6 research outputs found
Changing foreign policy: the Obama Administration’s decision to oust Mubarak
This paper analyses the decision of the Obama administration to redirect its
foreign policy towards Egypt in the wake of the Arab Spring. It attempts to
highlight the issue of how governments deal with decision-making at times of
crisis, and under which circumstances they take critical decisions that lead to
major shifts in their foreign policy track record. It focuses on the process that
led to a reassessment of US (United States) foreign policy, shifting from decades
of support to the autocratic regime of Hosni Mubarak, towards backing his
ouster. Specifically, the paper attempts to assess to what extent the decision to
withdraw US support from a longstanding state-leader and ally in the Middle
East can be seen as a foreign policy change (FPC). A relevant research question
this paper pursues is: how can the withdrawal of US support to a regime
considered as an ally be considered, in itself, as a radical FPC
The optimal management of Seymour fractures in children and adolescents: a systematic review protocol
BACKGROUND: Seymour fractures are open, displaced juxta-epiphyseal fractures of the distal phalanx, with an overlying nail bed laceration that occur in children and adolescents with an open physis. This fracture occurs rarely, but its potential consequences are clinically significant. Due to anatomical particulars and proximity to the growth plate, this open fracture may result in soft tissue infection and osteomyelitis, leading to growth arrest and persistent mallet deformity. At present, there is no consensus as to the optimal management of Seymour fractures. The objective of this study will be to systematically evaluate the existing evidence on the management of Seymour fractures in children and adolescents and to establish what are the most important factors pertaining to an uncomplicated recovery.
METHODS: We designed and registered a study protocol for a systematic review of randomised controlled trials and observational studies. A comprehensive literature search will be conducted (from inception to present) in MEDLINE, EMBASE, CINAHL and Cochrane Library databases. Grey literature will be identified through searching Open Grey and dissertation databases using an exhaustive search strategy. All clinical studies examining the management of Seymour fractures will be included. The interventions (irrigation and debridement; prophylactic antibiotics) and their timings (early vs late) will be compared to no antibiotics and no debridement. Primary outcome measures will be the incidence of superficial and deep infection. Secondary outcomes will include other adverse events such mal-union, non-union, need for re-operation, physeal disturbance and nail dystrophy/atrophy. Two independent reviewers will screen all citations, full-text articles, and abstract data. Conflicts will be resolved through discussion. The study methodological quality (or bias) will be appraised using an appropriate tool. A narrative synthesis will be performed. If data permits, we will conduct random-effects meta-analysis where appropriate.
DISCUSSION:
This review will provide evidence for the management of Seymour fractures, based on a cumulation of existing smaller studies. Due to the rarity of this fracture pattern, included studies are expected to be mainly observational and prone to bias; however, there is value in summarising the evidence to guide clinicians.
SYSTEMATIC REVIEW REGISTRATION:
Systematic review registration: PROSPERO CRD42020153726
Management of Seymour Fractures in Children and Adolescents: A Systematic Review and Meta-Analysis.
PURPOSE
Seymour fractures are injuries with a potentially high risk of infection and osteomyelitis. The optimal management of this pediatric open fracture is unknown. We performed a systematic review and meta-analysis to summarize the best evidence for these fractures and determine their optional management based on primary clinical studies.
METHODS
A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis was performed. A comprehensive search strategy was applied to the MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and gray literature databases (from May 1966 to April 15, 2020). Studies describing patients under the age of 18 years with Seymour fractures were included. Treatment was grouped based on debridement and antibiotic status as well as the timing of these interventions. The primary outcome was infection. The secondary outcomes included malunion, physeal disturbance, and nail dystrophy.
RESULTS
The searches helped identify 56 records, of which 10 nonrandomized studies met our inclusion criteria, comprising 352 patients and 355 fractures. Early (<48 hours) debridement was associated with significantly less risk of infection (risk ratio [RR]Â = 0.28 [95% CI, 0.12-0.64]) and malunion (RRÂ = 0.25 [95% CI, 0.07-0.99]). Prophylactic (<24 hours) antibiotics significantly reduced the risk of infection (RRÂ = 0.21 [95% CI, 0.10-0.43]). In addition, prophylactic antibiotics and debridement were associated with a 70% reduction in the risk of infection (RRÂ = 0.30 [95% CI, 0.11-0.83]). Over one-third of patients with delayed presentation (median 8.5 days) were infected at presentation.
CONCLUSIONS
The high-risk nature of Seymour fractures may be mitigated by prompt recognition and early, basic interventions, which can usually be performed in any setting.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV