Evidence-based Recommendations For Management Research Articles

Qualitative Interviews Exploring Adverse Event Mitigation Strategies in Adults Receiving Amikacin Liposome Inhalation Suspension.

This study aimed to gain insight from patients with refractory Mycobacterium avium complex lung disease (MAC-LD) into strategies used to manage adverse events (AEs) associated with amikacin liposome inhalation suspension (ALIS). We conducted semi-structured interviews with US patients with refractory MAC-LD prescribed ALIS in a real-world setting. Interview transcripts were analyzed and coded to identify patterns in participants' descriptions of their ALIS treatment experiences, including AEs and their disruptiveness, and AE mitigation strategies, including participants' ratings of strategies' effectiveness. Concept saturation was also assessed. Twenty participants (mean age 48.7years; 80% women; mean ALIS duration 5.45months) were interviewed. At the time of the interview, 15 participants (75%) had received ALIS for > 1month and 13 (65%) were currently receiving ALIS. Participants described 44 unique AE mitigation strategies, which can be categorized into three groups: prepare for treatment; prevent increased emergence of AEs; and persist on treatment by mitigating AEs. Common strategies (reported by ≥ 50% of participants) included use of educational materials from the patient support program, localized management of throat irritation, and symptom management to reduce fatigue. Evidence of concept saturation was observed: no new strategies were identified in the last five interviews, which suggests the sample was robust enough to identify all mitigation strategies likely to be used by the broader patient population. This real-world study identified a diverse set of potential AE mitigation strategies intended to help individual patients prepare for ALIS treatment, prevent the increased emergence of certain AEs, and mitigate the impact of AEs on treatment persistence. Developing a comprehensive accounting of the types of mitigation strategies in use among patients in real-world settings can inform future investigation of the effectiveness of such strategies, and support evidence-based recommendations for treatment management.

Assessing Practice Variation of Anesthetic Management for Endovascular Thrombectomy in Acute Ischemic Stroke: A Comprehensive Multicenter Survey.

This study explored the current global landscape of periprocedural care of acute ischemic stroke patients undergoing endovascular thrombectomy (EVT). An anonymous, 54-question electronic survey was sent to 354 recipients in hospitals worldwide. The responses were stratified by World Bank country income level into high-income (HICs) and low/middle-income (LMICs) countries. A total of 354 survey invitations were issued. Two hundred twenty-three respondents started the survey, and 87 fully completed surveys were obtained from centers in which anesthesiologists were routinely involved in EVT care (38 in HICs; 49 in LMICs). Respondents from 35 (92.1%) HICs and 14 (28.6%) LMICs reported that their centers performed >50 EVTs annually. Respondents from both HICs and LMICs reported low rates of anesthesiologist involvement in pre-EVT care, though a communication system was in place in 100% of HIC centers and 85.7% of LMIC centers to inform anesthesiologists about potential EVTs. Respondents from 71.1% of HIC centers and 51% of LMIC centers reported following a published guideline during EVT management, though the use of cognitive aids was low in both (28.9% and 24.5% in HICs and LMICs, respectively). Variability in multiple areas of practice, including choice of anesthetic techniques, monitoring and management of physiological variables during EVT, and monitoring during intrahospital transport, were reported. Quality metrics were rarely tracked or reported to the anesthesiology teams. This study demonstrated variability in anesthesiology involvement and in clinical care during and after EVT. Centers may consider routinely involving anesthesiologists in pre-EVT care, using evidence-based recommendations for EVT management, and tracking adherence to published guidelines and other quality metrics.

Bowel Management in the Acute Phase of Spinal Cord Injury.

