The Number Needed to Treat for Music as a Medicine against Perioperative Anxiety: A Systematic Review and Meta-Analysis.

This systematic review indicates that music interventions compared to standard care may have beneficial effects on anxiety, depression, hope, pain, and fatigue in adults with cancer. The results of two trials suggest that music interventions may have a beneficial effect on anxiety in children with cancer. Too few trials with pediatric participants were included to draw conclusions about the treatment benefits of music for other outcomes. For several outcomes, music therapy interventions delivered by a trained music therapist led to consistent results across studies and this was not the case for music medicine interventions. Moreover, evidence of effect was found for music therapy interventions for QoL and fatigue but not for music medicine interventions. Most trials were at high risk of bias and low or very low certainty of evidence; therefore, these results need to be interpreted with caution.

This systematic review indicates that music interventions may have beneficial effects on anxiety, pain, fatigue and QoL in people with cancer. Furthermore, music may have a small effect on heart rate, respiratory rate and blood pressure. Most trials were at high risk of bias and, therefore, these results need to be interpreted with caution.

Using patient-reported outcomes and physiological indicators to test the effects of music intervention and aromatherapy on reducing anxiety for intensive care unit (ICU) patients undergoing mechanical ventilation. Patients with ICU admission duration >24h were randomly assigned to a Music intervention group (n = 41), Aromatherapy group (n = 47), or Control group (rest only; n = 44). Each patient in the Music group listened to music; each patient in the Aromatherapy group received lavender essential oil massage on his/her back for 5min; each patient in the Control group wore noise-canceling headphones. Anxiety was measured using the Chinese version of the Stage-Trait Anxiety Inventory (C-STAI) and the Visual Analogue Scale for Anxiety (VAS-A) at baseline, post-test, and 30-min follow-up. Heart rate, breathing rate, and blood pressure were measured every 10min from baseline to the 30-min follow-up. The Music group had significantly better post-test VAS-A and C-STAI scores, and had lower heart rate and blood pressure than the Control group. The Aromatherapy group had significantly better VAS-A score and lower heart rate than the Control group. The 30-min follow-up showed that both Music and Aromatherapy groups had lower heart rate and blood pressure than the Control group. Music and aromatherapy interventions were both effective for ICU patients. The effects of music intervention were greater than that of aromatherapy; both interventions maintained the effects for at least 30min.

The use of 3-dimensionally printed models to optimize patient education and alleviate perioperative anxiety in Mohs micrographic surgery: A randomized controlled trial

2025 Background: Low-grade gliomas (LGG) account for 17-22% of all primary brain tumors. Optimal surgical management consists of optimum safe resection with the goal of complete resection. We performed a systematic review and meta-analysis to quantify the association of extent of resection with likelihood of survival, expressing our results in numbers needed to treat (NNT). Methods: A systematic review and study-level meta-analysis to determine the association of resection with overall survival and progression-free survival in newly diagnosed, supratentorial LGG in adults was performed by querying PubMed. Data were extracted to compare gross total resection (GTR) to subtotal resection (STR) and STR to biopsy (Bx) to determine relative risks (RR) of death and progression at 2, 5, and 10 years. Data were analyzed using a random effects model. NNT were calculated from significant comparisons and rounded up to the nearest whole number. Quality of evidence was determined by American Academy of Neurology criteria. Results: The systematic review resulted in 283 potential studies. Ultimately 29 studies were included in at least one comparison. There were no high quality (class I and II) or prospective studies discovered in the review. Comparing GTR to STR, RR with 95% confidence intervals (CI) of death at 2, 5, and 10 years, and NNT to avoid one death at 2, 5, and 10 years (GTR vs. STR) were 0.29 [0.17-0.52, p < 0.0001, NNT 17], 0.39 [0.29-0.51, p < 0.00001, NNT 6], and 0.50 [0.35-0.70, p < 0.0001 NNT 4]. RR and NNT for progression (GTR vs. STR) at 2, 5, and 10 years were 0.37 [0.24-0.57, p < 0.0001 NNT 7], 0.50 [0.39-0.64, p < 0.0001 NNT 4], and 0.67 [0.53-0.84, p = 0.0005 NNT 4]. Comparing STR to Bx, RR of death at 2, 5, and 10 years were 0.55 [0.34-0.88, p = 0.01 NNT 10], 0.9 [0.61-1.34], and 0.95 [0.73-1.23]. Conclusions: Increasing resection thresholds appear to be associated with improved overall and progression free survival, but the body of literature consists of low quality studies. Prospective studies are required to explore whether extent of resection matters or whether resectable tumors share a favorable biology associated with better outcome.

