Search

Objective To evaluate the role of disease-modifying anti-rheumatic drugs (DMARDs) on wound healing outcomes of patients with autoimmune disease at our tertiary wound care center. Approach Retrospective review of patients presenting to our wound care center between 2014 and 2018 with both chronic wounds and a history of inflammatory disease. Patient demographics, comorbid conditions, and progression to complete wound healing were compared between those taking DMARDs or not at the time of wound onset. The study adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Results 58 patients with a total of 296 wounds were retrospectively reviewed. Patients were taking at least one DMARD at wound onset in 217 (73.3%) of these wounds. The average number of DMARDs at wound onset was 1.5 (SD 1.2). 210 wounds progressed to heal (70.9%) with a median time to healing of 229.5 days (IQR 71.0-490.0). Of the 210 wounds that healed, patients taking at least one DMARD had a significantly shorter time to healing relative to patients who were not on any DMARDs (median 190.5 vs 340.0 days, p=0.0156). Innovation Characterizing wound healing outcomes at a tertiary hospital with a dedicated wound care center and analyzing the role of DMARDs in wound healing progression. Conclusions Chronic wounds are notoriously challenging to treat in the setting of autoimmune disease. The median time to healing in the studied cohort was 229.5 days, which is alarming when compared to patients with non-infected diabetic foot ulcers, who take a median time to heal of 30.8 days at our institution.10.

AIM AND OBJECTIVES The purpose of this study was to investigate which factors are associated with the quality of dementia care in acute care hospitals. BACKGROUND The number of people with dementia who are admitted to acute care hospitals is increasing. Improving the quality of dementia care in acute care hospitals is an important issue. Prior studies have demonstrated that not only knowledge and nursing experience, but also psychological factors and the nursing practice environment are related to high-quality care on general wards. DESIGN Cross-sectional hypothesis-testing design. METHODS Participants were nurses providing care to people with dementia at acute care hospitals. Questionnaires were distributed to 300 acute care hospitals in Japan, 10 copies each and 773 valid responses were received. Based on the hypothesis model, variables were tested using multiple regression analysis. The model described the relationship between quality of care, personal attributes and the nursing practice environment. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used. RESULTS Almost 90% of the study sample was female, the mean age was 37.4 ± 9.3 years, and the mean nursing experience was 14.0 ± 8.7 years. The results showed that nursing foundations for quality of care, staffing and resource adequacy, specialist consultation, promoting systematic recreation and exchange, knowledge, and feelings towards people with dementia were associated with the quality of dementia care in acute care hospitals. The adjusted coefficient of determination was 0.367. CONCLUSION This study identified factors associated with the quality of dementia care in acute care hospitals. Knowledge and feelings towards people with dementia are important, and the nursing practice environment plays an important role in improving the quality of dementia care. RELEVANCE TO CLINICAL PRACTICE Not only improving nurse's practical ability but also a supportive nursing practice environment enhances the quality of dementia care in acute care hospitals.

Background Within Australia and internationally, there is increasing and widespread recognition of the importance of developing nurses’ capabilities in research and evidence-based practice to advance the discipline. Literature is sparse on the contribution of nursing Honours degrees to academic, professional, and industry outcomes in nursing. Aims and objectives To critically evaluate the contribution of a Bachelor of Nursing (Honours) degree to individual career development and nursing leadership, the profession, higher education, and the health industry to inform future directions. Methods This case study of a longstanding Bachelor of Nursing (Honours) degree uses data collected from multiple sources. The data included university and public records, as well as an anonymous online survey in 2018-19 of all students who had enrolled in the programme since 2004. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Cross-Sectional Studies checklist was followed. Findings Of the 95 Honours programme graduates, 22.1% (n = 21) progressed to PhD studies, and 33.7% (n = 32) produced one or more publications. Of the 42 participants who accessed the survey, 78.6% (n = 33) had completed the nursing Honours programme, and 21.4% (n = 9) had commenced but did not complete the degree. Insufficient time was the main reason for not completing the nursing Honours degree, and qualitative responses indicated the nursing Honours degree developed student confidence and skills relevant to research and professional practice. Discussion Findings highlight opportunities for nursing Honours degrees to contribute to individual achievement, best practices in healthcare, development of future leaders in nursing, and discipline-specific research outcomes. Conclusion Nursing Honours degrees can offer important benefits to the individual, as well as the profession and the healthcare industry.

AIMS AND OBJECTIVES To determine if the use of an emergency nursing framework improves the accuracy of clinical documentation. BACKGROUND Accurate clinical documentation is a nursing professional responsibility essential for high-quality and safe patient care. The use of the emergency nursing framework "HIRAID" (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) improves emergency nursing care by reducing treatment delays and improving escalation of clinical deterioration. The effect of HIRAID on the accuracy of nursing documentation is unknown. DESIGN A quasi-experimental pre-post study was conducted and the report was guided by the strengthening the reporting of observational studies in epidemiology (STROBE) checklist. METHODS HIRAID was implemented in four regional/rural Australian emergency departments (ED) using a range of behaviour change strategies. The blinded electronic healthcare records of 120 patients with a presenting problem of shortness of breath, abdominal pain or fever were reviewed. Quantity measures of completeness and qualitative measures of completeness and linguistic correctness of documentation adapted from the D-Catch tool were used to assess accuracy. Differences between pre-post groups were analysed using Wilcoxon rank-sum and two-sample t-tests for continuous variables. Pearson's Chi-square and Fisher exact tests were used for the categorical data. RESULTS The number of records containing the essential assessment components of emergency care increased significantly from pre- to post-implementation of HIRAID. This overall improvement was demonstrated in both paediatric and adult populations and for all presentation types. Both the quantitative and qualitative measures of documentation on patient history and physical assessment findings improved significantly. CONCLUSION Use of HIRAID improves the accuracy of clinical documentation of the patient history and physical assessment in both adult and paediatric populations. RELEVANCE TO CLINICAL PRACTICE The emergency nursing framework "HIRAID" is recommended for use in clinical practice to increase the documentation accuracy performed by emergency nurses.

AIMS: This study aimed to investigate the application of infrared thermal imaging and adopt deep learning to detect air leakage for determining the fitness of respirators during fit-checks. BACKGROUND: The outbreak of Covid-19 virus constitutes a public health crisis with substantial resultant morbidities and mortalities; has exerted profound impacts. METHODS: This was a prospective observational study, employing a non-probability sampling method on a convenience sample to recruit the participants and followed the Strengthening the Reporting of Observational Studies in Epidemiology statement guidelines. RESULTS: The use of infrared thermal imaging identified air leakage points as a disruption to the facial thermal pattern distribution at (a) front of face; (b) right lateral of the face; (c) left lateral of the face; (d) top of the facemask with the head facing down; and (e) bottom of the facemask with the head facing up. Results also indicated that artificial intelligence tools and the proliferation of deep learning have the potential to detect the location of air leakage locations. CONCLUSION: The use of infrared thermal imaging provides evidence of the feasibility and applicability of infrared thermal imaging techniques in detecting air leakage for individuals wearing respirators. CLINICAL RELEVANCE: The use of infrared thermal technology can serve a potential role in complement fit-checking of respiratory protective devices and offers promising practical utility in determining the fitness of respirators for nurses at the frontline to protect against the air-borne viruses.

Background: The Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) is the cause of the Coronavirus Diseases of 2019 (COVID-19). This virus has been responsible for the global pandemic of 2020 and 2021 with over 107 million confirmed cases and over 2.3 million deaths. An important population that deserves meticulous consideration during the COVID-19 pandemic is pregnant woman; however, in many places in the world there is inadequate screening for SARS-COV-2 during pregnancy. We aimed to determine the impact of maternal and neonatal cord blood SARS-COV-2 antibodies and placental transfer ratios in a region with a low screening plan. Methods: We performed a blind study in Babahoyo, Ecuador; one of the SARS-CoV-2epicenters in South America. Blood samples were collected from 100 serum samples collected from pregnant women at the time of delivery along with corresponding neonatal cord blood. SARS-CoV-2 IgG specific antibodies were determined using a enzyme linked immunosorbent assay (ELISA) for IgG and IgM SARS-CoV-2-specific nucleocapsid and spike antigens (DiaPro, Milano, Italy Cat number COV19G.CE). Findings: We observed 32% of pregnant women to be serological positive in areas lacking an appropriate screening program. We also show data that suggests an efficient passive immunization of the fetus to SARS-CoV-2 during pregnancy. Interpretation: There is a high incidence of SARS-CoV-2 infection during pregnancy. The best prevention for protecting the mother from infection is vaccination, which, will provide the fetus and neonate with a strong protection against SARS-CoV-2 infection through passive placental transfer of SARS-CoV-2 specific antibodies. This is especially important because newborns are highly susceptible to many viral infections. Funding: NIAID 1R01AI145829-01 Declaration of Interest: None to declare. Ethical Approval: This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines. This was retrospective study done with samples sent for tests evaluation that were originally not related to this study. A consent waiver was approved since the samples were not collected for the study and the samples used were defined as dischargeable material.

