51
|
Jostrup E, Nyström M, Tallberg P, Söderlund G, Gustafsson P, Claesdotter-Knutsson E. Effects of Auditory and Visual White Noise on Oculomotor Inhibition in Children With Attention-Deficit/Hyperactivity Disorder: Protocol for a Crossover Study. JMIR Res Protoc 2024; 13:e56388. [PMID: 39146010 DOI: 10.2196/56388] [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: 01/15/2024] [Revised: 05/07/2024] [Accepted: 05/27/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND In attention-deficit/hyperactivity disorder (ADHD), poor inhibitory control is one of the main characteristics, with oculomotor inhibition impairments being considered a potential biomarker of the disorder. While auditory white noise has demonstrated the ability to enhance working memory in this group, visual white noise is still unexplored and so are the effects of both types of white noise stimulation on oculomotor inhibition. OBJECTIVE This crossover study aims to explore the impact of auditory and visual white noise on oculomotor inhibition in children with ADHD and typically developing (TD) children. The study will investigate the impact of different noise levels (25% and 50% visual, 78 dB auditory), and performance will be evaluated both with and without noise stimulation. We hypothesize that exposure to white noise will improve performance in children with ADHD and impair the performance for TD children. METHODS Memory-guided saccades and prolonged fixations, known for their sensitivity in detecting oculomotor disinhibition in ADHD, will be used to assess performance. Children diagnosed with ADHD, withdrawing from medication for 24 hours, and TD children without psychiatric disorders were recruited for the study. RESULTS Data collection was initiated in October 2023 and ended in February 2024. A total of 97 participants were enrolled, and the first results are expected between September and November 2024. CONCLUSIONS This study will examine whether cross-modal sensory stimulation can enhance executive function, specifically eye movement control, in children with ADHD. In addition, the study will explore potential differences between auditory and visual noise effects in both groups. Our goal is to identify implications for understanding how noise can be used to improve cognitive performance. TRIAL REGISTRATION ClinicalTrials.gov NCT06057441; https://clinicaltrials.gov/study/NCT06057441. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56388.
Collapse
Affiliation(s)
- Erica Jostrup
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Marcus Nyström
- Lund University Humanities Lab, Lund University, Lund, Sweden
| | - Pia Tallberg
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
- Outpatient Department, Child and Adolescent Psychiatry Clinic, Region Skåne, Lund, Sweden
| | - Göran Söderlund
- Faculty of Teacher Education Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Education and Special Education, University of Gothenburg, Gothenburg, Sweden
| | - Peik Gustafsson
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Emma Claesdotter-Knutsson
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
- Outpatient Department, Child and Adolescent Psychiatry Clinic, Region Skåne, Lund, Sweden
| |
Collapse
|
52
|
Pfaff H, Schmitt J. Shifting from Theoretical Best Evidence to Practical Best Evidence: an Approach to Overcome Structural Conservatism of Evidence-Based Medicine and Health Policy. DAS GESUNDHEITSWESEN 2024. [PMID: 39146964 DOI: 10.1055/a-2350-6435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
There is disparity in the healthcare sector between the extent of innovation in medical products (e. g., drugs) and healthcare structures. The reason is not a lack of ideas, concepts, or (quasi-) experimental studies on structural innovations. Instead, we argue that the slow implementation of structural innovations has created this disparity partly because evidence-based medicine (EBM) instruments are well suited to evaluate product innovations but less suited to evaluate structural innovations. This article argues that the unintentional interplay between EBM, which has changed significantly over time to become primarily theoretical, on the one hand, and caution and inertia in health policy, on the other, has resulted in structural conservatism. Structural conservatism is present when healthcare structures persistently and essentially resist innovation. We interpret this phenomenon as an unintended consequence of deliberate EBM action. Therefore, we propose a new assessment framework to respond to structural innovations in healthcare, centered on the differentiation between the theoretical best (possible) evidence, the practical best (possible) evidence, and the best available evidence.
Collapse
Affiliation(s)
- Holger Pfaff
- University of Cologne, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation; Cologne, Germany
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Med. Fakultät der TU Dresden, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| |
Collapse
|
53
|
Er-Reguyeg Y, Boudry C, Mouriaux F. Characteristics of retracted articles in ophthalmology. Heliyon 2024; 10:e35460. [PMID: 39165980 PMCID: PMC11334885 DOI: 10.1016/j.heliyon.2024.e35460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 07/08/2024] [Accepted: 07/29/2024] [Indexed: 08/22/2024] Open
Abstract
The retraction of publications is a crucial aspect of scientific integrity; it aims to correct the literature and alert scholars and the general public by identifying and labelling articles that contain erroneous data, unreliable findings, or flawed conclusions. Identifying and characterizing retracted articles within the scientific literature is thus very important. The aims of this article were to characterize retracted articles in the ophthalmological literature. One hundred and fifty-one retracted articles published between 1966 and 2023 were retrieved. The number of retracted articles showed an upward trend from 2020 onwards. Ocular oncology (n = 37, 24.5 %) was the most frequently represented subspeciality in the retracted articles, despite retina and uveitis being the most published. The most frequent reason for retraction was fake data (n = 62, 38 %). The labelling of retracted articles on some websites was unsatisfactory, especially on the free-access illegal platform Sci-Hub. On the other hand, platforms such as Dimensions, Scite and Retraction Watch exhibit promising accuracy. Improving the labelling of retractions is needed to reduce the citation of articles after they have been retracted. Solutions to reach this goal are discussed in this article.
Collapse
Affiliation(s)
| | - Christophe Boudry
- Normandie Univ, UNICAEN, Média Normandie, Caen, France
- URFIST, Ecole Nationale des Chartes, PSL Research University, Paris, France
| | - Frederic Mouriaux
- Ophthalmology Department, CHU Rennes-Rennes University, France
- CUO-Recherche, Centre de Recherche du CHU de Québec – Université Laval, Axe Médecine Régénératrice, Hôpital du Saint-Sacrement, Québec, Canada
| |
Collapse
|
54
|
Nielsen JB, Kristiansen IS, Thapa S. Increasing melanoma incidence with unchanged mortality: more sunshine, better treatment, increased diagnostic activity, overdiagnosis or lowered diagnostic threshold? Br J Dermatol 2024; 191:365-374. [PMID: 38655629 DOI: 10.1093/bjd/ljae175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Increasing melanoma incidence with less increasing mortality is observed in several countries. This discrepancy is not well understood. OBJECTIVES In this study, our aim was to discuss factors [ultraviolet radiation (UVR) exposure, melanoma treatment, diagnostic activity, overdiagnosis, pathologists' diagnostic threshold and clinicians' propensity to remove suspect skin lesions] that might influence melanoma incidence and mortality in Denmark. METHODS This was a register study with the number of melanocyte-related lesions and melanoma mortality based on comprehensive national pathology and mortality databases for the period 1999-2019. We investigated melanocyte-related diagnoses and mortality in a population of 5.5 million with a national healthcare system. Age-adjusted melanoma mortality and age-adjusted incidence of benign naevi, atypical lesion, or melanoma in situ and of invasive melanoma were computed for data analysis. RESULTS In total, 1 434 798 biopsies were taken from 704 682 individuals (65% female). The mean age at biopsy was 39.8 years in males and 37.6 in females. In males and females, the incidence of invasive melanoma increased by 87% during the period 1999-2011. During the subsequent period it increased by 9% in males but remained unchanged in females. The incidence of melanoma in situ increased by 476% in males and 357% in females during the study period, while the increases for atypical melanocytic lesions were 1928% and 1686%, respectively. Biopsy rates increased by 153% in males and 118% in females from 1999 through 2011 but fell by 20% in males and 22% in females during the subsequent period. Mortality varied slightly from year to year without any significant time trend for males or females. We identified no evidence of increased UVR exposure over the latest 30 years in Denmark. Immunotherapy of advanced melanoma was introduced in Denmark in 2010 and came into general use in 2014. CONCLUSIONS Comprehensive national data demonstrate increasing melanoma incidence correlated with increasing biopsy rates, but with no change in mortality. Previously suggested explanations for such a trend are a lowered threshold of melanoma diagnosis among pathologists, increased diagnostic activity in the presence of overdiagnosis and improved melanoma treatment. Because the study is observational and we have more explanatory factors than outcomes, the findings do not warrant conclusions about causal relationships.
Collapse
Affiliation(s)
- Jesper Bo Nielsen
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Ivar Sønbø Kristiansen
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Subash Thapa
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| |
Collapse
|
55
|
Alruwaili TA, Crawford K, Fooladi E. Shared decision-making in maternity care in Saudi Arabia: A cross-sectional study. Midwifery 2024; 138:104147. [PMID: 39180884 DOI: 10.1016/j.midw.2024.104147] [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: 04/04/2024] [Revised: 07/31/2024] [Accepted: 08/13/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Shared decision-making (SDM) in maternity care involves women actively in decisions, thereby reducing decisional conflicts and enhancing satisfaction with care. AIM To investigate SDM and the factors associated with it, and its correlation with respect in maternity care in Saudi Arabia. METHODS A comprehensive, nationwide online questionnaire-based study was conducted between January to May 2023, involving women aged 18 years and above who were either pregnant or had experienced pregnancy/childbirth in the past 12 months. The Mothers' Autonomy in Decision-Making (MADM) scale and the Mothers of Respect Index (MORi) were used. Low to very low SDM was defined as a score of ≤ 24 on the MADM and low to very low respected was defined as a score of ≤ 49 on the MORi. RESULTS A total of 505 women completed the survey. Low to very low SDM was reported by 137 (34.1 %, 95 confidence interval (CI), 29.6 % - 38.9 %) women. Factors significantly associated with low to very low SDM included seeing different obstetricians of different gender at each visit (adjusted odds ratio (AOR) 2.0, 95 % CI, 1.0 - 3.9), not meeting the same obstetrician throughout the pregnancy (AOR 2.6, 95 % CI, 1.2 - 5.6) and having an instrumental vaginal birth (AOR 6.67, 95 % CI, 1.6 - 28.1). There was a positive association between low to very SDM and feeling of low to very low respect ((χ2 = 83.8173, p < 0.001). CONCLUSION More than one-third of women experienced low to very low SDM in maternity care. This should alert healthcare providers to the importance of continuity of care in Saudi Arabia.
Collapse
Affiliation(s)
- Tahani Ali Alruwaili
- Monash Nursing and Midwifery School, Monash University, Melbourne, VIC, Australia; College of Nursing, Aljouf University, Sakaka, Saudi Arabia.
| | - Kimberley Crawford
- Monash Nursing and Midwifery School, Monash University, Melbourne, VIC, Australia. https://twitter.com/Kim_E_Crawford
| | - Ensieh Fooladi
- Monash Nursing and Midwifery School, Monash University, Melbourne, VIC, Australia. https://twitter.com/NC_Fooladi
| |
Collapse
|
56
|
Olsen CM. Ecological evidence for melanoma overdiagnosis in Denmark. Br J Dermatol 2024; 191:318-319. [PMID: 38752346 DOI: 10.1093/bjd/ljae206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/03/2024] [Indexed: 08/16/2024]
Affiliation(s)
- Catherine M Olsen
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| |
Collapse
|
57
|
von Wrede R, Witt JA, Jessen N, Lossius MI, Moskau-Hartmann S, Helmstaedter C. Screening for depression in patients with epilepsy: What are the benefits for physicians and patients in the real-life setting. Epilepsia 2024. [PMID: 39140982 DOI: 10.1111/epi.18089] [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: 05/13/2024] [Revised: 07/18/2024] [Accepted: 07/26/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE Screening for depression in people with epilepsy (PWE) is highly recommended in order to avoid underdiagnosis, misdiagnosis, or delayed diagnosis of this highly impacting comorbidity. Here we evaluated the impact of reporting and suggesting depression via the Beck Depression Inventory (BDI) on medical decision-making, and thereby the value of a depression screening for good medical practice. METHODS Of 445 BDI data sets, PWE with scores indicating moderate (BDI 19-29) to severe depressive disorder (BDI >29) were extracted and clinical reports were retrospectively reviewed regarding decisions on antidepressants, anti-seizure medications (ASMs), and non-pharmaceutical interventions. RESULTS Sixty-four PWE (14%; 56% female; mean age 39.7 years) showed elevated BDI scores, with 40 (63%) categorized as moderate depression and 24 (37%) as severe depression. Thirty-nine percent of PWE already had a pre-existing diagnosis of depression and 53% left the clinic with the diagnosis of depression, half of them with antidepressants. High depression scores were associated with any intervention in 53%, interventions with potentially mood affecting ASM in 19%, treatment with antidepressants in 11%, and non-pharmaceutical interventions in 41%. Non-pharmaceutical interventions were related to BDI scores. Changes of potentially mood-affecting ASMs were more frequent in PWE with moderate scores, and introduction of antidepressants appeared as a trend related to higher depression scores. SIGNIFICANCE The finding of an only weak relation between high depression scores, diagnoses of depression, and treatment consequences questions the diagnosis and treatment pathway and the clinical value of the BDI screening in PWE. Prospective standard procedures need to be established for depression diagnosis and treatment including follow-up evaluations of the validity of the diagnosis and effectiveness of the decisions taken.
Collapse
Affiliation(s)
- Randi von Wrede
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Nina Jessen
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Morten I Lossius
- Neurological Department, National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
| | | | | |
Collapse
|
58
|
da Silva EL, Pedraça ES, Salgueiro AP, Gazzi RP, Nunes JS, Cavagni J, Martins MAT, Rados PV, Pohlmann AR, Guterres SS, Frank LA, Visioli F. Efficacy and safety of a 0.05 % nanoencapsulated imiquimod hydrogel for the treatment of actinic cheilitis: Drug release analysis and clinical study. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2024; 62:102779. [PMID: 39147219 DOI: 10.1016/j.nano.2024.102779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/26/2024] [Accepted: 08/07/2024] [Indexed: 08/17/2024]
Abstract
Actinic cheilitis (AC) is a lip disorder, with no standard treatment. Imiquimod (IMIQ) is an immunomodulator that treat precancerous lesions; however, its commercial form causes severe adverse effects. This study aimed to assess IMQ release from a chitosan hydrogel containing 0.05 % nanoencapsulated (NANO) imiquimod (IMIQ-0.05 %-NANO) and its efficacy in AC treatment. The hydrogels were prepared by incorporating chitosan into polymeric nanocapsules (NCimiq) loaded with IMQ, produced using the interfacial deposition of preformed polymer method. IMQ release was evaluated using automated Franz Cells. A triple-blind randomized controlled trial (49 subjects) compared the efficacy of: IMIQ-0.05 %-NANO, 5 % free imiquimod (IMIQ-5 %), 0.05 % free imiquimod (IMIQ-0.05 %), and placebo hydrogel. The IMIQ-NANO-0.05 % and IMIQ-5 % groups exhibited significantly higher rates of clinical improvement (p < 0.05); however, the IMIQ-5 % group experienced more adverse effects (92.3 % of subjects) compared to other groups (p < 0.05). In conclusion, in the studied sample, IMIQ-NANO-0.05 % was a safe and effective option to treat AC.
