Paul Arthur Bain

Background: Emergency departments (EDs) play a critical role in caring for the aging population, particularly those nearing the end of life. Despite advances in integrating palliative care resources in the ED, targeted research on the impact of hospice and palliative care (HPC) consultations for older adults in ED settings remains limited. This systematic review protocol assesses the effects of ED-initiated HPC consultations on health outcomes and the quality of care for older adults. Objective: The objective of this systematic review is to synthesize the available evidence on the effectiveness of ED-initiated HPC consultations on the provision of advance care planning among older adults (≥60 years). Our review will focus on assessing several secondary outcomes, including mortality, hospital admissions, length of stay, repeat health service use, costs, and satisfaction levels among patients, caregivers, and clinicians. Methods: Following the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) reporting guidelines, our protocol outlines a comprehensive review of published studies. Systematic searches will be conducted in databases such as Medline, EMBASE, PubMed, Cochrane Trials database, and Web of Science from inception to present. Studies will be selected if they involve randomized, quasi-randomized, or observational designs examining the effectiveness of HPC interventions in the ED for older adults. Title, abstract and full text screening, risk of bias evaluation, and grading of the evidence will be completed independently and in duplicate by a group of emergency medicine and palliative care researchers. If feasible, a meta-analysis will be conducted using a random-effects model to evaluate the outlined outcomes Results: We will report descriptive statistics to describe the body of literature and we will pool absolute risk differences along with corresponding 95% CIs. We will also report on study risk of bias and certainty of the evidence. Conclusions: Despite the rapid growth of emergency medicine and HPC literature, a focused systematic review on the geriatric ED population remains absent. Our work not only fills a vital gap in the literature related to ED-initiated HCP consultations for older adults, but it sets the stage for significant future advancements in the care of older adults in the ED.

Introduction The rapidly growing population of older adults (individuals aged 65 years and older) presents a new set of challenges for healthcare providers in the emergency department (ED), given the prevalence of severe and life-threatening conditions among this group, such as chronic cancer, Alzheimer’s disease/dementia and congestive heart failure. ED encounters often represent a critical point in an older patient’s trajectory of care and can thus be an important opportunity for various interventions such as palliative care consultation. Therefore, identifying those who will benefit most from palliative care is of high importance, especially in determining the course of future treatment. Thus, we aim to conduct a systematic review assessing the efficacy of palliative care screening in the ED by assessing inpatient length of stay as the primary outcome and quality of life, percentage of hospitalisation and cost of care as secondary outcomes. Methods This study will use Ovid MEDLINE, Embase, EBSCO CINAHL, Web of Science and Cochrane as databases. The study population comprises adults aged 60 years and older, with no focus on any specific clinical specialty or disease. Patients who have not received palliative care screening will serve as the comparator. Only studies with an applicable comparator will be considered. Studies published from 1 January 2000 to 1 July 2025 will be included. All articles will be reviewed independently and in duplicate, and every author will participate in the review, data abstraction and conflict resolution process. Ethics and dissemination Ethical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO registration number CRD42024562389.

Various systematic reviews underscore the relevance of social support for resilience among refugees. This meta-analysis aims to determine the quantitative assessment of social support and resilience among refugees and the extent of the associations between social support and resilience among refugees. After a systematic literature search, we included twenty-three studies, and performed random-effects meta-regressions. Studies on resilience and social support among refugees very heterogeneously operationalize both constructs. While increases in social support among refugees accompany higher resilience in numerous studies, these associations are not significant. In contrast to previous reviews' conclusions, the current data cannot confirm a relationship between resilience and social support among refugees. Substantiated conclusions about the relationship between resilience and social support among refugees might be reached by a population-specific clear conceptualization and operationalization of the constructs, the content differentiation of the constructs, representative samples, and longitudinal and intervention studies.

Objective: Advances in surgical care have allowed the implementation of outpatient protocols across many traditionally inpatient procedures, including adrenal surgery. However, there is an ongoing debate regarding the safety of outpatient minimally invasive adrenalectomy. This study aims to perform a systematic review and meta‐analysis comparing outpatient to inpatient minimally invasive adrenalectomy. Methods: A systematic search for studies comparing outpatient versus inpatient minimally invasive adrenalectomy in September 2023 on Cochrane, EMBASE, Web of Science, and PubMed was performed. Inclusion criteria were studies comparing outpatient to inpatient minimally invasive adrenalectomy for primary adrenal diseases. Exclusion criteria were studies including open adrenalectomy, radiofrequency ablation, and patients with metastasis to the adrenals. Primary outcomes were 30‐day complications and readmissions. Statistical analysis was performed with a random effects model. Results: Five studies comprising 762 outpatient and 15,331 inpatient adrenalectomies met inclusion criteria. Pooled analysis showed no differences in adjusted 30‐day readmission (OR = 0.88; 95% CI 0.27–2.89; p = 0.84; I ² = 67%) and complication rates (OR = 0.68; 95% CI 0.39–1.18; p = 0.17; I ² = 32%). Similarly, no statistically significant differences were found for unadjusted outcomes of acute kidney injury, deep vein thrombosis, pneumonia, urinary tract infection, and surgical site infection. Conclusion: Our study demonstrated no differences in outcomes between outpatient and inpatient minimally invasive adrenalectomy. Future studies should address baseline characteristics that render patients more suitable for outpatient protocols and aim to establish comparable groups at baseline through quasi‐experimental methods. Trial Registration: PROSPERO Registration (CRD42023469240)