Purpose To investigate whether upright magnetic resonance imaging (MRI) has a role in defining thoracolumbar spine pathology in elite gymnastics. Methods A prospective cross-sectional observational study of National Senior and Junior Artistic gymnasts in three MRI positions (standard supine, upright flexed and extended positions). Two specialist musculoskeletal radiologists independently analysed images with neutral as a baseline with the effects of flexion and extension reported in line with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Results Forty (18 males) gymnasts aged 13–24 years with a mean (SD) of 32 (5.3) training hours per week consented with 75% showing MRI abnormalities. Degenerative disc disease (DDD) was evident in 55% participants with vertebral end plate (VEP) changes in 42.5%. Spondylolysis was present in 40% with an additional 17% showing chronic bilateral complete L5 pars defects. 23% participants demonstrated different MRI findings in upright flexion compared to neutral. Conclusion Findings suggest a high levels of MRI abnormalities in elite gymnastics including altered disc morphology and posterior element abnormalities. High prevalence of T11/12 DDD and VEP changes reflects the thoracolumbar junction being a transition zone. Upright MRI and varying spine position offer promise for enhanced visualisation of posterior element abnormalities.

Introduction Surgical site infections (SSI) are a preventable and common post-operative complication within general surgery. Intra-operative irrigation of surgical incisions is an inexpensive method to reduce post-operative SSI rates, however its use is predominantly limited to orthopaedic surgery. We aimed to assess the effects of pulsed lavage (PL) irrigation on SSI rates following elective and emergency laparotomies. Methods Elective and emergency patients who underwent a laparotomy between 2018 and 2019 were included. Relevant demographic and peri-operative risk factors collected retrospectively, following strengthening the reporting of observational studies in epidemiology (STROBE) criteria. The primary outcome was rate of superficial SSI within 30 days of the operation. Independent risk factors were assessed via multivariate logistic regression analysis. Results 176 patients were identified, with an average age of 60.7 ± 19.1 y. 82.4% (145/176) were emergencies and the mean ASA grade was 2.8. Fifty-two patients (29.5%) had PL used during their operation. Thirty-seven patients (29.8%, 37/124) in the control group developed a SSI, compared to seven patients (13.5%, 7/52) in the PL group (P = 0.022). At multi-variate analysis, the use PL conferring an Odds Ratio 0.36 (CI 0.12-0.94, P= 0.047) for developing a SSI. Conclusion PL appears to significantly reduced the rate of SSI following laparotomy. There remains scope to reduce the incidence of this common and expensive post-operative complication, and PL could provide a potential cost-effective means to deliver improved outcomes. Future prospective randomised trials are essential to fully assess its benefits and wider use within general surgery.

Blood loss is a potential cause of morbidity and mortality in craniosynostosis surgery. Recent reports have suggested that the use of tranexamic acid (TXA), an antifibrinolytic agent, mitigates this blood loss. A comprehensive systematic review and subsequent meta-analysis was undertaken, with the view to clarify the effectiveness of TXA in reducing blood loss and transfusion requirements in craniosynostosis surgery. Medline and PubMed databases were searched using the preferred reporting items for systematic reviews and meta-analyses technique, and 7003 articles were assessed based on predefined selection criteria. Seven trials were identified, of which 2 were randomized controlled trials and the remainder retrospective cohort studies. All trials were assessed using the Jadad and strengthening the reporting of observational studies in epidemiology scores. The meta-analysis found a clear statistical reduction in blood loss in those patients who received TXA perioperatively, with a combined blood loss reduction of 7.06 ml/kg (95% confidence interval -8.97 to -5.15, P

Aim The study aimed to describe and explain the self‐assessed gerontological nursing competence levels of Finnish nursing students and factors relating to it. Design A cross‐sectional study design, reported by The Strengthening the Reporting of Observational studies in Epidemiology guidelines. Methods Data were collected with the GeroNursingCom instrument, which features 53 items relating to 11 competence factors. The K‐clustering technique and the Chi‐squared, Kruskal‐Wallis and Mann Whitney tests were used to analyse the data. Results Seven hundred and ninety‐nine nursing students from nine randomly selected higher education institutions were invited to participate in 2019. Three distinct student profiles were identified according to the data (N = 274): Profile A—lower intermediate competence (23.1% of students), Profile B—intermediate competence (45.8%) and Profile C—high competence (31.1%). The strongest competence area for all students was appreciative encounter and interaction, and the weakest was supporting the older person’s sexuality. Nursing students have diverse backgrounds and their overall competence in gerontological nursing is shaped in part by their previous education, motivations and work experience. Relevance to clinical practice Recognizing students’ different gerontological nursing competence profiles enables the implementation of targeted education to improve competence in clinical practice.

AIMS AND OBJECTIVES This study aimed to examine the impact of digital stories about aged care residents on staff knowledge and understanding regarding those residents. BACKGROUND More than a quarter of a million older Australians live in residential aged care facilities. This living arrangement can inhibit the expression of a person's sense of identity. Without objects and cues that reflect the person's selfhood, it can be difficult for a person to express their uniqueness. Staff may not sufficiently appreciate the resident's individuality and therefore may not be able to customise care for the resident. DESIGN This study used a single-arm trial design. METHODS The study was conducted in four residential aged care facilities. Short digital life stories (3-4 min) of eight residents were constructed by student volunteers over 6 months. Participants (n = 53 care staff) completed a self-report measure of their knowledge and understanding of a resident before and after watching the resident's story. The study adhered to guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) (see Appendix S1). RESULTS Pre- and post-test scores of the measure were compared using paired samples t-tests. These scores changed significantly, showing an improvement of knowledge and understanding regarding residents. CONCLUSIONS Watching digital life stories were associated with improvements in knowledge and understanding by staff, and hence have the potential to foster a greater level of understanding of residents by such staff, and more person-centred care practices within residential aged care facilities. RELEVANCE TO CLINICAL PRACTICE Digital stories about aged care residents are quick and efficient methods for improving aged care staff members' knowledge and understanding of the residents under their care. With such understanding, staff may be able to better customise care for residents, thereby validating residents' sense of identity and elevating residents' quality of life.

Objective Expert consensus increasingly recognizes intensive multidisciplinary intervention (IMI) as the standard of care to address chronic and severe feeding problems in pediatric populations. In this study, we examined the clinical presentation, intervention characteristics, and treatment outcomes for young children receiving IMI for avoidant restrictive rood intake disorder (ARFID) involving nutritional insufficiencies associated with severe food selectivity. Method We followed the Strengthening the Reporting of Observational Studies in Epidemiology statement to conduct this retrospective chart review. The review focused on consecutive patients (birth to age 21 years) admitted to the IMI program over a 5-year period (June 2014 to June 2019). Inclusion criteria required micronutrient insufficiencies (vitamins A, B12, C, D, E; folic acid; calcium; iron; and zinc) and chronic mealtime refusal behavior (e.g., turning head away from food/spoon, pushing or throwing spoon, crying, screaming, and leaving the table) associated with severe food selectivity. Results Over the 5-year period, 63 of the patients met study entry requirements. Of these, 60 patients (50 boys and 10 girls; mean age = 72 ± 39 months; range = 23-181) completed intervention (95% treatment completion rate). At discharge, dietary diversity improved by 16 new therapeutic foods (range: 8-22), rapid acceptance and swallowing of new foods exceeded clinical benchmarks (80% or > bites), and risk for nutritional inadequacies declined for this patient cohort. Discussion Results of the current study support the benefits of IMI to increase dietary variety, improve mealtime behaviors, and enhance nutritional intake for children with ARFID presenting with severe food selectivity.

