A systematic methodology review of fluorescence-guided cancer surgery to inform the development of a core master protocol and outcome set

Background Fluorescence-guided precision cancer surgery may improve survival and minimize patient morbidity. Efficient development of promising interventions is however hindered by a lack of common methodology. This methodology review aimed to synthesize descriptions of technique, governance processes, surgical learning and outcome reporting in studies of fluorescence-guided cancer surgery to provide guidance for the harmonized design of future studies. Methods A systematic search of MEDLINE, EMBASE and CENTRAL databases from 2016–2020 identified studies of all designs describing the use of fluorescence in cancer surgery. Dual screening and data extraction was conducted by two independent teams. Results Of 13,108 screened articles, 426 full text articles were included. The number of publications per year increased from 66 in 2016 to 115 in 2020. Indocyanine green was the most commonly used fluorescence agent (391, 91.8%). The most common reported purpose of fluorescence guided surgery was for lymph node mapping (195, 5%) and non-specific tumour visualization (94, 2%). Reporting about surgical learning and governance processes incomplete. A total of 2,577 verbatim outcomes were identified, with the commonly reported outcome lymph node detection (796, 30%). Measures of recurrence (32, 1.2%), change in operative plan (23, 0.9%), health economics (2, 0.1%), learning curve (2, 0.1%) and quality of life (2, 0.1%) were rarely reported. Conclusion There was evidence of methodological heterogeneity that may hinder efficient evaluation of fluorescence surgery. Harmonization of the design of future studies may streamline innovation

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

Fluoroquinolone-induced achilles tendinopathy – A case report and management recommendations

Fluoroquinolone antibiotics are frequently used in the management of infection despite being associated with several side effects including the potential to cause tendon injury. While numerous case reports of Achilles tendon injury related to fluoroquinolone exposure exist in the literature, there is a paucity of research evaluating the effectiveness of treatment interventions for the condition. The author presents a case of chronic bilateral Achilles tendinopathy associated with two separate exposures to ciprofloxacin and its subsequent management with eccentric loading exercises and extracorporeal shockwave therapy (ESWT)

Biplanar versus Triplanar Chevron Osteotomy for the Correction of Hallux Valgus: A Comparison of Radiologic Outcomes

Abstract Introduction: Hallux valgus is a common disorder of the foot. The chevron osteotomy is among the most common methods of surgically correcting mild to moderate hallux valgus, though it has been associated with inadequate distal metatarsal articular angle (DMAA) correction and risk of hallux valgus recurrence. This study aimed to compare the effectiveness of the triplanar and biplanar chevron osteotomies in correcting mild to moderate hallux valgus. Specifically, we aimed to determine if the triplanar chevron osteotomy results in superior correction of the DMAA compared to the biplanar chevron osteotomy. Methods: A retrospective review of patient medical charts and preoperative and postoperative radiographs was performed. A total of 55 patients were included, with 28 patients in the biplanar chevron group and 27 patients in the triplanar chevron group. The DMAA and intermetatarsal (IM) angles were measured on preoperative and postoperative radiographs. Statistical analysis was carried out on SPSS. Results: The DMAA and IM angles improved significantly in both groups (p = &lt;0.001). There was no significant difference in the mean postoperative IM angle in the biplanar versus triplanar groups (9.58 degrees versus 9.19 degrees, respectively, p = 0.279). There was a significant difference in the mean postoperative DMMA in the triplanar versus biplanar groups (7.88 degrees versus 8.79 degrees, respectively, p = 0.026). Conclusions: The biplanar and triplanar chevron osteotomies are equally effective in reducing IM angle in mild to moderate hallux valgus. The triplanar chevron osteotomy significantly increases DMAA correction when compared to the biplanar chevron osteotomy and may therefore reduce hallux valgus recurrence.</jats:p

Is the COVID-19 vaccination a ray of hope for the elimination of prevalent infectious diseases in the future?

In recent years, many disease outbreaks and pandemics have been reported and have posed serious public health challenges. Therefore, vaccination on a large scale is the only hope to prevent and control these vaccine-preventable diseases. This letter discusses the COVID-19 vaccination’s role in preventing other infectious diseases.</p

An integrative systematic review on interventions to improve layperson’s ability to identify trustworthy digital health information

Health information on the Internet has a ubiquitous influence on health consumers’ behaviour. Searching and evaluating online health information poses a real challenge for many health consumers. To our knowledge, our systematic review paper is the first to explore the interventions targeting lay people to improve their e-health literacy skills. Our paper aims to explore interventions to improve laypeople ability to identify trustworthy online health information. The search was conducted on Ovid Medline, Embase, Cochrane database, Academic Search Complete, and APA psych info. Publications were selected by screening title, abstract, and full text, then manual review of reference lists of selected publications. Data was extracted from eligible studies on an excel sheet about the types of interventions, the outcomes of the interventions and whether they are effective, and the barriers and facilita?tors for using the interventions by consumers. A mixed-methods appraisal tool was used to appraise evidence from quantitative, qualitative, and mixed-methods studies. Whittemore and Knafl’s integrative review approach was used as a guidance for narrative synthesis. The total number of included studies is twelve. Media literacy interventions are the most common type of interventions. Few studies measured the effect of the interventions on patient health outcomes. All the procedural and navigation/ evaluation skills-building interventions are significantly effective. Computer/internet illiteracy and the absence of guidance/facilitators are significant barriers to web-based intervention use. Few interventions are distinguished by its implementation in a context tailored to consumers, using a human-centred design approach, and delivery through multiple health stakeholders’ partnership. There is potential for further research to understand how to improve consumers health information use focusing on collaborative learning, using human-centred approaches, and addressing the social determinants of health.</p

An integrative systematic review on interventions to improve layperson’s ability to identify trustworthy digital health information

Health information on the Internet has a ubiquitous influence on health consumers’ behaviour. Searching and evaluating online health information poses a real challenge for many health consumers. To our knowledge, our systematic review paper is the first to explore the interventions targeting lay people to improve their e-health literacy skills. Our paper aims to explore interventions to improve laypeople ability to identify trustworthy online health information. The search was conducted on Ovid Medline, Embase, Cochrane database, Academic Search Complete, and APA psych info. Publications were selected by screening title, abstract, and full text, then manual review of reference lists of selected publications. Data was extracted from eligible studies on an excel sheet about the types of interventions, the outcomes of the interventions and whether they are effective, and the barriers and facilitators for using the interventions by consumers. A mixed-methods appraisal tool was used to appraise evidence from quantitative, qualitative, and mixed-methods studies. Whittemore and Knafl’s integrative review approach was used as a guidance for narrative synthesis. The total number of included studies is twelve. Media literacy interventions are the most common type of interventions. Few studies measured the effect of the interventions on patient health outcomes. All the procedural and navigation/ evaluation skills-building interventions are significantly effective. Computer/internet illiteracy and the absence of guidance/facilitators are significant barriers to web-based intervention use. Few interventions are distinguished by its implementation in a context tailored to consumers, using a human-centred design approach, and delivery through multiple health stakeholders’ partnership. There is potential for further research to understand how to improve consumers health information use focusing on collaborative learning, using human-centred approaches, and addressing the social determinants of health.</p