Oklahoma State University Medical Center

Introduced in SQL Server 2017, the graph database stores nodes and edges within SQL Server, allowing you to use T-SQL to query graph data. Graph data is specifically oriented around many-to-many relationships. Graph data doesn’t lend itself to traditional relational structures but instead is focused on hierarchies and relationships past those more traditional structures. Graph data is separated from either traditional analytical data, better served by columnstore indexes, or OLTP systems, better served by rowstore indexes. However, when you have a data set that consists of complex hierarchical data, focused on the relationships between that data, the graph database comes into play.

As you have seen throughout the book, query tuning isn’t easy. Microsoft has recognized this and has introduced a large number of automatic performance enhancements into SQL Server over the last four versions. These are all mechanisms to attempt to deal with common query performance issues without forcing people to rewrite their code or restructure their databases. There are many ways that Microsoft can use the internals of the engine to deal with what would have been in the past problematic code. In this chapter, I’ll be covering

Traumatic musculoskeletal injuries may result in chronic pain and mobility limitations, decreasing quality of life, and increasing predisposition to comorbid disorders. Osteopathic manipulative treatment (OMT) utilizes palpatory assessment and application of manual forces as an adjunct intervention for musculoskeletal disease. Multiple studies have demonstrated OMT's potential benefits for a range of disease states, but data on osteopathic OMT are limited. The objective of our study was to understand the potential benefits of a novel OMT for trauma outpatient program for the care of injured patients suffering chronic pain and mobility limitations. In 2021, the New York University (NYU) Langone Hospital-Long Island Level 1 Trauma Center established a novel outpatient OMT for Trauma Program (OTP). We performed a retrospective analysis of OTP patients seen from January 1, 2021 to December 31, 2022 with the chief complaint of refractory chronic (persistent≥3 months since inciting injury) postinjury pain and mobility limitations (inclusion criterion). We excluded patients missing follow-up, then extracted and analyzed patient demographic, injury-specific, and OMT data. Data are presented as frequencies (percentages) or medians (interquartile range [IQR]). Forty-three patients (75.4 % of patients treated at the outpatient OTP) reported a mechanism of injury (MOI). Of these, 30 (69.8 %) met the inclusion criteria, and seven met the exclusion criterion, yielding 23 total patients for the analysis (40.3 % of the total OTP population). 73.9 % were female aged 46 (39-59) years old. Patients presented 3.00 (0.58-20) years since etiologic injury. MOIs included 56.5 % motor vehicle collisions (MVC), 21.7 % falls, 8.7 % penetrating, and 13.0 % sports-related or lifting injuries. Patients reported 3 (2-4) treatment modalities tried and 2 (1-3) medications attempted prior to the OTP. After the first OMT session, 95.7 % of patients reported subjective improvement in pain with a decrease in pain score 3 (3-7) out of 10. After OMT, patients also self-reported ease of activities of daily living (ADLs, 82.6 %), improved sleep hygiene (26.1 %), improved anxiety/mood (65.2 %), and decreased use of analgesic medication (13.0 %). Four (17.4 %) reported post-OMT complication of 2-3 days of self-limited, mild musculoskeletal pain. Univariate logistic regression models demonstrate that OMT benefited patients regardless of time since inciting injury. OMT may benefit refractory chronic traumatic pain and mobility limitations regardless of the time since inciting the injury. This is the first major publication from the OTP and bolsters proof-of-concept for an organized OMT program at a level 1 trauma center. Further study, including comparative analysis with more formalized pain assessments utilizing validated tools as well as standardized OMT session surveys, is warranted.

BackgroundMigraine headache (MH) is a prevalent and complex neurological disorder affecting over one billion individuals worldwide, making it one of the leading causes of years lived with disability. Randomized controlled trials (RCTs) support evidence-based neurology, but whether recent trials provide practice-ready information remains unclear. This study aims to identify common shortcomings in design and reporting; highlight trial features that enhance value to practicing clinicians; and offer recommendations that improve the alignment between MH research and patient-centered care.MethodsWe systematically reviewed RCTs focused on acute or preventive MH interventions indexed in Embase and MEDLINE from January 1, 2019, to December 31, 2024, against a 13-item usefulness criteria that captures clinical utility and transparency. Published RCT search filters were adapted from Cochrane strategies, and the complete strategy is available on Open Science Framework (OSF). Trial characteristics and usefulness predictors were analyzed via descriptive statistics and linear regression models. Risk of bias assessment was not performed due to the unavailability of the planned tool. Our evaluation may be influenced by subjectivity in valuing certain clinical utility criteria.ResultsOur systematic review of 169 MH RCTs reveals a field marked by slow yet measurable progress: while over half (50.9%) surpassed the midpoint on the usefulness scale, fewer than 2% met the threshold for high utility. Notably, patient-centeredness (98.8%) and context placement (66.9%) were commonly satisfied. However, other domains, particularly data availability (1.8%) and economic evaluation (0.6%), remain significantly underdeveloped. A Pearson’s correlation analysis between clinical utility and transparency demonstrated a weakly positive trend (r = 0.23, p < 0.05); however, total usefulness varied, suggesting that policy guidelines have not invoked substantial design changes in MH research.ConclusionThese findings highlight a persistent mismatch between the evidence clinicians need and the trials currently conducted. To bridge this gap, future MH RCTs could broaden eligibility, publish de-identified data and economic analyses, and reflect positive patient outcomes. Strengthening these domains may accelerate translation of research into reliable and equitable MH care for the more than one billion people affected worldwide.Supplementary InformationThe online version contains supplementary material available at 10.1186/s10194-025-02158-1.

