Elective removal vs. retaining of hardware after osteosynthesis in asymptomatic patients—a scoping review

Abstract Background Osteosynthesis is the internal fixation of fractures or osteotomy by mechanical devices (also called hardware). After bone healing, there are two options: one is to remove the hardware, the other is to leave it in place. The removal of the hardware in patients without medical indication (elective) is controversially discussed. We performed a scoping review to identify evidence on the elective removal of hardware in asymptomatic patients compared to retaining of the hardware to check feasibility of performing a health technology assessment. In addition, we wanted to find out which type of evidence is available. Methods A systematic literature search was performed in PubMed, Embase, EconLit, and CINAHL (November 2019). We included studies comparing asymptomatic patients with an internal fixation in the lower or upper extremities whose internal fixation was electively (without medical indication) removed or retained. We did not restrict inclusion to any effectiveness/safety outcome and considered any comparative study design as eligible. Study selection and data extraction was performed by two reviewers. Results We identified 13476 titles/abstracts. Of these, we obtained 115 full-text publications which were assessed in detail against the inclusion criteria. We included 13 studies (1 RCT, 4 cohort studies, 8 before-after studies) and identified two ongoing RCTs. Nine assessed the removal of the internal fixation in the lower extremities (six of these syndesmotic screws in ankle fractures only) and two in the upper extremities. One study analysed the effectiveness of hardware removal in children in all types of extremity fractures. Outcomes reported included various scales measuring functionality, pain and clinical assessments (e.g. range of motion) and health-related quality of life. Conclusions We identified 13 studies that evaluated the effectiveness/safety of hardware removal in the extremities. The follow up times were short, the patient groups small and the ways of measurement differed. In general, clinical heterogeneity was high. Evidence on selected topics, e.g. syndesmotic screw removal is available nevertheless not sufficient to allow a meaningful assessment of effectiveness.

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Elective removal vs. retaining of hardware after osteosynthesis in asymptomatic patients – A scoping review.

10.21203/rs.3.rs-27666/v1 ◽

2020 ◽

Author(s):

Barbara Prediger ◽

Tim Mathes ◽

Christian Probst ◽

Dawid Pieper

Keyword(s):

Internal Fixation ◽

Scoping Review ◽

Data Extraction ◽

Upper Extremities ◽

Hardware Removal ◽

Medical Indication ◽

Safety Outcome ◽

Asymptomatic Patients ◽

Mechanical Devices ◽

Removal Of Hardware

Abstract Background Osteosynthesis is the internal fixation of fractures or osteotomy by mechanical devices (also called hardware). After bone healing there are two options: One is to remove the hardware the other is to leave it in place. The elective removal of the hardware in asymptomatic patients is controversially discussed. We performed a scoping review to assess if there is evidence on the removal of hardware in patients without medical indication (elective) compared to retaining of the hardware. In addition we wanted to find out which type of evidence is available. Methods A systematic literature search was performed in Pubmed, Embase, EconLit and Cinahl (11/2019). We included studies comparing asymptomatic patients with an internal fixation in the lower or upper extremities whose internal fixation was electively (without medical indication) removed or retained. We did not restrict inclusion to any effectiveness/safety outcome and considered any comparative study design as eligible. Study selection and data extraction was performed by two reviewers. Results We identified 13476 titles/abstracts. Of these we obtained 115 full-text publications which were assessed in detail against the inclusion criteria. We included 13 studies (1 RCT, 4 cohort studies, 8 before-after studies) and identified two ongoing RCTs. Nine assessed the removal of the internal fixation in the lower extremities (six of these syndesmotic screws in ankle fractures only) and two in the upper extremities. One study analysed the effectiveness of hardware removal in children in all types of extremity fractures. Outcomes reported included various scales measuring functionality, pain and clinical assessments (e.g. range of motion) and health-related quality of life. Conclusions We identified 13 studies that evaluated the effectiveness/safety of hardware removal in the extremities. Moreover we found two ongoing RCTs. The follow up times were short, the patient groups small and the ways of measurement differed. In general clinical heterogeneity was high. Evidence on selected topics e.g. syndesmotic screw removal is available nevertheless not sufficient to allow a meaningful assessment of effectiveness.

