Centre For Evidence-Based Medicine Research Articles

Clinical recommendations on penile reconstructive and prosthetic surgery: a consensus statement from the Asia-Pacific Society of Sexual Medicine.

Penile reconstructive and prosthetic surgery remains a highly specialized field where potential complications can be devastating, and unrealistic patient expectations can often be difficult to manage. Furthermore, surgical practice can vary depending on locoregional expertise and sociocultural factors. The Asia Pacific Society of Sexual Medicine (APSSM) panel of experts reviewed contemporary evidence regarding penile reconstructive and prosthetic surgery with an emphasis on key issues relevant to the Asia-Pacific (AP) region and developed a consensus statement and set of clinical practice recommendations on behalf of the APSSM. The Medline and EMBASE databases were searched using the following terms: "penile prosthesis implant," "Peyronie's disease," "penile lengthening," "penile augmentation," "penile enlargement," "buried penis," "penile disorders," "penile trauma," "transgender," and "penile reconstruction" between January 2001 and June 2022. A modified Delphi method was undertaken, and the panel evaluated, agreed, and provided consensus statements on clinically relevant penile reconstructive and prosthetic surgery, namely (1) penile prosthesis implantation, (2) Peyronie's disease, (3) penile trauma, (4) gender-affirming (phalloplasty) surgery, and (5) penile esthetic (length and/or girth enlargement) surgery. Outcomes were specific statements and clinical recommendations according to the Oxford Centre for Evidence-Based Medicine, and if clinical evidence is lacking, a consensus agreement is adopted. The panel provided statements on clinical aspects of surgical management in penile reconstructive and prosthetic surgery. There is a variation in surgical algorithms in patients based on sociocultural characteristics and the availability of local resources. Performing preoperative counseling and obtaining adequate informed consent are paramount and should be conducted to discuss various treatment options, including the pros and cons of each surgical intervention. Patients should be provided with information regarding potential complications related to surgery, and strict adherence to safe surgical principles, preoperative optimization of medical comorbidities and stringent postoperative care are important to improve patient satisfaction rates. For complex patients, surgical intervention should ideally be referred and performed by expert high-volume surgeons to maximize clinical outcomes. Due to the uneven distribution of surgical access and expertise across the AP region, development of relevant comprehensive surgical protocols and regular training programs is desirable. This consensus statement covers comprehensive penile reconstructive and prosthetic surgery topics and is endorsed by the APSSM. The variations in surgical algorithms and lack of sufficient high-level evidence in these areas could be stated as a limitation. This APSSM consensus statement provides clinical recommendations on the surgical management of various penile reconstructive and prosthetic surgeries. The APSSM advocates for surgeons in AP to individualize surgical options based on patient condition(s) and needs, surgeon expertise, and local resources.

A Systematic Review: Landscape of Private Equity in Dermatology From Past to Present.

The primary objective of this abstract is to define the growing trend of private equity (PE) backed consolidation of dermatology practices and explore its impact on patient care. The secondary objective is to better inform dermatologists of the acquisition process as well as how practices are valued in the event of a leveraged buyout. A systematic review was conducted using PRISMA guidelines using PubMed/MEDLINE and Web of Science in July 2021. Studies included were graded using the Oxford Center for Evidence-Based Medicine 2011 Levels of Evidence.1 A total of 18 articles met the inclusion/exclusion criteria. With the current environment of low interest rates combined with increasing cost of medical operations and non-clinical administrative burdens, PE is positioned to expand exponentially in total value through leveraged buyouts of solo and small dermatology groups.2 Selling dermatologists receive payment in form of upfront cash, and equity in escrow incentivizes them to continue the growth of their clinic so that it can be consolidated into a larger portfolio of practices to be sold to another buyer in 3-7 years at a far higher valuation. Within the fragmented $8.4 billion-dollar dermatology space, PE-backed practices represent approximately 10-15% of all private practices.3-5 Dermatologists should be aware of both the risks and the rewards of acquisition by PE given the fiduciary responsibility to shareholders and their patients. J Drugs Dermatol. 2023;22(4): doi:10.36849/JDD.6892 Citation: Sung CT, Salem S, Oulee A, et al. A systematic review: Landscape of private equity in dermatology from past to present. J Drugs Dermatol. 2023;22(4):404-408. doi:10.36849/JDD.6892.

