Centre For Evidence-Based Medicine Research Articles

Effects of Physical Exercise on Neurofilament Light Chain and Glial Fibrillary Acidic Protein Level in Patients with Multiple Sclerosis: A Systematic Review and Bayesian Network Meta-Analysis

Background: The prognosis of people with multiple sclerosis (MS) has improved substantially in recent decades due to advances in diagnosis and treatment. Due to the unpredictable course and heterogenous treatment response in MS, there is a clear need for biomarkers that reflect disease activity in the clinical follow-up of these patients. We conducted a systematic review with Bayesian network meta-analysis with the aim of analyzing the effects of physical exercise on neurofilaments (NfL) and glial fibrillary acidic protein (GFAP) levels in patients with MS. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, starting with a PICO (patient/population, intervention, comparison, and outcome) question: what are the clinical effects of physical exercise (with independence of the type) on NfL and/or GFAP levels in patients with MS compared with other interventions or no intervention whatsoever? A systematically comprehensive literature search was conducted from January to March 2024 to identify original studies that answered the PICO question, using the main data sources. The quality of the studies included was assessed using the Quality Index of Downs & Black. For studies included in the systematic review that followed a randomized controlled trial (RCT) design, the methodological quality of each paper was assessed using the Physiotherapy Evidence Database (PEDro) Scale. Risk of bias was also explored by two independent reviewers. Finally, all articles were classified according to the levels of evidence and grades of recommendation for diagnosis studies established by the Oxford Center for Evidence-Based Medicine. For continuous outcome measures with enough comparisons and a methodological quality greater than or equal to good according to the PEDro scale, a Bayesian network meta-analysis (NMA) was applied. The statistical analyses were performed in R (version 4.1.3, R Core Team 2023) using the “BUGSnet” and “gemtc” packages. Bayesian NMA can be used to obtain a posterior probability distribution of all the relative treatment effects, which allows us to quantify the uncertainty of parameter estimates and to rank all the treatments in the network. Results: Eight studies were included in this systematic review and six articles in the NMA, and they were appraised for quality. The characteristics of the included studies, types of training and described protocols, methodological quality, risk of bias, and clinical effects on the studied biomarkers were outlined. Qualitative synthesis, effects of different exercise modalities in NfL with the Bayesian NMA, selection of the final model and model assessment, and ranking of interventions are also shown. Conclusions: Our findings indicated that moderate-intensity exercise is more likely to reduce NfL concentration compared to high-intensity exercise, and, in turn, high-intensity exercise is more likely to reduce NfL concentration than low-intensity exercise. However, the effects of high-intensity exercise on GFAP levels were inconclusive.

A Systematic Review of Micropulse Laser Trabeculoplasty (MLT) in Primary Open-Angle Glaucoma (POAG) Management: Efficacy, Safety, and Future Perspectives.

Micropulse laser trabeculoplasty (MLT) is gaining attention as a non-invasive treatment option for primary open-angle glaucoma (POAG), offering an alternative to traditional surgeries and medications. This systematic review evaluates the effectiveness, safety, and potential of MLT in glaucoma management. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, following the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) recommendations. We identified 79 articles, and after removing duplicates and screening abstracts, 56 articles were eligible for further review. A detailed full-text analysis was conducted on 26 articles, of which 15 met the predefined inclusion criteria. MLT shows promise as a primary or adjunctive treatment for reducing intraocular pressure (IOP) in glaucoma and ocular hypertension patients. Current evidence supports its efficacy and safety; however, additional long-term studies are needed to confirm its durability and compare its effectiveness with traditional surgical and pharmacological approaches. Standardizing treatment protocols and refining patient selection criteria could enhance MLT's clinical value and support its broader adoption in glaucoma care.

