Type Of Study Design Research Articles

Coronary flow reserve predicts response to anti-ischaemic therapy in patients with angina with non-obstructive coronary arteries

Abstract Background Half of all patients with angina have non-obstructive coronary arteries (ANOCA) and therapy is often empirical. The CorMicA trial showed improved symptom scores with a physiology-guided approach but the mechanistic relationship between physiological classification and outcome remains unclear. Purpose To assess if invasively assessed coronary flow reserve (CFR) can predict change in exercise time (ET) and angina-specific quality of life (QOL) in response to anti-ischaemic therapy in patients with ANOCA. Methods Prospective, randomised, crossover trial of consecutively evaluated patients with ANOCA. Inclusion criteria: (i) typical and limiting angina; (ii) non-obstructive coronary arteries (fractional flow reserve >0.80); (iii) normal left ventricular systolic function. Coronary physiological assessment was performed using a pressure and Doppler dual sensor-tipped wire in the left anterior descending artery and microvascular dysfunction defined a priori as CFR<2.5 in response to intravenous Adenosine. Patients, clinicians, and researchers were blinded to coronary physiology data. All patients were then sequentially treated with Amlodipine and Ranolazine (in a randomised order), in 4 week blocks with 1 week washout (Figure 1). The outcome measures are 1) Primary (objective): change in ET on exercise stress testing and 2) Secondary (subjective): change in angina-specific QOL on Seattle Angina Questionnaire (SAQ). Data are presented as mean±SD or median (IQR). Results Sixty-six patients with ANOCA were enrolled into the study [62±8 years, 64% females, CCS 3 (2, 3)]; eight patients were excluded. Forty patients had an impaired CFR (2.0±0.3), whilst 18 patients had normal CFR (3.1±0.6), with similar baseline ET (324±133 vs 321±136 seconds, respectively; p=0.94). Patients with an impaired CFR improved their exercise capacity with Ranolazine (ΔET 70±108 seconds; p<0.01) and Amlodipine (ΔET 70±82 seconds; p<0.01). However, there was no such improvement in patients with normal CFR, with either Ranolazine (ΔET 16±88 seconds; p=0.49) or Amlodipine (ΔET 21±59 seconds; p=0.18) (Figure 2). There was no evidence of a training effect (ΔET between visit 1 and visit 4 was 15±112 seconds; p=0.57). Angina-specific QOL improved in patients with impaired CFR [Ranolazine ΔSAQ 12±18 (p<0.01) and Amlodipine ΔSAQ 8±13 (p<0.01)]; the change in SAQ was less marked in patients with normal CFR [Ranolazine ΔSAQ 7±14 (p=0.07) and Amlodipine ΔSAQ 6±10 (p=0.03)]. Conclusion Patients with impaired CFR demonstrated an improved exercise capacity, whereas patients with normal CFR did not. CFR-guided management of ANOCA is likely to be superior to an empirical strategy. This type of physiology-blinded study design could act as a template for future therapy trials in patients with stable angina.Study design for therapeutic trialResponse to anti-ischaemic therapy

Nursing Support for Nausea and Vomiting in Patients With Cancer: A Scoping Review.

Nausea and vomiting are symptoms commonly experienced by patients with advanced cancer and have a wide range of causes, including pharmacological interventions. Additionally, multiple factors often simultaneously cause nausea and vomiting. These highly distressing symptoms may be directly or indirectly related to the disease and can significantly impact both the physical and psychological well-being of patients. This study aims to identify the nursing support provided to reduce nausea and vomiting experienced by patients with cancer. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist and Arksey and O'Malley's framework. We searched the PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Central Register of Controlled Trials in the Cochrane Library, and the Ichushi-Web of the Japan Medical Abstract Society databases for all content published from the inception of each database through July 31, 2023. A total of 4,625 scientific articles were identified after literature screening. In total, 58 articles were included for full-text review, and 10 articles were finally selected for review. The types of study designs comprised six randomized controlled trials, three prospective observational studies, and one before-after study with no controls. The types of cancers included in the articles were colorectal, breast, lung, pancreatic, gynecological, stomach, and sarcoma. The total sample size of the study population was 793 patients (range = 12-281) for intervention studies and 4,333 patients (range = 20-4,197) for observational studies. Nursing support, extracted from the 10 articles, was classified into the following six types: massage therapy, acupressure, early palliative care, psychosocial support, self-symptom monitoring, and coordinated care. The review yielded six classifications of nursing support for nausea and vomiting in cancer patients. Future research should examine the feasibility of providing nursing support for nausea and vomiting in cancer patients.

