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Incidence of preoperative instrumental activities of daily living (IADL) dependence and adverse outcomes in older surgical patients: A systematic review and meta-analysis

Posted on 21/05/2023 by Best Paper AwardLeave a Comment

Study objective:

Instrumental activities of daily living (IADLs) are essential to patient function and quality of life after surgery. In older surgical patients, the incidence of preoperative IADL dependence has not been well characterized in the literature. This systematic review and meta-analysis aimed to determine the pooled incidence of preoperative IADL dependence and the associated adverse outcomes in the older surgical population.

Design:

Systematic review and meta-analysis.

Setting:

MEDLINE, MEDLINE Epub Ahead of Print and In-Process, In-Data-Review & Other Non-Indexed Citations, Embase/Embase Classic, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews, ClinicalTrials.Gov, the WHO ICTRP (International Clinical Trials Registry Platform) were searched for relevant articles from 1969 to April 2022.

Patients:

Patients aged ≥60 years old undergoing surgery with preoperative IADL assessed by the Lawton IADL Scale.

Interventions:

Preoperative assessment.

Measurement:

The primary outcome was the pooled incidence of preoperative IADL dependency. Additional outcomes included post-operative mortality, postoperative delirium [POD], functional status improvement, and discharge disposition.

Main results:

Twenty-one studies (n = 5690) were included. In non-cardiac surgeries, the pooled incidence of preoperative IADL dependence was 37% (95% CI: 26.0%, 48.0%) among 2909 patients. Within cardiac surgeries, the pooled incidence of preoperative IADL dependence was 53% (95% CI: 24.0%, 82.0%) among 1074 patients. Preoperative IADL dependence was associated with an increased risk of postoperative delirium than those without IADL dependence (44.9% vs 24.4, OR 2.26; 95% CI: 1.42, 3.59; I²: 0%; P = 0.0005).

Conclusions:

There is a high incidence of IADL dependence in older surgical patients undergoing non-cardiac and cardiac surgery. Preoperative IADL dependence was associated with a two-fold risk of postoperative delirium. Further work is needed to determine the feasibility of using the IADL scale preoperatively as a predictive tool for postoperative adverse outcomes.

Keywords:

Delirium, systematic review and meta-analysis; Functional dependence; Instrumental activities of daily living (IADL); Older patients; Preoperative assessment.

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Controlled-release hydromorphone and risk of infection in adults: a systematic review

Posted on 29/04/2023 by Best Paper AwardLeave a Comment

Background:

Preliminary evidence suggests that people who inject drugs (PWID) may be at an increased risk of developing infective endocarditis (IE), hepatitis C virus (HCV) infection, and/or human immunodeficiency virus (HIV) infection from hydromorphone controlled-release formulation. The hypothesized mechanism is related to insolubility of the drug, which promotes reuse, leading to contamination of injecting equipment. However, this relationship has not been confirmed. We aimed to conduct a systematic review including adult PWID exposed to controlled-release hydromorphone and the risk of acquiring IE, HCV, and HIV.

Methods:

We searched MEDLINE, EMBASE, and Evidence Based Medicine reviews from inception until September 2021. Following pilot testing, two reviewers conducted all screening of citations and full-text articles, as well as abstracted data, and appraised risk of bias using the Newcastle-Ottawa scale and Effective Practice and Organization of Care tool. Equity issues were examined using the PROGRESS-PLUS framework. Discrepancies were resolved consistently by a third reviewer. Meta-analysis was not feasible due to heterogeneity across the studies.

Results:

After screening 3,231 citations from electronic databases, 722 citations from unpublished sources/reference scanning, and 626 full-text articles, five studies were included. Five were cohort studies, and one was a case-control study. The risk of bias varied across the studies. Two studies reported on gender, as well as other PROGRESS-PLUS criteria (race, housing, and employment). Three studies focused specifically on the controlled-release formulation of hydromorphone, whereas two studies focused on all formulations of hydromorphone. One retrospective cohort study found an association between controlled-release hydromorphone and IE, whereas a case-control study found no evidence of an association. One retrospective cohort study found an association between the number of hydromorphone controlled-release prescriptions and prevalence of HCV. None of the studies specifically reported on associations with HIV.