BACKGROUND: Neurogenic bowel and bladder are well-known complications of spinal cord injury. During the acute phase of recovery from spinal cord injury, spinal shock occurs, resulting in loss of reflexes and peristalsis of the gastrointestinal tract. These impairments can result in complications in the gastrointestinal tract and, secondarily, the respiratory system due to the distention of the abdomen. Current guidelines for bowel management target the chronic phase of spinal cord injury after a diagnosis of neurogenic bowel dysfunction can be made. METHODS: The purpose of this literature review was to determine evidence-based recommendations for bowel management during the acute phase of spinal cord injury. A systematic search using the databases CINAHL, PubMed, Cochrane Library, and ProQuest was used to identify relevant evidence. RESULTS: The available evidence is based on expert consensus, is dated, and tends to be based on studies conducted during the chronic phase of injury. Careful assessment of the symptoms of bowel dysfunction would indicate that during the acute phase of spinal cord injury, spinal shock causes a patient to experience an areflexive bowel pattern where bowel motility is limited and reflexes are absent. Management of areflexive bowel includes establishment of a daily bowel program including manual removal of stool. To improve emptying of stool, factors such as rectal and oral medications, fluid, fiber, and activity may be adjusted according to need. CONCLUSION: There is limited evidence focused specifically on bowel management in the acute phase of spinal cord injury. Bowel management is complex and multifaceted and needs to be individualized to the patient as well as frequently reevaluated with changes in condition. Further research is needed to evaluate outcomes for bowel management in the acute phase of spinal cord injury to promote best practices.

Prevention and Management of Osteoradionecrosis in Patients With Head and Neck Cancer Treated With Radiation Therapy: ISOO-MASCC-ASCO Guideline.

To provide evidence-based recommendations for prevention and management of osteoradionecrosis (ORN) of the jaw secondary to head and neck radiation therapy in patients with cancer. The International Society of Oral Oncology-Multinational Association for Supportive Care in Cancer (ISOO-MASCC) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials and observational studies, published between January 1, 2009, and December 1, 2023. The guideline also incorporated systematic reviews conducted by ISOO-MASCC, which included studies published from January 1, 1990, through December 31, 2008. A total of 1,539 publications were initially identified. There were 487 duplicate publications, resulting in 1,052 studies screened by abstract, 104 screened by full text, and 80 included for systematic review evaluation. Due to limitations of available evidence, the guideline relied on informal consensus for some recommendations. Recommendations that were deemed evidence-based with strong evidence by the Expert Panel were those pertaining to best practices in prevention of ORN and surgical management. No recommendation was possible for the utilization of leukocyte- and platelet-rich fibrin or photobiomodulation for prevention of ORN. The use of hyperbaric oxygen in prevention and management of ORN remains largely unjustified, with limited evidence to support its practice.Additional information is available at www.asco.org/head-neck-cancer-guidelines.

Running the Risk - Examining Dermatologic Concerns and Skin Neoplasms in Runners

This review summarizes the most prevalent dermatologic conditions encountered by runners and provides evidence-based recommendations for prevention and management. Due to high levels of ultraviolet radiation exposure, friction forces, specific environment of the activity and used garment runners are at the risk of various dermatologic complications, including skin neoplasms. Sun protection measures, such as applying sunscreen with sufficient SPF, wearing photoprotective clothing, and avoiding peak sun hours, are crucial for mitigating this risk. Friction-related injuries like blisters, calluses, and jogger's nipples are common among runners and can be prevented through proper footwear, moisture management, and lubrication. Educational interventions promoting safety practices are necessary to raise awareness and encourage behavioural change among runners.

Fillers impacting follicles: the emerging complication of filler-induced alopecia.

Filler-induced alopecia is a transient alopecia characterized by localized hair loss and often attributed to vascular compromise following dermal filler injections in facial regions. Although an uncommon phenomenon, the rising incidence of filler-induced alopecia underscores the importance of understanding and managing this condition. We performed an extensive PubMed review of articles reporting filler-induced alopecia and summarizing the implicated filler types, injection areas, hair loss patterns, symptom onset, course progression, treatments, and prognosis. Hyaluronic acid injections were the most implicated in filler-induced alopecia cases, with calcium hydroxylapatite and autologous fat less frequently associated. No cases involved other dermal filler types. Although recovery times varied depending on the treatment, hyaluronidase (HAase) injections rapidly restored near-normal hair density within 3-4 months. Minoxidil and platelet-rich plasma play a more minor role in restoring hair growth but may be used as adjuncts with HAase to facilitate hair growth. Finally, alternative interventions like intralesional triamcinolone, warm compresses, and nitroglycerin warrant exploration, given limited robust clinical data. Our study promotes awareness of filler-induced alopecia's rising incidence and offers practical insights and evidence-based recommendations for effective management. By equipping dermatologists with this knowledge, our aim is to improve patient outcomes and reduce adverse events in filler-based procedures.

Lymphovascular Invasion in Cutaneous Squamous Cell Carcinoma.

Although there is a large body of literature regarding risk stratification and outcomes for perineural invasion (PNI) in cutaneous squamous cell carcinoma (cSCC), there is a relative paucity of studies exploring the role of lymphovascular invasion (LVI) in cSCC and a lack of clear evidence-based guidelines for how to manage patients with these tumors. This article is intended to review the available literature regarding LVI in cSCC and formulate evidence-based recommendations for clinical management. A literature review was conducted using PubMed to find relevant articles relating to outcomes and management of primary cSCC with LVI. The available literature suggests that LVI is a major risk factor for poor outcomes and increased morbidity and mortality in cSCC. Lymphovascular invasion is a very high-risk feature that should place these tumors in the highest-risk category, and management of these tumors should be similar to that of squamous cell carcinoma with PNI.

Pain Management in Surgical Treatment of Facial Fractures: Alternative Approaches to Opioid Use

Study Design Literature review. Objective This review aims to explore current opioid use trends for surgical management of facial fractures, as well as methods and alternative treatments to decrease opioid use. Methods Review of selected literature from Medline and Google Scholar. Results Despite the devastating effects of the opioid epidemic and recent policy changes aimed at reducing unnecessary opioid prescription, opioids remain commonly used for pain management after facial fracture repair. Recently, use of multimodal analgesic therapy has been suggested to decrease opioid dosage utilized for post-operative pain control. Alternatives to medication therapies have been proposed for pain management; however, standardized recommendations for pain management in facial fracture patients remain unclear. Conclusions Further research is required to establish evidence-based recommendations for pain management in craniofacial fracture repair.

Abstract 86: Outcomes of Endovascular Therapy for Late Large Vessel Occlusion in Patients With Pre-Stroke Disability

Background: There is a paucity of research to develop evidence-based recommendations for endovascular management in the extended time window (>6 hours after time last seen well [TLSW]) for large vessel occlusion (LVO) patients with pre-stroke disability. Methods: We analyzed data from a multinational cohort (66 sites, 10 countries from 2014 to 2022) of acute ischemic stroke patients with pre-stroke modified Rankin Scale (mRS) 0-4 and anterior or posterior circulation LVO who received endovascular therapy 6-24 hours after TLSW. The primary outcome was the composite of functional independence (FI, mRS 0-2) or return to pre-stroke mRS (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS 2-4) vs those without (mRS 0-1). Results: There were 2231 patients (median age 77 years; median NIH Stroke Scale 16) included in the present study, of whom 564 (25.3%) had pre-stroke disability. The primary outcome (FI or ROR) was seen in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR 30.7%), compared with 44.1% of those without (FI, 44.1%; RoR 13.0%) ( P <0.0001, Figure 1 ). In both multivariable logistic regression and inverse probability of treatment weighting analysis, pre-stroke disability was not associated with a lower odds of achieving FI or RoR (adjusted odds ratio [aOR] 0.76, 95% confidence interval [CI] 0.50-1.15 and aOR 0.73, 95% CI 0.43-1.25, respectively). FI or ROR was achieved at a higher percentage with reperfusion with mTICI ≥2b than with mTICI 0-2a, both in patients with pre-stroke disability (34.8% vs 10.8%, P <0.0001) and in those without (49.2% vs 12.1%, P <0.0001). Symptomatic intracranial hemorrhage occurred in 6.3% in both groups ( P =0.995). Conclusions: A substantial proportion of late LVO patients with pre-stroke disability regained pre-stroke mRS after EVT and did not have a worse functional prognosis than patients without pre-stroke disability when their pre-stroke mRS was considered.