5 Meta-Analysis of Cognitive Functioning Following Non-Severe COVID-19 Infection

Objective:To effectively diagnose and treat cognitive post-COVID-19 symptoms, it is important to understand objective cognitive difficulties across the range of acute COVID-19 severity. The aim of this meta-analysis is to describe objective neuropsychological test performance in individuals with non-severe (mild/moderate) COVID-19 cases in the post-acute stage of infection (>28 days after initial infection).Participants and Methods:This meta-analysis was pre-registered with Prospero (CRD42021293124) and utilized the PRISMA reporting guidelines, with screening conducted by at least two independent reviewers for all aspects of the screening and data extraction process. Inclusion criteria were established before the article search and were as follows: (1) Studies using adult participants with a probable or formal and documented diagnosis of COVID-19 in the post-acute stage of infection; (2) Studies comparing cognitive functioning using objective neuropsychological tests in one or more COVID-19 groups and a comparison group, or one group designs using tests with normative data; (3) Asymptomatic, mild, or moderate cases of COVID-19. Twenty-seven articles (n=18,202) with three types of study designs and three articles with additional longitudinal data met our full criteria.Results:Individuals with non-severe initial COVID-19 infection demonstrated worse cognitive performance compared to healthy comparison participants (d=-0.412 [95% CI, -0.718, -0.176)], p=0.001). We used metaregression to examine the relationship between both average age of the sample and time since initial COVID-19 infection (as covariates in two independent models) and effect size in studies with comparison groups. There was no significant effect for age (b=-0.027 [95% CI (0.091, 0.038)], p=0.42). There was a significant effect for time since diagnosis, with a small improvement in cognitive performance for every day following initial acute COVID-19 infection (b=0.011 [95% CI (0.0039, 0.0174)], p=0.002). However, those with mild (non-hospitalized) initial COVID-19 infections performed better than did those who were hospitalized for initial COVID-19 infections (d=0.253 [95% CI (0.372, 0.134)], p<0.001). For studies that used normative data comparisons, there was a small, non-significant effect compared to normative data (d=-0.165 [95% CI (-0.333, 0.003)], p=0.055).Conclusions:Individuals who have recovered from non-severe cases of COVID-19 may be at risk for cognitive decline or impairment and may benefit from cognitive health interventions.

Comparison of the diagnostic value of 18F-NaF PET/CT and 99mTc-MDP SPECT for bone metastases: a systematic review and meta-analysis.

Bone scintigraphy, the standard tool for detecting bone metastases has some insufficiencies; thus, supplementary imaging techniques are needed. This study is a comprehensive meta-analysis of studies reporting and comparing the diagnostic efficacy of 18F-sodium fluoride (18F-NaF) positron emission tomography/computed tomography (PET/CT) and 99mTc-MDP single-photon emission computed tomography (SPECT) for bone metastases. Literature related to the diagnosis of bone metastases using 18F-NaF PET/CT and 99mTc-MDP SPECT was searched on PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang databases, and VIP. Evaluation of study quality was performed according to Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Pooled sensitivity (SEN) and specificity (SPE) were assessed along with heterogeneity. The subject operating characteristic curve was plotted, the area under the curve (AUC) was calculated, and the pre- and post-test probabilities were compared. Finally, 11 articles, consisting of 1,085 patients and 1,782 lesions, were included. At the patient level (11 articles), the results were pooled SEN =0.92 and SPE =0.96 for PET/CT, SEN =0.80 and SPE =0.90 for SPECT. The AUC of PET/CT [0.98 (0.96-0.99)] was higher than that of SPECT [0.92 (0.89-0.94), P<0.05]. At the lesion level (6 articles), the results were pooled SEN =0.96 and SPE =0.98 for PET/CT, SEN =0.76 and SPE =0.94 for SPECT. The AUC of PET/CT [0.99 (0.98-1.00)] was higher than that of SPECT [0.94 (0.92-0.96); P<0.05]. Statistical heterogeneity existed, and meta-regression showed that, at patient-based level, the study design type, tumor character, and the selection blinding method were the main sources of heterogeneity. Furthermore, both PET/CT and SPECT had superior SEN for osteogenic metastases than non-osteogenic metastases (P=0.01). At the lesion level, tumor character was a source of heterogeneity accompanied by an increased SEN for osteogenic metastases, and the SEN for SPECT combined with CT was improved [SEN =0.87 (0.68-1.00), P=0.03]. 18F-NaF PET/CT has a higher SEN and SPE than 99mTc-MDP SPECT in diagnosing bone metastases, nevertheless, it is necessary to fully understand the primary tumor and the characteristics of the imaging protocol to choose suitable modality for individuals. Combining SPECT with CT improves the diagnostic efficacy than having SPECT alone and can be a powerful supplement to PET/CT for suspected osteogenic bone metastases.

