An ultrasound-guided method for short peripheral catheter insertion is a better alternative to traditional techniques for both adult and pediatric patients, reports a study published in BMCNurs
]. Because we are conscious that the Preferred Reporting Items for Overviews of Reviews guidelines will be soon released, we have also considered most of the key aspects of methods and results reported in the majority of the overviews of reviews published so far [A comprehensive literature search was conducted in MEDLINE , EMBASE , Web of Science, and Cochrane Library from their inception until February 23, 2022.
Studies were excluded when: involved patients with long-term central venous lines; ultrasound was used to insert an arterial or central venous access, or to insert a LPC or MC; the ultrasound group was compared to another different from the traditional method ; and its design was not systematic review or meta-analysis of all comparative study designs . No language restriction was applied.
], and mean difference or standardized mean difference, depending on the nature of the effect measures. Graphs were performed using STATA SE software, version 15 .The comprehensive literature search retrieved a total of 2946 articles. From all of them, 12 systematic reviews were included in this systematic review. (Fig.
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Population dynamics and demographic history of Eurasian collared lemmings - BMC Ecology and EvolutionBackground Ancient DNA studies suggest that Late Pleistocene climatic changes had a significant effect on population dynamics in Arctic species. The Eurasian collared lemming (Dicrostonyx torquatus) is a keystone species in the Arctic ecosystem. Earlier studies have indicated that past climatic fluctuations were important drivers of past population dynamics in this species. Results Here, we analysed 59 ancient and 54 modern mitogenomes from across Eurasia, along with one modern nuclear genome. Our results suggest population growth and genetic diversification during the early Late Pleistocene, implying that collared lemmings may have experienced a genetic bottleneck during the warm Eemian interglacial. Furthermore, we find multiple temporally structured mitogenome clades during the Late Pleistocene, consistent with earlier results suggesting a dynamic late glacial population history. Finally, we identify a population in northeastern Siberia that maintained genetic diversity and a constant population size at the end of the Pleistocene, suggesting suitable conditions for collared lemmings in this region during the increasing temperatures associated with the onset of the Holocene. Conclusions This study highlights an influence of past warming, in particular the Eemian interglacial, on the evolutionary history of the collared lemming, along with spatiotemporal population structuring throughout the Late Pleistocene.
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Molecular testing to deliver personalized chemotherapy recommendations: risking over and undertreatment - BMC MedicineBackground In the adjuvant setting of cancer treatment, de-escalation strategies have the goal of omitting or minimizing treatment in patients, without compromising outcomes. Historically, eligibility for adjuvant treatment solely relied on the patient’s clinical and tumor’s pathological characteristics. At the turn of the century, based on new biological understanding, molecular-based strategies were tested and sometimes implemented. Main body However, we illustrate how molecularly based de-escalation strategies may paradoxically lead to overtreatment. This may happen when the novel approach is tested in lieu of standard management and may not yield the same results when being implemented in addition to usual practice. In the DYNAMIC trial, adjuvant chemotherapy decision in stage II colon cancer was compared between a circulating tumor DNA (ctDNA)-based approach and the standard care. We show this may result in more patients receiving oxaliplatin-based chemotherapy and may expose a similar proportion of patients to chemotherapy if the novel strategy is implemented in addition to usual practice. The other potential risk is undertreatment. We provide an illustration of early breast cancer, where the decision of adjuvant chemotherapy based on the gene expression signature MammaPrint may lead to inferior outcomes as compared with the clinico-pathologic strategy. This may also happen when non-inferiority designs have large margins. Among solutions, it should be acknowledged that clinico-pathological features, like T4 in colon cancer, may not be abandoned and replaced by novel strategies in real-life practice. Therefore, novel strategies should be tested in addition to standard of care, and not in lieu of. Second, de-escalation trials should focus on the settings where the standard of care has a widespread agreement. This would avoid the risk of testing non-inferiority against an ineffective therapy, which guarantees successes without providing informative data. Conclusi
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Desperate NHS pays up to £2,500 for nursing shiftsSpending on agency staff jumps by 20% as bosses pay premium rates to plug holes in rotas.