Collapse
Affiliation(s)
- Eduardo Liberato da Silva
- Department of Oral Medicine, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Erick Souza Pedraça
- Department of Oral Medicine, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Arthur Pias Salgueiro
- Department of Oral Medicine, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Rafaela Pletsch Gazzi
- Post-graduation Program of Pharmaceutical Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Júlia Silveira Nunes
- Department of Oral Medicine, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Juliano Cavagni
- Department of Periodontology, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Marco Antônio Trevizani Martins
- Department of Oral Medicine, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Oral Medicine Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Pantelis Varvaki Rados
- Department of Oral Medicine, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Adriana Raffin Pohlmann
- Post-graduation Program of Pharmaceutical Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Núcleo de Terapias Nanotecnológicas (NTnano), Faculdade de Farmácia da Universidade Federal do Rio Grande do Sul, Brazil
| | - Silvia Stanisçuaski Guterres
- Post-graduation Program of Pharmaceutical Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Núcleo de Terapias Nanotecnológicas (NTnano), Faculdade de Farmácia da Universidade Federal do Rio Grande do Sul, Brazil
| | - Luiza Abrahão Frank
- Post-graduation Program of Pharmaceutical Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Núcleo de Terapias Nanotecnológicas (NTnano), Faculdade de Farmácia da Universidade Federal do Rio Grande do Sul, Brazil
| | - Fernanda Visioli
- Department of Oral Medicine, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Núcleo de Terapias Nanotecnológicas (NTnano), Faculdade de Farmácia da Universidade Federal do Rio Grande do Sul, Brazil; Experimental Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
| |
Collapse
|
59
|
Gupta M, Gupta P, Devi P, Utkarsh, Butola D, Butola S. Patients' experiences of mechanical ventilation in intensive care units in low- and lower-middle-income countries: protocol of a systematic review. Syst Rev 2024; 13:217. [PMID: 39135133 PMCID: PMC11318143 DOI: 10.1186/s13643-024-02630-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 07/25/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Mechanical ventilation (MV) in intensive care units (ICUs) is a stressful experience for patients. However, these experiences have not been systematically explored in low- and lower-middle-income countries (LLMICs). This systematic review (SR) aims to explore the patients' experiences of MV in ICUs in LLMICs and the factors influencing their experiences. METHODS The PICO framework will be used to operationalize the review question into key concepts: population (mechanically ventilated adult patients in ICUs), phenomenon of interest (experiences) and context (LLMICs). PubMed, Embase, PsycINFO, CINAHL, Cochrane Library, Scopus and Web of Science will be systematically searched since database inception. Citation, reference list and PubMed-related article searching of included studies will be done to ensure literature saturation. Empirical peer-reviewed literature exploring adult patients' (aged ≥ 18 years) experiences of MV in ICUs in LLMIC will be included. All study designs (quantitative, qualitative and mixed methods) will be included. Two independent reviewers will perform screening, data extraction and critical appraisal. The mixed-methods appraisal tool (MMAT) and Popay's narrative synthesis will be used for critical appraisal and data synthesis, respectively. DISCUSSION This SR aims to bridge a gap in knowledge as previous evidence synthesis has described this phenomenon in developed countries. The review design, with the inclusion of quantitative, qualitative and mixed-methods studies, intends to provide a rich and in-depth exploration of the issue. The findings will be presented as themes, subthemes and their explanatory narratives. The gaps in available literature will be identified, and implications of SR findings on policy, practice and future research will be presented. The strength of this SR lies in its systematic, comprehensive, transparent, robust and explicit methodology of identifying, collating, assessing and synthesizing available evidence. By prior registration and reporting of this SR protocol, we aim to ensure transparency and accountability and minimize bias. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42024507187.
Collapse
Affiliation(s)
- Mayank Gupta
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
| | - Priyanka Gupta
- Department of Anaesthesiology, Graphic Era Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Preeti Devi
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
| | - Utkarsh
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
| | - Damini Butola
- Department of Clinical Psychology, Ranchi Institute of Neuro-Psychiatry and Allied Sciences, Kanke, Ranchi, Jharkhand, India
| | | |
Collapse
|
60
|
Palavani LB, Camerotte R, Vieira Nogueira B, Ferreira MY, Oliveira LB, Pari Mitre L, Coelho Nogueira de Castro W, Canto Gomes GL, Fabrini Paleare LF, Batista S, Fim Andreão F, Bertani R, Dias Polverini A. Innovative solutions? Belzutifan therapy for hemangioblastomas in Von Hippel-Lindau disease: A systematic review and single-arm meta-analysis. J Clin Neurosci 2024; 128:110774. [PMID: 39128437 DOI: 10.1016/j.jocn.2024.110774] [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: 07/08/2024] [Revised: 07/31/2024] [Accepted: 08/03/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Von Hippel-Lindau (VHL) disease is a rare autosomal dominant disorder that predisposes patients to develop multiple cysts and tumors, such as hemangioblastomas (HBs) and clear cell renal cell carcinoma (ccRCC), due to mutations in the VHL tumor suppressor gene. While treatment of HBs varies based on their characteristics and has improved patient survival, it still involves high morbidity and mortality, leading to ongoing debates and studies to refine therapy strategies. Recent developments include the emergence of Belzutifan, a novel inhibitor targeting hypoxia-inducible factor 2α (HIF-2α), which has shown promising results in ongoing trials, particularly for patients not immediately requiring surgery. METHODS This systematic review and meta-analysis aimed to comprehensively evaluate the efficacy and safety of Belzutifan for treating HBs associated with VHL disease. Search was conducted across Medline, Embase, Cochrane, and Web of Science databases. Statistical Analysis was performed, with proportions and 95 % confidence intervals. Statistical analyses were carried out using R Studio. RESULTS Ten studies were selected, comprising 553 patients. The population mean age was 40 (24-65), and 50 % of the population was formed by males. In terms of proportion, 6 analyses were performed: Disease Stability of 31 % [95 %CI:14 %-47 %; I2 = 2 %]; Disease Progression of 2 %[95 %CI:0 %-9 %; I2 = 0 %]; Partial Response of 75 % [95 %CI:54 %-96 %; I2 = 58 %]. Complete response of 1 % [95 %CI:0 %-7 %; I2 = 0 %];and Side effects, anemia 81 % rate [95 % CI:54 %-100 %; I2 = 94 %], and fatigue rate of 79 % [95 % CI:54 %-100 %;I2 = 94 %]. CONCLUSION Results indicate that Belzutifan effectively stabilizes disease, reduces tumor progression, and achieves significant therapeutic responses, although side effects like anemia and fatigue were noted.
Collapse
Affiliation(s)
| | | | | | - Márcio Yuri Ferreira
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Leonardo B Oliveira
- Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Lucas Pari Mitre
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil
| | | | | | | | - Sávio Batista
- Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil
| | | |
Collapse
|
61
|
Heesen R, Rubin H, Schneider MD, Woolaston K, Bortolus A, Chukwu EE, Kaufer R, Mitova V, Schwenkenbecher A, Schwindt E, Slanickova H, Sogbanmu TO, Hewitt CL. A model of faulty and faultless disagreement for post-hoc assessments of knowledge utilization in evidence-based policymaking. Sci Rep 2024; 14:18495. [PMID: 39122844 PMCID: PMC11316112 DOI: 10.1038/s41598-024-69012-3] [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: 02/21/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
When evidence-based policymaking is so often mired in disagreement and controversy, how can we know if the process is meeting its stated goals? We develop a novel mathematical model to study disagreements about adequate knowledge utilization, like those regarding wild horse culling, shark drumlines and facemask policies during pandemics. We find that, when stakeholders disagree, it is frequently impossible to tell whether any party is at fault. We demonstrate the need for a distinctive kind of transparency in evidence-based policymaking, which we call transparency of reasoning. Such transparency is critical to the success of the evidence-based policy movement, as without it, we will be unable to tell whether in any instance a policy was in fact based on evidence.
Collapse
Grants
- RG2023/1 Zentrum für interdisziplinäre Forschung, Universität Bielefeld
- RG2023/1 Zentrum für interdisziplinäre Forschung, Universität Bielefeld
- RG2023/1 Zentrum für interdisziplinäre Forschung, Universität Bielefeld
- RG2023/1 Zentrum für interdisziplinäre Forschung, Universität Bielefeld
- RG2023/1 Zentrum für interdisziplinäre Forschung, Universität Bielefeld
- RG2023/1 Zentrum für interdisziplinäre Forschung, Universität Bielefeld
- RG2023/1 Zentrum für interdisziplinäre Forschung, Universität Bielefeld
- RG2023/1 Zentrum für interdisziplinäre Forschung, Universität Bielefeld
- RG2023/1 Zentrum für interdisziplinäre Forschung, Universität Bielefeld
- RG2023/1 Zentrum für interdisziplinäre Forschung, Universität Bielefeld
- RG2023/1 Zentrum für interdisziplinäre Forschung, Universität Bielefeld
- RG2023/1 Zentrum für interdisziplinäre Forschung, Universität Bielefeld
- RG2023/1 Zentrum für interdisziplinäre Forschung, Universität Bielefeld
- 2045007 Directorate for Social, Behavioral and Economic Sciences
- Norbert Elias Fellowship Volkswagen Foundation
- Norbert Elias Fellowship Volkswagen Foundation
- 11220210100507CO Consejo Nacional de Investigaciones Científicas y Técnicas
- 024.003.025 Nederlandse Organisatie voor Wetenschappelijk Onderzoek
Collapse
Affiliation(s)
- Remco Heesen
- Department of Philosophy, Logic and Scientific Method, London School of Economics and Political Science, London, UK.
| | - Hannah Rubin
- Department of Philosophy, University of Missouri, Columbia, USA
| | | | - Katie Woolaston
- School of Law, Queensland University of Technology, Brisbane, Australia
| | - Alejandro Bortolus
- Instituto Patagónico Para El Estudio de los Ecosistemas Continentales (IPEEC-CONICET), Puerto Madryn, Argentina
| | - Emelda E Chukwu
- Center for Infectious Diseases Research, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Ricardo Kaufer
- Center for Interdisciplinary Research (ZiF), Bielefeld University, Bielefeld, Germany
- Academy for Territorial Development (ARL), Leibniz Association, Hannover, Germany
| | - Veli Mitova
- African Centre for Epistemology and Philosophy of Science, University of Johannesburg, Johannesburg, South Africa
| | - Anne Schwenkenbecher
- School of Humanities, Arts and Social Sciences, Murdoch University, Perth, Australia
- Centre for Biosecurity and One Health, Murdoch University, Perth, Australia
| | - Evangelina Schwindt
- Instituto de Biología de Organismos Marinos (IBIOMAR-CONICET), Puerto Madryn, Argentina
| | - Helena Slanickova
- Faculty of Philosophy, University of Groningen, Groningen, the Netherlands
| | - Temitope O Sogbanmu
- Department of Zoology, University of Lagos, Lagos, Nigeria
- Environmental Evidence Synthesis and Knowledge Translation (EESKT) Research Group, University of Lagos, Lagos, Nigeria
| | - Chad L Hewitt
- Centre for Biosecurity Research Analysis and Synthesis, Lincoln University, Lincoln, New Zealand
- Centre for Biosecurity and One Health, Murdoch University, Perth, Australia
| |
Collapse
|
62
|
Kokkali M, Pinioti E, Lappas AS, Christodoulou N, Samara MT. Effects of Trazodone on Sleep: A Systematic Review and Meta-analysis. CNS Drugs 2024:10.1007/s40263-024-01110-2. [PMID: 39123094 DOI: 10.1007/s40263-024-01110-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND AND OBJECTIVES Sleep problems and insomnia are common, challenging to treat, and transcend specific diagnoses. Although trazodone is a popular choice, robust meta-analytic evidence is lacking. This systematic review and meta-analysis investigates the efficacy and safety of trazodone for sleep disturbances, reflecting recent updates in insomnia diagnosis and treatment. METHODS We searched Medline, Embase, APA PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to 1 May 2024, for Randomized Controlled Trials (RCTs) comparing trazodone with placebo and reporting sleep-related outcomes. The minimum pharmacotherapy duration was 5 days. Included were all RCTs regardless of blinding (open-label or single- or double-blind), while quasi-randomized studies were excluded. The Cochrane Risk of Bias Tool for Randomized Trials assessed bias. Analyses used a random-effects model on an intention-to-treat (ITT) basis. Risk ratio (RR) was used for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes. When different units or scales were used, Hedge's adjusted g standardized mean difference (SMD) was calculated. Subgroup and preplanned sensitivity analyses explored heterogeneity and evaluated findings' strength and consistency. RESULTS In total, 44 RCTs with 3935 participants were included. Trazodone did not significantly impact subjective total sleep time (TST) [WMD = 0.73 min, 95% confidence interval (CI) - 24.62; 26.07, p = 0.96] but improved sleep quality (SQ) (SMD = - 0.58, 95% CI - 0.87; - 0.28, p < 0.01) and secondary outcomes. These included the number of nocturnal awakenings (SMD = - 0.57, 95% CI - 0.85; - 0.30], p < 0.01), nocturnal time awake after sleep onset (WMD = - 13.47 min, 95% CI - 23.09; - 3.86], p < 0.01), objective TST by polysomnography (WMD = 27.98 min, 95% CI 4.02; 51.95, p = 0.02), and sleep efficiency (WMD = 3.32, 95% CI 0.53; 1.57, p = 0.02). Tolerability issues included more dropouts owing to adverse effects (RR = 2.30, 95% CI 1.45; 3.64, p < 0.01), any sleep-related adverse effects (RR = 3.67, 95% CI 1.07; 12.47, p = 0.04), more adverse effects in general (RR = 1.18, 95% CI 1.03; 1.33, p = 0.02), and more sleep-related adverse effects (RR = 4.31, 95% CI 2.29; 8.13, p < 0.01). CONCLUSION Trazodone extends total sleep time but does not affect perceived sleep duration. It may improve sleep quality and continuity but has minor effects on sleep latency, efficiency, and daytime impairment. Trazodone is associated with adverse effects, necessitating a careful risk-benefit assessment. Limited data restrict generalizability, underscoring the need for more research. REGISTRATION PROSPERO registration number,CRD42022383121.
Collapse
Affiliation(s)
- Maria Kokkali
- Department of Psychiatry, School of Medicine, University of Thessaly, 41334, Larissa, Greece
| | - Elisavet Pinioti
- Department of Psychiatry, School of Medicine, University of Thessaly, 41334, Larissa, Greece
| | - Andreas S Lappas
- Department of Psychiatry, School of Medicine, University of Thessaly, 41334, Larissa, Greece
- Aneurin Bevan University Health Board, Wales, UK
| | - Nikolaos Christodoulou
- Department of Psychiatry, School of Medicine, University of Thessaly, 41334, Larissa, Greece
- Medical School, University of Nottingham, Nottingham, UK
| | - Myrto T Samara
- Department of Psychiatry, School of Medicine, University of Thessaly, 41334, Larissa, Greece.
| |
Collapse
|
63
|
Liu TJ, Wolber AK, Sherwood C, Soyer HP. Patient and doctor anecdotal observations: narrative insights for reducing diagnostic excisions and promoting early detection of melanomas. Int J Dermatol 2024. [PMID: 39123279 DOI: 10.1111/ijd.17441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Affiliation(s)
- Timothy J Liu
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, QLD, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Anna K Wolber
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Carl Sherwood
- School of Economics, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, QLD, Australia
| | - H Peter Soyer
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, QLD, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| |
Collapse
|
64
|
Reinhardt L, Strasser C, Steeb T, Petzold A, Heppt MV, Wessely A, Berking C, Meier F. General practitioners' perspectives on statutory skin cancer screening-A questionnaire-based cross-sectional survey in Germany. PLoS One 2024; 19:e0308508. [PMID: 39116110 PMCID: PMC11309404 DOI: 10.1371/journal.pone.0308508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/24/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND In Germany, skin cancer screening (SCS) is available free of charge every two years to all those with statutory health insurance over the age of 35. General Practitioners (GP) can carry out the screening if they have completed an 8-hour training course. GPs play a crucial role in the implementation of SCS and act as gatekeepers between initial patient contact and referral to dermatologists. OBJECTIVE To record how comprehensively GPs carry out SCS in terms of patient information and body examination, as well as to explore GPs opinions on the feasibility of SCS. METHODS A cross-sectional survey was conducted. A questionnaire was sent to GPs with permission to perform SCS in two regions of Germany (Bavaria and Saxony) between August and September 2021. Data were analyzed using descriptive analysis. Subgroup analysis was performed according to regions (federal state, location of physician´s office), professional experience (experience in years, number of monthly screenings, age) and gender. Open questions were evaluated using qualitative content analysis. RESULTS In the survey, 204 GPs responded. Genitalia (40.7%, 83/203), anal fold (62.3%, 127/204) and oral mucosa (66.7%, 136/204) were the least examined body regions during screening. Information on risks (false-positive findings: 18.6%, 38/203; false-negative findings: 13.2%, 27/203; overdiagnosis: 7.8%, 16/203) and benefits (48.0%, 98/202) were not always provided. GPs who performed screenings more frequently were more likely to provide information about the benefits of SCS (p<0.001; >10 vs. <5 screenings per month). Opinions were provided on uncertainties, knowledge requirements, structural and organizational requirements of SCS, SCS training and evaluation. The organization and remuneration of the SCS programme was seen as a barrier to implementation. GPs expressed uncertainties especially in unclear findings and in dermatoscopy. CONCLUSION Uncertainties in the implementation of the SCS should be addressed by offering refresher courses. Good networking between GPs and dermatologists is essential to improve SCS quality.
