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Wagner G, Ringeval M, Raymond L, Paré G. Digital health competences and AI beliefs as conditions for the practice of evidence-based medicine: a study of prospective physicians in Canada. MEDICAL EDUCATION ONLINE 2025; 30:2459910. [PMID: 39890587 PMCID: PMC11789221 DOI: 10.1080/10872981.2025.2459910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 12/14/2024] [Accepted: 01/19/2025] [Indexed: 02/03/2025]
Abstract
BACKGROUND The practice of evidence-based medicine (EBM) has become pivotal in enhancing medical care and patient outcomes. With the diffusion of innovation in healthcare organizations, EBM can be expected to depend on medical professionals' competences with digital health (dHealth) and artificial intelligence (AI) technologies. OBJECTIVE We aim to investigate the effect of dHealth competences and perceptions of AI on the adoption of EBM among prospective physicians. By focusing on dHealth and AI technologies, the study seeks to inform the redesign of medical curricula to better prepare students for the demands of evidence-based medical practice. METHODS A cross-sectional survey was administered online to students at the University of Montreal's medical school, which has approximately 1,400 enrolled students. The survey included questions on students' dHealth competences, perceptions of AI, and their practice of EBM. Using structural equation modeling (SEM), we analyzed data from 177 respondents to test our research model. RESULTS Our analysis indicates that medical students possess foundational knowledge competences of dHealth technologies and perceive AI to play an important role in the future of medicine. Yet, their experiential competences with dHealth technologies are limited. Our findings reveal that experiential dHealth competences are significantly related to the practice of EBM (β = 0.42, p < 0.001), as well as students' perceptions of the role of AI in the future of medicine (β = 0.39, p < 0.001), which, in turn, also affect EBM (β = 0.19, p < 0.05). CONCLUSIONS The study underscores the necessity of enhancing students' competences related to dHealth and considering their perceptions of the role of AI in the medical profession. In particular, the low levels of experiential dHealth competences highlight a promising starting point for training future physicians while simultaneously strengthening their practice of EBM. Accordingly, we suggest revising medical curricula to focus on providing students with practical experiences with dHealth and AI technologies.
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Affiliation(s)
- Gerit Wagner
- Faculty Information Systems and Applied Computer Sciences, Otto-Friedrich Universität, Bamberg, DE, Germany
| | - Mickaël Ringeval
- Département de technologies de l’information, HEC Montréal, Montréal, CA, Canada
| | | | - Guy Paré
- Département de technologies de l’information, HEC Montréal, Montréal, CA, Canada
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Birkelund L, Dieperink KB, Sodemann M, Lindell JF, Steffensen KD, Nielsen DS. Language - a vital pill missing in patients' treatment: language barriers during cancer care through the eyes of patients and families. Int J Qual Stud Health Well-being 2025; 20:2448127. [PMID: 39801442 PMCID: PMC11731038 DOI: 10.1080/17482631.2024.2448127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 12/26/2024] [Indexed: 01/16/2025] Open
Abstract
PURPOSE When serious illness occurs, effective communication is essential but challenged by language barriers. This study explores how patients with limited Danish proficiency and their families experience language barriers during cancer care in two Danish public hospitals. METHOD Adopting a phenomenological-hermeneutic approach, the study stresses narratives in understanding participants' lived experiences. Accordingly, nine qualitative, semi-structured interviews were conducted with 17 informants, including nine patients and eight relatives. The interviews were audio-recorded and transcribed verbatim. RESULTS Based on analysis, three themes were identified: 1) A history of pain behind the language barrier; 2) Linguistic pain-a feeling of being trapped in mother tongue; and 3) Barriers and pathways to linguistic safety. The findings reveal that painful stories were not only brought into the hospital but continued there. Painful feelings associated with being unable to communicate directly with the healthcare professionals seemed inescapable, but continuity of empathetic care providers, including professional interpreters, increased the well-being of both patients and family members. CONCLUSION Language barriers not only make patients more susceptible to misunderstandings and medical errors but amplify experiences of pain during cancer care. The generated knowledge from this study emphasizes language as a foundational element in advancing more equitable cancer care.
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Affiliation(s)
- Lisbeth Birkelund
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Family Focused Healthcare Research Center, University of Southern Denmark, Odense, Denmark
- Center for Shared Decision Making, Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark
- Research Center for Culture and Older People (Vulnerability), University of Southern Denmark, Odense, Denmark
| | - Karin Brochstedt Dieperink
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Family Focused Healthcare Research Center, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Morten Sodemann
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Infectious Diseases, Migrant Health Clinic, Odense University Hospital, Odense, Denmark
| | - Johanna Falby Lindell
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
| | - Karina Dahl Steffensen
- Center for Shared Decision Making, Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Dorthe Susanne Nielsen
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Research Center for Culture and Older People (Vulnerability), University of Southern Denmark, Odense, Denmark
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Jeyaraman N, Jeyaraman M, Ramasubramanian S, Balaji S, Muthu S. Voices that matter: The impact of patient-reported outcome measures on clinical decision-making. World J Methodol 2025; 15:98066. [DOI: 10.5662/wjm.v15.i2.98066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 09/09/2024] [Accepted: 09/25/2024] [Indexed: 11/27/2024] Open
Abstract
The critical role of patient-reported outcome measures (PROMs) in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research. PROMs encapsulate a patient's health status directly from their perspective, encompassing various domains such as symptom severity, functional status, and overall quality of life. By integrating PROMs into routine clinical practice and research, healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly. The deployment of PROMs supports dynamic patient-provider interactions, fostering better patient engagement and adherence to treatment plans. Moreover, PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy, particularly in chronic and mental health conditions. However, challenges in implementing PROMs include data collection and management, integration into existing health systems, and acceptance by patients and providers. Overcoming these barriers necessitates technological advancements, policy development, and continuous education to enhance the acceptability and effectiveness of PROMs. The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.