Having cancer may result in extensive emotional, physical and social suffering. Music interventions have been used to alleviate symptoms and treatment side effects in cancer patients. To compare the effects of music therapy or music medicine interventions and standard care with standard care alone, or standard care and other interventions in patients with cancer. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 10), MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, Science Citation Index, CancerLit, www.musictherapyworld.net, CAIRSS, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, and the National Research Register. All databases were searched from their start date to September 2010. We handsearched music therapy journals and reference lists and contacted experts. There was no language restriction. We included all randomized controlled trials (RCTs) and quasi-randomized trials of music interventions for improving psychological and physical outcomes in patients with cancer. Participants undergoing biopsy and aspiration for diagnostic purposes were excluded. Two review authors independently extracted the data and assessed the risk of bias. Where possible, results were presented in meta analyses using mean differences and standardized mean differences. Post-test scores were used. In cases of significant baseline difference, we used change scores. We included 30 trials with a total of 1891 participants. We included music therapy interventions, offered by trained music therapists, as well as listening to pre-recorded music, offered by medical staff. The results suggest that music interventions may have a beneficial effect on anxiety in people with cancer, with a reported average anxiety reduction of 11.20 units (95% confidence interval (CI) -19.59 to -2.82, P = 0.009) on the STAI-S scale and -0.61 standardized units (95% CI -0.97 to -0.26, P = 0.0007) on other anxiety scales. Results also suggested a positive impact on mood (standardised mean difference (SMD) = 0.42, 95% CI 0.03 to 0.81, P = 0.03), but no support was found for depression.Music interventions may lead to small reductions in heart rate, respiratory rate, and blood pressure. A moderate pain-reducing effect was found (SMD = -0.59, 95% CI -0.92 to -0.27, P = 0.0003), but no strong evidence was found for enhancement of fatigue or physical status. The pooled estimate of two trials suggested a beneficial effect of music therapy on patients' quality of life (QoL) (SMD = 1.02, 95% CI 0.58 to 1.47, P = 0.00001).No conclusions could be drawn regarding the effect of music interventions on distress, body image, oxygen saturation level, immunologic functioning, spirituality, and communication outcomes.Seventeen trials used listening to pre-recorded music and 13 trials used music therapy interventions that actively engaged the patients. Not all studies included the same outcomes and due to the small number of studies per outcome, we could not compare the effectiveness of music medicine interventions with that of music therapy interventions. This systematic review indicates that music interventions may have beneficial effects on anxiety, pain, mood, and QoL in people with cancer. Furthermore, music may have a small effect on heart rate, respiratory rate, and blood pressure. Most trials were at high risk of bias and, therefore, these results need to be interpreted with caution.

The Role of Cooling Centers in Protecting Vulnerable Individuals from Extreme Heat.

