Evidence-based Application Research Articles

Therapeutic mechanism and key active ingredients of Yinxing Mihuan Oral Solution in coronary heart disease comorbidity with anxiety: A network pharmacology and molecular docking approach.

Yinxing Mihuan Oral Solution (YMOS) is a Chinese patent medicine for treating coronary heart disease combined anxiety (CHDCA), but the molecular mechanism of its treatment is still unclear. This article aims to understand the molecular mechanism, optimize clinical drug use, and guide new drug development. Using the Swiss Target Prediction database, we obtained the main chemical composition of YMOS. Then we used network pharmacology to identify their potential targets. Network construction, coupled with protein-protein interaction and enrichment analysis was used to identify representative components and core targets. Finally, molecular docking simulation was conducted to further refine the drug-target interaction. Forty-two active chemicals were found in YMOS and 91 target genes related to CHDCA. The treatment effect was found to be associated with 1908 biological processes and 160 pathways, as revealed by the outcomes of the enrichment analysis. The potential therapeutic mechanisms of the drug are closely related to its antioxidant, anti-inflammatory, and vascular function regulation pathways, and the main core targets include albumin, tumor necrosis factor, TP53, AKT serine/threonine kinase 1, interleukin 1 beta, and vascular endothelial growth factor A. The potential molecular mechanisms of YMOS in CHDCA treatment were identified using network pharmacology and molecular docking approaches. The results reveal the systemic biological implications of YMOS. This study has systematically uncovered the molecular mechanism of YMOS for the first time, offering fresh insights for evidence-based clinical applications.

An Optimal Scalp Rotation Flap Design: Mathematical and Bio-Mechanical Analysis

The design and implementation of successful rotational flaps of the scalp remains a complex process. There are several described techniques, all of which are based on a two-dimension surface, absent consideration of the convexity and thereby three-dimensional nature of the scalp. This has contributed to flaps that are either too small or unnecessarily large in a bid to compensate.Mathematical analysis using trigonometric and algebraic formulae were used to derive the relationship between the defect, triangulation, the contour of the scalp, the radius of the arc of rotation for the flap and scalp skin tension. Polyurethane models were used to test the applicability of the resultant formula, and a consecutive clinical case series is presented.Rotation flap dimensions were calculated using an apex angle of 30 degrees depicted as a two-dimensional construct. The contour of the defect was then measured as the depth of depression with radius of the rotation flap calculated based on the changes in flap surface area across the defect. Finite Element Analysis was utilised to measure redistribution of tension along the flap reconstructing the defect, and the efficacy of the approach confirmed in the consecutive clinical series. The current study provides a reliable flap design based on mathematical analysis, with evidence-based application to the clinical setting.

The Enhancement of Statistical Literacy: A Cross-Institutional Study Using Data Analysis and Text Mining to Identify Statistical Issues in the Transition to University Education

Statistics modules are included in most university degrees, independent of the degree area, and this means that many students face these modules underprepared and struggle because of a lack of statistics knowledge. The Maths Support Centre (MSC) in the University College Dublin (UCD) provides support for various mathematics-related subjects, with statistics students being the second-largest cohort of visitors. The overall goal of this paper is to identify the common statistical issues students face during the transition from secondary education to tertiary education. The main data set for this study is the data from UCD students who have accessed the UCD MSC since 2015/16 for statistics support; the categorization of statistical concepts has been made with the statistics module description for each statistics subject at the Universidad Rey Juan Carlos (URJC). First, we conducted a categorization of statistical concepts taught in university (based on URJC’s catergorization); after that, UCD MSC tutor comments were categorized and validated, and subsequently descriptive analyses and text mining were used on the UCD MSC comments to achieve a deeper understanding of the statistical issues. The statistical issues presented were categorized as descriptive statistics (22.8%), probability (44%), statistical inference (29.2%), and statistical software (4%). Students struggled with material that was introduced at university level rather than material seen at secondary level. Our findings on students’ main statistical issues contribute to the development of a suite of evidence-based educational applications and games to support undergraduate students internationally in first- and second-year statistical modules.

Digital health applications – a digital solution for the health of the future?