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Affiliation(s)
- Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, TN 600077, India
- Department of Research Methods, Orthopaedic Research Group, Coimbatore, TN 641045, India
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, TN 600077, India
- Department of Research Methods, Orthopaedic Research Group, Coimbatore, TN 641045, India
| | - Swaminathan Ramasubramanian
- Department of Orthopaedics, Government Medical College, Omandurar Government Estate, Chennai, TN 600002, India
| | - Sangeetha Balaji
- Department of Orthopaedics, Government Medical College, Omandurar Government Estate, Chennai, TN 600002, India
| | - Sathish Muthu
- Department of Research Methods, Orthopaedic Research Group, Coimbatore, TN 641045, India
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, TN 641021, India
- Department of Orthopaedics, Government Medical College, Karur, TN 639004, India
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Xie X, Huang M, Ma S, Xin Q, Wang Y, Hu L, Zhao H, Li P, Liu M, Yuan R, Miao Y, Zhu Y, Cong W. The role of long non-coding RNAs in cardiovascular diseases: A comprehensive review. Noncoding RNA Res 2025; 11:158-187. [PMID: 39896344 PMCID: PMC11783329 DOI: 10.1016/j.ncrna.2024.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 12/25/2024] [Accepted: 12/26/2024] [Indexed: 02/04/2025] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide, posing significant challenges to healthcare systems. Despite advances in medical interventions, the molecular mechanisms underlying CVDs are not yet fully understood. For decades, protein-coding genes have been the focus of CVD research. However, recent advances in genomics have highlighted the importance of long non-coding RNAs (lncRNAs) in cardiovascular health and disease. Changes in lncRNA expression specific to tissues may result from various internal or external factors, leading to tissue damage, organ dysfunction, and disease. In this review, we provide a comprehensive discussion of the regulatory mechanisms underlying lncRNAs and their roles in the pathogenesis and progression of CVDs, such as coronary heart disease, atherosclerosis, heart failure, arrhythmias, cardiomyopathies, and diabetic cardiomyopathy, to explore their potential as therapeutic targets and diagnostic biomarkers.
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Affiliation(s)
- Xuena Xie
- School of Pharmacy, Faculty of Medicine, Macau University of Science and Technology, Macau SAR, 999078, China
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Meiwen Huang
- School of Pharmacy, Faculty of Medicine, Macau University of Science and Technology, Macau SAR, 999078, China
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Shudong Ma
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
- Faculty of Chinese Medicine, Macau University of Science and Technology, 999078, China
| | - Qiqi Xin
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Yuying Wang
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Lantian Hu
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
- Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Han Zhao
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
- Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Pengqi Li
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Mei Liu
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
- Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Rong Yuan
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Yu Miao
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Yizhun Zhu
- School of Pharmacy, Faculty of Medicine, Macau University of Science and Technology, Macau SAR, 999078, China
| | - Weihong Cong
- School of Pharmacy, Faculty of Medicine, Macau University of Science and Technology, Macau SAR, 999078, China
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
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Leung B, Treleaven J, Dinsdale A, Marsh L, Thomas L. Serious adverse events associated with conservative physical procedures directed towards the cervical spine: A systematic review. J Bodyw Mov Ther 2025; 41:56-77. [PMID: 39663097 DOI: 10.1016/j.jbmt.2024.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 07/16/2024] [Accepted: 10/13/2024] [Indexed: 12/13/2024]
Abstract
BACKGROUND Previous reviews on serious adverse events (SAEs) following physical interventions involving the neck have focused on vascular SAEs or those related to cervical manipulation. OBJECTIVE To review the evidence for all serious adverse events associated with any physical cervical procedures and describe SAE characteristics. METHODS Searches were conducted in PubMed, EMBASE, CINAHL, Scopus, Cochrane, Web of Science and Index to Chiropractic Literature from inception to May 2023 for studies reporting characteristics of SAE following any neck intervention and patient demographics. RESULTS Two hundred and thirty-three studies describing 334 SAE cases were identified. Forty-one were reported in the last 5 years. The results confirmed findings of past reviews with most events being vascular (58%) and mainly arterial dissection or vertebral artery related and the majority involving manipulation (75%). However lesser-known SAES ie neurological (25%), combined vascular/neurological (12%) and others (5%) which included cases such as cerebrospinal fluid leaks, phrenic nerve palsies and retinal detachments were identified. Further, some followed procedures such as vestibular testing, gentle mobilization, exercises, acupuncture or even massage. Initial symptoms included sharp increases in headache/neck pain, nausea, vomiting, dizziness and altered sensation, during treatment or within 48 h, often preceding neurological signs. Most recovered favourably (62%), 16% with disability, 6% died, the rest were unspecified. CONCLUSION Most SAEs were vascular and associated with manipulation but awareness of potential neurological and orthopaedic injuries and other procedures should be raised. Monitoring for early signs of SAEs for up to 48 h post-intervention is advisable if a SAE is suspected.
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Affiliation(s)
- Bryden Leung
- School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Julia Treleaven
- School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Alana Dinsdale
- School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Linda Marsh
- School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Lucy Thomas
- School of Health and Rehabilitation Sciences, University of Queensland, Australia.
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Putera I, La Distia Nora R, Dewi AC, Suhada DS, Cifuentes-González C, Rojas-Carabali W, Patnaik G, Mejia-Salgado G, Sitompul R, Edwar L, Susiyanti M, Aziza Y, Biswas J, Gupta V, de-la-Torre A, Agrawal R. Antiviral therapy for cytomegalovirus retinitis: A systematic review and meta-analysis. Surv Ophthalmol 2025; 70:215-231. [PMID: 39549781 DOI: 10.1016/j.survophthal.2024.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 11/02/2024] [Accepted: 11/13/2024] [Indexed: 11/18/2024]
Abstract
Cytomegalovirus retinitis (CMVR) is a significant cause of blindness in patients with advanced acquired immunodeficiency syndrome (AIDS). There are no established guidelines for its treatment, resulting in varied antiviral approaches. We pooled data from 59 studies (4501 patients) to evaluate treatment variations and outcomes (CRD42022321088). Overall pooled estimates showed visual acuity improvement at 18 % (95 % CI: 7-41 %), inflammation resolution at 90 % (95 % CI: 81-95 %), retinal detachment at 11 % (95 % CI: 8-14 %), and recurrence at 19 % (95 % CI: 11-31 %). The main antiviral treatment approaches identified were: (1) intravenous antivirals alone in 33 studies, (2) intravitreal antivirals alone in 26 studies, (3) oral antivirals alone in 3 studies, and (4) a combination of systemic (oral or intravenous[IV]) and intravitreal antivirals in 7 studies, with varying schemes and durations. Ganciclovir was the predominant antiviral, with intravenous administration being the most reported (in 23 studies), followed by intravitreal administration (in 20 studies). While visual acuity improvement was comparable, inflammation resolution tended to be higher with intravitreal than with IV antivirals, though not statistically significant (88 %, 95 % CI: 69-96 % vs 75 %, 95 % CI: 35-94 %, p = 0.38). Retinitis progression rate for IV ganciclovir was lower than for those without ganciclovir. Inflammation recurrence was significantly lower in antiretroviral (ART)-treated compared to non-ART-treated HIV/AIDS patients (10 % (95 % CI: 4-20 %) vs 33 % (95 % CI: 19-50 %), p < 0.01). Neutropenia, particularly with ganciclovir, was the most reported adverse effect (up to 50 %).