Coastal Dynamics in Jayapura City, Papua

The investigation focuses on understanding land use and cover patterns in Jayapura City, along with drivers and climate change impacts in coastal areas. It explores tourism's role in coastal land use and assesses its sustainability. Using a comprehensive approach combining literature review and on-the-ground data collection, the study identifies knowledge gaps and key variables. It gathers site-specific data to validate findings and inform evidence-based recommendations for resilient coastal management. Socioeconomic aspects, including impacts on local communities and indigenous groups, are considered. This research aims to promote sustainable land use practices and address the challenges posed by climate change and tourism in coastal areas.

Review of the Assessment and Management of Perinatal Mood and Anxiety Disorders.

Perinatal mood and anxiety disorders (PMADs) are the most common complication of childbirth. When poorly controlled, they are associated with worse obstetric outcomes, such as higher rates of preterm birth and unplanned cesarean delivery. They are also associated with suicide, a leading cause of perinatal maternal death. This article provides an overview of evidence-based recommendations for screening, assessment, and management of PMADs, including suicide risk assessment and management and pharmacological and nonpharmacological treatment options compatible with pregnancy and lactation. Although specialized reproductive psychiatrists can provide expert guidance for the management of PMADs, their scarcity means that most patients will not have access to this expert care and instead will seek guidance from general psychiatrists. This article provides a clinical guide for generalists that is based on the best current evidence, including recently released treatment guidelines.

Influence of cancer in pregnancy on obstetric and neonatal outcomes: an observational retrospective cohort study.

The study aimed to review the oncological characteristics and treatment of pregnancy-associated cancers and analyze the obstetric and neonatal outcomes to provide evidence-based recommendations for reproductive function preservation, oncological treatment, and obstetric management. We conducted an observational retrospective cohort study among pregnant patients with cancer in 7 Chinese tertiary A hospitals from 2003 to 2021. We conducted multiple logistic regression to determine the influence of various factors on preterm birth and small-for-gestational-age infants, log-binomial regression to analyze temporal changes, and χ² tests to explore the effects of cancer type/treatment. Of 204 women, 17% terminated their pregnancies; 59% received pre-delivery treatment. Every 6 years, the rates of pregnancy termination (relative risk [RR]=0.48; 95% confidence interval [CI]=0.35-0.67) and iatrogenic preterm births (RR=0.73; 95% CI=0.54-0.98) reduced, and that of pre-delivery treatment increased, mainly due to increased rates of surgery (RR=1.87; 95% CI=1.31-2.67). Maternal systemic diseases were related to small-for-gestational-age infants (odds ratio [OR]=12.02; 95% CI=1.82-79.43). Chemotherapy with taxanes plus platinum-based agents was related to adverse obstetric outcomes (OR=1.87; 95% CI=1.42-2.46; p<0.05). Thyroid (OR=0.36; 95% CI=0.22-0.57) and ovarian cancer (OR=0.70; 95% CI=0.50-0.98) were associated with fewer cesarean sections. Thyroid cancer was associated with fetal growth restriction (OR=5.21; 95% CI=1.21-22.55). Rates of pregnancy termination in cancer declined. Taxane plus platinum-based chemotherapy was associated with adverse obstetric outcomes. Cancer type influenced outcomes. Chinese Clinical Trial Register Identifier: ChiCTR2100044292.