68 Subjective Cognitive Functioning Following Non-Severe COVID-19 Acute Infections: A Meta-Analysis

Objective:Emerging evidence suggests that individuals recovering from COVID-19 perceive changes to their cognitive function and psychological health that persist for weeks to months following acute infection. Although there is a strong relationship between initial COVID-19 infection severity and development of prolonged symptoms, there is only a modest relationship between initial COVID-19 severity and self-reported severity of prolonged symptoms. While much of the research has focused on more severe COVID-19 cases, over 90% of COVID-19 infections are classified as mild or moderate. Previous work has found evidence that non-severe COVID-19 infection is associated with cognitive deficits with small-to-medium effect sizes, though patients who were not hospitalized generally performed better on cognitive measures than did those who were hospitalized for COVID-19 infection. As such, it is important to also quantify subjective cognitive functioning in non-severe (mild or moderate) COVID-19 cases. Our meta-analysis examines self-reported cognition in samples that also measured objective neuropsychological performance in individuals with non-severe COVID-19 infections in the post-acute (&gt;28 days) period.Participants and Methods:This study’s design was preregistered with PROSPERO (CRD42021293124) and used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist for reporting guidelines. Inclusion criteria were established prior to article searching and required peer-reviewed studies to have (1) used adult participants with a probable or documented diagnosis of non-severe (asymptomatic, mild, or moderate) COVID-19 who were in the post-acute stage (&gt;28 days after initial infection); (2) used objective neuropsychological testing to document cognitive functioning; and (3) include a self-report measure of subjective cognition. At least two independent reviewers conducted all aspects of the screening, reviews, and extraction process. Twelve studies with three types of study design met full criteria and were included (total n=2,744).Results:Healthy comparison group comparison: Compared with healthy comparison participants, the post-COVID-19 group reported moderately worse subjective cognition (d=0.546 [95% CI (0.054, 1.038)], p=0.030). Severity comparison: When comparing hospitalized and not hospitalized groups, patients who were hospitalized reported modestly worse subjective cognition (d=-0.241, [95% CI (-0.703, 0.221)], p=0.30), though the difference was not statistically significant. Normative data comparison: When all non-severe groups (mild and moderate; k=12) were compared to the normative comparison groups, there was a large, statistically significant effect (d=-1.06, [95% CI (-1.58, -0.53)], p=0.001) for self-report of worse subjective cognitive functioning.Conclusions:There was evidence of subjective report of worse cognitive functioning following non-severe COVID-19 infection. Future work should explore relationships between objective neuropsychological functioning and subjective cognitive difficulties following COVID-19.

Tuberculosis infection control practice among healthcare workers in Ethiopia: a protocol for systematic review and meta-analysis

BackgroundTuberculosis (TB) is a main concern of health care workers in sub-Saharan Africa. Healthcare workers have the potential to have contact with TB patients and are the main stakeholders in...

Assessment of Knowledge and Practice Regarding the Contraceptive Methods among Married Couple Attending at Mother and Child Welfare Center, Bogura, Bangladesh

Background: The contraceptive method is essential in promoting maternal and child health. It improves health through adequate birth spacing, avoiding pregnancy at high-risk maternal ages, and high parity. It is often used as a synonym for birth control, however. Objective: The aim was to assess the level of Knowledge and Practice Regarding Contraceptive Methods among married couples attending at Mother and Child welfare center in Bogura. Methodology: This is a descriptive type of cross-sectional study design that was used, and a 120 sample size that was a purposive sampling technique followed by those who meet the inclusion criteria to assess the Knowledge and Practice Regarding Contraceptive Methods among married couples. The instruments for data collection were a semi-structured questionnaire and a self-report method composed of three parts: Demographic variables, knowledge, and practice-based information on Contraceptive Methods. Results: The present study's findings revealed that the majority of the 59% were within &lt;25 years, 90% were Muslim, and 85% were housewives. Regard the knowledge revealed that the average low level regarding the use of contraceptive methods among married couples. It is expected that the study will provide a better understanding of the uses of contraceptive methods. Conclusion: This can be achieved by providing educational and motivational activities and improvement in family planning services needed to promote contraceptive methods. The present study concluded that a significant proportion of respondents have a low level of knowledge and practice regarding contraceptive methods.

