scholarly journals Use of Platelet-Rich Fibrin in the Treatment of Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Liang Chen ◽  
Yi Ding ◽  
Guoping Cheng ◽  
Shu Meng
Keyword(s):  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Periodontal Regeneration ◽  
Risk Of Bias ◽  
Secondary Outcome ◽  
Intrabony Defects ◽  
Platelet Rich Fibrin ◽  
Probing Depth ◽  
Autologous Platelet Concentrate ◽  
Depth Reduction

Background. Platelet-rich fibrin (PRF) is a kind of autologous platelet concentrate which is easy to obtain and cheap. In recent years, it has been studied to improve the effect of periodontal regeneration. However, few studies have systematically evaluated the complementary effect of PRF in the treatment of intrabony defects. The present review is aimed at systematically assessing the effects of PRF on clinical and radiological outcomes of the surgical treatment of periodontal intrabony defects. Methods. The protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews) as CRD42020206056. An electronic search was conducted in MEDLINE, Cochrane, and EMBASE databases. Only randomized clinical trials were selected. Systematically healthy patients with two or three walls of intrabony defects were considered. Intrabony defect (IBD) depth reduction and bone fill (BF) % were set as primary outcomes while probing depth (PD) reduction, clinical attachment level (CAL) gain, and gingival margin level (GML) gain were considered as the secondary outcome. When possible, a meta-analysis was performed. Results. Eighteen articles fulfilled the inclusion criteria, and seventeen studies were quantitatively analyzed. Of 17 studies, four were rated as high risk of bias and thirteen as the moderate risk of bias. Two comparisons were set: (1) open flap debridement (OFD) combined with PRF and OFD alone and (2) bone grafting (BG) combined with PRF and BG alone. Compared to OFD alone, OFD+PRF showed significantly greater in all primary and secondary outcomes. Compared to BG alone, BG+PRF showed significantly greater in IBD depth reduction, PD reduction, CAL gain, and GML gain. Conclusions. The use of PRF was significantly effective in the treatment of periodontal intrabony defects. The benefit of OFD+PRF may be greater than BG+PRF. PRF can promote early wound healing in periodontal surgery. As all included studies were not at low risk of bias, well-designed RCTs having a high methodological quality are needed to clarify the additional effectiveness of PRF in the treatment of intrabony defects in the future.

scholarly journals Platelet Rich Fibrin and Bone Graft in the Treatment of Intrabony Defect in Periodontitis Patients

2018 ◽  
Vol 2 (2) ◽  
pp. 49-55
Author(s):  
Shilu Shrestha ◽  
Surendra Man Shrestha ◽  
Ameena Pradhan ◽  
Shreeya Aryal
Keyword(s):  
Bone Graft ◽  
Graft Material ◽  
Intrabony Defects ◽  
Pocket Depth ◽  
Porous Hydroxyapatite ◽  
Platelet Rich Fibrin ◽  
Polypeptide Growth Factors ◽  
Radiographic Outcomes ◽  
Probing Depth ◽  
Depth Reduction

Background: Porous hydroxyapatite and β-tricalcium phosphate (β-TCP + HA) bone grafting material has resulted in clinically acceptable responses when used to fill the periodontal intrabony defects. PRF is an autologous leukocyte and platelet preparation that concentrates various polypeptide growth factors which therefore holds potential to be used as regenerative treatment for periodontal defects. Aim: The purpose of this study was to evaluate clinical and radiographic outcomes in periodontal intrabony defects treated with platelet rich fibrin compared to alloplastic bone graft material. Materials and Methods: Twenty subjects (10 subject per group, one site/subject) were treated either with platelet rich fibrin or alloplastic bone graft (30% β-TCP+ 70% HA). Primary clinical parameters: PD, CAL were taken at baseline, three months, six months and nine months post-operatively. Standardised radiographic data were collected at baseline, six months and nine months postoperatively. Results: Preoperative parameters were similar for both groups. Postsurgical measurements revealed a greater reduction in pocket depth in bone graft group (2.5 mm), greater CAL gain (2.2 mm) and greater defect fill (1.30 mm) as compared to platelet rich fibrin group (1.50 mm, 1.6 mm and 0.80 mm respectively ) at nine months. Conclusion: Treatment of intrabony defects with alloplast (30% β TCP+ 70% HA) or platelet rich fibrin both resulted in a significant probing depth reduction, CAL gain and bone depth reduction, with significantly better improvement in bone graft group.