Aim: This study aimed to identify which strategies are being adopted to deal with family restrictions in health units and assess nurses’ perceptions of including families in nursing care during the current pandemic. Background: Due to the COVID-19 pandemic, health organisations limited access for visitors. Introduction: Family centred care needs to be guaranteed, and alternatives for face-toface interaction should be fostered. Therefore, there is an urgent need to rethink the family in nursing care during a pandemic. Methods: We conducted a descriptive exploratory mixed-method study in Portugal using an electronic questionnaire. The study included 192 nurses recruited using a nonprobabilistic convenience sample. The study was reported using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Results: A total of 41.1% of participants (n = 79) reported that visits to their services were not authorised, and 66.7%(n=128) reported resorting to video calls because of the restrictions imposed. Regarding attitude assessment, the average score of the scale was 77.9 (SD = 10.0), ranging between 26 and 98.When analysing the different dimensions of the ‘Families’ Importance in Nursing Care - Nurses Attitudes’ scale, family data stand out as a burden. Conclusion: Although a large percentage of participants had a positive attitude towards families and tried to find strategies to maintain family centred care, many nurses still considered the family as a burden. The current COVID-19 pandemic may have aggravated this perception. Implications for nursing practice, nursing policy and health policy: The continued implementation of family centred nursing practice is essential for child-well-being, including during the current pandemic. Therefore, having intervention policies with alternative forms of care is highly recommended. info:eu-repo/semantics/publishedVersion

Aims and objectives The aims of the study were to (i) estimate the prevalence of frailty among older adults with type 2 diabetes, and (ii) investigate risk factors associated with frailty in the study group. Background The high prevalence of frailty among older adults and its adverse health impacts including higher risks for physical disabilities and a higher mortality rate is quickly evolving to become an important public health issue. Design A cross-sectional design. Methods Data were collected from the Clinical Diabetes Centre of our study group. Frailty was assessed using the Chinese version of the Tilburg frailty indicator. Other questionnaires included Activities of Daily Living, Mini-Mental State Examination, Taiwan Geriatric Depression Scale and Instrumental Activities of Daily Living. Multivariable logistic regression was established to identify factors associated with frailty. The STrengthening the Reporting of OBservational studies in Epidemiology checklist was used preparing the manuscript. Results A total of 248 subjects were recruited in this study, a total of 66 participants had frailty (26.6%). Our results showed that factors including age, number of chronic diseases, cerebrovascular accident, renal diseases, frequency of falling, frequency of hyperglycaemia, Activities of Daily Living, depression, Mini-Mental State Examination, and Instrumental Activities of Daily Living ≧1 task disability were correlated with frailty in older adults with type 2 diabetes. After adjusting for confounding factors, multivariate logistic regression analyses showed a significant increase in the probability of frailty by 1.72-times when comparing type 2 diabetes subjects with depression to those without depression. Conclusion This study revealed that depression is a significant factor associated with the occurrence of frailty among older adults with type 2 diabetes. Relevance to clinical practice Our results provided strong clinical evidence showing depression as an important factor associated with the risk of frailty in older individuals with type 2 diabetes. We recommend early detection via routine screenings for symptoms of depression during diabetes care to achieve early prevention or the delay of frailty and its implicated adverse health consequences.

Purpose The habits acquired during adolescence may continue into adulthood. Therefore, the identification and prevention of Internet addiction is an important goal. The aim of this study was to investigate the effects of Internet addiction on the lifestyles of adolescents in a sample in the Mediterranean region of Turkey. Design and methods The sample consisted of 367 adolescents. Data were collected using a personal information form, the Internet Addiction Scale, and the Healthy Lifestyle Behaviours Scale-II between January and June 2018. This manuscript has been prepared according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results The mean Internet addiction score among the included adolescents was found to be moderate. Males aged 17 years with divorced parents and adolescents who have poor relationships with family members and friends had higher average Internet addiction scores. A negative and moderate relationship between Internet addiction and healthy lifestyle behaviours was identified among adolescents. Conclusions Internet addiction is negatively and moderately predictive of an adolescent's lifestyle. Practice implications Strengthening relationships with family and friends can prevent adolescents from developing Internet addictions and increase healthy lifestyle behaviours. Courses should be added to the curriculum that aim to improve the understanding of the risks and benefits (e.g. e-mail, Internet tools) associated with the Internet for both school staff and students. The results of the present study can be used to guide the development of a healthy Internet use program targeted at adolescents for use by school nurses.

Objectives To estimate the prevalence of extra-glandular lesions in patients with immunoglobulin G4-related sialadenitis (IgG4-RS). Methods Six electronic databases (PubMed, EMBASE, Science Direct, Scopus, Web of Science, and China National Knowledge Infrastructure) were systematically searched from the date of inception of each database to March 2021. The Strengthening the Reporting of Observational Studies in Epidemiology statement was used to conduct methodological quality assessment, and a random-effect meta-analysis model was applied to estimate the prevalence. Publication bias was visually assessed using a funnel plot and calculated via Begg's and Egger's tests. The Stata 15 software was used to perform data analysis. Results A total of 43 articles comprising 1,864 patients with IgG4-RS were considered to be eligible for this study. The pooled prevalence of extra-salivary gland lesions in IgG4-RS was 76.53% with a confidence interval (CI) of (69.39%, 83.04%). A higher prevalence was associated with studies published before or during 2015 (84.38%, CI [74.23%, 92.58%]) than those published after 2015 (68.55%, CI [58.44%, 77.88%]). Lacrimal gland involvement (54.68%, CI [45.61%, 63.60%]) and lymph node swelling (56.96%, CI [48.16%, 65.56%]) were the most frequent lesions. Conclusions Extra-glandular lesions were common in patients with IgG4-RS. More high-quality prospective studies with less heterogeneity are required to determine the accurate prevalence.

A better understanding of the association between sedentary behavior and heart failure is essential for the development of interventions to improve patients' outcomes. Therefore, a systematic review was conducted to determine the association between sedentary behavior and all-cause mortality, health-related quality of life, and depression in heart failure patients. We searched Web of Science, PubMed, Embase, and Cochrane Library and articles in references on 7 May 2021. The search results were limited to articles on heart failure patients over the age of 18, observational studies investigating the association between sedentary behavior and heart failure, and studies reporting one or more outcomes of interest. Two reviewers independently screened the literature and extracted data. Strengthening the Reporting of Observational Studies in Epidemiology was used to assess the quality of articles. Nine observational studies were included, of which, four were of high quality. Four cohort studies indicated that sedentary behavior was significantly associated with increased all-cause mortality (hazard ratio: 1.97; 95% confidence interval: 1.60 to 2.44; I2 = 38.9%). In addition, subgroup analysis based on geographical regions was conducted (hazard ratio: 1.82; 95% confidence interval: 1.46 to 2.29; I2 = 0%). Sedentary behavior was associated with worse health-related quality of life in patients with heart failure, and the regression coefficients ranged from 0.004 to 0.033 (95% confidence interval: 0.0004 to 0.055). Although sedentary behavior was associated with increased all-cause mortality and worse quality of life in patients with heart failure, further studies are needed to determine whether this association is causal.

Background Cancer is a life crisis that can have devastating consequences not only on the affected individual but also on his/her caregivers. Objective The aim of this study was to investigate the influence of psychological resilience and metacognitions of cancer survivors and their family caregivers (FCs) on fear of recurrence (FoR). Methods This study used a cross-sectional design while adhering to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Data were collected from 112 cancer survivors and 112 FCs recruited from 5 oncology hospitals. Results The cancer survivors and caregivers reported low levels of psychological resilience, which we found to be correlated with great fear of recurrence in cancer survivors and FCs. It was also in relation with metacognitions in cancer survivors and FCs.The findings showed that psychological resilience negatively predicted the fear of recurrence, whereas the metacognitions positively predicted the fear of recurrence in cancer survivors and FCs. The total effects of psychological resilience on the FoR in cancer survivors and FCs were 0.920 (confidence interval [CI], -2.059 to 0.072) and 0.061 (CI, -0.475 to 0.474), respectively. The total effects of metacognition on the FoR in cancer survivors and FCs were 1.164 (CI, 0.217-2.371) and 0.486 (CI, 0.016-1.058), respectively. Conclusions The findings underline the direct and indirect mediating role of psychological resilience and metacognition of cancer survivors and FCs on FoR. Implication for practice The findings are particularly important to oncology nurses, who as 24-hour care providers are important sources of psychosocial care. Their awareness of factors influencing FoR is critical for achieving positive outcomes.