Metabolic effects of monounsaturated fatty acid−enriched diets on glycaemic control in patient with type 2 diabetes: an evidence-based case report

Introduction: Diabetes mellitus type 2 (T2D) is the most common type of diabetes. There is an ongoing debate as to whether nutrient quality or quantity is mainly responsible for the effects on hyperglycaemic control of patients with T2D. Monounsaturated fatty acid (MUFA) has a metabolic effect in reducing the risk factor for metabolic syndrome to prevent and control hyperglycaemia in patients with T2D and is recommended by professional organizations.
 Methods: Literature searching was conducted by advanced searching in Pubmed, Cochrane Library, Scopus, and ProQuest database using MeSH Terms combined with Title/Abstract. After removing duplicates, the literature were screened based on the eligibility criteria. Critical appraisal and level of evidence of the selected literature were determined based on Oxford Centre for Evidence-Based Medicine.
 Results: Two selected literature were relevant to answer our clinical question, both literature are systematic review/meta-analysis studies. The first literature is a study by Fumiaki et al. (2016), while the second is by Frank Qian et al. (2016). All literature provided evidence that a diet high in MUFA could improve glucose-insulin homeostasis among patients with T2D. These effects were marked by lower fasting blood glucose and haemoglobin A1c (HbA1c), and insulin level in the enriched MUFA diet group compared to PUFA.
 Conclusion: Nutrient quality is mainly responsible for the effects on glycaemic control profile in patients with T2D, with a high MUFA diet consistent with favourable effects to improve fasting glucose and HbA1c.

The Effects of Curcumin Supplementation on Glycaemic Index in Women with Polycystic Ovarian Syndrome: An Evidence Based Case Report

Background: PCOS is the most common cause of infertility around the world. PCOS is associated with impaired glucose tolerance and higher tendency to develop type 2 diabetes. Curcumin, which is known for its anti-inflammatory, antioxidant, and antidiabetic properties, may show promising effect in regulating blood glucose.
 Objective: This study aims to evaluate the effect of curcumin supplementation on improving glycaemic profile in women with PCOS.
 Methods: Literature searching was conducted by advanced searching in Pubmed, Cochrane Library, Scopus, and ProQuest database using MeSH Terms combined with Title/Abstract. After removing duplicates, the literatures were screened based on the eligibility criteria. Critical appraisal and level of evidence of the selected literatures were determined based on Oxford Centre for Evidence-Based Medicine.
 Results: Two selected literatures were relevant to answer our clinical question. The first literature is a systematic review/meta-analysis study by Chien et al (2021) and the latter is a randomized controlled trial by Asan et al (2020). Both literatures show that curcumin supplementation is beneficial in improving glycaemic profile in PCOS patients. These effects were marked by lower fasting blood glucose, insulin level, and HOMA-IR in curcumin group compared to the control group.
 Conclusion: Curcumin supplementation for at least 6 weeks significantly improve glycaemic profile in women with PCOS. Curcumin supplementation is also considered safe and well tolerable. However, more studies are needed to investigate further regarding the long-term effects of curcumin supplementation.
 Keywords: curcumin, turmeric, polycystic ovarian syndrome, glycaemic profile

FIGO recommendations: Use of midurethral slings for the treatment of stress urinary incontinence.

Stress urinary incontinence (SUI) is a global problem. It can significantly adversely impact a woman's quality of life. The use of synthetic mesh in vaginal surgery is controversial, especially when used for pelvic organ prolapse surgery. Although negative effects have been reported, the synthetic mesh midurethral sling (MUS) is considered to be safe and effective in the surgical treatment of SUI. To provide evidence-based data and recommendations for the obstetrician/gynecologist who treats women with SUI and performs or plans to perform MUS procedures. Academic searches of MEDLINE, the Cochrane Library, Embase, and Google Scholar articles published between 1987 and March 2020 were performed by a subgroup of the Urogynecology and Pelvic Floor Committee, International Federation of Gynecology and Obstetrics (FIGO). The obtained scientific data were associated with a level of evidence according to the Oxford University Centre for Evidence-Based Medicine and GRADE Working Group system. In the absence of concrete scientific evidence, the recommendations were made via professional consensus. The FIGO Urogynecology and Pelvic Floor Committee reviewed the literature and prepared this evidence-based recommendations document for the use of MUS for women with SUI. Despite the extensive literature, there is a lack of consensus in the optimal surgical treatment of SUI. These recommendations provide a direction for surgeons to make appropriate decisions regarding management of SUI. The MUS is considered safe and effective in the treatment of SUI, based on many high-quality scientific publications and professional society recommendations. Comprehensive long-term data and systemic reviews are still needed, and these data will become increasingly important as women live longer. These recommendations will be continuously updated through future literature reviews.