Acute care nurses' experience in providing evidence-based care for patients with laparotomy wounds: A scoping review.

To systematically search and synthesise available literature on barriers and enablers to evidence-based care for patients with laparotomy wounds reported by acute care nurses. Specifically, we focused on wound assessment, infection control techniques, wound products used, escalation of care, dressing application, documentation and holistic care. The Preferred Reporting Items for Systematic review and Meta-Analyses extension for Scoping Reviews Checklist and explanation documents directed the review. The methodology framework created by Arksey and O'Malley, updated by Levac et al., and the Joanna Briggs Institute were utilised to assist the scoping review process. Data synthesis was guided by the Theoretical Domains Framework. Six qualitative and mixed methods studies were selected for the review. Most reported barriers and enablers were mapped to knowledge, skills, beliefs about consequences, environmental context and resources and beliefs about capability domains. The main barriers were limited access to and utilisation of wound assessment tools and clinical practice guidelines for wound management and suboptimal time management skills. Inconsistent management of laparotomy wounds was related to ward culture and nurses' lack of knowledge and skills in surgical wound assessment and aseptic technique during wound encounters. The reported enablers were knowledge of multi-factorial risk factors for surgical wound recovery, valuing education and reflective practice and believing that protocols should be utilised alongside comprehensive wound assessments. Holistic wound care included patient education on the role of mobilisation and nutrition in wound healing. Acute care nurses do not routinely incorporate comprehensive, evidence-based care recommendations for laparotomy wound management. Further research on evidence-based care behaviours in managing laparotomy wounds is required. The results indicate a need for standardising the practice of laparotomy wound management while acknowledging the current challenges faced in the ward environment.

Non-cigarette Tobacco Use and Stroke Among West Africans: Evidence From the SIREN Study.

Non-cigarette tobacco (NCT) represents a form of tobacco use with a misperceived significance in chronic disease events. Whether NCT use is sufficient to promote stroke events, especially among Africans, is yet to be understood. This study assessed the relationship between NCT use and stroke among indigenous Africans. A total of 7617 respondents (NCT users: 41 vs. non-NCT: 7576) from the Stroke Investigative Research and Educational Network (SIREN) study were included in the current analysis. NCT use was defined as self-reported use of smoked (cigars or piper) or smokeless (snuff or chewed) tobacco in the past year preceding stroke events. Stroke was defined based on clinical presentation and confirmed with a cranial computed tomography/magnetic resonance imaging. Multivariable-adjusted logistic regression was applied to estimate the odds ratio (OR) and 95% confidence interval (CI) for the relationship of NCT with stroke at a two-sided p < .05. Out of the 41 (0.54%) who reported NCT use, 27 (65.9%) reported using smokeless NCT. NCT users were older than non-NCT users (62.8 ± 15.7 vs. 57.7 ± 14.8 years). Overall, NCT use was associated with first-ever stroke (OR: 2.08; 95% CI: 1.02, 4.23) in the entire sample. Notably, smokeless NCT use was independently associated with higher odds of stroke (OR: 2.74; 95% CI: 1.15, 6.54), but smoked NCT use (OR: 0.16; 95% CI: 0.02, 1.63) presented a statistically insignificant association after adjusting for hypertension and other covariates. NCT use was associated with higher odds of stroke, and public health interventions targeting NCT use might be promising in reducing the burden of stroke among indigenous Africans. A detailed understanding of the relationship between NCT use and stroke will likely inform well-articulated policy guidance and evidence-based recommendations for public health prevention and management of stroke on the African continent.

Risk and management of post-operative infectious complications in inflammatory bowel disease: A systematic review.