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Elective removal vs. retaining of hardware after osteosynthesis in asymptomatic patients – A scoping review.

10.21203/rs.3.rs-27666/v2 ◽

2020 ◽

Author(s):

Barbara Prediger ◽

Tim Mathes ◽

Christian Probst ◽

Dawid Pieper

Keyword(s):

Internal Fixation ◽

Scoping Review ◽

Data Extraction ◽

Upper Extremities ◽

Hardware Removal ◽

Medical Indication ◽

Safety Outcome ◽

Asymptomatic Patients ◽

Mechanical Devices ◽

Removal Of Hardware

Abstract BackgroundOsteosynthesis is the internal fixation of fractures or osteotomy by mechanical devices (also called hardware). After bone healing, there are two options: One is to remove the hardware, the other is to leave it in place. The removal of the hardware in patients without medical indication (elective) is controversially discussed. We performed a scoping review to identify evidence on the elective removal of hardware in asymptomatic patients compared to retaining of the hardware to check feasibility of performing a health technology assessment. In addition, we wanted to find out which type of evidence is available.MethodsA systematic literature search was performed in Pubmed, Embase, EconLit and Cinahl (11/2019). We included studies comparing asymptomatic patients with an internal fixation in the lower or upper extremities whose internal fixation was electively (without medical indication) removed or retained. We did not restrict inclusion to any effectiveness/safety outcome and considered any comparative study design as eligible. Study selection and data extraction was performed by two reviewers. ResultsWe identified 13476 titles/abstracts. Of these we obtained 115 full-text publications which were assessed in detail against the inclusion criteria. We included 13 studies (1 RCT, 4 cohort studies, 8 before-after studies) and identified two ongoing RCTs. Nine assessed the removal of the internal fixation in the lower extremities (six of these syndesmotic screws in ankle fractures only) and two in the upper extremities. One study analysed the effectiveness of hardware removal in children in all types of extremity fractures. Outcomes reported included various scales measuring functionality, pain and clinical assessments (e.g. range of motion) and health-related quality of life.ConclusionsWe identified 13 studies that evaluated the effectiveness/safety of hardware removal in the extremities. The follow up times were short, the patient groups small and the ways of measurement differed. In general clinical heterogeneity was high. Evidence on selected topics e.g. syndesmotic screw removal is available nevertheless not sufficient to allow a meaningful assessment of effectiveness.

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Artificial Intelligence for Skin Cancer Detection: A Scoping Review (Preprint)

10.2196/preprints.22934 ◽

2020 ◽

Author(s):

Abdulrahman Takiddin ◽

Jens Schneider ◽

Yin Yang ◽

Alaa Abd-Alrazaq ◽

Mowafa Househ

Keyword(s):

Artificial Intelligence ◽

Skin Cancer ◽

Scoping Review ◽

Performance Metrics ◽

Data Extraction ◽

Characteristic Curve ◽

Evaluation Metrics ◽

Cancer Type ◽

Computer Algorithms ◽

Scoping Reviews

BACKGROUND Skin cancer is the most common cancer type affecting humans. Traditional skin cancer diagnosis methods are costly, require a professional physician, and take time. Hence, to aid in diagnosing skin cancer, Artificial Intelligence (AI) tools are being used, including shallow and deep machine learning-based techniques that are trained to detect and classify skin cancer using computer algorithms and deep neural networks. OBJECTIVE The aim of this study is to identify and group the different types of AI-based technologies used to detect and classify skin cancer. The study also examines the reliability of the selected papers by studying the correlation between the dataset size and number of diagnostic classes with the performance metrics used to evaluate the models. METHODS We conducted a systematic search for articles using IEEE Xplore, ACM DL, and Ovid MEDLINE databases following the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. The study included in this scoping review had to fulfill several selection criteria; to be specifically about skin cancer, detecting or classifying skin cancer, and using AI technologies. Study selection and data extraction were conducted by two reviewers independently. Extracted data were synthesized narratively, where studies were grouped based on the diagnostic AI techniques and their evaluation metrics. RESULTS We retrieved 906 papers from the 3 databases, but 53 studies were eligible for this review. While shallow techniques were used in 14 studies, deep techniques were utilized in 39 studies. The studies used accuracy (n=43/53), the area under receiver operating characteristic curve (n=5/53), sensitivity (n=3/53), and F1-score (n=2/53) to assess the proposed models. Studies that use smaller datasets and fewer diagnostic classes tend to have higher reported accuracy scores. CONCLUSIONS The adaptation of AI in the medical field facilitates the diagnosis process of skin cancer. However, the reliability of most AI tools is questionable since small datasets or low numbers of diagnostic classes are used. In addition, a direct comparison between methods is hindered by a varied use of different evaluation metrics and image types.

