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(1) Background: Treatment of dyslipidemia via statin therapy in the non-liver transplant (LT) population is associated with a mortality benefit; however, the impact of statin therapy in post-LT population is not well-defined. This meta-analysis seeks to investigate the safety and efficacy of statin therapy in post-LT patients. (2) Methods: A systematic literature search on Medline and EMBASE database was conducted. A single-arm proportional meta-analysis and conventional pair-wise meta-analysis were performed to compare different outcomes with a random effects model. (3) Results: A total of 11 studies were included in this study, with 697 LT recipients identified to be on statin therapy. Statins were underutilized with only 32% (95% CI: 0.15–0.52) of 1094 post-LT patients on therapy. The incidence of adverse events of 14% (95% CI: 0.05–0.25) related to statin therapy was low. A significant mortality benefit was noted in patients on statin therapy with HR = 0.282 (95% CI: 0.154–0.517, p < 0.001), and improved lipid profiles post LT. The use of statins also significantly decreased odds of graft rejection (OR = 0.33; 95% CI: 0.15–0.73) and hepatocellular carcinoma (HCC) recurrence (HR = 0.32, 95% CI: 0.11–0.89). (4) Conclusions: Statin therapy is safe and efficacious in post-LT patients. Future studies to evaluate the effects of interactions between statins and immunosuppressant therapy are warranted.

Problem Parents of children with chronic kidney disease face tremendous burdens of care, having to adopt dual roles as parents and informal healthcare providers, delivering home-based clinical care, despite lacking proper qualification and training. Eligibility criteria A systematic review of qualitative studies was conducted to identify sources of distress among parents caring for children with chronic kidney disease undergoing dialysis, excluding children who have had renal transplants. Guided by PRISMA guidelines, six electronic databases (PubMed, Embase, PsycINFO, Scopus, Cochrane, Google Scholar) were searched for relevant articles published in English. A three-step inductive thematic synthesis method outlined by Thomas and Harden (2018) was used to form descriptive themes and the Critical Appraisal Skill Program (CASP) qualitative checklist was utilised to appraise the quality of included articles. Sample A total of 23,129 title and abstracts were reviewed; 161 full texts were reviewed. Thirteen papers, with the experiences of 183 parents, met the inclusion criteria. Most included studies were conducted in Western countries, which may limit the applicability of this review to other countries. Results Five themes emerged: disease-related distress, personal struggles, family structure, lack of resources and unrealistic social expectations. Conclusion Parents of children with chronic kidney disease undergoing dialysis experienced distress at multiple levels. Implication Healthcare professionals caring for children with chronic kidney disease could screen parents early for distress, and refer them to relevant psychosocial and community services.

BACKGROUND Interprofessional communication (IPC) improves patient care, cost efficiency and improves teamwork among healthcare professionals. For medical students IPC training is crucial to navigating complex healthcare practices yet there is little consistency to IPC training. This scoping review looks at IPC training approaches for medical students to improve preparedness for clinical practice.METHODS Arksey and O’Malley (2005) framework for scoping review was used to guide this review of articles on IPC training for medical students published between 1 January 2000 to 31 December 2017 in PubMed, ScienceDirect, JSTOR, Google Scholar, ERIC, Embase, Scopus, PsycINFO, Mednar and OpenGrey. A ‘split approach’ that sees concurrent independent use of a directed content analysis and Braun and Clarke’s approach to thematic approach was employed by different members of the research team to scrutinize the data.RESULTS 17,493 titles and abstracts were found, 250 full-text articles were reviewed and 70 full text articles were included. The ‘split approach’ to analysis forwarded similar themes that corresponded with the different levels of Miller’s Pyramid. These were “Knows”, “Knows How”, “Shows how” and “Does”. Each stage involves particular training modalities and context appropriate modes of assessments to measure medical students’ competency levels. IPC training was found to be well received, positive, increased students’ understanding and practice of communication. Obstacles to IPC training include scheduling constraints, inexperienced and untrained teachers, and initial anxiety and adjustment for students.CONCLUSIONS This scoping review reveals IPC training to be competency and assessment based, and dependent upon learning objectives and a clear alignment of expectations. Faculty training, a conducive learning environment tailored to the learner, and effective assessment methods at each training stage are crucial to the success of IPC training. Further evaluations are recommended to ensure the translatability of these findings to other medical specialities and other healthcare professions.

