Update on efficacy of the approved remdesivir regimen for treatment of COVID-19: a systematic review with meta-analysis and trial sequential analysis of randomised controlled trials.

BACKGROUND: Efficacy of remdesivir for COVID-19 remains unclear. We updated our published systematic review to better inform on the use of remdesivir for COVID-19. METHODS: We searched for randomised controlled trials (RCTs) among hospitalised COVID-19 patients. Meta-analysis was conducted using an inverse variance, random-effects model, presenting relative risk (RR) or mean difference (MD) and their associated 95% confidence intervals (CIs). Statistical heterogeneity was calculated using the I2 statistic. In addition, we conducted trial sequential analysis (TSA). Outcomes with additional data were clinical progression, hospitalisation days, and all-cause mortality. RESULTS: We included nine RCTs (12,876 individuals). Three trials each were of a low, unclear, and a high risk of bias. Compared with no treatment/placebo, remdesivir (100mg daily, over 10 days) significantly improved clinical progression (RR 1.06, CI 1.02-1.11), but did not significantly reduce hospitalisation days (MD -0.48, CI -2.18-1.21) and all-cause mortality (RR 0.92, CI 0.84-1.01). TSA suggested that further information is not required to conclude on the efficacy of remdesivir in improving clinical progression, and that, while more information is required for hospitalisation days and all-cause mortality, further RCTs to prove fewer hospitalisation days may be futile, as efficacy of remdesivir for this outcome is unlikely. CONCLUSIONS: Remdesivir appeared promising for COVID-19, but there is insufficient evidence of its efficacy. High quality RCTs are needed for a stronger evidence base.

A randomized trial of the effectiveness of an ultrasonic denture hygiene intervention program among community dwelling elders.

Purpose: This study aimed to assess the effectiveness of ultrasonic denture hygiene interventions in improving denture cleanliness among elderly individuals. Materials and methods: Sixty-six participants who had received upper metal framework removable partial dentures within the past 5 years were randomly allocated into three denture hygiene intervention groups: group 1 (mechanical cleaning with a toothbrush and ultrasonic cleaning with cetylpyridinium chloride), group 2 (mechanical cleaning with a toothbrush and ultrasonic cleaning with distilled water), and control (mechanical cleaning with a toothbrush only). Denture cleanliness was assessed at baseline and 1-month using: i) Denture Cleanliness Index (DCI) scores; ii) plaque coverage percentage; and (iii) microbiological samples for bacterial and yeast detection. Differences between groups were assessed with one-way analysis of variance and Chi-squared tests. Results: Mean DCI scores and mean percentages of plaque coverage area were significantly reduced in group 1 and group 2, compared to the control group for both cobalt chromium (CoCr) and acrylic fitting surfaces (p<0.001). No significant differences were found between groups 1 and 2 with regard to the prevalence and viable counts of yeasts or total microbial viable counts. No significant differences in the investigated clinical and microbiological parameters were observed between CoCr and acrylic surfaces following the intervention period. Conclusion: The ultrasonic cleaner was significantly more effective than mechanical cleaning in the reduction of biofilm coverage on metal framework removable partial dentures over a 1-month intervention period. Nevertheless, the adjunctive use of cetylpyridinium chloride with ultrasonic cleaning did not yield additional benefits.

Oral care knowledge, attitude and practice among nursing staff in acute hospital settings in Hong Kong.

Investigating the oral care delivered by nursing staff in acute hospital setting is having a remarkable shortage within the current literature. This was provoked due to lack of previous performed investigation in the acute hospital setting besides inconsistent existence of a standardized and comprehensive oral care knowledge, attitude and practice (KAP) instrumentation. Therefore, the purpose of this study is to assess the oral care KAP level for inpatients among nursing staff; to identify possible barriers to the provision of oral care; and to identify training preferences to improve the oral care of inpatients, in acute hospital settings in Hong Kong; and to provide standardized comprehensive KAP based assessment tool that would benefit and guide other future studies. In this study, a cross-sectional survey was conducted after a 55-item self-administered structured questionnaire was developed. A modified KAP tool was developed. The tool includes 4 domains: oral care knowledge, attitude, practice, and experience. Nursing staff was recruited from July 2018 to April 2019 via convenience sampling. Either online or printed questionnaires were completed. Proportions of nursing staff with good KAP, as defined by having 60% of the total score in the respective domain, were estimated with 95% confidence intervals (CI). Analysis of covariance was used to compare the mean scores of KAP among different independent variables and identify the factors associated with good KAP. 404 nursing staff were recruited. Approximately 29.5%, 33.7% and 14.9% of the respondents had good oral care knowledge, attitude and practice, respectively, and 53.2% of the respondents had unpleasant oral care experience. Better oral care practice was associated with higher levels of oral care knowledge (ß = 0.1) and oral care attitude (ß = 0.3). To conclude: nursing staff in acute hospital settings reported low levels of oral care KAP with variations between the RN, EN and HCA. This study adds to the literature the association between oral care unpleasant experiences and the oral care practice, as well as oral care knowledge and attitude which also in turns associated with practice. The developed standardised tool could be applied for future studies. Recommendations on the future research, training and practices were made.

