'It depends': what 86 systematic reviews tell us about what strategies to use to support the use of research in clinical practice

BACKGROUND

The gap between research findings and clinical practice is well documented and a range of strategies have been developed to support the implementation of research into clinical practice. The objective of this study was to update and extend two previous reviews of systematic reviews of strategies designed to implement research evidence into clinical practice.

METHODS

We developed a comprehensive systematic literature search strategy based on the terms used in the previous reviews to identify studies that looked explicitly at interventions designed to turn research evidence into practice. The search was performed in June 2022 in four electronic databases: Medline, Embase, Cochrane and Epistemonikos. We searched from January 2010 up to June 2022 and applied no language restrictions. Two independent reviewers appraised the quality of included studies using a quality assessment checklist. To reduce the risk of bias, papers were excluded following discussion between all members of the team. Data were synthesised using descriptive and narrative techniques to identify themes and patterns linked to intervention strategies, targeted behaviours, study settings and study outcomes.

RESULTS

We identified 32 reviews conducted between 2010 and 2022. The reviews are mainly of multi-faceted interventions (n = 20) although there are reviews focusing on single strategies (ICT, educational, reminders, local opinion leaders, audit and feedback, social media and toolkits). The majority of reviews report strategies achieving small impacts (normally on processes of care). There is much less evidence that these strategies have shifted patient outcomes. Furthermore, a lot of nuance lies behind these headline findings, and this is increasingly commented upon in the reviews themselves.

DISCUSSION

Combined with the two previous reviews, 86 systematic reviews of strategies to increase the implementation of research into clinical practice have been identified. We need to shift the emphasis away from isolating individual and multi-faceted interventions to better understanding and building more situated, relational and organisational capability to support the use of research in clinical practice. This will involve drawing on a wider range of research perspectives (including social science) in primary studies and diversifying the types of synthesis undertaken to include approaches such as realist synthesis which facilitate exploration of the context in which strategies are employed.

Loneliness among single and coupled individuals in response to the COVID-19 pandemic: A cross-country analysis

Background/Objective

Research suggests that the COVID-19 pandemic has increased social isolation and loneliness and that, in general, single individuals experience a higher degree of loneliness than coupled individuals. Loneliness may also vary across cultures as a function of social norms and Hofstede's dimensions of national culture. Therefore, the aim of the present study was to examine whether the link between relationship status and loneliness in the context of the COVID-19 pandemic differed across countries as a function of cultural values captured in terms of Hofstede's six dimensions of national culture.

Method

Multilevel modeling was used to analyze the archival data collected in the COVIDiSTRESS Global Survey (41 countries and 102,957 participants) and the COVIDiSTRESS Global Survey - Round II (23 countries and 8227 participants).

Results

The analyses demonstrated the statistical significance of the interactions between relationship status and six Hofstede's dimensions of national culture in the link between relationship status and loneliness. The estimated effect sizes of these interactions were, however, almost zero.

Conclusions

The lack of effect size of the interactions between relationship status and Hofstede's dimensions of national culture for loneliness may have substantive significance. This finding implies that, on average, loneliness as a function of relationship status may be less reactive in the context of the COVID-19 pandemic to the effects of social norms and values across which countries vary.

Contrast-Enhanced Ultrasound with Deep Learning with Attention Mechanisms for Predicting Microvascular Invasion in Single Hepatocellular Carcinoma

RATIONALE AND OBJECTIVES

Prediction of microvascular invasion (MVI) status of hepatocellular carcinoma (HCC) holds clinical significance for decision-making regarding the treatment strategy and evaluation of patient prognosis. We developed a deep learning (DL) model based on contrast-enhanced ultrasound (CEUS) to predict MVI of HCC.

MATERIALS AND METHODS

We retrospectively analyzed the data for single primary HCCs that were evaluated with CEUS 1 week before surgical resection from December 2014 to February 2022. The study population was divided into training (n = 198) and test (n = 54) cohorts. In this study, three DL models (Resnet50, Resnet50+BAM, Resnet50+SE) were trained using the training cohort and tested in the test cohort. Tumor characteristics were also evaluated by radiologists, and multivariate regression analysis was performed to determine independent indicators for the development of predictive nomogram models. The performance of the three DL models was compared to that of the MVI prediction model based on radiologist evaluations.

RESULTS

The best-performing model, ResNet50+SE model achieved the ROC of 0.856, accuracy of 77.2, specificity of 93.9%, and sensitivity of 52.4% in the test group. The MVI prediction model based on a combination of three independent predictors showed a C-index of 0.729, accuracy of 69.4, specificity of 73.8%, and sensitivity of 62%.

CONCLUSION

The DL algorithm can accurately predict MVI of HCC on the basis of CEUS images, to help identify high-risk patients for the assist treatment.

A prospective randomized study

Introduction

Despite of their extensive use, drains remain controversial without clear guidelines, and there is unclear evidence on drain use in spine procedures. Negative pressure drainage is theoretically more effective in preventing postoperative hematomas. On the contrary, it may result in excessive drainage and blood loss.The aim of this study was to compare the outcome between the uses of negative versus natural drainage in single level posterior lumbar interbody fusion (PLIF).

Research question

The aim is to compare between negative versus natural drainage after single-level PLIF as regard to postoperative wound infection, wound healing, temperature, pain and neurological deficits.