Background: Surgical care is essential to achieving health system goals, including Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs). The Lancet Commission on Global Surgery (LCoGS) proposed core indicators to assess surgical system capacity, delivery, and financial risk protection. Despite their importance, variability and inconsistent reporting limit their utility in tracking progress toward Global Surgery 2030. Aims: This review aims to quantify the status of five global surgery indicators globally, describe current indicator reporting practices, and identify facilitators and barriers to regular indicator reporting, providing recommendations to improve future tracking and policy implementation. Methods: Following the Joanna Briggs Institute (JBI) and PRISMA-ScR guidelines, we will search peer-reviewed databases and grey literature to identify studies reporting LCoGS indicators. Data extraction will focus on indicator status, reporting frequency, and associated challenges. Results will be analyzed quantitatively and thematically. Conclusion: By mapping current indicator reporting, this review will provide actionable insights to inform future policy, improve data collection practices, and accelerate progress toward achieving Global Surgery 2030 targets.

Background: India accounts for about one-quarter of people contracting tuberculosis (TB) disease annually and nearly one-third of TB deaths globally. Many Indians do not navigate all care cascade stages to receive TB treatment and achieve recurrence-free survival. Guided by a population/exposure/comparison/outcomes (PECO) framework, we report findings of a systematic review to identify factors contributing to unfavorable outcomes across each care cascade gap for TB disease in India. Methods and findings: We defined care cascade gaps as comprising people with confirmed or presumptive TB who did not: start the TB diagnostic workup (Gap 1), complete the workup (Gap 2), start treatment (Gap 3), achieve treatment success (Gap 4), or achieve TB recurrence-free survival (Gap 5). Three systematic searches of PubMed, Embase, and Web of Science from January 1, 2000 to August 14, 2023 were conducted. We identified articles evaluating factors associated with unfavorable outcomes for each gap (reported as adjusted odds, relative risk, or hazard ratios) and, among people experiencing unfavorable outcomes, reasons for these outcomes (reported as proportions), with specific quality or risk of bias criteria for each gap. Findings were organized into person-, family-, and society-, or health system-related factors, using a social-ecological framework. Factors associated with unfavorable outcomes across multiple cascade stages included: male sex, older age, poverty-related factors, lower symptom severity or duration, undernutrition, alcohol use, smoking, and distrust of (or dissatisfaction with) health services. People previously treated for TB were more likely to seek care and engage in the diagnostic workup (Gaps 1 and 2) but more likely to suffer pretreatment loss to follow-up (Gap 3) and unfavorable treatment outcomes (Gap 4), especially those who were lost to follow-up during their prior treatment. For individual care cascade gaps, multiple studies highlighted lack of TB knowledge and structural barriers (e.g., transportation challenges) as contributing to lack of care-seeking for TB symptoms (Gap 1, 14 studies); lack of access to diagnostics (e.g., X-ray), non-identification of eligible people for testing, and failure of providers to communicate concern for TB as contributing to non-completion of the diagnostic workup (Gap 2, 17 studies); stigma, poor recording of patient contact information by providers, and early death from diagnostic delays as contributing to pretreatment loss to follow-up (Gap 3, 15 studies); and lack of TB knowledge, stigma, depression, and medication adverse effects as contributing to unfavorable treatment outcomes (Gap 4, 86 studies). Medication nonadherence contributed to unfavorable treatment outcomes (Gap 4) and TB recurrence (Gap 5, 14 studies). Limitations include lack of meta-analyses due to the heterogeneity of findings and limited generalizability to some Indian regions, given the country’s diverse population. Conclusions: This systematic review illuminates common patterns of risk that shape outcomes for Indians with TB, while highlighting knowledge gaps—particularly regarding TB care for children or in the private sector—to guide future research. Findings may inform targeting of support services to people with TB who have higher risk of poor outcomes and inform multicomponent interventions to close gaps in the care cascade.