Indications for surgery in inflammatory bowel disease (IBD) include treatment-refractory disease or severe complications such as obstruction, severe colitis, dysplasia, or neoplasia. Infectious complications following colorectal surgery in IBD are significant, particularly in high-risk patients. To gather evidence on risk factors associated with increased post-operative infectious complications in IBD and explore management strategies to reduce morbidity and mortality. A systematic review adhering to PRISMA-P guidelines was conducted. MEDLINE (PubMed) and Cochrane Library databases were searched using specific keywords. Inclusion criteria encompassed studies involving patients with IBD undergoing abdominal surgery with infectious complications within 30 d postoperatively. Exclusion criteria included patients under 18 years and non-infectious complications. Selected papers were analyzed to identify factors contributing to post-operative infections. A narrative analysis was performed to provide evidence-based recommendations for management. The data were then extracted and assessed based on the Reference Citation Analysis (https://www.referencecitationanalysis.com/). The initial database search yielded 1800 articles, with 330 articles undergoing full-text review. After excluding duplicates and irrelevant papers, 35 articles were included for analysis. Risk factors for post-operative complications in patients with IBD included hypoalbuminemia, malnutrition, preoperative abscess, and obesity. Perioperative blood transfusion was associated with increased infectious complications. Medications such as 5-aminosalicylates and immunomodulators did not increase post-operative complications. Corticosteroids were associated with an increased risk of complications. Ustekinumab and vedolizumab showed similar rates of infectious complications compared to other treatments. The impact of minimally invasive surgery on post-operative complications varied across studies. In order to reduce post-operative infectious complications in patients with IBD, a comprehensive approach involving multiple disciplines is necessary.

Rapid maxillary expansion: a clinical insight for the general dental practitioner

Rapid maxillary expansion is an orthodontic treatment approach for corrections of transverse discrepancies, such as crossbites. Rapid maxillary expansion expands the palate by applying forces to the teeth and surrounding tissues to separate the mid-palatal suture, allowing for the correction of the indicated malocclusions. A general dental practitioner should be aware of the indications, treatment strategy and play an important role in the timely referral of patients for orthodontic assessment. This article offers a comprehensive overview of rapid maxillary expansion, expansion protocols, and an in-depth analysis of the prevalent characteristics associated with expansion, along with evidence-based recommendations for effective management. CPD/Clinical relevance: This paper aims to give the general dental practitioner clinical insight into rapid maxillary expansion, the devices used and the indications for use.

PROSPECT methodology for developing procedure-specific pain management recommendations: an update.

The procedure-specific postoperative pain management (PROSPECT) working group develops evidence-based pain management recommendations. PROSPECT methodology is unique and rigorous. However, several limitations were recognised that needed to be addressed, and several new factors were identified that improved PROSPECT methodology. The aim of this article is to present updated PROSPECT methodology for development of recommendations for procedure-specific pain management, focusing on the methodological revisions we will implement. In future, included randomised clinical trials will need to be prospectively registered on a publicly accessible clinical trials database and the study design, including the primary outcome in the registration, should coincide with that in the published manuscript. Placebo-controlled studies in which the analgesic intervention of interest is solely paracetamol, non-steroidal anti-inflammatory drugs, cyclo-oxygenase-2-specific inhibitors or opioids will not be included. Studies comparing one drug in a particular class with another in the same class will also not be included. Future projects will use the Cochrane Collaboration risk of bias tool for quality of reporting of methodology and results. A modified Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach will be used for grading of level of evidence and strength of recommendations. Finally, the updated PROSPECT methodology addresses several other limitations and implements new factors that all add rigour and transparency to developing procedure-specific pain management recommendations.

IBD and Motherhood: A Journey through Conception, Pregnancy and Beyond.

