Assessment of reliability in orthodontic literature.

OBJECTIVES: To map the statistical methods applied to assess reliability in orthodontic publications and to identify possible trends over time. MATERIALS AND METHODS: Original research articles published in 2009 and 2019 in a subset of orthodontic journals were downloaded. Publication characteristics, including publication year, number of authors, single vs multicenter study, geographic origin of the study, statistician involvement, study category, subject category, types of reliability assessment, and statistical methods applied to assess reliability, were recorded. Descriptive statistics, Chi-square tests, and logistic regression analyses were performed to investigate associations between reliability analysis and study characteristics. RESULTS: A total of 768 original research articles were analyzed. The most prevalent study category was observational (69%) with a statistician involved in 16% of studies. Overall, reliability was assessed in 47% of studies, and the most frequent methods applied to assess reliability were intraclass correlation coefficients or kappa statistics (60.4%). The odds of applying appropriate methods were greater in 2019 than in 2009 (odds ratio [OR]: 2.43; 95% confidence interval [CI]: 1.75, 3.37; P < .001). Involvement of a statistician resulted in greater odds of applying appropriate methods compared to no statistician involvement (OR: 1.88; 95% CI: 1.23, 2.87; P < .01). CONCLUSIONS: Over the past decade (2009 vs 2019), reliability assessment became more common in the orthodontic literature, and studies applying correct statistical methods to assess reliability significantly increased. This trend was more apparent in studies that involved a statistician, which may highlight the role of the statistician.

Sustained low efficiency dialysis is non-inferior to continuous renal replacement therapy in critically ill patients with acute kidney injury: A comparative meta-analysis.

BACKGROUND: Critically ill adults with acute kidney injury (AKI) experience considerable morbidity and mortality. This systematic review aimed to compare the effectiveness of continuous renal replacement therapy (CCRT) versus sustained low efficiency dialysis (SLED) for individuals with AKI. METHODS: We carried out a systematic search of existing databases according to standard methods and random effects models were used to generate the overall estimate. Heterogeneity coefficient was also calculated for each outcome measure. RESULTS: Eleven studies having 1160 patients with AKI were included in the analyses. Meta-analysis results indicated that there was no statistically significant difference between SLED versus continuous renal replacement therapy (CRRT) in our primary outcomes, like mortality rate (rate ratio [RR] 0.67, 95% confidence interval [CI] 0.44-1.00; P = .05), renal recovery (RR 1.08, 95% CI 0.83-1.42; P = .56), and dialysis dependence (RR = 1.03, 95% CI 0.69-1.53; P = .89). Also, no statistically significant difference was observed for between SLED versus CRRT in the secondary outcomes: that is, length of intensive care unit stay (mean difference -0.16, 95% CI -0.56-0.22; P = .41) and fluid removal rate (mean difference -0.24, 95% CI -0.72-0.24; P = .32). The summary mean difference indicated that there was a significant difference in the serum phosphate clearance among patients treated with SLED and CRRT (mean difference -1.17, 95% CI -1.90 to -0.44, P = .002). CONCLUSIONS: The analysis indicate that there was no major advantage of using continuous renal replacement compared with sustained low efficiency dialysis in hemodynamically unstable AKI patients. Both modalities are equally safe and effective in treating AKI among critically ill patients.

Angiotensin converting enzyme inhibitors and risk of lung cancer: A systematic review and meta-analysis.

BACKGROUND: We performed a meta-analysis to determine whether a consistent relationship exists between the use of angiotensin converting enzyme inhibitors (ACEIs) and the risk of lung cancer. Accordingly, we summarized and reviewed previously published quantitative studies. METHODS: Eligible studies with reference lists published before June 1st, 2019 were obtained from searching several databases. Random effects' models were used to summarize the overall estimate of the multivariate adjusted odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Thirteen observational studies involving 458,686 ACEI users were included in the analysis, Overall, pooled risk ratios indicate that ACEIs use was not a risk factor for lung cancer (RR 0.982, 95% C.I. 0.873 - 1.104; P = .76). There was significant heterogeneity between the studies (Q = 52.54; P < .001; I2 = 86.07). There was no significant association between ACEIs use and lung cancer in studies with over five years of ACEIs exposure (RR 0.95, 95% C.I. 0.75 - 1.20; P = .70); and ≤ 5years of exposure to ACEIs (RR 0.98, 95% C.I. 0.83 - 1.15; P = .77). There were no statistically significant differences in the pooled risk ratio obtained according to the study design (Q = 0.65; P = .723) and the comparator regimen (Q = 3.37; P = .19). CONCLUSIONS: The use of ACEIs was not associated with an increased risk of lung cancer. Nevertheless, well-designed observational studies with different ethnic populations are still needed to evaluate the long-term (over 10 years) association between ACEIs use and lung cancer.

Referral Time of Advance Cancer Patients to Palliative Care Services and Its Predictors in Specialized Cancer Center.

Background and aim Globally, there is a discrepancy in whether terminal cancer patients are early referred to palliative care service (PCS) or not. A late referral can lead to a delay in treating and palliating those patients in need. The aim of this study is to investigate the referral time patterns of advanced cancer patients to PCS in Princess Noorah Oncology Center (PNOC) at King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia. In addition, this study evaluates the factors that influence referral time to the palliative care unit (PCU), along with the overall survival rate. Methods This was a retrospective cross-sectional study (chart review) conducted at the inpatient unit in PNOC and included all patients referred to PCS between January 1st, 2016, and December 31, 2016. In total, 153 patients met the inclusion criteria, and their data were collected and analyzed. Results The median length of stay (LOS) was five days (95% CI: 3.85-6.15). Among the 153 patients, 22 (14.4%) died within 24 hours of enrollment to PCU. Patients who were referred to the PCU with non-metastasis disease had a median LOS of nine days, which is significantly longer than the median LOS in patients with metastatic disease (95% CI: 0.35-0.82, p=0.004), which indicates that they referred relatively earlier to PCU. The hazard ratio for death in patients with non-metastatic cancer stage was 0.54 (95% CI: 0.35-0.82, p=0.004). Conclusion Referral of advanced cancer patients to palliative care services occurs late in their disease course in our institution, like other institutions, with variation in LOS, which shorten their stay at palliative, as well as, affects their quality of life (QOL) and ability to plan or make a decision regarding their care. Education of the public and, most importantly, the medical community is needed.

