Identifying Relevant Evidence for Systematic Reviews and Review Updates

Systematic reviews identify, assess and synthesise the evidence available to answer complex research questions. They are essential in healthcare, where the volume of evidence in scientific research publications is vast and cannot feasibly be identified or analysed by individual clinicians or decision makers. However, the process of creating a systematic review is time consuming and expensive. The pace of scientific publication in medicine and related fields also means that evidence bases are continually changing and review conclusions can quickly become out of date. Therefore, developing methods to support the creating and updating of reviews is essential to reduce the workload required and thereby ensure that reviews remain up to date. This research aims to support systematic reviews, thus improving healthcare through natural language processing and information retrieval techniques. More specifically, this thesis aims to support the process of identifying relevant evidence for systematic reviews and review updates to reduce the workload required from researchers. This research proposes methods to improve studies ranking for systematic reviews. In addition, this thesis describes a dataset of systematic review updates in the field of medicine created using 25 Cochrane reviews. Moreover, this thesis develops an algorithm to automatically refine the Boolean query to improve the identification of relevant studies for review updates. The research demonstrates that automating the process of identifying relevant evidence can reduce the workload of conducting and updating systematic reviews

An Evaluation of Medication Safety related Communications in the Patient Healthcare Pathway in Kuwait

Background: Patient safety is a recognised public health issue. When post-market medication safety information emerges, the benefits and risks of the medication concerned are usually evaluated by drug regulatory agencies. The outcomes of such pharmacovigilance activities are communicated to the public, patients and other healthcare professionals (HCPs). The aim of these medication safety communications might vary from improving the intended recipients’ knowledge or attitudes to outlining specific actions to be followed by them. However, it is currently recognised that sharing medication-related information does not improve patients’ safety on its own if not accompanied by an accurate implementation of these recommendations in clinical practice. Despite their importance in protecting patient safety and subsequently affecting public health, no previous study was found to have evaluated or described the process of creating and disseminating medication safety communications by the Kuwaiti drug regulatory agency. Equally, no study was found to have investigated the impact of or the factors affecting the implementation of regulatory-related medication safety communications in Kuwait. Therefore, this thesis aimed to address these gaps in knowledge by evaluating medication safety communications in the patient healthcare pathway in Kuwait. Methods: This multiphase study was preceded by a systematic literature review of the factors affecting HCPs’ implementation of regulatory-related medication safety communications, using a narrative synthesis approach. Following the systematic review, multiphase research was initiated. This consisted of three phases, each of which focused on a specific stakeholder group involved in the process of medication safety communication. Phase 1 involved Kuwait Drug and Food Control (KDFC), an administration within the Ministry of Health (MOH), as the regulatory agency responsible for pharmacovigilance activities. This was a convergent mixed-methods study. Data collection in this phase included documents produced by KDFC or issued to KDFC relating to medication safety and three face-to-face interviews with KDFC employees involved in pharmacovigilance activities. Documents were analysed using a descriptive quantitative approach and a framework analysis technique. Phase 2 focused on healthcare professionals working in MOH hospitals in Kuwait. This phase was an exploratory mixed-methods study, where focus group discussions were conducted followed by the distribution of an online survey. The focus group discussions were analysed using a thematic analysis technique. In the second part of this phase, an online survey was developed based on Phase 1, the focus group discussions and the systematic literature review. Survey data analysis included descriptive analysis (frequency and percentile) and statistical analysis including principal component analysis (PCA) and the Kruskal–Wallis H test, which was followed by a post hoc analysis of variables that had significant results. Other statistical tests applied included Fisher’s exact test, the Mann–Whitney U Test, and multivariate regression analysis. Participants’ answers to open-ended survey questions were analysed using a conventional content analysis technique. Phase 3 was an interpretive phenomenology study. This phase involved semi-structured phone interviews with six female patients of childbearing age who used a valproate-related medication for epilepsy or migraine. These patients had been prescribed the valproate-related medication in one of six secondary hospitals and one specialist neurology hospital within the MOH hospitals. An interpretive phenomenological analysis technique was applied to analyse the transcripts. Results: The results of the systematic literature review indicated that the factors affecting HCPs’ implementation of medication safety communications occur at multiple levels. These levels included the sources or senders of the safety information (delays in the delivery of medications safety communications), healthcare institutions (hospitals’ position and interpretations of the recommendations), the HCPs (knowledge of the content of medications safety communications), and the patients and/or their carers (willingness to use the medication concerned). Phase 1 revealed a lack of legislation and a pharmacovigilance-specific policy. Results from Phase 2 reflected poor knowledge of the concept of medication safety communications within the context of pharmacovigilance and a lack of familiarity with the tools used by KDFC to communicate emerging medication information among HCPs. In the survey, although the majority of HCPs who responded were aware of the teratogenicity of VRM (65.1%, (n = 110/169)), only 2.6% had responded correctly to the statements of the VRM KDFC recommendations. More than half of the participants (57%) reported changing their practice to accommodate at least one intended KDFC recommendation. Providing female patients with written information (37.2%) and counselling female patients about contraceptive use (37.2%) were the most reported intended changes in practice. The most reported barriers to implementation included not having the capacity in terms of time and/or the infrastructure to implement the recommendations (33.8%). Four themes originating from patient interviews included (1) the timeline of the patient’s experience (2) varied knowledge and perception with valproate use, (3) patient’s expectations from HCPs and (4) experiences and preferences towards medication safety communications. Conclusion: Medication safety communications are essential tools for disseminating information related to medication safety updates to HCPs, patients and the public. This research identified challenges at the level of the sender (KDFC) and the intended recipients (HCPs and patients) that could reduce the ability of KDFC’s medication safety communications to reach clinical practices. The first step in increasing their reach is to adapt electronic methods for disseminating such information. Involving stakeholders, such as HCPs and patients, in evaluating the clarity and understandability of KDFC’s medication safety communications should be the focus of future research

