Quality assessment of Clinical Practice Guidelines (CPG) for the diagnosis and treatment of inflammatory bowel disease using the AGREE II instrument: a systematic review

Background

The incidence and diagnosis of inflammatory bowel disease (IBD) has increased considerably in recent years. Many clinical practice guidelines (CPG) have been developed for the management of this disease across different clinical contexts, however, little evidence exists on their methodological quality. Therefore, we aimed to systematically evaluate the quality of CPGs for the diagnosis and treatment of IBD using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.

Methods

We identified CPGs by searching databases (MEDLINE - PubMed, EMBASE, CINAHL, LILACS) and other sources of gray literature on January 2022. We included guidelines with specific recommendations for the diagnosis and treatment of IBD and evaluated them with the AGREE II instrument to assess their methodological quality. Six independent reviewers assessed the quality of the guidelines and resolved conflicts by consensus. We assessed the degree of agreement using the intraclass correlation coefficient (ICC) and change in quality over time was appraised in two periods: from 2012 to 2017 and from 2018 to 2022.

Results

We analyzed and evaluated 26 CPGs that met the inclusion criteria. The overall agreement among reviewers was moderate (ICC: 0.74; 95% CI 0.36 - 0.89). The mean scores of the AGREE II domains were: “Scope and purpose” 84.51%, “Stakeholder involvement” 60.90%, “Rigor of development” 69.95%, “Clarity of presentation” 85.58%, “Applicability” 26.60%, and “Editorial independence” 62.02%. No changes in quality were found over time.

Conclusions

The quality of the CPGs evaluated was generally good, with a large majority of the assessed guidelines being “recommended” and “recommended with modifications”; despite this, there is still room for improvement, especially in terms of stakeholder involvement and applicability. Efforts to develop high quality CPGs for IBD need to be further optimized.

Influence of cavitation, pelleting, extrusion and torrefaction petreatments on anaerobic biodegradability of barley straw and vine shoots

When dealing with lignocellulosic biomass in anaerobic digestion, a pretreatment stage is always required to open the structure of the material, facilitating its degradation. Numerous methods have been developed to pretreat lignocellulosic biomass. Four of them: cavitation, pelleting, extrusion and torrefaction have been comparatively studied in this paper as ways to improve the production of methane by anaerobic digestion of two different feedstocks: barley straw and vine shoots. Additionally, how the selected pretreatments and the nature of the feedstock influence the formation of individual volatile fatty acids was examined. Cavitation was revealed as the most efficient pretreatment, increasing 240% and 360% the methane production for barley straw and vine shoots, respectively, although in absolute terms, barley straw has higher production rate and yield than vine shoots. Torrefaction carried out at 180 °C increased methane production, 81% for straw and 25% for vine shoots, while the process at higher temperatures (220 °C) negatively affected biogas production from both feedstocks. Finally, volatile fatty acids accumulation seems to neutralize any potential positive effects of densification pretreatments.

Detection and management of agitation in psychiatry: A Delphi expert consensus study

Introduction

The assessment and management of psychomotor agitation may result in the use of coercive or sedative treatments. In the absence of conclusive evidence, the consensus of experts can guide clinical decisions.

Objectives

To seek consensus recommendations on the assessment and management of psychomotor agitation.

Methods

An international expert task force in this field developed consensus using the Delphi method. Twenty-seven experts were invited to participate and 91% of them agreed. Initial survey items were gathered from the content of literature search (systematic review). This included open-ended questions inviting participants to add suggestions by e-mail correspondence. After this initial first round, the Delphi study was conducted online using Google Forms. Survey items were rated on a 5-point scale. Items rated by at least 80% of experts as essential or important were included. Items rated as essential or important by 65–79% of experts were included in the next survey for re-rating. Items with consensus below to 65% were rejected and excluded.