Materials and methods

A prospective randomized study of consecutive PLIF patients at a single level for lumbar disc prolapse was performed between January 2019 and January 2020. The patients were randomly assigned to either the negative suction drainage group or natural drainage group. Negative suction was created by maximum compression of the reservoir to create negative pressure. In the other group, natural pressure drainage was kept without any negative pressure.Our study included a total of 62 patients who met the inclusion criteria. They were divided into two groups; 33 patients had negative suction drains and 29 patients had natural drainage. There were 32 female (51.6%) and 30 male (48.4%). Their ages ranged between of 23-69 years, with a mean age of 42.11 ​± ​8.89 years.

Results

Drainage volume was statistically higher in the negative group on the day of surgery (day 0) as well as the 1st and second days after. However, no significant differences were observed as regards to postoperative temperature, pain, wound infection, temperature, or neurological deficits.

Discussion &conclusion

In this prospective randomized study, our results revealed that natural drainage in short term can reduce the total amount of blood in the drain, and therefore the blood loss without significant differences in postoperative wound infection, wound healing, temperature, pain, or neurological deficits in single-level PLIF.

Penetrating colon trauma - outcomes related to single versus multiple colonic suture injuries

INTRODUCTION

There is no conclusive evidence to guide surgical management in the presence of multiple colonic injuries as opposed to a single colonic injury, and whether multiple colonic suture lines are associated with worse outcomes than single suture lines.

AIM

We reviewed the outcomes of penetrating colonic trauma in relation to whether patients had single versus multiple colonic suture lines (primary repair or anastomosis) following laparotomy.

METHODS

A retrospective study was conducted at a major trauma centre in South Africa from (2012-2020) for all patients over 18 years who had sustained penetrating colon injury.

RESULTS

541 cases were included: 409 with single suture line and 54 with multiple suture lines. There were no differences between groups in terms of mechanism of injury (gunshot vs stab; p = 0.328), Injury Severity Score (p = 0.071), or Penetrating Abdominal Trauma Index (p = 0.396). Admission lactate was worse for multiple suture line patients (p = 0.049), but no other blood gas parameters were different, and there was no higher incidence of damage control surgery (p = 0.558) or ICU admission (p = 0.156) for this group. There was a higher rate of diversion in the multiple suture line group (p < 0.001). Univariable logistic regression did not show an increased risk of gastro-intestinal complications, suture line leak rate, or mortality for multiple suture lines compared to single.

CONCLUSION

It appears that there is no appreciable difference in outcome between patients with a single colonic suture line compared to patients with more than one suture line following trauma laparotomy. In light of this, each injury should be treated on its own merit, in the context of the patient's overall physiological condition, without undue fear of leaving the patient with more than one colonic suture line. However, judicious use of diversion remains advisable.

Partner responsiveness moderates the relation between COVID-19-related stressors and changes in mood during the pandemic

The COVID-19 pandemic has created an unusually stressful situation for many people around the world. Due to the restrictions, many have been isolated in their homes, and having a responsive partner may have become even more important. The present study aimed to investigate (1) whether there were any differences in social and work-related stressors and changes in negative mood during the COVID-19 pandemic as a function of marital status, and (2) whether perceived partner responsiveness can attenuate the associations between COVID-19-related stressors and changes in negative mood. The participants were 2,400 Brazilian adults recruited via the Internet, using a virtual sampling strategy. They were assigned to three distinct groups based on their relationship status. The results showed that a relatively large proportion of the sample reported increased levels of negative mood, and that married/cohabitating couples reported low levels of negative change in mood compared to single participants. We also found that partner responsiveness attenuated the association between stress and mental health, but only for people who were dating. Our study contributes new insights by showing that effects on mental health during the COVID-19 pandemic are dependent on relationship type and perceived partner responsiveness.

Understanding mechanisms in the adsorption of lead and copper ions on chili seed waste in single and multicomponent systems: a combined experimental and computational study

In the current work, a deep study to understand the adsorption phenomena occurring in single and multicomponent systems was conducted by using spectroscopic characterization, and computational tools. The experimental results showed that the adsorption capacity of chili seed is higher for Pb2+ (48 mg/g) than Cu2+ (4.1 mg/g) ions in single systems. However, the adsorption study in multicomponent systems provides important conclusions of the concentration effect of the metal ions, showing a significant antagonistic and competitive effect of both ions under equivalent concentrations of them (qPb2+ is 56% reduced) or high concentration of Pb2+ (qCu2+ is 50% reduced). Computational results correlated well with the experimental ones and evidenced all interactions proposed from spectroscopy results, accounting for the occurrence of complexation and electrostatic mechanisms between metal ions and the surface oxygenated functional groups (hydroxyl, carboxyl, and carboxylate) onto chili seed. Chemistry quantum descriptors supported the reactivity behavior of the chemical species implicated. All results evidenced that Pb2+ and Cu2+ adsorption on chili seed surface is governed by the occurrence of combined ionic exchange, π-interaction, complexation, and electrostatic attraction.

Evaluation of the Efficacy of Single Anastomosis Sleeve Ileal (SASI) Bypass for Patients with Morbid Obesity: a Multicenter Study

BACKGROUND

Single anastomosis sleeve ileal (SASI) bypass is a newly introduced bariatric and metabolic procedure. The present multicenter study aimed to evaluate the efficacy of the SASI bypass in the treatment of patients with morbid obesity and the metabolic syndrome.