Antimicrobial stewardship implementation before and during the COVID-19 pandemic in the acute care settings: a systematic review

© The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Introduction: Antibiotics are widely administered for various indications, leading to increased antimicrobial resistance (AMR) in acute care hospitals. Since the onset of the COVID-19 pandemic, Antimicrobial Stewardship (AMS) effective strategies should be used to maintain the rational use of antibiotics and decrease the threat of Antimicrobial Resistance (AMR). Aim: This systematic literature review aims to investigate the AMS intervention Before-the-pandemic (BP) and During-the-pandemic (DP) from the literature. Design and setting: Systematic literature review of primary studies on AMS implementation in acute care settings. Methods: Relevant studies published between 2000 and March 2021 were obtained from Medline (via PubMed), OVID, CINAHL, International Pharmaceutical Abstracts, Psych Info, Scopus, Web of Science, Cochrane Library, OpenGrey, and Google Scholar, using a comprehensive list of search terms. Public Health England (PHE) toolkit was agreed upon as a gold standard for the AMS implementation. Results: There were 8763 articles retrieved from the databases. Out of these, 13 full-text articles met the inclusion criteria for the review. The AMS implementation was identified in the included studies into AMS strategies (Core strategies & Supplemental strategies), and AMS measures BP and DP. Conclusion: This Systematic literature review summarises AMS implementation strategies and measures all over the previous 20 years of research. There are many lessons learnt from COVID-19 pandemic. The proper selection of the AMS implementation strategies and measures appeared to be effective in maintaining the appropriate use of antibiotics and decreasing the AMR threat, especially during the COVID-19 pandemic. Further studies are required to provide empirical data to evaluate the AMS implementation and identify which of these strategies and measures were effective BP and DP. In order to be prepared for any emergency/crisis or future pandemics.Peer reviewe

Dietary knowledge assessment among the patients with type 2 diabetes in Madinah: A cross-sectional study [version 2; peer review: 2 approved]

Background There is a huge burden of nutrition-related non-communicable diseases, and diabetes is one of the leading chronic nutrition-related diseases affecting more than 500 million people globally. Collecting information regarding the awareness of dietary and nutrition knowledge among diabetic patients is the first step to developing a disease prevention program. Thus, this study primarily aims at assessing the dietary awareness of diabetes patients attending the diabetic centre in Madinah governorate, Saudi Arabia. Methods The study was started in November 2020 and ended in October 2021. The study participants (315) were type 2 diabetes mellitus (T2DM) patients attending a diabetic centre in Madinah, Saudi Arabia. A self-prepared dietary knowledge questionnaire (DKQ) was used in this research. The variables include balanced diet, food type, food choice, carbohydrate, protein, and fat. Knowledge score was, and the total score was levelled/categorized into ‘good’, ‘average’, and ‘poor’. Data were analysed by SPSS v.26. Results The study results identified the current knowledge of T2DM patients about different dietary items. The knowledge score of 62.2% of participants showed an average level of dietary knowledge, which is statistically significant. When we separately evaluated their understanding of different dietary components, we found that T2DM patients had poor knowledge of carbohydrates (30.15%), fat, food choices (47.7%), and type (34.6%). However, they had acceptable knowledge of proteins (56.5%). Conclusion Our participants exhibited acceptable knowledge about proteins but poorer knowledge of other food groups. A healthy, well-balanced diet is essential for excellent glycaemic control. Educating and arranging a health education program regarding dietary knowledge is recommended, specially designed for diabetic patients so that patients can opt for a healthier lifestyl