Collapse
Affiliation(s)
- Lydia Reinhardt
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
- Skin Cancer Center at the National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Cristin Strasser
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
- Skin Cancer Center at the National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Theresa Steeb
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), Erlangen, Germany
| | - Anne Petzold
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), Erlangen, Germany
| | - Markus V. Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), Erlangen, Germany
| | - Anja Wessely
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), Erlangen, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), Erlangen, Germany
| | - Friedegund Meier
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
- Skin Cancer Center at the National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| |
Collapse
|
65
|
Umair M, Khan M, Olivier J. Accounting for regression to the mean under the bivariate t-distribution. Stat Methods Med Res 2024:9622802241267808. [PMID: 39118352 DOI: 10.1177/09622802241267808] [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: 08/10/2024]
Abstract
Regression to the mean occurs when an unusual observation is followed by a more typical outcome closer to the population mean. In pre- and post-intervention studies, treatment is administered to subjects with initial measurements located in the tail of a distribution, and a paired sample t -test can be utilized to assess the effectiveness of the intervention. The observed change in the pre-post means is the sum of regression to the mean and treatment effects, and ignoring regression to the mean could lead to erroneous conclusions about the effectiveness of the treatment effect. In this study, formulae for regression to the mean are derived, and maximum likelihood estimation is employed to numerically estimate the regression to the mean effect when the test statistic follows the bivariate t -distribution based on a baseline criterion or a cut-off point. The pre-post degrees of freedom could be equal but also unequal such as when there is missing data. Additionally, we illustrate how regression to the mean is influenced by cut-off points, mixing angles which are related to correlation, and degrees of freedom. A simulation study is conducted to assess the statistical properties of unbiasedness, consistency, and asymptotic normality of the regression to the mean estimator. Moreover, the proposed methods are compared with an existing one assuming bivariate normality. The p -values are compared when regression to the mean is either ignored or accounted for to gauge the statistical significance of the paired t -test. The proposed method is applied to real data concerning schizophrenia patients, and the observed conditional mean difference called the total effect is decomposed into the regression to the mean and treatment effects.
Collapse
Affiliation(s)
- Muhammad Umair
- Department of Statistics, Quaid-i-Azam University Islamabad, Pakistan
| | - Manzoor Khan
- Department of Statistics, Quaid-i-Azam University Islamabad, Pakistan
- School of Mathematics and Statistics, University of New South Wales, Sydney, Australia
| | - Jake Olivier
- School of Mathematics and Statistics, University of New South Wales, Sydney, Australia
| |
Collapse
|
66
|
Artigues Serra F, Pinecki Socias S, Fanjul FJ, Peñaranda M, Homar F, Sorni P, Serra J, Rey A, Ventayol L, Macia MD, Ribas MÀ, Riera M. Factors associated with SARS-CoV-2 infection among people living with HIV: Data from the Balearic cohort (EVHIA). PLoS One 2024; 19:e0308568. [PMID: 39110761 PMCID: PMC11305541 DOI: 10.1371/journal.pone.0308568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 07/25/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION The impact of SARS-CoV-2 infection among people living with HIV (PLWH) has been a matter of research. We evaluated the incidence and factors associated with SARS-CoV-2 diagnosis among PLWH. We also assessed factors related to vaccination coverage in the Balearic Islands. METHODS A retrospective analytical study was performed, including patients from the Balearic cohort (EVHIA) who were visited at least twice between 1st January 2020 and 31st March 2022. Chi-square test and Mann-Whitney U test were used to compare categorical and continuous variables respectively. Multivariable Cox proportional hazards regression models were estimated to identify risk factors. RESULTS A total of 3567 patients with HIV were included. The median age was 51 years (IQR 44-59). Most of them were male (77,3%), from Europe (82,1%) or South America (13,8%). During the study period 1036 patients were diagnosed with SARS-CoV-2 infection (29%). The incidence rate was 153,24 cases per 1000 person-year. After multivariable analysis, men who have sex with men (MSM) were associated with an increased risk of SARS-CoV-2 infection (adjusted hazard ratio 1,324, 95% CI 1,138-1,540), whereas African origin, tobacco use and complete or booster vaccination coverage were negatively related. Overall, complete vaccination or booster coverage was recorded in 2845 (79,75%) patients. When analysing vaccination uptake, older patients (adjusted hazard ratio 5,122, 95% CI 3,170-8,288) and those with a modified comorbidity index of 2-3 points (adjusted hazard ratio 1,492, 95% CI 1,056-2,107) had received more vaccine doses. CONCLUSIONS In our study no HIV related factor was associated with an increased risk of SARS-CoV-2 infection, except for differences in the transmission route. Possible confounding variables such as mask wearing or social interactions could not be measured. Vaccines were of utmost importance to prevent SARS-CoV-2 infection. Efforts should be made to encourage vaccination in those groups of PLWH with less coverage.
Collapse
Affiliation(s)
- Francisca Artigues Serra
- Department of Internal Medicine, Section of Infectious Diseases, Son Espases University Hospital-IDISBA, Palma, Balearic Islands, Spain
| | - Sophia Pinecki Socias
- Department of Internal Medicine, Section of Infectious Diseases, Son Espases University Hospital-IDISBA, Palma, Balearic Islands, Spain
| | - Francisco Javier Fanjul
- Department of Internal Medicine, Section of Infectious Diseases, Son Espases University Hospital-IDISBA, Palma, Balearic Islands, Spain
| | - Maria Peñaranda
- Department of Internal Medicine, Section of Infectious Diseases, Son Espases University Hospital-IDISBA, Palma, Balearic Islands, Spain
| | - Francisco Homar
- Department of Internal Medicine, Son Llatzer University Hospital-IDISBA, Palma, Balearic Islands, Spain
| | - Patricia Sorni
- Department of Internal Medicine, Son Llatzer University Hospital-IDISBA, Palma, Balearic Islands, Spain
| | - Julia Serra
- Department of Internal Medicine, Inca Regional Hospital, Inca, Balearic Islands, Spain
| | - Adelaida Rey
- Department of Internal Medicine, Inca Regional Hospital, Inca, Balearic Islands, Spain
| | - Lola Ventayol
- Department of Internal Medicine, Manacor Regional Hospital, Manacor, Balearic Islands, Spain
| | - Maria Dolores Macia
- Department of Microbiology, Son Espases University Hospital-IDISBA CIBERINFEC, Palma, Balearic Islands, Spain
| | - Maria Àngels Ribas
- Department of Internal Medicine, Section of Infectious Diseases, Son Espases University Hospital-IDISBA, Palma, Balearic Islands, Spain
| | - Melchor Riera
- Department of Internal Medicine, Section of Infectious Diseases, Son Espases University Hospital-IDISBA CIBERINFEC, Palma, Balearic Islands, Spain
| |
Collapse
|
67
|
Hysa E, Casabella A, Gotelli E, Campitiello R, Schenone C, Genova C, Tanda ET, Sulli A, Smith V, Cimmino MA, Paolino S, Cutolo M. Polymyalgia rheumatica and giant cell arteritis induced by immune checkpoint inhibitors: A systematic literature review highlighting differences from the idiopathic forms. Autoimmun Rev 2024; 23:103589. [PMID: 39117006 DOI: 10.1016/j.autrev.2024.103589] [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: 04/18/2024] [Revised: 08/03/2024] [Accepted: 08/04/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION An altered immune tolerance disturbed by immune checkpoint inhibitors (ICIs) may contribute to new-onset polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). This systematic literature review (SLR) examines the characteristics of PMR and GCA-like syndromes following anticancer treatment with ICIs, summarizing their demographic, clinical and treatment-related features to provide insights whether they differ from the idiopathic forms. METHODS The SLR was conducted in Medline and EMBASE databases from inception to July 2024, and in the EULAR/ACR abstract database (2021-2023). ICI-induced PMR and GCA syndromes were compared to the primary forms of the diseases using data from studies that included both groups as comparators. For manuscripts lacking direct comparisons, we summarized the main findings and discussed the differences using systematic reviews or large observational studies on the primary forms. RESULTS From 1237 screened abstracts, 46 met the inclusion criteria, involving 358 patients (314 with ICI-PMR and 44 with ICI-GCA). ICI-PMR had an estimated pooled prevalence of 0.1% [95% CI: 0.07%, 0.14%] among ICI recipients and 15.9% [95% CI: 12.6%, 19.9%] among patients experiencing rheumatic immune-related adverse events. Patients with ICI-PMR had a male-to-female ratio of 1.7:1 and a mean age of 71 ± 4 years. Most cases were associated with PD1/PDL1 blockers (87%). Clinical features included inflammatory pain in the girdles (100%), though pelvic girdle involvement was under-reported in some cases (3/28 studies). Peripheral arthritis was present in 35% of patients. Laboratory tests showed normal or slightly elevated inflammatory markers in 26% of cases. Glucocorticoids (GCs) led to symptom improvement in 84% of cases although 20% required immunosuppressive treatment and 14% experienced relapses. ICI-GCA had a prevalence of 0.06% among ICI recipients, with equal gender distribution and a mean age of 71 ± 5 years. Most patients received anti-PD1/PDL1 blockers (57%). Clinical manifestations included cephalic symptoms (75%), permanent visual loss (23%) and symptoms related to large-vessel involvement (54%). High-dose GCs were effective, with 96% achieving remission, though 17% experienced relapses. CONCLUSIONS ICI-induced PMR and GCA may have distinct clinical profiles compared to idiopathic forms, with potentially milder symptoms and better treatment responses. Further studies are needed to confirm these findings and better understand the long-term outcomes and pathophysiology of these conditions.
Collapse
Affiliation(s)
- Elvis Hysa
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy; Department of Experimental Medicine (DIMES), University of Genova, Genoa, Italy
| | | | - Emanuele Gotelli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Rosanna Campitiello
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carlotta Schenone
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Carlo Genova
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Academic Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
| | - Enrica Teresa Tanda
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy; UOC Medical Oncology Clinic 2, Department of Internal Medicine, University of Genova, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, Department of Rheumatology, Ghent University Hospital, Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Marco Amedeo Cimmino
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Sabrina Paolino
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| |
Collapse
|
68
|
Lax SJ, Van Vogt E, Candy B, Steele L, Reynolds C, Stuart B, Parker R, Axon E, Roberts A, Doyle M, Chu DK, Futamura M, Santer M, Williams HC, Cro S, Drucker AM, Boyle RJ. Topical anti-inflammatory treatments for eczema: network meta-analysis. Cochrane Database Syst Rev 2024; 8:CD015064. [PMID: 39105474 DOI: 10.1002/14651858.cd015064.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
BACKGROUND Eczema (atopic dermatitis) is the most burdensome skin condition worldwide and cannot currently be prevented or cured. Topical anti-inflammatory treatments are used to control eczema symptoms, but there is uncertainty about the relative effectiveness and safety of different topical anti-inflammatory treatments. OBJECTIVES To compare and rank the efficacy and safety of topical anti-inflammatory treatments for people with eczema using a network meta-analysis. SEARCH METHODS We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase and trial registries on 29 June 2023, and checked the reference lists of included studies. SELECTION CRITERIA We included within-participant or between-participant randomised controlled trials (RCTs) in people of any age with eczema of any severity, but excluded trials in clinically infected eczema, seborrhoeic eczema, contact eczema, or hand eczema. We included topical anti-inflammatory treatments used for at least one week, compared with another anti-inflammatory treatment, no treatment, or vehicle/placebo. Vehicle is a 'carrier system' for an active pharmaceutical substance, which may also be used on its own as an emollient for dry skin. We excluded trials of topical antibiotics used alone, complementary therapies, emollients used alone, phototherapy, wet wraps, and systemic treatments. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Primary outcomes were patient-reported eczema symptoms, clinician-reported eczema signs and investigator global assessment. Secondary outcomes were health-related quality of life, long-term control of eczema, withdrawal from treatment/study, and local adverse effects (application-site reactions, pigmentation changes and skin thinning/atrophy were identified as important concerns through patient and public involvement). We used CINeMA to quantify our confidence in the evidence for each outcome. MAIN RESULTS We included 291 studies involving 45,846 participants with the full spectrum of eczema severity, mainly conducted in high-income countries in secondary care settings. Most studies included adults, with only 31 studies limited to children aged < 12 years. Studies usually included male and female participants, multiple ethnic groups but predominantly white populations. Most studies were industry-funded (68%) or did not report their funding sources/details. Treatment duration and trial participation were a median of 21 and 28 days (ranging from 7 days to 5 years), respectively. Interventions used were topical corticosteroids (TCS) (172), topical calcineurin inhibitors (TCI) (134), phosphodiesterase-4 (PDE-4) inhibitors (55), janus kinase (JAK) inhibitors (30), aryl hydrocarbon receptor activators (10), or other topical agents (21). Comparators included vehicle (170) or other anti-inflammatory treatments. The risk of bias was high in 242 of the 272 (89.0%) trials contributing to data analyses, most commonly due to concerns about selective reporting. Network meta-analysis (NMA) was only possible for short-term outcomes. Patient-reported symptoms NMA of 40 trials (6482 participants) reporting patient-reported symptoms as a binary outcome ranked tacrolimus 0.1% (OR 6.27, 95% CI 1.19 to 32.98), potent TCS (OR 5.99, 95% CI 2.83 to 12.69), and ruxolitinib 1.5% (OR 5.64, 95% CI 1.26 to 25.25) as the most effective, all with low confidence. Mild TCS, roflumilast 0.15%, and crisaborole 2% were the least effective. Class-level sensitivity analysis found potent/very potent TCS had similar effectiveness to potent TCI and was more effective than mild TCI and PDE-4 inhibitors. NMA of 29 trials (3839 participants) reporting patient-reported symptoms as a continuous outcome ranked very potent TCS (SMD -1.99, 95% CI -3.25 to -0.73; low confidence) and tacrolimus 0.03% (SMD -1.57, 95% CI -2.42 to -0.72; moderate confidence) the highest. Direct information for tacrolimus 0.03% was based on one trial of 60 participants at high risk of bias. Roflumilast 0.15%, delgocitinib 0.25% or 0.5%, and tapinarof 1% were the least effective. Class-level sensitivity analysis found potent/very potent TCS had similar effectiveness to potent TCI and JAK inhibitors and mild/moderate TCS was less effective than mild TCI. A further 50 trials (9636 participants) reported patient-reported symptoms as a continuous outcome but could not be included in NMA. Clinician-reported signs NMA of 32 trials (4121 participants) reported clinician signs as a binary outcome and ranked potent TCS (OR 8.15, 95% CI 4.99, 13.57), tacrolimus 0.1% (OR 8.06, 95% CI 3.30, 19.67), ruxolitinib 1.5% (OR 7.72, 95% CI 4.92, 12.10), and delgocitinib 0.5% (OR 7.61, 95% CI 3.72, 15.58) as most effective, all with moderate confidence. Mild TCS, roflumilast 0.15%, crisaborole 2%, and tapinarof 1% were the least effective. Class-level sensitivity analysis found potent/very potent TCS more effective than potent TCI, mild TCI, JAK inhibitors, PDE-4 inhibitors; and mild TCS and PDE-4 inhibitors had similar effectiveness. NMA of 49 trials (5261 participants) reported clinician signs as a continuous outcome and ranked tacrolimus 0.03% (SMD -2.69, 95% CI -3.36, -2.02) and very potent TCS (SMD -1.87, 95% CI -2.69, -1.05) as most effective, both with moderate confidence; roflumilast 0.15%, difamilast 0.3% and tapinarof 1% were ranked as least effective. Direct information for tacrolimus 0.03% was based on one trial in 60 participants with a high risk of bias. For some sensitivity analyses, potent TCS, tacrolimus 0.1%, ruxolitinib 1.5%, delgocitinib 0.5% and delgocitinib 0.25% became some of the most effective treatments. Class-level analysis found potent/very potent TCS had similar effectiveness to potent TCI and JAK inhibitors, and moderate/mild TCS was more effective than mild TCI. A further 100 trials (22,814 participants) reported clinician signs as a continuous outcome but could not be included in NMA. Investigator Global Assessment NMA of 140 trials (23,383 participants) reported IGA as a binary outcome and ranked ruxolitinib 1.5% (OR 9.34, 95% CI 4.8, 18.18), delgocitinib 0.5% (OR 10.08, 95% CI 2.65, 38.37), delgocitinib 0.25% (OR 6.87, 95% CI 1.79, 26.33), very potent TCS (OR 8.34, 95% CI 4.73, 14.67), potent TCS (OR 5.00, 95% CI 3.80, 6.58), and tacrolimus 0.1% (OR 5.06, 95% CI 3.59, 7.13) as most effective, all with moderate confidence. Mild TCS, crisaborole 2%, pimecrolimus 1%, roflumilast 0.15%, difamilast 0.3% and 1%, and tacrolimus 0.03% were the least effective. In a sensitivity analysis of low risk of bias information (12 trials, 1639 participants), potent TCS, delgocitinib 0.5% and delgocitinib 0.25% were most effective, and pimecrolimus 1%, roflumilast 0.15%, difamilast 1% and difamilast 0.3% least effective. Class-level sensitivity analysis found potent/very potent TCS had similar effectiveness to potent TCI and JAK inhibitors and were more effective than PDE-4 inhibitors; mild/moderate TCS were less effective than potent TCI and had similar effectiveness to mild TCI. Longer-term outcomes over 6 to 12 months showed a possible increase in effectiveness for pimecrolimus 1% versus vehicle (4 trials, 2218 participants) in a pairwise meta-analysis, and greater treatment success with mild/moderate TCS than pimecrolimus 1% (based on 1 trial of 2045 participants). Local adverse effects NMA of 83 trials (18,992 participants, 2424 events) reporting application-site reactions ranked tacrolimus 0.1% (OR 2.2, 95% CI 1.53, 3.17; moderate confidence), crisaborole 2% (OR 2.12, 95% CI 1.18, 3.81; high confidence), tacrolimus 0.03% (OR 1.51, 95%CI 1.10, 2.09; low confidence), and pimecrolimus 1% (OR 1.44, 95% CI 1.01, 2.04; low confidence) as most likely to cause site reactions. Very potent, potent, moderate, and mild TCS were least likely to cause site reactions. NMA of eight trials (1786 participants, 3 events) reporting pigmentation changes found no evidence for increased pigmentation changes with TCS and crisaborole 2%, with low confidence for mild, moderate or potent TCS and moderate confidence for crisaborole 2%. NMA of 25 trials (3691 participants, 36 events) reporting skin thinning found no evidence for increased skin thinning with short-term (median 3 weeks, range 1-16 weeks) use of mild TCS (OR 0.72, 95% CI 0.12, 4.31), moderate TCS (OR 0.91, 95% CI 0.16, 5.33), potent TCS (OR 0.96, 95% CI 0.21, 4.43) or very potent TCS (OR 0.88, 95% CI 0.31, 2.49), all with low confidence. Longer-term outcomes over 6 to 60 months showed increased skin thinning with mild to potent TCS versus TCI (3 trials, 4069 participants, 6 events with TCS). AUTHORS' CONCLUSIONS Potent TCS, JAK inhibitors and tacrolimus 0.1% were consistently ranked as amongst the most effective topical anti-inflammatory treatments for eczema and PDE-4 inhibitors as amongst the least effective. Mild TCS and tapinarof 1% were ranked amongst the least effective treatments in three of five efficacy networks. TCI and crisaborole 2% were ranked most likely to cause local application-site reactions and TCS least likely. We found no evidence for increased skin thinning with short-term TCS but an increase with longer-term TCS.