Discussion:

Very few studies have examined the risk of IE, HCV, and HIV infection after exposure to controlled-release hydromorphone. Very low-quality and scant evidence suggests uncertainty around the risks of blood-borne infections, such as HCV and IE to PWID using this medication.

Keywords:

Controlled-release hydromorphone; HCV; HIV; Infective endocarditis; Knowledge synthesis; Risk factor; Systematic review.

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Translating Scientific Discovery Into Health Policy Impact: Innovative Bibliometrics Bridge Translational Research Publications to Policy Literature

Posted on 12/04/2023 by Best Paper AwardLeave a Comment

doi: 10.1097/ACM.0000000000005225.

Online ahead of print.

Affiliations

¹ N.M. Llewellyn is associate director, Evaluation and Continuous Improvement Program, Georgia Clinical and Translational Science Alliance, Emory University School of Medicine, Atlanta, Georgia; ORCID: https://orcid.org/0000-0003-1267-2720.
² A.A. Weber is program coordinator, Evaluation and Continuous Improvement Program, Georgia Clinical and Translational Science Alliance, Emory University School of Medicine, Atlanta, Georgia.
³ C.M. Pelfrey is associate professor and director, Evaluation, Case Western Reserve University School of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0002-6108-7555.
⁴ D. DiazGranados is associate professor and director, Evaluation and Team Science, Wright Center, Virginia Commonwealth University, School of Medicine, Richmond, Virginia; ORCID: https://orcid.org/0000-0002-0624-7093.
⁵ E.J. Nehl is associate research professor and director, Evaluation and Continuous Improvement Program, Georgia Clinical and Translational Science Alliance, Emory University Rollins School of Public Health, Atlanta, Georgia; ORCID: https://orcid.org/0000-0003-3930-9235.

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Nicole M Llewellyn et al.

Acad Med.

2023.

doi: 10.1097/ACM.0000000000005225.

Online ahead of print.

Affiliations

¹ N.M. Llewellyn is associate director, Evaluation and Continuous Improvement Program, Georgia Clinical and Translational Science Alliance, Emory University School of Medicine, Atlanta, Georgia; ORCID: https://orcid.org/0000-0003-1267-2720.
² A.A. Weber is program coordinator, Evaluation and Continuous Improvement Program, Georgia Clinical and Translational Science Alliance, Emory University School of Medicine, Atlanta, Georgia.
³ C.M. Pelfrey is associate professor and director, Evaluation, Case Western Reserve University School of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0002-6108-7555.
⁴ D. DiazGranados is associate professor and director, Evaluation and Team Science, Wright Center, Virginia Commonwealth University, School of Medicine, Richmond, Virginia; ORCID: https://orcid.org/0000-0002-0624-7093.
⁵ E.J. Nehl is associate research professor and director, Evaluation and Continuous Improvement Program, Georgia Clinical and Translational Science Alliance, Emory University Rollins School of Public Health, Atlanta, Georgia; ORCID: https://orcid.org/0000-0003-3930-9235.

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Abstract

To understand how translational science efforts lead to outcomes, it is common to examine publications as a key step in the translational process. The National Institutes of Health’s Clinical and Translational Science Awards (CTSA) program aims to accelerate that process by providing support to investigators. Although it is challenging to measure the impact of such support on translational outcomes, CTSA-supported research that arises in research publications can advance translation through use of these publication in public policy and guideline documents from government health agencies, intergovernmental organizations, and other outlets. Using cutting-edge bibliometric tools, the authors evaluated how CTSA-supported research has extended its impact beyond academic silos to influence public policy literature. The authors identified approximately 118,490 publications that acknowledged receiving support from a CTSA hub, from the inception of the program in 2006 through 2021. Articles were queried in the Overton policy database, which indexes references to publications in global policy literature. The search revealed 13% of CTSA-supported articles were referenced in policy documents, significantly more than the expected proportion (10%) calculated by Overton. References came from 576 policy source outlets across 87 countries, predominantly the United States and Europe. The most frequent sources included guidelines in PubMed Central, the World Health Organization, and the Centers for Disease Control and Prevention. The authors illustrate the bridge from translational research to public policy with case studies of 6 articles based on CTSA-supported research and having notable policy impact. They found articles with greater clinical relevance, altmetric attention (i.e., nonacademic community/public attention), and academic citation influence were more likely to be referenced in policy literature. Study findings help to characterize the kinds of research that have influenced and may be expected to influence health policy in the future.

