Recurrence rates of diabetic foot ulcers vary widely in the published literature. The aim of this systematic review is to estimate recurrence rates of diabetic foot ulcers. We did a PubMed search and ...performed a review of reference lists for studies reporting recurrence of diabetic foot ulcers. The weighted relative risk (RR) and corresponding 95% confidence interval (CI) for recurrence was estimated. Forty‐nine studies reporting recurrence of diabetic foot ulcers were included. A pooled estimate for recurrence rate was 22.1% per person‐year (py) (95% CI, 19.0‐25.2%). Recurrence rate was 24.9% per py in Europe (95% CI, 20.0%‐29.7%), 17.8% per py in North America (95% CI, 12.7%‐22.9%), 16.9% per py in Africa (95% CI, 4.7%‐29.0%), and 17.0% per py in Asia (95% CI, 11.1%‐23.0%). Turkey had the highest recurrence rate of 44.4% per py (95% CI, 24.9%‐63.9%), and Bangladesh had the lowest of 4.3% per py (95% CI, 2.3%‐6.3%). Recurrence rates of diabetic foot ulcers before 2002, between 2002 and 2008, and after 2008 were 22.2% per py (95% CI, 17.6%‐26.8%), 21.9% per py (95% CI, 17.0%‐26.8%), and 21.8% per py (95% CI, 16.3%‐27.2%), respectively. Recurrence rates of diabetic foot ulcers are high. Recurrence rates vary widely in different regions and have decreased recently. More attention towards recurrence of diabetic foot ulcers is urgently required.
Systematic review of published prevalence of adjacent segment degeneration (ASD) after spine surgery.
To evaluate the prevalence of ASD in patients after cervical and lumbar spine surgery.
ASD is a ...common complication after spine surgery in long-term follow-up. A large body of literature has been reported on the topic, but no meta-analysis of the epidemiological data on ASD has been published
We searched the MEDLINE until March 2012 published in English language that reported the prevalence of ASD after spine surgery. We determined the ASD rates by calculating proportions and 95% confidence interval (CI) for each study and then pooled the data to derive a pooled proportion and 95% CI.
A total of 94 studies with 34,716 patients from 19 countries were included. The occurrence of radiograph ASD ranged from 4.8% to 92.2%, and the pooled prevalence was 29.3% (95% CI, 22.7%-35.8%) by the random-effects model. The occurrence of symptoms ASD ranged from 0.0% to 30.3%, and the pooled prevalence was 7.4% (95% CI, 6.4%-8.5%). In cervical position, the occurrence of radiograph ASD and symptoms ASD was 32.8% (95% CI, 17.8%-47.9%) and 6.3% (95% CI, 4.8%-7.8%); in lumbar position, the occurrence of radiograph ASD and symptoms ASD was 26.6% (95% CI, 21.3%-31.9%) and 8.5% (95% CI, 6.4%-10.7%). In the 0.5- to 2- or less, more than 2- to 5- or less, and more than 5- to 20- or less year diagnosis time, the radiograph ASD prevalence was 21.8% (16.0%-27.6%), 33.6% (21.8%-45.4%), and 37.4% (10.7%-64.1%), respectively; and the symptoms ASD prevalence was 6.5% (4.8%-8.1%), 12.1% (8.2%-16.0%), and 3.2% (2.5%-4.0%), respectively.
Spine surgery is associated with significant risk of ASD. These figures may be useful in the estimation of the burden of the ASD after spine surgery.
People with serious mental illness are at great risk of suicide, but little is known about the suicide rates among this population. We aimed to quantify the suicide rates among people with serious ...mental illness (bipolar disorder, major depression, or schizophrenia).
PubMed and Web of Science were searched to identify studies published from 1 January 1975 to 10 December 2020. We assessed English-language studies for the suicide rates among people with serious mental illness. Random-effects meta-analysis was used. Changes in follow-up time and the suicide rates were presented by a locally weighted scatter-plot smoothing (LOESS) curve. Suicide rate ratio was estimated for assessments of difference in suicide rate by sex.
Of 5014 identified studies, 41 were included in this analysis. The pooled suicide rate was 312.8 per 100 000 person-years (95% CI 230.3-406.8). Europe was reported to have the highest pooled suicide rate of 335.2 per 100 000 person-years (95% CI 261.5-417.6). Major depression had the highest suicide rate of 534.3 per 100 000 person-years (95% CI 30.4-1448.7). There is a downward trend in suicide rate estimates over follow-up time. Excess risk of suicide in males was found 1.90 (95% CI 1.60-2.25). The most common suicide method was poisoning 21.9 per 100 000 person-years (95% CI 3.7-50.4).