Digital health applications in otorhinolaryngology

With the passing of the "Digital Care Act" by the German Bundestag at the end of 2019, it was made possible, among other things, for digital health applications to be reimbursed by statutory health insurance companies under certain conditions. The aim of this work is to identify digital health applications related to ear, nose, and throat medicine and to describe the underlying evidence. The digital health applications register was analyzed to identify digital health applications with an indication area relating to an otorhinolaryngologic disease. Digital health applications were included that were either permanently or provisionally included, or currently deleted if further information was available. The underlying evidence was assessed according to the recommendations of the Oxford Center for Evidence-Based Medicine for therapeutic studies. Atotal of six digital health applications with adirect or indirect connection to otorhinolaryngology were identified, three of which were permanently and two provisionally included in the directory. One digital health application has currently been withdrawn by the manufacturer. The permanently recorded digital health applications are based on evidence level1b. The introduction of digital health applications is sometimes also discussed critically, but they represent an innovative approach and various digital health applications with ahigh level of underlying evidence are already available, especially for the ear, nose, and throat area.

WHO Guideline for the Pharmacological Treatment of Hypertension in Adults

Every year, more people die from cardiovascular diseases than from any other cause. Hypertension significantly increases the risk of heart, brain, kidney, and other diseases. The last World Health Organization (WHO) guideline on hypertension was published in 1999 and is now outdated. The new WHO guideline of 2021 provides the most up-to-date recommendations for the pharmacological treatment of adult patients with hypertension. The aim of this study was to provide an overview of the WHO guideline translated into German and to summarize the main recommendations. The guideline was developed by WHO in accordance with WHO standards. The executive summary was translated into German by the WHO Collaborating Centre for Evidence-based Medicine at the University of Continuing Education Krems (Austria). WHO provides recommendations on blood pressure thresholds for initiating pharmacological treatment, the performance of examinations before initiating treatment, the choice of medication, target blood pressure, the frequency of assessments, and treatment by nonphysician professionals. This evidence-based global public health guideline from WHO captures the most up-to-date key recommendations for the pharmacological treatment of hypertension in adults.

Consensus statements on cranio-orbital reconstruction materials and application in Chinese adult patients (2023)

Cranio-orbital bone defects caused by various reasons may affect patients' appearance, and even lead to severe complications. Herein, based on the clinical evidence level classification and recommendation level of the Evidence-based Medicine Center of Oxford University, domestic experts majoring in neurosurgery and ophthalmology learned from guidelines abroad and relevant evidence-based medicine, and repeatedly discussed the formulation of repair strategies and material selection for cranio-orbital defects caused by different reasons, covering the performance of various reconstruction materials, the selection and application of materials in different diseases and circumstances, material-related complications and other issues. Finally, the modified Delphi method was used to recruit experts' suggestions, and 23 consensus recommendations were formulated in three aspects, thereby providing scientific and practical clinical guidance for the standardized diagnosis and treatment of cranio-orbital reconstruction and repair.

Brazilian Psychiatric Association guidelines on the integration of spirituality into mental health clinical practice: Part 1. Spiritual history and differential diagnosis.

To present evidence-based guidelines for clinical practice regarding religiosity and spirituality in mental health care in Brazil. A systematic review was conducted to identify potentially eligible articles indexed in the PubMed, PsycINFO, SciELO, LILACS, and Cochrane databases. A summary of recommendations and their levels of evidence was produced in accordance with Oxford Centre for Evidence-Based Medicine guidelines. The systematic review identified 6,609 articles, 41 of which satisfied all inclusion criteria. Taking a spiritual history was found to be an essential part of a compassionate and culturally sensitive approach to care. It represents a way of obtaining relevant information about the patient's religiosity/spirituality, potential conflicts that could impact treatment adherence, and improve patient satisfaction. Consistent evidence shows that reported perceptual experiences are unreliable for differentiating between anomalous experiences and psychopathology. Negative symptoms, cognitive and behavioral disorganization, and functional impairment are more helpful for distinguishing pathological and non-pathological anomalous experiences. Considering the importance of religiosity/spirituality for many patients, a spiritual history should be routinely included in mental health care. Anomalous experiences are highly prevalent, requiring a sensitive and evidence-based approach to differential diagnosis.

