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This is a scoping review protocol for the management of non-angulated, non-displaced, paediatric distal forearm fractures with either a bandage or splint.

A systematic review on self-management interventions of lower urinary tract symptoms in men

Protocol for Systematic Review

Systematic Review

This is a protocol for a systematic review of studies which have reported on pandemic-induced changes in healthcare utilisation.

We investigate whether the benefits for preventing urinary tract infection by cranberry juice consumption (Jepson et al., 2012) are due to the consumption of cranberries specifically or due to an increased fluid intake (Scott et al., 2020). We will therefore evaluate the effectiveness and safety of increased non-fluid cranberry intake (e.g., cranberry tablets), fluid cranberry intake (e.g., cranberry juice), and intake of fluid other than cranberry (e.g., water, other juices, etc.).

This protocol is the first for a planned series of scoping reviews to review available evidence about overdiagnosis and overuse of healthcare services in LMICs.

Christoph Schnelle,1 Justin Clark,1 Rachel Mascord,2 Mark A Jones1 1Institute of Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia; 2General Dentist, BMA House, Sydney, New South Wales, AustraliaCorrespondence: Christoph Schnelle, Institute of Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia, Email christoph.schnelle@student.bond.edu.auPurpose: Despite billions of doctor visits worldwide each year, little is known on whether doctors themselves affect patients’ physical health after accounting for intervention and confounders such as patients’ and doctors’ data, hospital effects, nor how strong that doctors’ effect is. Knowledge of surgeons’ and psychotherapists’ effects exists, but not for 102 other medical specialties notwithstanding the importance of such knowledge.Methods: Eligibility Criteria: Randomized controlled trials (RCTs), case-control, and cohort studies including medical doctors except surgeons for any intervention, reporting the proportion of variance in patients’ outcomes owing to the doctors (random effects), or the fixed effects of grading doctors by outcomes, after multivariate adjustment. Exclusions: studies of < 15 doctors or solely reporting doctors’ effects for known variables.Sources: Medline, Embase, PsycINFO, inception to June 2020. Manual search for papers referring/referred to by resulting studies.Risk of Bias: Using Newcastle–Ottawa scale.Results: Despite all medical interventions bar surgery being eligible, only thirty cohort papers were found, covering 36,239 doctors, with 10 specialties, 21 interventions, 60 outcomes (17 unique). Studies reported doctors’ effects by grading doctors from best to worst, or by diversely calculating the doctor-attributed percentage of patients’ outcome variation, ie the intra-class correlation coefficient (ICC). Sixteen studies presented fixed effects, 18 random effects, and 3 another approach. No RCTs found. Thirteen studies reported exceptionally good and/or poor performers with confidence intervals wholly outside the average performance. ICC range 0 to 33%, mean 3.9%. Highly diverse reporting, meta-analysis therefore not applicable.Conclusion: Doctors, on their own, can affect patients’ physical health for many interventions and outcomes. Effects range from negligible to substantial, even after accounting for all known variables. Many published cohorts may reveal valuable information by reanalyzing their data for doctors’ effects. Positive and negative doctor outliers appear regularly. Therefore, it can matter which doctor is chosen.Keywords: physicians’ effect, practice effect, physicians’ practice pattern, clinical competence, professional practice gap, delivery of health care, quality of health care, physicians

A protocol for a scoping review

Christoph Schnelle,1 Justin Clark,1 Rachel Mascord,2 Mark A Jones1 1Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia; 2General Dentist, BMA House, Sydney, New South Wales, AustraliaCorrespondence: Christoph Schnelle, Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia, Email christoph.schnelle@student.bond.edu.auObjective: To find and review published papers researching surgeons’ effects on patients’ physical health. Clinical outcomes of surgery patients with similar prognoses cannot be fully explained by surgeon skill or experience. Just as there are “hospital” and “psychotherapist” effects, there may be “surgeons” effects that persist after controlling for known variables like patient health and operation riskiness.Methods: Cohort studies and randomized controlled trials (RCTs) of any surgical intervention, which, after multivariate adjustment, either showed proportion of variance in patients’ physical health outcomes due to surgeons (random effects) or graded surgeons from best to worst (fixed effects). Studies with < 15 surgeons or only ascribing surgeons’ effects to known variables excluded. Medline, PubMed, Embase, and PsycINFO were used for search until June 2020. Manual search for papers referring/referred by resulting studies. Risk of bias assessed by Cochrane risk-of-bias tool and Newcastle–Ottawa Scale.Results: Included studies: 52 cohort studies and three RCTs of 52,436+ surgeons covering 102 outcomes (33 unique). Studies either graded surgeons from best to worst or calculated the intra-class correlation coefficient (ICC), the percentage of patients’ variation due to surgeons, in diverse ways. Sixteen studies showed exceptionally good and/or bad performers with confidence intervals wholly above or below the average performance. ICCs ranged from 0 to 47%, median 4.0%. There are no well-established reporting standards; highly heterogeneous reporting, therefore no meta-analysis.Discussion: Interpretation: There is a surgeons’ effect on patients’ physical health for many types of surgeries and outcomes, ranging from small to substantial. Surgeons with exceptional patient outcomes appear regularly even after accounting for all known confounding variables. Many existing cohort studies and RCTs could be reanalyzed for surgeons’ effects especially after methodological reporting guidelines are published.Conclusion: In terms of patient outcomes, it can matter which surgeon is chosen. Surgeons with exceptional patient outcomes are worth studying further.Keywords: physicians, physicians’ effect, doctors’ effect, therapists’ effect, practice effect, clinical competence, professional practice gap, surgeons’ practice pattern, quality of health care, delivery of health care