Covid-19 among migrants, refugees, and internally displaced persons: systematic review and synthesis of the global empirical literature

Abstract National pandemic response and preparedness plans aim at mitigating the spread of infectious diseases and protecting public health. Yet, they often fail to consider migrants. Evidence from the pandemic's early phase indicates that migrants are disproportionally affected by the Covid-19 pandemic and its consequences. Yet, synthesized evidence quantifying the magnitude of inequalities in infection risk, consequences of disease, or consequences of public health measures is lacking. We conducted a systematic review of the literature from 12/2019 to 11/2021 to synthesise the empirical evidence in this field. We considered all types of articles and study designs. The synthesis of evidence was divided into qualitative and quantitative analysis. Out of 6961 studies we included 243 to describe the heterogenous research landscape in terms of design, population, country context, and outcomes reported. The qualitative synthesis (n = 44) highlights the complex interplay of social and Covid-19 related factors at macro-, meso- and micro-level, resulting in high exposure, risk of infection, impacts of public health measures, and health impacts for migrants. The meta-analysis of n = 45 quantitative studies shows that migrants have an elevated risk of infection (RR: 2.46 (95%CI: 1.96-3.07)) compared to non-migrants, but a similar risk of hospitalization (RR: 1.05 (95%CI: 0.80-1.37)). Among those hospitalized, migrants have a lower risk of mortality (RR: 0.57 (95%CI: 0.32-1.03)). Yet, population-based excess mortality tends to be higher among migrants compared to non-migrants (RR: 1.30 (95%CI: 0.90-1.89)). Overall, high heterogeneity in reporting and quality of primary studies hampered the comparability of data. The qualitative results highlight the syndemic nature of the crisis, with cascading effects and interactions among socio-economic and health inequalities. They also illustrate the lack of evidence on some migrant categories, e.g., labor migrants, undocumented migrants, and returnees.

Eight characteristics of rigorous multilevel implementation research: a step-by-step guide

BackgroundAlthough healthcare is delivered in inherently multilevel contexts, implementation science has no widely endorsed methodological standards defining the characteristics of rigorous, multilevel implementation research. We identify and describe eight characteristics of high-quality, multilevel implementation research to encourage discussion, spur debate, and guide decision-making around study design and methodological issues.RecommendationsImplementation researchers who conduct rigorous multilevel implementation research demonstrate the following eight characteristics. First, they map and operationalize the specific multilevel context for defined populations and settings. Second, they define and state the level of each construct under study. Third, they describe how constructs relate to each other within and across levels. Fourth, they specify the temporal scope of each phenomenon at each relevant level. Fifth, they align measurement choices and construction of analytic variables with the levels of theories selected (and hypotheses generated, if applicable). Sixth, they use a sampling strategy consistent with the selected theories or research objectives and sufficiently large and variable to examine relationships at requisite levels. Seventh, they align analytic approaches with the chosen theories (and hypotheses, if applicable), ensuring that they account for measurement dependencies and nested data structures. Eighth, they ensure inferences are made at the appropriate level. To guide implementation researchers and encourage debate, we present the rationale for each characteristic, actionable recommendations for operationalizing the characteristics in implementation research, a range of examples, and references to make the characteristics more usable. Our recommendations apply to all types of multilevel implementation study designs and approaches, including randomized trials, quantitative and qualitative observational studies, and mixed methods.ConclusionThese eight characteristics provide benchmarks for evaluating the quality and replicability of multilevel implementation research and promote a common language and reference points. This, in turn, facilitates knowledge generation across diverse multilevel settings and ensures that implementation research is consistent with (and appropriately leverages) what has already been learned in allied multilevel sciences. When a shared and integrated description of what constitutes rigor is defined and broadly communicated, implementation science is better positioned to innovate both methodologically and theoretically.

Trends in exercise for hypertension: a bibliometric analysis.

To investigate development trends and research hotspots of exercise for hypertension research and provide researchers with fresh perspectives for further studies. Articles and reviews regarding exercise and hypertension spanning May 1st 2003 to May 18th 2023 were retrieved from the Web of Science Core Collection (WOSCC) database. VOSviewer and Citespace were mainly used to perform and visualize co-authorship, co-citation, and co-occurrence analysis of countries, institutions, authors, references and keywords in this field. A total of 1,643 peer-reviewed papers were identified, displaying a consistent increasing trend over time. The most prolific country and institution were Brazil and University of Sao Paulo, respectively. And we identified the most productive author was lrigoyen, Maria Claudia C, while Pescatello Linda S was the most co-cited author. Journal of hypertension was the most prominent journal, and Hypertension was the journal which was the most co-cited. And this field can be divided into 3 research themes: exercise interventions for hypertension, age-specific relevance of exercise for hypertension, and the global burden of hypertension and the role of exercise. According to the result of keywords analysis, epidemiological information, types of exercise, target population, mechanism, and study design are significant research areas. "Resistance training", "adults", and "heart rate variability" were identified as the major future research foci. The findings offer a scientific insight into exercise for hypertension research, presenting researchers with valuable information to understand the current research status, hotspots, and emerging trends for future investigation.