The patterns of abdominal trauma and factors associated with ICU admission in a major trauma center in Medina

BackgroundTrauma is a significant health problem in Saudi Arabia. In polytrauma victims, the abdomen is the second most affected body region following the head. In the Middle East, abdominal trauma prevalence ranges from 15 per cent to 82 per cent. AimsThis study aims to assess the patterns of blunt and penetrating abdominal traumas and to assess the factors associated with ICU admission.MethodsThis is a retrospective analytical study conducted at a major trauma centre in Medina, Saudi Arabia. Admitted abdominal trauma patients from 2015 to 2018 were included. Paediatric and isolated extra-abdominal traumas were excluded. Descriptive analysis was used to identify patterns of abdominal trauma. Chi-squared test and independent t-test were applied to evaluate the association of the mechanism of injury, solid abdominal organs, associated extra-abdominal injuries, and type of injury. Multiple regression analysis was conducted to assess factors associated with ICU admission in abdominal trauma. ResultsWe included a total of 218 patients with a mean age of 32.7±13.9 years. Males (78.4 per cent) were predominantly greater in number than females (21.6 per cent). The primary mechanisms of injury were motor vehicle collisions (MVCs) (76.6 per cent), followed by stab wounds (12.4 per cent) and falls (7 per cent). The liver and spleen were the most injured organs (31 per cent and 30 per cent, respectively). Chest injuries were the most associated extra-abdominal trauma (47.2 per cent). The majority of MVC patients (88.6 per cent) had BTA, while stab wound was the main mechanism of injury in penetrating trauma (12 per cent) (P < 0.001). Penetrating trauma patients required laparotomy more than BTA patients (52.9 per cent and 8 per cent; P < 0.05). Eighteen percent of patients needed ICU admission. Factors positively associated with ICU admission (P < 0.05) were head and neck, musculoskeletal, and thoracic injuries and a moderate Revised Trauma Score (RTS).ConclusionBlunt abdominal trauma was the dominant type of abdominal injury in this study. The majority of patients were young adult males. MVCs and stab wounds were the predominant mechanisms of injury. The most affected organs were the liver and spleen. Chest injuries were the most associated extra-abdominal trauma. Factors positively associated with ICU admission were head and neck, chest, and musculoskeletal injuries and a moderate RTS

HEPATOPROTECTIVE ACTIVITY OF COSTUS SPECIOSUS (KOEN. EX. RETZ.) AGAINST PARACETAMOL-INDUCED LIVER INJURY IN MICE

Background: Liver diseases are a common cause of mortality and morbidity over the world. It is caused mainly by toxic chemicals and chemotherapeutic agents. Costus speciosus (Koen ex. Retz.) (Zingiberaceae) is widely employed in various traditional medicines for the prevention and treatment of different aliments. The purpose of this study is to assess the protective effect of C. speciosus rhizomes MeOH extract against the injury of the liver induced by paracetamol (PA) in mice. Material and Methods: The mice were pretreated for seven days with distilled H2O, silymarin 12 mg/kg or 100 and 200 mg/kg MeOH extract. Then, PA (750 mg/kg) was also intra-peritoneal administrated once a day. Animals were euthanatized 24 h after the damage inducement. The levels of the serum enzymes aspartate aminotransferase (AST), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase, in addition to the tumor necrosis factor-alpha (TNF-α), were determined. Moreover, the histopathological examination was carried out. Results: Administration of the MeOH extract (200 mg/kg) showed improvement in the toxic effects of PA through significant fall on the serum markers enzymes of liver damage: AST, ALT, and ALP, as well as TNF-α, compared to silymarin. In parallel, the histopathological profile in the mice` liver also proved that extract markedly minimized the PA toxicity and maintained the liver tissues` histoarchitecture to near the normal ones more than that achieved by silymarin. Conclusion: The findings suggested that C. speciosus extract acts as a potential hepatoprotective agent against PA-induced liver toxicity. This hepato-protection effect may be due to the existence of steroids, saponins, different glycosides, and phenolic compounds in C. speciosus

Association between Renal Stones Sonographic Findings and Demographic Data among Patients at Riyadh Hospitals, Saudi Arabia

Background: Ultrasound is the primary imaging modality to identify renal stones (RS) in patients with acute flank pain. This study aimed to evaluate the presence, location, and size of RS diagnosed by ultrasound in association with age, gender, and BMI among patients at Riyadh hospitals. Methods and Results: In this case-control study, a total of 250 records (130/52% for males and 120/48% for females) from 2018 to 2019 were reviewed from January to March 2020 at different hospitals in Riyadh. In this study, 150(60%) records of patients with RS and 100(40%) records of patients without RS were collected to evaluate the risk factor for RS formation in the central area of Saudi Arabia. A designed data collection sheet containing all variables (demographic and sonographic) of the study was used. Demographic data included gender, age, and body mass index (BMI). Sonographic data included RS presence (yes, no), RS location (right kidney [RK], left kidney [LK], both kidneys), and RS size (small [1cm]). The study found that RS were more common among males than females (P0.05) Conclusion: Among patients at Riyadh hospitals, females are less affected by RS than males. Gender is a significant risk factor for the development of RS. The effect of BMI is obvious on renal stone location and size