Metformin may have a role in reducing the incidence of colorectal cancer (CRC) and improving survival outcome. This meta-analysis explored the effect of metformin use on colorectal adenoma and cancer incidence, and colorectal oncological outcomes. A database search was conducted on Medline, Embase and CNKI for studies comparing metformin vs. non-metformin users, metformin users vs. non-diabetics and metformin users vs. diabetics with diet-only treatment. Meta-analysis was done with DerSimonian and Laird with risk ratios (RR), and hazard ratios (HR) for survival outcomes. We included 58 studies and summarized incidences of colorectal adenoma and cancer, as well as cancer survival outcomes. Metformin users had a significant lower incidence of colorectal adenoma (RR 0.77, CI 0.67–0.88, p

Introduction Interprofessional communication (IPC) enhances patient experiences and outcomes and improves well-being and satisfaction among health care professionals. This scoping review seeks to guide design of IPC training in internal medicine. Methods The framework of Arksey and O'Malley (2005) guided this systematic scoping review in internal medicine across PubMed, Embase, CINAHL, Scopus, PsycINFO, ERIC, JSTOR, and Google Scholar databases for publications from the years 2000 to 2018. Results Twenty-two thousand eight hundred seventy-four abstracts were retrieved, 326 full-text articles were reviewed, and 32 articles were included. The themes identified using directed content analysis were indications for an IPC program, training stages, and obstacles. The rationale for IPC programs was to improve interprofessional teamwork and enhance patient care. IPC training occurs in five stages beginning with instilling the role, value, and skills behind IPC and gradually practicing these skills within the clinical setting. The challenges to IPC highlight the need to confront workplace hierarchies and the lack of resources. Discussion The findings of this systematic scoping review also serve to underscore the importance of understanding, evaluating, and influencing the clinical environment and the work environment and the need for new assessment tools that will guide the individualized, longitudinal, competency-based learning process that underpins IPC training.

The usage of indocyanine green (ICG) dye is commonly associated with decreased anastomotic leakage rates in colectomies. This study aims to perform a network meta-analysis to assess the usage of ICG fluorescence imaging in right-sided colectomies. Medline, Embase, Cochrane Trials, CNKI, and WanFang electronic databases were reviewed, and meta-analysis of proportions, comparative meta-analysis, and network meta-analysis were conducted in this review. Studies comparing ICG usage with conventional approaches of anastomosis were selected, with postoperative anastomotic leak rate being the primary outcome. Ten articles were included, with a total of 675 patients involved, of which 515 patients underwent colorectal surgery with ICG. Anastomotic leak rates with ICG were estimated to be 1% (CI 0.00–0.04) and 3% (CI 0.01–0.06) for right and left procedures, respectively. No significant difference was observed in left-sided colectomies (OR 0.587; 95% CI 0.218–1.582; p = 0.292). There were nearly half the odds of anastomotic leakage when ICG was used in right-sided colectomies (OR 0.524; 95% CI 0.128–2.137). With the ability to potentially avert postoperative anastomotic leakage, coupled with its minimal costs and side effects, administration of ICG in colectomies in centers where equipment is available should be encouraged.

Objectives This qualitative review aims to provide a clearer understanding of concerns general surgery (GS) patients face in the preoperative period. Methods Medline, CINAHL, PsycINFO and Web of Science were searched for articles describing the preoperative concerns of GS patients. Qualitative and mixed method studies were included. Key quotes were extracted, coded, and thematically analyzed according to Thomas and Harden’s methodology. Results 27 articles were included. Three main themes were generated: (1) lead-up to surgery, (2) postoperative recovery process and (3) standard of care. While waiting for surgery, patients were often shrouded with uncertainty and concerned themselves with the potential impacts of their disease and surgery on their wellbeing and recovery. Furthermore, patients’ trust and confidence in Healthcare Professionals (HCPs) was compromised when standard of care was perceived to be deficient, resulting in doubts about HCPs’ credibility and capabilities. Conclusion Patients’ preoperative concerns often stem from the uncertainty and unfamiliarity surrounding surgery. To address this, a combination of effective preoperative education, individualised communication and involvement of social support should be considered. Practice implications Preoperative concerns can negatively impact patients and effective interventions will result in a better perioperative experience with fewer negative consequences arising from patients’ fear and anxiety.

Cardiovascular disease is a significant cause of morbidity and mortality in dialysis patients. With the increasing prevalence of dialysis patients, there is a need to systematically identify the epidemiology of cardiovascular disease in hemodialysis and peritoneal dialysis patients. A meta-analysis was conducted in reference to the MOOSE and PRISMA guidelines. Database searches were conducted on Medline and Embase on 17 March 2020. Meta-analysis of proportions was used to summarize the overall prevalence of events. Pairwise comparisons were used to compare between hemodialysis and peritoneal dialysis, and meta-regression was applied to identify the factors influencing disease. A total of 28 studies were included in the review and prevalence of cardiovascular disease events including coronary artery disease, coronary artery complications, congestive heart failure, peripheral arterial disease, atrial fibrillation, and cardiovascular mortality were summarized. Atrial fibrillation (RR 1.287 CI 1.154–1.436, p