Self-Management Programs for Chronic Non-Cancer Pain: A Rapid Review of Randomized Trials.

BACKGROUND: The body of evidence regarding self-management programs (SMPs) for adult chronic non-cancer pain (CNCP) is steadily growing, and regular updates are needed for effective decision-making. OBJECTIVES: To systematically identify, critically appraise, and summarize the findings from randomized controlled trials (RCTs) of SMPs for CNCP. METHODS: We searched relevant databases from 2009 to August 2021 and included English-language RCT publications of SMPs compared with usual care for CNCP among adults (18+ years old). The primary outcome was health-related quality of life (HR-QoL). We conducted meta-analysis using an inverse variance, random-effects model and calculated the standardized mean difference (SMD) and associated 95% confidence interval (CI) and statistical heterogeneity using the I2 statistic. RESULTS: From 8538 citations, we included 28 RCTs with varying patient populations, standards for SMPs, and usual care. No RCTs were classified as having a low risk of bias. There was no evidence of a significant improvement in overall HR-QoL, irrespective of pain type, immediately post-intervention (SMD 0.01, 95%CI -0.21 to 0.24; I2 57%; 11 RCTs; 979 participants), 1-4 months post-intervention (SMD 0.02, 95%CI -0.16 to 0.20; I2 48.7%; 12 RCTs; 1160 participants), and 6-12 months post-intervention (SMD 0.07, 95%CI -0.06 to 0.21; I2 26.1%; 9 RCTs; 1404 participants). Similar findings were made for physical and mental HR-QoL, and for specific QoL assessment scales (e.g., SF-36). CONCLUSIONS: There is a lack of evidence that SMPs are efficacious for CNCP compared with usual care. Standardization of SMPs for CNCP and better planned/conducted RCTs are needed to confirm these conclusions.

Characteristics and methodological standards across systematic reviews with Meta-analysis of efficacy and/or effectiveness of influenza vaccines: an overview of reviews.

BACKGROUND: While systematic reviews (SR) generally suggest that vaccination is an effective way to prevent influenza infection, it is not clear if these conclusions are based on high quality SR methods. As such, we systematically identified, critically appraised, and summarised the characteristics and adherence to methodological standards in SRs with meta-analysis of efficacy/effectiveness of influenza vaccines. METHODS: We searched MEDLINE, Embase, Scopus, CINAHL, Global Health, and CDSR for English-language SR publications up to July 11, 2022. We summarised the characteristics, adherence to methodological standards and SR quality (AMSTAR 2). RESULTS: From 11,193 retrieved citations, we included 48 publications (47 SRs). Seventy-five percent were of a critically low quality, 19% of a low quality, 2% of a moderate quality, and 4% of a high quality. Thirteen percent were industry-funded, about 13% co-authored by industry employee(s), and 4% commissioned by an organisation or authority. Only 45% percent reported protocol registration, 6% reported collaboration with a knowledge synthesis librarian/information specialist, and 60% utilised a reporting checklist (e.g. PRISMA). CONCLUSIONS AND RELEVANCE: SRs with meta-analysis of efficacy/effectiveness of influenza vaccines are mostly of critically low quality and even the more recent reviews did not follow current best SR practices. These findings are significant in view of the controversies that surround influenza vaccines, and the use of SRs in informed decision-making. However, the findings do not justify curtailment or cessation of influenza vaccine use as vaccines continue to offer substantial net public health benefit.HighlightsWe systematically identified, critically appraised, and summarised the characteristics and adherence to methodological standards in 47 systematic reviews with meta-analysis of efficacy/effectiveness of influenza vaccines.13% of the reviews were industry-funded.About 13% of the reviews were co-authored by industry employee(s).4% of the reviews were commissioned by an organisation/authority.45% of the reviews reported protocol registration.6% of the reviews reported collaborating with a knowledge synthesis librarian/information specialist to prepare the search strategy.60% of the reviews reported using the PRISMA (or similar) checklist.75% of the reviews were judged to be of critically low quality; 19% of low quality; 2% of moderate quality; 4% of high quality.