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Affiliation(s)
- Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia; Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Internal Medicine, Section Allergy & Clinical Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia; Department of Internal Medicine, Section Allergy & Clinical Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Arlin Chyntia Dewi
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Ditta Shabrina Suhada
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Carlos Cifuentes-González
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia; Programme for Ocular Inflammation & Infection Translational Research, National Healthcare Group, Singapore, Singapore; National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - William Rojas-Carabali
- Programme for Ocular Inflammation & Infection Translational Research, National Healthcare Group, Singapore, Singapore; Department of Bioinformatics, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | | | - Germán Mejia-Salgado
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Ratna Sitompul
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Lukman Edwar
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Made Susiyanti
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Yulia Aziza
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | | | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Rupesh Agrawal
- Programme for Ocular Inflammation & Infection Translational Research, National Healthcare Group, Singapore, Singapore; Department of Bioinformatics, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, UK; UCL-Institute of Ophthalmology, UK; National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Duke NUS Medical School, Singapore; Singapore Eye Research Institute, Singapore
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Spitler C, Rutz R, Blackwood N, Wally M, Johnson J, Krause P, Ahn J, Mohammed Z, McClure M, Billings R, Yu Z, Yeager M. Management of hip fracture patients on direct oral anticoagulants: a survey of orthopaedic trauma surgeons, systematic review, and meta-analysis. OTA Int 2025; 8:e360. [PMID: 39876981 PMCID: PMC11774270 DOI: 10.1097/oi9.0000000000000360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 12/11/2024] [Accepted: 12/17/2024] [Indexed: 01/31/2025]
Abstract
Objectives This systematic review examined the literature regarding management of fracture patients who take direct oral anticoagulant (DOAC) medications, with a focus on delay in surgical treatment, and need for transfusions. In addition, a survey of orthopaedic trauma surgeons was conducted to gain insight on current practices. Data Sources A review of PubMed, Cochrane, Embase, and Scopus databases was performed from inception through March 2024, including English language publications. Study Selection Studies were included if they reported time to surgery and transfusion rates among fracture patents who were taking DOAC medications. Additional data points were collected on an "if-reported" basis, including mortality, venous thromboembolism, and bleeding complications. Data Extraction In all, 4546 abstracts were screened. Full-text review was conducted on 86 publications, and 25 articles were included in the final analysis. Each article was independently screened by 2 reviewers, with disputes settled by a third reviewer. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool. Data Synthesis Descriptive statistics are reported for overall study findings. Meta-analysis was performed for the variables "time to surgery" and "transfusion rate." Conclusions Our findings indicate that fracture patients taking DOACs experience longer delays before surgery but have equivalent transfusion rates compared with nonanticoagulated patients. Survey results indicate that surgeons do not delay operating on emergent or percutaneous cases, regardless of anticoagulant medications. In circumstances when they do delay, they are more likely to do so for patients taking DOAC medications. Level of Evidence Level III, systematic review and meta-analysis of Level II and III articles.
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Affiliation(s)
- Clay Spitler
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Robert Rutz
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Nigel Blackwood
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Meghan Wally
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC
| | - Joseph Johnson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Peter Krause
- Department of Orthopaedic Surgery, Louisiana State University School of Medicine, New Orleans, LA
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Zuhair Mohammed
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Mark McClure
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Rebecca Billings
- UAB Libraries, University of Alabama at Birmingham, Birmingham, AL
| | - Ziqing Yu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC
| | - Matthew Yeager
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Orthopaedic Trauma Association's Evidence-Based Quality Value and Safety Committee
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC
- Department of Orthopaedic Surgery, Louisiana State University School of Medicine, New Orleans, LA
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
- UAB Libraries, University of Alabama at Birmingham, Birmingham, AL
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Herman PM, Crawford CC, Maglione MA, Newberry SJ, Amieux PS, Blyden-Taylor K, Khorsan R, Prenguber M, Rice E, Shollar A, Tyson T, Vassighi N, Coulter ID. The current state of the quality of homeopathic clinical research. Complement Ther Med 2025; 88:103108. [PMID: 39551363 DOI: 10.1016/j.ctim.2024.103108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 11/04/2024] [Accepted: 11/06/2024] [Indexed: 11/19/2024] Open
Abstract
Homeopathy is a system of therapeutics that treats disease with highly diluted substances based on the Law of Similars, which holds that "like cures like." Despite widespread use, homeopathy lacks a comprehensive and robust evidence base. We examined the state of homeopathic clinical research by critically assessing the overall quality of peer-reviewed, recently published, English-language, homeopathic clinical research in terms of internal, external, and model validity using standard and homeopathic-specific instruments. Further, we convened an international panel of nine experts in research methods and homeopathy to identify gaps in homeopathic research and prioritize areas for future study. We reviewed 99 clinical research studies targeting a wide range of populations and conditions. Studies were conducted in Western and Asian countries, with the largest number (30 percent) conducted in India. Of the 99 studies reviewed, 85 were controlled trials; 79 of these were randomized. There were many areas where the quality of the studies could be improved. About two-thirds of the 85 controlled trials had either high (42 percent) or unclear (24 percent) risk of bias according to internationally recognized standards for internal validity. Of the 14 observational (cohort) studies, over one-third did not control for important confounders in the outcome analyses. Regarding external validity, adherence was reported in less than a third of studies (n=31). Forty percent of studies (79 % of observational studies) did not report on safety. Regarding model validity, fewer than two-thirds of the studies were consistent with homeopathic principles. Our expert panel was mixed on whether the homeopathic research literature was missing important populations and/or conditions, and they suggested a variety of priority areas. Panelists also expressed a variety of opinions about the types of homeopathy that should be prioritized for future study but also noted that since homeopathic practice differs by country, each country may have different priorities. Panelists agreed with the findings of the literature review that the research literature was at least somewhat deficient in all three types of validity. Although our assessment of validity was [by necessity] based only on what was reported, this assessment suggests the need for both better reporting and higher quality research. They recommended the use of reporting guidelines to improve all types of validity, the identification of exemplar studies to help guide researchers to improve internal validity, and, given the limitations of the instruments available to measure external and model validity, that these instruments be validated and configured to provide summary scores. Finally, substantial discussion addressed the need to bring more research expertise into homeopathic studies, both by better training homeopathic researchers and by collaborating with experienced conventional medicine research groups.
