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Comparing operative outcomes and resection quality in robotic vs open pancreaticoduodenectomy: A meta-analysis of 54,000 patients
No full textBackground: High morbidity and mortality make pancreaticoduodenectomy (PD) one of the most complicated surgical procedures. This meta-analysis aimed to compare the outcomes of robotic pancreaticoduodenectomy (RPD) versus open pancreaticoduodenectomy (OPD).Method: A comprehensive literature search of PubMed, Cochrane Central, and Google Scholar was conducted from inception to November 2024. Studies comparing RPD and OPD in adults aged ≥ 18 years were included. Data for the outcomes of interest were extracted.Results: Forty-one studies with a total of 54,287 patients were pooled. RPD is significantly superior to OPD in terms of overall postoperative complications (RR = 0.91, 95% CI: [0.86-0.97]; p = 0.001), wound infections (RR = 0.63, 95% CI: [0.49-0.81], p = 0.0004), estimated blood loss (WMD = -171.99 ml, 95% CI: [ -217.76 to -126.22], p \u3c 0.01) and hospitalization duration (WMD = -1.33 days, 95% CI: [ -1.84 to -0.82], p \u3c 0.01) with a longer operating time (WMD = 73.22 min, 95% CI: [56.20 to 90.23], p \u3c 0.01).Conclusion: In conclusion, RPD shows a lower risk of wound infections and overall postoperative morbidity compared to OPD. It has lower estimated blood loss, shorter hospitalization duration, and a longer operating time. The two approaches were comparable in terms of resection quality. More high-quality RCTs are required to draw definite conclusions
Prevalence of metabolic syndrome among pregnant women: A systematic review and meta-analysis
No full textPurpose: Metabolic syndrome (MetS) is a cluster of risk factors that increase the risk of cardiometabolic diseases. The prevalence of MetS and individual components across pregnancy has not been reviewed in the literature. This research was conducted to identify the prevalence of MetS and its components among pregnant women.Methods: The PubMed, EMBASE, CINAHL, Web of Science and Scopus databases were searched. The review protocol is registered in PROSPERO (CRD42023460729). Quality assessment was performed using the JBI critical appraisal checklist. The study selection, data extraction and data analyses were performed in accordance with the MOOSE guidelines.Results: The prevalence of MetS among pregnant women was 16.3%, (n = 3946). The prevalences for individual MetS components were: low HDL, 12.3% (n = 1108); high fasting glucose, 16.2% (n = 2333); high triglycerides, 48.5% (n = 2880); obesity, 42.7% (n = 5162) and high blood pressure 37.7% (n = 828). According to the definitions used to diagnose MetS, the prevalences were 18.2% according to the World Health Organization, 15.0% according to the International Diabetes Federation and 17.2% according to the National Cholesterol Education Program Adult Treatment Panel III. When stratified by gestational age at assessment, the prevalence of MetS was 9.9% before 16 weeks\u27 and 24.1% after 20 weeks\u27 of gestation.Conclusion: This review demonstrates that MetS is detected in approximately one-fifth of pregnant women. Screening for MetS and its components during pregnancy may help identify young women at risk for future cardiovascular diseas
Muslim teachers’ voices on citizenship education: Negotiating faith and democracy
No full textPakistan is a Muslim majority country where Islamic values dominate the political landscape and inform socio-political ideals and practices. Islam therefore plays a vital role in shaping education and its narratives. The official discourse on citizenship education is a case in point. This appears fixated with the construction of nationhood, defined in Islamic terms, rather than promoting a rights-based discourse on citizenship. Against this background, the study reported here explores the perspectives of a group of Pakistani citizenship education teachers on how they make sense of citizenship as a curriculum experience for students. We thematically analysed teachers’ interviews within an interpretive framework. The results suggest that citizenship discourse is significantly influenced by the interrelationship between Islam and modernity in Muslim societies. Our findings revealed two main approaches: some teachers attempted to Islamise the concept of citizenship for students by identifying its basis within a broad interpretation of Islam, and others had a comparatively liberal approach to citizenship. Both groups generally promoted equal citizenship, although they justified it from two distinct epistemic positions. We also identified distinctive features of citizenship that are illustrative of the Muslim context
Health Professions Education