METHODS

This is a retrospective, seven-country, multicenter study on patients with morbid obesity who underwent the SASI bypass. Data regarding patients' demographics, body mass index (BMI), percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), and improvement in comorbidities at 12 months postoperatively and postoperative complications were collected.

RESULTS

Among 605 patients who underwent the SASI, 54 were excluded and 551 (390; 70.8% female) were included. At 12 months after the SASI, a significant decrease in the BMI was observed (43.2 ± 12.5 to 31.2 ± 9.7 kg/m²; p < 0.0001). The %TWL was 27.4 ± 13.4 and the %EWL was 63.9 ± 29.5. Among the 279 patients with type 2 diabetes mellitus (T2DM), complete remission was recorded in 234 (83.9%) patients and partial improvement in 43 (15.4%) patients. Eighty-six (36.1%) patients with hypertension, 104 (65%) patients with hyperlipidemia, 37 (57.8%) patients with sleep apnea, and 70 (92.1%) patients with GERD achieved remission. Fifty-six (10.1%) complications and 2 (0.3%) mortalities were recorded. Most complications were minor. All patients had 12 months follow-up.

CONCLUSIONS

The SASI bypass is an effective bariatric and metabolic surgery that achieved satisfactory weight loss and improvement in medical comorbidities, including T2DM, hypertension, sleep apnea, and GERD, with a low complication rate.

Single versus Double Burr Hole for Drainage of Chronic Subdural Hematoma: Randomized Controlled Study

BACKGROUND

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical emergencies. Most neurosurgeons currently drained CSDH through single or double burr holes; however, few studies have compared the 2 approaches to drainage. The aim of this study is to compare the recurrent rate following double and single burr hole for CSDH in our practice.

METHODS

This is a randomized controlled study from January 2015 to December 2019 in a neurosurgical unit in Kaduna, Nigeria. All patients with imaging diagnosis of subacute or chronic subdural hematoma who enrolled in the study had either a single or double burr hole. Patients were followed up for 6 months after surgery to assess for recurrence. Data were analyzed using SPSS version 25 for Windows. The Fisher exact test was performed to compare the 2 treatment groups. A 2-sided P value < 0.05 was considered statistically significant.

RESULTS

A total of 192 patients were enrolled in the study with 99 in the single-burr hole group and 93 in the double burr-hole group. The overall recurrence rate in this study was 2.6%. The recurrence rate in the single arm was 3%, and in the double arm it was 2.2%. There was no statistically significant difference in recurrence between the 2 groups (P = 1.000).

CONCLUSIONS

A single burr hole is as efficacious as a double burr hole in terms of relief of symptoms and recurrence, and it has a shorter duration of surgery.

Combination versus single-agent as palliative chemotherapy for gastric cancer

BACKGROUND

Although combination chemotherapy (CC) is generally recommended in recurrent or primary metastatic gastric cancer (RPMGC), the results of randomized trials are conflicting.

METHODS

A retrospective review was conducted on 687 RPMGC patients who received palliative chemotherapy. We compared the overall survival (OS) between CC and single-agent chemotherapy (SC) among these patients, and we analyzed the clinicopathological characteristics affecting outcome including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR).

RESULTS

Although 521 patients (75.8%) underwent CC, SC was more frequently performed in elderly patients (57.6%) and ECOG performance status (PS) 2 or 3 (65.8%) patients (p < 0.0001, in each case). The median OS of patients who received CC was significantly longer than that of patients who received SC (11 vs. 8 months, p < 0.0001). No difference in OS between CC and SC was observed in elderly patients (p = 0.583), poor PS (p = 0.810), signet ring cell (p = 0.347), palliative surgical resection (p = 0.307), and high PLR (p = 0.120), with a significant interaction between age and type of regimen (p = 0.012). Moreover, there was no difference in OS between CC and SC after propensity score matching (p = 0.322). Multivariate analysis revealed that palliative resection and ≥ second-line chemotherapy were independently associated with favorable OS (p < 0.0001, in each case), whereas poor PS (p = 0.004), signet ring cell (p < 0.0001), peritoneal metastasis (p = 0.04), high NLR (p = 0.001), and high PLR (p = 0.033) were independent prognostic factors of poor OS.

CONCLUSIONS

Although CC is the standard of care in RPMGC, SC can be considered a reasonable option in certain subgroups, such as elderly patients.

Psychiatric diagnosis, gender, aggression, and mode of attempt in patients with single versus repeated suicide attempts

There is evidence that patients with multiple suicide attempts in their history are at greater risk to repeat attempt and eventually die by suicide compared to those with a single attempt. This cross-sectional study aimed to explore possible differences in clinical characteristics between patients with a single attempt and patients with repeated attempts. Two hundred thirty one patients hospitalised in psychiatric department after suicide attempt were studied. Comparisons were made in relation to age, gender, psychiatric diagnosis, aggression, depression severity, suicide intent and mode of attempt. Highest frequencies of patients with repeated attempts were found for bipolar disorder (69%) and lowest for adjustment/personality disorders (39%). In patients with repeated attempts, female gender was associated with non-violent attempt mode. Depressive symptomatology was higher in patients with repeated attempts among females. In patients with depression those with repeated attempts were younger than patients with single attempt. In patients with mood disorders, total aggression and hostility scores were higher in females with repeated attempts but not in males. Psychiatric diagnosis, gender and attempt mode are features that differentiate patients with single and repeated attempts and should be considered to identify patients at increased risk to repeat attempt and design effective prevention interventions.