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The socioeconomic burden of antibiotic resistance in conflict-affected settings and refugee hosting countries: a systematic scoping review

Conflict and Health ◽

10.1186/s13031-021-00357-6 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Elsa Kobeissi ◽

Marilyne Menassa ◽

Krystel Moussally ◽

Ernestina Repetto ◽

Ismail Soboh ◽

...

Keyword(s):

Antibiotic Resistance ◽

Scoping Review ◽

Statistical Power ◽

Data Extraction ◽

Quality Data ◽

Sufficient Information ◽

Socioeconomic Burden ◽

General Populations ◽

Global Threat ◽

The Cost

Abstract Background Antibiotic resistance (ABR) is a major global threat. Armed and protracted conflicts act as multipliers of infection and ABR, thus leading to increased healthcare and societal costs. We aimed to understand and describe the socioeconomic burden of ABR in conflict-affected settings and refugee hosting countries by conducting a systematic scoping review. Methods A systematic search of PubMed, Medline (Ovid), Embase, Web of Science, SCOPUS and Open Grey databases was conducted to identify all relevant human studies published between January 1990 and August 2019. An updated search was also conducted in April 2020 using Medline/Ovid. Independent screenings of titles/abstracts followed by full texts were performed using pre-defined criteria. The Newcastle-Ottawa Scale was used to assess study quality. Data extraction and analysis were based on the PICOS framework and following the PRISMA-ScR guideline. Results The search yielded 8 studies (7 publications), most of which were single-country, mono-center and retrospective studies. The studies were conducted in Lebanon (n = 3), Iraq (n = 2), Jordan (n = 1), Palestine (n = 1) and Yemen (n = 1). Most of the studies did not have a primary aim to assess the socioeconomic impact of ABR and were small studies with limited statistical power that could not demonstrate significant associations. The included studies lacked sufficient information for the accurate evaluation of the cost incurred by antibiotic resistant infections in conflict-affected countries. Conclusion This review highlights the scarcity of research on the socioeconomic burden of ABR on general populations in conflict-affected settings and on refugees and migrants in host countries, and lists recommendations for consideration in future studies. Further studies are needed to understand the cost of ABR in these settings to develop and implement adaptable policies.

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Exploration of recovery of people living with severe mental illness (SMI) in low/middle-income countries (LMICs): a scoping review

BMJ Open ◽

10.1136/bmjopen-2020-045005 ◽

2021 ◽

Vol 11 (3) ◽

pp. e045005

Author(s):

Fadia Gamieldien ◽

Roshan Galvaan ◽

Bronwyn Myers ◽

Zarina Syed ◽

Katherine Sorsdahl

Keyword(s):

Mental Illness ◽

Severe Mental Illness ◽

Scoping Review ◽

Data Extraction ◽

Flow Diagram ◽

Personal Recovery ◽

Middle Income ◽

Middle Income Countries ◽

Provider Perspectives ◽

Low Middle Income Countries

ObjectiveTo examine the literature on how recovery of people with severe mental illness (SMI) is conceptualised in low/middle-income countries (LMICs), and in particular what factors are thought to facilitate recovery.DesignScoping review.Data sources and eligibilityWe searched 14 electronic databases, hand searched citations and consulted with experts during the period May–December 2019. Eligible studies were independently screened for inclusion and exclusion by two reviewers. Unresolved discrepancies were referred to a third reviewer.Data extraction and synthesisAll bibliographical data and study characteristics were extracted using a data charting form. Selected studies were analysed through a thematic analysis emerging from extracted data.ResultsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram offers a summary of the results: 4201 titles, 1530 abstracts and 109 full-text articles were screened. Ten articles were selected for inclusion: two from Turkey, two from India, and one each from China, Swaziland, Indonesia, Egypt, South Africa and Vietnam. Although most studies used qualitative methods, data collection and sampling methods were heterogeneous. One study reported on service provider perspectives while the rest provided perspectives from a combination of service users and caregivers. Three themes emerged from the data analysis. First, studies frame recovery as a personal journey occurring along a continuum. Second, there was an emphasis on social relationships as a facilitator of recovery. Third, spirituality emerged as both a facilitator and an indicator of recovery. These themes were not mutually exclusive and some overlap exists.ConclusionAlthough there were commonalities with how high-income countries describe recovery, we also found differences in conceptualisation. These differences in how recovery was understood reflect the importance of framing the personal recovery concept in relation to local needs and contextual issues found in LMICs. This review highlighted the current sparse evidence base and the need to better understand recovery from SMI in LMICs.

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Artificial Intelligence and Ethics in Dentistry: A Scoping Review

Journal of Dental Research ◽

10.1177/00220345211013808 ◽

2021 ◽

pp. 002203452110138

Author(s):

C.M. Mörch ◽

S. Atsu ◽

W. Cai ◽

X. Li ◽

S.A. Madathil ◽

...

Keyword(s):

Artificial Intelligence ◽

Scoping Review ◽

Ethical Issues ◽

Data Extraction ◽

Cochrane Library ◽

Data Sets ◽

Ethical Challenges ◽

Internal Validation ◽

Neural Learning ◽

Learning Techniques

Dentistry increasingly integrates artificial intelligence (AI) to help improve the current state of clinical dental practice. However, this revolutionary technological field raises various complex ethical challenges. The objective of this systematic scoping review is to document the current uses of AI in dentistry and the ethical concerns or challenges they imply. Three health care databases (MEDLINE [PubMed], SciVerse Scopus, and Cochrane Library) and 2 computer science databases (ArXiv, IEEE Xplore) were searched. After identifying 1,553 records, the documents were filtered, and a full-text screening was performed. In total, 178 studies were retained and analyzed by 8 researchers specialized in dentistry, AI, and ethics. The team used Covidence for data extraction and Dedoose for the identification of ethics-related information. PRISMA guidelines were followed. Among the included studies, 130 (73.0%) studies were published after 2016, and 93 (52.2%) were published in journals specialized in computer sciences. The technologies used were neural learning techniques for 75 (42.1%), traditional learning techniques for 76 (42.7%), or a combination of several technologies for 20 (11.2%). Overall, 7 countries contributed to 109 (61.2%) studies. A total of 53 different applications of AI in dentistry were identified, involving most dental specialties. The use of initial data sets for internal validation was reported in 152 (85.4%) studies. Forty-five ethical issues (related to the use AI in dentistry) were reported in 22 (12.4%) studies around 6 principles: prudence (10 times), equity (8), privacy (8), responsibility (6), democratic participation (4), and solidarity (4). The ratio of studies mentioning AI-related ethical issues has remained similar in the past years, showing that there is no increasing interest in the field of dentistry on this topic. This study confirms the growing presence of AI in dentistry and highlights a current lack of information on the ethical challenges surrounding its use. In addition, the scarcity of studies sharing their code could prevent future replications. The authors formulate recommendations to contribute to a more responsible use of AI technologies in dentistry.

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Scanxiety: a scoping review about scan-associated anxiety

BMJ Open ◽

10.1136/bmjopen-2020-043215 ◽

2021 ◽

Vol 11 (5) ◽

pp. e043215

Author(s):

Kim Tam Bui ◽

Roger Liang ◽

Belinda E Kiely ◽

Chris Brown ◽

Haryana M Dhillon ◽

...