The smartphone is the epitome of technical innovation in recent decades. It is part of everyday life for many people – why not use it to promote health with evidence-based applications? Germany is the first country in the world to include evidence-based digital health applications in the service portfolio of its health insurance companies. There is a lack of resources in various medical specialities. Digital health applications can be a solution to support people and promote sustainable medical care. The benefits are obvious, but the utilisation rates are low. However, it can provide access to better healthcare for a large part of the population that is otherwise not considered in the debate. Some European countries have recognised the potential, but it remains to be seen how this digital solution will set up itself in the future. This Perspective Article is intended as a stimulus to integrate digital health applications into the debates on digitally enhanced healthcare, as the social impact is crucial. It therefore addresses the question of whether digital health applications can be a solution for the future.

Digital Beacons of Hope? The Challenges and Potentials of Digital Health Applications for Children and Adolescents with Mental Disorders in Germany

Digital Beacons of Hope? The Challenges and Potentials of Digital Health Applications for Children and Adolescents with Mental Disorders in Germany Abstract: With the Digital Healthcare Act, Germany has taken a decisive step toward promoting high-quality, evidence-based digital health applications (DiHAs). Presently, there is a significant gap in the provision of mental health services throughout Germany, particularly regarding children and adolescents and especially in the aftermath of the COVID-19 pandemic. DiHAs as low-threshold, location- and time-independent additional mental health services - may offer a way to address this situation. Particularly in the emerging generation of digital natives, there is a high demand for digital mental health services. However, despite the rapidly growing supply of DiHAs for adults, there is a lack of approved DiHAs for children and adolescents with mental disorders. Rather, the demand for care is left to the unregulated market of diverse internet- and mobile-based interventions; early studies have questioned the evidence base, safety, and quality. This discrepancy arises from various specific challenges and risks that reduce incentives to develop DiHAs for this particularly vulnerable target group, including (1) limited evidence, (2) high complexity in study execution, (3) high complexity in the development of applications, (4) poorly researched specific risks, and (5) high regulatory requirements. This article discusses these challenges and risks and outlines the perspectives for a high-quality, safe, and evidence-based digital mental healthcare for children and adolescents.

Rapidly progressive coronary atherosclerosis in a young male: a retrospective advanced CCT phenotype analysis

We present a real-life case of a very young man with multiple risk factors who progressed rapidly from minimally obstructive non-calcified plaque on computed tomography angiography (CCTA) to severe three-vessel coronary disease presenting with STEMI. It questions the reliability of zero coronary calcium in high-risk subgroups like familial hypercholesterolemia, high Lp(a), and the young. While CCTA can accurately visualize non-calcified plaque, its interpretation requires expertise and clinical judgment should consider both imaging and clinical risk factors for management. Advanced plaque quantification, peri-coronary (PCAT), and epicardial (EAT) adipose tissue could help better-stratified patients but the evidence-based clinical application remains unknown.

Positive mindset: PsyCap’s roles in PERMA+4 and positive organizational psychology, behavior, and scholarship 2.0

This paper explores the role of mindset and Positive Organizational Psychology (POP) in modern workplaces amid increasing acknowledgment of mental and emotional attitudes influencing how individuals perceive and interact with the world. It discusses the shift in focus from traditional problem-centric approaches in behavioral sciences to a balanced perspective that encompasses both strengths and deficits, as advocated by Seligman and Csikszentmihalyi. This shift has given rise to Positive Organizational Behavior (POB) and Positive Organizational Scholarship (POS), emphasizing human resource strengths and psychological capacities. The paper draws on the PERMA+4 framework, an extension of Seligman’s original model incorporating Physical Health, Mindset, Work Environment, and Economic Security alongside Positive Emotions, Engagement, Relationships, Meaning, and Accomplishment to emphasize the unique role of Positive Mindset. It specifically describes promising research on work-related well-being and optimal work performance, evidence-based practices, and programs at the worker, supervisor/leader, group, and organizational level of analysis. Relatedly, this paper illustrates how one of the most empirically sound constructs within the positive psychology literature, Psychological Capital (PsyCap), can be used to cultivate the essential building block of Positive Mindset toward well-being practices, programs, and applications and more broadly, positive organizational psychology, behavior, and scholarship 2.0 research and applications at multiple levels of analysis. PsyCap theory, research, and evidence-based practices and applications will be discussed in light of how employees’ Positive Mindsets improve the quality of workplaces and the effectiveness of organizations.