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Management of Pain and Cachexia in Pancreatic Cancer: Protocol for Two Systematic Reviews, Network Meta-Analysis, Surveys, and Focus Groups

Posted on 04/04/2023 by Best Paper AwardLeave a Comment

Background:

Approximately 75% of people with pancreatic cancer experience pain, and >50% of them have cachexia (weakness and wasting of the body). However, there is considerable uncertainty regarding the management of these distressing symptoms.

Objective:

Our primary objectives are to compare the relative benefits and harms of different interventions for pain in people with unresectable pancreatic cancer and for prevention and treatment of cachexia due to pancreatic cancer, through systematic reviews and network meta-analysis. Our secondary objectives are to develop an evidence-based clinical care pathway to manage pain and prevent and treat cachexia in people with pancreatic cancer through surveys and focus groups involving patients, carers, and health care professionals.

Methods:

We will perform 2 systematic reviews of the literature related to pain and cachexia in people with pancreatic cancer using searches from Cochrane Library, MEDLINE, Embase, Science Citation Index, and trial registries. Two researchers will independently screen for eligibility and identify randomized controlled trials (no language or publication status restriction), comparing interventions for pain or cachexia based on full-texts for articles shortlisted during screening. We will assess risk of bias in the trials using the Cochrane risk of bias tool (version 2.0) and obtain data related to baseline prognostic characteristics, potential effect modifiers and outcome data related to overall survival, health-related quality of life, treatment-related complications, and resource utilisation. We aim to conduct network meta-analysis on outcomes with multiple treatment comparisons where possible, otherwise, meta-analysis with direct comparisons, or narrative synthesis. We will perform various subgroup and sensitivity analyses. Using information obtained from both systematic reviews, we will conduct 2 surveys: one directed to patients or carers to assess acceptability of interventions, and the other to health care professionals to assess feasibility of delivery in the National Health Service. Four mixed focus groups will be conducted to evaluate findings and foster consensus in the development of the care pathway.

Results:

Funding was awarded from April 2022 (NIHR202727). Both systematic review protocols were prospectively registered on PROSPERO in May 2022. Formal searches began thereafter. Approval by the University College London Research Ethics Committee (23563/001) was received in December 2022. Data collection began in January 2023; data analysis will begin in May 2023 (completion expected by October 2023).

Conclusions:

This study will comprehensively encompass major interventions for management of pain in people with unresectable pancreatic cancer, and prevention and treatment of cachexia in people with pancreatic cancer. Key stakeholders will facilitate the development of an evidence-based care pathway, ensuring both acceptability and feasibility. The project ends in April 2024 and published results are expected within 12 months of completion. We aim to present the findings through patient group websites, conferences, and publications, irrespective of the findings, in a peer-reviewed journal.

International registered report identifier (irrid):

DERR1-10.2196/46335.

Keywords:

cachexia; pain relief; palliative care; pancreatic cancer; quality of life; systematic review.

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Artificial Intelligence in Food Safety: A Decade Review and Bibliometric Analysis

Posted on 29/03/2023 by Best Paper AwardLeave a Comment

Artificial Intelligence (AI) technologies have been powerful solutions used to improve food yield, quality, and nutrition, increase safety and traceability while decreasing resource consumption, and eliminate food waste. Compared with several qualitative reviews on AI in food safety, we conducted an in-depth quantitative and systematic review based on the Core Collection database of WoS (Web of Science). To discover the historical trajectory and identify future trends, we analysed the literature concerning AI technologies in food safety from 2012 to 2022 by CiteSpace. In this review, we used bibliometric methods to describe the development of AI in food safety, including performance analysis, science mapping, and network analysis by CiteSpace. Among the 1855 selected articles, China and the United States contributed the most literature, and the Chinese Academy of Sciences released the largest number of relevant articles. Among all the journals in this field, PLoS ONE and Computers and Electronics in Agriculture ranked first and second in terms of annual publications and co-citation frequency. The present character, hot spots, and future research trends of AI technologies in food safety research were determined. Furthermore, based on our analyses, we provide researchers, practitioners, and policymakers with the big picture of research on AI in food safety across the whole process, from precision agriculture to precision nutrition, through 28 enlightening articles.