Efficacy of treatment methods for uncontrolled hypertension and its effects on atrial fibrillation: A systematic narrative review.

OBJECTIVES: Uncontrolled hypertension is a main predisposing risk factor leading to chronic atrial fibrillation (AF). Although several treatment methods for patients with HTN and AF were developed in past decades, further investigations of their efficacies are needed. This systematic narrative review presents an overview of studies reporting treatment efficacies in patients with HTN and/or AF. METHODS: A narrative-based systematic review was performed using EMBASE, Medline, PubMed, Google Scholar, and the Cochrane Library searching for relevant papers published between October 2008 and October 2018. Out of 4481 studies, only 15 studies could be included following the inclusion criteria. RESULTS: Included studies reported treatment measures, measured outcomes, and efficacies in adult patients with HTN and AF with defined interventions and methodologies. Treatment methods with effective outcomes were administration of hydrochlorothiazide, losartan or atenolol, telmisartan or amlodipine, or general anti-hypertensive drugs. Treatment methods that showed the most effective outcomes (lowering AF recurrence and improving BP control) were those containing pulmonary vein (or antrum) isolation (PVI/PVAI) (6 studies) and/or in conjunction with renal denervation (RDN)(6 studies). Treatment methods showing the most effective outcomes were PVI/PVAI in conjunction with RDN. CONCLUSION: The latest evidence shows that PVI (in conjunction with RDN in some instances) was more efficacious among patients suffering from HTN and/or AF.

Effect of donor hypertension on renal transplant recipients' blood pressure, allograft outcomes and survival: a systematic review and meta-analysis.

BACKGROUND: The effect of donor hypertension on the blood pressure of renal transplant recipients and the allograft outcomes are unclear. The aim of this study was to summarize the evidence about the effects of donor hypertension on renal transplant recipients' blood pressure, renal allograft outcomes and mortality. METHODS: Studies published from January 1960 to 31 January 2019 in English were identified through a systematic search of six databases; PubMed, Embase, SCOPUS, Web of Science, Cochrane Database of Systematic Reviews, and CINAHL. Eligible observational studies with at least 1 year of follow-up were selected. Pooled estimates were obtained using random effects model. RESULTS: We identified 15 papers from eight countries containing data on donor hypertension and renal transplantation carried out between 1963 and 2014. The median (range) follow-up period of the studies was 3.8 (1-11.9) years. The prevalence of post-transplant hypertension among recipients of a renal allograft from a normotensive donor range from 8 to 17.6%, while the prevalence of post-transplant hypertension among recipients of a renal allograft from a hypertensive donor range from 2.9 to 25%. Overall, pooled risk ratios (RR) indicated that donor hypertension was a risk factor for allograft failure or loss among renal transplant recipients (RR 1.31; 95% CI 1.06-1.63: P = 0.014). However, donor hypertension was not a risk factor for mortality among renal transplant recipients (RR 0.996; 95% CI 0.652-1.519: P = 0.984). CONCLUSIONS: Donor hypertension increases the risk of post-transplant hypertension among renal transplant recipients and increases the risk of allograft failure, However, donor hypertension was not a risk factor for mortality among renal transplant recipients, Closer monitoring should be given to renal allograft recipients from hypertensive donors, and further well-designed studies are needed to expand our knowledge of the impact of donor hypertension on the survival of renal allograft recipients.

Difficulties in conducting clinical research among healthcare practitioners in Saudi Arabia: A cross-sectional survey.

BACKGROUND: Research activity represents an important process conducted to address an issue in a precise and systematic manner. Data of this kind regarding the methodological difficulties encountered by healthcare practitioners in conducting clinical research in Saudi Arabia are scarce. This study aims to assess the methodological difficulties encountered by healthcare practitioners in conducting clinical research in Saudi Arabia. MATERIALS AND METHODS: This cross-sectional survey was conducted among healthcare practitioners who conducted or who were involved in research in Saudi Arabia from June 2018 through August 2018. Data were collected through SurveyMonkey, using a modified version of a questionnaire from a previous similar study. RESULTS: Overall, 236 respondents participated in the study, more than half, that is, 131 (55.50%) had conducted research as principal investigators, 41 (17.40%) had never attended a research workshop, and 57 (24.20%) were members of research committees. Respondents identified "formulating the research title" and "cooperation between research partners" as the easiest research steps by 58 (24.58%) for each. "Receiving funds and financial resources to complete the research project" ranked the highest difficult step by 124 (52.54%) of the respondents. Attending >2 clinical research workshops was significantly associated with lower methodological difficulty scores. Specifically, those who attended scored 35.28 ± 12.86, while those who did not scored 42.34 ± 12.64, with a highly statistically significant difference (P = 0.001). CONCLUSION: These findings show that securing funding and finding an available biostatistician contributed greatly to the methodological difficulties of conducting clinical research. The difficulty score decreased significantly with increasing the number of clinical research workshops attended by the researchers.