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Desperate NHS pays up to £2,500 for nursing shiftsFor many shifts, bosses have been so short-staffed they have been willing to breach the government pay caps for these agency workers, most of whom are doctors and nurses.
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COVID-19 vaccine hesitancy and short-term and long-term intentions among unvaccinated young adults: a mixed-method approach - BMC Public HealthBackground Only 63.8% of Americans who are 18-to-24-years-old have been fully vaccinated for COVID-19 as of June 1, 2022. The Grand Forks County, North Dakota is facing a similar challenge. As of June 2022, 47% of individuals in the 19-to-29-year-old age group are vaccinated. Focusing on unvaccinated individuals in their 20s, Study 1 aims to understand the ways in which receiving COVID-19 vaccines is construed using qualitative interviews; and Study 2 compares the predictors of short-term vaccination intention (i.e., next month) with those of long-term vaccination intention (i.e., three to 5 years) using an online survey. Methods For Study 1, we conducted five focus groups and four in-depth interviews via Zoom with a total of 26 unvaccinated individuals in their 20s living in the Grand Forks County. Constant comparison process was used to categorize data into themes and to recognize characteristics of the identified themes. The aim was to develop themes and associated characteristics. For Study 2, we conducted an online survey with a convenience sample of 526 unvaccinated individuals. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for associations between attitudes, perceptions, and beliefs in misinformation and short-term and long-term vaccination intentions, accounting for demographics and socioeconomic status. Results In Study 1, two themes were identified: feelings of uncertainty sparked by profits and monetization and navigating the fear of the unknown. In Study 2, an increase in the confidence of COVID-19 vaccines showed significantly higher odds of short-term intention (OR = 2.658, 95%CI 1.770, 3.990) and long-term intention (OR = 1.568, 95% CI 1.105, 2.226). Believing in misinformation had significantly lower odds of short-term intention (OR = 0.712, 95%CI 0.513, 0.990), while more positive attitudes (OR = 1.439, 95% CI 1.024, 2.024), stronger preference in calculating the benefits of COVID-19 vaccines (OR = 2.108, 95% CI 1.
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Mendelian randomization analysis of factors related to ovulation and reproductive function and endometrial cancer risk - BMC MedicineBackground Observational epidemiological studies suggest a link between several factors related to ovulation and reproductive function and endometrial cancer (EC) risk; however, it is not clear whether these relationships are causal, and whether the risk factors act independently of each other. The aim of this study was to investigate putative causal relationships between the number of live births, age at last live birth, and years ovulating and EC risk. Methods We conducted a series of observational analyses to investigate various risk factors and EC risk in the UK Biobank (UKBB). Additionally, multivariate analysis was performed to elucidate the relationship between the number of live births, age at last live birth, and years ovulating and other related factors such as age at natural menopause, age at menarche, and body mass index (BMI). Secondly, we used Mendelian randomization (MR) to assess if these observed relationships were causal. Genome-wide significant single nucleotide polymorphisms (SNPs) were extracted from previous studies of woman’s number of live births, age at menopause and menarche, and BMI. We conducted a genome-wide association analysis using the UKBB to identify SNPs associated with years ovulating, years using the contraceptive pill, and age at last live birth. Results We found evidence for a causal effect of the number of live births (inverse variance weighted (IVW) odds ratio (OR): 0.537, p = 0.006), the number of years ovulating (IVW OR: 1.051, p = 0.014), in addition to the known risk factors BMI, age at menarche, and age at menopause on EC risk in the univariate MR analyses. Due to the close relationships between these factors, we followed up with multivariable MR (MVMR) analysis. Results from the MVMR analysis showed that number of live births had a causal effect on EC risk (OR: 0.783, p=0.036) independent of BMI, age at menarche and age at menopause. Conclusions MVMR analysis showed that the number of live births causally reduced the ri
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