Robot-assisted rehabilitation for children with neurological disabilities: Results of the Italian consensus conference CICERONE.

The use of robotic technologies in pediatric rehabilitation has seen a large increase, but with a lack of a comprehensive framework about their effectiveness. An Italian Consensus Conference has been promoted to develop recommendations on these technologies: definitions and classification criteria of devices, indications and limits of their use in neurological diseases, theoretical models, ethical and legal implications. In this paper, we present the results for the pediatric age. A systematic search on Cochrane Library, PEDro and PubMed was performed. Papers published up to March 1st, 2020, in English, were included and analyzed using the methodology of the Centre for Evidence-Based Medicine in Oxford, AMSTAR2 and PEDro scales for systematic reviews and RCT, respectively. Some positives aspects emerged in the area of gait: an increased number of children reaching the stance, an improvement in walking distance, speed and endurance. Critical aspects include the heterogeneity of the studied cases, measurements and training protocols. Many studies demonstrate the benefits of robotic training in developmental age. However, it is necessary to increase the number of trials to achieve greater homogeneity between protocols and to confirm the effectiveness of pediatric robotic rehabilitation.

Signals of Adverse Drug Reactions Communicated by Pharmacovigilance Stakeholders: A Scoping Review of the Global Literature.

Signals of adverse drug reactions (ADRs) can be supported by reports of ADRs and by interventional and non-interventional studies. The evidence base and features of ADR reports that are used to support signals remain to be comprehensively described. To this end, we have undertaken a scoping review. We searched the following databases: PubMed, EMBASE, PsycINFO, Web of Science, and Google Scholar, without language or time restrictions. We also hand searched the bibliographies of relevant studies. We included studies of any design if the results were described as signals. We assessed the levels of evidence using the Oxford Centre for Evidence-Based Medicine (OCEBM) criteria and coded features of reports of ADRs using the Bradford Hill guidelines. Overall, 1974 publications reported 2421 studies of signals; 1683/2421 were clinical assessments of anecdotal reports of ADRs, but only 225 (13%) of these included explicit judgments on which features of the ADR reports were supportive of a signal. These 225 studies yielded 228 signals; these were supported by features, which were: 'experimental evidence' (i.e., positive dechallenge or rechallenge, 154 instances [68%]), 'temporality' (i.e., time to onset, 130 [57%]), 'exclusion of competing causes' (49 [21%]), and others (40 [17%]). Positive dechallenge/rechallenge often co-occurred with temporality (77/228). OCEBM 4 (i.e., case series and case-control studies) was the most frequent level of evidence (2078 studies). Between 2013 and 2019, there was a three-fold increase in clinical assessments of reports of ADRs compared with a less than two-fold increase in studies supported by higher levels of evidence (i.e., OCEBM 1-3). We identified an increased rate between 2013 and 2019 in disproportionality analyses (about 15 studies per year), mostly from academia. Most signals were supported by temporality and dechallenge/rechallenge, but clear reporting of judgments on causality remains infrequent. The number of studies supported only by anecdotal reports of ADRs increased from year to year. The impact of a growing number of signals of disproportionate reporting communicated without an accompanying clinical assessment should be evaluated.

Idiopathic Parkinson's disease and chronic pain in the era of deep brain stimulation: a systematic review and meta-analysis.