This Campbell systematic review assesses the effects of advocacy interventions on intimate partner violence and women's wellbeing. The review summarizes findings from 13 studies. Physical abuse: After one year, brief advocacy had no effect in two healthcare studies and one community study, but it reduced minor abuse in one antenatal care study. Another antenatal study showed reduced abuse immediately after brief advocacy, but women were also treated for depression, which may have affected results. Two studies provided weak evidence that intensive advocacy reduces physical abuse up to two years after the intervention. Sexual abuse was reported in four studies that found no effects. Emotional abuse: One antenatal care study reported reduced emotional abuse at 12 months after advocacy. Depression: Brief advocacy prevented depression in abused women attending healthcare services and pregnant women immediately after advocacy. Intensive advocacy did not reduce depression in shelter women followed up at 12 and 24 months. The moderate‐to‐low quality evidence came mostly from studies with a low risk of bias. Quality of life: Three trials of brief advocacy trials no benefit on quality of life. Intensive advocacy showed a weak benefit in two studies in domestic violence shelters/refuges, and a primary care study showed improved motivation to do daily tasks immediately after advocacy. Abstract BACKGROUND Intimate partner abuse is common worldwide, damaging the short‐ and long‐term physical, mental, and emotional health of survivors and children. Advocacy may contribute to reducing abuse, empowering women to improve their situation by providing informal counselling and support for safety planning and increasing access to different services. Advocacy may be a stand‐alone service, accepting referrals from healthcare providers, or part of a multi‐component (and possibly multi‐agency) intervention provided by service staff or others. OBJECTIVES To assess the effects of advocacy interventions within or outside healthcare settings in women who have experienced intimate partner abuse. SEARCH METHODS In April 2015, we searched CENTRAL, Ovid MEDLINE, EMBASE, and 10 other databases. We also searched WHO ICTRP, mRCT, and UK Clinical Research Network (UKCRN), and examined relevant websites and reference lists with forward citation tracking of included studies. For the original review we handsearched six key journals. We also contacted first authors of eligible papers and experts in the field. SELECTION CRITERIA Randomised or quasi‐randomised controlled trials comparing advocacy interventions for women with experience of intimate partner abuse versus no intervention or usual care (if advocacy was minimal and fewer than 20% of women received it). DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias and undertook data extraction. We contacted authors for missing information needed to calculate statistics for the review and looked for adverse events. MAIN RESULTS We included 13 trials involving 2141 participants aged 15 to 65 years, frequently having low socioeconomic status. The studies were quite heterogeneous in terms of methodology, study processes and design, including with regard to the duration of follow‐up (postintervention to three years), although this was not associated with differences in effect. The studies also had considerable clinical heterogeneity in relation to staff delivering advocacy; setting (community, shelter, antenatal, healthcare); advocacy intensity (from 30 minutes to 80 hours); and abuse severity. Three trials evaluated advocacy within multi‐component interventions. Eleven measured some form of abuse (eight scales), six assessed quality of life (three scales), and six measured depression (three scales). Countries and ethnic groups varied (one or more minority ethnic groups in the USA or UK, and local populations in Hong Kong and Peru). Setting was associated with intensity and duration of advocacy. Risk of bias was high in five studies, moderate in five, and low in three. The quality of evidence (considering multiple factors such as risk of bias, study size, missing data) was moderate to low for brief advocacy and very low for intensive advocacy. Incidence of abuse Physical abuse Moderate quality pooled data from two healthcare studies (moderate risk of bias) and one community study (low risk of bias), all with 12‐month follow‐up data, showed no effect on physical abuse for brief (< 12 hours) advocacy interventions (standardised mean difference (SMD) 0.00, 95% confidence interval (CI) ‐ 0.17 to 0.16; n = 558). One antenatal study (low risk of bias) showed an association between brief advocacy and reduced minor physical abuse at one year (mean difference (MD) change ‐ 1.00, 95% CI ‐ 1.82 to ‐ 0.18; n = 110). An antenatal, multi‐component study showed a greater likelihood of physical abuse ending (odds ratio (OR) 0.42, 95% CI 0.23 to 0.75) immediately after advocacy (number needed to treat (NNT) = 8); we cannot exclude impact from other components. Low to very low quality evidence from two intensive advocacy trials (12 hours plus duration) showed reduced severe physical abuse in women leaving a shelter at 24 months (OR 0.39, 95% CI 0.20 to 0.77; NNT = 8), but not at 12 or 36 months. Sexual abuse Meta‐analysis of two studies (n = 239) showed no effect of advocacy on sexual abuse (SMD ‐ 0.12, 95% CI ‐ 0.37 to 0.14), agreeing with the change score (MD ‐ 0.07, 95% CI ‐ 0.30 to 0.16) from a third study and the OR (0.96, 95% CI 0.44 to 2.12) from a fourth antenatal, multi‐component study. Emotional abuse One study in antenatal care, rated at low risk of bias, showed reduced emotional abuse at ≤ 12‐month follow‐up (MD (change score) ‐ 4.24, 95% CI ‐ 6.42 to ‐ 2.06; n = 110). Psychosocial health Quality of life Meta‐analysis of two studies (high risk of bias) showed intensive advocacy slightly improved overall quality of life of women recruited from shelters (MD 0.23, 95% CI 0.00 to 0.46; n = 343) at 12‐month follow‐up, with greater improvement in perceived physical quality of life from a primary care study (high risk of bias; MD 4.90, 95% CI 0.98 to 8.82) immediately postintervention. Depression Meta‐analysis of two studies in healthcare settings, one at high risk of bias and one at moderate risk, showed that fewer women developed depression (OR 0.31, 95% CI 0.15 to 0.65; n = 149; NNT = 4) with brief advocacy. One study at high risk of bias reported a slight reduction in depression in pregnant women immediately after the intervention (OR 0.51, 95% CI 0.20 to 1.29; n = 103; NNT = 8). There was no evidence that intensive advocacy reduced depression at ≤ 12‐month follow‐up (MD ‐ 0.14, 95% CI ‐ 0.33 to 0.05; 3 studies; n = 446) or at two years (SMD – 0.12, 95% CI – 0.36 to 0.12; 1 study; n = 265). Adverse effects Two women died, one who was murdered by her partner and one who committed suicide. No evidence links either death to study participation. AUTHORS' CONCLUSIONS Results suggest some benefits from advocacy. However, most studies were underpowered. Clinical and methodological heterogeneity largely precluded pooling of trials. Therefore, there is uncertainty about the magnitude of benefit, the impact of abuse severity, and the setting. Based on the evidence reviewed, intensive advocacy may improve short‐term quality of life and reduce physical abuse one to two years after the intervention for women recruited from domestic violence shelters or refuges. Brief advocacy may provide small short‐term mental health benefits and reduce abuse, particularly in pregnant women and for less severe abuse. Plain language summary LIMITED EVIDENCE AND LIMITED EFFECTS OF ADVOCACY TO REDUCE INTIMATE PARTNER VIOLENCE The Campbell review in brief Intensive advocacy may improve everyday life for women in domestic violence shelters/refuges and reduce physical abuse. There is no clear evidence that intensive advocacy reduces sexual, emotional, or overall abuse, or that it benefits women's mental health. It is unclear whether brief advocacy is effective. What is this review about? Partner abuse or domestic violence is common worldwide. It includes physical, emotional, and sexual abuse; threats; withholding money; causing injury; and long lasting physical and emotional health problems. Active support by trained people, which is called ‘advocacy‘, may help women make safety plans, deal with abuse, and access community resources. Advocacy may be a stand‐alone service, accepting referrals from healthcare providers, or part of a multi‐component, and possibly multi‐agency, intervention. It may take place in the com