Background: The global burden of trauma disproportionately affects low-income countries and middle-income countries (LMIC), with variability in trauma systems between countries. Military and civilian healthcare systems have a shared interest in building trauma capacity for use during peace and war. However, in LMICs it is largely unknown if and how these entities work together. Understanding the successful integration of these systems can inform partnerships that can strengthen trauma care. This scoping review aims to identify examples of military-civilian trauma systems integration and describe the methods, domains, and indicators associated with integration including barriers and facilitators. Methods: A scoping review of all appropriate databases was performed to identify papers with evidence of military and civilian trauma systems integration. After manuscripts were selected for inclusion, relevant data was extracted and coded into methods of integration, domains of integration, and collected information regarding indicators of integration, which were further categorized into facilitators or barriers. Results: Seventy-four studies were included with authors from 18 countries describing experiences in 23 countries. There was a predominance of authorship and experiences from High-Income Countries (91.9 and 75.7%, respectively). Five key domains of integration were identified; Academic Integration was the most common (45.9%). Among indicators, the most common facilitator was administrative support and the lack of this was the most common barrier. The most common method of integration was Collaboration (50%). Conclusion: Current evidence demonstrates the existence of military and civilian trauma systems integration in several countries. High-income country data dominates the literature, and thus a more robust understanding of trauma systems integration, inclusive of all geographic locations and income statuses, is necessary prior to development of a framework to guide integration. Nonetheless, the facilitators identified in this study describe the factors and environment in which integration is feasible and highlight optimal indicators of entry.

Background: Emergence agitation is a complex syndrome of altered consciousness after emergence from anesthesia. It can result in injury to patients and staff and is associated with other postoperative complications. Sevoflurane has been associated with emergence agitation, potentially due to low tissue solubility and therefore speed of emergence. Prior meta‐analyses comparing emergence agitation incidence between sevoflurane and isoflurane anesthetics did not demonstrate a statistically significant difference. Given the publication of additional relevant studies not included in prior meta‐analyses as well as improved diagnosis of emergence agitation, we aim to perform an updated, comprehensive meta‐analysis comparing emergence agitation incidence between sevoflurane and isoflurane anesthetics in children.Methods: We conducted an updated systematic review and meta‐analysis of clinical trials comparing sevoflurane to isoflurane in children I² = 40.01%, p < .001)). Time to extubation, awakening times, and postanesthetic care unit duration were not significantly different. The protective effect of isoflurane compared to sevoflurane remained significant in subgroups of patients who received premedication or intraoperative systemic analgesics (risk ratios: (0.48 [0.28–0.82]; I² = 60.78%, p = .01), (0.52 [0.37–0.75]; I² = 0.00%, p < .001), respectively).Conclusion: The risk of emergence agitation in children after maintenance anesthesia with sevoflurane is significantly greater than with isoflurane; we did not find evidence of prolonged emergence or postanesthetic length of stay. When possible, isoflurane should be considered for maintenance anesthesia over sevoflurane in patients at high risk of emergence agitation.

Background: Extensive research collaborations exist between researchers from high-income countries (HICs) and those from low-income countries (LICs) and lower-middle-income countries (LMICs). Previous research has suggested that authors from LICs and LMICs are underrepresented as first and last authors in the orthopaedic literature on local populations, particularly in LICs. We present a bibliometric analysis of authorship solely in studies published in orthopaedic journals that are based in LICs and LMICs. Methods: The Global Index Medicus was queried, and all articles published from January 1, 2010, to December 31, 2021, in journals with a focus on orthopaedic surgery that were based in an LIC or an LMIC were included. Logistic regressions were calculated to assess the predictors of local authorship. Results: Over 92% of studies included in our analysis had first or last authors from LICs or LMICs. In terms of study type, the majority (89%) of studies were clinical, although largely of low-level evidence (78% of clinical studies were case reports, case series, or descriptive studies). None received funding. LIC or LMIC first authorship and last authorship were less likely for most types of nonclinical studies. LIC or LMIC first authorship was more likely when there were more study authors. LIC or LMIC first authorship and last authorship were less likely when there were more countries affiliated with the study authors. Finally, when compared with studies with only LIC or LMIC authors, those with a combination of HIC and LIC or LMIC authors had significantly lower rates of LIC or LMIC first authorship (93.3% versus 62.5%) and last authorship (97.7% versus 70.8%). Conclusions: Our study presents one of the first analyses to assess authorship patterns in the orthopaedic literature of locally published journals in LICs and LMICs. Future studies are needed to contextualize our findings within a broader bibliometric landscape in order to better address the ongoing challenges to building research capacity in LICs and LMICs. Clinical Relevance: Our study highlights important observations regarding authorship in international, collaborative research in orthopaedics.