Pain is the most common nonmotor symptom of Parkinson's disease (PD) and is often undertreated. Deep brain stimulation (DBS) effectively mitigates the motor symptoms of this multisystem neurodegenerative disease; however, its therapeutic effect on nonmotor symptoms, especially pain, remains inconclusive. While there is a critical need to help this large PD patient population, guidelines for managing this significant disease burden are absent. Herein, the authors systematically reviewed the literature and conducted a meta-analysis to study the influence of traditional (subthalamic nucleus [STN] and globus pallidus internus [GPi]) DBS on chronic pain in patients with PD. The authors performed a systematic review of the literature and a meta-analysis following PRISMA guidelines. Risk of bias was assessed using the levels of evidence established by the Oxford Centre for Evidence-Based Medicine. Inclusion criteria were articles written in English, published in a peer-reviewed scholarly journal, and about studies conducting an intervention for PD-related pain in no fewer than 5 subjects. Twenty-six studies were identified and included in this meta-analysis. Significant interstudy heterogeneity was detected (Cochran's Q test p < 0.05), supporting the use of the random-effects model. The random-effects model estimated the effect size of DBS for the treatment of idiopathic pain as 1.31 (95% CI 0.84-1.79). The DBS-on intervention improved pain scores by 40% as compared to the control state (preoperative baseline or DBS off). The results indicated that traditional STN and GPi DBS can have a favorable impact on pain control and improve pain scores by 40% from baseline in PD patients experiencing chronic pain. Further trials are needed to identify the subtype of PD patients whose pain benefits from DBS and to identify the mechanisms by which DBS improves pain in PD patients.

Intraoperative Optical Coherence Tomography in the Management of Macular Holes: State of the Art and Future Perspectives.

Non-invasive diagnostic technologies in ophthalmology have substantially transformed contemporary clinical practice. Intraoperative optical coherence tomography (iOCT) systems have recently been used for various surgical interventions, including the treatment of full-thickness macular holes (FTMHs). We conducted a systematic review on the use of iOCT and its possible benefits in the management of FTMHs, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). The level of evidence according to the Oxford Centre for Evidence-Based Medicine (OCEM) 2011 guidelines, and the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, were assessed for all included articles. 1131 articles were initially extracted, out of which 694 articles were obtained after duplicates were removed and their abstracts screened. A total of 65 articles was included for full-text review. Finally, 17 articles remained that fulfilled the inclusion criteria. Even though there is just a small number of studies with solid results, the use of iOCT in FTMH surgery may be a helpful tool for both novice and experienced surgeons planning and managing difficult cases. Additionally, it could be used for teaching reasons and for exploring novel surgical techniques.

The effect of different administrations of testosterone therapy on adverse prostate events: A Bayesian network meta-analysis.

Hypogonadism has become a major cause endangering men's health and quality of life all over the world. Testosterone Therapy (TT) is a widely accepted treatment for relieving hypogonadal symptoms. However, the effect of different administrations of TT on prostate safety is still unclear. We did a thorough search of PubMed, Embase and Cochrane Library to identify eligible studies up to January 2022. Randomized controlled trials (RCTs) and Cohort studies evaluating the impacts of using different formulations of TT on prostate parameters were included. Changes of prostate-specific antigen (PSA) level and prostate cancer (Pca) cases were used as the primary outcomes. Quality of individual studies was estimated by RoB2 (Cochrane tool for assessing the risk of bias in randomized trials) and the Newcastle-Ottawa scale (Tool for assessing non-RCTs). Certainty of evidence for each study was evaluated according to the evidence assessment criteria of the Oxford Evidence-based Medicine Center. Random-effect network meta-analysis(NMA)was performed based on the Bayesian model. Thirty-five studies (30 RCTs and 5 Cohort studies) with 7,740 participants were included. TT administration led to fewer Pca patients (RR=0.62, 95%CI [0.39,0.99], I2=0%), while little decreasing in PSA level (MD=-0.05, 95%CI [-0.08, -0.02], I2=0%). The NMA revealed that compared with other formulations, the intramuscular injection was the most likely to rank first in decreasing Pca cases. The TT also resulted in more biopsy cases (RR=2.38, 95%CI [1.01,5.60], I2=0%). As for NMA, intramuscular injection also performed relatively better in fewer prostate biopsy cases compared with transdermal group. TT does not lead to abnormal PSA changes and increased risk of Pca in patients with hypogonadism or low testosterone level. Compared with other preparations of TT, intramuscular injection proved better in minimizing Pca cases and was more likely to result in fewer prostate biopsy cases.

Physical Activity in South Asian Indians: A Systematic Review of Randomized Controlled Trials.