Collapse
Affiliation(s)
- Stephanie J Lax
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Eleanor Van Vogt
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Bridget Candy
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Lloyd Steele
- Department of Dermatology, Royal Free London, London, UK
- Wellcome Sanger Institute, Cambridge, UK
| | - Clare Reynolds
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Beth Stuart
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Emma Axon
- Cochrane Methods Support Unit, Cochrane, London, UK
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK
| | - Megan Doyle
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Derek K Chu
- Department of Medicine, and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Masaki Futamura
- Department of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Miriam Santer
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Suzie Cro
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Aaron M Drucker
- Department of Medicine, University of Toronto, Toronto, Canada
- Research and Innovation Institute and Department of Medicine, Women's College Hospital, Toronto, Canada
| | - Robert J Boyle
- National Heart & Lung Institute, Section of Inflammation and Repair, Imperial College London, London, UK
| |
Collapse
|
69
|
Rudan I, Katikireddi SV, Kerr S, Millington T, Grange Z, Sullivan C, Fagbamigbe AF, Swallow B, Kurdi A, Morrison K, Jeffrey K, Simpson CR, Ritchie L, Robertson C, Sheikh A. Selecting the most informative positive and negative controls for self-controlled case series (SCCS): Rationale, approach, and lessons from studies investigating the safety of COVID-19 vaccines. J Glob Health 2024; 14:03037. [PMID: 39105317 DOI: 10.7189/jogh.14.03037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
Affiliation(s)
- Igor Rudan
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Algebra University College, Zagreb, Croatia
| | | | - Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | | | | | | | - Ben Swallow
- School of Mathematics and Statistics, University of St Andrews, St. Andrews, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Karen Jeffrey
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Colin R Simpson
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Lewis Ritchie
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Chris Robertson
- Public Health Scotland, Glasgow, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
70
|
Hong SA. Toward better pandemic governance and preparedness: South Korea's whole-of-nation approach to COVID-19. BMC Public Health 2024; 24:2126. [PMID: 39107756 PMCID: PMC11302091 DOI: 10.1186/s12889-024-19655-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 07/30/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND The profound impact of coronavirus disease (COVID-19) has led to an increased demand for sustainable pandemic governance practices. This study explored emerging hybrid governance practices that provide robust evidence on how to address the complex challenges of pandemics effectively. South Korea, which was severely affected by COVID-19, has implemented a novel governance approach using a whole-of-nation (WoN) model. This hybrid pandemic governance approach, which integrates both whole-of-government and whole-of-society approaches, has enabled synergistic and cohesive multi-sectoral coordination among all stakeholders (public authorities, private enterprises, and civil society) to address multifaceted challenges collectively and strengthen their resilience capacity. This study investigated South Korea's WoN practices and their embedded context and identified key governance enablers facilitating this approach. METHODS This study employed a case study design based on an extensive analysis of policy and program documents, drawing on South Korea's publicly available data from January 1, 2020 to March 30, 2023. It assessed six system-level collaborative pandemic governance practices and key enablers, all of which were intended to fortify the country's pandemic response. RESULTS The primary areas of the country's WoN governance practices for COVID-19 control were (i) whole-of-government policy-making and response, (ii) COVID-19 testing system, (iii) digital surveillance of COVID-19, (iv) COVID-19 triage and treatment system, (v) domestic vaccine production, and (vi) community engagement. Key governance enablers for implementing the WoN model were establishing a legal foundation, ensuring decisive and strong governance and leadership, increasing public investment, applying a whole-of-health approach with augmented investment in public health, enhancing crisis communication, and mobilizing local leaders and civil society organizations in the national public health response. CONCLUSIONS In exploring innovative approaches to pandemic governance for increased efficacy, responsiveness, and impact, the WoN approach emerged as highly relevant. This example of emerging practice allows policy-makers to re-evaluate their governance strategies and initiatives to improve multi-agency partnerships across the country in their pandemic-preparedness planning.
Collapse
Affiliation(s)
- Shin Ae Hong
- Crisis, Disaster and Risk Management, College of Natural Science, Sungkyunkwan University, Seoul, South Korea.
| |
Collapse
|
71
|
Krajewski O, Opiełka M, Urbanowicz K, Chojnowski K, Kochany P, Pawłowski K, Tomaszewska J, Peters GJ, Smoleński RT, Bełdzińska MM. Management of neurological symptoms in Lesch-Nyhan disease: A systematic review. Neurosci Biobehav Rev 2024; 165:105847. [PMID: 39117131 DOI: 10.1016/j.neubiorev.2024.105847] [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: 04/06/2024] [Revised: 07/08/2024] [Accepted: 08/05/2024] [Indexed: 08/10/2024]
Abstract
Lesch-Nyhan Disease (LND) is an X-linked recessive genetic disorder arising from hypoxanthine phosphoribosyltransferase 1 gene mutations, leading to a complete deficiency. LND presents a complex neurological profile characterized by generalized dystonia, motor dysfunctions and self-injurious behavior, which management is challenging. We conducted a systematic review of studies assessing the efficacy of pharmacological and non-pharmacological interventions in management of neurological symptoms in LND (PROSPERO registration number:CRD42023446513). Among 34 reviewed full-text papers; 22 studies were rated as having a high risk of bias. Considerable heterogeneity was found in studies regarding the timing of treatment implementation, adjunctive treatments and outcome assessment. Single-patient studies and clinical trials often showed contradictory results, while therapeutic failures were underreported. S-Adenosylmethionine and Deep Brain Stimulation were the most studied treatment methods and require further research to address inconsistencies. The evidence from levodopa studies underlines that optimal timing of treatment implementation should be thoroughly investigated. Standardized study design and reducing publication bias are crucial to overcome current limitations of assessing intervention efficacy in LND.
Collapse
Affiliation(s)
- Oliwier Krajewski
- Department of Biochemistry, Medical University of Gdansk, Gdansk 80-211, Poland
| | - Mikołaj Opiełka
- Department of Biochemistry, Medical University of Gdansk, Gdansk 80-211, Poland
| | | | - Karol Chojnowski
- Department of Biochemistry, Medical University of Gdansk, Gdansk 80-211, Poland; Department of Developmental Neurology, Medical University of Gdansk, Gdansk 80-211, Poland
| | - Paweł Kochany
- Department of Biochemistry, Medical University of Gdansk, Gdansk 80-211, Poland; Department of Medical Chemistry, Medical University of Gdansk, Gdansk 80-211, Poland
| | - Kacper Pawłowski
- Department of Biochemistry, Medical University of Gdansk, Gdansk 80-211, Poland
| | - Jagoda Tomaszewska
- Department of Biochemistry, Medical University of Gdansk, Gdansk 80-211, Poland
| | - Godefridus J Peters
- Department of Biochemistry, Medical University of Gdansk, Gdansk 80-211, Poland; Cancer Center Amsterdam, Amsterdam U.M.C., VU University Medical Center (VUMC), Department of Medical Oncology, Amsterdam 1081 HV, The Netherlands
| | - Ryszard T Smoleński
- Department of Biochemistry, Medical University of Gdansk, Gdansk 80-211, Poland.
| | | |
Collapse
|
72
|
De las Cuevas C, Benadero O. Exploring the Relationship Between Psychological Constructs and Decision-Making Preferences in Psychiatric Outpatients. Patient Prefer Adherence 2024; 18:1629-1640. [PMID: 39131691 PMCID: PMC11313499 DOI: 10.2147/ppa.s469579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/31/2024] [Indexed: 08/13/2024] Open
Abstract
Objective This study aimed to elucidate the relationships among health locus of control, psychological reactance, attitudes toward psychiatric treatment, and patient decision-making preferences within a psychiatric outpatient population. Methods A total of 200 consecutive psychiatric outpatients from a community mental health center in Tenerife, Spain, were approached for participation between September 2023 and March 2024. Of these, 151 patients consented to participate in this cross-sectional study. Participants were selected based on their willingness to participate and were provided with informed consent forms. Data were collected using the Patient's Health Belief Questionnaire on Psychiatric Treatment (PHBQPT) and the Control Preferences Scale (CPS). The PHBQPT evaluates health beliefs impacting adherence to psychiatric treatment, while the CPS assesses the preferred level of involvement in medical decision-making. Sociodemographic data were also collected to contextualize the findings. Results Significant correlations were found between patients' control preferences and their attitudes towards medication, compliance with psychiatric advice, and perceptions of treatment control. A collaborative control preference was notably associated with positive attitudes toward medication and trust in the psychiatrist. These findings suggest that tailored treatment approaches prioritizing patient involvement could enhance adherence and outcomes. Conclusion The study underscores the importance of considering psychological constructs in psychiatric care to foster a holistic, patient-centered approach. Recognizing and integrating patients' control preferences, attitudes towards medication, and psychological reactance can improve the therapeutic relationship and treatment adherence. Future research should explore longitudinal and interventional studies to further understand the impact of aligning treatment approaches with patient preferences and psychological profiles.
Collapse
Affiliation(s)
- Carlos De las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry and Instituto Universitario de Neurociencia (IUNE), University of La Laguna, La Laguna, Canary Islands, Spain
| | - Omaira Benadero
- School of Medicine of the University of La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| |
Collapse
|
73
|
Anitha K, Singh MK, Kohat K, Sri Varshini T, Chenchula S, Padmavathi R, Amerneni LS, Vishnu Vardhan K, Mythili Bai K, Chavan MR, Bhatt S. Recent Insights into the Neurobiology of Alzheimer's Disease and Advanced Treatment Strategies. Mol Neurobiol 2024:10.1007/s12035-024-04384-1. [PMID: 39102108 DOI: 10.1007/s12035-024-04384-1] [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: 03/19/2024] [Accepted: 07/18/2024] [Indexed: 08/06/2024]
Abstract
In recent years, significant advancements have been made in understanding Alzheimer's disease from both neurobiological and clinical perspectives. Exploring the complex systems underlying AD has unveiled insights that could potentially revolutionize therapeutic approaches. Recent investigations have highlighted intricate interactions among genetic, molecular, and environmental factors in AD. Optimism arises from neurobiological advancements and diverse treatment options, potentially slowing or halting disease progression. Amyloid-beta plaques and tau protein tangles crucially influence AD onset and progression. Emerging treatments involve diverse strategies, such as approaches targeting multiple pathways involved in AD pathogenesis, such as inflammation, oxidative stress, and synaptic dysfunction pathways. Clinical trials using humanized monoclonal antibodies, focusing on immunotherapies eliminating amyloid-beta, have shown promise. Nonpharmacological interventions such as light therapy, electrical stimulation, cognitive training, physical activity, and dietary changes have drawn attention for their potential to slow cognitive aging and enhance brain health. Precision medicine, which involves tailoring therapies to individual genetic and molecular profiles, has gained traction. Ongoing research and interdisciplinary collaboration are expected to yield more effective treatments.