The effect of Cu-resistant plant growth-promoting rhizobacteria and EDTA on phytoremediation efficiency of plants in a Cu-contaminated soil

Remediation of heavy metal-contaminated soils is essential for safe agricultural or urban land use, and phytoremediation is among the most effective methods. The success of phytoremediation relies on the size of the plant biomass and bioavailability of the metal for plant uptake. This research was carried out to determine the effect of Ethylenediaminetetraacetic acid (EDTA) ligand and Cu-resistant plant growth-promoting rhizobacteria (PGPR) on phytoremediation efficiency of selected plants as well as fractionation and bioavailability of copper (Cu) in a contaminated soil. The test conditions included three plant species (maize: Zea mays L., sunflower: Helianthus annuus L., and pumpkin: Cucurbita pepo L.) and six treatments, comprising two PGPR strains (Pseudomonas cedrina K4 and Stenotrophomonas sp. A22), two PGPR strains with EDTA, EDTA, and control (without PGPR and EDTA). The combination of EDTA and PGPR enhanced the Cu concentration in both shoot and root tissues and increased the plant biomass. The Cu specific uptake was at a maximum level in the shoots of pumpkin plants when treated with the PGPR strain K4 + EDTA (202 μg pot^-1), and the minimum amount of Cu was recorded for sunflower with no PGPR or EDTA addition (29.6 μg pot^-1). The result of the PGPR-EDTA treatments showed that the combined application of EDTA and PGPR increased the shoot Cu-specific uptake approximately fourfold in pumpkin. Pumpkin with the highest shoot Cu specific uptake and maize with the highest root Cu specific uptake were the most effective plants in phytoextraction and phytostabilization, respectively. The effectiveness of different PGPR-EDTA treatments in increasing Cu specific uptake by crop plants was assessed by measuring the amount of Cu extracted from the rhizosphere soil adhering to the roots of crop species, by the use of the single extractants Diethylenetriamine pentaacetic acid (DTPA), H₂O, NH₄NO₃, and NH₄OAc. PGPR-EDTA treatments increased the amount of water-extractable Cu from rhizosphere soils more than ten times that of the control. The combined application of the EDTA and PGPR reduced the carbonated Fe and Mn oxide-bound Cu in the contaminated soil, and increased the soluble and exchangeable concentration of Cu. Pumpkin, with high shoot biomass and the highest shoot Cu specific uptake was found to be the most effective field crop in phytoextraction of Cu from the contaminated soil. The results of this pot study demonstrated that the EDTA+PGPR treatment could play an important role in increasing the Cu bioavailability and specific uptake by plants, and thus increasing the phytoremediation efficiency of plants in Cu-contaminated areas.

The association of marital status and mortality among men with early-stage prostate cancer treated with radical prostatectomy: insight into post-prostatectomy survival strategies

PURPOSE

The purpose of this study was to determine the association of marital status, a marker of social support, with all-cause and prostate cancer-specific mortality in a cohort of men with early-stage prostate cancer treated with radical prostatectomy.

METHODS

We conducted a retrospective cohort study of 3,579 men treated for localized (stage 1-2) prostate cancer with radical prostatectomy at a single institution between 1994 and 2004. Marital status (not married vs. married) and marital history (never married, divorced, widowed vs. married) at the time of prostatectomy were examined in relation to (1) all-cause mortality and (2) prostate cancer-specific mortality using Cox proportional hazards regression.

RESULTS

Not being married (vs. married) at the time of radical prostatectomy was associated with an increased risk of all-cause mortality [Hazard Ratio (HR) 1.42; 95% Confidence Interval (CI) 1.10, 1.85]. Similarly, in analyses of marital history, never-married men were at highest risk of all-cause mortality (HR 1.77, 95% CI 1.19, 2.63). Unmarried status (vs. married) was also associated with an increased risk of prostate cancer-specific mortality (HR 1.97; 95% CI 1.01, 3.83).

CONCLUSIONS

Unmarried men with prostate cancer were at greater risk for death after radical prostatectomy. Among married men with prostate cancer, marriage likely serves as a multi-faceted proxy for many protective factors including social support. Future studies should explore the mechanisms underlying these findings to inform the development of novel prostate cancer survival interventions for unmarried men and those with low social support.

A comparison of union rates and complications between single screw and double screw fixation of sliding calcaneal osteotomy

BACKGROUND

The number of screws used for sliding calcaneal osteotomy fixation has not been examined in the literature. The purpose of this paper is to examine this topic.

METHODS

Retrospective chart review was performed on 190 patients who met selection criteria. We compared complication risk for single versus double screw, headed versus headless screw, and short versus longitudinal incision cases.

RESULTS

The mean age was 48.4 (18-83) years and average follow up was 28 (12-150) weeks. All cases achieved radiographic union. Overall complication rate was 19.5% (37/190). Risk of complication did not differ significantly between single and double screw (RR: 1.170; 95% CI: 0.66-2.09; p=0.594) or short and extended incision groups (RR: 0.868; 95% CI: 0.42-1.80; p=0.704). Risk of complication differed significantly between headed and headless screw fixation (RR: 5.558; 95% CI: 2.69-11.50; p<0.0001).

CONCLUSIONS

Single screw fixation of sliding calcaneal osteotomy achieves similar outcomes as double screw fixation. Headless screws are advantageous for minimizing hardware pain and subsequent hardware removal.