No full textHigh-quality education and training programs for the full spectrum of health professionals involved with cancer care are central to achieving improvements in cancer control in all parts of the world. There is a logical and evidence-based approach to curriculum design, program implementation, and evaluation that will likely result in successful outcomes. This chapter suggests an optimal approach to curriculum design and gives examples of constructive health professions educational interventions in the global setting, with a focus on socioeconomically disadvantaged regions. Current challenges for oncology health professions education are outlined. Opportunities for improving educational and hence cancer patient outcomes through policy, educational advocacy, and resource sharing are discussed. The possibilities arising from the digital educational revolution in the setting of oncology health professions education are highlighted
Socio-medical factors associated with neurodevelopmental disorders on the Kenyan coast
Full text linkNeurodevelopmental disorders (NDDs) are a group of conditions with their onset during the early developmental period and include conditions such as autism and intellectual disability. Occurrence of NDDs is thought to be determined by both genetic and environmental factors, but data on the role of environmental factors for NDD in Africa is limited. This study investigates environmental influences on NDDs in children from Kenya. This case-control study compared children with NDDs and typically developing children from two studies on the Kenyan coast. We included 172 study participants from the Kilifi Autism study and 151 from the NeuroDev study who had a diagnosis of at least one NDD and 112 and 73 with no NDD diagnosis from each study, respectively. Potential risk factors were identified using unadjusted univariable analysis and adjusted multivariable logistic regression. Univariable analysis in the Kilifi Autism study sample revealed hypoxic-ischaemic encephalopathy conferred the largest odds ratio (OR) 10.52 [95%CI: 4.04, 27.41] for NDDs, followed by medical complications during pregnancy (gestational hypertension & diabetes, eclampsia, maternal bleeding) (OR=3.17 [95%CI: 1.61, 6.23]). In the NeuroDev study sample, labor and birth complications (OR=7.30 [95%CI 2.17, 24.61]), neonatal jaundice (OR=5.49 [95%CI 1.61,18.72]) and infection during pregnancy (OR= 5.31 [95%CI 1.56, 18.11]) conferred the largest risk associated with NDDs. In the adjusted analysis, seizures before age 3 years in the Kilifi Autism study and labor and birth complications in the NeuroDev study conferred the largest increased risk. Higher parity, the child being older and delivery at home were associated with a reduced risk for NDDs. Recognition of important risk factors such as labor and birth complications could guide preventative interventions, developmental screening of at-risk children and monitoring progress of these children. Further studies examining the etiology of NDDs in population-based samples, including investigating the interaction between genetic and environmental factors, are needed
Using implementation science to define the model and outcomes for improving quality in NEST360, a multicountry alliance for reducing newborn mortality in sub-Saharan Africa
No full textBackground: Improving small and sick newborn care (SSNC) is crucial in resource-limited settings. Newborn Essential Solutions and Technologies (NEST360), a multicountry alliance, aims to reduce newborn mortality through evidence-based interventions. NEST360 developed a multipronged approach to improving quality. We use implementation research (IR) to describe this approach and report emerging implementation outcomes.
Methods: The implementation research logic model (IRLM) was applied to link contextual factors, implementation strategies, mechanisms and implementation outcomes, capturing successes and challenges of the improving quality approach. Data sources included programmed data, peer-reviewed publications and team input. Contextual factors were organized by the NEST360-UNICEF SSNC implementation toolkit. Strategies were grouped by the Expert Recommendations for Implementation Change list, and implementation outcomes were measured using Proctor’s implementation outcomes.
Results: We developed an IRLM to describe the implementation of NEST360’s improving quality model. This IRLM included 33 contextual factors; 42% were barriers, 42% were facilitators, and 15% were both a barrier and facilitator. Additionally, we identified 10 implementation strategies that NEST360 used. The logic model also describes the connections between the contextual factors, the strategies that address them, and the preliminary implementation outcomes. Examples of the outcomes measured include Reach with 100% of units logging into the NEST360-Implementation Tracker (NEST-IT) at least once (October 2023 to March 2024), Adoption with 100% of units conducting a quality improvement (QI) project (April 2024 to June 2024), and Feasibility with 93% of units reporting NEST-IT data in their QI project documentation (April 2024 to June 2024). Finally, this study identified sustainability strategies as a critical need.
Conclusions: Integrating IR and QI enhances SSNC in resource-limited settings. Addressing barriers, leveraging facilitators and using structured IR frameworks advanced QI efforts, thereby improving intervention reach, adoption and feasibility while building scalable systems for high-quality healthcare