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Affiliation(s)
- Patricia M Herman
- RAND, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA.
| | - Cindy C Crawford
- RAND, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA.
| | | | - Sydne J Newberry
- RAND, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA.
| | - Paul S Amieux
- Bastyr University Research Institute, 14500 Juanita Drive NE, Kenmore, WA 98028, USA.
| | | | - Raheleh Khorsan
- Southern California University of the Health Sciences, 16200 E. Amber Valley Drive, P.O. Box 1166, Whittier, CA 90609-1166, USA.
| | - Marcia Prenguber
- University of Western States, 8000 NE Tillamook Street, Portland, OR 97213, USA.
| | - Elizabeth Rice
- Bastyr University San Diego, 4106 Sorrento Valley Boulevard, San Diego, CA 92121, USA.
| | - Andy Shollar
- Southern California University of the Health Sciences, 16200 E. Amber Valley Drive, P.O. Box 1166, Whittier, CA 90609-1166, USA.
| | - Tiesha Tyson
- Southern California University of the Health Sciences, 16200 E. Amber Valley Drive, P.O. Box 1166, Whittier, CA 90609-1166, USA.
| | - Nazanin Vassighi
- Bastyr University San Diego, 4106 Sorrento Valley Boulevard, San Diego, CA 92121, USA.
| | - Ian D Coulter
- RAND, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA.
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Piticchio T, Chiardi I, Tumminia A, Frasca F, Rotondi M, Trimboli P. PEG Precipitation to Detect Macro-TSH in Clinical Practice: A Systematic Review. Clin Endocrinol (Oxf) 2025; 102:235-244. [PMID: 39702982 PMCID: PMC11788973 DOI: 10.1111/cen.15179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 10/31/2024] [Accepted: 11/28/2024] [Indexed: 12/21/2024]
Abstract
Macro-thyroid-stimulating hormone (macro-TSH) is a complex formed by monomeric TSH with anti-TSH antibodies, causing falsely elevated TSH levels and potential misdiagnosis of hypothyroidism. Identification of macro-TSH is essential for proper treatment and patient follow-up. Its diagnostic gold standard is gel filtration chromatography (GFC), which is very expensive, time-consuming, and rarely available. Polyethylene glycol (PEG) precipitation is more accessible and inexpensive. The aim of the study was to review evidence on PEG precipitation for the detection of macro-TSH to standardize its application in clinical practice. METHODS According to PRISMA guidelines, we conducted up to August 2024 a comprehensive search of PubMed and Scopus databases, using terms related to macro-TSH and PEG precipitation. RESULTS We included 23 studies with 4476 subjects, encompassing 10 observational studies and 13 case series/reports. All studies showed a low risk of bias. They were conducted in tertiary centres and included newborns to elderly subjects. The most of evidence about the procedure has been achieved with PEG concentrations of 12.5%. The PEG-precipitable TSH of the macro-TSH cases was always higher than 75% ranging on average from 81% to 90%. No-macro-TSH cases (controls) showed a PEG-precipitable TSH percentage ranging from 44.1% to 61.8%. CONCLUSIONS PEG precipitation can be taken into account as a useful diagnostic tool for macro-TSH. However, it is necessary to perform PEG precipitation in cases with a highly suspicious clinical picture and at the same time perform all available ancillary tests. PEG-precipitable TSH > 75% can be considered a reliable diagnostic threshold for macro-TSH cases.
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Affiliation(s)
- Tommaso Piticchio
- Department of Clinical and Experimental Medicine, Endocrinology SectionUniversity of CataniaCataniaItaly
- Department of Medicine and SurgeryUniversity of Enna “Kore”EnnaItaly
| | | | | | - Francesco Frasca
- Department of Clinical and Experimental Medicine, Endocrinology SectionUniversity of CataniaCataniaItaly
- Endocrinology SectionGaribaldi‐Nesima HospitalCataniaItaly
| | - Mario Rotondi
- Department of Internal Medicine and TherapeuticsUniversity of PaviaPaviaItaly
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine DisruptorsIstituti Clinici Scientifici Maugeri IRCCSPaviaItaly
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and DiabetologyEnte Ospedaliero CantonaleBellinzonaSwitzerland
- Faculty of Biomedical SciencesUniversità della Svizzera ItalianaLuganoSwitzerland
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10
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Jensen HI, Farmer SLH, Skaarup LO, Løkke A, Hygum A, Ipsen MJ, Gamst LH, Klausen MB. Development and testing of a generic patient decision aid for end-of-life care. PATIENT EDUCATION AND COUNSELING 2025; 132:108608. [PMID: 39705964 DOI: 10.1016/j.pec.2024.108608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 12/05/2024] [Accepted: 12/12/2024] [Indexed: 12/23/2024]
Abstract
OBJECTIVES The objective of this study was to develop and test a patient decision aid for end-of-life care to be used when some or all life-sustaining treatments have been withheld or withdrawn. METHODS A multi-professional, multi-sectorial group together with patients and relatives used a systematic process to develop and test the patient decision aid, including alpha and beta testing. RESULTS Healthcare professionals, patients and relatives were involved in the development and testing. The final Decision Helper included three areas with nine options: follow-up (outpatient clinic and general practitioner), palliative care (primary care, specialised palliative care team, hospital admission and hospice) and treatment level (intensive care, resuscitation attempt and nutrition via feeding tube). Most participants agreed that the amount of information in the Decision Helper was appropriate, that it clearly presented benefits and disadvantages and that it was useful in the value clarification process, helping to verbalise preferences and what is most important for patients. CONCLUSIONS Most patients and healthcare professionals found that the decision aid would be helpful in facilitating shared decision-making in an end-of-life conversation. PRACTICE IMPLICATIONS The decision aid will be usable in different healthcare setting ensuring that end-of-life care is in accordance with patients' wishes.
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Affiliation(s)
- Hanne Irene Jensen
- Department of Anesthesiology and Intensive Care, Vejle Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark; Department of Anesthesiology and Intensive Care, Kolding Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense M, Denmark.
| | - Sarah Leeth Hansen Farmer
- Department of Medicine, Hematology, Vejle Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Lillian Oxholm Skaarup
- Department of Medicine, Hematology, Vejle Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Anders Løkke
- Department of Regional Health Research, University of Southern Denmark, Odense M, Denmark; Department of Medicine, Vejle Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Anette Hygum
- Department of Oncology, Palliative Care Unit, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Mette Jo Ipsen
- Department of Quality, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Lisbeth Høilund Gamst
- Center for Shared Decision-making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Maybritt Brunsgård Klausen
- Center for Shared Decision-making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
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11
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Androff D, Schlinkert D, Um MY, Hatch E, Olsen-Medina K, Mathis CM. Refugees' Experiences Accessing and Receiving Health care in the Southwestern U.S. SOCIAL WORK IN PUBLIC HEALTH 2025; 40:45-56. [PMID: 39620494 DOI: 10.1080/19371918.2024.2434272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2024]
Abstract
Resettled refugees face physical and mental health challenges including the violence and trauma of their displacement. Once resettled in the U.S. refugees face difficulties accessing healthcare. This qualitative study explored refugees' experiences with barriers and facilitators to accessing healthcare. Thirty-four resettled refugee adults from five different countries of origin participated in focus groups. Study results identified logistical and language barriers to accessing healthcare, experiences with discrimination and fear, and the role of integration in promoting access and satisfaction with healthcare. Implications are provided for improving access to healthcare for refugees in the U.S.