Results

The initial survey included 52 items. The second web-based survey included 33 items. The briefer third survey consisted of 6 items that needed rerating. Twenty-two of the initial 33 items were endorsed and formed the clinical recommendations on the assessment and management of the psychomotor agitation. The endorsed items were categorized into 5 domains forming the clinical recommendations.

Conclusions

The panel expert generated 22 recommendations on the assessment and management of agitation. The Delphi method is a suitable formal iterative process for reaching consensus on relevant and controversial issues.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Euthymia is not always euthymia: Clinical status of bipolar patients after 6 months of clinical remission

Introduction

Most studies selected euthymic patients with bipolar disorder in inter-episodic phase according to clinical remission criteria at least between 1 and 6 months. However, possible differences can exist in the course of clinical symptoms in bipolar patients related to the duration of clinical remission.

Objectives

The main aim of this study was to evaluate the clinical status of bipolar patients after 6 months of clinical remission.

Methods

We performed a cross-sectional study of bipolar outpatients in clinical remission for at least 6 months. Bipolar Depression Rating Scale (BDRS), Young Mania Rating scale, Pittsburgh Sleep Quality Index (PSQI) scale, Visual Analogic Scales (VAS) evaluated cognitive impairment were used to assess residual symptomatology of patients. Multivariate analysis (MANCOVA) was conducted for analysing possible differences between 3 groups of patients according to their duration of clinical remission (< 6 months–1 year, < 1 year–3 years, < 3 years–5 years).

Results

A total of 525 patients were included into the study. The multivariate analysis indicated a significant effect of the duration of clinical remission on the different residual symptoms (Pillai's trace: F 4.48, P < 0.001). The duration of clinical remission was associated with the significant improvement of the BDRS total score (P = 0.013), the PSQI total score (P < 0.001) and the cognitive VAS total score (P < 0.001)

Conclusion

These results support a possible improvement of residual symptoms according to the duration of clinical remission in bipolar patients. Any definition of euthymia should specify the duration criteria.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Long term testing of Microbial Fuel Cells: Comparison of different anode materials

This paper focuses on the long term operation and testing of three Microbial Fuel Cells (MFC) having three different anode materials: commercial carbon felt (C-FELT), polyaniline-deposited carbon felt (C-PANI) and carbon-coated Berl saddles (C-SADDLES). A mixed consortium from seawater was used as inoculum and acetate was used as substrate. Tests were conducted for four months under 1000Ω external load. The maximum power generation was obtained by C-SADDLES (102mWm(-2)) followed by C-FELT and C-PANI, respectively. A similar trend was obtained with the evaluation of electrical energy produced: C-SADDLES (2222J), C-PANI (2183J) and C-FELT (2114J). However, the performance of C-PANI decreased over time, most evidently due to degradation or deactivation of deposited polyaniline by the microorganisms' activity. These results provide evidence that the three-dimensional structure, C-SADDLES, offers excellent biocompatibility, high specific surface area, high conductivity and most importantly these properties are maintained for a long period of time.

Electrochemical and impedance characterization of Microbial Fuel Cells based on 2D and 3D anodic electrodes working with seawater microorganisms under continuous operation

A mixed microbial population naturally presents in seawater was used as active anodic biofilm of two Microbial Fuel Cells (MFCs), employing either a 2D commercial carbon felt or 3D carbon-coated Berl saddles as anode electrodes, with the aim to compare their electrochemical behavior under continuous operation. After an initial increase of the maximum power density, the felt-based cell reduced its performance at 5 months (from 7 to 4 μW cm(-2)), while the saddle-based MFC exceeds 9 μW cm(-2) (after 2 months) and maintained such performance for all the tests. Electrochemical impedance spectroscopy was used to identify the MFCs controlling losses and indicates that the mass-transport limitations at the biofilm-electrolyte interface have the main contribution (>95%) to their internal resistance. The activation resistance was one order of magnitude lower with the Berl saddles than with carbon felt, suggesting an enhanced charge-transfer in the high surface-area 3D electrode, due to an increase in bacteria population growth.