This review systematically examines the characteristics and effectiveness of randomized controlled trials with aerobic physical activity (PA) interventions tailored to South Asian Indians (SAIs). PubMed/MEDLINE, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, and Google Scholar were searched. The search yielded 1,842 studies; 11 met the criteria. The Center for Evidence-Based Medicine's critical appraisal tool was used to assess the quality of studies. Studies that used supervised structured PA sessions, educational material in SAI languages, motivational strategies, and positive reinforcement for goal setting, reported significant improvement in PA (p < .05; Cohen's d ≤ 0.3 to >0.8). Future PA studies in India featuring SAIs would benefit from clinic-based one-on-one structured aerobic PA interventions. In contrast, SAI immigrants in Western countries would benefit from community-based structured aerobic PA interventions that are offered in groups and culturally adapted.

Shaping the future of teledermatology: a literature review of patient and provider satisfaction with synchronous teledermatology during the COVID-19 pandemic.

SummaryFollowing the onset of the COVID‐19 pandemic, widespread adoption of synchronous teledermatology (e.g., live videoconferencing) has increased patient and provider familiarity. To our knowledge, no teledermatology reviews have exclusively characterized patient and provider satisfaction with synchronous models of teledermatology. This study determines the quantitative evaluation of patient and provider satisfaction through a literature review of synchronous teledermatology studies conducted during the COVID‐19 pandemic. A review of the literature was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines within the PubMed database. Search terms included, but were not limited to, teledermatology, patient satisfaction, and provider satisfaction. Studies were evaluated for quality of evidence based on guidelines described by the Oxford Center for Evidence‐based Medicine. Fifteen studies satisfied the inclusion criteria which described the satisfaction of 7871 patients and 146 providers with synchronous teledermatology during the COVID‐19 pandemic. Patients and providers were overall satisfied with access measures, the patient‐ provider relationship and the ability of synchronous teledermatology to meet patient needs. Limitations of the virtual physical exam and image or video quality were two consistent limiting factors in patient and provider experience, respectively. Patients and providers perceive that synchronous teledermatology meets the needs of the patient. Patients perceived satisfactory patient‐provider relationship through synchronous teledermatology. Practices can identify best applications and educate patients on expectations of the virtual examination in order to enhance utilization and sustainability of synchronous teledermatology beyond the pandemic.

The Effect of Maximalist Running Shoes on Impact Loading: A Critically Appraised Topic

Clinical Scenario: Running injuries are common in runners. The use of maximal cushioned shoes (MAX) has been suggested as a preventive measure for reducing impact loading and thus running-related injuries. Clinical Question: Do maximalist running shoes reduce impact loading compared to traditional shoes in runners? Summary of Key Findings: A search was performed for articles exploring MAX on impact loading in runners. Five articles were included in this critically appraised topic. All were case-controlled laboratory studies that compared the MAX to a traditional running shoe. None of the studies found a reduction in impact loading with use of the MAX. Clinical Bottom Line: Based on five case-controlled studies, a MAX does not reduce impact loading on level surfaces or downhill running. Based on mixed results, the MAX may increase impact forces during level and downhill running. Future research should include randomized controlled trials that assess impact forces after the runner has adapted to the MAX and after running ultradistances. Strength of Recommendation: In agreement with the Center of Evidence-Based Medicine, the consistent results from five Level III intervention studies designate that there is Level C evidence that MAX do not reduce impact loading during a single running trial.

Could anterior closed-wedge high tibial osteotomy be a viable option in patients with high posterior tibial slope who undergo anterior cruciate ligament reconstruction? A systematic review and meta-analysis.

This study aims to examine the clinical and radiological outcomes of patients who underwent ACL reconstruction (ACLR) combined with anterior closed-wedge high tibial osteotomy (ACW-HTO) for posterior tibial slope (PTS) reduction to investigate the efficacy of this procedure in improving anterior knee stability and preventing graft failure in primary and revision ACLR. A literature search was conducted in six databases (PubMed, Embase, Medline, Web of Science, Cochrane, and Scopus). The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The initial screening identified 1246 studies. Each eligible clinical article was screened according to the Oxford Centre for Evidence-Based Medicine 2011 levels of evidence (LoE), excluding clinical studies of LoE V. Quality assessment of the articles was performed using the ROBINS-I methodological evaluation. This systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO). For the outcomes that were possible to perform a meta-analysis, a p < 0.05 was considered statistically significant. Five clinical studies were included in the final analysis. A total of 110 patients were examined. Pre- and post-operative clinical and objective tests that assess anteroposterior knee stability, PTS, clinical scores, and data on surgical characteristics, complications, return to sports activity, and graft failure after ACLR were investigated. A meta-analysis was conducted using R software, version 4.1.3 (2022, R Core Team), for Lysholm score and PTS outcomes. A statistically significant improvement for both these clinical and radiological outcomes (p < 0.05) after the ACW-HTO surgical procedure was found. ACLR combined with ACW-HTO restores knee stability and function with satisfactory clinical and radiological outcomes in patients with an anterior cruciate ligament injury associated with a high PTS and seems to have a protective effect from further ruptures on the reconstructed ACL. Level IV.