Artificial Intelligence Application in Diagnosing, Classifying, Localizing, Detecting and Estimation the Severity of Skin Condition in Aesthetic Medicine: A Review

ABSTRACTBackgroundThe integration of artificial intelligence (AI) and machine learning (ML) has revolutionized aesthetic medicine, enhancing the diagnosis, classification, and treatment of skin conditions. These technologies offer high precision, personalized care, and the potential to reduce human error. This review aimed to evaluate the current applications of AI and ML in aesthetic medicine, focusing on studies graded as Level I or II evidence by the Oxford Centre for Evidence‐Based Medicine (CEBM).MethodsA comprehensive search of MEDLINE, PubMed, and Ovid databases identified studies employing AI and ML for diagnosing and managing skin conditions. Studies were included if they demonstrated high diagnostic accuracy, improved treatment personalization, or other measurable clinical outcomes.ResultsAI and ML systems showed high accuracy in detecting and diagnosing conditions such as skin cancer, acne, psoriasis, and seborrheic dermatitis. AI‐based platforms facilitated personalized treatment plans, enhancing therapeutic outcomes while minimizing errors. The integration of AI reduced diagnostic time and lowered healthcare costs, demonstrating significant potential for improving patient care. However, challenges such as algorithmic bias, data privacy concerns, and the need for high‐quality training datasets were highlighted.ConclusionAI and ML have transformative potential in aesthetic medicine, offering improved diagnostic precision, enhanced patient outcomes, and cost reductions. Addressing limitations related to algorithm bias, regulatory oversight, and data quality is essential to fully realize the benefits of AI in clinical practice. Future research should focus on developing robust, ethical, and regulatory‐compliant AI solutions.

Consensus evidence-based clinical practice guide for the diagnosis and management of osteoporosis in childhood and adolescence

BackgroundThe incidence of osteoporosis in children has increased dramatically during the last decade. This has been attributed to better survival rates of children living with chronic disorders, the increased use of medications known to have a negative impact on the children’s bones, and the increased preference for indoor activities and sedentary life in healthy children. Recent advances in pediatric osteoporosis definition, along with a lack of management recommendations or national consensus on its diagnosis and treatment, have led to a wide range of approaches being implemented to manage this illness. The aim of this work was to develop an optimal evidence-based consensus, target-oriented, on-steered therapeutic approach for children with osteoporosis. Based on 15 key clinical questions, a qualitative literature evaluation was conducted to provide evidence-based recommendations for the treatment of pediatric osteoporosis. An expert panel of 14 pediatric osteoporosis specialists conducted a Delphi survey. The level of evidence for each element was assessed using the Oxford Centre for Evidence-based Medicine (CEBM) System, when available, and/or based on the expert panel’s personal experience. All recommendations with an agreement rate of 75% or higher were included.ResultsThirty-six recommendations, categorized into 13 domains, had evidence 4 or 5 and consequently were included in the Delphi survey. This was assessed online and a response rate of 82.4% was achieved. Delphi 2 round revealed that all the recommendations achieved 75% or more level of agreement and therefore have been accepted and included in this management recommendations. Based on that an algorithm showing an approach to pediatric osteoporosis management and maintenance of therapy has been developed.ConclusionFor the management of children with osteoporosis, consulting a pediatric bone specialist is strongly advised, either by referral or by advice. This is extremely relevant because children are uniquely capable of recovering spontaneously or with the assistance of medication. This includes also vertebral fractures reshaping. Consequently, there is a huge opportunity to improve bone mass accretion and thus musculoskeletal health in children with osteoporosis.

The use of cannabidiol as adjunctive therapy in adult patients with drug-resistant epilepsy: a systematic review and meta-analysis.

Highly purified cannabidiol (CBD), recently approved for various neurological disorders, is explored as a potential therapeutic avenue for drug-resistant epilepsy (DRE) among adult people with epilepsy (PWE) in this systematic review and meta-analysis. To conduct an extensive literature review and meta-analysis of CBD use for DRE in adult PWE. Systematic review and meta-analysis. We conducted a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and two electronic resources; we searched Ovid MEDLINE and Scopus using appropriate keywords until August 2023. Data were presented as standardized mean difference (SMD) and odds ratio with confidence interval (CI) via random effect. We appraised the risk of bias of the included studies using the Joanna Briggs Institute critical appraisal tool while their strength of evidence with the Oxford Centre for Evidence-Based Medicine (OCEBM) and Grading of Recommendations Assessment Development and Education (GRADE) Levels of Evidence. We identified 16 studies, 3 of which were randomized controlled trials and 3 prospective cohort studies, while the rest were expanded access programs, deriving a total of 668 participants receiving CBD for seizure control. CBD was used concomitantly with antiseizure medications in all studies. There was a statistically significant seizure reduction in the group receiving CBD therapy compared to the placebo group (SMD: -1.50, 95% CI (-3.47, 0.47), p < 0.01). The evidence on CBD use in adult patients with DRE demonstrates a moderate level of certainty according to GRADE level and OCEBM level 2. Further prospective studies involving multiple centers are encouraged to study both the efficacy and safety of CBD in adult patients with DRE. International Prospective Register of Systematic Reviews (PROSPERO) 2023 CRD42023449955.