scholarly journals Outcomes of Ivermectin in the treatment of COVID-19: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Alex Castañeda-Sabogal ◽  
Diego Chambergo-Michilot ◽  
Carlos J. Toro-Huamanchumo ◽  
Christian Silva-Rengifo ◽  
José Gonzales-Zamora ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Case Series ◽  
Risk Of Bias ◽  
Hospitalized Patients ◽  
Secondary Outcome ◽  
Inverse Variance ◽  
Retrospective Cohort Studies ◽  
Meta Analyses

AbstractBackgroundTo assess the outcomes of ivermectin in ambulatory and hospitalized patients with COVID-19.MethodsFive databases and websites for preprints were searched until January 2021 for randomized controlled trials (RCTs) and retrospective cohorts assessing ivermectin versus control in ambulatory and hospitalized participants. The primary outcome was overall mortality. Secondary outcome was recovered patients. For meta-analysis, random-effects and inverse variance meta-analyses with logarithmic transformation were performed. ROBINS-I for cohort studies, and the Cochrane Risk of Bias 2.0 tool for trials were used. The strength of evidence was assessed using GRADE.ResultsAfter the selection, twelve studies (five retrospective cohort studies, six randomized clinical trials and one case series), were included. In total, 7412 participants were reported, the mean age was 47.5 (SD 9.5) years, and 4283 (58%) were male. Ivermectin was not associated with reduced mortality (logRR: 0.89, 95% CI 0.09 to 1.70, p = 0.04, I2= 84.7%), or reduced patient recovery (logRR 5.52, 95% CI -24.36 to 35.4, p = 0.51, I2 = 92.6%). All studies had a high risk of bias, and showed a very low certainty of the evidence.ConclusionsThere insufficient certainty and quality of evidence to recommend the use of ivermectin to prevent or treat ambulatory or hospitalized patients with COVID-19.

Novel oral anticoagulats for the treatment of left ventricle thrombosis: a systematic review and meta-analysis

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Serenelli ◽  
F Vitali ◽  
R Pavasini ◽  
E Tonet ◽  
G Pompei ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Ventricular Thrombus

Abstract Funding Acknowledgements Type of funding sources: None. Background novel oral anticoagulants (NOACs) are not guideline-recommanded treatment for left ventricular thrombus.  Purpose: the aim of this meta-analysis is to compare NOACs versus vitamin-K atagonsits (VKAs) efficacy in treating left ventricular thrombus (LVT). Methods: we systematically searched MEDLINE, Cochrane Library, Biomed Central, and Web of Science for trials comparing NOACs versus VKAs in the setting of LVT. Five studies, out of the 74 initially selected after first screening, were included in the meta-analysis. For the development of this meta-analysis, the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. The shortlisted studies were retrieved as full articles and appraised independently by two unblinded reviewers. The Mantel-Haensel method with a random effect model was used for the pooled analysis. The primary outcome was the occurrence of stroke and systemic embolism. Secondary outcome was occurrence of left ventricular thrombosis resolution during treatment.  Results: 707 patients were included in the analysis for the primary outcome. Of these, 230 were treated with NOACs and 477 with VKAs. The pooled OR for the primary outcome was 0.71 (95% CI 0.18-2.86, I2 67%), thus showing similar effect in term of ischaemic protection. A total of 698 patients, 228 on NOACs and 470 on VKAs were included in the analysis of the secondary outcome. The pooled OR for the secondary outcome pooled OR 0.97, 95% CI 0.56-1.68, I2 46%. Conclusions and Relevance: NOACs seem to have a similar efficacy profile compare to VKAs and so they should be considered as an alternative treatment for left ventricular thrombosis. Large prospective randomized clinical trials are needed to confirm this exploratory finding. Abstract Figure 1

