Systematic review of the barriers and facilitators to dietary modification in people living with type 2 diabetes and pre-diabetes from South Asian ethnic populations.

AIMS: Lifestyle and dietary modification are effective in the prevention and management of Type 2 diabetes Mellitus (T2DM). However, South Asian (SA) populations living in Western countries have low adherence rates to healthcare advice and experience poor diabetes control and clinical outcomes compared with the general population. This systematic review aimed to summarise the barriers and facilitators of dietary modification within people from South Asian (SA) ethnicity with T2DM or pre-diabetes. METHODS: A systematic search of PubMed, Web of Science and Scopus generated 3739 articles, of which seven were included. Qualitative and quantitative data were inputted utilising COVIDENCE. Qualitative data were analysed by thematic analysis. RESULTS: Thematic analysis identified three facilitators: (1) cultural sensitivity, (2) health education and (3) support networks. Barriers include (1) healthcare inequity, (2) cultural insensitivity, (3) social pressures, (4) misconceptions and (5) time constraints. Good access to health care and motivation were the most common facilitators discussed. Misconceptions on T2DM management and cultural insensitivity contributed to the majority of barriers discussed. CONCLUSIONS: Culturally tailored interventions could improve adherence to diet modification in people with T2DM from SA ethnicity. Interventions involving the application of social media to challenge intergenerational stigmas and misinformation, distributing culturally appropriate resources and providing diets tailored to the SA palate could help.

Outcome reporting in therapeutic mammaplasty: a systematic review.

BACKGROUND: Therapeutic mammaplasty (TM) is an oncological procedure which combines tumour resection with breast reduction and mastopexy techniques. Previous systematic reviews have demonstrated the oncological safety of TM but reporting of critically important outcomes, such as quality of life, aesthetic and functional outcomes, are limited, piecemeal or inconsistent. This systematic review aimed to identify all outcomes reported in clinical studies of TM to facilitate development of a core outcome set. METHODS: Medline, EMBASE, CINAHL and Web of Science were searched from inception to 5 August 2020. Included studies reported clinical outcomes following TM for adult women. Two authors screened articles independently for eligibility. Data were extracted regarding the outcome definition and classification type (for example, oncological, quality of life, etc.), time of outcome reporting and measurement tools. RESULTS: Of 5709 de-duplicated records, 148 were included in the narrative synthesis. The majority of studies (n = 102, 68.9 per cent) reported measures of survival and/or recurrence; approximately three-quarters (n = 75, 73.5 per cent) had less than 5 years follow-up. Aesthetic outcome was reported in half of studies (n = 75, 50.7 per cent) using mainly subjective, non-validated measurement tools. The time point at which aesthetic assessment was conducted was highly variable, and only defined in 48 (64.0 per cent) studies and none included a preoperative baseline for comparison. Few studies reported quality of life (n = 30, 20.3 per cent), functional outcomes (n = 5, 3.4 per cent) or resource use (n = 28, 18.9 per cent). CONCLUSION: Given the oncological equivalence of TM and mastectomy, treatment decisions are often driven by aesthetic and functional outcomes, which are infrequently and inconsistently reported with non-validated measurement tools.

The Imperial Joint Line Congruency Measurement is a valuable tool in total knee arthroplasty.

BACKGROUND: Preservation of joint line height is an important factor in post-operative function after Total Knee Arthroplasty (TKA). This is the first study investigating the reliability of the novel Imperial Joint Line Congruency Measurement (IJLCM) technique for the assessment of joint line height using plain radiographs. METHODS: The reliability of two techniques used to measure joint line height on pre-operative and post-operative plain radiographs is presented. 120 patients that underwent TKA from 6 different international centres were included. Measurements were performed using each technique by two senior orthopaedic surgeons at two different timepoints (test-retest). Two undergraduate medical students performed joint line measurements using the most reproducible of the two techniques on 40 pre-operative and post-operative images to establish the reliability of the measurement technique. RESULTS: The IJLCM demonstrated an average absolute difference of 1.83mm (CI 1.56-2.10mm) and excellent inter and intra-rater reliability between senior orthopaedic surgeons (>0.92 (CI 0.88-0.94) when measuring joint line height on plain radiographs. Overall Crohnbach's alpha over 0.92 confirmed internal consistency. Measurements performed using the control technique as previously described by Figgie et al. had an average absolute difference of 5.75mm (5.17-6.32mm). Comparison of measurements by senior orthopaedic surgeons and medical students using the IJLCM technique with ANOVA and student's t-test demonstrated acceptable agreement and inter-rater reliability of >0.92 (0.87-0.95). CONCLUSION: This study shows excellent accuracy, precision, and reliability of the novel IJLCM technique. Furthermore, excellent agreement between senior orthopaedic surgeons and medical students when using the IJLCM could be shown. The IJLCM technique is reliable for joint line assessment.

Blood loss and transfusion risk in robotic-assisted knee arthroplasty: A retrospective analysis.

BACKGROUND: The purpose of this study was to compare total blood loss and the risk of receiving a blood transfusion in robotic-assisted total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) against conventional jig-based techniques. METHODS: Robotic TKA (n = 50) and UKA (n = 50) patients were matched to contemporary controls for TKA (n = 50) and UKA (n = 50) and retrospectively analysed. RESULTS: Robotic TKA patients experienced 23.7% less blood loss compared to conventional TKA patients (911.0 ml vs 1193.7 ml, p < 0.01), and were associated with an 83% relative risk reduction of receiving a transfusion (2% of patients vs 12%, p = 0.02). Robotic UKA patients did not demonstrate less blood loss compared to corresponding controls (821.7 ml vs 854.7 ml, p = 0.69). Both UKA groups received no transfusions. CONCLUSIONS: Robotic surgical systems in TKA reduces blood loss and lowers the risk of requiring a blood transfusion. In UKA, robotic-assisted arthroplasty did not reduce blood loss compared to conventional arthroplasty.