Impact of author characteristics on outcomes of single- versus double-blind peer review: a systematic review of comparative studies in scientific abstracts and publications

AbstractThe purpose of this systematic review was to assess the role of double-blind (DB) peer review on bias against authors when compared to single-blind (SB) peer review in scientific publications. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a search of databases including Pubmed, Embase, and Web of Science, without language or date restrictions, was conducted to identify original research studies comparing peer-review outcomes between DB and SB methods based on any of the following author characteristics: gender, race, geographic location, personal prestige, institutional prestige. Studies were ranked Level I, II, or III for quality of evidence based on a modified version of the Oxford Center for Evidence-Based Medicine 2011 Levels of Evidence. Of 29 studies included, five level I studies, the highest quality evidence, showed that in SB peer review, the following author characteristics were associated with more positive outcomes: male gender, White race, location of the US or North America, well-published or known in their field, or affiliation with prestigious institutions. The evidence of whether DB peer review resulted in better outcomes for authors lacking these characteristics was more discordant, possibly due to lack of effective blinding or due to unblinded editor decisions. However, if bias reduction is defined as elimination of advantages afforded to only certain types of authors, DB peer review should be considered.

European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence-based recommendations.

Pancreatic exocrine insufficiency (PEI) is defined as a reduction in pancreatic exocrine secretion below the level that allows the normal digestion ofnutrients. Pancreatic disease and surgery are the main causes of PEI. However, other conditions and upper gastrointestinal surgery can also affect the digestive function of the pancreas. PEI can cause symptoms of nutritional malabsorption anddeficiencies, which affect the quality of life and increase morbidity and mortality. These guidelines were developed following the United European Gastroenterology framework for the development of high-quality clinical guidelines. After a systematic literature review, the evidence was evaluated according to the Oxford Center for Evidence-Based Medicine and the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted on using the Delphi method. The diagnosis of PEI should be based on a global assessment of symptoms, nutritional status, and a pancreatic secretion test. Pancreatic enzyme replacement therapy (PERT), together with dietary advice and support, are the cornerstones of PEI therapy. PERT is indicated in patients with PEI that is secondary to pancreatic disease, pancreatic surgery, or other metabolic or gastroenterological conditions. Specific recommendations concerning the management of PEI under various clinical conditions are provided based on evidence and expert opinions. This evidence-based guideline summarizes the prevalence, clinical impact, and general diagnostic and therapeutic approaches for PEI, as well as the specifics of PEI in different clinical conditions. Finally, the unmet needs for future research are discussed.

Honey as a wound dressing on superficial partial-thickness burn injury in a resource-limited setting: An EBCR at Ende General Hospital

This study aimed to compare the efficacy of honey and conventional SSD cream in accelerating burn wound healing, specifically in resource-limited healthcare settings. A comprehensive literature search was conducted using PubMed and Cochrane databases. Following systematic screening of titles and abstracts based on predetermined inclusion and exclusion criteria, six articles were selected for analysis, comprising four systematic reviews, one randomized controlled trial (RCT), and one cross-sectional study. The methodological quality of the selected studies was critically appraised using validated tools from the Centre for Evidence-Based Medicine, University of Oxford. The analysis included six studies: four systematic reviews, one randomized controlled trial (RCT), and one cross-sectional study. six studies: four systematic reviews, one randomized controlled trial (RCT), and one cross-sectional study. Quality assessment indicated that the systematic reviews and cross-sectional study demonstrated robust methodological quality. These high-quality studies consistently reported significant reductions in burn wound healing time when honey dressings were utilized. However, the included RCT failed to report effect measurements, limiting the interpretation and clinical significance of its findings. Honey has a faster healing effect on superficial thickness burns than SSD cream and is affordable. Therefore, honey can be used as an alternative wound dressing in areas with limited facilities.