Keywords:

CiteSpace; artificial intelligence; bibliometric review; food safety.

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Functional recovery with peripheral nerve block versus general anesthesia for upper limb surgery: a systematic review

Posted on 25/03/2023 by Best Paper AwardLeave a Comment

Background:

Peripheral nerve block is a common anesthetic technique used during orthopedic upper limb surgery. Injection of local anesthetics around the target nerve inhibits the action of voltage-dependent sodium channels, inhibiting neurotransmission of pain impulses and providing motor immobility. Compared to general anesthesia, it could improve functional recovery by inhibiting nociceptive impulses and inflammation, thus reducing postoperative pain and immobilization and improving postoperative rehabilitation. This systematic review evaluates the impact of peripheral nerve block versus general anesthesia on postoperative functional recovery following orthopedic upper limb surgery.

Methods:

We searched CENTRAL, MEDLINE, CINHAL, EMBASE, and Scopus trial databases from inception until September 2021 for studies comparing peripheral nerve block to general anesthesia. We collected data on functional recovery, range of motion, patient satisfaction, quality of life, and return to work. We pooled studies using a random-effects model and summarized the quality of evidence with the GRADE approach.

Results:

We assessed 373 citations and 19 full-text articles for eligibility, and included six studies. Six studies reported on functional recovery, but failed to detect a significant superiority of peripheral nerve block over general anesthesia (3 RCT studies, N = 160; SMD -0.15; CI at 95% -0.60-0.3; I² = 45%; p = 0.07; low quality of evidence and 3 observational studies, N = 377; SMD -0.35; CI at 95% -0.71-0.01; I² = 64%; p = 0.06; very low quality of evidence).

Conclusions:

Current literature is limited and fails to identify the benefit of peripheral nerve block on functional recovery. More studies are needed to assess the impact on long-term recovery. Considering the potential impact on clinical practice and training, a prospective study on functional recovery is ongoing (NCT04541745).

Trial registration:

PROSPERO ID CRD42018116298. Registered on December 4, 2018.

Keywords:

Brachial plexus; Functional recovery; Nerve block; Peripheral anesthesia; Postoperative recovery; Upper limb surgery.

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Research productivity and training support for doctoral students in the biological and biomedical sciences

Posted on 06/03/2023 by Best Paper AwardLeave a Comment

. 2023 Feb 14;5(3):131-148.

doi: 10.1096/fba.2022-00117.

eCollection 2023 Mar.

Affiliations

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Michael D Schaller.

FASEB Bioadv.

2023.

Abstract

Training of doctoral students as part of the next generation of the biomedical workforce is essential for sustaining the scientific enterprise in the United States. Training primarily occurs at institutions of higher education, and these trainees comprise an important part of the workforce at these institutions. Federal investment in the support of doctoral students in the biological and biomedical sciences is distributed differently than the distribution of students across different types of institutions, for example, public vs private. Institutions in states that historically receive less federal support for research also receive less support for doctoral student training. Doctorates at different types of institution exhibit little difference in research productivity, with the exception of citations, and subsequent receipt of additional NIH awards. Thus, training outcomes, which are related to the quality of the student and training environment, are similar across different institutions. Research productivity of doctoral students does not correlate with the number of F31s awarded to an institution. Factors that correlate with F31 funding include R01 funding levels and program size. The findings suggest strategies for institutions to increase success at securing F31s and modification of policy to promote more equitable distribution of F31s across institutions.

Keywords:

F31; NIH; biomedical workforce; citation; doctoral student; productivity; publication.

Conflict of interest statement

The author has no relevant financial or non‐financial interests to disclose.