How Different Preparation Techniques Affect MRI-Induced Anxiety of MRI Patients: A Preliminary Study

Background: Magnetic resonance imaging (MRI) exams may cause patients to feel anxious before or during the scan, which affects the scanning outcome and leads to motion artifacts. Adequate preparation can effectively alleviate patients’ anxiety before the scan. We aimed to assess the effect of different preparation methods on MRI-induced anxiety: We conducted a prospective randomized study on MRI patients between March and May 2022. We divided 30 patients into two groups: the control group, which received routine preparation (RP), and the experimental group, which received video preparation (VP).We used the State-Trait Anxiety Inventory (STAI) to measure anxiety levels before and after the interventions. We assessed patients’ self-satisfaction after the scan: After preparation, VP (STAI mean = 10.7500) and RP (STAI mean = 12.7857), we observed a significant association between the pre- and post-STAI results in VP (p = 0.025). The effects of both methods in decreasing anxiety were more significant for first-timers (p = 0.009 in RP/0.014 in VP). We noted high satisfaction levels for both forms of preparation. The VP technique was superior in reducing patient anxiety, especially in first-time MRI patients. Hence, VP techniques can be used in different clinical settings to reduce anxiety and facilitate patients’ understanding of the instructions given

Forecasting wind power based on an improved al-Biruni Earth radius metaheuristic optimization algorithm

Wind power forecasting is pivotal in optimizing renewable energy generation and grid stability. This paper presents a groundbreaking optimization algorithm to enhance wind power forecasting through an improved al-Biruni Earth radius (BER) metaheuristic optimization algorithm. The BER algorithm, based on stochastic fractal search (SFS) principles, has been refined and optimized to achieve superior accuracy in wind power prediction. The proposed algorithm is denoted by BERSFS and is used in an ensemble model’s feature selection and optimization to boost prediction accuracy. In the experiments, the first scenario covers the proposed binary BERSFS algorithm’s feature selection capabilities for the dataset under test, while the second scenario demonstrates the algorithm’s regression capabilities. The BERSFS algorithm is investigated and compared to state-of-the-art algorithms of BER, SFS, particle swarm optimization, gray wolf optimizer, and whale optimization algorithm. The proposed optimizing ensemble BERSFS-based model is also compared to the basic models of long short-term memory, bidirectional long short-term memory, gated recurrent unit, and the k-nearest neighbor ensemble model. The statistical investigation utilized Wilcoxon’s rank-sum and analysis of variance tests to investigate the robustness of the created BERSFS-based model. The achieved results and analysis confirm the effectiveness and superiority of the proposed approach in wind power forecasting

A novel voting classifier for electric vehicles population at different locations using Al-Biruni earth radius optimization algorithm

The rising popularity of electric vehicles (EVs) can be attributed to their positive impact on the environment and their ability to lower operational expenses. Nevertheless, the task of determining the most suitable EV types for a specific site continues to pose difficulties, mostly due to the wide range of consumer preferences and the inherent limits of EVs. This study introduces a new voting classifier model that incorporates the Al-Biruni earth radius optimization algorithm, which is derived from the stochastic fractal search. The model aims to predict the optimal EV type for a given location by considering factors such as user preferences, availability of charging infrastructure, and distance to the destination. The proposed classification methodology entails the utilization of ensemble learning, which can be subdivided into two distinct stages: pre-classification and classification. During the initial stage of classification, the process of data preprocessing involves converting unprocessed data into a refined, systematic, and well-arranged format that is appropriate for subsequent analysis or modeling. During the classification phase, a majority vote ensemble learning method is utilized to categorize unlabeled data properly and efficiently. This method consists of three independent classifiers. The efficacy and efficiency of the suggested method are showcased through simulation experiments. The results indicate that the collaborative classification method performs very well and consistently in classifying EV populations. In comparison to similar classification approaches, the suggested method demonstrates improved performance in terms of assessment metrics such as accuracy, sensitivity, specificity, and F-score. The improvements observed in these metrics are 91.22%, 94.34%, 89.5%, and 88.5%, respectively. These results highlight the overall effectiveness of the proposed method. Hence, the suggested approach is seen more favorable for implementing the voting classifier in the context of the EV population across different geographical areas