Effects of Tissue Flossing on Athletic Performance Measures: A Systematic Review.

The primary aim of this study was to investigate the efficacy of tissue flossing on athletic performance measures. A secondary aim was to explore the efficacy of tissue flossing when applied to a joint or soft tissue (i.e., muscle belly) on athletic performance measures. An article search was completed in the PubMed/MEDLINE, EBSCO, SCOPUS, and OneSearch electronic databases up to May 2024. Studies were included if they used tissue flossing as a primary intervention among healthy participants and used one or more athletic performance measures as an outcome. Exclusion criteria included studies that did not investigate tissue flossing on athletic performance measures among healthy participants, studies that used tissue flossing for blood flow restriction training, case studies, narrative reviews, dissertations, conference proceedings, and papers written in a language other than English. Eighteen articles and 559 total participants were included in the final analysis. Study quality was assessed by two independent reviewers using the Downs and Black Checklist and the Oxford Centre for Evidence-based Medicine. The major findings suggest that a single tissue flossing treatment ranging from 2 to 10 min that includes active single joint or active closed chain exercises may enhance post-intervention muscle strength, jump performance, and balance up to 45 to 60 min post-intervention. Tissue flossing to a joint or soft tissue both produced mixed results among studies, a definitive answer on which technique is superior cannot be determined at this time. Further direct comparison studies are needed for these two techniques.

Peritoneal flap hernioplasty for large ventral hernias: a systematic review and meta-analysis : PFH for large ventral hernia.

Primary closure of large ventral hernia is difficult and is usually complicated by postoperative mesh bulge, migration, and higher recurrence. Techniques like component separation and bridging mesh, transversus abdominus release, da Silva triple-layer repair, and peritoneal flap hernioplasty (PFH) are common treatment options. To evaluate the early postoperative and long-term outcomes of PFH for large ventral hernias. A systematic literature search was performed on the electronic databases of PubMed, Web of Knowledge, and Scopus till July 28, 2024. We performed a single-arm meta-analysis of non-comparative studies using OpenMeta[Analyst] software (Center for Evidence-Based Medicine, Brown University, Rhode Island, USA). Five studies including 432 patients (238 male and 194 female patients in a ratio of 1.23:1.0) underwent PFH for large ventral hernia. The estimated proportion of patients who may experience skin necrosis, seroma, hematoma, superficial surgical site infection, and deep mesh infection were 1.2% (95% CI: 0.001, 0.022; I2: 0.53%) 5.8% (95% CI: 0.036, 0.080; I2: 0%), 3.7% (95% CI: 0.007, 0.067; I2: 59.32%), 10.6% (95% CI: 0.077, 0.135; I2: 0%), and 0.9% (95% CI: -0.004, 0.022; I2: 15.99%) respectively. Similarly, the estimated recurrence rate and chronic pain following PFH was 1.9% (95% CI: 0.005, 0.033; I2: 2%) and 11.6% (95% CI: 0.032, 0.200; I2: 83.43%) respectively during the mean follow-up time of 33 months (95% CI: 1.9, 64.1). PFH seems to be a safe and feasible procedure for the repair of complex or large ventral hernias where it is difficult to perform primary fascial closure. Further studies with a direct comparison of PFH with component separation techniques are necessary to validate the results of our study.

Effectiveness and Feasibility of Blood Flow Restriction Training for People with Multiple Sclerosis: A Systematic Review.