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Affiliation(s)
- David Androff
- School of Social Work, Arizona State University, Phoenix, USA
| | - David Schlinkert
- Research, and Learning, Center for Applied Research and Innovation in Supply Chain Africa, W.P. Carey School of Business, Arizona State University, Phoenix, USA
| | - Mee Young Um
- School of Social Work, Arizona State University, Phoenix, USA
| | - Elizabeth Hatch
- Research Specialist, School of Social Work, Arizona State University, Phoenix, USA
| | - Kira Olsen-Medina
- Graduate Research Assistant, School of Transborder Studies, Arizona State University, Phoenix, USA
| | - Cherra M Mathis
- College of Social Work, University of Kentucky, Lexington, USA
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12
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Goetz G, Schandelmaier S, Busse R, Wild C, Panteli D. Implementation of the EU's Health Technology Assessment regulation: where does existing methods guidance require concretization and what are the relevant methodological options? Int J Technol Assess Health Care 2025; 41:e9. [PMID: 39909858 DOI: 10.1017/s0266462324004793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2025]
Abstract
OBJECTIVES The EUnetHTA Core Model® is well-established in the HTA community. Some recommendations of corresponding guidance documents leave room for alternative methodological choices. Considering the new HTA regulation (HTAR), we aimed to identify needs for concretization (NCs) in EUnetHTA guidance and provide indicative methodological options. METHODS We carried out a qualitative document analysis and structured group discussion. Twenty-two EUnetHTA documents were screened using transparent criteria. Identified NCs were classified into topics according to the PRISMA statement and presented to Austrian HTA practitioners (n = 11) during a structured group discussion. Participants rated NC's importance. To identify potential solutions, selected key handbooks for generic (Cochrane) and HTA-specific (IQWIG/NICE) evidence synthesis were systematically reviewed and matching content was charted against the NCs. RESULTS Thirty-two topics with varying numbers of NCs were identified, twenty-six during the screening process, and six from the group discussion. Most of the topics related to evidence synthesis methods (nine topics), evidence eligibility criteria (nine topics), risk of bias (three topics), and certainty assessment (three topics). Other topics related to information sources, search strategy, data collection process, data items, effect measures, and reporting bias. One or more methodological approaches and recommendations could be identified for each identified topic from the included methodological handbooks. CONCLUSIONS Our analysis identified a need for concretization in some EUnetHTA guidelines. The structured overview of methodological options may support HTA doers in adapting and applying the guidelines to the national and local practical context.
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Affiliation(s)
- Gregor Goetz
- Austrian Institute for Health Technology Assessment (AIHTA), Vienna, Austria
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Stefan Schandelmaier
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
- School of Public Health, University College Cork, Cork, Ireland
- MTA-PTE Lendület "Momentum" Evidence in Medicine Research Group, Medical School, University of Pécs, Pécs, Hungary
| | - Reinhard Busse
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Claudia Wild
- Austrian Institute for Health Technology Assessment (AIHTA), Vienna, Austria
| | - Dimitra Panteli
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
- European Observatory on Health Systems and Policies, Brussels, Belgium
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13
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Grimes DR. Tortured confessions? Potentially erroneous statistical inferences may underpin misleading claims of harms in reanalyses of COVID-19 and HPV vaccines. Vaccine 2025; 46:126657. [PMID: 39725574 DOI: 10.1016/j.vaccine.2024.126657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 11/09/2024] [Accepted: 12/18/2024] [Indexed: 12/28/2024]
Abstract
The safety and efficacy of vaccination is a subject contentious in the public mind. Despite overwhelming evidence of their benefits to public health, COVID-19 and human papilloma virus (HPV) vaccines have been the focus of intense concerns. While the original phase III trials and post-market phase IV studies have continued to show their benefits and positive safety profile, some authors have attempted to reassess the original trial data, purporting to showing hidden harms for both COVID-19 and HPV vaccines. It is critical to ascertain why such divergent claims could stem from analysis of the same data, and this work accordingly examines these reports. In both cases, we find that erroneous statistical assumptions and unwarranted inferences are likely to have influenced the conclusions drawn, and identifies choices that would tend to result in spurious findings. This work also examines the wider issues with unregistered posthoc examinations on known trial data without preregistration, and how this may result in data-dredging, the torturing of data until it confesses to non-existent relationships, and how we might prevent against this on vaccine science.
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Affiliation(s)
- David Robert Grimes
- TCD Biostatistics Unit, Discipline of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Dublin, Ireland.
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14
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Kumar S, Neyazi A, Mehta R, Sah R. Systematic Review and Meta-Analysis on Breastfeeding Could Have Used More Effective Quality Assessment Tools. Acta Paediatr 2025. [PMID: 39907266 DOI: 10.1111/apa.70009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2024] [Revised: 01/07/2025] [Accepted: 01/27/2025] [Indexed: 02/06/2025]
Affiliation(s)
- Shubham Kumar
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - Ahmad Neyazi
- Afghanistan Center for Epidemiological Studies, Herat, Afghanistan
- Faculty of Medicine, Ghalib University, Herat, Afghanistan
| | - Rachana Mehta
- Clinical Microbiology, RDC, Manav Rachna International Institute of Research and Studies, Faridabad, India
| | - Ranjana Sah
- Department of Paediatrics, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed-to-be-University), Pune, India
- Department of Public Health Dentistry, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed-to-be-University), Pune, India
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Jolliffe L, Lannin NA, Larcombe S, Major B, Hoffmann T, Lynch E. Training and education provided to local change champions within implementation trials: a rapid systematic review. Implement Sci 2025; 20:8. [PMID: 39910625 DOI: 10.1186/s13012-025-01416-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 01/02/2025] [Indexed: 02/07/2025] Open
Abstract
BACKGROUND Translating research into clinical practice is challenging. One implementation intervention that supports translation is employment of a change champion. It is important to understand how individuals are prepared for the change champion role. This rapid systematic review aimed to identify the education, training, and support provided to individuals in change champion roles within implementation trials. METHOD Rapid review approach. We searched the Scopus database to identify systematic reviews on champions, knowledge brokers, facilitators, and implementation support practitioners. The most recent reviews on each topic were screened to find eligible studies. To identify studies published after these reviews, we searched Medline, PsycINFO, OVID, CINAHL, ProQuest, SCOPUS, and EBSCO. We included randomised and cluster randomised controlled trials that reported on implementation interventions in healthcare settings involving a local change champion. RESULTS Fifteen cluster randomised controlled trials were included. Specific champion training was provided in 12 studies (80%), but none reported incorporating adult learning principles into their education program. Some form of post-training support was reported in 11 studies (73%). Only two studies included content on behaviour or organizational change in the champion preparation program. Most programs were not individualized, and details of training and support were poorly reported. CONCLUSIONS Training needs and educational outcomes of change champions are poorly reported in implementation trials. Training tends not to align with adult learning. More rigorous development and reporting of programs to prepare change champions to support implementation of evidence in healthcare is recommended. REGISTRATION PROSPERO registration number CRD42022368276.