Ecological and environmental factors affecting the risk of tick-borne encephalitis in Europe, 2017 to 2021.

BackgroundTick-borne encephalitis (TBE) is a disease which can lead to severe neurological symptoms, caused by the TBE virus (TBEV). The natural transmission cycle occurs in foci and involves ticks as vectors and several key hosts that act as reservoirs and amplifiers of the infection spread. Recently, the incidence of TBE in Europe has been rising in both endemic and new regions.AimIn this study we want to provide comprehensive understanding of the main ecological and environmental factors that affect TBE spread across Europe.MethodsWe searched available literature on covariates linked with the circulation of TBEV in Europe. We then assessed the best predictors for TBE incidence in 11 European countries by means of statistical regression, using data on human infections provided by the European Surveillance System (TESSy), averaged between 2017 and 2021.ResultsWe retrieved data from 62 full-text articles and identified 31 different covariates associated with TBE occurrence. Finally, we selected eight variables from the best model, including factors linked to vegetation cover, climate, and the presence of tick hosts.DiscussionThe existing literature is heterogeneous, both in study design and covariate types. Here, we summarised and statistically validated the covariates affecting the variability of TBEV across Europe. The analysis of the factors enhancing disease emergence is a fundamental step towards the identification of potential hotspots of viral circulation. Hence, our results can support modelling efforts to estimate the risk of TBEV infections and help decision-makers implement surveillance and prevention campaigns.

The State of Use and Utility of Negative Controls in Pharmacoepidemiologic Studies.

Uses of real-world data in drug safety and effectiveness studies are often challenged by various sources of bias. We undertook a systematic search of the published literature through September 2020 to evaluate the state of use and utility of negative controls to address bias in pharmacoepidemiologic studies. Two reviewers independently evaluated study eligibility and abstracted data. Our search identified 184 eligible studies for inclusion. Cohort studies (115, 63%) and administrative data (114, 62%) were, respectively, the most common study design and data type used. Most studies used negative control outcomes (91, 50%), and for most studies the target source of bias was unmeasured confounding (93, 51%). We identified 4 utility domains of negative controls: 1) bias detection (149, 81%), 2) bias correction (16, 9%), 3) P-value calibration (8, 4%), and 4) performance assessment of different methods used in drug safety studies (31, 17%). The most popular methodologies used were the 95% confidence interval and P-value calibration. In addition, we identified 2 reference sets with structured steps to check the causality assumption of the negative control. While negative controls are powerful tools in bias detection, we found many studies lacked checking the underlying assumptions. This article is part of a Special Collection on Pharmacoepidemiology.

Effect of dexamethasone administration for postoperative nausea and vomiting prophylaxis on glucose levels in adults with diabetes undergoing elective surgery: a systematic review with meta-analysis.