The suicide rates among people with serious mental illness were high, highlighting the requirements for increasing psychological assessment and monitoring. Further study should focus on region and age differences in suicide among this population.
Pressure injuries (PIs) have now become a common complication of the elderly patients. Some studies have observed that pressure injuries may increase mortality, but this area of evidence has not been ...evaluated and summarised. The aim of this study was to compare the mortality of patients with pressure injuries and those without pressure injuries. A meta‐analysis of observational studies was performed. PubMed, Cochrane Library, Embase, and Web of Science were searched up to April 2019. Studies about mortality among the elderly patients with and without pressure injuries were included. Methodological quality was assessed by the Newcastle‐Ottawa Scale (NOS). The fixed effect or random effect model was determined by the test of heterogeneity. The subgroup analysis was performed based on the pressure injuries stages, the region, and the type of study design. The meta‐regression analysis was performed to investigate the relationship between the mortality and patients' enrolled year, average age, the incidence of pressure injuries, and gender ratio. The sensitivity analysis was used to explore the impact of an individual study by excluding one at a time. The hazard ratio (HR) and 95% confidence intervals (CIs) in terms of the comparison of two groups were extracted for meta‐analysis. A survival curve between two groups by individual patient‐level was drew. Eight studies with 5523 elderly patients were included in the analysis. Follow‐up periods for the included studies ranged from about 0.5 to 3 years. The elderly patients who complicated with pressure injuries had a higher risk of death. The pooled HR was 1.78 (95% CI 1.46‐2.16). A funnel plot showed no publication bias. Further subgroup analysis showed that HR values for the patient stage 3 to 4 pressure injuries (HR:2.41; 95% CI:1.08‐5.37) were higher than stage 1‐4 and 2‐4 pressure injuries (HR: 1.66; 95% CI: 1.35‐2.05; HR: 1.74; 95% CI: 1.16‐2.60). The meta‐regression analysis found that patients' enrolled year, average age, the incidence of pressure injuries, and gender ratio were not the sources of heterogeneity. Sensitivity analyses showed that the outcomes of the study did not change after removing the Onder's article. The survival curve at the individual patient‐level also indicated that patients complicated with pressure injuries significantly increased the risk of death (HR: 1.958; 95% CI: 1.79‐2.14) in elderly patients. Our meta‐analysis indicated that patients complicated with pressure injuries are estimated to have a two times higher risk on mortality compared with patients without pressure injuries during the 3 years follow‐up period. Particular attention should be given to the elderly patients who are at higher risk for mortality.
Although the SARS-CoV-2 Omicron variant is considered to induce less severe disease, there have been no consistent results on the extent of the decrease in severity.
To compare the clinical outcomes ...of COVID-19–positive patients with Omicron and Delta variant infection.
Searches were implemented up to 8 November 2022 in PubMed, Web of Science, BioRvix, and MedRvix.
Eligible studies were cohort studies reporting the clinical outcomes of COVID-19–positive patients with Omicron and Delta variant infection, including hospitalization, intensive care unit (ICU) admission, receiving invasive mechanical ventilation (IMV), and death.
COVID-19–positive patients with Omicron and Delta variant infection.
Risk of bias was assessed employing the Newcastle-Ottawa Scale.
Random-effect models were employed to pool the ORs and 95% CIs to compare the risk of clinical outcome. I2 was employed to evaluate the heterogeneity between studies.
A total of 33 studies with 6 037 144 COVID-19–positive patients were included in this meta-analysis. In the general population of COVID-19–positive patients, compared with Delta, Omicron variant infection resulted in a decreased risk of hospitalization (10.24% vs. 4.14%, OR = 2.91, 95% CI = 2.35–3.60), ICU admission (3.67% vs. 0.48%, OR = 3.64, 95% CI = 2.63–5.04), receiving IMV (3.93% vs. 0.34%, OR = 3.11, 95% CI = 1.76–5.50), and death (2.40% vs. 0.46%, OR = 2.97, 95% CI = 2.17–4.08). In the hospitalized patients with COVID-19, compared with Delta, Omicron variant infection resulted in a decreased risk of ICU admission (20.70% vs. 12.90%, OR = 1.63, 95% CI = 1.32–2.02), receiving IMV (10.90% vs. 5.80%, OR = 1.65, 95% CI = 1.28–2.14), and death (10.72% vs. 7.10%, OR = 1.44, 95% CI = 1.22–1.71).
Compared with Delta, the severity of Omicron variant infection decreased.
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