Multiple actions of melatonin in reducing viral pathophysiologies

Viral infections lead to significant morbidity and mortality while the effective therapeutic approaches are lacking. Melatonin (MEL) (N-acetyl-5-methoxytryptamine) is a pleiotropic molecule that has a variety of functions, including the antiviral properties. It is a potent antioxidant, anti-inflammatory agent, a stimulator of immune functions, and regulator of apoptosis. These effects support the use of MEL in viral infections, which are often associated with excessive inflammatory responses and elevated oxidative stress. The virus- and cytokine- storm-driven control of the pineal and mitochondrial melatonergic pathway regulates immune responses and increases gut dysbiosis, suppressing levels of the short-chain fatty acid, butyrate, and increasing circulating lipopolysaccharides, stimulating viral replication and host symptoms severity. MEL has a contrasting role in controlling the pathophysiological effects of various viruses due to its chronobiotic, antioxidant and anti-inflammatory actions. Several recent preclinical and clinical studies have documented a robust protective effect of MEL against viral infections, including COVID-19 and it has emerged as an excellent candidate for protection against an array of different viruses. This review summarizes available data on the beneficial effects of MEL on viral pathophysiological actions, and also discusses and highlights likely evidence-based therapeutic applications.

Update on evidence-based clinical application of sodium-glucose cotransporter inhibitors: Insight to uncommon cardiovascular disease scenarios in diabetes.

In this paper, we concentrate on updating the clinical research on sodium-glucose cotransporter inhibitors (SGLTis) for patients with type 2 diabetes who have heart failure with a preserved injection fraction, acute heart failure, atrial fibrillation, primary prevention of atherosclerotic cardiovascular disease/cardiovascular disease, and acute myocardial infarction. We searched the data of randomized controlled trials and meta-analyses of SGLTis in patients with diabetes from PubMed between January 1, 2020 and April 6, 2024 for our review. According to our review, certain SGLTis (empagliflozin, dapagliflozin, canagliflozin, and tofogliflozin), but not sodium-glucose cotransporter 1 inhibitor (SGLT1i), exhibit relatively superior clinical safety and effectiveness for treating the abovementioned diseases. Proper utilization of SGLTis in these patients can foster clinical improvement and offer an alternative medication option. However, clinical trials involving SGLTis for certain diseases have relatively small sample sizes, brief intervention durations, and conclusions based on weak evidence, necessitating additional data. These findings are significant and valuable for providing a more comprehensive reference and new possibilities for the clinical utilization and scientific exploration of SGLTis.

Medical traumatic stress: Integrating evidence-based clinical applications from health and trauma psychology.

Medical events in both childhood and adulthood, including components of the illness or injury and subsequent medical intervention, recovery, and disability, are increasingly being recognized as potentially traumatic. There has been an increased focus on scholarly work related to medical trauma and medically induced posttraumatic stress disorder (PTSD). Existing evidence suggests that trauma-focused treatment can promote both physical and psychological recovery. However, there continues to be a dearth of clinical guidance on how to (a) best identify and treat prior trauma exposure that complicates adjustment to illness and increases the risk for medically induced PTSD and (b) address medically induced PTSD while concurrently targeting health-related concerns (e.g., pain, adjustment to illness, acquired disability) that may negatively impact recovery. Originally presented as a premeeting institute at the 2023 Annual Meeting of the International Society for Traumatic Stress Studies, this paper describes the biopsychosocial impacts of medical trauma on adults and considerations for assessment and intervention in both traditional trauma and integrated care settings. This includes clinical applications, including assessment, case conceptualization, and health and rehabilitation interventions, that can promote health-related adjustment and coping within the context of trauma-focused treatment.