The objective of this review was to evaluate the effect of intravenous dexamethasone given intraoperatively for postoperative nausea and vomiting prophylaxis on maximal blood glucose level within the initial 24 hours following elective surgery for patients with diabetes. Postoperative nausea and vomiting is a prevalent adverse effect of anesthesia that leads to morbidity, increased health care costs, and unanticipated hospital admissions. Dexamethasone is an effective prophylactic agent that confers secondary analgesic and anti-inflammatory benefits. However, its use in patients with diabetes remains controversial due to the potential for increased postoperative blood glucose levels. This review considered studies with participants 18 years of age or older with type 1 or 2 diabetes undergoing an elective surgical procedure. Eligible studies reported postoperative blood glucose levels in adults with diabetes after receiving a single 4-10 mg prophylactic dose of intravenous dexamethasone intraoperatively for postoperative nausea and vomiting. The primary outcome was maximum blood glucose level in the first 24 hours after surgery. All study designs were eligible for inclusion. Studies were excluded if they lacked a control group with diabetes or if they did not report maximum blood glucose values in both groups. A search of MEDLINE, CINAHL Complete, Embase, Web of Science, TRIP database, and the Cochrane Database of Systematic Reviews was completed in October 2021. Gray literature resources were also searched. No date or language restrictions were applied. Methodological quality was assessed using JBI appraisal tools for randomized controlled trials, cohort studies, and case-control studies. A meta-analysis of maximal postoperative blood glucose level within 24 hours of surgery was performed, as well as subgroup analyses by dexamethasone dose, insulin treatment, and study design type. Eleven studies (4 randomized controlled trials, 6 cohort studies, and 1 case-control study) were included in this review, with 1 study excluded from meta-analysis and results reported narratively. The total sample size of studies included in meta-analysis was 2567. The administration of dexamethasone significantly increased maximal blood glucose levels in the 24 hours immediately following surgery compared with control groups with diabetes, as demonstrated by randomized controlled trials (mean difference [MD] 39.56 mg/dL; 95% CI 16.18 to 62.94; P < 0.001; I2 = 87%) and observational studies (MD 26.31 mg/dL; 95% CI 7.10 to 45.52; P = 0.007; I2 = 92%). This increase in blood glucose was significant for all doses of dexamethasone: 4 mg (MD 40.81 mg/dL; 95% CI 2.42 to 79.19; P = 0.001; I2 = 91%), 8 mg (randomized controlled trials only; MD 39.45 mg/dL; 95% CI 15.32 to 63.58; P = 0.001; I2 = 86%), and mixed 4-10 mg dose (MD 30.82 mg/dL; 95% CI 6.75 to 54.88; P < 0.012; I2 = 93%). Postoperative hyperglycemia persisted in studies using insulin treatment as well as those not using insulin protocols. The overall certainty of the findings ranged from very low for outcomes that included cohort studies to moderate when outcomes from randomized controlled trials were analyzed separately. However, the quantitative findings of the experimental and observational studies were clinically similar. Risk of bias presented minimal concerns in all included studies. Dexamethasone leads to transient postoperative hyperglycemia in patients with diabetes undergoing elective surgery when given as a single 4-10 mg intravenous dose for postoperative nausea and vomiting prophylaxis. The clinical relevance of hyperglycemia is debatable given its small magnitude and transient nature. Without more tightly controlled data, methodological consistency, and baseline blood glucose values, it is impossible to test causal links between hyperglycemia and pre-existing patient factors (eg, hemoglobin A1C levels) or postoperative complications. PROSPERO CRD42020185607.

Prevalence of Diarrheagenic Escherichia coli and its Relation to Household Factors and Symptoms Distribution among Children in Babylon Governorate Hospitals, Iraq

Background: Diarrheagenic Escherichia coli, pose a significant threat and have been associated with a range of disorders, including gastrointestinal infections that may develop into various diseases such as diarrhea, Urinary tract infection, septic shock, and meningitis. Objective: to determine the Prevalence of E. coli and household factors and symptom distribution associated with E. coli among children under-12 years in Babylon Governorate. Methods: Using a descriptive cross-sectional type of study design and a Non-random convenient sampling technique with a proposed sample of 200 children were used to evaluate the Prevalence of Escherichia coli bacteria at two hospitals in the Babylon Governorate. They were: (Babil educational hospital for Maternity and Children and Al Noor Hospital for Children) located in Al Hillah City, the center of Babylon Governorate. This study was performed from October 1st, 2022, to May 1st, 2023. Results: The majority of participants, 63%, did not have E. coli, while 37% were found to have E. coli. which indicates a high prevalence of E. coli infection among under 12 years children. The highest reported symptom is diarrhea, accounting for 35.40%, followed by vomiting at 20.40%, fever at 16.60%, and loss of appetite at 14.70%. Approximately 33.5% of respondents confirmed that someone in their family experienced similar symptoms during the same period. Families with 4-5 members and 6-8 members were more likely (41%) to have E. coli in comparison to families with 3 members (15.4%). Families with more than 4 children were more likely to have E. coli (100%) in comparison to families with only one child (23.2%). Families with 4 and more rooms were less likely to have E. coli (25%, 0%). Conclusions: These results indicate that diarrhea followed by vomiting and fever were the highest reported symptoms. Approximately 53% of respondents confirmed that someone in their family or neighbor experienced similar symptoms during the same period. The results also showed that Families with 4-5 members and 6-8 members, Families with more than 4 children, Families with 3 or fewer rooms, Families who raise animals (especially sheep), and family members of the same infected child were more likely to have E. coli with significant association.

Defining Cephalomedullary Nail Breakage Rates: A Systematic Review and Meta-Analysis.

