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Al-Frejat Z, Martini N, Esper A, Al-Frejat D, Younes S, Hanna M. GERD: Latest update on acid-suppressant drugs. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2024; 7:100198. [PMID: 39282236 PMCID: PMC11393603 DOI: 10.1016/j.crphar.2024.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 08/07/2024] [Accepted: 08/19/2024] [Indexed: 09/18/2024] Open
Abstract
GERD is a very familiar diagnosis among health care providers due to its massive spread, and its symptoms can affect the quality of life for a respectable slice of its patients. Therefore, what can only be described as a logical consequence, a pursuit of a treatment that can both relieve symptoms and have minimal side effects is still ongoing to cover the large demographic affected by GERD. In the following review, analysis will be made of GERD, including possible regulatory activity, of certain drugs to the already discussed pathways involved in GERD patients.
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Affiliation(s)
- Zyad Al-Frejat
- Faculty of Medicine, Al Baath University, Homs, Syria
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Nafiza Martini
- Faculty of Medicine, Damascus University, Damascus, Syria
- Stemosis for Scientific Research, Damascus, Syria
| | - Alia Esper
- Faculty of Medicine, Al Baath University, Homs, Syria
- Stemosis for Scientific Research, Damascus, Syria
| | - Diana Al-Frejat
- Faculty of Medicine, Damascus University, Damascus, Syria
- Faculty of Dentistry, Syrian Private University, Damascus, Syria
| | - Samer Younes
- Faculty of Pharmacy, Tartous University, Tartous, Syria
- Stemosis for Scientific Research, Damascus, Syria
| | - Majd Hanna
- Faculty of Medicine, Damascus University, Damascus, Syria
- Stemosis for Scientific Research, Damascus, Syria
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Greenwood H, Davidson AR, Thomas R, Albarqouni L. Common barriers and enablers to the use of non-drug interventions for managing common chronic conditions in primary care: an overview of reviews. BMC PRIMARY CARE 2024; 25:108. [PMID: 38582829 PMCID: PMC10998330 DOI: 10.1186/s12875-024-02321-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/23/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Non-drug interventions are recommended for chronic condition prevention and management yet are underused in clinical practice. Understanding barriers and enablers to using non-drug interventions may help implement non-drug interventions in primary care. We aimed to conduct an overview of reviews to identify and summarise common barriers and enablers for using non-drug interventions for common chronic conditions in primary care. METHODS We included qualitative and quantitative reviews that used systematic process or methods to examine barriers and enablers to using non-drug interventions for chronic condition prevention and management in primary care settings. We searched 5 electronic databases (PubMed, Cochrane Database of Systematic Reviews, EMBASE, PsycInfo and CINAHL) from inception to September 2022. Two authors independently screened reviews. One author extracted and deductively coded data to Consolidated Framework of Implementation Research (CFIR) (and where relevant, Theoretical Domains Framework [TDF]). A second author validated 10% of extracted data and coding. Data was synthesised thematically using CFIR and TDF. One author assessed the methodological quality of included reviews using a modified AMSTAR 2 tool, with 10% validated by a second author. We assessed overlap between primary studies in included reviews. RESULTS From 5324 records, we included 25 reviews, with data predominately from patients. Overall, 130 subthemes (71 barrier and 59 enabler) were identified across 4 CFIR domains (Innovation, Outer Setting, Inner Setting, and Individuals), and all TDF domains. Common barrier and enabler subthemes were identified for CFIR constructs of Innovation Adaptability, Innovation Cost, Innovation Relative Advantage, Local Attitudes, External Pressure, Local Conditions, Relational Connections, Available Resources, and Access to Knowledge and Information. For TDF domains, important barrier and enabler subthemes were identified for Knowledge, Skills, Environmental Context and Resources, Beliefs about Consequences, Reinforcement, and Emotion. CONCLUSIONS We synthesised reviews to provide new insight into common barriers and enablers for using non-drug interventions to prevent and manage chronic conditions in primary care. The factors identified can inform the development of generalisable implementation interventions to enhance uptake of multiple non-drug interventions simultaneously. TRIAL REGISTRATION This study was registered in PROSPERO (CRD42022357583).