Neurosurgical Resection and Stereotactic Radiation Versus Stereotactic Radiation Alone in Patients with a Single or Solitary Brain Metastasis

BACKGROUND

Brain metastases commonly manifest in patients with cancer, with ∼20%-50% presenting with 1 intracranial lesion. Among patients with 1, small brain metastasis and controlled or absent extracranial disease, it remains unclear whether aggressive intracranial management using neurosurgical resection plus cavity stereotactic radiosurgery/stereotactic radiotherapy (SRS/SRT) rather than SRS/SRT alone is beneficial. In patients with controlled or absent extracranial disease and 1 brain metastasis ≤2 cm in size, we evaluated the effect of surgery plus SRS/SRT compared with SRS/SRT on oncologic outcomes, including overall survival.

METHODS

We retrospectively identified 86 patients with controlled or absent extracranial disease and 1 brain metastasis ≤2 cm in size who had been treated from 2000 to 2015 at our institution. We examined differences in the rates of local and distant failure, use of salvage treatment, and other oncologic outcomes, including all-cause mortality.

RESULTS

The baseline characteristics were similar between the 2 cohorts. The median follow-up period for the surviving patients was 38 months. On multivariable analysis, surgical resection plus cavity SRS/SRT was associated with a lower risk of all-cause mortality (hazard ratio, 0.44; 95% confidence interval, 0.19-1.00; P = 0.05) compared with SRS/SRT alone. The 1- and 2-year rates of overall survival were 100% and 88% versus 74% and 52% for surgery plus cavity SRS/SRT versus SRS/SRT alone, respectively.

CONCLUSIONS

Aggressive, local therapy, including neurosurgical resection, might benefit patients with 1 brain metastasis in the context of controlled or absent systemic disease, even if the lesion in question is small. Further studies are needed to evaluate these associations.

Asthma, rhinitis, and nasal polyp multimorbidities

The aim of this review is to assist pulmonologists in the management of diseases involving both the upper and lower respiratory tract that are linked by a common, interrelated epidemiology, clinical signs and symptoms, and inflammatory mechanism - asthma, in particular. The document discusses the definitions of the various sinonasal phenotypes associated with asthma: allergic and non-allergic rhinitis and chronic rhinosinusitis with or without nasal polyps. Diagnostic criteria and severity levels are also listed. Particular attention has been given to the 2 main syndromes associated with asthma: (i)allergic rhinitis, the most common, and (ii)chronic rhinosinusitis with nasal polyps, the disease most closely associated with severe asthma. To summarize, the upper respiratory tract should always be evaluated in order to achieve a single diagnosis and comprehensive treatment of the "united airway".

Potential Impact of Vascular Endothelial Growth Factor Gene Variation (-2578C>A) on Breast Cancer Susceptibility in Saudi Arabia: a Case-Control Study

Aim:

VEGF gene polymorphisms can induce either increase or inhibition of VEGF secretion, with altered promoter activity. The VEGF rs699947 SNP is located in the promoter region and is associated with susceptibility to breast carcinoma development. Here, we investigated the association of the -2578C>A polymorphism in the VEGF gene with breast cancer risk in Saudi women.

Methodology:

Genotyping of the VEGF-gene variation (-2578A>C) was performed using the amplification refractory mutation system PCR. We investigated the association of VEGF gene variants with different clinicopathological features of breast cancer patients.

Results:

A significant difference was observed in genotype distribution among the breast cancer cases and sex matched healthy controls (p=0.03). The frequencies of the three genotypes CC, CA, AA found in the patient samples were 37%, 45% and 18% and in the healthy controls were 54%,37%, and 09% respectively. An increased risk of developing breast cancer in Saudi women was associated with the VEGF −2578 AA genotype (OR = 2.91, 95 % CI, 1.18-7.20; p = 0.01; RR 1.78 (1.01-3.11 p=0.01), the VEGF −2578 A allele (OR = 1.79, 95 % CI, 1.17-2.73; p = 0.004: RR 1.35 1.07-1.71) and the VEGFR-(CA+ AA) (OR 1.99 1.13-3.51; RR 1.401.0-1.85). Thus the A allele increased the risk of BC when compared with C allele. When we stratified groups of patients according to the status of tumor markers, stage, age and metastasis, statistically significant associations with −2578 C/A SNP were revealed.

Conclusion:

Our data showed a significant association of the VEGF -2578C>A polymorphism with BC susceptibility in Saudi women. The VEGF -2578AA homozygote significantly increases the risk and can be useful as a predisposing genetic marker. Further studies with larger sample sizes are necessary to confirm our findings.

Single-Session Behavioral Interventions for Sexual Risk Reduction: A Meta-Analysis

BACKGROUND

Evidence-based, single-session STI/HIV interventions to reduce sexual risk taking are potentially effective options for implementation in resource-limited settings and may solve problems associated with poor participant retention.

PURPOSE

The purpose of the study is to estimate the efficacy of single-session, behavioral interventions in reducing unprotected sex or increasing condom use.

METHODS

Data sources were searched through April 2013 producing 67 single-session interventions (52 unique reports; N = 20,039) that included outcomes on condom use and/or unprotected sex.

RESULTS

Overall, participants in single-session interventions reduced sexual risk taking relative to control groups (d ₊  = 0.19, 95 % CI = 0.11, 0.27). Within-group effects of the interventions were larger than the between-groups effects when compared to controls.