Dexamethasone in Patients with Spontaneous Intracerebral Hemorrhage: An Updated Meta-Analysis

2020 ◽  
Vol 49 (5) ◽  
pp. 495-502
Author(s):  
Stephanie Wintzer ◽  
Josef Georg Heckmann ◽  
Hagen B. Huttner ◽  
Stefan Schwab
Keyword(s):  
Clinical Trials ◽  
High Risk ◽  
Intracerebral Hemorrhage ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Control Groups ◽  
Language Data ◽  
Negative Effect

<b><i>Background:</i></b> Spontaneous intracerebral hemorrhage (ICH) is a frequent cerebrovascular disorder and still associated with high mortality and poor clinical outcomes. The purpose of this review was to update a 15-year-old former meta-analysis on randomized clinical trials (RCTs) addressing the question of whether ICH patients treated with dexamethasone have better outcomes than controls. <b><i>Methods:</i></b> The electronic databases PubMed, SCOPUS, and Cochrane as well as web platforms on current clinical trials were searched for the years 1970–2020 without constriction on language. Data were extracted and outcomes were pooled for conventional and cumulative meta-analysis using a commercial software program (www.Meta-Analysis.com). <b><i>Results:</i></b> Finally, 7 RCTs were identified and analyzed including 248 participants in the dexamethasone groups and 242 in the control groups. Five studies showed a high risk of bias. The overall relative risk (RR) for death was 1.32 (95% confidence interval [CI] 0.99–1.76; <i>p</i> = 0.06) and did not differ significantly between the 2 groups. After exclusion of studies with high risk of bias, the RR for death was 1.37 (95% CI 0.54–3.42; <i>p</i> = 0.51). The RR for poor outcome did not differ significantly between the 2 groups analyzed for all included studies (RR = 0.69; 95% CI 0.47–1; <i>p</i> = 0.05) and after exclusion of studies with high risk of bias (RR = 0.7; 95% CI 0.45–1.08; <i>p</i> = 0.11). The RR for complications did not differ significantly including all studies (RR = 1.29; 95% CI 0.77–2.17; <i>p</i> = 0.34) and after exclusion of studies with high risk of bias (RR = 1.27; 95% CI 0.18–8.89; <i>p</i> = 0.81). The cumulative statistics delivered no other results; however, it pointed out fewer complications over time in the dexamethasone group. <b><i>Conclusion:</i></b> Clear evidence of a beneficial or negative effect of dexamethasone is still lacking. Modern RCTs or observational studies with propensity design are necessary to evaluate the efficacy and safety of treatment with dexamethasone in patients with ICH.

scholarly journals Xuezhikang Capsule for Type 2 Diabetes with Hyperlipemia: A Systematic Review and Meta-Analysis of Randomized Clinical Trails

2015 ◽  
Vol 2015 ◽  
pp. 1-13
Author(s):  
Min Li ◽  
Qingyong He ◽  
Yinfeng Chen ◽  
Bo Li ◽  
Bo Feng ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Large Scale ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Group 5 ◽  
Xuezhikang Capsule ◽  
Clinical Trails ◽  
Unclear Risk