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Affiliation(s)
- Laura Jolliffe
- Department of Occupational Therapy, Peninsula Health, 2 Hastings Road, Frankston, VIC, 3199, Australia.
- Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Highway, Frankston, VIC, 3199, Australia.
- National Centre for Healthy Ageing, 2 Hastings Road, Frankston, VIC, 3199, Australia.
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, 99 Commercial Road, Prahran, Melbourne, VIC, 3004, Australia
- Alfred Health, 55 Commercial Road, Prahran, Melbourne, VIC, 3004, Australia
| | - Stacy Larcombe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt North Sturt Rd, Bedford Park, Adelaide, SA, 5042, Australia
| | - Brendan Major
- Department of Neuroscience, Central Clinical School, Monash University, 99 Commercial Road, Prahran, Melbourne, VIC, 3004, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Tammy Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, QLD, 4226, Australia
| | - Elizabeth Lynch
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt North Sturt Rd, Bedford Park, Adelaide, SA, 5042, Australia
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16
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Alexeeff SE, Van Den Eeden SK, Deosaransingh K, Sidney S, Liao NS, Rana JS. Wildfire Air Pollution and Rates of Cardiovascular Events and Mortality in Northern California in 2018. J Am Heart Assoc 2025:e036264. [PMID: 39908096 DOI: 10.1161/jaha.124.036264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 01/02/2025] [Indexed: 02/07/2025]
Abstract
BACKGROUND We examined the association between acute cardiovascular disease (CVD) events and wildfire air pollution in California in 2018. METHODS The study included adult (≥18 years) members of Kaiser Permanente Northern California, an integrated health care system. Outcomes included CVD events (hospitalizations for acute myocardial infarction, heart failure, or stroke, and CVD death) and death from any cause. Fine particulate air pollution (particulate matter <2.5 microns in diameter; PM2.5) exposure was assessed in categories (Good <12 μg/m3, Moderate 12-34 μg/m3, High ≥35 μg/m3) and continuously. Poisson time series regression was used to model daily event rates during July 1 to December 31, 2018, using a spline to adjust for long-term time trends. We calculated rate ratios (RR) to estimate the association between wildfire air pollution and daily rate of CVD events and deaths. RESULTS Our study included 3.2 million adults with a total follow-up of 587.9 million person-days. High PM2.5 concentrations during the Mendocino Complex wildfire in July to August was associated with an increased rate of CVD events (RR, 1.231 [95% CI, 1.039-1.458]) and death (RR, 1.358 [95% CI, 1.128-1.635]) compared with Good PM2.5 concentrations. In contrast, there was no evidence of increased risk during the Camp wildfire in November (RR for CVD events, 0.966 [95% CI, 0.894-1.044]; RR for all-cause mortality, 0.985 [95% CI, 0.904-1.074] High versus Good PM2.5 concentrations). CONCLUSIONS There was some evidence of increased rates of CVD events and death during wildfires, but results were inconsistent. With ongoing climate change, large wildfires are a pressing public health concern and future work is needed to understand differences in health outcomes by wildfire.
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Affiliation(s)
- Stacey E Alexeeff
- Division of Research Kaiser Permanente Northern California Pleasanton CA USA
| | | | | | - Stephen Sidney
- Division of Research Kaiser Permanente Northern California Pleasanton CA USA
| | - Noelle S Liao
- Division of Research Kaiser Permanente Northern California Pleasanton CA USA
| | - Jamal S Rana
- Division of Research Kaiser Permanente Northern California Pleasanton CA USA
- Department of Cardiology Kaiser Permanente Oakland Medical Center Oakland CA USA
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17
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Slater R, Walker S, Eccleston C, Bellieni C, Hirekodi T, Carbajal R, Smart L, Laughey W, Cobo MM, Friedrichsdorf S. Moments that matter: childhood pain treatment shapes pain for life-we can do better every time in every child. BMC Med 2025; 23:64. [PMID: 39901139 PMCID: PMC11792334 DOI: 10.1186/s12916-025-03869-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 01/14/2025] [Indexed: 02/05/2025] Open
Abstract
BACKGROUND Needle procedures, such as vaccinations, blood draws, and intravenous cannulation, are the most frequent source of childhood pain, causing fear and reducing the uptake of medical procedures. Every child has the right to expect pain relief, and we have evidence-based tools to reduce needle procedure-related pain. Therefore, the lack of analgesic provision for needle pain is not justified. We argue that better informed and motivated healthcare professionals and families can advocate for appropriate pain relief in every child, every time. OBSERVATIONS Engaging communication campaigns are needed to educate our healthcare professionals. Evidence-based modalities such as topical anaesthesia, sucrose or breastfeeding, comfort positioning, and age-appropriate distractions should be available for every child during needle procedures. However, high-quality information is not enough to change behaviour-healthcare professionals need to be motivated, encouraged, and inspired. Parents and carers should be empowered to advocate for their children and be aware that their child has the right to receive pain relief during these procedures. CONCLUSIONS AND RELEVANCE: This is a call to action-we need collaboration between academics, healthcare professionals, industry and charities, to expedite behavioural change and parental advocacy through high-quality communication strategies. Effective pain management in infants and children can play a crucial role in promoting the uptake of vaccinations and medical procedures and can influence future attitudes to pain.