Introduction Open lower extremity fractures pose a challenge for treating surgeons. All surgical strategies have the common aim to facilitate fracture healing. Fracture union, however, should be critically considered in the context of functional recovery and not in isolation. Both local and free tissue transfer have benefits and drawbacks. Aim This study aims to compare the functional outcomes of open tibial diaphyseal fractures managed with internal fixation, comparing outcomes of those receiving free tissue transfer as opposed to local flaps Methods This study follows the STrengthening the Reporting of Observational studies in Epidemiology (STROBE) criteria. Data were collected retrospectively from a prospectively maintained database at our institution. Inclusion criteria included a non-comminuted Gustilo type-IIIB open tibial diaphyseal fracture requiring intramedullary nailing. Forty three patients with local flaps and 180 patients with free flaps were included Results and conclusion 233 patient underwent reconstruction for open fracture using local flaps (n=43) or free flaps (n=180). In the context of Gustilo type-IIIB non-comminuted, mid-tibial diaphyseal fractures treated with intramedullary nailing, free fasciocutaneous flap reconstructions leads to significantly improved functional outcomes in patients of all ages when compared to local fasciocutaenous flaps. (77 ± 19 v 50 ± 22 % for local flaps; P

Background Scar revisions have been increasing in number. Patient-reported outcome measures are one tool to aid scar modulation decision-making. The aims of this study were to determine patient, scar, and clinical risk factors for (1) low SCAR-Q Appearance, Symptom, and Psychosocial Impact scores and how this differs for children; and (2) the potential need for future scar revision surgery to better identify such patients in a clinical setting. Methods A multicenter international cross-sectional cohort study based on survey data of participants with traumatic, surgical, and burn scars attending plastic, hand, and burn clinics in four countries was conducted following the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Univariate analysis to identify risk factors and multivariable logistic analysis to select risk factors were completed. Collinearity for nonindependent factors and C statistic for model discrimination were also calculated. Results Seven hundred thirty-one participants completed the study booklet, and 546 participants (74.7 percent) had full data. Independent risk factors were determined to be a bothersome scar and perception of scarring badly for all three scales. Risk factors for self-reporting the need for future surgery included a health condition, scarring badly, scar diagnosis, prior scar revision, and low Psychosocial Impact scores. We did not identify evidence of multicollinearity. C statistics were high (0.81 to 0.84). Conclusions This study is the first multicenter international study to examine independent risk factors for low patient-reported outcome measure scores and the potential need for future scar revision surgery. Patients that perceive themselves as scarring badly and having a bothersome scar were at a higher risk of scar appearance concern, an increased symptom burden, and poorer psychosocial impact scores. Clinical question/level of evidence Risk, III.

Purpose: To evaluate the safety and efficacy of remdesivir in adult patients with COVID-19. Methods: PubMed, Embase, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, and medRxiv databases were searched using a search strategy tailored to each database. The Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the reporting of observational studies in epidemiology (STROBE) checklists were used for the studies' qualitative assessment. The outcomes studied were mortality, all adverse events, serious adverse events, and clinical improvement. The quantitative synthesis was conducted using fixed and random effects models in the CMA 2.2. Heterogeneity was tested using the I-squared (I2) measure. Results: In general, six studies, including five randomized controlled trials and one cohort study were found eligible. Comparison of the findings related to both groups receiving remdesivir (10-day remdesivir group) and placebo/control group showed that remdesivir treatment had no significant effect on mortality at day 14 of the treatment (RR=0.769; 95% CI :0.563-1.050; p=0.098), and all adverse events (RR= 1.078; 95% CI: 0.908-1.279; p= 0.392). However, remdesivir had a significant effect on clinical improvement at day 14 compared to placebo/control (OR= 1.447; 95% CI: 1.005-2.085; p= 0.047) and reduced serious adverse events (RR= 0.736; 95% CI: 0.611-0.887; p= 0.001). Conclusion: Remdesivir has positive effects on clinical improvement, and reduction of the risk of serious adverse events. However, it does not influence the mortality at day 14 of treatment.

BackgroundCurrently, insufficient bone volume always occurs in the posterior maxilla which makes implantation difficult. Short implants combined with transcrestal sinus floor elevation (TSFE) may be an option to address insufficient bone volume.PurposeThe clinical performance of short implants combined with TSFE was compared with that of conventional implants combined with TSFE according to the survival rate.MethodIn this systematic review and meta-analysis, we followed the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Articles were identified through PubMed, Embase, the Cochrane Library, and manual searching. Eligibility criteria included clinical human studies. The quality assessment was performed according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The odds ratio (OR) with its confidence interval (CI) was considered the essential outcome for estimating the effect of short implants combined with TSFE.ResultsThe registration number is INPLASY202050092. Eleven studies met the inclusion criteria, including 1 cohort study and 10 cross-sectional studies. With respect to the 1-year survival rate, no significant effect was observed between short implants (length ≤ 8 mm) and conventional implants combined with TSFE (I2=0%, OR=1.04, 95% CI: 0.55-1.96). Similarly, no difference was seen between the two groups regarding the survival rate during the healing period (I2=10%, OR=0.74, 95% CI: 0.28-1.97) and 3-year loading (OR=1.76, 95% CI: 0.65-4.74).ConclusionThere was no evidence that the survival rate of short implants combined with TSFE was lower or higher than that of conventional implants combined with TSFE when the residual bone height was poor and the implant protrusion length of short implants was less than or similar to conventional implants. Nevertheless, the results should be interpreted cautiously due to the lack of random controlled trials in our meta-analysis.

Objectives Case–control studies are often used to identify the risk factors for pancreatic cancer. The objective of this study was to evaluate the reporting of case–control studies of the risk factors for pancreatic cancer using the Strengthening The Reporting of OBservational Studies in Epidemiology (STROBE) for case–control studies checklist. Study Design and Setting We conducted a comprehensive literature search of the MEDLINE and EMBASE databases to identify reports of case–control studies published between 2016 and 2018. We scored article reporting using a reporting adherence form developed from the STROBE checklist for case–control studies, consisting of 14 STROBE items related to the title, abstract, methods, and results sections. Results We included reports of 47 case–control studies investigating a variety of risk factors, such as medical conditions and lifestyle factors. Reporting was inconsistent and inadequate. Efforts to address bias and how the study size was arrived at were particularly poorly described. Study cases were described in more detail than study controls. Conclusion Reporting of case–control studies remains inadequate more than 10 years after the STROBE reporting guideline was published. Our findings suggest that authors do not understand the extent to which study methods and findings should be reported to enable studies to be fully understood, and their methods reproduced., Highlights • Reporting in a sample of case–control studies was found to be inadequate. • Clear, complete reporting is essential for study findings to be understood and compared. • Clearly described methods allow studies to be reproduced. • The use of the Strengthening The Reporting of OBservational Studies in Epidemiology reporting guideline is essential when reporting observational studies.

Background The quality of emergency general surgery (EGS) studies that use the American College of Surgeons-National Quality Improvement Program (ACS-NSQIP) database is variable. We aimed to critically appraise the methodologic reporting of EGS ACS-NSQIP studies. Study design We searched the PubMed ACS-NSQIP bibliography for EGS studies published from 2004 to 2019. The quality of reporting of each study was assessed according to the number of criteria fulfilled with respect to the 13-item RECORD statement and the 10-item JAMA Surgery checklist. Three criteria in each checklist were not applicable and were therefore excluded. An analysis was conducted comparing studies published in high and low impact factor (IF) journals. Results We identified a total of 99 eligible studies. Twenty-six percent of studies were published in high IF journals, and 73% of the journals had a policy requiring adherence to reporting statements. The median number of criteria fulfilled for the RECORD statement (out of 10 items) and the JAMA Surgery checklist (out of 7 items) were both equal to 4 (interquartile range [IQR] 3, 5). Sixty-three percent of studies did not explain the methodology for data cleaning, 81% of studies did not describe the population selection process, and 55% did not discuss the implications of missing variables. There were no differences in overall scores between studies published in high and low IF journals. Conclusions The methodologic reporting of EGS studies using ACS-NSQIP remains suboptimal. Future efforts should focus on improving adherence to the policies to mitigate potential sources of bias and improve the credibility of large database studies.