Objective. To evaluate the efficacy and safety of Xuezhikang capsule treating type 2 diabetes with hyperlipidemia.Methods. We searched six databases to identify relevant studies published before January 2015. Two review authors independently extracted data and assessed the Cochrane risk of bias tool. We resolved disagreements with this assessment through discussion and a decision was achieved by consensus.Results. We included 21 studies (1548 participants). Treatment courses were at least 8 weeks. Overall, the risk of bias of included trials was unclear. Among them, 16 studies could conduct meta-analysis. The result showed that compared with routine group (5 studies), Xuezhikang group had more effect on decreasing TC, TG, LDL-C, and rising HDL-C. However, compared with statins group (11 studies), Xuezhikang group has less effect on decreasing TC, TG, and rising HDL-C. Meanwhile, two groups had no statistical differences of LDL-C level.Conclusion. Xuezhikang capsule may be effective for treating type 2 diabetes with hyperlipemia. Our findings should be considered cautiously due to unclear risk of bias of the included studies and low methodological quality. Therefore, more strictly designed large-scale randomized clinical trials are needed to evaluate the efficacy of Xuezhikang capsule in type 2 diabetes with hyperlipemia.

What is the Efficacy of Beta-tricalcium Phosphate as Graft Material in Periodontal Infra-bony Defects? Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Reham Al-Jasser ◽  
Abdulelah AlSubaie ◽  
Fayez Alshehri
Keyword(s):  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Controlled Study ◽  
Bony Defect ◽  
Graft Material ◽  
Inclusion Criteria ◽  
Pocket Depth ◽  
Clinical Attachment Level ◽  
Attachment Level ◽  
Depth Reduction

Abstract Background: β-TCP is a synthetic grafting material (alloplasts)that can be used as allografts and xenografts in peridontal periodontal infra-bony defect. However, it is important to compare this material outcomes in such treatments when comparted to others Therefore, the aim of this review is to evaluate the effectiveness of β-TCP in the regeneration of periodontal infra-bony defect. Methods: Three electronic databases (Cochrane, Pubmed, Embase) were searched up to March 2020. The inclusion criteria consist of regeneration of periodontal infra-bony defect via implementation of β-TCP in combination with other bone graft materials. Outcomes consisted of pocket depth reduction, clinical attachment level gain and bone fill. Results: Five studies were included according to inclusion criteria. β-TCP found to be superior than debridement alone while it shown comparable result to other bone grafts materials in term of pocket depth reduction, clinical attachment level gain and bone fill. the outcomes of the regenerative procedures of periodontal infra-bony defect with the use of β-TCP in combination with other growth factors seems to be superior than alone. Conclusion: β-TCP seems to be a promising material to be used in periodontal infra-bony defect regeneration. However, randomized clinical trials with larger sample size and more controlled study design are needed to support the findings.

scholarly journals Vaccines to prevent COVID-19: a protocol for a living systematic review with network meta-analysis including individual patient data (The LIVING VACCINE Project)

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Steven Kwasi Korang ◽  
Sophie Juul ◽  
Emil Eik Nielsen ◽  
Joshua Feinberg ◽  
Faiza Siddiqui ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Individual Patient Data ◽  
Viral Vector ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Serious Adverse Events ◽  
Meta Analyses ◽  
Harmful Effects

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) which has rapidly spread worldwide. Several human randomized clinical trials assessing potential vaccines are currently underway. There is an urgent need for a living systematic review that continuously assesses the beneficial and harmful effects of all available vaccines for COVID-19. Methods/design We will conduct a living systematic review based on searches of major medical databases (e.g., MEDLINE, EMBASE, CENTRAL) and clinical trial registries from their inception onwards to identify relevant randomized clinical trials. We will update the literature search once a week to continuously assess if new evidence is available. Two review authors will independently extract data and conduct risk of bias assessments. We will include randomized clinical trials comparing any vaccine aiming to prevent COVID-19 (including but not limited to messenger RNA; DNA; non-replicating viral vector; replicating viral vector; inactivated virus; protein subunit; dendritic cell; other vaccines) with any comparator (placebo; “active placebo;” no intervention; standard care; an “active” intervention; another vaccine for COVID-19) for participants in all age groups. Primary outcomes will be all-cause mortality; a diagnosis of COVID-19; and serious adverse events. Secondary outcomes will be quality of life and non-serious adverse events. The living systematic review will include aggregate data meta-analyses, trial sequential analyses, network meta-analyses, and individual patient data meta-analyses. Within-study bias will be assessed using Cochrane risk of bias tool. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) and Confidence in Network Meta-Analysis (CINeMA) approaches will be used to assess certainty of evidence. Observational studies describing harms identified during the search for trials will also be included and described and analyzed separately. Discussion COVID-19 has become a pandemic with substantial mortality. A living systematic review assessing the beneficial and harmful effects of different vaccines is urgently needed. This living systematic review will regularly inform best practice in vaccine prevention and clinical research of this highly prevalent disease. Systematic review registration PROSPERO CRD42020196492

