Tinkering with Perfection: Theory Development in the Intervention Cultural Adaptation Field

Background Testing evidence-based interventions (EBIs) outside of their home countryhas become increasingly commonplace. There is a need for theoretically guided researchon how to best create and test the effects of culturally adapted interventions.Objective To illustrate how the field might raise the scientific and practical value offuture effectiveness and dissemination trials of culturally adapted interventions, as well asto provide support for theoretically informed research on this subject to take greater root.Methods Nine theories that offer guidance on how to adapt existing EBIs for a newcultural group were summarized and evaluated.Results Commonalities among the selected theories included a focus on the need forcollaboration as part of the adaptation process and shared emphasis on taking systematicsteps to select an intervention to adapt, as well as calls for adaptations to be guided byspecific types of empirical studies. Among the theories, variability existed in terms of whatconstituted an adaptation.Conclusions As EBIs go global, intervention adaptation promises to be the subject ofsubstantial future scholarly attention. There is a need to develop systematic evidence-basedmethods that allow for some degree of adaptation, while still bringing about EBIs’ desiredbenefits.</p

Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence

Abstract We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3–0.9%) 12 months and 1.8% (95%CI 1.1–2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1–0.3%) 12 months and 0.6% (95%CI 0.5–0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3–82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure