Dual‐ vs. Single‐Antibiotic Loaded Cement for Hip Hemiarthroplasty: A Systematic Review and Meta‐Analysis

Background: Antibiotic‐loaded cement (ALC) is often used to reduce the risk of surgical site infections (SSIs) in hip hemiarthroplasty; however, controversy exists regarding the use of dual antibiotic‐loaded cement (DALC) and single antibiotic‐loaded cement (SALC). Objective: This systematic review and meta‐analysis compare the efficacy of DALC and SALC for hip hemiarthroplasty. Methods: For this systematic review, a search was undertaken in the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and ClinicalTrials.gov. Grey literature such as ProQuest Dissertations and Theses Global (PQDT) was also explored. The inclusion criteria comprised randomized controlled trials (RCTs) or comparative observational studies, and patients undergoing hip hemiarthroplasty with DALC or SALC. Newcastle–Ottawa Scale (NOS) and RoB 2.0 tools were used for risk of bias assessment in observational and RCTs, respectively. Review Manager (RevMan, version 5.4.1; The Cochrane Collaboration, Copenhagen, Denmark) was used for statistical analysis. The primary outcome was the incidence of deep SSIs. Results: A total of five articles, including 28,418 participants, met the inclusion criteria. Three of the included studies were retrospective studies, one quasi‐randomized study, and one RCT. The primary outcome revealed that DALC was associated with a statistically significant reduction in deep SSIs compared to SALC (RR, 0.47; 95% CI, 0.29–0.76; p = 0.002; I2 = 27%). Subgroup analysis based on the study design did not show a significant difference for deep SSIs (p = 0.29). The majority of the secondary outcomes, such as superficial SSIs, mortality, participants with ≥ 1 complication, or antibiotic use, did not show any significant difference. However, DALC significantly lowered the risk of any infection (RR, 0.55; 95% CI, 0.38–0.79; p = 0.001; I2 = 27%). Conclusion: In conclusion, DALC can significantly reduce the risk of SSIs and the overall rate of any infection in hip hemiarthroplasty. A limitation of this study is that RCTs were pooled with observational studies, which decreased the power of analysis. Therefore, further research, including large RCTs, is needed to validate these findings

Machine Learning and External Validation of the IDENTIFY Risk Calculator for Patients with Haematuria Referred to Secondary Care for Suspected Urinary Tract Cancer

Background: The IDENTIFY study developed a model to predict urinary tract cancer using patient characteristics from a large multicentre, international cohort of patients referred with haematuria. In addition to calculating an individual's cancer risk, it proposes thresholds to stratify them into very-low-risk (<1%), low-risk (1–<5%), intermediate-risk (5–<20%), and high-risk (≥20%) groups. Objective: To externally validate the IDENTIFY haematuria risk calculator and compare traditional regression with machine learning algorithms. Design, setting, and participants: Prospective data were collected on patients referred to secondary care with new haematuria. Data were collected for patient variables included in the IDENTIFY risk calculator, cancer outcome, and TNM staging. Machine learning methods were used to evaluate whether better models than those developed with traditional regression methods existed. Outcome measurements and statistical analysis: The area under the receiver operating characteristic curve (AUC) for the detection of urinary tract cancer, calibration coefficient, calibration in the large (CITL), and Brier score were determined. Results and limitations: There were 3582 patients in the validation cohort. The development and validation cohorts were well matched. The AUC of the IDENTIFY risk calculator on the validation cohort was 0.78. This improved to 0.80 on a subanalysis of urothelial cancer prevalent countries alone, with a calibration slope of 1.04, CITL of 0.24, and Brier score of 0.14. The best machine learning model was Random Forest, which achieved an AUC of 0.76 on the validation cohort. There were no cancers stratified to the very-low-risk group in the validation cohort. Most cancers were stratified to the intermediate- and high-risk groups, with more aggressive cancers in higher-risk groups. Conclusions: The IDENTIFY risk calculator performed well at predicting cancer in patients referred with haematuria on external validation. This tool can be used by urologists to better counsel patients on their cancer risks, to prioritise diagnostic resources on appropriate patients, and to avoid unnecessary invasive procedures in those with a very low risk of cancer. Patient summary: We previously developed a calculator that predicts patients’ risk of cancer when they have blood in their urine, based on their personal characteristics. We have validated this risk calculator, by testing it on a separate group of patients to ensure that it works as expected. Most patients found to have cancer tended to be in the higher-risk groups and had more aggressive types of cancer with a higher risk. This tool can be used by clinicians to fast-track high-risk patients based on the calculator and investigate them more thoroughly

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The Carcinogenicity of Smokeless Tobacco- Are the Young People Aware

Background: To determine the awareness regarding the carcinogenicity of smokeless tobacco products(SLT) amongst adolescents and youth and identify potential predisposing factors associated with poor awareness. Methods: This cross sectional study included adolescents and youth age groups (10-24 years of age) A self designed questionnaire was used to interview 423 respondents who visited medical and surgical OPDs. Information was collected upon demographic variables in addition to the awareness, family use and use of smokeless tobacco. Perception about carcinogenicity of tobacco was analyzed in relation to gender and educational status Results: The mean age of the respondents and users was 21 and 21.6years respectively. Seventy eight (18.44%) users of SLT were identified. Majority (95.6%) were aware of SLT use in the area and greatest awareness was about Niswar (90%). Majority (82.5%) considered SLT harmful for health. Awareness about carcinogenicity of tobacco was statistically high (OR=3.09) in educated subjects. In 61.5% family use of SLT was present. The most common sources of knowledge were social contacts (60%). Most (68.8%) respondents considered SLT less harmful then smoking. Conclusion: Awareness regarding carcinogenic effects of SLT is inadequate

Investigation of Deformation in Bimorph Piezoelectric Actuator: Analytical, Numerical and Experimental Approach

Piezoelectric actuators are widely used in many fields such as medical instruments, optics, and aerospace due to their small size and high reliability. Piezoelectric cantilever actuators are used in different configurations such as unimorph and bimorph. In this paper, a 3-D lead zirconate titanate (PZT) bimorph was modeled in COMSOL Multiphysics software for investigation of series and parallel configuration. Theoretical analysis has been developed for the measurement of deformation of a piezoelectric cantilever in inverse piezoelectric effect. The experiment was also performed to examine the deformation of piezoelectric bimorph cantilever. It is found that under a constant applied electric field of 100 V bimorph piezoelectric actuator produces maximum deformation at 100 mm length, 30 mm width, and 20 mm thickness. It is also found that piezoelectric series benders have relatively less deformation than piezoelectric parallel benders. Experimental results show good agreement with theoretical and Numerical results.</jats:p