Collapse
Affiliation(s)
- Anitha K
- School of Pharmacy and Technology Management (SPTM), SVKM's Narsee Monjee Institute of Management Studies (NMIMS) Deemed to University, Shirpur, 425405, India
| | | | - Komal Kohat
- All India Institute of Medical Sciences, Madhya Pradesh, Bhopal, 462020, India
| | - Sri Varshini T
- All India Institute of Medical Sciences, Raipur, 462020, India
| | - Santenna Chenchula
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, 462020, India.
| | - Padmavathi R
- SVS Medical College, Hyderabad, Telangana, India
| | | | - Vishnu Vardhan K
- All India Institute of Medical Sciences, Madhya Pradesh, Bhopal, 462020, India
| | | | - Madhav Rao Chavan
- All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - Shvetank Bhatt
- School of Health Sciences and Technology, MIT World Peace University, Dr. Vishwanath Karad, Pune, 411038, Maharashtra, India
| |
Collapse
|
74
|
Soler-Font M, Aznar-Lou I, Almansa J, Peña P, Silva-Peñaherrera M, Serra C, Ramada JM. Cost-Effectiveness of a Multi-faceted Workplace Intervention to Reduce Musculoskeletal Pain in Nursing Staff: A Cluster-Randomized Controlled Trial (INTEVAL_Spain). JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10227-6. [PMID: 39102106 DOI: 10.1007/s10926-024-10227-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE To evaluate the cost-effectiveness of a multifaceted workplace intervention to reduce musculoskeletal pain (MSP) in nursing staff. METHODS The study was a 1-year cluster-randomized controlled trial. The intervention combined participatory ergonomics, health promotion, and case management. The control group received usual care. Societal and health system perspectives were used. Costs included direct health and indirect costs. The effects were MSP and quality-adjusted life years (QALYs). MSP was measured using the Standardized Nordic Questionnaire at baseline and 6- and 12-month follow-up. QALYs were measured using the EuroQol-5D-3L at 6- and 12-month follow-up. Incremental costs and QALYs were modelled using generalized linear models. MSP was analysed through generalized logistic models. Incremental cost-effectiveness ratios (ICERs) were calculated, and cost-effectiveness planes and acceptability curves were constructed. RESULTS Total mean costs per person were €614 and €216 for the intervention and control group, respectively, with a societal perspective. The intervention mean cost was €38/person. From the societal perspective, the ICER showed that overall additional €68 (€9 from a health system perspective) were required to achieve 1-extra-percentage-point reduction of MSP. ICERs were €34 from the societal and €4 from the health system perspectives for neck, shoulders and upper back pain; €53 and €7 for low back; €179 and €23 for hands; €39 and €5 for legs; €115 and €14 for the knees; €36 and €5 for feet For MSP in the elbows. For participants with pain in the elbow, and for QALYs, the ICER showed that the intervention group was dominated by the control group. CONCLUSION This intervention was not cost-effective in terms of QALYs. However, in terms of MSP, with a willingness to pay of €100, the probability of the intervention being cost-effective was around 90%. Further studies incorporating our recommendations are needed to confirm these findings. STUDY REGISTRATION ISRCTN15780649, retrospectively registered.
Collapse
Affiliation(s)
- Mercè Soler-Font
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Ignacio Aznar-Lou
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Josué Almansa
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pilar Peña
- Occupational Health Service, Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Michael Silva-Peñaherrera
- Centre for Research in Occupational Health, University Pompeu Fabra/Hospital del Mar Research Institute, Edifici PRBB (campus del Mar), Doctor Aiguader, 8808003, Barcelona, Spain
| | - Consol Serra
- CIBER of Epidemiology and Public Health, Madrid, Spain.
- Centre for Research in Occupational Health, University Pompeu Fabra/Hospital del Mar Research Institute, Edifici PRBB (campus del Mar), Doctor Aiguader, 8808003, Barcelona, Spain.
- Occupational Health Service, Hospital del Mar, Barcelona, Spain.
| | - José Maria Ramada
- CIBER of Epidemiology and Public Health, Madrid, Spain
- Centre for Research in Occupational Health, University Pompeu Fabra/Hospital del Mar Research Institute, Edifici PRBB (campus del Mar), Doctor Aiguader, 8808003, Barcelona, Spain
- Occupational Health Service, Hospital del Mar, Barcelona, Spain
| |
Collapse
|
75
|
Ponnam HB, Chirravuri SS, Konduru SP, Jammalamadaka S. Exploring the Role of Homeopathic Intervention in Post-COVID Functional Gastrointestinal Disorders: A Case Series of 12 Patient Profiles. HOMEOPATHY 2024. [PMID: 39102855 DOI: 10.1055/s-0044-1787003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
BACKGROUND In the last 2 years of the pandemic, a wide range of cases of post-COVID functional gastrointestinal disorders (PC-FGIDs) has been reported. AIM This case series aimed to investigate the role of homeopathic intervention in the treatment of PC-FGIDs. METHODS This is a retrospective analysis of the clinical data of individuals who had suffered from PC-FGIDs that were diagnosed based on clinical symptoms using the Gastrointestinal Symptoms Rating Scale (GSRS) and treated exclusively with individualized homeopathic medicines. Cases that had undergone regular monthly assessment using the GSRS and had a Post-COVID-19 Functional Status (PCFS) score for up to 3 months were considered. RESULTS Thirty cases were screened and twelve were included according to the study criteria. The mean age of seven women and five men was 36 years. GSRS and PCFS scores showed marked improvement in each of 10 cases within the 3-month treatment period. CONCLUSION Homeopathic intervention proved beneficial in 10 of 12 patients with PC-FGIDs. The findings may help researchers plan future controlled clinical studies in this field.
Collapse
Affiliation(s)
- Hima Bindu Ponnam
- Department of Clinical Research, Regional Research Institute for Homeopathy, Hyderabad, Telangana State, India
| | | | - Shanmukha Priya Konduru
- Department of Clinical Research, Regional Research Institute for Homeopathy, Hyderabad, Telangana State, India
| | - Swathi Jammalamadaka
- Department of Clinical Research, Regional Research Institute for Homeopathy, Hyderabad, Telangana State, India
| |
Collapse
|
76
|
Chen H, Ge S, Yao P, Yang T, Cao X, Sun D. Evaluation of the Quality of Management Guidelines for Children and Adolescents With Autism Spectrum Disorder. Psychol Rep 2024:332941241269510. [PMID: 39102695 DOI: 10.1177/00332941241269510] [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: 08/07/2024]
Abstract
OBJECTIVE To systematically assess the quality of management guidelines for children and adolescents with autism spectrum disorder, analyze key management recommendation differences and causes among guidelines, and provide better guideline assessments for clinical workers. METHODS Clinical guidelines for managing children and adolescents with autism were systematically retrieved from a database. Four reviewers independently evaluated the guidelines using the assessment guideline tool, Appraisal of Guidelines for Research and Evaluation II (AGREE II), and the intra-group correlation coefficient (ICC) was used to measure the consistency of the assessment guidelines among the four reviewers and the differences and reasons for the recommendations and supporting evidence were compared and analyzed. RESULTS A total of ten management guidelines for children and adolescents with autism spectrum disorder published from 2014 to 2022 were included in this study, with high overall agreement between raters (range of intra-group correlation coefficients: 53.3% ∼ 85.0%), and areas with better median scores and ranges in Protocol II were as follows: domain 1 (scope and purpose, median = 86.1%, 59.7%-98.6%), Domain 4 (clarity of statements, median = 88.2%, 38.9%-100.0%) and domain 6 (independence of editors, median = 71.9%, 0.0%-100.0%). Among the ten guidelines the guidelines published by the Scott Intercollegiate Guidelines Network in 2016 and by the National Institute for health and care excellence in 2021 scored high and were recommended for adoption, 88.7%, 84.9%, respectively. CONCLUSION There is considerable variation between the quality of guidelines for the management of children and adolescents with autism spectrum disorders.
Collapse
Affiliation(s)
- Huiling Chen
- The Key Laboratory of the 2nd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shiliang Ge
- Department of Burn Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Penghao Yao
- The Key Laboratory of the 2nd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ting Yang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xia Cao
- The Key Laboratory of the 2nd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Dali Sun
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, China
| |
Collapse
|
77
|
Murray M, Kai J, Dentinger A, Kaplan L, Roman M, O'Brien E, Kearney J, Kaneshiro B, Zhu F, Fialkowski MK. Prenatal intention to human milk feed in the native Hawaiian population: predictors of any human milk feeding from birth to six months postpartum. Int Breastfeed J 2024; 19:54. [PMID: 39097709 PMCID: PMC11297697 DOI: 10.1186/s13006-024-00660-x] [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: 02/02/2024] [Accepted: 07/20/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Rates of non-communicable diseases are disproportionately high among Native Hawaiian (NH) people, and the proportion of NH infants being fed human milk (HM) is the lowest among all ethnicities within the state of Hawai'i. The aim of this study was to explore biological, socio-economic, and psychosocial determinants of the initiation and duration of human milk feeding (HMF) among a study of NH mothers and infants. METHODS A sample of 85 NH mother-infant dyads who were participating in a larger prospective study were involved in this research. Recruitment for the parent was delayed due to the COVID-19 pandemic. Recruitment started in November 2020 and continued until April 2022. Questionnaires were distributed at birth, two-months, four-months, and six-months postpartum. Questionnaires addressed topics relating to maternal and infant characteristics and infant feeding practices. Descriptive statistics, comparative analysis, and multivariate logistic regression tests were conducted. RESULTS The majority of participating mothers were aged between 31 and 35 years, had some college education or more, were employed, and multiparous. The majority of infants were receiving HM at each timepoint (94% at birth, 78% at two-months postpartum, and 76% at four and six-months postpartum). Factors found to be significantly associated with HMF initiation and duration were prenatal intention to HMF, maternal educational attainment, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation, and Supplemental Nutrition Assistance Program (SNAP) recipiency. A prenatal intention to HMF was found to be a strong predictor of HMF at birth (aOR = 64.18, 95% CI 2.94, 1400.28) and at two-months postpartum (aOR = 231.55, 95% CI 2.18, 2418.3). Participants not involved with WIC were more likely to be HMF at four-months postpartum (aOR = 6.83, 95% CI 1.01, 46.23). CONCLUSION This research supports existing evidence that prenatal intention to HMF and higher maternal educational attainment are positive predictors of HMF. WIC participation and being a SNAP recipient were found to be negatively associated with HMF which suggests a need for more culturally tailored support. Further research is required to reduce the gap in knowledge related to the determinants of HMF in NH.
Collapse
Affiliation(s)
- Méabh Murray
- School of Biological Sciences, Technological University Dublin, Grangegorman, Dublin, D02 HW71, Ireland
- Trinity College Dublin, College Green, The University of Dublin, Dublin, D02 PN40, Ireland
| | - Jessie Kai
- Department of Human Nutrition, Food, and Animal Sciences, University of Hawai'i at Mānoa, Honolulu, HI, 96822, USA
| | - Amanda Dentinger
- Department of Human Nutrition, Food, and Animal Sciences, University of Hawai'i at Mānoa, Honolulu, HI, 96822, USA
| | - Leah Kaplan
- Department of Human Nutrition, Food, and Animal Sciences, University of Hawai'i at Mānoa, Honolulu, HI, 96822, USA
| | - Meliza Roman
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
| | - Eileen O'Brien
- School of Biological Sciences, Technological University Dublin, Grangegorman, Dublin, D02 HW71, Ireland
| | - John Kearney
- School of Biological Sciences, Technological University Dublin, Grangegorman, Dublin, D02 HW71, Ireland
| | - Bliss Kaneshiro
- Department of Obstetrics, and Women's Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA
| | - Fengqing Zhu
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, 47907, USA
| | - Marie K Fialkowski
- Population Sciences in the Pacific Program, University of Hawai'i Cancer Center, Honolulu, HI, 96813, USA.
| |
Collapse
|
78
|
Maas BR, van den Bergh R, van den Berg SW, Hulstein E, Stadhouders N, Jeurissen PPT, de Vries NM, Bloem BR, Munneke M, Ben-Shlomo Y, Darweesh SKL. The PRIME-NL study: evaluating a complex healthcare intervention for people with Parkinson's disease in a dynamic environment. BMC Neurol 2024; 24:269. [PMID: 39097689 PMCID: PMC11297616 DOI: 10.1186/s12883-024-03778-x] [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: 03/21/2024] [Accepted: 07/23/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND An innovative, integrative care model for people with Parkinson (PRIME Parkinson) has gradually been implemented in a selected region of the Netherlands since 2021. A prospective evaluation of this model (PRIME-NL study) was initiated in parallel, spanning the year prior to implementation (baseline) and the implementation period. Following publication of the original study protocol, the COVID-19 crisis delayed implementation of the full PRIME Parkinson care model by two years and hampered the recruitment of study participants. OBJECTIVE To describe which methodological adjustments were made to the study protocol because of these developments. METHODS We compare various outcomes between a region where PRIME Parkinson care was implemented (innovation region) versus the rest of the Netherlands (usual care region). We use healthcare claims data of virtually all people with Parkinson in the Netherlands and annual questionnaires in a representative subsample of 984 people with Parkinson, 566 caregivers and 192 healthcare professionals. Four major methodological adjustments had to be made since publication of the original protocol. First, we extended the evaluation period by two years. Second, we incorporated annual process measures of the stage of implementation of the new care model. Third, we introduced a real-time iterative feedback loop of interim results to relevant stakeholders. Fourth, we updated the statistical analysis plan. DISCUSSION This manuscript provides transparency in how the design and analyses of the evaluation study had to be adapted to control for external influences in a dynamic environment, including eruption of the COVID-19 crisis. Our solutions could serve as a template for evaluating other complex healthcare interventions in a dynamic environment.
Collapse
Affiliation(s)
- Bart R Maas
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud university medical center, Nijmegen, The Netherlands
| | - Robin van den Bergh
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud university medical center, Nijmegen, The Netherlands
| | - Sanne W van den Berg
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud university medical center, Nijmegen, The Netherlands
| | - Eveline Hulstein
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud university medical center, Nijmegen, The Netherlands
| | - Niek Stadhouders
- IQ Health, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Patrick P T Jeurissen
- IQ Health, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Nienke M de Vries
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud university medical center, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud university medical center, Nijmegen, The Netherlands
| | - Marten Munneke
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud university medical center, Nijmegen, The Netherlands
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sirwan K L Darweesh
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud university medical center, Nijmegen, The Netherlands.
| |
Collapse
|
79
|
Nainar SMH. Assessing robustness of results of randomised clinical trials using Fragility Index. Eur Arch Paediatr Dent 2024:10.1007/s40368-024-00930-6. [PMID: 39093533 DOI: 10.1007/s40368-024-00930-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 07/10/2024] [Indexed: 08/04/2024]
Affiliation(s)
- S M H Nainar
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
80
|
Michelon I, Nachtigal GC, Dacoregio MI, Moraes ACBK, Moraes M, Piva LS, da Costa CT, Lund RG, Michelon D. Treatment options for cisplatin-ineligible patients with locally advanced head and neck squamous cell carcinoma: a systematic review. J Cancer Res Clin Oncol 2024; 150:379. [PMID: 39093329 PMCID: PMC11297068 DOI: 10.1007/s00432-024-05887-z] [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: 05/25/2024] [Accepted: 07/09/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE There is no agreed-upon standard option for patients with locally advanced head and neck squamous cell carcinoma (LA HNSCC) unfit for cisplatin-based regimens. Therefore, we performed a systematic review to explore alternative options for this population. METHODS We searched PubMed, Cochrane, and Embase databases for observational studies and clinical trials (CTs) assessing treatment options for LA HNSCC cisplatin-ineligible patients. This study was registered in PROSPERO under the number CRD42023483156. RESULTS This systematic review included 24 studies (18 observational studies and 6 CTs), comprising 4450 LA HNSCC cisplatin-ineligible patients. Most patients were treated with cetuximab-radiotherapy [RT] (50.3%), followed by carboplatin-RT (31.7%). In seven studies reporting median overall survival (OS) in patients treated with cetuximab-RT, it ranged from 12.8 to 46 months. The median OS was superior to 40 months in two studies assessing carboplatin-RT, and superior to 15 months in two studies assessing RT alone. For other regimens such as nimotuzumab-RT, docetaxel-RT, and carboplatin-RT plus paclitaxel the median OS was 21, 25.5, and 28 months, respectively. CONCLUSIONS Our systematic review supports the use of a variety of therapy combinations for LA HNSCC cisplatin-ineligible patients. We highlight the urgent need for clinical studies assessing treatment approaches in this population.