scholarly journals Effect of dose administration aids on adherence to self-administered medications: a systematic review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030536
Author(s):  
Kanika Chaudhri ◽  
Madeleine Kearney ◽  
Richard O Day ◽  
Anthony Rodgers ◽  
Emily Atkins
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
Meta Analysis ◽  
Study Participant ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Dose Administration ◽  
Common Solution ◽  
The Impact

IntroductionForgetting to take a medication is the most common reason for non-adherence to self-administered medication. Dose administration aids (DAAs) are a simple and common solution to improve unintentional non-adherence for oral tablets. DAAs can be in the form of compartmentalised pill boxes, automated medication dispensing devices, blister packs and sachets packets. This protocol aims to outline the methods that will be used in a systematic review of the current literature to assess the impact of DAAs on adherence to medications and health outcomes.Methods and analysisRandomised controlled trials will be identified through electronic searches in databases including EMBASE, MEDLINE, CINAHL and the Cochrane Library, from the beginning of each database until January 2020. Two reviewers will independently screen studies and extract data using the standardised forms. Data extracted will include general study information, characteristics of the study, participant characteristics, intervention characteristics and outcomes. Primary outcome is to assess the effects of DAAs on medication adherence. Secondary outcome is to evaluate the changes in health outcomes. The risk of bias will be ascertained by two reviewers in parallel using The Cochrane Risk of Bias Tool. A meta-analysis will be performed if data are homogenous.Ethics and disseminationEthics approval will not be required for this study. The results of the review described within this protocol will be disseminated through publication in a peer-reviewed journal and relevant conference presentations.PROSPERO registration numberCRD42018096087

scholarly journals Use of Platelet-Rich Fibrin in the Treatment of Grade 2 Furcation Defects: Systematic Review and Meta-Analysis

2020 ◽  
Vol 9 (7) ◽  
pp. 2104
Author(s):  
Francesco Tarallo ◽  
Leonardo Mancini ◽  
Luciano Pitzurra ◽  
Sergio Bizzarro ◽  
Michele Tepedino ◽  
...  
Keyword(s):  
Bone Graft ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Low Risk ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Platelet Rich Fibrin ◽  
Furcation Defects ◽  
Secondary Outcomes