Background Adjuvant endocrine therapies are known to induce undesirable adverse effects such as vasomotor, vaginal and musculoskeletal symptoms among breast cancer patients. Drugs used in these therapies are often metabolised by cytochrome P450 (CYP) enzymes, in which their metabolising activities can be modified by single nucleotide polymorphisms (SNP) in CYP genes and CYP genotypes. This review aims to explore whether SNPs or genotypes of CYP are associated with the occurrence, frequency and severity of vasomotor, vaginal and musculoskeletal symptoms in breast cancer patients on adjuvant endocrine therapies. Methods A literature review was conducted using five electronic databases, resulting in the inclusion of 14 eligible studies, and their findings were presented narratively. Selected items from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist were used for critical appraisal of the reporting quality of the included studies. Results Most of the included studies showed that SNPs or genotypes of CYP that modify its metabolising activity have no effect on the occurrence, frequency or severity of vasomotor symptoms, including hot flashes. One study showed no correlation of these genetic variations in CYP with musculoskeletal symptoms, and no data were available on the association between such genetic variations and vaginal symptoms. Conclusions Overall, genetic variations in CYP have no effect on the experience of hot flashes among breast cancer patients. We recommend exploration of the link between the active metabolites of chemotherapeutic drugs and the molecules shown to affect the occurrence or severity of hot flashes, and the establishment of the relationship between such genetic variations and patients’ experience of musculoskeletal and vaginal symptoms. Subgroup analyses based on patients’ duration of adjuvant endocrine therapies in such studies are recommended.

Aims and objectives This study aimed to implement cluster analysis of self-concept and job satisfaction to identify subgroups in nurses with master's degree and explore the associations of turnover intention with characteristics among these clusters. Design A cross-sectional study adhering to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Methods A convenience sample of 408 nurses with master's degree in China filled out the survey from 19 November 2019 to 30 December 2019. A sociodemographic questionnaire, the Nurses' Self-Concept Questionnaire (NSCQ), Job Satisfaction Scale (JSS) and Turnover Intention Questionnaire (TIQ) were adopted to collect the data. K-means cluster analysis was implemented on the R software, and data were analysed using SPSS 24.0. Results Three subgroups were identified based on cluster analysis of NSCQ and JSS subscales in 405 nurses (99.3%) available for statistical analysis, among whom 30.9%, 17% and 48.1% were allocated to these clusters respectively. Turnover intention significantly differed among the three clusters, with cluster 2 having the highest turnover intention and cluster 1 having the lowest turnover intention. Working department, position, professional title, clinical nurse specialist and annual income were factors differentiating TIQ scores in each cluster. Conclusions This study identified three clusters of nurses with master's degree and showed that each cluster was associated with the level of turnover intention. The unique characteristics of the three clusters may be also helpful in identifying and providing specific managerial or social support to reduce turnover rates in nurses with master's degree. Relevance to clinical practice Cluster analysis is s an unsupervised machine learning method to identify meaningful subgroups within heterogeneous population based on variables distributions and patterns underlying in the data set. Through clustering, nurses with multi-dimensional characteristics could be allocated into subgroups associated with turnover intention. As a result, nursing managers could provide approaches for each subgroup to reduce turnover intention.

Objective:A year after the emergence of a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as a new crisis in respiratory infections, there remain many uncertainties and unknowns about SARS-CoV-2 and the disease it causes, called coronavirus disease (COVID-19). Although COVID-19 is known as a respiratory disease, some atypical manifestations have been seen, different from those seen in other types of viral respiratory infections. This paper aims to describe designing, launching, and implementing a data collection system for all respiratory diseases, with a focus on SARS-CoV-2 from the onset of this pandemic.Method:The current registry is designed in compliance with the standard Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, along with the declaration of Helsinki principles.Results:A respiratory disease registry, with an emphasis on COVID-19 and other co-infections, was developed. Data consisted of demographic, clinical, and supporting information about SARS-CoV-2 and other respiratory viral diseases.Conclusion:It is hoped that the current data registry will facilitate patient evaluation and improve the outcomes of cases of respiratory infection defined by a particular condition, disease, or exposure. Moreover, the registry can harmonize data about the treatment, outcomes, and well-being of patients who receive care over time, and identify best practices.

Context Evidence-based guidelines for active surveillance (AS), a treatment option for men with low-risk prostate cancer, recommend regular follow-up at periodic intervals to monitor disease progression. However, gaps in monitoring can lead to delayed detection of cancer progression, leading to a missed window of curability. Objective We aimed to identify the extent to which real-world observational studies reported adherence to monitoring protocols among prostate cancer patients on AS. When reported, we sought to characterize definitions of adherence. Evidence acquisition We systematically reviewed observational studies assessing outcomes of prostate cancer patients on AS, published before March 22, 2019 in PubMed, Embase, and CENTRAL. Adherence definitions were considered time bound if they included prespecified time and binary if adherence was assessed but did not specify a time interval. We assessed study quality using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Evidence synthesis Forty-five studies met our inclusion criteria. Eleven studies did not report any data on adherence to AS protocols. Twenty-five studies did not explicitly measure adherence, but provided relevant data (eg, number of patients who received a repeat biopsy). Six studies reported adherence using a time-bound definition, while three studies used a binary definition. Twenty-three studies provided information on patients lost to follow-up. Conclusions Most studies reporting outcomes of patients on AS did not measure or report adherence. When reported, adherence was often not time specific. As some AS patients will benefit from maintaining a window of curability, clinical practices and future studies should track and report adherence and associated factors. Patient summary We reviewed real-world observational studies examining outcomes of prostate cancer patients on active surveillance. Most studies did not clearly define or report adherence to monitoring protocols, which is important to consider for appropriate disease management.

To evaluate the association between baseline global longitudinal strain (GLS) and ΔGLS (difference of baseline GLS and follow-up) and cardiac resynchronization therapy (CRT) response defined either with clinical or with echocardiographic characteristics. This meta-analysis was performed in accordance to both the Meta-Analysis of Observational Studies in Epidemiology and Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Two independent investigators performed a comprehensive systematic search in MedLine, EMBASE and Cochrane databases through September 2019 without limitations. Data analysis was performed by using the Review Manager software (RevMan), version 5.3, and Stata 13 software. A p value of less than 0.05 (two-tailed) was considered statistically significant. Twelve studies (1004 patients, mean age 63.8 years old, males 69.4%) provided data on the association of baseline GLS with the response to CRT therapy. We found that CRT responders had significantly better resting GLS values compared with non-responders [GLS mean difference −2.13 (−3.03, −1.23), p

AIM To identify generic measures used to measure quality of life (QoL) in pediatric multiple sclerosis research, estimate an overall score of children and adolescents with pediatric multiple sclerosis, and compare the scores to scores of typically developing children and adolescents. METHOD A systematic search was conducted on four databases. All studies were included if: the sample was children with pediatric demyelinating disorders; self-reported QoL/health-related quality of life (HRQoL) measures or results were reported; and the mean age of the sample was below 21 years. Quality of the included articles was appraised using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and the Mixed Methods Appraisal Tool checklist. A meta-analysis was also conducted. RESULTS A total of 12 full-text articles were included. Content analysis showed that many components of QoL were not included in the measures. Seven studies were included in the meta-analysis. The meta-analyzed score was 75.7 (95% confidence interval 71.2-80.3) with a pooled standard deviation of 16.6. Scores of typically developing children and children with pediatric multiple sclerosis were similar. INTERPRETATION Most measures assessed HRQoL and not QoL. Development of a condition-specific measure of QoL for children and adolescents with pediatric multiple sclerosis would make an important contribution to the field. What this paper adds Health-related quality of life (HRQoL) measures were used to measure quality of life in pediatric multiple sclerosis. HRQoL scores in pediatric multiple sclerosis were similar to typically developing children and adolescents.

Aims and objectives To measure time spent on clinical documentation and nurses and midwives' perceptions of this aspect of their role. Background Nurses and midwives rely on accurate documentation when planning care. However, documenting and communicating care can be onerous, time-consuming and at times duplicated or redundant. While documentation provides a record and means of communicating care, it should not detract from the delivery of care. Design An observational time and motion study and survey design reported using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Methods The study was conducted with Western Australian nurses and midwives working in a private not-for-profit hospital from July-October 2019. An observational study was undertaken to measure the practice of documentation on each shift. Participants' perceptions of clinical documentation were measured using a self-report survey. Results A total of 120 hr of observation were undertaken. Total observed time spent on documentation was 28.1% on morning shifts, 22.7% on afternoon shifts and 20.9% on night duty. The mean self-reported time for clinical documentation was 50.4% on morning shifts, 40.7% on afternoon shifts and 37.9% on night duty. Issues with duplication and unnecessary paperwork were identified. Conclusions Although participants tended to overestimate time spent on documentation, it still consumed a significant proportion of time. Frustrations with paperwork may amplify nurses' negative perceptions of documentation. Clinical documentation needs to be reviewed, revised and reduced to release time back to direct patient care and reduce clinician dissatisfaction. Relevance to clinical practice Clinical documentation is required in all areas of clinical practice and forms an important legal record. Understanding the demands of clinical documentation can assist in reviewing and improving documentation to release time back to direct patient care.