To establish the background rate of breakage of cephalomedullary nails. MEDLINE, PubMed, and Web of Science were searched on April 3, 2023. All English-language studies that examined trochanteric with or without subtrochanteric fractures and identified cephalomedullary nail breakage as an outcome measure and a breakage rate could be derived were included. Implants captured were predominantly the TFNA, TFN, and PFN by DePuy Synthes, various versions of the Gamma nail by Stryker, the Zimmer Natural Nail by Zimmer Biomet, and the Intertan by Smith and Nephew. The author, year of publication, dates of implant insertion, study design, method of detection of breakages, implant used, number of implant breakages, number of implants inserted, breakage rate, and follow-up were extracted. Meta-analysis of included studies used descriptive nonparametric statistics and a noncomparative proportion for the pooled result. Differences in results between study design types were compared using the mean breakage rate per study design. Cephalomedullary nail breakage is a rare complication with a median reported rate of 0.6% and a pooled result rate of 0.4%. Ninety-five percent of studies had a breakage rate of 1.3% or less, which sets a benchmark from the reported literature for future studies. There is wide variability in rates of breakage reported between different types of study designs with single-center review studies reporting breakage rates nearly 4-fold greater than large-scale administrative database reviews. The rate of implant breakage should not be used in isolation to judge an implant's performance. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Epidemiology, clinical characteristics, diagnosis, and complications of scrub typhus infection in Nepal: a systematic review.

Scrub typhus (ST) is a neglected tropical disease of serious concern in Nepal. This systematic review aims to describe the burden of disease, clinical presentation, and complications of ST infection in Nepal. A systematic search of PubMed, EMBASE, Google Scholar, and national databases was conducted for any literature published in English between January 2000 and January 2023. Any type of study design (observational studies, case series, and interventional studies) that reported laboratory-confirmed ST and was conducted in Nepal among patients of all age groups was included. The seroprevalence of ST among acute undifferentiated febrile illness (AUFI) cases, geographical distribution, monthly distribution, clinical presentations, complications, and treatment were assessed by the study. A total of 15 studies with 10,977 participants were included in the review. The seroprevalence of ST among the AUFI cases in Nepal was 19.31%. Young people at or below 20 years of age were mostly affected. The maximum number of cases were reported from Bagmati province (59.46%) and in the month of August (26.33%). Fever, headache, cough, shortness of breath, nausea, and abdominal pain were the clinical characteristics in decreasing order of occurrence. The most common complication was acute kidney injury, followed by respiratory problems, cardiac issues, and neurological manifestations. The case fatality rate of ST in Nepal was 2.56%. The authors findings showed a significant burden of ST among AUFI cases in Nepal. Improved surveillance, general public awareness, and early detection post-calamities could help reduce the disease burden and improve patient outcomes.

What Is the Empirical Research Base of Early Childhood Coaching? A Mapping Review

This study examined the empirical base for early childhood (birth to 8) coaching via a systematic mapping review of the relevant literature, including diverse research designs to represent the full breadth of published studies related to early childhood coaching. The systematic review yielded 374 unique studies published between 1987 and 2019 that were coded for type of study design (e.g., causal; quantitative noncausal; qualitative; single-case design); research populations; and reported content, structure, and processes of early childhood coaching. Descriptive analyses revealed that almost half of the study designs were causal (45.99%); over 75% of the studies were interested in the outcomes or experiences of teachers. The most targeted coaching content domains were social-emotional (44.92% of studies) and language/literacy development (43.58% of studies). Reporting on coaching structure was inconsistent across studies. Observation was the most reported coaching strategy during instruction (73.53% of studies), and provision of evaluative feedback was the most frequently reported coaching strategy outside of instruction (62.83% of studies). The review identified the literature base includes a diversity of study designs, and a great majority of studies occur in preschool settings (70.32%). Findings also suggest that a growing number of coaching studies are focused on child outcomes (60.16%). Results indicate a need for more studies that focus on coaches directly as well as research about coaching in infant/toddler programs and in content domains beyond social-emotional and language/literacy.

Career development of doctorally prepared nurses.

