); after conventional laparoscopic partial nephrectomy of 4.7% (95% CI 2.6-8.3); after robot-assisted partial nephrectomy of 2.9% (95% CI 2.2-3.7); and after thermal ablation of 2.9% (95% CI 2.3-3.8). Pooled estimates demonstrating mean estimated blood loss of 262 ml (95% CI 200-324) for open partial nephrectomy; 224 ml (95% CI 193-254) for conventional laparoscopic partial nephrectomy; and 163 ml (95% CI 136-190) for robot-assisted partial nephrectomy. This review provides the best available estimates of major complications and mean blood loss after partial nephrectomy in patients with small renal masses.

Effects of probiotic supplementation on the anthropometric nutritional status of patients with type 2 Diabetes mellitus: A systematic review and meta-analysis protocol.

Diabetes mellitus (DM) is characterized by hyperglycemia due to insufficient insulin production or utilization. Previous studies have shown a relationship between the gut microbiota and DM, driving interest in probiotic supplementation to modulate the microbiota and glucose metabolism in patients with DM, although the exact mechanisms remain unclear. Probiotics can influence metabolic factors and improve the composition of the microbiota, possibly helping to reduce weight in patients with DM. The objective of this review is to compile and analyze the most relevant evidence on the effects of probiotic supplementation on the nutritional anthropometric status of patients with type 2 Diabetes mellitus (T2DM). Methodological guidelines will be followed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the study has been registered in the International Prospective Register of Systematic Reviews under reference number CRD42023480243. Studies will be selected through an active search of the PubMed, Science Direct, and SCOPUS databases using the following search descriptors: gut microbiota, body weight, and metabolic diseases, according to medical subject headings. The assessment of the methodological quality of the studies will be carried out using the Cochrane Collaboration instrument. The risk of bias will be analyzed using the Revised Cochrane tool for risk of bias in randomized controlled trials (RoB 2). A meta-analysis will be performed if heterogeneity is acceptable and justifiable; otherwise, the results will be presented in a qualitative narrative synthesis. The results of probiotic supplementation are expected to demonstrate improvements in anthropometric parameters such as body weight, BMI and abdominal and waist circumference in patients with T2DM, thus providing valuable evidence for clinical application.

Automated derivation of diagnostic criteria for lung cancer using natural language processing on electronic health records: a pilot study

BackgroundThe digitisation of healthcare records has generated vast amounts of unstructured data, presenting opportunities for improvements in disease diagnosis when clinical coding falls short, such as in the recording of patient symptoms. This study presents an approach using natural language processing to extract clinical concepts from free-text which are used to automatically form diagnostic criteria for lung cancer from unstructured secondary-care data.MethodsPatients aged 40 and above who underwent a chest x-ray (CXR) between 2016 and 2022 were included. ICD-10 and unstructured data were pulled from their electronic health records (EHRs) over the preceding 12 months to the CXR. The unstructured data were processed using named entity recognition to extract symptoms, which were mapped to SNOMED-CT codes. Subsumption of features up the SNOMED-CT hierarchy was used to mitigate against sparse features and a frequency-based criteria, combined with univariate logarithmic probabilities, was applied to select candidate features to take forward to the model development phase. A genetic algorithm was employed to identify the most discriminating features to form the diagnostic criteria.Results75002 patients were included, with 1012 lung cancer diagnoses made within 12 months of the CXR. The best-performing model achieved an AUROC of 0.72. Results showed that an existing ‘disorder of the lung’, such as pneumonia, and a ‘cough’ increased the probability of a lung cancer diagnosis. ‘Anomalies of great vessel’, ‘disorder of the retroperitoneal compartment’ and ‘context-dependent findings’, such as pain, statistically reduced the risk of lung cancer, making other diagnoses more likely. The performance of the developed model was compared to the existing cancer risk scores, demonstrating superior performance.ConclusionsThe proposed methods demonstrated success in leveraging unstructured secondary-care data to derive diagnostic criteria for lung cancer, outperforming existing risk tools. These advancements show potential for enhancing patient care and results. However, it is essential to tackle specific limitations by integrating primary care data to ensure a more thorough and unbiased development of diagnostic criteria. Moreover, the study highlights the importance of contextualising SNOMED-CT concepts into meaningful terminology that resonates with clinicians, facilitating a clearer and more tangible understanding of the criteria applied.