Background Foot characteristics and mechanics are hypothesized to affect aetiology of several lower extremity musculoskeletal conditions, including knee osteoarthritis (KOA). The purpose of this systematic review was to identify the foot characteristics and mechanics of individuals with KOA. Methods Five databases were searched to identify relevant studies on foot characteristics and mechanics in people with KOA. Meta-analyses were performed where common measures were found across included studies. Included studies were evaluated for data reporting quality using the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist. Results Thirty-nine studies were included in this systematic review. Two studies reported participants with KOA had statistically significantly (P Conclusion A more pronated foot posture was noticed in those with KOA. However, it was not possible to establish a relationship between other foot characteristics or mechanics in people with KOA due to heterogeneity between the included study and limited number of studies with similar measurements. There is need for identifying common measurement techniques and reporting metrics when studying the foot in those with KOA.

Objectives: The specific aims are: 1) To characterize the health, wellness, and lifestyle of graduate and undergraduate students, and how these characteristics change over time; 2) To evaluate associations between lifestyle factors and gut microbiota populations and diversity; and 3) To evaluate associations between stress and stress management practices with sleep habits, quality of life, and overall health. Design: The International Cohort on Lifestyle Determinants of Health (INCLD Health) longitudinal cohort study is designed to assess health behaviors and lifestyle practices amongst adults studying complementary and integrative health (CIH) and higher-education students more generally after at least one to six years of exposure to CIH education. INCLD Health will adhere to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. Settings/Location: Colleges and universities with a CIH focus or interest with the flagship site being the National University of Natural Medicine. Participants: Adults currently enrolled in a college or university with a CIH focus or interest. Outcome Measures: Study visits will be conducted at baseline, 6 months, then every 12 months until the end of each participants' degree program. Measures include anthropometrics; serum and salivary biomarkers of cardiovascular risk, reproductive hormones, and cortisol; nutritional intake measured by a digital food frequency questionnaire; sequencing of fecal microbiota; plus validated questionnaires investigating mood, perceived stress, stress management practices, physical activity, sleep, and wellness. Conclusions: The INCLD Health Study, approved by the NUNM IRB in late 2018, will enroll a unique cohort of adults to characterize the use of CIH practices in relation to short- and long-term health. Our study design provides a breadth of information that could be implemented at multiple sites internationally allowing for comparisons across diverse student cohorts with relatively low cost and personnel.

Background Medical students have a worse perception of Quality of Life (QoL) and a high prevalence of psychosocial suffering when compared to the general population. The objective of this study was to investigate associated factors with Quality of Life of Brazilian medical students from an exploratory analysis in a cross-sectional study described in accordance with the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) guidelines. Methods This is a cross-sectional and multicenter study with national sample randomized by sex and year of the course. Data were collected between August 2011 and August 2012, using an electronic platform (VERAS platform). Our outcomes included: personal quality of life (QoLp) and quality of life related to medical course activities (QoLmc), both measured using a score ranging from 0 (worst) to 10 (best). Variables as predictors: the World Health Organization Quality of Life Assessment abbreviated version (WHOQOL-BREF); VERAS-Q (a questionnaire created to evaluate the QoL of students in health professions); Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Maslach Burnout Inventory (MBI), Resilience Scale (RS-14), Interpersonal Reactivity Multidimensional Scale (IRMS) and Dundee Ready Education Environment Measure (DREEM). Results Our sample is comprised of 1350 (81.8%) medical students. When comparing predictors and both quality of life outcome measures, we found a negative correlation between QoL and the BDI, PSQI and ESS scores. Through a multiple linear regression mode we identified the median of significant predictors to higher QoL. We then run a tree regression model that demonstrated that the VERAS-Q—physical health domain (a domain assessing self-care, self-perception of health, sleep, leisure, physical activity and appearance) was the most important factor predicting QoL. Students with a VERAS-Q-physical health score ≥ 60.9 and a VERAS-Q-time management (address the management of the student's time, free time and whether he can dedicate himself to other activities besides the course) score ≥ 55.7 presented the best QoLmc (score: 8.08–9.63%). Students with a VERAS-Q-physical health score ≥ 79.7 presented the highest QoLp (score 8.93–8.74%). Conclusion Physical symptoms, self-perception of health and self-care assessed by the VERAS-Q physical domain had association with both final outcomes. Time management seems to have a protective role for better Quality of Life. These variables should be taken in consideration when designing interventions to improve Quality of Life among medical students.

Background Previous research has suggested an ethnic association of Heck’s disease with a prominent genetic and familial inheritance pattern, but no systematic review has been reported, which has collected all the evidence in one paper. The aim was estimation of the updated age estimates and gender predilection of this disease and also questioning its proposed link to ethnic and geographical factors. Methods Heck’s disease from 1966 until present are tabulated, including various descriptive characteristics. After removal of duplicates and adhering to all the inclusion criteria, we shortlisted 95 case reports. The quality assessment of all included studies has been done following STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines. Results We found an age range of 3–92 years (mean: 23.1 years) with a male to female ratio of 3:4. Geographical distribution revealed one of the main findings of this study, which was an increased incidence of Heck’s disease in the European region. Conclusions As already observed and established, there is a much greater prevalence of this disease in the indigenous populations of the world and more research should be encouraged to understand the correct transmission and pattern of spread of this disease.

Objective To systematically review studies on canine agenesis prevalence in different populations and continents, based on the jaw, sex, location, and associated dental anomalies. Methods Electronic and hand searches of English literature in PubMed, Web of Science, Scopus, OpenGrey, and Science Direct were conducted, and the authors were contacted when necessary. Observational studies (population-based, hospital/clinic-based, and cross-sectional) were included. For study appraisal and synthesis, duplicate selection was performed independently by two reviewers. Study quality was assessed using a modified Strengthening the Reporting of Observational Studies in Epidemiology checklist, with main outcome of prevalence of canine agenesis. Results The global population prevalence of canine agenesis was 0.30% (0.0-4.7%), highest in Asia (0.54%), followed by Africa (0.33%), and the least in Europe and South America (0.19% in both continents). Canine agenesis was more common in the maxilla (88.57%), followed by both maxilla and mandible (8.57%), and the least common was mandible-only presentation (2.86%). The condition was more common in females (female:male ratio = 1.23), except in Asia (female:male ratio = 0.88) and Africa (female:male ratio = 1). In Asia, unilateral agenesis was almost twice as prevalent as bilateral, but in Europe, the bilateral form was more common. Conclusions The overall prevalence of canine agenesis is 0.30%, with the highest prevalence in Asia, followed by Africa, Europe, and South America. The condition is more common in the maxilla than the mandible, and in females than males (except in Asia and Africa), with unilateral agenesis being more common in Asia and the bilateral form showing a greater prevalence in Europe.

Background and Objectives: Disaster as a natural devastating event leads to terrific injuries, morbidities, and mortalities, particularly in developing countries. The aim of this study was to evaluate the management of emergency response of health teams to natural disasters in Iran. Materials and Methods: Some international databases, such as PubMed, ISI, and Scopus, were searched to find English articles between May 2000 and May 2019. Finally, 22 published articles were entered into the study. Keywords included “disaster,” “flood,” “earthquake,” “wildfires,” “tornadoes,” “hurricanes,” “drought,” “famine,” “natural catastrophe,” “storms,” “avalanche,” “health team,” and “Iran” or a combination of them in the title/abstracts. Results: There were >12618 relevant research articles; in this systematic review, 22 published articles consisted of two interventional, one modeling, nine qualitative and ten cross-sectional studies were included. We used Strengthening the Reporting of Observational Studies in Epidemiology Checklist, a checklist of items that should be included in reports of observational studies for selected articles. The summary of the selected articles the selection process using Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Conclusions: The findings of the current study revealed that two subjects were important; extra education in the college course and in-service training at hospitals using educational pamphlets and having a special committee to manage the disaster.