Comparison of Gilteritinib and Salvage Chemotherapy in FLT3-Mutated Acute Myeloid Leukemia on the Number Needed to Treat for Various Clinical Outcomes: A Secondary Analysis of the Admiral Trial

Treatment of people with schizophrenia using older typical antipsychotic drugs such as haloperidol can be problematic. Many fail to respond to these older antipsychotics and more people experience disabling adverse effects. Aripiprazole is said to be one of a new generation of atypical antipsychotics with good antipsychotic properties and minimal adverse effects. To evaluate the effects of aripiprazole for people with schizophrenia and schizophrenia-like psychoses. We searched the Cochrane Schizophrenia Group's Register (September 2005) which is based on regular searches of BIOSIS, CENTRAL, CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected references of all identified studies for further trials. We contacted relevant pharmaceutical companies, the FDA and authors of trials for additional information. All clinical randomised trials comparing aripiprazole with placebo, typical or atypical antipsychotic drugs for schizophrenia and schizophrenia-like psychoses. We extracted data independently. For homogenous dichotomous data we calculated random effects, relative risk (RR), 95% confidence intervals (CI) and, where appropriate, numbers needed to treat (NNT) on an intention-to-treat basis. For continuous data, we calculated weighted mean differences (WMD). Despite the fact that 7110 people participated in fifteen randomised aripiprazole studies, we were unable to extract any usable data on death, service outcomes, general functioning, behaviour, engagement with services, satisfaction with treatment; economic outcomes or cognitive functioning. Study attrition was very large and data reporting poor. Compared with placebo, aripiprazole significantly decreased relapse in both the short and medium term (n=300, 1 RCT, RR 0.66 CI 0.5 to 0.8, NNT 5 CI 4 to 8). It also produced better compliance with study protocol (n=2271, 8 RCTs, RR 0.72 CI 0.5 to 0.97, NNT 26 CI 16 to 239). Aripiprazole may decrease prolactin levels below that expected from placebo (n=305, 1 RCT, RR 0.32 CI 0.1 to 0.8, NNT 14 CI 11 to 50). Compared with typical antipsychotics there were no significant benefits for aripiprazole with regards to global state, mental state, quality of life or leaving the study early. Both groups reported similar rates of adverse effects, with the exception of akathisia (n= 955 RR 0.31 CI 0.2 to 0.6, NNT 20 CI 17 to 32) and the need for antiparkinson medication (n=1854, 4 RCTs, RR 0.45 CI 0.3 to 0.6, NNT 4 CI 3 to 5) which were lower in those receiving aripiprazole. When compared with olanzapine and risperidone, aripiprazole was no better or worse on outcomes of global state and leaving the study early. The rates of adverse effects were also similar, with the exception of less elevation of prolactin (n=301, 1 RCT, RR 0.04 CI 0.02 to 0.1, NNT 2 CI 1 to 2.5) and less prolongation of the average QTc (30 mg/day) (n=200, 1 RCT, WMD -10.0, CI -16.99 to -3.0) compared with risperidone. When compared with standard care (mixed group receiving typical and atypical antipsychotics) one aripiprazole study did have significantly less people not responding to treatment (n=1599, RR 0.70 CI 0.7 to 0.8, NNT 5 CI 4 to 6 ), not satisfied with care (n=1599, RR 0.62 CI 0.6 to 0.7, NNT 4 CI 4 to 5) and less people leaving the study early (n=1599, 1 RCT, RR 0.81 CI 0.7 to 0.9, NNT 13 CI 8 to 39). Results from the five new papers identified from the updated review search, did not significantly alter the main results or conclusions of the original review. Aripiprazole may be effective for the treatment of schizophrenia, but it does not differ greatly from typical and atypical antipsychotics with respect to treatment response, efficacy or tolerability. In comparison with typical antipsychotics, aripiprazole may have a lower risk of akathisia, and in comparison to atypical antipsychotics, less risk of raised prolactin and prolongation of the QTc interval. Clearly reported pragmatic short, medium and long term randomised controlled trials should be undertaken to determine its position in everyday clinical practice.

To assess whether the relative and absolute benefit of hypertension treatment in women varies with age or race. Literature search of studies from 1966 to 1998 using MEDLINE, reviews, and consultation with experts. Studies were eligible if they were randomized controlled trials of pharmacological treatment of primary hypertension, with cardiovascular morbidity and mortality outcomes, and with over one hundred women enrolled. The pooled population included 23,000 women. Relative risks were combined for each endpoint to form summary risk ratios (RR) using meta-analytic techniques based on a random-effects model. Summary RR's were converted to numbers needed to treat (NNT). Data were dichotomized by age to approximate menopausal status (30 to 54 years, and 55 years and older), and by race (white and African American). In women ages 55 years or older (90% white), hypertension treatment results in a 38% risk reduction in fatal and nonfatal cerebrovascular events (95% confidence interval (CI) 27-47%, 5 year NNT 78), a 25% reduction in fatal and nonfatal cardiovascular events (95% CI 17-33%, 5 year NNT 58), and a 17% reduction in cardiovascular mortality (95% CI 3-29%, 5 year NNT 282). In women ages 30 to 54 years (79% white), hypertension treatment results in a 41% risk reduction in fatal and nonfatal cerebrovascular events (95% CI 8-63%, 5 year NNT 264), and a 27% risk reduction in fatal and nonfatal cardiovascular events (95% CI 4-44%, 5 year NNT 259). Hypertension treatment in African American women (mean age 52 years) reduced the risk of fatal and nonfatal cerebrovascular events by 53% (95% CI 29-69%, 5 year NNT 39), fatal and nonfatal cardiovascular events by 45% (95% CI 18-63%, 5 year NNT 21), fatal and nonfatal coronary events by 33% (95% CI 6-52%, 5 year NNT 48), and all cause mortality by 34% (95% CI 14-49%, 5 year NNT 32). Analyses in white women 30 to 54 years old did not show any statistically significant treatment benefit or harm. Hypertension treatment lowers the relative and absolute risk of cardiovascular morbidity and mortality in women ages 55 years and older, and in African American women of all ages. A greater effort should be made to increase awareness and treatment in these groups of women. Although relative risk reductions for cerebrovascular and cardiovascular events are similar for younger and older women, the NNT of younger women is at least 4 times higher. Decisions for treatment of hypertension in younger white women should be influenced by the individual patient's absolute risk of cardiovascular disease.

