Explore the vast range of titles available.

Background Healthcare costs are rising, and a substantial proportion of medical care is of little value. De-implementation of low-value practices is important for improving overall health outcomes and reducing costs. We aimed to identify and synthesize randomized controlled trials (RCTs) on de-implementation interventions and to provide guidance to improve future research. Methods MEDLINE and Scopus up to May 24, 2021, for individual and cluster RCTs comparing de-implementation interventions to usual care, another intervention, or placebo. We applied independent duplicate assessment of eligibility, study characteristics, outcomes, intervention categories, implementation theories, and risk of bias. Results Of the 227 eligible trials, 145 (64%) were cluster randomized trials (median 24 clusters; median follow-up time 305 days), and 82 (36%) were individually randomized trials (median follow-up time 274 days). Of the trials, 118 (52%) were published after 2010, 149 (66%) were conducted in a primary care setting, 163 (72%) aimed to reduce the use of drug treatment, 194 (85%) measured the total volume of care, and 64 (28%) low-value care use as outcomes. Of the trials, 48 (21%) described a theoretical basis for the intervention, and 40 (18%) had the study tailored by context-specific factors. Of the de-implementation interventions, 193 (85%) were targeted at physicians, 115 (51%) tested educational sessions, and 152 (67%) multicomponent interventions. Missing data led to high risk of bias in 137 (60%) trials, followed by baseline imbalances in 99 (44%), and deficiencies in allocation concealment in 56 (25%). Conclusions De-implementation trials were mainly conducted in primary care and typically aimed to reduce low-value drug treatments. Limitations of current de-implementation research may have led to unreliable effect estimates and decreased clinical applicability of studied de-implementation strategies. We identified potential research gaps, including de-implementation in secondary and tertiary care settings, and interventions targeted at other than physicians. Future trials could be improved by favoring simpler intervention designs, better control of potential confounders, larger number of clusters in cluster trials, considering context-specific factors when planning the intervention (tailoring), and using a theoretical basis in intervention design. Registration OSF Open Science Framework hk4b2

Knee ligaments and tendons play an important role in stabilizing and controlling the motions of the knee. Injuries to the ligaments can lead to abnormal mechanical loading of the other supporting tissues (e.g., cartilage and meniscus) and even osteoarthritis. While the condition of knee ligaments can be examined during arthroscopic repair procedures, the arthroscopic evaluation suffers from subjectivity and poor repeatability. Near infrared spectroscopy (NIRS) is capable of non-destructively quantifying the composition and structure of collagen-rich connective tissues, such as articular cartilage and meniscus. Despite the similarities, NIRS-based evaluation of ligament composition has not been previously attempted. In this study, ligaments and patellar tendon of ten bovine stifle joints were measured with NIRS, followed by chemical and histological reference analysis. The relationship between the reference properties of the tissue and NIR spectra was investigated using partial least squares regression. NIRS was found to be sensitive towards the water ( R 2 CV = .65) and collagen ( R 2 CV = .57) contents, while elastin, proteoglycans, and the internal crimp structure remained undetectable. As collagen largely determines the mechanical response of ligaments, we conclude that NIRS demonstrates potential for quantitative evaluation of knee ligaments.

Background De-implementation of low-value care can increase health care sustainability. We evaluated the reporting of direct costs of de-implementation and subsequent change (increase or decrease) in health care costs in randomized trials of de-implementation research. Methods We searched MEDLINE and Scopus databases without any language restrictions up to May 2021. We conducted study screening and data extraction independently and in duplicate. We extracted information related to study characteristics, types and characteristics of interventions, de-implementation costs, and impacts on health care costs. We assessed risk of bias using a modified Cochrane risk-of-bias tool. Results We screened 10,733 articles, with 227 studies meeting the inclusion criteria, of which 50 included information on direct cost of de-implementation or impact of de-implementation on health care costs. Studies were mostly conducted in North America (36%) or Europe (32%) and in the primary care context (70%). The most common practice of interest was reduction in the use of antibiotics or other medications (74%). Most studies used education strategies (meetings, materials) (64%). Studies used either a single strategy (52%) or were multifaceted (48%). Of the 227 eligible studies, 18 (8%) reported on direct costs of the used de-implementation strategy; of which, 13 reported total costs, and 12 reported per unit costs (7 reported both). The costs of de-implementation strategies varied considerably. Of the 227 eligible studies, 43 (19%) reported on impact of de-implementation on health care costs. Health care costs decreased in 27 studies (63%), increased in 2 (5%), and were unchanged in 14 (33%). Conclusion De-implementation randomized controlled trials typically did not report direct costs of the de-implementation strategies (92%) or the impacts of de-implementation on health care costs (81%). Lack of cost information may limit the value of de-implementation trials to decision-makers. Trial registration OSF (Open Science Framework): https://osf.io/ueq32 .

Background The depth of anesthesia (DOA) is estimated based on the anesthesia-induced electroencephalogram (EEG) changes. However, the surgical environment, as well as the patient him/herself, generates electrical interferences that cause EEG waveform distortion. Case presentation A 52-year-old patient required general anesthesia due to the right femur necrotizing fasciitis. He had no history of epilepsy or head injury. His cardiovascular status was stable without arrhythmia under propofol and remifentanil anesthesia. The DOA was evaluated with Root® with SedLine® Brain Function Monitoring (Masimo Inc, Irvine, CA). The EEG showed a rhythmic, heart rate time-locked pulsation artifact, which diminished after electrode repositioning. Offline analysis revealed that the pulse wave-like interference in EEG was observed at the heart rate frequency. Conclusions We experienced an anesthesia case that involves a pulsation artifact generated by the superficial temporal artery contaminating the EEG signal. Numerous clinical conditions, including pulsation artifact, disturb anesthesia EEG.

ObjectiveThis study aimed to establish the current situation, intellectual base, hotspots, development trends, and frontiers of oral health literacy (OHL) from the literature.MethodsWe analyzed 1505 bibliographic records dated between January 1990 and December 2020 retrieved from the Web of Science Core Collection and the Scopus database. We used CiteSpace for word frequency analysis, co-occurrence analysis, co-citation analysis, clustering analysis, and burst analysis.ResultsThe total number of publications increased year-on-year, with the majority of publications coming from the USA. Most studies focused on the relationship between (oral) health literacy and oral health, and the development of OHL instruments. The top 10 keywords by frequency were “health literacy”, “oral health”, “attitude to health”, “dental caries”, “adult”, “children”, “dental care”, “knowledge”, “questionnaire”, and “adolescent”. The keyword with the highest burst intensity was “dental health education”.ConclusionsOHL research is a thriving field. The field is focused on the development of an OHL instrument and health promotion practice. Strategic cooperation among countries, institutions, authors, hospitals, and communities will be important to encourage further OHL research and address oral health problems.

The First World War cost many lives and the dental profession was not exempt. Some were serving in their professional capacity within the forces, but many were not. The British Dental Association wished to commemorate those members who had sacrificed their lives by providing a Memorial plaque at the association's headquarters.

Most dentists have a 'thingummybob' or a 'whatsit' in their instrument armamentarium, to which their dental nurse is supposed to be able to lay their hand instantly. Usually dental instruments are logically named to avoid this potential source of confusion. However, some instruments are not, of which the straight probe is one example. The straight probe is not logically named, quite simply because it is not straight. It is bent. This paper investigates the anomaly and suggests that a forgotten hero of the profession is responsible for the development of this indispensable instrument.