Green and low-cost synthesis of PANI–TiO2 nanocomposite mesoporous films for photoelectrochemical water splitting

Green and low-cost synthesis procedure for preparation of PANI/TiO₂ mesoporous nanocomposite films with enhanced photocatalytic performance, thanks to a synergic reaction mechanism between PANI and TiO₂ under UV light irradiation.

[Resident of emergency attitude towards patients-physician relationship at the Hospital de Clínicas- Asunción, Paraguay]

INTRODUCTION

The doctor-patient relationship is reaching great importance in recent times, is highlighted their importance in areas as varied as satisfaction, compliance, perception of professional competence, the frequency of legal issues relating to malpractice and even the prognosis of the disease or the general health of the patient.

OBJECTIVE

To evaluate the doctor-patient relationship from the point of view of residents of emergency unit.

METHODS

An observational, descriptive study. The sample consisted of 36 doctors from different areas of the Emergency Rooms of the Hospital de Clínicas- Asunción, Paraguay. The patient-physician relationship was evaluated using an instrument developed by RA Chavarria-Islas et al. with four indicators: Respect, Information, Consent and Dedication.

RESULTS

69.4% of residents have a regular patient-physician relationship; despite the 2.78% has a good relationship, 25% bad relationship and 2.78% a very bad relationship.

CONCLUSION

Gaps in doctor-patient relationship were found in this study.. It is interesting to invest greater efforts to enhance the doctor-patient relationship as one of the edges to improve health care, which is vital in emergency care.

Bipolar disorder in the elderly: a cohort study comparing older and younger patients

OBJECTIVE

The purpose of this study was to analyze differences in clinical and socio-demographic characteristics between older and younger bipolar outpatients paying special attention to depressive symptoms in a large, naturalistic cohort.

METHOD

Five hundred and ninety-three DSM-IV-TR bipolar outpatients were enrolled. Clinical characteristics were assessed according to DSM-IV-TR (SCID-I). Subjects were categorized into two groups according to current age (older OBD: age > 65 years; younger-YBD: age < 65 years).

RESULTS

About 80% of patients were younger (N = 470), and a fifth were older (N = 123), with a mean age of 77.30 years in OBD. Older patients were more likely to be married, not qualified, bipolar II, with depressive polarity of first episode, higher age at illness onset, higher age at first hospitalization. They were more likely to present with depressive predominant polarity, with lifetime history of catatonic, psychotic and melancholic features, age at illness onset >40 years, as well as suffering from more medical comorbidities when compared to younger bipolars.

CONCLUSION

The clinical presentation of bipolar disorder in late life would be defined more frequently by melancholic depressive features and a predominantly depressive polarity. These results suggest that treatment strategies for elderly bipolar patients should focus in the prevention of depressive episodes.

Evaluation of pre-treatment processes for increasing biodegradability of agro-food wastes

Anaerobic digestion (AD) technology can be employed for treating sewage sludge, livestock waste or food waste. Generally, the hydrolysis stage is the rate-limiting step of the AD processes for solid waste degradation. Therefore, physical, chemical and biological pre-treatment methods or their combination are required, in order to reduce the rate of such a limiting step. In this study, four methods (mechanical shredding, acid hydrolysis, alkaline hydrolysis and sonication) were tested to improve methane production and anaerobic biodegradability of different agro-food wastes and their mixtures. The kinetics of anaerobic degradation and methane production ofpre-treated individual wastes and selected mixtures were investigated with batch tests. Sonication at lower frequencies (37 kHz) proved to give the best results with methane productivity enhancements of over 100% in the case of pig manure and in the range of 10-47% for the other wastes assayed. Furthermore, the ultimate methane production was proportional, in all the cases, to the specific energy input applied (Es). Sonication can, thus, enhance waste digestion and the rate and quantity of biogas generated. The behaviour of the other pre-treatments under the conditions assayed is not significant. Only a slight enhancement of biogas production (around 10%) was detected for whey and waste activated sludge (WAS) after mechanical shredding. The lack of effectiveness of chemical pre-treatments (acid and alkaline hydrolysis) can be justified by the inhibition of the methanogenic process due to the presence of high concentrations of sodium (up to 8 g l(-1) in some tests). Only in the case of WAS did the acid hydrolysis considerably increase the biodegradability of the sample (79%), because in this case no inhibition by sodium took place. Some hints of a synergistic effect have been observed when co-digestion of the mixtures was performed.