BackgroundNaltrexone is a pharmacological intervention widely used for alcohol use disorder (AUD), opioid use disorder (OUD), and several off-label conditions. Systematic reviews (SRs) play a critical role in synthesizing data on the efficacy and safety of such interventions to inform clinical guidelines and decision-making. However, adequate reporting of harms in SRs remains inconsistent, limiting the ability to fully assess the safety profile of naltrexone. This study evaluates completeness of harms reporting and methodological quality in SRs focusing on naltrexone.MethodsA comprehensive search of MEDLINE, EMBASE, Epistemonikos, and the Cochrane Database of Systematic Reviews was conducted. The study employed masked, duplicate screening and data extraction. Included SRs were evaluated for completeness of harms reporting using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) harms checklist and other established frameworks. Methodological quality was appraised using the A MeaSurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) tool, and primary study overlap among SRs was assessed through corrected covered area (CCA) analysis.ResultsA total of 87 SRs were included in the analysis. Only 1.1% (1/87) utilized severity scales to classify harms, and 4.6% (4/87) defined harms in their methods. Nearly half (48.3%) of SRs failed to address harms as either a primary or secondary outcome. A total of 82.8% (72/87) of SRs were rated as “critically low” quality by AMSTAR-2. Statistical analysis revealed a significant relationship between “critically low” AMSTAR-2 ratings and incomplete harms reporting (p = 0.0486). Additionally, four SR pairs demonstrated “high” overlap (>50%) of primary studies, accompanied by inconsistencies in harms reporting.ConclusionOur findings underscore the critical need for improved and standardized harms reporting in SRs on naltrexone. Inconsistent and incomplete reporting limits the ability of clinicians to fully assess the safety profile of naltrexone within systematic reviews. Adopting established frameworks such as PRISMA harms extensions and severity scales is imperative to enhance transparency and reliability in SRs. This study advocates for methodological improvements in SRs to support comprehensive safety evaluations and evidence-based prescribing of naltrexone.

As systematic reviews and meta-analyses (SRMAs) are crucial for treatment development, they must provide guidelines that represent diverse patient demographics to promote equitable health care. As new research and treatment modalities are being developed for geographic atrophy (GA), establishing an equitable research foundation is becoming vitally important to physicians as they personalize their treatment plans. This analysis aims to determine whether SRMAs pertaining to GA are reporting equity-related items utilizing the PROGRESS-Plus framework. We conducted a cross-sectional analysis by searching databases for systematic reviews and meta-analyses concerning GA from the year 2000 to November 2023. From this search, 176 articles returned, but only 57 of them met all the inclusion criteria. After screening the articles for inclusion, data pertaining to PROGRESS-Plus items were extracted. All analyses were conducted in a masked and duplicative fashion.χ 2tests were employed to determine whether associations existed between the variables. From the initial search, 176 articles returned, of which 119 were excluded due to duplication, data unrelated to GA, or because it was animal-based research. Of the remaining 57 studies, 26 (45.6 %) included zero PROGRESS-Plus items. Fewer articles from the US-reported equity items (31.3 %, 5/16) compared to other countries (63.4 %, 26/41), which held statistical significance (p=0.028). The American Academy of Ophthalmology has created initiatives to increase diversity, equity, and inclusion within the subspecialty. By using the PROGRESS-Plus framework, this study concluded that the majority of the articles pertaining to GA do not meet equity item objectives. As these documents aid physicians in developing treatment plans, these findings are concerning as physicians may find it more difficult to individually tailor treatment plans according to each patient's holistic needs. Limitations in this study included unintentional omission or misclassification of research documents despite the comprehensive search string and double-blinded analysis. Furthermore, the results of this study cannot be generalized to other areas of research.

Background: Polycystic ovary syndrome (PCOS) is the leading cause of anovulatory infertility. Although numerous randomized controlled trials (RCTs) have evaluated treatment options, their clinical applicability remains unclear. Objectives: To evaluate

Abstract Background and Aims Cardiovascular disease is a leading cause of mortality, with significant investments in research to improve treatment and prevention. Data sharing enhances transparency, reproducibility, and collaboration, yet data sharing statement (DSS) inclusion remains inconsistent. This study evaluates DSS prevalence, content, and influencing factors in high-impact cardiology journals, examines journal policy influence, and assesses data sharing feasibility by contacting authors who indicated data availability. Methods A cross-sectional analysis was conducted to assess DSS inclusion in top cardiology, selected general medicine, emergency medicine, and orthopaedic surgery journals. A systematic PubMed search identified clinical studies published from 2020 to 2023. Logistic regression models assessed factors associated with DSS inclusion, while thematic analysis categorized DSS content. Corresponding authors who indicated data availability upon request were contacted to evaluate follow-through. Results Among 2941 articles, 1004 (34.14%) included a DSS. Data sharing statement prevalence varied by discipline: cardiology (52%), general medicine (96%), emergency medicine (12%), and orthopedic surgery (14%). Policy enforcement drove DSS inclusion, with post-policy articles significantly more likely to contain a DSS. Funding status, study design, article access, and impact factor also influenced DSS presence. Thematic analysis identified conditional availability and gatekeeping as dominant DSS themes. Of authors who stated data were available upon request, only 31% ultimately provided access. Conclusions Data sharing statement inclusion in cardiology research remains inconsistent, with journal policies playing a key role in increasing prevalence. However, real-world data-sharing practices often fall short of stated commitments. Addressing logistical and financial barriers will be essential to improving data availability in cardiology research.