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Affiliation(s)
- Hannah Greenwood
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia.
| | - Alexandra R Davidson
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Rae Thomas
- Tropical Australian Academic Health Centre, Townsville, Australia
| | - Loai Albarqouni
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
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De A, Mishra N, Chang HT. An approach to the dermatological classification of histopathological skin images using a hybridized CNN-DenseNet model. PeerJ Comput Sci 2024; 10:e1884. [PMID: 38435616 PMCID: PMC10909212 DOI: 10.7717/peerj-cs.1884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024]
Abstract
This research addresses the challenge of automating skin disease diagnosis using dermatoscopic images. The primary issue lies in accurately classifying pigmented skin lesions, which traditionally rely on manual assessment by dermatologists and are prone to subjectivity and time consumption. By integrating a hybrid CNN-DenseNet model, this study aimed to overcome the complexities of differentiating various skin diseases and automating the diagnostic process effectively. Our methodology involved rigorous data preprocessing, exploratory data analysis, normalization, and label encoding. Techniques such as model hybridization, batch normalization and data fitting were employed to optimize the model architecture and data fitting. Initial iterations of our convolutional neural network (CNN) model achieved an accuracy of 76.22% on the test data and 75.69% on the validation data. Recognizing the need for improvement, the model was hybridized with DenseNet architecture and ResNet architecture was implemented for feature extraction and then further trained on the HAM10000 and PAD-UFES-20 datasets. Overall, our efforts resulted in a hybrid model that demonstrated an impressive accuracy of 95.7% on the HAM10000 dataset and 91.07% on the PAD-UFES-20 dataset. In comparison to recently published works, our model stands out because of its potential to effectively diagnose skin diseases such as melanocytic nevi, melanoma, benign keratosis-like lesions, basal cell carcinoma, actinic keratoses, vascular lesions, and dermatofibroma, all of which rival the diagnostic accuracy of real-world clinical specialists but also offer customization potential for more nuanced clinical uses.
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Affiliation(s)
- Anubhav De
- School of Computing Science & Engineering, VIT Bhopal University, Madhya Pradesh, India
| | - Nilamadhab Mishra
- School of Computing Science & Engineering, VIT Bhopal University, Madhya Pradesh, India
| | - Hsien-Tsung Chang
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Artificial Intelligence Research Center, Chang Gung University, Taoyuan, Taiwan
- Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan
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Albarqouni L, Greenwood H, Dowsett C, Hoffmann T, Thomas R, Glasziou P. Attitudes, beliefs, behaviours and perspectives on barriers and enablers of Australian general practitioners towards non-drug interventions: a national survey. Fam Med Community Health 2024; 12:e002457. [PMID: 38199611 PMCID: PMC10806537 DOI: 10.1136/fmch-2023-002457] [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] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Many guidelines recommend non-drug interventions (NDIs) for managing common conditions in primary care. However, compared with drug interventions, NDIs are less widely known, promoted and used. We aim to (1) examine general practitioners' (GPs') knowledge, attitudes and practices for NDIs, including their use of the Royal Australian College of General Practitioners (RACGP) Handbook of Non-Drug Interventions (HANDI), and (2) identify factors influencing their use of NDIs and HANDI. METHODS We conducted a web-based cross-sectional survey of practicing GP members in Australia during October-November 2022. The survey contained five sections: characteristics of GP; knowledge and use of NDIs; attitudes towards NDIs; barriers and enablers to using HANDI; and suggestions of NDIs and ideas to improve the uptake of NDIs in primary care. RESULTS Of the 366 GPs who completed the survey, 242 (66%) were female, and 248 (74%) were ≥45 years old. One in three GPs reported that they regularly ('always') recommend NDIs to their patients when appropriate (34%), whereas one-third of GPs were unaware of HANDI (39%). GPs identified several factors that improve the uptake of HANDI, including 'access and integration of HANDI in clinical practice', 'content and support to use in practice' and 'awareness and training'. CONCLUSIONS While many GPs are aware of the effectiveness of NDIs and often endorse their use, obstacles still prevent widespread adoption in primary care. The results of this survey can serve as a foundation for developing implementation strategies to improve the uptake of effective evidence-based NDIs in primary care.