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Affiliation(s)
- Rebeccah Slater
- Department of Paediatrics, University of Oxford, Oxford, UK.
| | - Suellen Walker
- Developmental Neurosciences Department, UCL GOS Institute of Child Health, UCL, London, UK
| | - Christopher Eccleston
- Centre for Pain Research, The University of Bath, Bath, UK
- Department of Experimental, Clinical and Health Psychology, Ghent University, Ghent, Belgium
- Department of Psychology, The University of Helsinki, Helsinki, Finland
| | - Carlo Bellieni
- Department of Pediatrics, University of Siena, Siena, Italy
| | - Tanvi Hirekodi
- School of Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Ricardo Carbajal
- Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau- Sorbonne Université, INSERM U1153, Paris, France
| | | | - William Laughey
- Reckitt Health Care UK Ltd, Hull, UK
- Health Professions Education Unit, Hull York Medical School, York, UK
| | - Maria M Cobo
- Department of Paediatrics, University of Oxford, Oxford, UK
- Colegio de Ciencias Biologicas y Ambientales, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | - Stefan Friedrichsdorf
- Division of Pediatric Pain, Palliative Care & Integrative Medicine, University of California San Francisco, San Francisco, USA
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18
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Dujic H, Bücher K, Schüler IM, Schmidt P, Hertel S, Timpel J, Jablonski-Momeni A, Schilke R, Kapferer-Seebacher I, Zschocke J, Liebermann A, Güth JF, Edelhoff D, Heinrich-Weltzien R, Kühnisch J. Dental Management of Genetic Dental Disorders: A Critical Review. J Dent Res 2025:220345241305330. [PMID: 39905279 DOI: 10.1177/00220345241305330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2025] Open
Abstract
Genetic dental disorders (GDDs) can occur either isolated or as part of syndromes. Clinically, deviations in tooth shape, size, or structure, as well as the absence of multiple teeth, lead to severe dysfunction and a reduced quality of life, requiring lifelong preventive, conservative, and prosthodontic dental care. The dental management of prevalent dental diseases, such as caries or periodontitis, has been based on decades of research, whereas scientific data on the dental management of GDDs are scarce. This lack of data is challenging for dental practitioners, who must primarily rely on empirical knowledge only. Therefore, a systematic literature search and review were conducted on the dental management of common GDDs, such as ectodermal dysplasia, amelogenesis imperfecta, dentinogenesis imperfecta, periodontitis as a manifestation of rare systemic diseases, and X-linked hypophosphatemia and hypophosphatasia. The review revealed that 468 of the 9,115 retrieved publications met the inclusion criteria, with most being case reports or case series, highlighting a lack of robust clinical trials. This critical review provides a brief summary of the genetic background, key clinical signs, and treatment options for these conditions. The dominance of case reports emphasizes the need for improved reporting standards and long-term follow-up to support comprehensive data synthesis and meta-analyses. In addition, the uneven global distribution of publications suggests disparities in access to advanced dental care for GDDs. Efforts to standardize reporting and improve treatment documentation globally are crucial to addressing these challenges. In this way, information on GDD management can be improved, and statistical analyses of the data can be performed.
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Affiliation(s)
- H Dujic
- Department of Conservative Dentistry and Periodontology, LMU University Hospital, LMU Munich, Munich, Germany
| | - K Bücher
- Department of Conservative Dentistry and Periodontology, LMU University Hospital, LMU Munich, Munich, Germany
| | - I M Schüler
- Department of Orthodontics, Section of Preventive and Pediatric Dentistry, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - P Schmidt
- Department of Special Care Dentistry, Witten/Herdecke University, Witten, Germany
| | - S Hertel
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - J Timpel
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - A Jablonski-Momeni
- Department of Orthodontics, Dental School, Philipps-University Marburg, Marburg, Germany
| | - R Schilke
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Hannover Medical School, Hannover, Germany
| | - I Kapferer-Seebacher
- University Hospital for Conservative Dentistry and Periodontology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Zschocke
- Division of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - A Liebermann
- Department of Prosthetic Dentistry, University Hospital of Cologne, Cologne, Germany
| | - J F Güth
- Department of Prosthetic Dentistry, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - D Edelhoff
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | - R Heinrich-Weltzien
- Department of Orthodontics, Section of Preventive and Pediatric Dentistry, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - J Kühnisch
- Department of Conservative Dentistry and Periodontology, LMU University Hospital, LMU Munich, Munich, Germany
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D'Souza RS, Saini C, Hussain N, Javed S, Prokop L, Her YF. Global estimates of prevalence of chronic painful neuropathy among patients with chemotherapy-induced peripheral neuropathy: systematic review and meta-analysis of data from 28 countries, 2000-24. Reg Anesth Pain Med 2025:rapm-2024-106229. [PMID: 39880412 DOI: 10.1136/rapm-2024-106229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Accepted: 12/05/2024] [Indexed: 01/31/2025]
Abstract
INTRODUCTION Although the prevalence of chemotherapy-induced peripheral neuropathy (CIPN) has been reported, the proportion of patients with CIPN who report chronic painful neuropathy remains poorly understood, despite its significant impact on patients' quality of life and treatment outcomes. METHODS A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome was the pooled prevalence of chronic (≥3 months) painful CIPN among patients diagnosed with CIPN. Estimates from each study were transformed using double arcsine transformation and pooled in a meta-analysis using an inverse variance heterogeneity model. Subgroup analysis was conducted based on geographical region, sex, chemotherapy regimen, primary cancer type, and funding source; meta-regression analysis was conducted based on study design, human development index (HDI), and publication year. RESULTS 77 studies from 28 countries, encompassing 10 962 patients with CIPN, were included. Among patients diagnosed with CIPN, the pooled prevalence of those reporting chronic painful CIPN was estimated at 41.22% (95% CI 32.40 to 50.19; 95% prediction interval 23.71 to 61.28). Substantial heterogeneity was observed across studies (I²=95.27%; 95% CI for I2 94.58 to 95.86). Subgroup analysis revealed that patients treated with platinum based agents and taxanes had the highest prevalence of chronic painful CIPN (40.44% and 38.35%, respectively), and among primary cancers, those with lung cancer reported the highest prevalence of chronic painful CIPN (60.26%). Study design, HDI, and publication year were non-significant moderators of prevalence estimates. Based on our GRADE (Grading of Recommendations, Assessment, Development and Evaluation) assessment, the certainty of evidence was considered very low. CONCLUSION This study provides the first comprehensive global estimate of the prevalence of chronic painful CIPN, highlighting its significant burden on patients worldwide. The variation in prevalence across geographical regions, chemotherapy regimens, and primary cancers underscores the need for tailored pain management strategies and further research to address potential disparities. TRIAL REGISTRATION PROSPERO CRD42024579459.