Multiple sclerosis (MS) is an immune-mediated inflammatory disease that primarily targets the myelin of axons. Extremities are frequently affected, resulting in a negative impact on both activities of daily living (ADL) and quality of life. In recent years, there has been increasing interest in the potential benefits of exercise and blood flow restriction training (BFRT) programs as a therapeutic tool in people with neurological disorders. The aim of the present systematic review was to know the clinical effects of BFRT programs in people with MS. A systematically comprehensive literature search was conducted and registered in PROSPERO prior to its execution under the reference number CRD42024588963. The following data sources were used: Pubmed, Scopus, Web of Science (WOS) and the Cochrane Library. The following data were extracted from the papers: study design, sample, interventions, dosage, outcome measures and results. To assess the methodological quality of the papers included, the Quality Index of Downs and Black was used. Additionally, the articles were classified according to the levels of evidence and grades of recommendation for diagnosis studies established by the Oxford Center for Evidence-Based Medicine. Also, the Cochrane Handbook for Systematic Reviews of Interventions was used by two independent reviewers to assess risk of bias, assessing the six different domains. Seven articles with a total of 71 participants were included in the review. Of the seven articles, five papers studied the effectiveness of BFRT combined with strengthening exercises and two papers studied the effect of BFRT combined with aerobic exercise. Of the five articles that analyzed BFRT combined with strengthening exercises, only two presented a control group. Both performed a low-load resistance training in combination with BFRT with four series, 30/15/15/15 repetitions and a rest of 1 min between the series and 3 min between the exercises. The control groups to which they were compared performed a high intensity strengthening exercise protocol which had the same exercises, sets, rests and duration of the protocol as the experimental groups. For those two papers which investigated the effects of BFRT combined with aerobic training, exercise was performed in two sessions per week for a period of 8 and 6 weeks, respectively. In both studies, the experimental protocol began with a warm-up phase and ended with a cool-down phase, and there were differences in cuff management. All these investigations found positive effects in the interventions that combined exercise with BFRT. The characteristics, outcome measures, effects of the interventions and the assessment of the methodological quality of the included studies and risk of bias are shown in the tables. BFRT in people with MS appears to be effective and safe for people with MS. BFRT might show positive clinical effects on strength, hypertrophy and balance outcomes. Nevertheless, future research should be conducted with better methodological quality to ensure the potential benefits of BFRT in people with MS since the studies analyzed present a high risk of bias and methodological limitations.

Spotlight on Amniotic Membrane Extract Eye Drops: A Review of the Literature.

To review the literature focusing on the effectiveness of amniotic membrane extract eye drops (AMEDs) in the treatment of ocular surface diseases. PubMed/MEDLINE, Scopus, and CENTRAL databases were searched until March 4, 2024. Overall, we identified 1,121 studies, 26 of which were selected for a full-text review. Twelve studies met the inclusion criteria and were analyzed for clinical improvements, time to resolution of corneal staining, adverse events, and preparation methods. Strength of clinical data was graded according to the Oxford Center for Evidence-Based Medicine. Overall, AMED compounds were used in 296 eyes of 205 patients. Fifty-nine percent of eyes were treated for dry eye disease, 23% for an epithelial defect, and the rest (18%) for other corneal wound healing disorders. Three main types of eye drops preparation were described, that is, lyophilized, homogenized, and fresh AMED. Although the methods of outcome reporting were heterogeneous, all included studies showed various grades of improvement in both signs and symptoms. The overall incidence of ocular side effects was 2.3%. Despite the suboptimal quality of evidence, overall, the available literature suggests that AMED is a valuable tool in the treatment of ocular surface disorders.

As-Needed Pilocarpine for Radiation-Induced Xerostomia in Head and Neck Cancers.

This study aimed to evaluate the efficacy of as-needed pilocarpine for the management of radiation-induced xerostomia. Additionally, the study sought to assess the side effects associated with an as-needed regimen. A randomized, double-blinded, placebo-controlled crossover study was conducted on patients who had undergone radiation therapy for head and neck cancers and developed xerostomia. Participants took pilocarpine or placebo as needed for symptom relief at 2 weeks per treatment, which included a one-week washout period. The primary outcome measure was the severity of dry mouth symptoms, quantified using the Xerostomia Inventory (XI). The primary outcome was the change in the XI score. Among the 20 participants who completed the crossover study, there was a significant reduction in XI scores during the treatment phase with pilocarpine compared to the scores during the placebo phase. The mean difference in XI scores was -18.05 (95% CI: -17.17, -6.13, p < 0.001), with a-49.77 ± 3.22% change (p < 0.001). Only one participant withdrew due to pilocarpine side effects. As-needed pilocarpine administration is effective in relieving symptoms of radiation-induced xerostomia, with fewer side effects and reduced treatment costs compared to fixed-dose regimens. This study guides the potential shift toward flexible dosing strategies in clinical practice, promoting enhanced patient-centered, tailored care and adherence. According to the Oxford Center for Evidence-Based Medicine 2011 level of evidence guidelines Laryngoscope, 134:4542-4548, 2024.