Noninvasive respiratory support following extubation in critically ill adults with obesity: a systematic review and network meta-analysis

BackgroundThe treatment of burn patients is very challenging because burn injuries are one of the most severe traumas that can be experienced. The effect of music therapy on burn patients has been widely reported, but the results have been inconsistent. Thus, we performed a systematic review and meta-analysis of randomized controlled trials in burn patients to determine the effect of music during treatments.MethodsWe searched a variety of electronic databases, including MEDLINE (via PubMed), EMBASE, Cochrane Library, Psychinfo, VIP Database for Chinese Technical Periodicals (VIP) and China National Knowledge Infrastructure (CNKI) for relevant trials on the basis of predetermined eligibility criteria. from their first available date through February 2016. Our search focused on two key concepts: music interventions (including music, music therapy and music medicine) and physical activity outcomes (including pain, anxiety, burn characteristics, dressing changes, wound care, debridement and rehabilitation). Two reviewers independently screened records and extracted data from all eligible studies. Statistical heterogeneity was determined using Q-test and the I2 statistic. The endpoints included standardized mean differences (SMDs) and 95% confidence intervals (CIs). Publication bias was tested by Begg’s funnel plot and Egger’s test.ResultsA total of 17 studies met the inclusion criteria, for a total of 804 patients. A statistically significant difference in pain relief was demonstrated between music and non-music interventions (SMD = −1.26, 95% CI [−1.83, −0.68]), indicating that music intervention has a positive effect on pain alleviation for burn patients. The results indicated that music interventions markedly reduced anxiety in individuals compared to non-music interventions (SMD = −1.22, 95% CI [−1.75, −0.69]). Correspondingly, heart rate decreases were found after treatments that included music interventions (SMD = −0.60, 95% CI [−0.84, −0.36]).ConclusionIn summary, a positive correlation was found between treatments including music interventions and pain alleviation, anxiety relief, and heart rate reduction in burn patients. However, additional high-quality studies with carefully considered music interventions for burn patients are still needed.

ystematic reviews provide the best estimates ofthe true effects (both beneficial and adverse) ofmedical interventions (1). In this era of evidence-based medicine, clinicians are increasingly using sys-tematic reviews to keep up with new evidence and toguide their clinical decision-making. Yet the mainchallenges for clinicians are to translate the results ofsystematic reviews into clinical practice and to pro-vide optimal patient care. This concept is known as“applicability.” Applicability addresses whether aparticular treatment that showed an overall benefit ina study or systematic review can be expected to con-vey the same benefit to an individual patient (2).This paper outlines a framework for how quantita-tive systematic reviews (meta-analyses) should be re-ported and how they may be used to identify thoseindividuals in whom the treatment is likely to do moregood than harm. We illustrate the concepts by usingdata from systematic reviews of ondansetron for thetreatment and prevention of postoperative nausea andvomiting (PONV). Throughout this paper, we use theterms “baseline” and “underlying risk” interchange-ably. Underlying risk is defined as the risk of event fora patient under the control condition; it indicates theaverage risk of a patient if not treated (3).

Impact of antiparasitic therapy on cardiovascular outcomes in chronic Chagas disease. A systematic review and meta-analysis