Evidence-Based Design Application of Water Landscaping for Rehabilitation Gardens for Patients with Mental Disorders

Evidence-Based Design Application of Water Landscaping for Rehabilitation Gardens for Patients with Mental Disorders

Development of system-based digital decision support (“Pocket Ark”) for post-flood enhanced response coordination and worker safety: an Intervention Mapping approach

BackgroundThe health and safety of workers who work in areas severely damaged by natural weather events (reconstruction workers) is becoming an increasingly important health problem as these disasters increase in intensity and frequency. An evidence-based, innovative e-learning tool, Pocket Ark, has been developed to meet this need.MethodsIntervention Mapping, an iterative public health programming methodology, was used to create strategies designed to support the development and implementation of the Pocket Ark application for the health and safety of reconstruction workers before, after, and during natural disasters.DiscussionThe development of an evidence-based application, Pocket Ark, uses the concept of the Intervention Mapping planning framework. It can be an effective bridge of pre-deployment education, deployment health, and safety support for the reconstruction work in the immediate post-disaster environment.

Update to the essential genomic nursing competencies and outcome indicators.

Genomic healthcare applications have relevance to all healthcare professionals including nursing, and most evidence-based clinical applications impact the quality and safety of healthcare. To guide nursing genomic competency initiatives, the Essential Nursing Competencies and Curricula Guidelines for Genetics and Genomics were established through a process of consensus in 2005. A 2009 update incorporated outcome indicators consisting of specific areas of knowledge and clinical performance indicators, to help support academic integration. Almost 20 years have elapsed since these competencies were first established, yet incorporating the competencies into general and specialty scope and standards of nursing practice is inconsistent, competency integration into curricula is highly uneven, continuing education in genomics for nurses is limited, and the genomic capacity of the nursing workforce remains low. These deficits have persisted despite substantial advances in genomic technology which substantially reduced costs and increased evidence-based clinical applications, including direct to consumer genomic tests, the integration of genomics into evidence-based guidelines, and evidence that genomics impacts the quality and safety of healthcare. The aim of this project was to update and achieve consensus on genomic competencies applicable to all registered nurses. This was a mixed methods study. The update to the competencies was performed based first on a literature review to update the competencies based on the current state of the evidence. Using the updated content, a modified Delphi study was conducted with registered nurse panelists from clinical, academic, and research settings. Once consensus was achieved, the competencies were made available through the American Nurses Association for public comment. Public comments were then reviewed and integrated as needed. The literature review resulted in a transition from genetics to genomics, given the reduction in costs, which resulted in an expansion of the scope of testing in both the germline and somatic contexts. Two Delphi rounds were required to reach consensus prior to the public comment period. Public comments were solicited through the American Nurses Association, and each comment was reviewed by the authors and addressed as indicated. The Essentials of Genomic Nursing: Competencies and Outcome Indicators constitute the minimum competency in genomics required of all registered nurses regardless of the level of academic training, role, or specialty. Evidence-based genomic applications span the entire healthcare continuum and, therefore, are relevant for all registered nurses regardless of academic training, role, practice setting, or clinical expertise. These competencies serve as the guide for the minimum requirements for registered nurse practice as well as guide curricula and continuing education for all registered nurses, including but not limited to administrators, educators, nursing leaders, practicing nurses, and researchers.

Field Testing the Family Behavior Support Mobile Application (FBSApp) During a Global Pandemic.

We developed and tested an evidence-based mobile application designed to support families in using functional assessment-based intervention strategies with their young children with disabilities and challenging behaviors in home settings. Five families participated in the study. We utilized a multiple-probe across participants design to examine the effects of the FBSApp on parents' use of intervention strategies and childrens' use of challenging behaviors and replacement behaviors. We adapted our procedures to include individualized coaching to provide meaningful and effective support after the onset of the COVID-19 pandemic. A functional relation was not identified between access to FBSApp and caregiver use of strategies; however, the addition of coaching did lead to increased strategy use for two of four caregivers. A functional relation was identified between the use of the FBSApp plus coaching and CB. Families reported the app and coaching procedures favorably. We found that responsive, family-centered research CAN be conducted in spite of significant history events, and that mobile apps and virtual meeting platforms can be an accessible and efficient method for supporting families. The use of single case design allowed for flexible, yet methodologically sound procedures. More work is needed examining effective and efficient virtual supports for families.

Smartphone Use in the Management of Neurological Emergencies: A Simulation-Based Study.