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Affiliation(s)
- Loai Albarqouni
- Institute for Evidence-based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Robina, Queensland, Australia
| | - Hannah Greenwood
- Institute for Evidence-based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Robina, Queensland, Australia
| | - Caroline Dowsett
- Institute for Evidence-based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Robina, Queensland, Australia
| | - Tammy Hoffmann
- Institute for Evidence-based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Robina, Queensland, Australia
| | - Rae Thomas
- Institute for Evidence-based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Robina, Queensland, Australia
- Tropical Australian Academic Health Centre, Townsville, Queensland, Australia
| | - Paul Glasziou
- Institute for Evidence-based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Robina, Queensland, Australia
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Hungin AP, Yadlapati R, Anastasiou F, Bredenoord AJ, El Serag H, Fracasso P, Mendive JM, Savarino EV, Sifrim D, Udrescu M, Kahrilas PJ. Management advice for patients with reflux-like symptoms: an evidence-based consensus. Eur J Gastroenterol Hepatol 2024; 36:13-25. [PMID: 38006602 PMCID: PMC10695341 DOI: 10.1097/meg.0000000000002682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/11/2023] [Indexed: 11/27/2023]
Abstract
Patients with reflux-like symptoms (heartburn and regurgitation) are often not well advised on implementing individualised strategies to help control their symptoms using dietary changes, lifestyle modifications, behavioural changes or fast-acting rescue therapies. One reason for this may be the lack of emphasis in management guidelines owing to 'low-quality' evidence and a paucity of interventional studies. Thus, a panel of 11 gastroenterologists and primary care doctors used the Delphi method to develop consolidated advice for patients based on expert consensus. A steering committee selected topics for literature searches using the PubMed database, and a modified Delphi process including two online meetings and two rounds of voting was conducted to generate consensus statements based on prespecified criteria (67% voting 'strongly agree' or 'agree with minor reservation'). After expert discussion and two rounds of voting, 21 consensus statements were generated, and assigned strength of evidence and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) rating. Eleven statements achieved the strongest (100%) agreement: five are related to diet and include identification and avoidance of dietary triggers, limiting alcohol, coffee and carbonated beverages, and advising patients troubled by postprandial symptoms not to overeat; the remaining six statements concern advice around smoking cessation, weight loss, raising the head-of-the-bed, avoiding recumbency after meals, stress reduction and alginate use. The aim of developing the consensus statements is that they may serve as a foundation for tools and advice that can routinely help patients with reflux-like symptoms better understand the causes of their symptoms and manage their individual risk factors and triggers.
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Affiliation(s)
- A. Pali Hungin
- Professor Emeritus, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Rena Yadlapati
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Foteini Anastasiou
- 4th Local Primary Care Team, Municipality Practice and Academic Practice of Heraklion; University of Crete, Crete, Greece
| | - Albert J. Bredenoord
- Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Hashem El Serag
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Pierluigi Fracasso
- Department of Gastroenterology and Digestive Endoscopy, Ospedale Sandro Pertini, Local Health Agency Roma 2, Rome, Italy
| | - Juan M Mendive
- La Mina Primary Care Academic Centre, Catalan Health Institute, University of Barcelona, Spain
| | - Edoardo V. Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Daniel Sifrim
- Wingate Institute of Neurogastroenterology, Queen Mary University of London, London, UK
| | | | - Peter J Kahrilas
- Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Gastroesophageal Reflux Treatment in Infancy Through Young Adulthood. Am J Gastroenterol 2023; 118:452-458. [PMID: 36717189 DOI: 10.14309/ajg.0000000000002160] [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] [Received: 09/30/2022] [Accepted: 12/20/2022] [Indexed: 02/01/2023]
Abstract
Gastroesophageal reflux treatment varies greatly across the pediatric age spectrum. Infant reflux treatments rely heavily on nutritional interventions, whereas reflux in older children is treated more commonly with medications. However, because of the broad differential diagnosis, treatment nonresponse merits a re-evaluation of the diagnosis being treated and additional testing to provide a more precision-medicine approach to care.