Keyword(s):

Scoping Review ◽

Perceived Risk ◽

Data Extraction ◽

Depression Scale ◽

Cochrane Central Register ◽

Contributing Factors ◽

Positron Emission ◽

Severity Scores ◽

Almost All ◽

Risk Of Cancer

ObjectivesTo identify available literature on prevalence, severity and contributing factors of scan-associated anxiety (‘scanxiety’) and interventions to reduce it.DesignSystematic scoping review.Data sourcesOvid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Scopus, EBSCO CINAHL and PubMed up to July 2020.Study selectionEligible studies recruited people having cancer-related non-invasive scans (including screening) and contained a quantitative assessment of scanxiety.Data extractionDemographics and scanxiety outcomes were recorded, and data were summarised by descriptive statistics.ResultsOf 26 693 citations, 57 studies were included across a range of scan types (mammogram: 26/57, 46%; positron-emission tomography: 14/57, 25%; CT: 14/57, 25%) and designs (observation: 47/57, 82%; intervention: 10/57, 18%). Eighty-one measurement tools were used to quantify prevalence and/or severity of scanxiety, including purpose-designed Likert scales (17/81, 21%); the State Trait Anxiety Inventory (14/81, 17%) and the Hospital Anxiety and Depression Scale (9/81, 11%). Scanxiety prevalence ranged from 0% to 64% (above prespecified thresholds) or from 13% to 83% (‘any’ anxiety, if no threshold). Mean severity scores appeared low in almost all measures that quantitatively measured scanxiety (54/62, 87%), regardless of whether anxiety thresholds were prespecified. Moderate to severe scanxiety occurred in 4%–28% of people in studies using descriptive measures. Nine of 20 studies assessing scanxiety prescan and postscan reported significant postscan reduction in scanxiety. Lower education, smoking, higher levels of pain, higher perceived risk of cancer and diagnostic scans (vs screening scans) consistently correlated with higher scanxiety severity but not age, gender, ethnicity or marital status. Interventions included relaxation, distraction, education and psychological support. Six of 10 interventions showed a reduction in scanxiety.ConclusionsPrevalence and severity of scanxiety varied widely likely due to heterogeneous methods of measurement. A uniform approach to evaluating scanxiety will improve understanding of the phenomenon and help guide interventions.

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Addressing barriers to the conduct and application of research in complementary and alternative medicine: a scoping review

BMC Complementary Medicine and Therapies ◽

10.1186/s12906-021-03371-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yasamin Veziari ◽

Saravana Kumar ◽

Matthew Leach

Keyword(s):

Alternative Medicine ◽

Complementary And Alternative Medicine ◽

Scoping Review ◽

Data Extraction ◽

Grey Literature ◽

Evidence Base ◽

Cochrane Library ◽

Educational Strategies ◽

The Cochrane Library ◽

Complementary And Alternative

Abstract Background Over the past few decades, the popularity of complementary and alternative medicine (CAM) has grown considerably and along with it, scrutiny regarding its evidence base. While this is to be expected, and is in line with other health disciplines, research in CAM is confronted by numerous obstacles. This scoping review aims to identify and report the strategies implemented to address barriers to the conduct and application of research in CAM. Methods The scoping review was undertaken using the Arksey and O’Malley framework. The search was conducted using MEDLINE, EMBASE, EMCARE, ERIC, Scopus, Web of Science, The Cochrane Library, JBI and the grey literature. Two reviewers independently screened the records, following which data extraction was completed for the included studies. Descriptive synthesis was used to summarise the data. Results Of the 7945 records identified, 15 studies met the inclusion criteria. Using the oBSTACLES instrument as a framework, the included studies reported diverse strategies to address barriers to the conduct and application of research in CAM. All included studies reported the use of educational strategies and collaborative initiatives with CAM stakeholders, including targeted funding, to address a range of barriers. Conclusions While the importance of addressing barriers to the conduct and application of research in CAM has been recognised, to date, much of the focus has been limited to initiatives originating from a handful of jurisdictions, for a small group of CAM disciplines, and addressing few barriers. Myriad barriers continue to persist, which will require concerted effort and collaboration across a range of CAM stakeholders and across multiple sectors. Further research can contribute to the evidence base on how best to address these barriers to promote the conduct and application of research in CAM.