Smartphone use in medicine is nearly universal despite a dearth of research assessing utility in clinical performance. We sought to identify and define smartphone use during simulated neuroemergencies. In this retrospective review of a prospective observational single-center simulation-based study, participants ranging from subinterns to attending physicians and stratified by training level (novice, intermediate, and advanced) managed a variety of neurological emergencies. The primary outcome was frequency and purpose of smartphone use. Secondary outcomes included success rate of smartphone use and performance (measured by completion of critical tasks) of participants who used smartphones versus those who did not. In subgroup analyses we compared outcomes across participants by level of training using t-tests and χ2 statistics. One hundred and three participants completed 245 simulation scenarios. Smartphones were used in 109 (45%) simulations. Of participants using smartphones, 102 participants looked up medication doses, 52 participants looked up management guidelines, 11 participants looked up hospital protocols, and 13 participants used smartphones for assistance with an examination scale. Participants found the correct answer 73% of the time using smartphones. There was an association between participant level and smartphone use with intermediate participants being more likely to use their smartphones than novice or advanced participants, 53% versus 29% and 26%, respectively (p < 0.05). Of the intermediate participants, those who used smartphones did not perform better during the simulation scenario than participants who did not use smartphones (smartphone users' mean score [standard deviation] = 12.3 [2.9] vs. nonsmartphone users' mean score [standard deviation] = 12.9 (2.7), p = 0.85). Participants commonly used smartphones in simulated neuroemergencies but use didn't confer improved clinical performance. Less experienced participants were the most likely to use smartphones and less likely to arrive at correct conclusions, and thus are the most likely to benefit from an evidence-based smartphone application for neuroemergencies.

Role of Music Therapy in Stress Reduction

This study aims to investigate the potential of music therapy as a stress reliever for young adults. Any unpleasant emotion or sensation, including strain and pressure, is referred to as stress. The clinical and evidence-based application of music interventions to fulfill specific goals within a therapeutic alliance by a qualified professional who has completed an approved music therapy program is known as music therapy. Music therapy mediations aim to improve well-being, reduce stress, ease pain, communicate emotions, improve memory, improve communication, and aid in physical recovery. A review of the literature demonstrates that music has a significant impact on a person's psychological state and lowers tension and anxiety.

Updating the WHO Model Lists of Essential Medicines to promote global access to the most cost-effective and safe medicines for mental disorders

IntroductionSince its first publication in 1977, the World Health Organization’s (WHO) Model List of Essential Medicines (EML) has guided the national procurement of medicines deemed essential to inform public health policy worldwide. Aiming to include the most effective, safe, and cost-effective medicines for priority conditions, WHO updates the EML every two years. However, over the past 45 years, updates to the mental health section of the EML have been infrequent, mostly involving the addition of individual medicines. A comprehensive revision of the entire section was never attempted.ObjectivesThe aim of this project was to update the mental health section of the EML to identify the most effective and safest medicines for mental disorders in the light of the most up-to-date evidence base.MethodsA series of nine evidence-based applications were submitted to the WHO Expert Committee on the Selection and Use of Essential Medicines in December 2022, recommending a substantial revision of the entire mental health section.ResultsAll of our applications were accepted by the WHO Expert Committee. For psychotic disorders, aripiprazole, olanzapine, paliperidone, and quetiapine were added as therapeutic alternatives to risperidone; short-acting intramuscular chlorpromazine was replaced by short-acting intramuscular olanzapine; first-generation antipsychotics were limited to oral haloperidol and chlorpromazine. For bipolar disorder, the list now includes second-generation antipsychotics such as quetiapine, aripiprazole, olanzapine, and paliperidone. Tricyclic antidepressants for depressive disorders were limited to amitriptyline alone. Treatment options for anxiety and obsessive-compulsive disorder are now expanded to include SSRIs. For anxiety disorders, diazepam and lorazepam became the only benzodiazepines recommended, with the specific caveat that they should only be used for short-term emergency treatment of acute and severe anxiety symptoms. Finally, chlorpromazine and haloperidol are no longer considered essential medications for psychotic disorders in children under 13 years of age.ConclusionsThe WHO released the 23rd EML in July 2023. After decades of minimal and inconsistent updates, groundbreaking changes have been made to its mental health section. The updated mental health section provides a compelling opportunity to improve the quality of medicine selection at the country level, with the goal of increasing the availability of the safest and most effective psychotropic medicines worldwide.Disclosure of InterestNone Declared

Quantitative assessment of customer segment, value proposition and appropriateness of minimum viable product features for technology commercialization in the environmental sciences