Risk of Developing Chronic Obstructive Pulmonary Disease in Non-Smoking Adults Exposed to Particulate Matter 2.5 Compared to Those Without Exposure

Background: Chronic obstructive pulmonary disease (COPD) development involves a complex pathway of host and environmental factors. Besides cigarette smoking, previous studies showed exposure to air pollution, such as particulate matter sized 2.5 μm or less (PM2.5), might also have an important role in COPD development because it might lead to airway remodeling and chronic lung inflammation. However, the cause-and-effect relationship between PM2.5 and COPD in non-smoking patients is still unclear.Methods: Literature searches were performed in five online medical databases (PubMed, EMBASE, ScienceDirect, EBSCOhost, and Cochrane Library) and hand-searching in Google Scholar. Filtering literature with the inclusion and exclusion criteria resulted in three relevant articles (1 case-control and 2 cohort studies). Critical appraisal was conducted using the Center of Evidence-Based Medicine (CEBM) worksheet from the University of Oxford for etiologic studies.Results: All three articles were considered valid. The prospective cohort was decided unimportant because of the non-significant adjusted hazard ratio (HR 1.23; 95% confidence interval [CI]=0.50-3.06). The case-control and retrospective studies had important results with adjusted odds ratio of 1.29 (95% CI=1.01-1.65) and 1.69 (95% CI=1.11-2.58), respectively. The relatively low number needed to harm (NNH) of 10-23 indicated that PM2.5 exposure was a meaningful factor for the risk of developing COPD in non-smoker adults. Both articles were considered applicable to our case. Conclusion: Non-smoking adults with exposure to PM2.5, compared to those without exposure, are at higher risk of developing COPD.

Acceptability of Digital Mental Health Interventions for Depression and Anxiety: Systematic Review.

Depression and anxiety disorders are common, and treatment often includes psychological interventions. Digital health interventions, delivered through technologies such as web-based programs and mobile apps, are increasingly used in mental health treatment. Acceptability, the extent to which an intervention is viewed positively, has been identified as contributing to patient adherence and engagement with digital health interventions. Acceptability, therefore, impacts the benefit derived from using digital health interventions in treatment. Understanding the acceptability of digital mental health interventions among patients with depression or anxiety disorders is essential to maximize the effectiveness of their treatment. This review investigated the acceptability of technology-based interventions among patients with depression or anxiety disorders. A systematic review was performed based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic Reviews) guidelines. We searched PubMed, Web of Science, and Ovid in May 2022. Studies were included if they evaluated digital interventions for the treatment of depression or anxiety disorders and investigated their acceptability among adult patients. Studies were excluded if they targeted only specific populations (eg, those with specific physical health conditions), investigated acceptability in healthy individuals or patients under the age of 18 years, involved no direct interaction between patients and technologies, used technology only as a platform for traditional care (eg, videoconferencing), had patients using technologies only in clinical or laboratory settings, or involved virtual reality technologies. Acceptability outcome data were narratively synthesized by the direction of acceptability using vote counting. Included studies were evaluated using levels of evidence from the Oxford Centre for Evidence-Based Medicine. The risk of bias was assessed using a tool designed for this review and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). A total of 143 articles met the inclusion criteria, comprising 67 (47%) articles on interventions for depression, 65 (45%) articles on interventions for anxiety disorders, and 11 (8%) articles on interventions for both. Overall, 90 (63%) were randomized controlled trials, 50 (35%) were other quantitative studies, and 3 (2%) were qualitative studies. Interventions used web-based programs, mobile apps, and computer programs. Cognitive behavioral therapy was the basis of 71% (102/143) of the interventions. Digital mental health interventions were generally acceptable among patients with depression or anxiety disorders, with 88% (126/143) indicating positive acceptability, 8% (11/143) mixed results, and 4% (6/143) insufficient information to categorize the direction of acceptability. The available research evidence was of moderate quality. Digital mental health interventions seem to be acceptable to patients with depression or anxiety disorders. Consistent use of validated measures for acceptability would enhance the quality of evidence. Careful design of acceptability as an evaluation outcome can further improve the quality of evidence and reduce the risk of bias. Open Science Framework Y7MJ4; https://doi.org/10.17605/OSF.IO/SPR8M.