CONCLUSIONS

Brief, targeted single-session sexual risk reduction interventions demonstrate a small but significant effect and should be prioritized.

Single- or double-unit UCBT following RIC in adults with AL: a report from Eurocord, the ALWP and the CTIWP of the EBMT

Background

The feasibility of cord blood transplantation (CBT) in adults is limited by the relatively low number of hematopoietic stem/progenitor cells contained in one single CB unit. The infusion of two CB units from different partially HLA-matched donors (double CBT) is frequently performed in patients who lack a sufficiently rich single CB unit.

Methods

We compared CBT outcomes in patients given single or double CBT following reduced-intensity conditioning (RIC) in a retrospective multicenter registry-based study. Inclusion criteria included adult (≥18 years) patients, acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL), complete remission (CR) at the time of transplantation, first single (with a cryopreserved TNC ≥ 2.5 × 10⁷/kg) or double CBT between 2004 and 2014, and RIC conditioning.

Results

Data from 534 patients with AML (n = 408) or ALL (n = 126) receiving a first single (n = 172) or double (n = 362) CBT were included in the analyses. In univariate analysis, in comparison to patients transplanted with a single CB, double CB recipients had a similar incidence of neutrophil engraftment but a suggestion for a higher incidence of grade II–IV acute GVHD (36 versus 28%, P = 0.08). In multivariate analyses, in comparison to single CBT recipients, double CBT patients had a comparable incidence of relapse (HR = 0.9, P = 0.5) and of nonrelapse mortality (HR = 0.8, P = 0.3), as well as comparable overall (HR = 0.8, P = 0.17), leukemia-free (HR = 0.8, P = 0.2) and GVHD-free, relapse-free (HR = 1.0, P = 0.3) survival.

Conclusions

These data failed to demonstrate better transplantation outcomes in adult patients receiving double CBT in comparison to those receiving single CBT with adequate TNC after RIC.

Electronic supplementary material

The online version of this article (doi:10.1186/s13045-017-0497-9) contains supplementary material, which is available to authorized users.

Gender difference in utilization willingness of institutional care among the single seniors: evidence from rural Shandong, China

Background

Institutional care has become an urgent issue in rural China. Rural single seniors, compared with their counterparts, have lower income and are more vulnerable. Gender is also a significant factor determining long-term institutional care. This study is designed to examine the gender difference towards utilization willingness of institutional care among rural single seniors.

Methods

A total of 505 rural single seniors were included in the analysis. Binary logistic regression model was used to examine the gender difference towards utilization willingness for institutional care, and also to identify the determinants of the utilization willingness for institutional care among rural single male and female seniors.

Results

Our study found that about 5.7% rural single seniors had willingness for institutional care in Shandong, China. Single females were found to be less willing for institutional care than single males in rural areas (OR = 0.19; 95 CI 0.06-0.57). It’s also found that psychological stress was associated with institutionalization willingness in both single males (P = 0.045) and single females (P = 0.013) in rural China. The rural single seniors who lived alone were found to be more willing for institutional care both in males (P = 0.032) and females (P = 0.002) compared with those who lived with children or others.

Conclusions

This study found that there was a gender difference towards utilization willingness for institutional care among single seniors in rural China. Factors including psychological stress and living arrangements were determinants of institutionalization willingness both in single males and females. Targeted policies should be made for rural single seniors of different gender.

Electronic supplementary material

The online version of this article (doi:10.1186/s12939-017-0577-z) contains supplementary material, which is available to authorized users.

Efficacy of single-dose hyaluronic acid products with two different structures in patients with early-stage knee osteoarthritis

[Purpose] There are many types of hyaluronic acid preparations, but no clear data are available about which preparations is more effective. The aim of this trial was to investigate the effectiveness of different types of hyaluronic acid preparations on pain and function of inpatients with knee osteoarthritis. [Subjects and Methods] All patients were diagnosed by clinical examination and x-ray. Ostenil PLUS^® was injected into 28 patients (group 1, 1.6 million daltons), and MONOVISC^® (group 2, 2.5 million daltons) was injected into 46 patients. Demographic data and Western Ontario and McMaster Universities Osteoarthritis Index and Visual Analog Scale scores were used for clinical evaluation at 1, 3, and 6 months post injection. [Results] In both groups, baseline Ontario and McMaster Universities Osteoarthritis Index and Visual Analog Scale scores were higher compared with those in subsequent evaluations. Based on the pre- and post-injection data, a significant reduction in all scores was observed after the injections for in both groups. According to intergroup comparisons, there was no significant difference in any of the scores between the two groups. [Conclusion] There were no difference in Ontario and McMaster Universities Osteoarthritis Index and Visual Analog Scale scores in patients with knee osteoarthritis injected with two different hyaluronic acid structures in short-term preparations.

Blastocyst culture using single versus sequential media in clinical IVF: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

The purpose of this study was to undertake a review of the available evidence comparing the use of a single medium versus sequential media for embryo culture to the blastocyst stage in clinical IVF.

METHODS

We searched the Cochrane Central, PubMed, Scopus, ClinicalTrials.gov, Current Controlled Trials and WHO International Clinical Trials Registry Platform to identify randomized controlled trials comparing single versus sequential media for blastocyst culture and ongoing pregnancy rate. Included studies randomized either oocytes/zygotes or women. Eligible oocyte/zygote studies were analyzed to assess the risk difference (RD) and 95 % confidence intervals (CI) between the two media systems; eligible woman-based studies were analyzed to assess the risk ratio (RR) and 95 % CI for clinical pregnancy rate.

