Moderate versus deep sedation in adults undergoing colonoscopy: systematic review and meta-analysis

Objective: To perform a systematic review and meta-analysis comparing effectiveness and safety of moderate and deep sedation during colonoscopy.

Research design and methods: We searched Medline, Embase, Central and Google scholar in May 2017 and updated in March 2018 to identify all randomized controlled trials that compared the effectiveness and safety of moderate and deep sedation during colonoscopy. The quality of studies was assessed using the “Risk of bias” tool. The primary endpoints were defined as patient satisfaction, physician satisfaction, incidence of recall and incidence of desaturation. Recovery time was also evaluated. Review Manager and Comprehensive Meta-Analysis software were used for statistical analysis.

Results: A total of 919 patients from three studies were included in the final analysis. The combined analysis did not reveal any differences in patient satisfaction between moderate and deep sedation (RR?=?0.94; 95% CI: 0.86 to 1.04; P_chi²?=?0.06; I²?=?65%; number needed to treat to harm [NNTH]?=?15.6; 95% CI: NNTH 7.8 to ∞ to number needed to treat to benefit [NNTB]?=?3078.0), physician satisfaction (RR?=?0.35; 95% CI: 0.02 to 6.95; P_chi² < 0.001; I²?=?100%; NNTB?=?1.6; 95% CI: 1.5 to 1.8), incidence of recall (RR?=?5.82; 95% CI: 0.51 to 66.48; P_chi²?=?0.11; I²?=?60%; NNTH?=?11.0; 95% CI: 7.5 to 20.5) or recovery time (mean difference?=?-6.77; 95% CI: -16.21 to 2.67; P_chi² < 0.001; I²?=?99%). However, incidence of desaturation was higher in the deep group than in the moderate group (RR?=?0.18; 95% CI: 0.01 to 0.99; P_chi²?=?0.48; I²?=?0%; NNTB?=?56.7; 95% CI: 31.6 to 273.1).

Conclusions: Moderate sedation showed comparable safety and effectiveness to deep sedation with respect to patient satisfaction, physician satisfaction, incidence of recall and recovery time.     

Concurrent removal of Cr(III), Cu(II), and Pb(II) ions from water by multifunctional TiO2/Alg/FeNPs beads

The use of multifunctional materials for water remediation is a modern approach where adsorption phenomena and heterogeneous photocatalysis can be applied for the removal of pollutants. Since the ideal remediation system should be able to remove both organic and inorganic pollutants, a crucial aspect to consider is the knowledge of operational parameters affecting the removal process, especially when heavy metal ions are present in concoction as in real systems. Given the proven efficiency of multifunctional TiO₂/Alg/FeNPs magnetic beads for the removal of model organic pollutants, this study investigated the possibility to exploit such system also for the removal of mixed heavy metals (MHM), specifically Cr(III), Cu(II), and Pb(II) ions, under ultraviolet irradiation at a wavelength of 254 nm. After a preliminary screening on the optimal catalyst loading, operating parameters such as the initial concentration of metal ions, contact and irradiation time, and pH were investigated to optimize the removal of metal ions using response surface methodology (RSM) via Box–Behnken design. Starting from a MHM solution containing 44 ppm of each metal ion, the removal of Pb(II), Cr(III), and Cu(II) ions in the aqueous solution was nearly completed (>98.4%) for all three ions within 72 min of irradiation at almost neutral pH (pH = 6.8). The stability of TiO₂/Alg/FeNPs was confirmed by retrieving and reusing the beads in three consecutive cycles of heavy metals removal without observing significant changes in catalyst efficiency.     

Shear Wave Elastography: A Review on the Confounding Factors and Their Potential Mitigation in Detecting Chronic Kidney Disease

Early detection of chronic kidney disease is important to prevent progression of irreversible kidney damage, reducing the need for renal transplantation. Shear wave elastography is ideal as a quantitative imaging modality to detect chronic kidney disease because of its non-invasive nature, low cost and portability, making it highly accessible. However, the complexity of the kidney architecture and its tissue properties give rise to various confounding factors that affect the reliability of shear wave elastography in detecting chronic kidney disease, thus limiting its application to clinical trials. The objective of this review is to highlight the confounding factors presented by the complex properties of the kidney, in addition to outlining potential mitigation strategies, along with the prospect of increasing the versatility and reliability of shear wave elastography in detecting chronic kidney disease.     

The Development and Operation of a Home Management System during the COVID-19 Pandemic: Experience of the Local Government Gyeonggi-do in Korea

During the three the coronavirus disease 2019 (COVID-19) surges in South Korea, there was a shortage of hospital beds for COVID-19 patients, and as a result, there were cases of death while waiting for hospitalization. To minimize the risk of death and to allow those confirmed with COVID-19 to safely wait for hospitalization at home, the local government of Gyeonggi-do in South Korea developed a novel home management system (HMS). The HMS team, comprised of doctors and nurses, was organized to operate HMS. HMS provided a two-way channel for the taskforce and patients to monitor the severity of patient''s condition and to provide healthcare counseling as needed. In addition, the HMS team cooperated with a triage/bed assignment team to expedite the response in case of an emergency, and managed a database of severity for real-time monitoring of patients. The HMS became operational for the first time in August 2020, initially managing only 181 patients; it currently manages a total of 3,707 patients. The HMS supplemented the government''s COVID-19 confirmed case management framework by managing patients waiting at home for hospitalization due to lack of hospital and residential treatment center beds. HMS also could contribute a sense of psychological stability in patients and prevented the situation from worsening by efficient management of hospital beds and reduction of workloads on public healthcare centers. To stabilize and improve the management of COVID-19 confirmed cases, governments should organically develop self-treatment and HMS, and implement a decisive division of roles within the local governments.