An overview of the characteristics and methodological standards across systematic reviews with Meta-analysis of efficacy/effectiveness of influenza antiviral drugs.

BACKGROUND: Influenza antiviral drugs remain controversial and it is not clear if conclusions on their efficacy/effectiveness are based on high quality systematic reviews (SRs). We systematically identified, critically appraised, and summarized the characteristics and adherence to methodological standards in SRs with meta-analysis of efficacy/effectiveness of influenza antiviral drugs for prevention and/or treatment of influenza. METHODS: We searched MEDLINE, Embase, Scopus, CINAHL, Global Health, and CDSR for English-language SR publications up to July 2020. We summarized the characteristics, adherence to methodological standards and SR quality (AMSTAR 2). RESULTS: From a total 3,898 citations after removal of duplicates from all identified citations, we included 24 SRs. Seventy-five percent (n = 18) were of a critically low quality, 8% (n = 2) of a low quality, 17% (n = 4) of a moderate quality, and none were of a high quality. Seventeen percent (n = 4) were industry-funded, 4% (n = 1) coauthored by industry employee(s), and 33% (n = 8) commissioned by an organization or authority. Only 33% percent (n = 8) reported protocol registration, 4% (n = 1) reported collaboration with a knowledge synthesis librarian/information specialist, and 17% (n = 4) utilized a systematic review reporting checklist. CONCLUSIONS: The evidence suggests that SRs of efficacy/effectiveness of influenza antiviral drugs are mostly of critically low quality and do not follow current best SR practices. These findings are significant in view of the important role of SRs in decision-making and the controversies that surround the use of the influenza antiviral drugs. However, the findings should not be interpreted to mean curtailment/cessation of use of antiviral drugs for influenza.

Offloading devices for neuropathic foot ulcers in adult persons with type 1 or type 2 diabetes: a rapid review with meta-analysis and trial sequential analysis of randomized controlled trials.

INTRODUCTION: Healing time for neuropathic planter foot ulcers (NPFUs) in persons with diabetes may be reduced through use of non-removable fiberglass total contact casting (F-TCC) compared with removable cast walkers (RCWs), although the evidence base is still growing. RESEARCH DESIGN AND METHODS: We conducted a rapid review and systematically searched for, and critically assessed, randomized controlled trials (RCTs) that compared the efficacy of F-TCC versus RCW, focusing on the time to ulcer healing in adult persons (18+ years) with NPFUs and type 1 or type 2 diabetes. We meta-analysed the mean differences and associated 95% CIs using an inverse variance, random-effects model. We also conducted a trial sequential analysis (TSA) to assess if the available evidence is up to the required information size for a robust conclusion. We assessed and quantified statistical heterogeneity between the included studies using the I2 statistic. RESULTS: Out of 102 retrieved citations, five RCTs met the eligibility criteria. Participants' inclusion in relation to stage of ulcer was highly variable as was peripheral neuropathy complicating comparisons. F-TCC appeared to present a shorter ulcer healing time (-5.42 days, 95% CI -9.66 days to -1.17 days; I2 9.9%; 5 RCTs; 169 participants) compared with RCW. This finding was supported by the TSA. CONCLUSIONS: There is limited evidence from RCTs to suggest that F-TCC has a shorter ulcer healing time compared with RCW among adults with diabetic NPFUs. Properly designed and conducted RCTs are still required for a stronger evidence base.

Effectiveness of T cell-mediated rejection therapy: A systematic review and meta-analysis.

