Modified sutureless and glue-free method versus conventional sutures for conjunctival autograft fixation in primary pterygium surgery: a systematic review and meta-analysis.

BACKGROUND: Pterygium is a common ocular surface disorder that requires surgical intervention for treatment. Conjunctival autografts are preferred over simple excision due to lower recurrence rates. This systematic review and meta-analysis compared the modified sutureless glue-free (MSGF) method with conventional sutures (CS) for conjunctival autograft fixation in primary pterygium surgery. METHODS: A comprehensive search was conducted in MEDLINE, Embase, CENTRAL, Google Scholar and ClinicalTrials.gov for randomised controlled trials (RCTs) comparing MSGF and CS conjunctival autografts. Outcome measures included operation time, recurrence and postoperative complications. Standardised mean difference (SMD) and risk ratio (RR) were used for continuous and dichotomous outcomes, respectively. RESULTS: 11 RCTs involving 833 participants were included. The analysis revealed that MSGF had a significantly shorter operation time compared with CS (SMD -3.704, 95% CI -5.122 to -2.287, p<0.001). CS was associated with a higher risk of foreign body sensation (RR 0.22, 95% CI 0.06 to 0.74, p=0.01). MSGF was associated with a higher risk of graft dehiscence (RR 9.01, 95% CI 2.74 to 29.68, p=0.000) and graft retraction (RR 2.37, 95% CI 1.17 to 4.77, p=0.02). No significant differences were found in recurrence, graft haemorrhage, granuloma, Dellen and conjunctival oedema. CONCLUSION: Using the MSGF technique in conjunctival autograft fixation for pterygium surgery reduces operation time by relying solely on the patient's blood for fixation. However, it increases the risk of graft dehiscence and retraction. However, CS is linked to a higher likelihood of experiencing foreign body sensations. Understanding the learning curve and surgeon familiarity with novel techniques is crucial for optimising patient care and surgical outcomes, while individualised decision-making is necessary considering the advantages and disadvantages of each approach. Further research is warranted to minimise complications and optimise surgical outcomes.

Assessment of Auscultation Skills Among Junior and Senior Healthcare Providers for Pediatric Patients: A Retrospective Study.

Background Heart murmurs are defined as whooshing or swishing sounds, unlike the normal lub-dub sounds detected by physicians while using a stethoscope. They usually develop due to numerous pathologies, with congenital defects accounting for the majority of pediatric murmurs. Few studies have addressed the difference in auscultating skills between senior and junior healthcare providers. Therefore, this study aims to collect local data on this topic as well as identify the gap between experienced and inexperienced providers in their ability to accurately detect heart murmurs. Methodology This study utilizes a quantitative retrospective design to collect data from King Abdulaziz Medical City and King Faisal Cardiac Centre, Saudi Arabia, from October 1, 2018, to September 30, 2019. The medical records of 292 pediatric patients, who were 14 years of age or below according to the centers' aging system, were collected from the Hospital Information System (BESTCare). Subsequently, it was determined whether a senior (R3-R4 residents and above) or a junior (R1-R2 residents and interns) healthcare provider ordered an echocardiogram (ECHO). Finally, using the centers' imaging system (Xcelera) the exact reason for referral, heart murmurs in the case of this study, was obtained, as well as whether a pathologic cause of a murmur was seen in the ECHO image. By obtaining the aforementioned data, the accuracy of each referral was analyzed using statistical analysis software. Results ECHO results were categorized into positive and negative outcomes depending on the presence of a structural heart defect, patent foramen ovale (PFO) was considered negative as it causes innocent murmurs. The majority of positive results were atrial septal defects, patent ductus arteriosus, and ventricular septal defects. The majority of negative results were either a structurally normal heart or PFO, which a great number of providers ordered an ECHO for. The Pearson score p-value using the chi-square test was 0.432, leading to the conclusion that junior and senior providers had a similar accuracy of referrals during the study period. Conclusions Junior healthcare providers display sufficient knowledge of heart murmur auscultation skills similar to senior healthcare providers during the study period. However, because the data only included two local centers with a limited sample and the absence of further local research on this topic, it is necessary to conduct studies of a larger scope on this topic.