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Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Chandan Saini
- Department of Rehabilitation Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Saba Javed
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Larry Prokop
- Mayo Clinic Libraries, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Yeng F Her
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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20
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Pagels L, Schindler O, Luedtke K. Overview of styles, content, learning effects and attitudes of students towards digitally enhanced physiotherapy education - a scoping review. BMC MEDICAL EDUCATION 2025; 25:176. [PMID: 39905432 DOI: 10.1186/s12909-025-06750-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 01/23/2025] [Indexed: 02/06/2025]
Abstract
BACKGROUND Digital competences are essential for lifelong learning, as highlighted by the European Commission and emphasized in the Digital Education Action Plan 2021-2027. The COVID-19 pandemic necessitated an unprecedented shift to online education, profoundly impacting fields like physiotherapy that heavily rely on practical skills. This scoping review aims to provide an overview of currently applied digitally enhanced learning methods, content, effect on knowledge gain and student perceptions in physiotherapy education. METHODS Following PRISMA guidelines for scoping reviews, a comprehensive search was conducted across multiple databases, including Medline, Web of Science, and ERIC, incorporating hand searches and expert consultations. Studies were included if they reported on any digitally enhanced educational methods in physiotherapy education, involving qualitative studies, clinical trials, observational studies, or case reports published in English or German from 2010 to February 2024. Data extraction focused on the digital tools that were used, the educational contents, individually measured outcomes, and the impact of digital education. RESULTS Out of 2988 screened studies, 67 met the inclusion criteria, encompassing 7160 participants. These sources of evidence primarily used quantitative methods (n = 51), with a minority using qualitative (n = 7) or mixed methods (n = 6). Nearly half employed hybrid educational approaches. Outcome measures included knowledge, performance, perception, satisfaction, and attitudes. Most sources of evidence reported positive impacts of digitally enhanced education, particularly in knowledge transfer and skill performance. Synchronous and asynchronous methods were used, with varying success across theoretical and practical courses. Gamification and virtual reality emerged as promising tools for enhancing engagement and learning outcomes. However, challenges included the limited direct interaction and perceived self-efficacy among students. CONCLUSION Digitally enhanced learning formats in physiotherapy education can enhance learning experiences and is generally welcomed by students, especially when blended with traditional methods. The integration of innovative digital strategies holds promise for the future of physiotherapy training, contingent on comprehensive support and training for educators and students alike.
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Affiliation(s)
- Larissa Pagels
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.
| | - Oskar Schindler
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany
- DHGS Deutsche Hochschule für Gesundheit und Sport, Berlin, Germany
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Luebeck, Luebeck, Germany
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21
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Gordon M, de Geus A, Banasiuk M, Benninga MA, Borrelli O, Boruta M, Darbari A, Dore-Stites D, Gould M, Hawa J, Jones KB, Khlevner J, Kilgore A, Mousa H, Nurko S, Sinopoulou V, Tabbers M, Thapar N. ESPGHAN and NASPGHAN 2024 protocol for paediatric functional constipation treatment guidelines (standard operating procedure). BMJ Paediatr Open 2025; 9:e003161. [PMID: 39904543 DOI: 10.1136/bmjpo-2024-003161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Accepted: 01/23/2025] [Indexed: 02/06/2025] Open
Abstract
INTRODUCTION Functional constipation is common in childhood, with chronicity leading to a significant impact on patients and their families. There is a significant range of therapies available to healthcare professionals for this condition, with many novel or recently studied. There is a need for an update to the joint European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)/North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines last released in 2014. We present the prospectively agreed operating procedure and technical review protocol in this manuscript. METHODS 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) will be used for all phases of this guideline development. The Guideline Development Group is formed by paediatric gastroenterologists from both the ESPGHAN as well as the NASPGHAN. A prospective exercise will agree on key outcomes, thresholds of magnitude that are significant at small, moderate and large levels. Systematic evidence searches, selection, extraction, appraisal and analysis will be performed following Cochrane guidance and GRADE guidance for objectively agreeing the certainty of findings. Additional use of network meta-analysis will identify areas of broad triangulation in the evidence. Summary of findings tables will be produced and inform evidence to decision frameworks. These will guide GRADE recommendations with voting to reach a consensus.
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Affiliation(s)
| | - Anna de Geus
- Peadiatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marcin Banasiuk
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warszawa, Poland
| | - Marc A Benninga
- Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Mary Boruta
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Anil Darbari
- Children's National Hospital, Washington, District of Columbia, USA
| | - Dawn Dore-Stites
- Pediatric Psychology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Michelle Gould
- Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Juliette Hawa
- Physical Therapy, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Kirsten Brooke Jones
- Clinical nutrition and Lactation, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Julie Khlevner
- Pediatric Gastroenterology, Hepatology and Nutrition, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Alexandra Kilgore
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Hayat Mousa
- Gastroenterology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Samuel Nurko
- Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Merit Tabbers
- Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Noord-Holland, Netherlands
| | - Nikhil Thapar
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
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Huang CW, Huang TY, Yang YF, Chang LY, Tu YK, Wu VC, Chen JY. Major Adverse Cardiovascular Events in Primary Aldosteronism After Adrenalectomy or Mineralocorticoid Receptor Antagonist Treatment: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2025; 14:e038714. [PMID: 39895534 DOI: 10.1161/jaha.124.038714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 12/17/2024] [Indexed: 02/04/2025]
Abstract
BACKGROUND The object of this study was to investigate the incidence rate of major adverse cardiovascular event (MACE) among patients with primary aldosteronism (PA) after adrenalectomy or mineralocorticoid receptor antagonist (MRA) treatment. METHODS AND RESULTS A systematic review and meta-analysis was conducted by searching PubMed, Embase, Cochrane Library, Web of Science, CINAHL, and Scopus through April 15, 2024. Studies reporting the MACE incidence rate in patients with PA after treatment were included. We adapted the random-effects model and performed subgroup and meta-regression analyses. A total of 20 studies involving 16 927 patients with PA were included. There were 5939 patients with PA who underwent adrenalectomy. A total of 10 474 patients received MRA treatment. Additionally, 546 patients received either adrenalectomy or MRA treatment. The pooled incidence rate of MACE among patients with PA after treatment was 2.20/100 patient-years (95% CI, 1.70-2.80), higher than that of non-PA hypertension (1.20/100 patient-years [95% CI, 0.70-2.10]). Patients with PA after adrenalectomy had a lower MACE incidence rate (2.00/100 patient-years [95% CI, 1.40-2.60]) compared with those undergoing MRA treatment (3.30/100 patient-years [95% CI, 2.40-4.10], P=0.017). Advanced age (coefficient: 0.071, P<0.001) and diabetes (coefficient: 0.070, P=0.001) increased the risk of posttreatment MACE. A curvilinear dose-response relationship between the posttreatment plasma renin activity and the MACE incidence was observed, with the lowest risks at plasma renin activity of 1.0 to 2.0 ng/mL per hour (Pnonlinearity<0.001). CONCLUSIONS The MACE incidence in treated patients with PA was 2.20 per 100 patient-years, higher than in patients with hypertension without PA. Maintaining posttreatment plasma renin activity between 1.0 and 2.0 ng/mL per hour appears crucial for minimizing cardiovascular risk. Adrenalectomy proved more effective than MRA treatment in reducing MACE risk. Advanced age and diabetes significantly increased the risk of posttreatment MACE.
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