The effectiveness of T cell-mediated rejection (TCMR) therapy for achieving histological remission remains undefined in patients on modern immunosuppression. We systematically identified, critically appraised, and summarized the incidence and histological outcomes after TCMR treatment in patients on tacrolimus (Tac) and mycophenolic acid (MPA). English-language publications were searched in MEDLINE (Ovid), Embase (Ovid), Cochrane Central (Ovid), CINAHL (EBSCO), and Clinicaltrials.gov (NLM) up to January 2021. Study quality was assessed with the National Institutes of Health Study Quality Tool. We pooled results using an inverse variance, random-effects model and report the binomial proportions with associated 95% confidence intervals (95% CI). Statistical heterogeneity was explored using the I2  statistic. From 2875 screened citations, we included 12 studies (1255 participants). Fifty-eight percent were good/high quality while the rest were moderate quality. Thirty-nine percent of patients (95% CI 0.26-0.53, I2 77%) had persistent ≥Banff Borderline TCMR 2-9 months after anti-rejection therapy. Pulse steroids and augmented maintenance immunosuppression were mainstays of therapy, but considerable practice heterogeneity was present. A high proportion of biopsy-proven rejection exists after treatment emphasizing the importance of histology to characterize remission. Anti-rejection therapy is foundational to transplant management but well-designed clinical trials in patients on Tac/MPA immunosuppression are lacking to define the optimal therapeutic approach.

A randomised clinical trial on the effect of oral antimicrobial sprays in institutionalised elders.

OBJECTIVE: To compare the effectiveness of chlorine dioxide, chlorhexidine and placebo sprays in improving oral hygiene among institutionalised elders. BACKGROUND: Available evidence suggests that oral sprays may be an effective alternative delivery method for plaque control; however, few studies have evaluated antimicrobial agents other than chlorhexidine. MATERIALS AND METHODS: A total of 228 elders across 11 nursing homes in Hong Kong were recruited into the clinical trial. Participants were randomly allocated into one of the following groups: 0.1% pH-balanced chlorine dioxide spray, 0.2% chlorhexidine spray or sterile water spray (placebo control), once daily. Dental plaque, gingival bleeding and other clinical oral health outcomes were assessed at baseline, 3 and 6 months. Participant acceptability of the interventions was assessed at the end of the clinical trial. RESULTS: Review assessments were conducted for 135 elders at 6 months. Significantly greater reductions in plaque index scores were observed with the chlorhexidine spray (0.4) and chlorine dioxide spray (0.3) than the placebo spray (0.1). While significant reductions in gingival bleeding scores were observed within the chlorhexidine (7.4), chlorine dioxide (7.5) and placebo (5.3) sprays after 6 months, change scores were not significantly different between groups. Significantly greater increases in the levels of staining were observed in the chlorhexidine spray group (-0.1) than the chlorine dioxide (0.0) and placebo spray (0.0) groups. CONCLUSION: Antimicrobial sprays were shown to be effective among institutionalised elders. Chlorine dioxide spray showed equivalent effects on dental plaque and gingival bleeding relative to the chlorhexidine spray over a 6-month period.

Interventions to improve early cancer diagnosis of symptomatic individuals: a scoping review.

OBJECTIVES: To summarise the current evidence regarding interventions for accurate and timely cancer diagnosis among symptomatic individuals. DESIGN: A scoping review following the Joanna Briggs Institute's methodological framework for the conduct of scoping reviews and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. DATA SOURCES: MEDLINE (Ovid), CINAHL (EBSCOhost) and PsycINFO (Ovid) bibliographic databases, and websites of relevant organisations. Published and unpublished literature (grey literature) of any study type in the English language were searched for from January 2017 to January 2021. ELIGIBILITY AND CRITERIA: Study participants were individuals of any age presenting at clinics with symptoms indicative of cancer. Interventions included practice guidelines, care pathways or other initiatives focused on achieving predefined benchmarks or targets for wait times, streamlined or rapid cancer diagnostic services, multidisciplinary teams and patient navigation strategies. Outcomes included accuracy and timeliness of cancer diagnosis. DATA EXTRACTION AND SYNTHESIS: We summarised findings graphically and descriptively. RESULTS: From 21 298 retrieved citations, 88 unique published articles and 16 unique unpublished documents (on 18 study reports), met the eligibility for inclusion. About half of the published literature and 83% of the unpublished literature were from the UK. Most of the studies were on interventions in patients with lung cancer. Rapid referral pathways and technology for supporting and streamlining the cancer diagnosis process were the most studied interventions. Interventions were mostly complex and organisation-specific. Common themes among the studies that concluded intervention was effective were multidisciplinary collaboration and the use of a nurse navigator. CONCLUSIONS: Multidisciplinary cooperation and involvement of a nurse navigator may be unique features to consider when designing, delivering and evaluating interventions focused on improving accurate and timely cancer diagnosis among symptomatic individuals. Future research should examine the effectiveness of the interventions identified through this review.