Dysmenorrhea is one of the well-established problems among women of reproductive age and can have adverse effects on the quality of life of the individual. Some studies suggest a relationship between vitamin D (Vit D) and calcium deficiency and the emergence of early dysmenorrhea. Accordingly, a systematic study was performed to investigate the role of calcium and Vit D in the relief of primary dysmenorrhea. A systematic literature search was performed in PubMed, Web of Science, Scopus, Science Direct, and Google Scholar for papers published between 2010 and 2020. The Consolidated Standards of Reporting Trials and Strengthening the Reporting of Observational Studies in Epidemiology checklists were used to assess the quality of the studies. The risk of bias was assessed using the Cochrane risk-of-bias assessment tool. Low calcium levels lead to an increase in uterine muscle contraction and can cause pain after decreased uterine blood flow. Furthermore, low levels of Vit D can increase primary dysmenorrhea by increasing prostaglandin production or reducing intestinal calcium absorption. That being the case, Vit D and calcium intake can be effective in reducing the severity of primary dysmenorrhea and in reducing the rate of analgesic use. Low levels of Vit D and calcium are inversely related to the severity of primary dysmenorrhea, and Vit D and calcium intake can reduce the severity of primary dysmenorrhea and its associated systemic symptoms. Therefore, the use of calcium and Vit D supplements can be recommended to relieve dysmenorrhea.

Cross-sectional studies on traditional Chinese medicine (TCM-CSs) have become the most published type of TCM observational study; however, the research scope of current TCM-CSs is unknown. A scoping review of the literature was performed. A descriptive approach to summarize the core study characteristics was prepared, along with structured tables and figures to identify salient points of similarities and differences noted across studies. The reporting quality of TCM-CSs was assessed according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) cross-sectional checklist. Eight databases (Embase, CENTRAL, MEDLINE, AMED, CBM, CNKI, WanFang, and VIP) were systematically searched for TCM-CSs published up until 20 January 2020. The literature screening and evaluating were independently conducted by two researchers. When there was disagreement, a third-party senior researcher made the judgment. A total of 198 TCM-CSs published between 1997 and 2019 were included, 160 English studies and 38 Chinese studies, respectively. More TCM-CSs were published in each successive year. The journal Evidence-Based Complementary and Alternative Medicine published more TCM-CSs (24) than any other journal. Most TCM-CSs were conducted in mainland China (81, 40.9%), followed by Taiwan, China (44, 22.2%) and HKSAR, China (19, 9.6%). The most commonly used sampling method was purposive sampling (94, 47.5%), following by convenience sampling (60, 30.3%). The research topics can be summarized in four major categories as follows: constitution-related research (11.1%), TCM pattern-related research (18.7%), TCM intervention-related research (55.1%), and others (15.6%). The average sufficient reporting rate of included TCM-CSs according to the STROBE cross-sectional checklist was 45.6%. Papers written in English reported 9 items (items 2, 4, 14a, 16a, 18, 19, 20, 21, and 22) more frequently than papers written in Chinese. The number of TCM-CSs is increasing. Research topics are diverse; however, the reporting quality is unsatisfactory. In particular, TCM-CSs need greater transparency and standardization.

Purpose: Transgender women (TW) are likely to experience job discrimination and engage in commercial sex transactions. As a group, they have the highest risk for HIV/AIDS. However, little is known about the health needs of transgender women sex workers (TWSW) in the United States and the structural and psychosocial barriers to their health care access. The objective of this systematic review was to systematically document these needs and barriers by using a framework approach. Methods: We searched PubMed, JSTOR, and Google Scholar for primary and secondary studies published in 2005-2019 that addressed the health of TWSW in the United States. We used a standardized data extraction form to gather data from eligible articles. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used to assess study quality. Results: Fifty-three articles met the inclusion criteria, including mentioning health-related topics among TWSW. More articles appeared in recent years. Most studies collected data with convenience samples in urban areas. Structural barriers reported included transphobia, lack of pre-exposure prophylaxis targeted at TW, and lack of health insurance coverage. Psychosocial barriers included distrust of the health care system, self-esteem, alcohol and substance use, and mental health. Conclusions: TWSW have unique health care needs that are not being addressed due to barriers to health care access. More research is required to identify non-HIV-related health burdens and details about psychosocial barriers to health care access.

Background Lately, suggestions have been emphasizing the importance of engaging patients and family members in infection control (IC) through participation and education after showing that patients and family members can aid in preventing the transmission of health care-associated infections. However, assessing patient education on IC measures in hospitals is poorly investigated. Purpose To identify all available studies in the literature that assessed hospitalized patients’ education on IC measures. Methods PubMed, Embase, and CINAHL were searched from inception till May 6, 2020 without restrictions. We used Strengthening the Reporting of Observational Studies in Epidemiology tool for assessing the reporting quality of each eligible study. Main Findings Of the 6,740 identified papers, 25 were eligible for inclusion. Education on health care-associated infections was investigated in 8 studies, education on central line-associated bloodstream infections in 1, education on surgical site infections in 2, education on hand hygiene in 12, education on isolation rationale, precautions, usage of personal protective equipment in 3, and education on respiratory hygiene in 1. In general, a low percentage of patient education on IC was found in most of the included papers. Conclusions The low percentage of patient education on IC in hospitals highlights the need for additional emphasis on patient involvement in IC. Further studies are needed to assess patient education on several IC measures and to explore the education of family members as well.

Aims This study aimed to describe the demographic characteristics and to measure annual changes in composition of the paediatric population attending a specialist tertiary hospital in Sydney, Australia, between 2015 and 2017. Background Australia has experienced steady growth in the number of people born overseas in the last fifty years thereby building a culturally and linguistically rich country. Such dynamic population changes pose a challenge to the nursing workforce, in particular how the needs of migrant families from non-English-speaking countries are accommodated. Design Retrospective review of medical records. Methods De-identified paediatric inpatient data were imported from a hospital database into Statistical Package for the Social Sciences (version 21) database for cleaning and analysis. Strengthening the reporting of observational studies in epidemiology checklist was completed. Results Paediatric inpatients born in a country other than Australia (8762, 5.7%) emigrated from 155 countries or were "born at Sea" (n = 13, 0.1%) and spoke an array of primary languages (n = 139), other than English. Whilst inpatient health service rates remained constant during the study period, an increased rate of service utilisation was reported for children born in Asia (IRR 1.3, p ≤ 0.001, 95% CI: 1.2-1.4) and in the Middle East (IRR 1.4, p ≤ 0.001, 95% CI: 1.2-1.6). Families who reported that they preferred to speak Chinese Languages, Middle Eastern languages (not Arabic) and languages of India reported increased rates. Conclusion Significant annual changes in composition of the paediatric population were reported. Regular analysis of local inpatient data will inform health care that is responsive to change and addresses the unique needs of diverse families. Relevance to clinical practice Diversity poses a potential challenge to the nursing workforce on a daily basis and more broadly. To meet the changing needs of diverse inpatient populations, nurses will need to plan, implement and evaluate cultural competency, linguistic access, workforce diversity and the quality of care to diverse populations.

Background: Obesity is associated with higher surgical and anaesthetic morbidity and difficulties. Aims: We aimed to investigate associations between maternal body mass index (BMI) and the in-theatre time taken to produce an anaesthetised state or to perform surgery for caesarean delivery. Materials and Methods: Using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, we identified all women who underwent caesarean section at a single institution (2009–2015). The prospectively collected data arising from antenatal and peripartum care were analysed. Generalised linear regression was used to examine associations between maternal BMI and the time taken to anaesthetise the mother and the duration of surgery. Results: Of a total of 24 761 caesarean deliveries, 5607 (22.7%) women were obese at antenatal registration. In-theatre anaesthetic preparation (18 vs 32 min, P < 0.001) and surgical duration (38 vs 52 min, P < 0.001) were longer in women with BMI ≥50 kg/m (BMI-50) than those with normal BMI (BMI-N). This difference remained significant after controlling for antenatal, intra-operative and immediate postoperative variables. Modifiable variables were identified that may mitigate the effects of severe obesity. Senior obstetric and anaesthetic care were both independently associated with a significant reduction in mean in-theatre anaesthetic preparation time and surgical duration, by 11 and three minutes respectively (P < 0.001), while epidural top-up significantly lessened mean anaesthetic in-theatre preparation duration by seven minutes (P < 0.001). Conclusions: Obese women had greater anaesthesia and surgery time, but the effect may potentially be mitigated by provision of care by experienced staff and prior establishment of epidural analgesia.