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Instruments for measuring nursing research competence: a protocol for a scoping review

BMJ Open ◽

10.1136/bmjopen-2020-042325 ◽

2021 ◽

Vol 11 (2) ◽

pp. e042325

Author(s):

Qirong Chen ◽

Chongmei Huang ◽

Aimee R Castro ◽

Siyuan Tang

Keyword(s):

Scoping Review ◽

Data Extraction ◽

Target Population ◽

Measurement Properties ◽

Nursing Research ◽

Measurement Instruments ◽

Health Measurement ◽

Research Competence ◽

Scoping Reviews

IntroductionNursing research competence of nursing personnel has received much attention in recent years, as nursing has developed as both an independent academic discipline and an evidence-based practiing profession. Instruments for appraising nursing research competence are important, as they can be used to assess nursing research competence of the target population, showing changes of this variable over time and measuring the effectiveness of interventions for improving nursing research competence. There is a need to map the current state of the science of the instruments for nursing research competence, and to identify well validated and reliable instruments. This paper describes a protocol for a scoping review to identify, evaluate, compare and summarise the instruments designed to measure nursing research competence.Methods and analysisThe scoping review will be conducted following Arksey and O’Malley’s methodological framework and Levac et al’s additional recommendations for applying this framework. The scoping review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. The protocol is registered through the Open Science Framework (https://osf.io/ksh43/). Eight English databases and two Chinese databases will be searched between 1 December 2020 and 31 December 2020 to retrieve manuscripts which include instrument(s) of nursing research competence. The literature screening and data extraction will be conducted by two researchers, independently. A third researcher will be involved when consensus is needed. The COnsensus-based Standards for the selection of health Measurement INstruments methodology will be used to evaluate the methodological quality of the included studies on measurement properties of the instruments, as well as the quality of all the instruments identified.Ethics and disseminationEthical approval is not needed. We will disseminate the findings through a conference focusing on nursing research competence and publication of the results in a peer-reviewed journal.

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Place, Power, and Premature Mortality: A Rapid Scoping Review on the Health of Women in Appalachia

American Journal of Health Promotion ◽

10.1177/08901171211011388 ◽

2021 ◽

pp. 089011712110113

Author(s):

Jessica R. Thompson ◽

Lauren R. Risser ◽

Madeline N. Dunfee ◽

Nancy E. Schoenberg ◽

Jessica G. Burke

Keyword(s):

Women’S Health ◽

Women's Health ◽

Scoping Review ◽

Quantitative Methods ◽

Data Extraction ◽

Ecological Factors ◽

Bibliographic Databases ◽

Theoretical Frameworks ◽

Appalachian Women ◽

Social Ecological

Objective: Appalachian women continue to die younger than in other US regions. We performed a rapid scoping review to summarize women’s health research in Appalachia from 2000 to 2019, including health topics, study populations, theoretical frameworks, methods, and findings. Data Source: We searched bibliographic databases (eg, PubMed, PsycINFO, Google Scholar) for literature focusing on women’s health in Appalachia. Study Inclusion and Exclusion Criteria: Included articles were: (1) on women’s health in Appalachia; (2) published January 2000 to June 2019; (3) peer-reviewed; and (4) written in English. We excluded studies without reported data findings. Data Extraction: Two coders reviewed articles for descriptive information to create summary tables comparing variables of interest. Data Synthesis: Two coders co-reviewed a sub-sample to ensure consensus and refine data charting categories. We categorized major findings across the social-ecological framework. Results: A search of nearly 2 decades of literature revealed 81 articles, which primarily focused on cancer disparities (49.4%) and prenatal/pregnancy outcomes (23.5%). Many of these research studies took place in Central Appalachia (eg, 42.0% in Kentucky) with reproductive or middle-aged women (82.7%). Half of the studies employed quantitative methods, and half used qualitative methods, with few mixed method or community-engaged approaches (3.7%). Nearly half (40.7%) did not specify a theoretical framework. Findings included complex multi-level factors with few articles exploring the co-occurrence of factors across multiple levels. Conclusions: Future studies should: 1) systematically include Appalachian women at various life stages from under-represented sub-regions; 2) expand the use of rigorous methods and specified theoretical frameworks to account for complex interactions of social-ecological factors; and 3) build upon existing community assets to improve health in this vulnerable population.

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