Figures

**FIGURE 1**

Source of financial support for doctoral students in biological and biomedical sciences. The source of financial support for doctoral students from 2017 to 2019 was retrieved from the GSS. The percentage of all doctoral students supported by different mechanisms at public, private, land grant, and IDeA institutions is shown. (A) Support from all sources. (B) Support from federal sources. (C) Support from the NIH. Fellows = students supported by individual fellowships. That is, a competitive award to the doctoral student, for example, an F31. Trainees = students supported on training grants, i.e. a financial award given to doctoral students selected by the institution, for example, supported on a T32. RAs = research assistantships, that is, students receiving stipends to perform research. TAs = teaching assistantships, that is, students receiving stipends to teach. There is a caveat that different institutions may define “Fellows”, “Trainees” and “Research Assistants” differently. Note that federal sources do not support teaching assistantships.

**FIGURE 2**

Historical record of doctorates awarded in biological and biomedical sciences and F31s awarded at US Universities. The number of doctorates awarded in biological and biomedical sciences from 1994 to 2020 was retrieved from the SED. The number of doctorates awarded (A) and percentage of total doctorates awarded (B) at private, public, land grant, and IDeA institutions was calculated. The number of F31s for each fiscal year from 1985 to 2021 was tallied using data acquired using NIH Reporter. The number of awards (C) and the percentage of awards (D) at public, private, land grant, and IDeA institutions are plotted.

**FIGURE 3**

Correlations with number of F31 awards. (A) The number of F31s at individual institutions is plotted against the number of R01s held at the institution during FY19. F31 and R01 data were extracted using NIH Reporter. (B) The number of F31s at individual institutions during FY19 is plotted against with number of doctorates awarded at the institution in 2019. F31 data were calculated using data from NIH Reporter. The number of doctorates awarded is from the SED.

**FIGURE 4**

Date of publication related to dissertation year. The year of publication relative to the year of dissertation was calculated by subtracting the dissertation year from the publication year. The number of first author publications and the number of total publications in each year relative to dissertation year are plotted. The 5th and 95th percentiles of first author and total publications are shown. A subset of the entire dataset, restricted based on time of publication relative to the dissertation year, was used for the analysis. Lines delineate the subset of publications used for the analysis of first author papers (“Firsts analysis”) and total papers (“Total analysis”).

References

1. Alberts B, Kirschner MW, Tilghman S, Varmus H. Rescuing US biomedical research from its systemic flaws. Proc Natl Acad Sci USA. 2014;111:5773‐5777.
  
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1. National Institutes of Health . Biomedical Research Workforce Working Group Report. National Institutes of Health; 2012.
1. National Academy of Sciences . The Postdoctoral Experience Revisited. National Academies Press; 2014.
  
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1. American Academy of Arts and Sciences . Restoring the Foundation: the Vital Role of Research in Preserving the American Dream: Report Brief. American Academy of Arts & Sciences; 2014.
1. National Research Council . Research Universities and the Future of America: Ten Breakthrough Actions Vital to our nation’s Prosperity and Security. National Academies Press; 2012.

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Global evidence of gender equity in academic health research: a scoping review

Posted on 15/02/2023 by Best Paper AwardLeave a Comment

Objectives:

To chart the global literature on gender equity in academic health research.

Design:

Scoping review.

Participants:

Quantitative studies were eligible if they examined gender equity within academic institutions including health researchers.

Primary and secondary outcome measures:

Outcomes related to equity across gender and other social identities in academia: (1) faculty workforce: representation of all genders in university/faculty departments, academic rank or position and salary; (2) service: teaching obligations and administrative/non-teaching activities; (3) recruitment and hiring data: number of applicants by gender, interviews and new hires for various rank; (4) promotion: opportunities for promotion and time to progress through academic ranks; (5) academic leadership: type of leadership positions, opportunities for leadership promotion or training, opportunities to supervise/mentor and support for leadership bids; (6) scholarly output or productivity: number/type of publications and presentations, position of authorship, number/value of grants or awards and intellectual property ownership; (7) contextual factors of universities; (8) infrastructure; (9) knowledge and technology translation activities; (10) availability of maternity/paternity/parental/family leave; (11) collaboration activities/opportunities for collaboration; (12) qualitative considerations: perceptions around promotion, finances and support.