Interventions to Improve the Occupational Performance of Youth With Persistent Postconcussion Symptoms: A Systematic Review.

Persistent postconcussion symptoms (PPCS) may negatively affect youth's occupational performance in activities of daily living, education, play and leisure, social participation, and rest and sleep. This review provides occupational therapists with evidence related to interventions for youth with PPCS. Searches were performed in Embase, PubMed, SportDiscus, CINAHL, and Web of Science. Inclusion criteria were as follows: studies published in English from January 1, 2013, to February 7, 2023; youth ages 3 to 18 yr old; PPCS for at least 2 wk after injury; interventions within the scope of occupational therapy; and outcomes related to areas of occupation. All levels of evidence (1-5) were included and graded for quality using the Oxford Centre for Evidence-Based Medicine (2009) levels of evidence. This review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Twenty articles met inclusion criteria (7 randomized controlled trials, 1 nonrandomized controlled group design, 3 single-group designs, 5 case series, and 4 single-subject designs). Interventions reviewed were active rehabilitation, vision-related interventions, psychoeducation, cognitive-behavioral therapy (CBT) techniques, the Cognitive Orientation to daily Occupational Performance (CO-OP), and music therapy. Strong evidence supports CBT, with significant clinical outcomes in sleep and education. Moderate strength of evidence supports psychoeducation and active rehabilitation for improving functional outcomes. More evidence is needed to make clinical recommendations regarding vision-related interventions, the CO-OP, and music therapy. Occupational therapists should consider CBT, psychoeducation, and active rehabilitation to improve occupational performance among youth with PPCS. Plain-Language Summary: Some youth will have persistent symptoms that do not resolve within 2 weeks after a concussion. Because of these persistent symptoms, they may have difficulty completing everyday activities. This review evaluated evidence addressing the ability of youth with persistent postconcussion symptoms (PPCS) to complete everyday activities. The authors found that cognitive-behavioral therapy, psychoeducation (aimed at helping youth understand and cope with their concussion symptoms), and active rehabilitation (aerobic and coordination exercises, such as jumping jacks and ball skills) should be considered when working with youth (ages 3-18 years) with PPCS. Using these interventions in occupational therapy sessions may improve the ability of youth to complete their everyday activities after a concussion.

Immunogenicity of Botulinum Toxin Type A in Different Clinical and Cosmetic Treatment, a Literature Review.

Botulinum toxin type A is widely utilized for both therapeutic and aesthetic purposes, yet concerns regarding its immunogenicity have raised issues related to treatment failure and adverse reactions. This review aims to evaluate the immunogenicity of commercially available botulinum toxin type A products across various clinical indications and identify the risk factors associated with antibody formation. A comprehensive search of electronic databases was conducted to find studies that investigated the immunogenicity of botulinum toxin type A in patients treated for different conditions. The studies were classified based on the Oxford Center for Evidence-Based Medicine's evidence hierarchy. The overall incidence of neutralizing antibody formation with botulinum toxin type A treatment is relatively low. However, it varies depending on the indication and is influenced by factors such as the frequency of injections and the cumulative dose. The total cumulative dose and the number of treatment cycles are critical factors in determining the risk of developing antibodies against botulinum toxin type A. This literature review highlights that the immunogenicity of botulinum toxin type A products differs across indications, with repeated injections posing a significant risk for the formation of neutralizing antibodies. The findings underscore the need for further research to better understand antibody formation mechanisms and to develop strategies that minimize their impact on treatment efficacy.