Implementation strategies in emergency management of children: A scoping review.

BACKGROUND: Implementation strategies are vital for the uptake of evidence to improve health, healthcare delivery, and decision-making. Medical or mental emergencies may be life-threatening, especially in children, due to their unique physiological needs when presenting in the emergency departments (EDs). Thus, practice change in EDs attending to children requires evidence-informed considerations regarding the best approaches to implementing research evidence. We aimed to identify and map the characteristics of implementation strategies used in the emergency management of children. METHODS: We conducted a scoping review using Arksey and O'Malley's framework. We searched four databases [Medline (Ovid), Embase (Ovid), Cochrane Central (Wiley) and CINAHL (Ebsco)] from inception to May 2019, for implementation studies in children (≤21 years) in emergency settings. Two pairs of reviewers independently selected studies for inclusion and extracted the data. We performed a descriptive analysis of the included studies. RESULTS: We included 87 studies from a total of 9,607 retrieved citations. Most of the studies were before and after study design (n = 68, 61%) conducted in North America (n = 63, 70%); less than one-tenth of the included studies (n = 7, 8%) were randomized controlled trials (RCTs). About one-third of the included studies used a single strategy to improve the uptake of research evidence. Dissemination strategies were more commonly utilized (n = 77, 89%) compared to other implementation strategies; process (n = 47, 54%), integration (n = 49, 56%), and capacity building and scale-up strategies (n = 13, 15%). Studies that adopted capacity building and scale-up as part of the strategies were most effective (100%) compared to dissemination (90%), process (88%) and integration (85%). CONCLUSIONS: Studies on implementation strategies in emergency management of children have mostly been non-randomized studies. This review suggests that 'dissemination' is the most common strategy used, and 'capacity building and scale-up' are the most effective strategies. Higher-quality evidence from randomized-controlled trials is needed to accurately assess the effectiveness of implementation strategies in emergency management of children.

An exploration of student access to a learning management system-challenges and recommendations for educators and researchers.

INTRODUCTION: This study examined student access to online resources of a faculty's learning management system (LMS). Issues relating to current e-learning resources usage were identified and formed the basis for recommendations to help assist stakeholders in teaching, learning and research. METHODS: Learning analytics from four cohorts of undergraduate dental students were extracted from the database of a LMS spanning between 2012 and 2016. Individual datasets were combined into one master file, re-categorised, filtered and analysed based on cohort, year of study, course and nature of online resource. RESULTS: A total of 157,293 access events were documented. The proportion of administrative to learning data varied across cohorts, with oldest cohort having the highest ratio (82:18) in their final year and most recent cohort having a ratio of 33:67 in their 4th year demonstrating a higher proportion to learning. Seven Learning domains were identified in the access data: access to problem-based learning resources was the highest and next was fixed prosthodontics videos. The prosthodontics discipline had the highest access across the curriculum while some others had very limited or even no learning access events. CONCLUSION: A number of limitations have been identified with the analytics and learning resources in this LMS and engagement with learning resource provision. More detailed data capture of access use and unique identifiers to resources as well as keyword tagging of the resources are required to allow accurate mapping and support of students learning. Moreover, motivation or nudging of students behaviour to more actively engage with learning content needs exploration.

Integration of geriatric assessment into clinical oncology practice: A scoping review.

Sixty percent of newly diagnosed cancers occur in older adults and more complex planning is required to sustain quality care for older populations. Individualized care incorporating geriatric assessment can predict early mortality and treatment toxicity for older cancer patients. We mapped and summarized the available evidence on the integration of geriatric assessment into clinical oncology practice, and ascertained which domains have been implemented. We systematically searched bibliographic databases and trial registries for reports of clinical studies, clinical practice guidelines, systematic and non-systematic reviews, and grey literature published in English. We gathered data on study characteristics, geriatric domains and strategies evaluated, and relevant study objectives and findings. From a total of 10,124 identified citations, 38 articles met our eligibility criteria, 3 of which were clinical practice guidelines. Nearly half of these articles came from the United States. Domains of the geriatric assessment implemented in studies ranged from 1 to 12, with varied combinations. We identified 27 studies on strategies for implementing geriatric assessment and 24 studies on feasibility of implementing geriatric assessment, into clinical oncology practice. We also identified 3 main geriatric assessment models: 2 from the United States and 1 from Australia. Furthermore, we identified 2 reviews that reported varied components of geriatric assessment models. There is increasingly robust evidence to implement formal geriatric assessment in oncology practice. There remains a great deal of variation in the tools recommended to address each of the domains in a geriatric assessment, with only 1 guideline (American Society of Clinical Oncology guideline) settling on a specific best practice. Protocol registration: Open Science Framework osf.io/mec93.