THERAPEUTIC INTERVENTIONS FOR ANXIETY DISORDERS: AN INTEGRATIVE REVIEW

Backgroud: Anxiety disorders are characterized by excessive emotional responses that generate major disturbances, causing cognitive and behavioral changes and triggering somatic manifestations. Therapeutic interventions show relevance and significant results for the treatment of anxiety. Aim: To identify therapeutic interventions used in the treatment of anxiety disorders. Method: A search for publications indexed in three electronic databases was conducted from January to March 2021. Titles, abstracts, and full-text reading by two independent reviewers were analyzed and classified by level of evidence developed by the Oxford Centre for Evidence-Based Medicine. Results: It resulted in 27 studies that observed the following therapeutic interventions: Psychoeducation; Mindfulness; Evidence-Based Behavioral Therapy; Applied Relaxation; Transdiagnostic CBT; Dialectical Behavioral Therapy; Positive Activity Techniques; Individual and Group CBT; Transcendence Technique Multifaceted Spiritually Based Intervention; Unified Protocol for Transdiagnostic Treatment of Emotional Disorders; Positive Activity Intervention Protocol; and Art Therapy. Conclusions: Of the therapeutic interventions used for the treatment of anxiety disorders, Mindfulness and Psychoeducation were the interventions of greater choice among the studies, which bring large benefit and autonomy to patients, considering that the implementation of these interventions can be performed by nurses and a multidisciplinary team in primary care services, also enabling the reduction of costs to the health system.

Outcomes of Non-Mucosa Sparing Endoscopic Sinus Surgery (Partial Reboot) in Refractory Chronic Rhinosinusitis with Nasal Polyposis: An Academic Hospital Experience.

The reboot approach could be an effective treatment option to lower recurrence rates (RRs) in recalcitrant Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). The purpose of this study was to investigate RR, recurrence-free survival (RFS), quality of life (QoL) improvement, and oral corticosteroid (OCS) intake in pluri-operated CRSwNP patients treated with partial reboot surgery. A consecutive sample of patients with recalcitrant CRSwNP, ineligible for monoclonal antibodies, underwent partial reboot surgery. The 22-item SinoNasal Outcome Test (SNOT-22), Visual Analogue Scales (VAS) scores, OCS intake, and endoscopic Nasal Polyp Score (NPS) were collected pre and postoperatively. The main outcomes were RR and RFS, and comparison of disease-free time with previous endoscopic surgeries. Thirty pluri-operated patients were enrolled. Before the reboot, all had experienced disease recurrence at a mean recurrence time of 8.08 ± 2.83 months after surgery. After reboot, 7 (23.3%) had recurrence at a mean time of 16.67 ± 3.07 months (p=0.02); none needed additional revision surgery till time of data collection. RR at 12, 18, and 24 months follow-up resulted significantly lower for reboot than other previous surgeries (p=0.010, p=0.002, p=0.016, respectively); RFS difference resulted significant (log-rank test=4.16; p=0.04). Differences between pre-and post-operative total and single-items scores of SNOT-22 were significant (p=0.001), as well as VAS scores (p=0.001). Before the reboot, 21 patients (70%) took ≥2 OCS courses per year; at the latest follow-up visit, none had taken any course of OCS after reboot. The reboot approach showed lower RR, longer RFS, improved QoL, and zeroing of OCS uptake. Larger samples and longer follow-up studies are needed to assess long-term efficacy and safety of this procedure. According to the Oxford Center for Evidence-Based Medicine 2011 level of evidence guidelines, this non-randomized retrospective cohort study is classified as level 4 evidence Laryngoscope, 2022. Laryngoscope, 133:1584-1589, 2023.