EMR-Based Interventions on HPV Vaccination Initiation, Completion, and Receiving the Next Dose: A Meta-Analytic Review

Despite the acknowledged importance of Human Papillomavirus (HPV) vaccination in reducing HPV-related diseases, the influence of electronic medical records (EMR) on HPV vaccination uptake (HVU) remains underexplored. This study aimed to evaluate the efficacy of EMR-based interventions on HVU. A systematic review and meta-analysis of randomized controlled trials were performed, focusing on studies that primarily used EMR-based interventions to measure initiation rates, completion rates, and receipt of the next required vaccine dose. Subgroup analyses were conducted to assess the differential effects of supplementary strategies, provider feedback, and parental education or reminders on these outcomes. The results of the comprehensive analysis provided robust evidence for the significant role of EMR interventions, demonstrating an average increase of 4.7% in vaccine initiation, 6.6% in vaccine completion, and 7.2% in receipt of the next HPV vaccine dose. Additionally, the subgroup analyses indicated that provider feedback and parental education could further enhance the effectiveness of EMR-based interventions. These findings support the broader adoption of digital health technologies in vaccination programs, offering vital insights for healthcare providers, policymakers, and researchers, and emphasizing the need for continued technological innovation to improve public health outcomes

Clinician Communication Training to Increase Human Papillomavirus Vaccination Uptake: A Systematic Review and Meta-Analysis

The battle against Human Papillomavirus (HPV)-related cancers is hindered by suboptimal vaccination rates, despite the proven efficacy and availability of vaccines. This systematic review and meta-analysis addressed this issue by evaluating the impact of clinician communication training on increasing HPV vaccination uptake among adolescents. From an initial pool of 3213 records, six randomized controlled trials involving 245,195 participants across the United States were rigorously selected and analyzed. Our findings indicated that clinician communication training could enhance vaccination uptake rates by an average of 5.2%. Specifically, presumptive communication strategies, which proactively assume a patient’s acceptance of vaccination, achieved a significant 9.1% increase in uptake, markedly outperforming the 2.3% increase observed with more passive conversational techniques. Moreover, interventions that incorporated audit and feedback processes were particularly impactful, boosting vaccination rates by 9.4%. The most striking results emerged from combining presumptive communication with audit and feedback, which propelled the effectiveness to an 11.4% increase in vaccination rates. These outcomes highlight the pivotal role of deliberate, targeted clinician–patient communication in improving health interventions. This study offers actionable insights for healthcare providers and policymakers to refine communication strategies, thus potentially maximizing HPV vaccination rates and mitigating the spread of HPV-related conditions

The prognostic impact of histological type on clinical outcomes of early-stage cervical cancer patients whom have been treated with radical surgery

The aim of this study was to determine the prognostic impact of histological type among squamous cell carcinoma (SCC), adenocarcinoma (AC) and adenosquamous carcinoma (ASC) on the treatment outcome of early-stage cervical cancer patients after radical hysterectomy. The cohort comprised of 626 patients, diagnosed with stages IA2-IB1 cervical cancer between 1987 and 2013. Four hundred and one patients had SCC, 190 had AC and 35 had ASC. The 5-year disease-free survival (DFS) rates for AC, SCC and ASC were 89.3% (95%CI 83.2–93.2), 88.7% (95%CI 84.8–91.7) and 82.1% (95%CI 61.9–92.2), respectively (p = .594). In multivariate analyses, only older age and deep stromal invasion were statistically significantly associated with DFS, whereas histologic cell type was not (p = .524). Subgroup analysis showed that in the intermediate-high-risk groups, the SCC group had a significantly longer DFS, compared with the AC group or the ASC group (p = .001) while there was no DFS difference in the low-risk group. We believe that histologic cell type had no impact in low-risk early-stage cervical cancer patients. However, in the intermediate-high-risk groups, SCC is a more favourable factor for survival than AC/ASC

Bovine Milk Fat Globule Membrane Supplementation and Neurocognitive Development: A Systematic Review and Meta-Analysis

Given the limited evidence, there is no conclusive proof of the neurocognitive benefits of bovine milk fat globule membrane supplementation in infant formula. This study evaluates the neurocognitive benefits of bovine milk fat globule membrane supplementation in formula, comparing it to standard formula and assessing its noninferiority to breast milk. Data were sourced from studies published between January 2000 and March 2024 from PubMed, Cochrane Library, Web of Science, and Embase. Eight randomized controlled trials involving 1352 healthy term neonates, infants, and children up to 2 years old were included. Bovine milk fat globule membrane supplementation was significantly associated with improved cognitive development (mean difference: 3.29, 95% CI: 1.65 to 4.93, p I2 = 0%, p = 0.564). It showed significant improvement in executive function but not in language, motor, or social-emotional development. In non-inferiority analysis, there was no significant difference compared to breast milk regarding cognitive development. These findings support bovine milk fat globule membrane as a valuable addition to infant formula for cognitive benefits

The role of random cervical biopsies in addition to colposcopy-directed biopsies in detection of CIN2+

The aim of this study was to determine the additional values of multiple cervical biopsies when any colposcopy was performed. We developed a cross-sectional study of 92 women, who had been referred for a colposcopy because of their abnormal cervical cytology. Colposcopy-directed biopsies were taken from lesions and random non-directed biopsies were added, if their directed biopsies were fewer than four in number. The biopsy sites were ranked according to the impression of the clinicians. Among the 92 women, the first biopsy was normal in 29.4%, revealing CIN1 in 28.3% and CIN2+ in 42.3%. In the second and third biopsies, the CIN2+ was found to have increased to 35.8% and 36.8%, respectively. The accumulative sensitivity for detecting CIN2+ was 84.8%, for a single biopsy. This increased to 97.0%, after two biopsies and then to 100%, after three and four biopsies. To conclude, although the taking of the additional biopsies increased the CIN2+ detection, collecting three cervical biopsies might be sufficient.Impact Statement What is already known on this subject? The colposcopy is considered to be the standard procedure in the detection of precancerous lesions of the cervix. However, nowadays, colposcopic biopsy practices do not have any single, acceptable guideline for the number of biopsies performed, and whilst a single biopsy is the most commonly adopted practice, some centres have used a biopsy protocol with multiple biopsies. What the results of this study add? This study determined the rate of the detection of CIN2+ by using multiple biopsy protocols during colposcopy for women who were referred with their abnormal cervical cytology. We explored the benefit of collecting additional lesion-directed biopsies and additional biopsies of a normal-appearing cervix in addition to a single biopsy. We found that two or three biopsies from a colposcopy should be enough for increasing the detection of CIN2+. Also, multiple biopsies increased the sensitivity of CIN2+ detection, especially in colposcopic impression for the low grade lesions. What the implications are of these findings for clinical practice and/or further research? We suggest that colposcopy-directed biopsies should be supplied by one or two random biopsies from other quadrants of the cervix