Interventions on health care providers to improve seasonal influenza vaccination rates among patients: a systematic review and meta-analysis of the evidence since 2000.

BACKGROUND: Seasonal influenza vaccination (SIV) rates remain suboptimal in many populations, even in those with universal SIV. OBJECTIVE: To summarize the evidence on interventions on health care providers (physicians/nurses/pharmacists) to increase SIV rates. METHODS: We systematically searched/selected full-text English publications from January 2000 to July 2019 (PROSPERO-CRD42019147199). Our outcome was the difference in SIV rates between patients in intervention and non-intervention groups. We calculated pooled difference using an inverse variance, random-effects model. RESULTS: We included 39 studies from 8370 retrieved citations. Compared with no intervention, team-based training/education of physicians significantly increased SIV rates in adult patients: 20.1% [7.5-32.7%; I2 = 0%; two randomized controlled trials (RCTs)] and 13.4% [8.6-18.1%; I2 = 0%; two non-randomized intervention studies (NRS)]. A smaller increase was observed in paediatric patients: 7% (0.1-14%; I2 = 0%; two NRS), and in adult patients with team-based training/education of physicians and nurses together: 0.9% (0.2-1.5%; I2 = 30.6%; four NRS). One-off provision of guidelines/information to physicians, and to both physicians and nurses, increased SIV rates in adult patients: 23.8% (15.7-31.8%; I2 = 45.8%; three NRS) and paediatric patients: 24% (8.1-39.9%; I2 = 0%; two NRS), respectively. Use of reminders (prompts) by physicians and nurses slightly increased SIV rates in paediatric patients: 2.3% (0.5-4.2%; I2 = 0%; two RCTs). A larger increase was observed in adult patients: 18.5% (14.8-22.1%; I2 = 0%; two NRS). Evidence from both RCTs and NRS showed significant increases in SIV rates with varied combinations of interventions. CONCLUSIONS: Limited evidence suggests various forms of physicians' and nurses' education and use of reminders may be effective for increasing SIV rates among patients.

The relation of online learning analytics, approaches to learning and academic achievement in a clinical skills course.

INTRODUCTION: This study examined relationships of students' access of e-learning (learning analytics) for a healthcare psychomotor skills course, approaches to learning (R-SPQ-2F psychometric) and academic achievement (summative examination results). An understanding of the relationships may help in supporting students learning. METHODS: Two consecutive cohorts of 5th year dental students were asked to complete the R-SPQ-2F questionnaire and permission to access data of online videos and associated quizzes and two summative written examination results were examined. The summative assessments were an OSCA and a written-paper question both in prosthodontics. Multiple linear regression and correlation analysis were performed. RESULTS: Students (n=98) performed a total of 10470 video access events and 7714 attempts in online quizzes. Deep learning approach was the strongest predictor variable (ß=0.270; P=.004) on written-paper question result. While video and quiz access were moderately correlated (r=0.600; P<.001) to each other, video access was not a significant predictor to either of the examination results. Quiz access was negatively associated with academic achievement for the written-paper question results (ß=-0.349; P<.001). CONCLUSIONS: Only deep approach to learning appeared to be relevant for the written-paper question examination grades. Conversely, the number of video and quiz access did not relate to either examination results. This suggests e-learning access and examinations do not appear to relate under the conditions explored. Other attributes of learning management access may need to be explored to determine if access to learning management systems may be useful in offering remedial support to students.

Seasonal influenza vaccination among cancer patients: A systematic review and meta-analysis of the determinants.