To integrate research literature regarding careers, career development and factors influencing the career development of doctorally prepared nurses. An integrative review. Medline, CINAHL and Embase were searched in June 2022 without time restrictions. Peer-reviewed empirical publications written in English with different types of study designs were included. Two researchers independently applied eligibility criteria, selected studies and conducted quality appraisals using Joanna Briggs checklists. Data were extracted and analysed using a convergent integrated approach with thematic analysis. Themes were established within three categories based on the research questions: career, career development and factors influencing career development. Twenty-two studies were included. Nine themes were identified. One theme regarding careers describes that doctorally prepared nurses need to prioritize work within different positions. The two themes focusing on career development described the need to determine career goals after the doctorate and further develop competencies. Six themes described factors influencing career development: 'Intrinsic motivation to improve health care and nursing education', 'Available support sources', 'Professional development programmes', 'Work-life balance', 'Organizational infrastructures for career advancement' and 'Competition and hostile treatment among colleagues'. Limited knowledge of the careers and career development of doctorally prepared nurses was found. Doctorally prepared nurses need to balance work with various part-time positions. Careers and career development could be supported by the development of structures for career advancement as well as supportive working environments. Doctorally prepared nurses with strong careers are important to health care and nursing as they generate and implement new knowledge into clinical practice and thereby support the improvement of (nursing) care and patient outcomes. This study provides considerations towards strengthening the careers of doctorally prepared nurses. PRISMA. No Patient or Public Contribution.

Cutaneous Adverse Events and Cancer Survival Prognosis With Immune Checkpoint Inhibitor Treatment

Growing research suggests that the prevalence of cutaneous immune-related adverse events (cirAEs) is associated with favorable outcomes among individuals with cancer who receive immune checkpoint inhibitor (ICI) treatment. To identify whether the presence of cirAEs and their subtypes subsequent to ICI administration is associated with enhanced cancer prognosis. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched for publications examining the association between cirAE development during ICI treatment and subsequent cancer prognosis. The initial search was limited to English-language publications from database inception until December 31, 2022; a subsequent search was performed on May 21, 2023. Two reviewers independently scrutinized the identical articles and included those that constituted original research evaluating the association between cirAE development and cancer prognosis. The search terms, study objectives, and methodological protocols were defined before study initiation. The aforementioned 2 reviewers performed data extraction independently and resolved discrepancies through agreement. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis and the Meta-analysis of Observational Studies in Epidemiology reporting guidelines. The protocol was prospectively registered with PROSPERO. Data analyses were conducted between May 21 and June 1, 2023. The major outcome end points were overall survival (OS) and progression-free survival (PFS). Subgroup analyses were also conducted according to cirAE type, cancer type, geographic region, study design, and ICI type. Given the heterogeneity inherent in the included studies, a DerSimonian-Laird random-effects model was adopted. This systematic review and meta-analysis included 23 studies with a total of 22 749 patients treated with ICIs. The occurrence of cirAEs was associated with improved OS (hazard ratio [HR], 0.61 [95% CI, 0.52-0.72]; P < .001) and PFS (HR, 0.52 [95% CI, 0.41-0.65]; P < .001). Consistent results were observed across all subgroups stratified by study design, geographic region, ICI type, and cancer type, aligning with the overall estimate of OS and PFS improvement. However, no statistically significant differences were identified in terms of PFS within studies conducted in the US. In this systematic review and meta-analysis, the presence of cirAEs and their subtypes was associated with improved prognosis for individuals with cancer undergoing ICI treatment. These findings suggest that cirAEs may have useful prognostic value in ICI treatment.

A meta-analytic review of accuracy and bias in romantic partner perceptions.

People's perceptions of their romantic partners are somewhat accurate but also contain biases. In the current meta-analytic review, we sought to examine overall levels of accuracy and bias in romantic partner perceptions and moderators of accuracy and bias. We examined tracking accuracy (k = 157), projection (k = 157), indirect accuracy (k = 69), and mean-level bias (k = 153) in perceptions of a romantic partner across samples that estimated tracking accuracy and projection simultaneously. Gender, relationship length, study design, geographic region, publication year, and judgment type were examined as potential moderators. Results revealed significant mean effect sizes for tracking accuracy (β = .24), projection (β = .42), similarity (β = .22), and indirect accuracy (β = .11). Overall, people tended to have mean-level accuracy (d = -0.006) even when constructs were coded as conceptually positive or negative (d = -0.03). Men seemed to view their partners more negatively. Publication year and relationship length did not matter for any perceptual process. Tracking accuracy was higher in overall judgments, whereas projection was higher in daily judgments. Positive interaction traits and mind-reading judgments showed a negative bias. Greater projection and positive bias in noninteraction judgments were associated with higher relationship quality. Our results are the first to provide effect sizes for projection, tracking accuracy while controlling for projection, and indirect accuracy, and build on prior research concerning the complex ways in which partners perceive each other. (PsycInfo Database Record (c) 2023 APA, all rights reserved).