RESULTS

No differences were observed between single and sequential media for either ongoing pregnancy per randomized woman (relative risk (RR) = 0.9, 95 % CI = 0.7 to 1.3, two studies including 246 women, I ² = 0 %) or clinical pregnancy per randomized woman (RR = 1.0, 95 % CI = 0.7 to 1.4, one study including 100 women); or miscarriage per clinical pregnancy: RR = 1.3, 95 % CI = 0.4 to 4.3, two studies including 246 participants, I ² = 0 %). Single media use was associated with an increase blastocyst formation per randomized oocyte/zygote (relative distribution (RD) = +0.06, 95 % CI = +0.01 to +0.12, ten studies including 7455 oocytes/zygotes, I ² = 83 %) but not top/high blastocyst formation (RD = +0.05, 95 % CI = -0.01 to +0.11, five studies including 3879 oocytes/zygotes, I ² = 93 %). The overall quality of the evidence was very low for all these four outcomes.

CONCLUSIONS

Although using a single medium for extended culture has some practical advantages and blastocyst formation rates appear to be higher, there is insufficient evidence to recommend either sequential or single-step media as being superior for the culture of embryos to days 5/6. Future studies comparing these two media systems in well-designed trials should be performed.

Single- versus dual-rod anterior instrumentation of thoracolumbar curves in adolescent idiopathic scoliosis

PURPOSE

Single or dual-rod instrumentation can be used for the anterior fixation of the spine in adolescent idiopathic scoliosis (AIS). We aim to compare the complications, radiographic and functional outcomes of patients with AIS who have undergone single and dual-rod instrumentation.

METHODS

This is a multi-centre study involving the Royal Children's, Royal Melbourne and Epworth hospitals. Three primary surgeons were involved to ensure homogeneity of surgical technique and implants. Patients with AIS and thoracolumbar curves (Lenke 5 and 6) undergoing anterior instrumentation from 1st January 2000 to 30th June 2013 were included. Radiographic data were collected from X-rays. The functional outcome was measured through the Scoliosis Research Society questionnaire (SRS-30).

RESULTS

The study included 58 patients (38 single-rod and 20 dual-rod patients). Thirty-nine patients were classified with Lenke 5 curves, while 19 patients had Lenke 6 curves. Structural interbody supports were used in 95 % of cases. In the preoperative to postoperative period, patients with single rods had an improvement of 75 and 51 % for primary and secondary curves, respectively, while patients with dual rods had an improvement of 70 and 38 % for primary and secondary curves, respectively. There were no cases of pseudoarthrosis or metalware failure in either group. Two patients (one single-rod and one dual-rod patient) required further unplanned posterior fusion. 91 % of patients were satisfied with the results of their back management.

CONCLUSION

Pseudoarthrosis and metalware failure are rare complications of anterior instrumentation. Our study found no significant difference in functional or radiographic outcome between single and dual-rod instrumentation.

LEVEL OF EVIDENCE

Level III.

Trends in the surgical treatment of lumbar spine disease in the United States

BACKGROUND CONTEXT

There is a lack of agreement among spine surgeons as to the best surgical treatment modality for many degenerative lumbar diseases. Although there are many studies examining trends in spinal surgery, specific studies reporting the variations in surgical treatment in the United States for these diseases are lacking.

PURPOSE

The aim of this study was to analyze trends in lumbar spinal fusion methods for common lumbar pathologies in the United States.

STUDY DESIGN/SETTING

National insurance database review: 2004-2009.

PATIENT SAMPLE

Data is taken from United Healthcare and represents more than 25 million patients.

OUTCOME MEASURES

No outcomes were measured in this study.

METHODS

Using a private insurance database, we identified patients who underwent one of five types of instrumented single-level lumbar spinal fusion for the 10 most common primary diagnoses. Surgery rates were reviewed from 2004 to 2009 and were stratified according to patient age, patient gender, and region in the United States. Poisson regression analysis was performed to determine regional and demographic differences in treatment modality. The authors received no funds in support of this work.

RESULTS

A total of 23,986 patients met our search criteria. Of the five fusion types, posterior lumbar interbody fusion (PLIF) with posterolateral fusion (PLF) was the most common (45%), followed by PLF (19%), anterior lumbar interbody fusion (ALIF, 16%), PLIF (10%), and ALIF with PLF (9%). There was a significant increase in PLIF with PLF (p<.0001), PLIF (p<.0001), PLF (p=.012), ALIF (p<.0001), and ALIF with PLF (p<.0001) from 2004 to 2009. After controlling for gender, there were significant differences between regions for all fusion types (p<.0001). The likelihood of a posterior fusion increased with age. Anterior fusions were more common in the 30- to 49-year-old age range than in patents older than 50. For patients in age groups older than 30, there was an increased number who underwent a circumferential fusion or an ALIF (p<.022). Fusion types were significantly different between genders (p<.026). Both genders had an overall increase in the number of fusions (p<.001) over the time period studied.

CONCLUSIONS

There are large differences in the United States for surgical treatment methods for lumbar spine pathology. These differences are likely multifactorial, with both patient and surgeon traits playing a role. Illustrating these differences will hopefully lead to outcomes research to determine the indications, efficacy, and appropriateness of these surgical methods, an important step on the path toward standardization of care.