Who Guideline for Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings

Low back pain is a very common condition that affects most people at some point in their lives. It represents a burden on those affected, reducing their ability to participate in activities of normal life; at the same time, dealing with it increases the economic costs of healthcare. The aim of this guideline was to contribute to WHO activities for reducing the impact of low back pain in adults and to support the WHO approach to integrated care for older people in primary care. In December 2023, the World Health Organization (WHO) published the "WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings". It was developed following the process according to the WHO handbook for guideline development. The team at the WHO Collaborating Centre for Evidence-Based Medicine at the University for Continuing Education Krems (Austria) translated the summary of this guideline for its application in German-speaking countries. The guideline addresses 37 interventions for the treatment of chronic primary low back pain in primary care and provides 24 recommendations and one good practice statement. No recommendations were made regarding twelve interventions due to equivocation or lack of sufficient evidence. The recommended interventions are intended to provide a range of options to support and personalize care for adults with chronic primary low back pain.

Pharmacokinetics and Pharmacodynamics of Systemic Corticosteroids in Autoimmune and Inflammatory Diseases: A Review of Current Evidence.

Systemic corticosteroids have a long history of use in the treatment of autoimmune and inflammatory diseases. Both efficacy and safety show large interindividual variability (IIV), suggesting that corticosteroids may have the potential for individualised dosing strategies to optimise therapy. This systematic review aims to provide an overview of current evidence on the pharmacokinetic (PK) and pharmacodynamic (PD) relationships of systemic corticosteroids in patients with autoimmune and inflammatory diseases. A systematic literature search was conducted in PubMed and Embase for PK/PD studies of systemic corticosteroids in autoimmune and inflammatory diseases in humans published until December 2023. Studies were scored from 1 to 5 according to criteria for the levels of evidence, as inspired by the Oxford Centre for Evidence-Based Medicine. Twelve studies (1981-2016) were included. The majority of these studies had a small sample size. The corticosteroids involved were prednisone, prednisolone, methylprednisolone and budesonide. Substantial IIV of corticosteroid PK was described in all studies. Evidence for a relationship between the PK of corticosteroids and efficacy was inconclusive and limited. However, there was some evidence for a relationship between the PK of prednisolone and the severity of Cushingoid features. There is insufficient evidence to draw firm conclusions on the potential associations between PK and clinical outcome of systemic corticosteroid treatment in autoimmune and inflammatory diseases. This is remarkable given the many decades that steroid drugs have been used in clinical care. Prospective research is recommended with robust and well-defined cohorts to fully quantify the PK/PD associations of corticosteroids.

Assessing the Reporting Quality of Machine Learning Algorithms in Head and Neck Oncology.

This study aimed to assess reporting quality of machine learning (ML) algorithms in the head and neck oncology literature using the TRIPOD-AI criteria. A comprehensive search was conducted using PubMed, Scopus, Embase, and Cochrane Database of Systematic Reviews, incorporating search terms related to "artificial intelligence," "machine learning," "deep learning," "neural network," and various head and neck neoplasms. Two independent reviewers analyzed each published study for adherence to the 65-point TRIPOD-AI criteria. Items were classified as "Yes," "No," or "NA" for each publication. The proportion of studies satisfying each TRIPOD-AI criterion was calculated. Additionally, the evidence level for each study was evaluated independently by two reviewers using the Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence. Discrepancies were reconciled through discussion until consensus was reached. The study highlights the need for improvements in ML algorithm reporting in head and neck oncology. This includes more comprehensive descriptions of datasets, standardization of model performance reporting, and increased sharing of ML models, data, and code with the research community. Adoption of TRIPOD-AI is necessary for achieving standardized ML research reporting in head and neck oncology. Current reporting of ML algorithms hinders clinical application, reproducibility, and understanding of the data used for model training. To overcome these limitations and improve patient and clinician trust, ML developers should provide open access to models, code, and source data, fostering iterative progress through community critique, thus enhancing model accuracy and mitigating biases. NA Laryngoscope, 2024.