Focused ultrasound therapy in movement disorders: management roadmap toward optimal pathway organization.

MRI-guided focused ultrasound (MRgFUS) lesioning is an innovative, safe and effective treatment which provides an innovative development in the field of minimally invasive stereotactic neurosurgery. Based on the application of focused ultrasound energy under full MR planning and thermal imaging control, unilateral lesioning of the thalamus, subthalamic nucleus, and globus pallidus is indicated for the treatment of movement disorders, including essential tremor, Parkinson's disease, and dystonia. We started to apply this technique in February 2019 for the treatment of patients with movement disorders. The authors developed a diagnostic therapeutic care pathway, which is herewith proposed and applied as an explication of standard clinical practice in use. The project was the result of the application of different methods such as Health Technology Assessment (HTA), Strengths, Weaknesses, Opportunities and Threats analysis (SWOT) and Demin -Plan, Do, Check, Act (PDCA) cycle. The aim of this project was to standardize the MRgFUS diagnostic-therapeutic pathway (DTP), describe its application and the appropriateness of different phases (patient selection, intervention phase and follow-up). Here, we described in detail our experience in the DTP application from 2019 up to now in 610 patients with movement disorders.

Adherence of systematic reviews to Cochrane RoB2 guidance was frequently poor: a meta epidemiological study.

OBJECTIVES: To assess whether the use of the revised Cochrane risk of bias tool for randomized trials (RoB2) in systematic reviews (SRs) adheres to RoB2 guidance. METHODS: We searched MEDLINE, Embase, Cochrane Library from 2019 to May 2021 to identify SRs using RoB2. We analyzed methods and results sections to see whether risk of bias was assessed at outcome measure level and applied to primary outcomes of the SR as per RoB2 guidance. The relation between SR characteristics and adequacy of RoB2 use was examined by logistic regression analysis. RESULTS: Two hundred-eight SRs were included. We could assess adherence in 137 SRs as 12 declared using RoB2 but actually used RoB1 and 59 did not report the number of primary outcomes. The tool usage was adherent in 69.3% SRs. Considering SRs with multiple primary outcomes, adherence dropped to 28.8%. We found a positive association between RoB2 guidance adherence and the methodological quality of the reviews assessed by AMSTAR2 (p-for-trend 0.007). Multivariable regression analysis suggested journal impact factor [first quartile vs. other quartiles] was associated with RoB2 adherence (OR 0.34; 95% CI: 0.16-0.72). CONCLUSIONS: Many SRs did not adhere to RoB2 guidance as they applied the tool at the study level rather than at the outcome measure level. Lack of adherence was more likely among low and very low quality reviews.

Nursing competence in continuous renal replacement therapy: development and validation of a measurement tool.

BACKGROUND: Acute Renal Failure is an essential condition frequently encountered in intensive care units and requires targeted treatment. The critical care nursing team must be adequately trained to manage patients undergoing Continuous Renal Replacement Therapy. OBJECTIVES: To develop and validate the Continuous Renal Replacement Therapy - Measurement Competency Tool, aimed at measuring nursing competence in managing patients undergoing renal replacement techniques. METHODS: A cross-sectional tool validation study with a test-retest.A total of 30 critical care nurses participated in this study. The study examined content and face validity. Test-retest reliability with Pearson's r correlation and internal consistency reliability was assessed using Cronbach's α. Current guidelines for Continuous Renal Replacement Therapy techniques were used to develop an instrument to measure nursing competence through an online survey. A pool of 10 experts evaluated this tool. RESULTS: The Continuous Renal Replacement Therapy - Measurement Competency Tool achieved good content and face validity (S-CVI= 0.97; I-CVI=87%-100%), and good internal consistency reliability (Cronbach's α= 0.799). Pilot testing and test-retesting was conducted with 30 critical care nurses. The intraclass correlation for the test-retest analysis indicates excellent test-retest reliability, confirming the stability of the tool. ConclUSION: The tool assesses nursing competence concerning Continuous Renal Replacement Therapy techniques in the intensive care unit, which proved to be valid and reliable. This new tool will make it possible to measure the competence of nurses with respect to Continuous Renal Replacement Therapy techniques.