An Investigation of Loneliness and Perceived Social Support Among Single and Partnered Young Adults

This study investigated the possible differences between single individuals and individuals in nonmarital romantic relationships in the domains of emotional (romantic and family) and social loneliness, and of perceived social support from family, friends and significant others. Based on a Polish university-student sample of 315 participants (167 women and 148 men) aged 19 to 25 years (M = 21.90, SD = 2.15), single relationship status was related to greater romantic and family loneliness, and to less perceived social support from significant others and family. Women reported a lower level of social loneliness and a higher level of perceived social support in comparison to men. Relationship status interacted with gender in predicting perceived social support from significant others and friends. Finally, the duration of remaining single and significant others’ support were found to be predictive of single young adults’ romantic loneliness. In addition, perceived social support from family and significant others were found to moderate the relationship between the duration of remaining single and romantic loneliness. In particular, high family support and medium-high support from significant others mitigated the negative impact of being single for a long time on romantic loneliness.

Partnered Polish Young Adults

The aim of this study was to examine whether young adults in nonmarital romantic relationships experience better mental health and lower levels of mental health problems compared to single young adults. In addition, the current study also tested the hypothesis that perceived social support mediates the association between relationship status (single vs. partnered) and mental health, and mental health problems. Five hundred fifty three participants (335 females and 218 males) aged 20-30 completed the Polish versions of General Health Questionnaire-28, Mental Health Continuum-Short Form, Social and Emotional Loneliness Scale for Adults-Short Form, and Multidimensional Scale of Perceived Social Support. Results indicated that single individuals reported lower emotional well-being than partnered individuals. No differences emerged between single and partnered individuals in regard to social and psychological well-being, as well in total well-being. Results also revealed no differences between single and partnered individuals in regard to somatic symptoms, anxiety and insomnia, social dysfunction, severe depression, and total mental health problems. Mediational analyses indicated the perceived social support mediates the association between partner status and mental health problems.

The single-leg-stance test in Parkinson's disease

Background

Timed single-leg-stance test (SLST) is widely used to assess postural control in the elderly. In Parkinson’s disease (PD), it has been shown that an SLST around 10 seconds or below may be a sensitive indicator of future falls. However, despite its role in fall risk, whether SLST times around 10 seconds marks a clinically important stage of disease progression has largely remained unexplored.

Methods

A cross-sectional study where 27 people with PD were recruited and instructed to undertake timed SLST for both legs was conducted. Disease motor impairment was assessed with the Unified Parkinson’s Disease Rating Scale Part 3 (UPDRS-III).

Results

This study found that: 1) the SLST in people with PD shows good test-retest reliability; 2) SLST values can be attributed to two non-overlapping clusters: a low (10.4 ± 6.3 seconds) and a high (47.6 ± 11.7 seconds) value SLST group; 3) only the low value SLST group can be considered abnormal when age-matched normative SLST data are taken into account for comparison; and 4) lower UPDRS-III motor performance, and the bradykinesia sub-score in particular, are only associated with the low SLST group.

Conclusion

These results lend further support that a low SLST time around 10 seconds marks a clinically important stage of disease progression with significant worsening of postural stability in PD.

Sils without Frills

Historically, invasive, large incisions were necessary to perform "open" abdominal surgical procedures. While effective, this method increased the possibility of multiple complications, including post-operative pain, wound infection, incisional hernia and prolonged hospitalization. Concerns over the rate of complications and morbidities led surgeons to develop laparoscopic surgical techniques, in which operations in the abdomen are performed through small incisions as opposed to larger, open incisions across the surgical site. There was a continuous effort to minimize the number of ports, and finally single incision laparoscopic surgery (SILS) came into practice. Sils without frills is a concept where multiple ports are made in a curved 2.5 cm incision in a triangle. The chopstick method is used to minimize instrument and telescope clash during the procedure. Standard laparoscopic instruments are introduced along with a 30 ° telescope. Instrument clashes are avoided by chop stick technique of crossing them at a proximal point so that ends are away from each other. Dissection takes place in forward backward movement after making lateral retraction by the other instrument. With experience the operative time is expected to become comparable with conventional laparoscopic cholecystectomy. But benefits regarding post operative pain in SILS has not been confirmed. It is felt that expertise and reduction of operative time may reduce post operative pain. No special telescopes, ports or hand instruments are needed for this procedure but may have a role in advanced laparoscopic procedures.

Women Religious and Married Women's Attitudes toward Menopause and Menopausal Symptoms

PURPOSE

This study was done to extend the understanding and knowledge of menopause by comparing attitudes toward menopause and menopausal symptoms of women religious and married women.

METHODS

The data were collected by self-report questionnaires from 126 women religious and 131 married women, between 40 and 59 years of age who lived in P city, D city and K province. A structured questionnaire was used which included demographic and health-related information, attitudes toward menopause, and menopausal symptoms. Data were analyzed by using chi2-test, t-test, and Pearson correlation coefficients with the SPSS/WIN 14.0 program.

RESULTS

The mean score for attitudes toward menopause of women religious and married women was 69.46 +/- 6.15 and 66.98 +/- 6.12 respectfully, and the difference was significant (p=.001). The mean score for menopausal symptoms of women religious and married women was 41.33 +/- 23.55 and 55.99 +/- 30.81 respectively, and the difference was also significant (p<.001). Attitudes toward menopause were negatively correlated with menopausal symptoms (r=-.27, p<.001).