Transitioning fundamental and applied science to evidence-based real-world applications is challenging yet necessary, especially in environmental sciences. In this paper, a quantitative data analysis method is presented to support decision-making by augmenting qualitative customer discover methods used for new technology adoption. This method can be used to assess: i) customer segment (CS) and value proposition (VP) validity and ii) the ability of a new technology to address the VP. Two different environmental technologies were evaluated to demonstrate this quantitative approach. CS and VP(s) that were previously qualitatively identified were statistically (in)validated using binomial testing. In each of the presented cases, the CS was statistically validated but only one of the three VPs for each case was validated. The validated performance parameters for each technologywere tested against cost and performance data using linear optimization. This testing allowed for the identification of conditions under which the technology met minimum customer performance requirements and where further data or technology modifications were still needed. These identified conditions establish the features necessary to transition the technologies to the minimum viable product (MVP) phase of commercialization. One technology was found to be ready for MVP development while the other technology needed additional data and modification. Both findings demonstrate the effectiveness of this quantitative data analysis method and guide decision-making in the early stages of technology commercialization.

Industry Sponsorship Bias in Collagenase Clinical Trials for Dupuytren Disease: A Meta-analysis.

Collagenase clostridium histolyticum (collagenase) was introduced in 2010 creating a nonoperative treatment option for Dupuytren disease with promising results in sponsored clinical trials. A meta-analysis was performed to investigate industry sponsorship bias. A systematic review of collagenase treatment of Dupuytren contracture was conducted. Articles containing mesh terms including "microbial collagenase" and "Dupuytren's contracture" were searched and limited to only clinical trials with similar protocols for inclusion. Meta-analysis of treatment endpoints of correction of contracture to 0-5 degrees after first and last injection was conducted comparing sponsored versus nonsponsored studies. Sixteen of the 29 identified articles met criteria for inclusion. Nonsponsored studies reported a significantly higher rate of meeting the primary treatment endpoint compared to sponsored studies after single injection for all joints (69.6% vs 56% P < 0.01), metacarpophalangeal joint (96% vs 64% P < 0.01), and proximal interphalangeal joint (67% vs 36% P = 0.011). The correction in contracture rates was similar between groups with studies evaluating more than one injection. Nonsponsored studies published higher success rates in meeting the primary endpoint of full correction after single injection than sponsored studies; however, similar results with multiple injections. This study demonstrated that sponsored studies of collagenase produced highly powered studies that may be reliably depended on for evidence-based clinical application.

Анализ доказательной базы эффективности моделей ранней помощи DIRFloortime и ESDM. Часть 2. Модель ESDM

&lt;p style="text-align: justify;"&gt;&lt;strong&gt;Objectives&lt;/strong&gt;. Describing empirically proven algorithms of the Early Start Denver Model (ESDM) is a relevant task to compare variants of the model practically presented in the correctional space and the empirically proven variant. The basic empirical studies of the effectiveness of the ESDM model are analyzed.&lt;/p&gt; &lt;p style="text-align: justify;"&gt;&lt;strong&gt;Methods&lt;/strong&gt;. The review considers 9 English-language sources, 5 articles in Russian, and a textbook on the Denver Early Intervention Model, which describe evaluations mainly in the format of randomized and controlled trials of the effectiveness of the ESDM model.&lt;/p&gt; &lt;p style="text-align: justify;"&gt;&lt;strong&gt;Results.&amp;nbsp;&lt;/strong&gt;The results of the analysis of the cited studies indicate a significantly greater effectiveness of the ESDM approach for children with autism spectrum disorders (ASD) compared to standard available care options on such parameters as: receptive and expressive speech, socialization, daily living skills, communication, motor skills, reduction of the main symptoms of autism, and reduction of parental stress.&lt;/p&gt; &lt;p style="text-align: justify;"&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;. The basic evidence-based applications of the ESDM model are described, which include: writing an individualized care plan, intensive sessions with the child for approximately 15 hours per week, regular parent training, independent interaction with children for approximately 2&amp;mdash;3 hours per day, and age of onset of care between 18 and 30 months. The conclusion has been made that the Early Start Denver Model (EDSM) is appropriate for working with early age children showing signs of ASD.&lt;/p&gt;