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McLaren-Kennedy A, Chaboyer W, Thalib L, Latimer S. The effect of head of bed elevation on sacral and heel subepidermal moisture in healthy adults: A randomised crossover study. J Tissue Viability 2023; 32:2-8. [PMID: 36732157 DOI: 10.1016/j.jtv.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/10/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Subepidermal moisture (SEM) changes may detect early tissue injury and enhance pressure injury risk assessments. However, little is known how modifiable factors, like head of bed elevation (HOBE), affect SEM. AIM This study investigated the influence of HOBE on sacral and heel SEM, using the Provizio ® SEM Scanner. METHOD A 2 × 2 randomised crossover study compared the effects of 30-min of 30⁰ versus 60⁰ HOBE on sacral and heel SEM in healthy adults. RESULTS 48 participants were randomly allocated to 30⁰ or 60⁰ HOBE and crossed over after a 60-min washout period. The mean age was 40.6 years (SD = 18.3). The study found the sacral and heel SEM values were not statistically different at 30⁰ versus 60⁰ HOBE. No clinically relevant association between SEM and characteristics of age, sex, body mass index and skin type were found. Baseline sacral and heel SEM values recovered after a 60-min washout period. Notably, half of the initial baseline measures suggested pressure injury risk. CONCLUSION The HOBE may not influence SEM at the sacrum and heels, in healthy adults after 30 min of loading. Standard operating procedures for measuring SEM for pressure injury risk assessment require a stronger body of evidence in varied populations and timeframes before this technology is widely adopted. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12622001456741.
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Affiliation(s)
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland and School of Nursing and Midwifery Griffith University, Gold Coast, Australia
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - Sharon Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland and School of Nursing and Midwifery Griffith University, Gold Coast, Australia
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Meyer JC, MacBride-Stewart S, Fadare JO, Abdulrahman Jairoun A, Haque M, Massele A, Kumar S, Sefah IA, P Skosana P, Godman B. Key Considerations From a Health Authority Perspective When Proton Pump Inhibitors Are Used to Treat Gastroesophageal Reflux Disease (GERD) and Their Implications. Cureus 2022; 14:e31918. [DOI: 10.7759/cureus.31918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 11/28/2022] Open
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Cano García L, García de Yébenes MJ, Vázquez NM, Martín Martín JM, Domínguez Quesada C, García-Díaz S, Rodríguez Vargas AI, de la Torre-Aboki J, Jiménez Núñez F, Espíldora Hernández F, León Mateos L, Vázquez Lojo A, Marcos Pérez E, Castiblanco L, Carmona L. Openreuma Consensus on the role of nursing in the care of patients with rheumatoid arthritis and diffuse interstitial lung disease. INVESTIGACION Y EDUCACION EN ENFERMERIA 2022; 40:e17. [PMID: 36867790 PMCID: PMC10017131 DOI: 10.17533/udea.iee.v40n3e17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/03/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To develop practical recommendations, based on the best available evidence and experience, on the nursing management of patients with rheumatoid arthritis (RA) and interstitial lung disease (ILD). METHODS The usual consensus methodology was used, with a nominal group, systematic reviews (SRs), and Delphi survey. The expert panel, consisting of rheumatology nurses, rheumatologists, a psychologist, a physiotherapist, and a patient, defined the scope, the users, the topics on which to explore the evidence and on which to issue recommendations. RESULTS Three PICO questions evaluated the efficacy and safety of pulmonary rehabilitation and non-pharmacological measures for the treatment of chronic cough and gastroesophageal reflux by means of SR of the literature. With the results of the reviews, 15 recommendations were established for which the degree of agreement was obtained with a Delphi survey. Three recommendations were rejected in the second round. The 12 recommendations were in patient assessment (n=4); patient education (n=4); and risk management (n=4). Only one recommendation was based on available evidence, while the remaining were based on expert opinion. The degree of agreement ranged from 77% to 100%. CONCLUSIONS This document presents a series of recommendations with the aim of improving the prognosis and quality of life of patients with RA-ILD. Nursing knowledge and implementation of these recommendations can improve the follow-up and prognosis of patients with RA who present with ILD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Loreto Carmona
- Instituto de Salud Musculoesquelética (Inmusc); Madrid, Spain
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