Biochemical methane potential (BMP) of agro-food wastes from the Cider Region (Spain)

An inventory of agro-food industry organic waste streams with a high potential for biogas transformation was studied in a logistically viable area (Cider Region, Asturias, Spain). Three industries were selected as the most viable ones: livestock, dairy and beverage. The potential for methane production from six wastes (beverage waste, BW; milled apple waste, MA; milk waste, MK; yogurt waste, YG; fats and oils from dairy wastewater treatment, F&O and cattle manure, CM) at five different substrate:inoculum ratios (0.25, 0.50, 0.75, 1.00 and 1.50) was evaluated in laboratory batch assays. Obtained methane yields ranged from 202-549 mL STP CH(4)·g VS waste(-1), and the methane content in biogas ranged from 58-76%. The ultimate practical biochemical methane potentials were slightly affected by the substrate:inoculum ratio. The estimation of the regional fluxes of waste and methane potentials suggests anaerobic digestion as a sustainable solution for the valorization of the organic wastes generated in this Region.

The role of microsurgery in reconstruction of oncologic chest wall defects

Regional pedicled myocutaneous flaps are usually the best choice for soft-tissue coverage of full-thickness chest wall defects. As defects increase in size, microsurgical techniques are necessary to augment blood flow to pedicled flaps or to provide free flap coverage from distant sites. This study retrospectively reviews all microsurgical procedures performed at one institution for the coverage of full-thickness chest wall defects. Twenty-five cases of full-thickness chest wall reconstruction are reviewed. There were 20 free flaps and five supercharged pedicled flaps. A rectus abdominis myocutaneous flap (free or supercharged) was used in 20 cases, and a filet free flap following forequarter amputation was used in five patients. Large skeletal defects were repaired with a Marlex mesh/methylmethacrylate sandwich prosthesis. There was 100 percent flap survival and one case of minor, partial flap loss. The prosthesis remained effectively covered in all cases. Five patients required ventilatory support for up to 10 days postoperatively. There were three perioperative deaths due to multisystem failure. Microsurgical techniques are extremely useful for reconstruction of complicated, composite chest wall defects. They are indicated when regional pedicled flap options are unavailable or inadequate. These flaps have a 100 percent success rate and uniformly result in stable soft-tissue coverage.

Revising the unsatisfactory breast augmentation

Revising an unsatisfactory result after breast augmentation requires a thorough understanding of the cause of the abnormality to develop a rational and effective treatment plan to achieve the best possible result. Often, more than one manipulation is required to correct the deformity. Using the techniques presented here, successful revision can be performed in the vast majority of cases.

Primary melanoma thickness correlated with regional lymph node metastases

We studied 119 patients with stage I primary cutaneous malignant melanoma, who were undergoing regional lymph node dissection, to determine the relationship of lymph node metastases to thickness of the primary lesion. The lymph nodes in the dissection specimen were each evaluated by serial sections. None of the patients with lesions less than 1.0 mm thick had nodal micrometastases. When lesions exceeded 1.0 mm in thickness, there was no appreciable increase in the incidence of nodal metastases until a thickness greater than 4.0 mm was reached, in which cases the incidence of metastases was 50%. Predictive variables were determined by multiple logistic regression analysis. Only lesions that were at least 4.0 mm thick and were not located on the upper extremities were significant predictors of lymph node metastases; within this category there was a 64% incidence of lymph node metastases.