Cancer patients are among high-risk individuals for whom seasonal influenza vaccine (SIV) is recommended, but rates of vaccination in this subpopulation remain suboptimal; even in jurisdictions with universal influenza vaccination programs. We sought to summarize the evidence to better understand the determinants of SIV uptake (vaccine receipt) among cancer patients. We searched MEDLINE, Embase, and CINAHL from 2000 to February 12, 2020, focusing on articles on the determinants of seasonal influenza vaccination among cancer patients, published in English. Study selection was conducted independently by 2 reviewers. One reviewer extracted data from the included studies and another reviewer checked the extracted data for errors. Outcomes were sociodemographic and health-related factors. We pooled adjusted results from studies using the inverse variance, random-effects method, and reported the odds ratios (OR) and their 95% confidence intervals (CI). Out of 2664 citations, 10 studies (mostly from USA and South Korea) met our eligibility criteria. Overall, being older (OR 2.23, 95% CI 1.46-3.38; I2 92.3%, [6 studies]), a nonsmoker (1.43, 1.32-1.51; I2 0%, [4 studies]), having a chronic illness (1.18, 1.07-1.29; I2 15.7%, [5 studies]), having had a medical check-up in the past year (1.75, 1.65-1.86; I2 0%, [2 studies]), and having health insurance (1.39, 1.13-1.72; I2 21.8%, [3 studies]) were associated with increased SIV uptake. Compared with being African-American, being Caucasian was also associated with increased SIV uptake (1.79, 1.47-2.13; I2 10.7%, [3 studies]). Limited evidence suggests seasonal influenza vaccination among cancer patients may be determined by some sociodemographic and health-related factors.

Seasonal influenza vaccination in older people: A systematic review and meta-analysis of the determining factors.

BACKGROUND/OBJECTIVES: Despite influenza vaccination programs in various jurisdictions, seasonal influenza vaccine (SIV) uptake remains suboptimal among older people (≥65years old), an important subpopulation for influenza vaccination. We sought to summarize determinants of SIV uptake (any vaccine receipt) and vaccination adherence (receipt of vaccine in two or more seasons in sequence) among older people. METHODS: We searched for population-based studies conducted in community-dwelling older people (irrespective of their health status) from 2000-2019. Two reviewers independently selected publications for inclusion. One reviewer extracted data from the included studies; a second checked the extracted data for errors. Disagreements were resolved by discussion and consensus, or a third reviewer. We were interested in the determinants of SIV uptake and vaccination adherence. Where appropriate, we pooled adjusted results using the inverse variance, random-effects method and reported the odds ratios (OR) and their 95% confidence intervals (CI). RESULTS: Out of 11,570 citations screened, we included 34 cross-sectional studies. The following were associated with increased SIV uptake: being older (OR 1.52, 95%CI 1.38-1.67 [21 studies]), white (1.30, 1.14-1.49 [10 studies]), married (1.23, 1.17-1.28 [9 studies]), non-smoker (1.28, 1.11-1.47 [7 studies]), of a higher social class (1.20, 1.06-1.36 [2 studies]), having a higher education (1.12, 1.04-1.21 [14 studies]), having a higher household income (1.11, 1.05-1.18 [8 studies]), having a chronic illness (1.53, 1.44-1.63 [16 studies]), having poor self-assessed health (1.23, 1.02-1.40 [9 studies]), having a family doctor (2.94, 1.79-4.76 [2 studies]), and having health insurance (1.58, 1.13-2.21 [6 studies]). The influence of these factors varied across geographical regions. Being older (1.26, 1.11-1.44 [2 studies]) was also associated with increased vaccination adherence. CONCLUSIONS: Several factors may determine SIV uptake and vaccination adherence among older people. More studies are needed to provide a stronger evidence base for planning more effective influenza vaccination programs.

Implementation strategies in emergency management of children: a scoping review protocol.

BACKGROUND: Behavior change is not simple, and the introduction of guidelines or protocols does not mean that they will be followed. As such, implementation strategies are vital for the uptake and sustainability of changes in medical protocols. Medical or mental emergencies may be life-threatening, especially in children due to their unique physiological needs. In emergency departments (EDs), where timely decisions are often made, practice change requires thoughtful considerations regarding the best approaches to implementation. As there are many studies reporting on a wide variety of implementation strategies in the emergency management of children in EDs, we aim to identify and map the characteristics of these studies. METHODS: We will conduct a scoping review to identify various implementation strategies in the emergency management of children using the Arksey and O'Malley framework. We will search MEDLINE (Ovid), Embase (Ovid), Cochrane Central (Wiley), and CINAHL (Ebsco), from inception to May 29, 2019, for implementation studies among the pediatric population (≤ 21 years) in a pediatric emergency setting. Two pairs of reviewers will independently select studies for inclusion and extract the data. We will perform a descriptive, narrative analysis of the characteristics of the identified implementation strategies. DISCUSSION: We will present specific characteristics and outcome measures of all included studies in a tabular form. The results of this review are expected to help identify and characterize successful implementation strategies in the emergency management of children in EDs. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework https://osf.io/h6jv2.