Context Robust methodology and ethical reporting are paramount for quality scientific research, but recently, that quality in addiction research has been questioned. Avenues to improve such research quality include adherence to reporting guidelines and proper usage of clinical trial registries. Reporting guidelines and clinical trial registries have been shown to lead researchers to more ethical and transparent methodology. Objectives To investigate the reporting guideline and clinical trial registration policies of addiction research journals and identify areas of improvement. Methods We used Google Scholar Metrics’ h-5 index to identify the top 20 addiction research journals. We then examined the instructions for authors from each journal to identify whether they required, recommended, or made no mention of trial registration and reporting guidelines, including the Consolidated Standards of Reporting Trials (CONSORT), Meta-Analysis of Observational Studies in Epidemiology (MOOSE), Quality of Reporting of Meta-analyses (QUOROM), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Standards for Reporting Diagnostic Accuracy Studies (STARD), Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), Animal Research: Reporting of In Vivo Experiments (ARRIVE), Case Reports (CARE), Consolidated Health Economic Evaluation Reporting Standards (CHEERS), Standards for Reporting Qualitative Research (SRQR), Standards for Quality Improvement Reporting Excellence (SQUIRE), Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT), Consolidated Criteria for Reporting Qualitative Research (COREQ), Transparent Reporting of a Multivariate Prediction Model for Individual Prognosis or Diagnosis (TRIPOD), Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P), and the International Committee of Medical Journal Editors (ICMJE) guidelines. We performed the same analysis regarding requirements for clinical trial registration. Results Of the 20 journals included in this study, 10 journals (50%) did not require adherence to any reporting guidelines. Trial registration followed a similar trend; 15 journals (75%) did not mention any form of trial or systematic review registration, and ClinicalTrials.gov was only recommended by only 1 journal (5%). Conclusions Among top addiction medicine journals, required adherence to reporting guidelines and clinical trial registry policies remains substandard. A step toward fulfilling the National Institute on Drug Abuses’ call for improvement in transparency and reproducibility within addiction research should include all journals adopting a strict reporting guideline and clinical trial registry adherence policy.

BACKGROUND Prolonged amenorrhoea occurs as a consequence of functional hypothalamic amenorrhoea (FHA) which is most often induced by weight loss, vigorous exercise or emotional stress. Unfortunately, removal of these triggers does not always result in the return of menses. The prevalence and conditions underlying the timing of return of menses vary strongly and some women report amenorrhoea several years after having achieved and maintained normal weight and/or energy balance. A better understanding of these factors would also allow improved counselling in the context of infertility. Although BMI, percentage body fat and hormonal parameters are known to be involved in the initiation of the menstrual cycle, their role in the physiology of return of menses is currently poorly understood. We summarise here the current knowledge on the epidemiology and physiology of return of menses. OBJECTIVE AND RATIONALE The aim of this review was to provide an overview of (i) factors determining the recovery of menses and its timing, (ii) how such factors may exert their physiological effects and (iii) whether there are useful therapeutic options to induce recovery. SEARCH METHODS We searched articles published in English, French or German language containing keywords related to return of menses after FHA published in PubMed between 1966 and February 2020. Manuscripts reporting data on either the epidemiology or the physiology of recovery of menses were included and bibliographies were reviewed for further relevant literature. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria served to assess quality of observational studies. OUTCOMES Few studies investigate return of menses and most of them have serious qualitative and methodological limitations. These include (i) the lack of precise definitions for FHA or resumption of menses, (ii) the use of short observation periods with unsatisfactory descriptions and (iii) the inclusion of poorly characterised small study groups. The comparison of studies is further hampered by very inhomogeneous study designs. Consequently, the exact prevalence of resumption of menses after FHA is unknown. Also, the timepoint of return of menses varies strongly and reliable prediction models are lacking. While weight, body fat and energy availability are associated with the return of menses, psychological factors also have a strong impact on the menstrual cycle and on behaviour known to increase the risk of FHA. Drug therapies with metreleptin or naltrexone might represent further opportunities to increase the chances of return of menses, but these require further evaluation. WIDER IMPLICATIONS Although knowledge on the physiology of return of menses is presently rudimentary, the available data indicate the importance of BMI/weight (gain), energy balance and mental health. The physiological processes and genetics underlying the impact of these factors on the return of menses require further research. Larger prospective studies are necessary to identify clinical parameters for accurate prediction of return of menses as well as reliable therapeutic options.

Rheumatoid vasculitis (RV) is one of the most severe extra-articular manifestations of rheumatoid arthritis, with significant morbidity and mortality, requiring aggressive treatment with corticosteroids and/or immunosuppressants. Recently, biological drugs were included in its therapeutic armamentarium. The objective of this study was to perform a systematic review on the use of biological drugs in the treatment of RV. A systematic literature review was performed based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations and searching articles in MEDLINE/PubMed, Cochrane, SciELO, Scopus, and Virtual Health Library electronic databases. Secondary references were also evaluated. The methodological quality of the selected studies was evaluated by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. Altogether, five articles, assessing the use of biological drugs, were included. Globally, 35 patients participated in the studies, of which 21 were treated with rituximab (RTX) in cycles of 1000 mg every 2 weeks; 9 used infliximab 5 mg/kg; 3 used infliximab 3 mg/kg; and 2 used etanercept 25 mg twice/week. In general, an improvement in clinical picture, reduction of the mean daily dose of corticosteroids, and improvement in the Birmingham Vasculitis Activity Score was achieved by the end of the treatment. Complete remission occurred in almost 70% of the cases. The adverse effect rate was 34%, mainly due to infections. There were two deaths, one due to sepsis and the other due to uncontrolled vasculitis, after the biological drug withdrawal, following the development of sepsis. Based on the results of the present review, we believe that the use of biological therapy such as RTX and anti-tumor necrosis factor α can be beneficial in treating this complication.

Aims and objectives To compare two health literacy measurements' ability to assess older adults' medication adherence by using the Korean Health Literacy Screening Questions (KHLSQ) and the Modified Korean Functional Health Literacy Test (M-KFHLT), and to identify an appropriate health literacy measurement. Background Lower health literacy has been associated with poorer medication adherence. Thus, health professionals should evaluate the available health literacy assessment instruments they are using and choose an appropriate instrument to assess health literacy to increase older adults' medication adherence. Design Following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist, a descriptive, cross-sectional study was conducted. Methods From November 2017-May 2018, 116 community-dwelling older adults were recruited in South Korea. Questionnaires were completed during a face-to-face interview with each participant in a private room; health literacy was assessed using the KHLSQ and the M-KFHLT and medication adherence using the Morisky Medication Adherence Scale. Results Health literacy assessed using the KHLSQ was found to be a predictor of medication adherence, but was not a predictor when measured by the M-KFHLT. Having low income, multiple chronic diseases and vision problems were also significant factors related to medication adherence. Conclusions This study suggests that health literacy was negatively associated with medication adherence. Furthermore, KHLSQ is an appropriate tool for healthcare providers to use when assessing health literacy to predict older adults' medication adherence. Relevance to clinical practice This finding indicated that healthcare providers should select an appropriate health literacy measurement that suits their purposes and the population they serve, particularly for older adults.

Background To evaluate a new procedure in daily clinical practice, it might not be sufficient to rely exclusively on the findings of randomized clinical trials (RCTs). This is the first systematic review providing a synthesis of the most important RCTs and relevant retrospective cohort studies on short- and long-term outcomes of laparoscopic surgery in colon cancer patients. Materials and methods In a literature search, more than 1800 relevant publications on the topic were identified. Relevant RCTs and representative high-quality retrospective studies were selected based on the widely accepted Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. Finally, 9 RCTs and 14 retrospective cohort studies were included. Results Laparoscopic surgery for colon cancer is associated with a slightly longer duration of surgery, but a variety of studies show an association with a lower rate of postoperative complications and a shorter duration of hospital stay. Particularly in older patients with more frequent comorbidities, laparoscopy seems to contribute to decreasing postoperative mortality. Concerning long-term oncologic outcomes, the laparoscopic and open techniques were shown to be at least equivalent. Conclusion The findings of the existing relevant RCTs on laparoscopic surgery for colon cancer are mostly confirmed by representative retrospective cohort studies based on real-world data; therefore, its further implementation into clinical practice can be recommended.