Mccartneyoddershede8416

The aim of this systematic literature review and meta-analysis is to assess the impact of hysteroscopic metroplasty for dysmorphic uteri on reproductive outcomes in women with recurrent miscarriages. Available studies were identified through a PubMed, Scopus, and Cochrane search until June 2019. Live-birth rate, clinical pregnancy and miscarriage rate after hysteroscopic metroplasty was evaluated. DerSimonian and Laird's random-effect model was used for relative risks, Freeman-Tukey Double Arcsine for pooled estimates and exact method to stabilize variances and CIs. Heterogeneity was quantified using I2-statistics. Six out of 164 published studies met the inclusion criteria. All (n = 221) women underwent metroplasty, using 5Fr-hysteroscope with bipolar electrodes or 26Fr/28Fr-resectoscope in outpatient or inpatient settings. After 6 to 60-month follow-up, reported live-birth rate was 50% (0.37-0.63 95% CI) from a clinical pregnancy rate of 73% (0.51-0.91 95% CI) and miscarriage rate was 23% (0.15-0.30 95% CI). Hysteroscopic metroplasty for dysmorphic uteri led half of the women who experienced recurrent miscarriages at least one live birth and is correlated to few surgical and obstetric complications. However, randomized clinical trials and case-control studies are unavailable due to ethical constrains; inhomogenity of follow-up durations and standardized protocols regarding preoperative diagnosis and post-surgical management resrict our conclusions. BACKGROUND Despite efforts by the U.S. Department of Defense to train behavioral health (BH) providers in evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD), numerous barriers limit EBP implementation. A context-tailored implementation approach called TACTICS (Targeted Assessment and Context-Tailored Implementation of Change Strategies) holds promise for increasing the use of EBPs such as prolonged exposure therapy (PE) in military treatment facilities. TACTICS combines a needs assessment, a rubric for selecting implementation strategies based on local barriers, an implementation toolkit, and external facilitation to support local champions and their implementation teams in enacting changes. This paper describes the rationale for and design of a study that will evaluate whether TACTICS can increase implementation of PE for PTSD and improve patient outcomes in military BH clinics relative to provider training in PE alone. METHODS The study is a multi-site, cluster randomized, stepped-wedge trial, with the military treatment facility as the unit of analysis. Eight facilities undergo a provider-training phase, followed by 5 months of TACTICS implementation. The timing of TACTICS at each facility is randomly assigned to begin 9, 14, or 19 months after beginning the provider-training phase. Primary analyses will compare the proportion of PTSD patients receiving PE and patients' mean improvement in PTSD symptoms before and after the onset of TACTICS. DISCUSSION TACTICS endeavors to balance standardization of empirically-supported implementation strategies with the flexibility of application necessary for success across varied clinical settings. If successful, TACTICS may represent a systematic and scalable method of promoting and supporting EBP implementation. TRIAL REGISTRATION Clinicaltrials.gov Identifier NCT03663452. BACKGROUND For adults, prevalence estimates of food sensitization (FS) and food allergy (FA) have been obtained in a standardized manner across Europe. ZD1839 datasheet For children, such estimates are lacking. OBJECTIVES To determine prevalence of self-reported FA, FS, probable FA (symptoms plus IgE-sensitization), and challenge-confirmed FA in European school-age children. METHODS Data on self-reported FA were collected through a screening questionnaire sent to a random sample of the general population of 7- to 10-year-old children in eight European centres in phase I of the EuroPrevall study. Data on FS and probable FA were obtained in phase II, comprising an extensive questionnaire on reactions to 24 commonly implicated foods, and serology testing. Food challenge was performed in phase III. RESULTS Prevalence (95%-CI) of self-reported FA ranged from 6.5% (5.4-7.6) in Athens to 24.6% (22.8-26.5) in Lodz; prevalence of FS from 11.0% (9.7-12.3) in Reykjavik to 28.7% (26.9-30.6) in Zurich; and prevalence of probable FA from 1.9% (0.8-3.5) in Reykjavik to 5.6% (3.6-8.1) in Lodz. In all centres, the majority of food-sensitized subjects had primary (non-cross-reactive) FS. However, FS due to PR-10 cross-reactivity was also common in Central-Northern Europe. Probable FA to milk and egg occurred frequently throughout Europe; to fish and shrimp mainly in the Mediterranean and Reykjavik. Peach, kiwi and peanut were prominent sources of plant FA in most countries, along with notably hazelnut, apple, carrot and celery in Central-Northern Europe, and lentils and walnut in the Mediterranean. CONCLUSION There are large geograhical differences in prevalence of FS and FA in school-age children across Europe. Both primary and cross-reactive FS and FA occur frequently. Over the last 25 years, health-related quality of life (HRQoL) has received increasing recognition, as it aids health practitioners in understanding the way a patient may be impacted by their health condition. Specifically, ocular allergy (OA) has been found to affect an individual emotionally, physically, socially and economically. Hence, scientists have developed multiple questionnaires, based on the different aetiologies of OA, to assess the quality of life (QoL) of individuals affected by the condition. One highly regarded questionnaire is the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and its variations, namely the Standardised Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ(S)), Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ), Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire ((N)RQLQ), Adolescent Rhinoconjunctivitis Quality of Life Questionnaire (AdolRQLQ) and Paediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ). Other questionnaires include the Eye Allergy Patient Impact Questionnaire (EAPIQ) and the Quality of Life of Children with Allergic Keratoconjunctivitis (QUICK) questionnaire, amongst others which are suitable for different countries.