Potential role of Candida albicans secreted aspartic protease 9 in serum induced-hyphal formation and interaction with oral epithelial cells.

INTRODUCTION: Candida albicans possesses the ability to switch rapidly between yeast to hyphal forms. Hyphal formation is a remarkable pathogenic characteristic, which allows C. albicans to invade into host cells. OBJECTIVES: This study was to investigate the role of the C. albicans SAP9 gene in hyphal formation and invasion ability. METHODS: The morphology of fungal cells in the hyphal-inducing liquid media (YPD+10% fetal bovine serum) was observed by the microscopy. And the morphology of the colony on solid agar plates of YPD+10% fetal bovine serum was photographed by the digital camera. The mRNA expressions of hypha-associated genes in serum medium were also analyzed by real time PCR. Then for the interaction between C. albicans and oral epithelial cells, endocytosis essay, invasion essay and damage assay were performed to compare the differences between the sap9Δ/Δ mutant strain and wild type strain. RESULTS: Compared with the wild type strain, the sap9Δ/Δ mutant strain exhibited a deficient yeast-to-hyphal morphological transition under serum hyphal-inducing conditions. Furthermore, the SAP9 knockout strain revealed a significant down-regulation of the expression of EFG1 (~40%), which is a transcription factor gene that mediates hyphae formation in C. albicans. Compared with the wild type strain, a 70% reduction in the endocytosis of the sap9Δ/Δ mutant strain by host cells was observed, as well as a 25% attenuation of active penetration and a 40% attenuation of host cell damage (P <0.05). CONCLUSIONS: Our data strongly suggests that C. albicans Sap9 is a potential hyphal-associated factor that responds to serum hyphal-inducing stimuli via a cAMP-protein kinase A pathway mediated by EFG1, and contributes to the process of invasion of Candida into the epithelial cells, leading to host cell damage.

Use of Learning Analytics Data in Health Care-Related Educational Disciplines: Systematic Review.

BACKGROUND: While the application of learning analytics in tertiary education has received increasing attention in recent years, a much smaller number have explored its use in health care-related educational studies. OBJECTIVE: This systematic review aims to examine the use of e-learning analytics data in health care studies with regards to how the analytics is reported and if there is a relationship between e-learning analytics and learning outcomes. METHODS: We performed comprehensive searches of papers from 4 electronic databases (MEDLINE, EBSCOhost, Web of Science, and ERIC) to identify relevant papers. Qualitative studies were excluded from this review. Papers were screened by 2 independent reviewers. We selected qualified studies for further investigation. RESULTS: A total of 537 papers were screened, and 19 papers were identified. With regards to analytics undertaken, 11 studies reported the number of connections and time spent on e-learning. Learning outcome measures were defined by summative final assessment marks or grades. In addition, significant statistical results of the relationships between e-learning usage and learning outcomes were reported in 12 of the identified papers. In general, students who engaged more in e-learning resources would get better academic attainments. However, 2 papers reported otherwise with better performing students consuming less e-learning videos. A total of 14 papers utilized satisfaction questionnaires for students, and all were positive in their attitude toward e-learning. Furthermore, 6 of 19 papers reported descriptive statistics only, with no statistical analysis. CONCLUSIONS: The nature of e-learning activities reported in this review was varied and not detailed well. In addition, there appeared to be inadequate reporting of learning analytics data observed in over half of the selected papers with regards to definitions and lack of detailed information of what the analytic was recording. Although learning analytics data capture is popular, a lack of detail is apparent with regards to the capturing of meaningful and comparable data. In particular, most analytics record access to a management system or particular e-learning materials, which may not necessarily detail meaningful learning time or interaction. Hence, learning analytics data should be designed to record the time spent on learning and focus on key learning activities. Finally, recommendations are made for future studies.