Results:

Literature search yielded 94 798 citations; 4753 full-text articles were screened, and 562 studies were included. Most studies originated from North America (462/562, 82.2%). Few studies (27/562, 4.8%) reported race and fewer reported sex/gender (which were used interchangeably in most studies) other than male/female (11/562, 2.0%). Only one study provided data on religion. No other PROGRESS-PLUS variables were reported. A total of 2996 outcomes were reported, with most studies examining academic output (371/562, 66.0%).

Conclusions:

Reviewed literature suggest a lack in analytic approaches that consider genders beyond the binary categories of man and woman, additional social identities (race, religion, social capital and disability) and an intersectionality lens examining the interconnection of multiple social identities in understanding discrimination and disadvantage. All of these are necessary to tailor strategies that promote gender equity.

Trial registration number:

Open Science Framework: https://osf.io/8wk7e/.

Keywords:

education & training (see medical education & training); general medicine (see internal medicine); health services administration & management.

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Implemented machine learning tools to inform decision-making for patient care in hospital settings: a scoping review

Posted on 07/02/2023 by Best Paper AwardLeave a Comment

Objectives:

To identify ML tools in hospital settings and how they were implemented to inform decision-making for patient care through a scoping review. We investigated the following research questions: What ML interventions have been used to inform decision-making for patient care in hospital settings? What strategies have been used to implement these ML interventions?

Design:

A scoping review was undertaken. MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews (CDSR) were searched from 2009 until June 2021. Two reviewers screened titles and abstracts, full-text articles, and charted data independently. Conflicts were resolved by another reviewer. Data were summarised descriptively using simple content analysis.

Setting:

Hospital setting.

Participant:

Any type of clinician caring for any type of patient.

Intervention:

Machine learning tools used by clinicians to inform decision-making for patient care, such as AI-based computerised decision support systems or “‘model-based'” decision support systems.

Primary and secondary outcome measures:

Patient and study characteristics, as well as intervention characteristics including the type of machine learning tool, implementation strategies, target population. Equity issues were examined with PROGRESS-PLUS criteria.

Results:

After screening 17 386 citations and 3474 full-text articles, 20 unique studies and 1 companion report were included. The included articles totalled 82 656 patients and 915 clinicians. Seven studies reported gender and four studies reported PROGRESS-PLUS criteria (race, health insurance, rural/urban). Common implementation strategies for the tools were clinician reminders that integrated ML predictions (44.4%), facilitated relay of clinical information (17.8%) and staff education (15.6%). Common barriers to successful implementation of ML tools were time (11.1%) and reliability (11.1%), and common facilitators were time/efficiency (13.6%) and perceived usefulness (13.6%).

Conclusions:

We found limited evidence related to the implementation of ML tools to assist clinicians with patient healthcare decisions in hospital settings. Future research should examine other approaches to integrating ML into hospital clinician decisions related to patient care, and report on PROGRESS-PLUS items.

Funding:

Canadian Institutes of Health Research (CIHR) Foundation grant awarded to SES and the CIHR Strategy for Patient Oriented-Research Initiative (GSR-154442). SCOPING REVIEW REGISTRATION: https://osf.io/e2mna.

Keywords:

BIOTECHNOLOGY & BIOINFORMATICS; Information technology; PRIMARY CARE; PUBLIC HEALTH.

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Incidence of preoperative instrumental activities of daily living (IADL) dependence and adverse outcomes in older surgical patients: A systematic review and meta-analysis

Controlled-release hydromorphone and risk of infection in adults: a systematic review

Translating Scientific Discovery Into Health Policy Impact: Innovative Bibliometrics Bridge Translational Research Publications to Policy Literature

Affiliations

Affiliations

Abstract

Management of Pain and Cachexia in Pancreatic Cancer: Protocol for Two Systematic Reviews, Network Meta-Analysis, Surveys, and Focus Groups

Artificial Intelligence in Food Safety: A Decade Review and Bibliometric Analysis

Functional recovery with peripheral nerve block versus general anesthesia for upper limb surgery: a systematic review

Research productivity and training support for doctoral students in the biological and biomedical sciences

Affiliation

Affiliation

Abstract

Conflict of interest statement

Figures

References

Global evidence of gender equity in academic health research: a scoping review

Implemented machine learning tools to inform decision-making for patient care in hospital settings: a scoping review

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