Collapse
Affiliation(s)
- Isabella Michelon
- Department of Medicine, Catholic University of Pelotas, Pelotas, Brazil
| | - Gilca Costa Nachtigal
- Department of Internal Medicine, Federal University of Pelotas Teaching Hospital (EBSERH), Pelotas, Brazil
| | | | - Ana Cristina Beitia Kraemer Moraes
- Department of Surgery, Faculty of Medicine, Catholic University of Pelotas, Pelotas, Brazil
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, 96015560, Brazil
| | - Mauricio Moraes
- Department of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Lívia Silva Piva
- Department of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Catiara Terra da Costa
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, 96015560, Brazil
| | - Rafael Guerra Lund
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, 96015560, Brazil
| | - Douver Michelon
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, 96015560, Brazil.
| |
Collapse
|
81
|
Siafis S, Wu H, Nomura N, Schneider-Thoma J, Bighelli I, Lorenz C, Dib JE, Tharyan P, Calver LA, Isbister GK, Chan EWY, Knott JC, Yap CYL, Mantovani C, Martel ML, Barbic D, Honer WG, Hansen WP, Huf G, Alexander J, Raveendran NS, Coutinho ESF, Priller J, Adams CE, Salanti G, Leucht S. Effectiveness of pharmacological treatments for severe agitation in real-world emergency settings: protocol of individual-participant-data network meta-analysis. Syst Rev 2024; 13:205. [PMID: 39095865 PMCID: PMC11295517 DOI: 10.1186/s13643-024-02623-z] [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: 11/03/2023] [Accepted: 07/20/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Severe psychomotor agitation and aggression often require immediate pharmacological intervention, but clear evidence-based recommendations for choosing among the multiple options are lacking. To address this gap, we plan a systematic review and individual-participant-data network meta-analysis to investigate their comparative effectiveness in real-world emergency settings with increased precision. METHODS We will include randomized controlled trials investigating intramuscular or intravenous pharmacological interventions, as monotherapy or in combination, in adults with severe psychomotor agitation irrespective of the underlying diagnosis and requiring rapid tranquilization in general or psychiatric emergency settings. We will exclude studies before 2002, those focusing on specific reasons for agitation and placebo-controlled trials to avoid concerns related to the transitivity assumption and potential selection biases. We will search for eligible studies in BIOSIS, CENTRAL, CINAHL Plus, Embase, LILACS, MEDLINE via Ovid, PubMed, ProQuest, PsycINFO, ClinicalTrials.gov, and WHO-ICTRP. Individual-participant data will be requested from the study authors and harmonized into a uniform format, and aggregated data will also be extracted from the studies. At least two independent reviewers will conduct the study selection, data extraction, risk-of-bias assessment using RoB 2, and applicability evaluation using the RITES tool. The primary outcome will be the number of patients achieving adequate sedation within 30 min after treatment, with secondary outcomes including the need for additional interventions and adverse events, using odds ratios as the effect size. If enough individual-participant data will be collected, we will synthesize them in a network meta-regression model within a Bayesian framework, incorporating study- and participant-level characteristics to explore potential sources of heterogeneity. In cases where individual-participant data are unavailable, potential data availability bias will be explored, and models allowing for the inclusion of studies reporting only aggregated data will be considered. We will assess the confidence in the evidence using the Confidence in Network Meta-Analysis (CINeMA) approach. DISCUSSION This individual-participant-data network meta-analysis aims to provide a fine-tuned synthesis of the evidence on the comparative effectiveness of pharmacological interventions for severe psychomotor agitation in real-world emergency settings. The findings from this study can greatly be provided clearer evidence-based guidance on the most effective treatments. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023402365.
Collapse
Affiliation(s)
- Spyridon Siafis
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Munich, Germany.
- German Center for Mental Health (DZPG), Partner site München/Augsburg, Munich, Germany.
| | - Hui Wu
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Munich, Germany
| | - Nobuyuki Nomura
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Munich, Germany
- German Center for Mental Health (DZPG), Partner site München/Augsburg, Munich, Germany
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Johannes Schneider-Thoma
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Munich, Germany
- German Center for Mental Health (DZPG), Partner site München/Augsburg, Munich, Germany
| | - Irene Bighelli
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Munich, Germany
- German Center for Mental Health (DZPG), Partner site München/Augsburg, Munich, Germany
| | - Carolin Lorenz
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Munich, Germany
| | - Joseph E Dib
- Division of Psychiatry & Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Prathap Tharyan
- Clinical Epidemiology Unit, Christian Medical Centre, Vellore, India
| | - Leonie A Calver
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Geoffrey K Isbister
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, NSW, Australia
| | - Esther W Y Chan
- Department of Pharmacology and Pharmacy, University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Science Park, Hong Kong SAR, China
- Department of Pharmacy, HKU-Shenzhen Hospital, Shenzhen, China
- HKU-SZ Institute of Research and Innovation (SIRI), Shenzhen, China
| | - Jonathan C Knott
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
| | - Celene Y L Yap
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Célia Mantovani
- Department of Neurosciences and Behavior, Ribeirao Preto School of Medicine, Universidade de Sao Paulo, São Paulo, Brazil
| | - Marc L Martel
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - David Barbic
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation & Outcomes Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| | - William G Honer
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | | | - Gisele Huf
- National Institute of Quality Control in Health, Oswaldo Cruz Foundation, Av. Brasil 4365, Manguinhos, Rio de Janeiro, Brazil
| | | | - Nirmal S Raveendran
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Evandro S F Coutinho
- Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Josef Priller
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Munich, Germany
- German Center for Mental Health (DZPG), Partner site München/Augsburg, Munich, Germany
- Neuropsychiatry and Laboratory of Molecular Psychiatry, Charité - Universitätsmedizin Berlin and DZNE, Berlin, Germany
- University of Edinburgh and UK DRI, Edinburgh, UK
| | - Clive E Adams
- Institute of Mental Health, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Georgia Salanti
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Stefan Leucht
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Munich, Germany
- German Center for Mental Health (DZPG), Partner site München/Augsburg, Munich, Germany
| |
Collapse
|
82
|
Abogunrin S, Adelakun A, Akinola T, Bashir U, Fagbohungbe B, Mueller E, Neeser K, Ogunnubi O, Parekh K. Challenges of consolidating evidence collected during a pandemic and lessons for the future. Curr Med Res Opin 2024; 40:1311-1322. [PMID: 38975733 DOI: 10.1080/03007995.2024.2377676] [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: 12/07/2023] [Revised: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE To illustrate the challenges encountered when gathering rapidly synthesized evidence in response to the coronavirus disease 2019 (COVID-19) pandemic. METHODS In this article, we describe the challenges encountered when we performed a systematic literature review (SLR) of randomized controlled trials (RCTs) on the efficacy and safety of treatments for severe COVID-19. The methods of the SLR are described in full, to show the context of our objectives. Then we use the results of the SLR to demonstrate the problems of producing synthesized evidence in this setting. RESULTS Various challenges were identified during this SLR. These were primarily a result of heterogeneity in the study methodology of eligible studies. Definitions of the patient populations and outcome measurements were highly variable and the majority of studies demonstrated a high risk of bias, preventing quantitative synthesis of the collated evidence. CONCLUSION Consolidating evidence from RCTs evaluating COVID-19 interventions was problematic. Guidance is needed for scenarios with high rapid output in primary research.
Collapse
Affiliation(s)
| | - Alex Adelakun
- Manchester University Foundation Trust, Manchester, UK
| | | | - Usman Bashir
- Community Medicine Department, Bayero University Kano, Kano, Nigeria
| | | | | | | | - Oluseun Ogunnubi
- Department of Psychiatry, College of Medicine of the University of Lagos, Lagos, Nigeria
| | | |
Collapse
|
83
|
Kidanemariam M, Graner MA, Bos WJW, Schroijen MA, de Koning EJP, Stiggelbout AM, Pieterse AH, Kunneman M. Patient-clinician collaboration in making care fit: A qualitative analysis of clinical consultations in diabetes care. PATIENT EDUCATION AND COUNSELING 2024; 125:108295. [PMID: 38749345 DOI: 10.1016/j.pec.2024.108295] [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: 10/05/2023] [Revised: 03/26/2024] [Accepted: 04/18/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE To confirm described dimensions of making care fit and explore how patients and clinicians collaborate to make care fit in clinical practice. METHODS As part of an ongoing study, we audiotaped and transcribed patient-clinician consultations in diabetes care. We purposively selected consultations based on participants' demographical, biomedical and biographical characteristics. We analysed transcripts using reflexive thematic analysis. We combined a deductive and inductive approach, using the pre-described dimensions of making care fit and adding new (sub-)dimensions when pertinent. RESULTS We analysed 24 clinical consultations. Our data confirmed eight previously described dimensions and provided new sub-dimensions of making care fit with examples from clinical practice (problematic situation, influence of devices, sense of options, shared agenda setting, clinician context, adapting to changing organization of care, and possibility to reconsider). CONCLUSION Our study confirmed, specified and enriched the conceptualization of making care fit through practice examples. We observed patient-clinician collaboration in exploration of patients' context, and by responsively changing, adapting or maintaining care plans. PRACTICE IMPLICATIONS Our findings support clinicians and researchers with insights in important aspects of patient-clinician collaboration. Ultimately, this would lead to optimal design of care plans that fit well in each patient life.
Collapse
Affiliation(s)
- Martha Kidanemariam
- Medical Decision making, Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Willem Jan W Bos
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands; Department of Internal Medicine, Sint-Antonius Hospital, Nieuwegein, the Netherlands
| | - Marielle A Schroijen
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Eelco J P de Koning
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision making, Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Arwen H Pieterse
- Medical Decision making, Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Marleen Kunneman
- Medical Decision making, Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
84
|
Izgu N, Metin ZG, Eroglu H, Semerci R, Pars H. Impact of spiritual interventions in individuals with cancer: A systematic review and meta-analysis. Eur J Oncol Nurs 2024; 71:102646. [PMID: 38943773 DOI: 10.1016/j.ejon.2024.102646] [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: 04/05/2024] [Revised: 06/05/2024] [Accepted: 06/14/2024] [Indexed: 07/01/2024]
Abstract
PURPOSE This meta-analysis aimed to determine how spiritual interventions affect cancer patients' physical, emotional, and spiritual outcomes and quality of life. METHODS Between 2012 and May 2024, the Cochrane Library, Scopus, PubMed, and Web of Science were searched considering the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Twenty-six randomized controlled trials were included, and 16 were synthesized in the meta-analysis. Bias risk was evaluated using the Cochrane risk-of-bias methodology for randomized studies. The Grading of Recommendations, Assessment, Development, and Evaluations tool was employed for evidence certainty. Heterogeneity was expressed through I2 and Q statistics. Hedge's g was calculated for effect sizes. Egger's and Kendall's Tau were used for publication bias. RESULTS Spiritual interventions yielded beneficial effects on fatigue (Hedges's g = 0.900, p < 0.001) and pain (Hedges's g = 0.670, p < 0.001) but not for overall symptom burden (Hedges's g = 0.208, p = 0.176). Significant effects were found for anxiety (Hedges's g = 0.301, p < 0.001), depression (Hedges's g = 0.175, p = 0.016), and psychological distress (Hedges's g = 0.178, p = 0.024), except for hopelessness (Hedges's g = 0.144, p = 0.091). Spiritual interventions enhanced faith (Hedges's g = 0.232, p = 0.035), the meaning of life (Hedges's g = 0.259, p = 0.002), spiritual well-being (Hedges's g = 0.268, p < 0.001), and quality of life (Hedges's g = 245, p < 0.001). Moderator analysis pointed out that cancer stage, total duration, delivery format, providers' qualification, content, and conceptual base of spiritual interventions significantly affect physical, emotional, and spiritual outcomes and quality of life. CONCLUSION This meta-analysis highlighted the benefits of spiritual interventions with varying effect sizes on patients' outcomes, as well as quality of life in cancer, and shed on how to incorporate these approaches into clinical practice.
Collapse
Affiliation(s)
- Nur Izgu
- Hacettepe University Faculty of Nursing, Internal Medicince Nursing Department, Ankara, Turkey.
| | - Zehra Gok Metin
- Hacettepe University Faculty of Nursing, Internal Medicince Nursing Department, Ankara, Turkey
| | - Hacer Eroglu
- Healthcare Vocational School, Lokman Hekim University, Ankara, Turkey
| | - Remziye Semerci
- Department of Pediatric Nursing, School of Nursing, Koç University, İstanbul, Turkey
| | - Hatice Pars
- Epidemiology MSc Program, The Institute of Health Sciences, Hacettepe University, Ankara, Turkey
| |
Collapse
|
85
|
Cracowski JL, Molimard M, Richard V, Roustit M, Khouri C. Assessing the benefit-risk balance of drugs. Some lessons from the COVID pandemic. Expert Opin Drug Saf 2024; 23:959-967. [PMID: 38898690 DOI: 10.1080/14740338.2024.2368811] [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: 03/26/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Drug efficacy and effectiveness are assessed respectively through clinical trials and pharmaco-epidemiological studies. However, relative and absolute benefits of drugs are distinct measures that must be considered in relation to the baseline risk of disease incidence, complication or progression. On the other hand, adverse drug reactions are independent of the basic risk but depend on the characteristics of the population treated. Given these prerequisites, how can we balance the benefits and risks of drugs? AREAS COVERED We use the example of therapeutics evaluated during Covid to describe how assessing the benefit-risk balance of drugs is a complex process. EXPERT OPINION Clinical trials are not designed to identify rare adverse events, underscoring the necessity for a pharmacovigilance system. Evaluating the balance between the benefits and risks of drugs is an ongoing process, demanding the simultaneous analysis of data from clinical trials, potential drug-drug interactions, pharmacovigilance monitoring and pharmaco-epidemiological studies, to identify potential safety concerns. In addition, pharmacologists must play a major role in educating the general public about drugs, aiding in the accurate interpretation of the benefit-risk balance and preventing misinformation.
Collapse
Affiliation(s)
- Jean-Luc Cracowski
- Centre Régional de Pharmacovigilance de Grenoble, Université Grenoble Alpes, Inserm U1300, Grenoble, France
| | | | | | - Matthieu Roustit
- Centre d'Investigation Clinique de Grenoble, Université Grenoble Alpes, Inserm U1300, Grenoble, France
| | - Charles Khouri
- Centre Régional de Pharmacovigilance de Grenoble, Université Grenoble Alpes, Inserm U1300, Grenoble, France
- Centre d'Investigation Clinique de Grenoble, Université Grenoble Alpes, Inserm U1300, Grenoble, France
| |
Collapse
|
86
|
La Rosa GRM, Scapellato S, Cicciù M, Pedullà E. Antimicrobial Activity of Antibacterial Sutures in Oral Surgery: A Scoping Review. Int Dent J 2024; 74:688-695. [PMID: 38429145 PMCID: PMC11287137 DOI: 10.1016/j.identj.2024.01.029] [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: 09/12/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE The aim of this scoping review was to explore and synthesise the current evidence on the antimicrobial activity of antibacterial suture materials used in oral surgery. METHODS The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. A bibliographic search was carried out in the PubMed and Scopus databases to retrieve all human clinical studies that investigated the antimicrobial efficacy of antibacterial-coated sutures used in oral surgery. Included studies were screened and extracted independently by 2 examiners. Data were tabulated and qualitatively described. RESULTS The search initially returned 150 articles and resulted in 5 included studies after the duplicates' removal and the full-text screening. Selected studies were published from 2014 to 2019. Three studies (60%) were randomised clinical trials, whilst the remaining studies did not report information on randomisation. The antimicrobial agents for coated sutures included triclosan and chlorhexidine. In almost all the studies, antibacterial-coated sutures exhibited lower bacterial retention compared to those without coating. CONCLUSIONS Within limitations, the antimicrobial-coated sutures employed in oral surgery exhibited good results in terms of their microbicidal activity when compared with sutures that were not coated. Considering the high variability and confounding factors identified in the included studies, more high-quality research is needed to confirm these results. Antimicrobial-coated sutures could represent a promising and clinically valid strategy to reduce microbial colonisation in oral surgery. The reduced bacterial adherence is likely to improve the clinical success of the surgical procedures. Yet, the cost-benefit ratio of antimicrobial-coated sutures should be assessed in larger clinical trials to confirm their efficacy over conventional noncoated sutures.