In periodontitis patients, furcation defects are crucial sites to regenerate due to their complex anatomy. Various modern surgical techniques and use of biomaterials have been suggested in the literature. Among all, platelet-rich fibrin (PRF) has potential in tissue regeneration thanks to its role in the release of growth factors. Therefore, the purpose of this study was to evaluate the beneficial effect of the addition of PRF to open flap debridement (OFD) or as an adjuvant to other biomaterials such as bone grafts in the treatment of grade 2 mandibular furcation defects. Systematic research was carried out on the databases Medline, Scopus, Embase, and Cochrane Library and registered on PROSPERO (CRD42020167662). According to the PICO guidelines by Cochrane, randomized trials and prospective non-randomized trials were evaluated, with a minimum follow-up period of 6 months. The inclusion criteria were the absence of systemic diseases, non-smoking patients, and a population aged from 18 to 65 years. Vertical pocket probing depth (PPD), vertical clinical attachment level (VCAL), and gingival recession (REC) were the primary outcomes. Vertical furcation depth (VFD), and the percentage of bone defect fill (%v-BDF) were considered as secondary outcomes. A meta-analysis of the primary and secondary outcomes was performed. Publication bias was assessed through a funnel plot. Eighty-four articles were initially extracted. Eight randomized clinical trials were analyzed according to the exclusion and inclusion criteria. The Quality assessment instrument (QAI) revealed four articles at low risk of bias, one at moderate, and three at high risk of bias. The metanalysis showed significant data regarding PPD, VCAL, VFD and %v-BDF in the comparison between PRF + OFD vs. OFD alone. The adjunct of PRF to a bone graft showed a significant difference for VCAL and a not statistically significant result for the other involved parameters. In conclusion, the adjunctive use of PRF to OFD seems to enhance the periodontal regeneration in the treatment of grade 2 furcation defects. The combination of PRF and bone graft did not show better clinical results, except for VCAL, although the amount of literature with low risk of bias is scarce. Further well-designed studies to evaluate the combination of these two materials are therefore needed.

scholarly journals Effectiveness of physical activity interventions for overweight and obesity during pregnancy: a systematic review of the content of behaviour change interventions

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Caragh Flannery ◽  
Milou Fredrix ◽  
Ellinor K. Olander ◽  
Fionnuala M. McAuliffe ◽  
Molly Byrne ◽  
...  
Keyword(s):  
Systematic Review ◽  
Physical Fitness ◽  
Pregnant Women ◽  
Behaviour Change ◽  
Meta Analysis ◽  
Intervention Group ◽  
Overweight And Obesity ◽  
Risk Of Bias ◽  
The Other ◽  
Secondary Outcome

Abstract Background Behaviour change techniques (BCTs) employed within PA intervention for pregnant women with a healthy body mass index (BMI) have been previously identified, however, these BCTS may differ for other weight profiles during pregnancy. The aim of this current review was to identify and summarise the evidence for effectiveness of PA interventions on PA levels for pregnant women with overweight and obesity, with an emphasis on the BCTs employed. Methods A systematic review and meta-analysis of PA intervention studies using the PRISMA statement was conducted. Searches were conducted of eight databases in January 2019. Strict inclusion/exclusion criteria were employed. The validity of each included study was assessed using the Cochrane Collaboration’s tool for assessing risk of bias. The primary outcome measure was change in PA levels, subjectively or objectively measured, with physical fitness as a secondary outcome. All intervention descriptions were double coded by two authors using Michie’s et al’s BCT taxonomy V1. Meta-analyses using random effect models assessed the intervention effects on PA. Other PA outcomes were summarised in a narrative synthesis. Results From 8389 studies, 19 met the inclusion criteria 13 of which were suitable for inclusion in a meta-analysis. The remaining 6 studies were described narratively due to insufficient data and different outcome measures reported. In the meta-analysis, comparing interventions to a control group, significant increases were found in the intervention group for metabolic equivalent (SMD 0.39 [0.14, 0.64], Z = 3.08 P = 0.002) and physical fitness (VO2 max) (SMD 0.55 [0.34, 0.75], Z = 5.20 P = < 0.001). Of the other six, five studies reported an increase in PA for the intervention group versus the control with the other study reporting a significant decrease for women in their 3rd trimester (p = 0.002). ‘Self-monitoring of behaviour’ was the most frequently used BCTs (76.5%), with ‘social support’ being newly identified for this pregnant population with overweight or obesity. Conclusions This review identified a slight increase in PA for pregnant women with overweight and obesity participating in interventions. However, due to the high risk of bias of the included studies, the results should be interpreted with caution. PA measures should be carefully selected so that studies can be meaningfully compared and standardised taxonomies should be used so that BCTs can be accurately assessed.

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