Collapse
Affiliation(s)
- Giusy Rita Maria La Rosa
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
| | - Simone Scapellato
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Marco Cicciù
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Eugenio Pedullà
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| |
Collapse
|
87
|
Cole MB, Wright B, Kett PM, Johnson H, Staloff J, Frogner BK. COVID-19 Federal Funding To Health Centers: Tracking Distribution, Locations, And Patient Characteristics. Health Aff (Millwood) 2024; 43:1190-1197. [PMID: 39102596 DOI: 10.1377/hlthaff.2024.00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
In 2020 and 2021, health centers received federal funding to support their COVID-19 pandemic response, yet little is known about how the funds were distributed. This study identified ten sources of funding distributed to 1,352 centers, ranging from $19 to $1.22 billion per center. When we examined patient and organizational characteristics by quartiles of funding per patient, health centers in the highest-funded quartile (quartile 4) were more likely rural and in the South; employed lower percentages of physicians; and had the highest percentages of sicker, uninsured, and unhoused patients. Centers in the lowest-funded quartile (quartile 1) were more likely urban, employed lower percentages of nurse practitioners, and had the highest percentages of Medicaid enrollees. With the end of pandemic-related funding in 2023, combined with Medicaid unwinding concerns, targeted investment is needed to mitigate a financial cliff and help maintain health centers' capacity to provide high-quality services to those most in need.
Collapse
Affiliation(s)
- Megan B Cole
- Megan B. Cole, Boston University, Boston, Massachusetts
| | - Brad Wright
- Brad Wright, University of South Carolina, Columbia, South Carolina
| | - Paula M Kett
- Paula M. Kett, University of Washington, Seattle, Washington
| | | | - Jonathan Staloff
- Jonathan Staloff, University of Washington and Veterans Affairs Puget Sound Health Care, Seattle, Washington
| | | |
Collapse
|
88
|
Buijs GS, Kooijenga AC, Rikken QGH, Schafroth MU, Kievit AJ, Blankevoort L. MRI and SPECT/CT demonstrate, with low certainty of evidence, the highest diagnostic accuracy for aseptic knee arthroplasty loosening: A systematic comparative diagnostic test review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2024; 32:2061-2074. [PMID: 38769774 DOI: 10.1002/ksa.12206] [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: 02/23/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE The purpose of this study was to evaluate and compare the diagnostic accuracy of modalities used to aid the diagnosis of aseptic knee arthroplasty loosening. METHODS A comparative diagnostic test accuracy systematic review and meta-analysis was conducted following the Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, EMBASE and Cochrane databases were searched for original articles evaluating diagnostic modalities up to March 2024. Included studies compared the modality (index test) to the intraoperative finding as reference test. The QUADAS-C (Quality Assessment of Diagnostic Accuracy Studies-Comparative) tool was used to assess the quality of the included studies. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used to evaluate the certainty of evidence. Level of evidence was evaluated using the Oxford Levels of Evidence tool. The primary outcome was the summary of diagnostic accuracy metrics for each modality as demonstrated by a summary receiver-operating characteristic (SROC) curve. RESULTS The search yielded 467 articles. Of these, 14 articles were included. These 14 articles evaluated a total of five different diagnostic modalities: bone scintigraphy (three studies, 146 cases), 18-fluorodeoxyglucose positron emission tomography (two studies, 50 cases), single-photon emission computed tomography combined with computed tomography (SPECT/CT) (seven studies, 371 cases), radionuclide arthrogram (three studies, 196 cases) and magnetic resonance imaging (MRI) (one study, 116 cases). Nine studies exhibited a high risk of bias in patient selection, and all studies showed a high risk of bias related to the reference test. The majority of the included studies were classified as Level III evidence, leading to an overall low level of certainty in the evidence. The most accurate tests, as demonstrated by the SROC analysis, were MRI and SPECT/CT, with sensitivities ranging from 0.00 to 1.00 and 0.33 to 1.00 and specificities between 0.31-1.00 and 0.00-1.00, respectively. CONCLUSIONS This review and meta-analysis evaluated available diagnostic modalities to aid the diagnosis of knee arthroplasty loosening and based on a low certainty of evidence suggests that MRI and SPECT/CT are currently the most accurate modalities available to aid the diagnosis of aseptic loosening of knee arthroplasty components. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- George S Buijs
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Anne C Kooijenga
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Quinten G H Rikken
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Matthias U Schafroth
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Arthur J Kievit
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| |
Collapse
|
89
|
Stutz B, Krueger B, Goletzke J, Jankovic N, Alexy U, Herder C, Dierkes J, Berg-Beckhoff G, Jakobsmeyer R, Reinsberger C, Buyken AE. Glycemic response to meals with a high glycemic index differs between morning and evening: a randomized cross-over controlled trial among students with early or late chronotype. Eur J Nutr 2024; 63:1593-1604. [PMID: 38605233 PMCID: PMC11329680 DOI: 10.1007/s00394-024-03372-4] [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: 07/01/2023] [Accepted: 02/20/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Glycemic response to the same meal depends on daytime and alignment of consumption with the inner clock, which has not been examined by individual chronotype yet. This study examined whether the 2-h postprandial and 24-h glycemic response to a meal with high glycemic index (GI) differ when consumed early or late in the day among students with early or late chronotype. METHODS From a screening of 327 students aged 18-25 years, those with early (n = 22) or late (n = 23) chronotype participated in a 7-day randomized controlled cross-over intervention study. After a 3-day observational phase, standardized meals were provided on run-in/washout (days 4 and 6) and intervention (days 5 and 7), on which participants received a high GI meal (GI = 72) in the morning (7 a.m.) or in the evening (8 p.m.). All other meals had a medium GI. Continuous glucose monitoring was used to measure 2-h postprandial and 24-h glycemic responses and their variability. RESULTS Among students with early chronotype 2-h postprandial glucose responses to the high GI meal were higher in the evening than in the morning (iAUC: 234 (± 92) vs. 195 (± 91) (mmol/L) × min, p = 0.042). Likewise, mean and lowest 2-h postprandial glucose values were higher when the high GI meal was consumed in the evening (p < 0.001; p = 0.017). 24-h glycemic responses were similar irrespective of meal time. Participants with late chronotype consuming a high GI meal in the morning or evening showed similar 2-h postprandial (iAUC: 211 (± 110) vs. 207 (± 95) (mmol/L) × min, p = 0.9) and 24-h glycemic responses at both daytimes. CONCLUSIONS Diurnal differences in response to a high GI meal are confined to those young adults with early chronotype, whilst those with a late chronotype seem vulnerable to both very early and late high GI meals. Registered at clinicaltrials.gov (NCT04298645; 22/01/2020).
Collapse
Affiliation(s)
- Bianca Stutz
- Faculty of Sciences, Institute of Nutrition, Consumption and Health, Paderborn University, Paderborn, Germany
| | - Bettina Krueger
- Faculty of Sciences, Institute of Nutrition, Consumption and Health, Paderborn University, Paderborn, Germany
| | - Janina Goletzke
- Faculty of Sciences, Institute of Nutrition, Consumption and Health, Paderborn University, Paderborn, Germany
| | - Nicole Jankovic
- Nutritional Epidemiology, Department of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-University Bonn, DONALD Study Centre, Dortmund, Germany
| | - Ute Alexy
- Nutritional Epidemiology, Department of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-University Bonn, DONALD Study Centre, Dortmund, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Munich-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jutta Dierkes
- Department of Clinical Medicine Center, University of Bergen, Bergen, Norway
| | - Gabriele Berg-Beckhoff
- The Faculty of Health Sciences, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Rasmus Jakobsmeyer
- Faculty of Sciences, Institute of Sports Medicine, Paderborn University, Paderborn, Germany
| | - Claus Reinsberger
- Faculty of Sciences, Institute of Sports Medicine, Paderborn University, Paderborn, Germany
| | - Anette E Buyken
- Faculty of Sciences, Institute of Nutrition, Consumption and Health, Paderborn University, Paderborn, Germany.
| |
Collapse
|
90
|
Makhoul I, Power S, Smith C, Niece T, O'Mahony D. ASCO Domestic Quality Programs. JCO Glob Oncol 2024; 10:e2400058. [PMID: 39159411 DOI: 10.1200/go.24.00058] [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: 02/06/2024] [Revised: 05/05/2024] [Accepted: 06/24/2024] [Indexed: 08/21/2024] Open
Abstract
A growing sense of the need to define good-quality cancer care has emerged in the past decade of the 20th century. The goals were to assess, improve, and reward quality. Animated debates between cancer care delivery academic and community organizations, governmental agencies, and insurance companies have led to multiple initiatives and pilot projects. ASCO was on the cutting edge of quality in oncology movement. We can define three phases, overlapping rather than sequential, in ASCO's journey. The first phase was generating definitions of good-quality care characterized by the publication of ASCO guidelines. The second phase was the creation of the tools to measure the implementation of standards of care with the creation of the Quality Oncology Practice Initiative (QOPI). The third phase was the launch of a comprehensive approach to cancer care quality as illustrated by QOPI Certification, then the more complete iteration, ASCO Certified Program. The latter is the most elaborate program to define quality from the patient and health care providers' perspective on one hand and governmental agencies and insurance providers' perspective on the other. Since the publication of the Ensuring Quality Cancer Care Report in 1998 to the ASCO Certified in 2023, a quarter century has elapsed. ASCO did not operate in a vacuum. Through collaborative efforts, reacting to and interacting with various players, it has advocated for positive change. During this period, ASCO has led the movement of quality in oncology intelligently and with the upmost sense of responsibility toward the patients, health care professionals, and society at large. While many of these efforts began domestically, their reach is extending globally through research, education, and the promotion of equitable care.
Collapse
Affiliation(s)
| | - Steve Power
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | | |
Collapse
|
91
|
Purgar M, Glasziou P, Klanjscek T, Nakagawa S, Culina A. Supporting study registration to reduce research waste. Nat Ecol Evol 2024; 8:1391-1399. [PMID: 38839851 DOI: 10.1038/s41559-024-02433-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/08/2024] [Indexed: 06/07/2024]
Abstract
An estimated 82-89% of ecological research and 85% of medical research has limited or no value to the end user because of various inefficiencies. We argue that registration and registered reports can enhance the quality and impact of ecological research. Drawing on evidence from other fields, chiefly medicine, we support our claim that registration can reduce research waste. However, increasing registration rates, quality and impact will be very slow without coordinated effort of funders, publishers and research institutions. We therefore call on them to facilitate the adoption of registration by providing adequate support. We outline several aspects to be considered when designing a registration system that would best serve the field of ecology. To further inform the development of such a system, we call for more research to identify the causes of low registration rates in ecology. We suggest short- and long-term actions to bolster registration and reduce research waste.
Collapse
Affiliation(s)
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | | | - Shinichi Nakagawa
- Evolution & Ecology Research Centre and School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Theoretical Sciences Visiting Program, Okinawa Institute of Science and Technology Graduate University, Onna, Japan
| | - Antica Culina
- Ruđer Bošković Institute, Zagreb, Croatia.
- Netherlands Institute of Ecology, Royal Netherlands Academy of Arts and Sciences, Wageningen, the Netherlands.
| |
Collapse
|
92
|
Kenny KP, Chauhan A, Pavitt S, Foy R, Day PF. Qualitative research in dental traumatology-A narrative review. Dent Traumatol 2024; 40:357-365. [PMID: 38264961 DOI: 10.1111/edt.12935] [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: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
This review highlights the recent contributions of qualitative research in advancing understanding of dental trauma injury and the barriers and enablers to guide policy for improved patient-centred care including transitional care. It summarises the common approaches and methods used and outlines the key factors that guide the appraisal of qualitative studies. It highlights the importance of the application of qualitative research methods in dental research to generate rich and detailed data to provide explanations and insights into people's experiences, beliefs and attitudes and the complexity of human decision-making and behaviour. In the past decade while there have been a growing number of publications of qualitative studies in dental journals, qualitative studies remain a small percentage of the published dental traumatology research. This may be because of limited understanding about the background, methods and rigour of qualitative research.
Collapse
Affiliation(s)
- Kate P Kenny
- School of Dentistry, University of Leeds, Leeds, UK
| | | | - Sue Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Peter F Day
- School of Dentistry, University of Leeds, Leeds, UK
- Community Dental Service, Bradford District Care NHS Foundation Trust, Bradford, UK
| |
Collapse
|
93
|
Pergolizzi JV, LeQuang JA, El-Tallawy SN, Wagner M, Ahmed RS, Varrassi G. An update on pharmacotherapy for trigeminal neuralgia. Expert Rev Neurother 2024; 24:773-786. [PMID: 38870050 DOI: 10.1080/14737175.2024.2365946] [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: 03/28/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Trigeminal neuralgia is a rare condition that can be effectively treated by carbamazepine or oxcarbazepine but these older drugs are associated with dose-dependent and potentially treatment-limiting adverse effects. Third-generation anticonvulsants, new calcitonin gene-related peptide blockers for migraine, and older drugs such as ketamine and cannabinoids may be promising adjuvants or monotherapeutic options. AREAS COVERED The new drugs, their presumed mechanisms of action, safety and efficacy are discussed herein. There is a paucity of robust clinical evidence in support of these drugs for trigeminal neuralgia. New migraine agents are considered as well although migraines and trigeminal neuralgia are distinct, albeit similar, conditions. No new drugs have been released to market in recent years with the specific indication of trigeminal neuralgia. EXPERT OPINION In real-world clinical practice, about half of trigeminal neuralgia patients take more than one agent for prevention and combination therapy may be the optimal approach. Combination therapy might allow for lower doses of carbamazepine or oxcarbazepine, thus reducing the number and severity of potential adverse events but the potential for pharmacokinetic drug-drug interactions must be considered. Drug therapy for trigeminal neuralgia involves acute or abortive treatments, often administered in hospital versus long-term preventive therapy, usually involving oral agents.
Collapse
Affiliation(s)
| | | | - Salah N El-Tallawy
- Anesthesia and Pain Department, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Anesthesia Department, Medicine, Minia University & NCI, Minia, Egypt
| | | | - Rania S Ahmed
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | |
Collapse
|
94
|
Hernandez AV, Liu A, Roman YM, Burela PA, Pasupuleti V, Thota P, Carranza-Tamayo CO, Retamozo-Palacios M, Benites-Zapata VA, Piscoya A, Vidal JE. Efficacy and safety of ivermectin for treatment of non-hospitalized COVID-19 patients: A systematic review and meta-analysis of 12 randomized controlled trials with 7,035 participants. Int J Antimicrob Agents 2024; 64:107248. [PMID: 38908535 DOI: 10.1016/j.ijantimicag.2024.107248] [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: 08/07/2023] [Revised: 03/15/2024] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
INTRODUCTION We systematically assessed benefits and harms of the use of ivermectin in non-hospitalized patients with early COVID-19. METHODS Five databases were searched until October 17, 2023, for randomized controlled trials (RCTs) in adult patients with COVID-19 treated with ivermectin against standard of care (SoC), placebo, or active drug. Primary outcomes were hospitalization, all-cause mortality, and adverse events (AEs). Secondary outcomes included mechanical ventilation (MV), clinical improvement, clinical worsening, viral clearance, and severe adverse events (SAEs). Random effects meta-analyses were performed, with quality of evidence (QoE) evaluated using GRADE methods. Pre-specified subgroup analyses (ivermectin dose, control type, risk of bias, follow-up, and country income) and trial sequential analysis (TSA) were performed. RESULTS Twelve RCTs (n = 7,035) were included. The controls were placebo in nine RCTs, SoC in two RCTs, and placebo or active drug in one RCT. Ivermectin did not reduce hospitalization (relative risk [RR], 0.81, 95% confidence interval [95% CI] 0.64-1.03; 8 RCTs, low QoE), all-cause mortality (RR 0.98, 95% CI 0.73-1.33; 9 RCTs, low QoE), or AEs (RR 0.89, 95% CI 0.75-1.07; 9 RCTs, very low QoE) vs. controls. Ivermectin did not reduce MV, clinical worsening, or SAEs and did not increase clinical improvement and viral clearance vs. controls (very low QoE for secondary outcomes). Subgroup analyses were mostly consistent with main analyses, and TSA-adjusted risk for hospitalization was similar to main analysis. CONCLUSIONS In non-hospitalized COVID-19 patients, ivermectin did not have effect on clinical, non-clinical or safety outcomes versus controls. Ivermectin should not be recommended as treatment in non-hospitalized COVID-19 patients.
Collapse
Affiliation(s)
- Adrian V Hernandez
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA; Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru.
| | - Anna Liu
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Yuani M Roman
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Paula Alejandra Burela
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | | | - Manuel Retamozo-Palacios
- Department of Infectious Diseases, Hospital Regional de Taguatinga, Taguatinga, Brasília-DF, Brazil
| | - Vicente A Benites-Zapata
- Master Program in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru
| | - Alejandro Piscoya
- Servicio de Gastroenterología, Departamento de Medicina, Hospital Guillermo Kaelin de la Fuente, Lima, Peru
| | - Jose E Vidal
- Division of Infectious Diseases, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Neurology, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil; Laboratory of Medical Investigation, Unit 49, Hospital das Clinicas, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
95
|
Garcia C, Rehman N, Matos-Silva J, Deng J, Ghandour S, Huang Z, Mbuagbaw L. Interventions to Improve Adherence to Oral Pre-exposure Prophylaxis: A Systematic Review and Network Meta-analysis. AIDS Behav 2024; 28:2534-2546. [PMID: 38814406 DOI: 10.1007/s10461-024-04365-4] [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] [Accepted: 04/30/2024] [Indexed: 05/31/2024]
Abstract
For people at risk of HIV infection, pre-exposure prophylaxis (PrEP) can reduce the risk of infection in anticipation of exposure to HIV. The effectiveness of PrEP relies upon a user's adherence to their PrEP regimen. We sought to assess the effect of PrEP adherence interventions compared to usual care or another intervention for people at risk of HIV. We searched electronic databases from 2010 onwards for randomized controlled trials (RCTs) involving persons at risk of HIV randomized to an adherence promoting intervention vs usual care or another intervention. We used network meta-analyses to compare PrEP adherence for all participant populations. Certainty of evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). 21 trials (N = 4917) were included in qualitative analysis (19 in network meta-analyses (N = 4101)). HIV self-testing interventions with adherence feedback elements improved adherence compared to usual care (risk ratio (RR): 1.83, 95%CI 1.19, 2.82). In contrast, HIV self-testing alone was inferior to HIV self-testing with adherence feedback (RR: 0.58, 95%CI 0.37-0.92). Reminders alone also were inferior to HIV self-testing with adherence feedback on adherence (RR: 0.53, 95%CI 0.34-0.84) and had similar effects on adherence as usual care (RR: 0.98, 95%CI: 0.86-1.11). Interventions with only one component were inferior for adherence than those with two components (RR: 0.74, 95%CI 0.62-0.88) and those with three components (RR: 0.78, 95%CI 0.65-0.93). The certainty of evidence was moderate for HIV self-testing plus adherence feedback and interventions with two or three components. When designing future PrEP adherence interventions, we recommend strategies with more than one but no more than three components.
Collapse
Affiliation(s)
- Cristian Garcia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Nadia Rehman
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jéssyca Matos-Silva
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jiawen Deng
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sara Ghandour
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zhongyu Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
96
|
Clausdorff Fiedler H, Prager R, Smith D, Wu D, Dave C, Tschirhart J, Wu B, Van Berlo B, Malthaner R, Arntfield R. Automated Real-Time Detection of Lung Sliding Using Artificial Intelligence: A Prospective Diagnostic Accuracy Study. Chest 2024; 166:362-370. [PMID: 38365174 DOI: 10.1016/j.chest.2024.02.011] [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: 11/10/2023] [Revised: 02/04/2024] [Accepted: 02/09/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Rapid evaluation for pneumothorax is a common clinical priority. Although lung ultrasound (LUS) often is used to assess for pneumothorax, its diagnostic accuracy varies based on patient and provider factors. To enhance the performance of LUS for pulmonary pathologic features, artificial intelligence (AI)-assisted imaging has been adopted; however, the diagnostic accuracy of AI-assisted LUS (AI-LUS) deployed in real time to diagnose pneumothorax remains unknown. RESEARCH QUESTION In patients with suspected pneumothorax, what is the real-time diagnostic accuracy of AI-LUS to recognize the absence of lung sliding? STUDY DESIGN AND METHODS We performed a prospective AI-assisted diagnostic accuracy study of AI-LUS to recognize the absence of lung sliding in a convenience sample of patients with suspected pneumothorax. After calibrating the model parameters and imaging settings for bedside deployment, we prospectively evaluated its diagnostic accuracy for lung sliding compared with a reference standard of expert consensus. RESULTS Two hundred forty-one lung sliding evaluations were derived from 62 patients. AI-LUS showed a sensitivity of 0.921 (95% CI, 0.792-0.973), specificity of 0.802 (95% CI, 0.735-0.856), area under the receiver operating characteristic curve of 0.885 (95% CI, 0.828-0.956), and accuracy of 0.824 (95% CI, 0.766-0.870) for the diagnosis of absent lung sliding. INTERPRETATION In this study, real-time AI-LUS showed high sensitivity and moderate specificity to identify the absence of lung sliding. Further research to improve model performance and optimize the integration of AI-LUS into existing diagnostic pathways is warranted.
Collapse
Affiliation(s)
| | - Ross Prager
- Division of Critical Care Medicine, Western University, London, ON, Canada
| | - Delaney Smith
- Lawson Health Research Institute, London, ON, Canada
| | - Derek Wu
- Lawson Health Research Institute, London, ON, Canada
| | - Chintan Dave
- Lawson Health Research Institute, London, ON, Canada
| | | | - Ben Wu
- Lawson Health Research Institute, London, ON, Canada
| | - Blake Van Berlo
- Faculty of Mathematics, University of Waterloo, Waterloo, ON, Canada
| | - Richard Malthaner
- Division of Thoracic Surgery, Western University, London, ON, Canada
| | - Robert Arntfield
- Division of Critical Care Medicine, Western University, London, ON, Canada
| |
Collapse
|
97
|
Castanon A, Duffield S, Ramagopalan S, Reynolds R. Why is target trial emulation not being used in health technology assessment real-world data submissions? J Comp Eff Res 2024; 13:e240091. [PMID: 38850128 DOI: 10.57264/cer-2024-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Affiliation(s)
| | - Stephen Duffield
- National Institute of Health & Care Excellence, Manchester, M1 4BT, UK
| | | | | |
Collapse
|
98
|
Lazo Green K, Tan MMC, Johnson EE, Ahmed N, Eastaugh C, Beyer F, Craig D, Spiers GF, Hanratty B. Interventions for cold homes: a rapid review of the health impacts. Eur J Public Health 2024; 34:682-695. [PMID: 38587096 PMCID: PMC11293810 DOI: 10.1093/eurpub/ckae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Cold homes are associated with an increased risk of adverse health outcomes for older people. To mitigate this risk, homes need to be heated to an appropriate temperature. This review aims to identify interventions designed to improve heating and temperatures within homes and summarize its impact on health, health service utilization and cost effectiveness. METHODS A rapid review was conducted. Studies assessing the effects of structural, financial, or behavioural interventions designed to improve home temperatures of residents aged 18+ years were eligible. Searches were carried out in four databases. A search for grey literature, and backward and forward citation searching were performed. Data were summarized in a narrative synthesis and mapped using EPPI-Reviewer and EPPI-Mapper software. RESULTS Eighteen studies reported across 19 publications were included. Structural interventions were associated with better mental health and quality of life, a reduction in health service utilization, and improvements in satisfaction with internal home temperature, social interactions and financial difficulties. The impact on physical health outcomes varied by age, gender and long-term conditions. Evidence about the impact of behavioural interventions was inconsistent. CONCLUSION Structural improvements to increase home temperatures may offer the potential to improve some aspects of health. However, the impact on physical health, including which groups are most likely to benefit, is unclear. Key gaps include the lack of evidence about the impact of financial interventions, and the impact of all types of interventions, on quality of life, mortality and costs.
Collapse
Affiliation(s)
- Kimberly Lazo Green
- Older People and Frailty Policy Research Unit, National Institute for Health and Care Research, The University of Manchester, Manchester, UK
- Healthy Ageing Research Group, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, UK
| | - Michelle M C Tan
- National Institute for Health and Care Research Older People and Frailty Policy Research Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Eugenie Evelynne Johnson
- National Institute for Health and Care Research Older People and Frailty Policy Research Unit, Newcastle University, Newcastle upon Tyne, UK
- Evidence Synthesis Group/Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Nisar Ahmed
- Older People and Frailty Policy Research Unit, National Institute for Health and Care Research, The University of Manchester, Manchester, UK
- Healthy Ageing Research Group, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, UK
| | - Claire Eastaugh
- National Institute for Health and Care Research Older People and Frailty Policy Research Unit, Newcastle University, Newcastle upon Tyne, UK
- Evidence Synthesis Group/Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Fiona Beyer
- National Institute for Health and Care Research Older People and Frailty Policy Research Unit, Newcastle University, Newcastle upon Tyne, UK
- Evidence Synthesis Group/Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Dawn Craig
- National Institute for Health and Care Research Older People and Frailty Policy Research Unit, Newcastle University, Newcastle upon Tyne, UK
- Evidence Synthesis Group/Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Gemma F Spiers
- National Institute for Health and Care Research Older People and Frailty Policy Research Unit, Newcastle University, Newcastle upon Tyne, UK
- Evidence Synthesis Group/Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Barbara Hanratty
- National Institute for Health and Care Research Older People and Frailty Policy Research Unit, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
99
|
Thijsen A, Gemelli CN, Hyde MK, Thorpe R, Masser BM. A rapid review of strategies to manage low iron levels in adults donating whole-blood: A focus on donor behaviour. Transfus Med 2024; 34:243-256. [PMID: 39031713 DOI: 10.1111/tme.13060] [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: 01/28/2024] [Revised: 05/21/2024] [Accepted: 06/11/2024] [Indexed: 07/22/2024]
Abstract
In recognition of the impact of whole-blood donation on body iron stores, there has been an increased focus assessing the efficacy of strategies to minimise the risk of iron deficiency (ID). Whilst donor behaviour is an important determinant of success, this literature is yet to be fully synthesised to help guide blood collection agencies when implementing these strategies into routine practice. This rapid review identifies strategies for management of low iron, how they have been communicated to donors, donor compliance with advice, donor use of external health services and their effect on donor retention. Web of Science, Medline, CINAHL and Wiley online library databases were searched from 2012 to November 2023, with 29 studies meeting inclusion criteria. Five iron management strategies were identified: oral iron supplementation (IS), education, dietary advice, lengthening inter-donation interval and switching donation type. Most studies (n = 16) focused on IS, with only four reporting how they communicated this to donors. Donor use of IS was high in controlled research environments but has not been evaluated when implemented into routine practice. None of the four studies on dietary advice included findings on donor acceptability. The proportion of donors consulting their doctor about a low iron result or their risk of ID was found to be suboptimal. However, in general, the identified strategies and communications had a positive effect on donor retention. More evidence is needed on how to increase donor knowledge and awareness of donation-related risk of ID as well as to identify how to effectively communicate strategies to donors to ensure optimal acceptability and use.
Collapse
Affiliation(s)
- Amanda Thijsen
- Research & Development, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
| | - Carley N Gemelli
- Research & Development, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Melissa K Hyde
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachel Thorpe
- Research & Development, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Barbara M Masser
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- Research & Development, Australian Red Cross Lifeblood, Brisbane, Queensland, Australia
| |
Collapse
|
100
|
Bschor T, Nagel L, Unger J, Schwarzer G, Baethge C. Differential Outcomes of Placebo Treatment Across 9 Psychiatric Disorders: A Systematic Review and Meta-Analysis. JAMA Psychiatry 2024; 81:757-768. [PMID: 38809560 PMCID: PMC11137661 DOI: 10.1001/jamapsychiatry.2024.0994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/11/2024] [Indexed: 05/30/2024]
Abstract
Importance Placebo is the only substance systematically evaluated across common psychiatric diagnoses, but comprehensive cross-diagnostic comparisons are lacking. Objective To compare changes in placebo groups in recent high-quality randomized clinical trials (RCTs) across a broad spectrum of psychiatric disorders in adult patients. Data Sources MEDLINE and the Cochrane Database of Systematic Reviews were systematically searched in March 2022 for the latest systematic reviews meeting predetermined high-quality criteria for 9 major psychiatric diagnoses. Study Selection Using these reviews, the top 10 highest-quality (ie, lowest risk of bias, according to the Cochrane Risk of Bias tool) and most recent placebo-controlled RCTs per diagnosis (totaling 90 RCTs) were selected, adhering to predetermined inclusion and exclusion criteria. Data Extraction and Synthesis Following the Cochrane Handbook, 2 authors independently carried out the study search, selection, and data extraction. Cross-diagnosis comparisons were based on standardized pre-post effect sizes (mean change divided by its SD) for each placebo group. This study is reported following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline. Main Outcome and Measure The primary outcome, pooled pre-post placebo effect sizes (dav) with 95% CIs per diagnosis, was determined using random-effects meta-analyses. A Q test assessed statistical significance of differences across diagnoses. Heterogeneity and small-study effects were evaluated as appropriate. Results A total of 90 RCTs with 9985 placebo-treated participants were included. Symptom severity improved with placebo in all diagnoses. Pooled pre-post placebo effect sizes differed across diagnoses (Q = 88.5; df = 8; P < .001), with major depressive disorder (dav = 1.40; 95% CI, 1.24-1.56) and generalized anxiety disorder (dav = 1.23; 95% CI, 1.06-1.41) exhibiting the largest dav. Panic disorder, attention-deficit/hyperactivity disorder, posttraumatic stress disorder, social phobia, and mania showed dav between 0.68 and 0.92, followed by OCD (dav = 0.65; 95% CI, 0.51-0.78) and schizophrenia (dav = 0.59; 95% CI, 0.41-0.76). Conclusion and Relevance This systematic review and meta-analysis found that symptom improvement with placebo treatment was substantial in all conditions but varied across the 9 included diagnoses. These findings may help in assessing the necessity and ethical justification of placebo controls, in evaluating treatment effects in uncontrolled studies, and in guiding patients in treatment decisions. These findings likely encompass the true placebo effect, natural disease course, and nonspecific effects.
Collapse
Affiliation(s)
- Tom Bschor
- Department of Psychiatry and Psychotherapy, University Hospital, Technical University of Dresden, Dresden, Germany
- Government Commission for Modern and Needs-Based Hospital Care, Berlin, Germany
| | - Lea Nagel
- Department of Psychiatry and Psychotherapy, University Hospital, Technical University of Dresden, Dresden, Germany
- Federal Joint Committee (G-BA), Berlin, Germany
| | - Josephine Unger
- Social Psychiatric Service, Berlin district of Reinickendorf, Berlin, Germany
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Christopher Baethge
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Cologne, Cologne, Germany
| |
Collapse
|