Inflammatory Bowel Disease (IBD) presents distinct challenges during pregnancy due to its influence on maternal health and pregnancy outcomes. This literature review aims to dissect the existing scientific evidence on pregnancy in women with IBD and provide evidence-based recommendations for clinical management. A comprehensive search was conducted across scientific databases, selecting clinical studies, systematic reviews, and other pertinent resources. Numerous studies have underscored an increased risk of complications during pregnancy for women with IBD, including preterm birth, low birth weight, neonates small for gestational age, and congenital malformations. Nevertheless, it's evident that proactive disease management before and throughout pregnancy can mitigate these risks. Continuation of IBD treatment during pregnancy and breastfeeding is deemed safe with agents like thiopurines, anti-TNF, vedolizumab, or ustekinumab. However, there's a call for caution when combining treatments due to the heightened risk of severe infections in the first year of life. For small molecules, their use is advised against in both scenarios. Effective disease management, minimizing disease activity, and interdisciplinary care are pivotal in attending to women with IBD. The emphasis is placed on the continual assessment of maternal and infant outcomes and an expressed need for further research to enhance the understanding of the ties between IBD and adverse pregnancy outcomes.

P11.51.B STATUS EPILEPTICUS IN WHO GRADE 2 AND 3 DIFFUSE GLIOMA - PREVALENCE AND PREDICTORS

Abstract BACKGROUND Status Epilepticus (SE) is a potentially life-threatening and highly debilitating manifestation of diffuse glioma. Glioma-associated SE has yet been poorly studied; consequently, evidence-based recommendations for clinical management are scarce. Prevalence and predictors of SE might vary across the biomolecular heterogeneity of glioma. We aimed to determine the prevalence of SE in grade 2 and 3 diffuse glioma throughout the disease trajectory, and identify associated baseline determinants (BD) and short-term determinants (STD). MATERIAL AND METHODS We conducted a single-center retrospective cohort-study in a consecutive cohort of patients with WHO grade 2 and 3 glioma, diagnosed between 2010 and 2017. Candidate determinant variables included demographic, clinical and tumor-related variables at first surgery (BD) and epilepsy-associated variables immediately preceding the first SE after diagnosis (STD). Occurrence of BD and STD was correlated to (a) all occurrences of SE and (b) SE with in-hospital treatment separately. A within-patient comparison of STD-frequency between a 30-day hazard period and control period, defined relative to the index-SE, was executed. Univariable and multivariable logistic regression analyses were performed for both BD and STD. RESULTS SE occurred in one third of the total cohort (n=63/197). Nearly 14% had an in-hospital treated SE. We identified several baseline clinical and tumor-related correlates of SE in the univariable analyses, including central, parietal and occipital tumor localization, tumor grade, extent of resection and acute symptomatic seizure occurrence after first surgery. In the multivariable model for all SE, parietal tumor localization and acute symptomatic seizure occurrence after first surgery were associated with an increased risk of SE, whereas baseline Karnofsky Performance Score (KPS) and cognitive disorders were associated with a decreased risk; for in hospital-treated SE, the model was too underpowered for valid analyses. None of the STD were significant predictors of (in-hospital) SE. CONCLUSION One third of patients with grade 2 and 3 diffuse glioma developed a SE at any timepoint after diagnosis. Baseline parietal tumor localization, postsurgical acute symptomatic seizure occurrence, KPS and cognitive status were identified as independent determinants of SE. These explorative findings, if validated, could guide personalized risk stratification, patient counselling and therapeutic decision-making in the clinic.

A clinician's guide to gallstones and common bile duct (CBD): A study protocol for a systematic review and evidence-based recommendations.

Gallstones are one of the most common and costly diseases of the gastrointestinal tract and occur when a combination of deposits consisting of fat or minerals accumulate in the gallbladder or common bile duct (CBD). This paper provides a comprehensive review of gallstone epidemiology, diagnosis, and management, focusing on current clinical guidelines and evidence-based approaches. A systematic literature review gathered information from various sources, including PubMed, Trip, Google Scholar, Clinical Key, and reputable medical association websites. Keywords related to gallstones, CBD stones, cholelithiasis, choledocholithiasis, and guidelines were used to extract relevant recommendations. Expert consultations and consensus meetings localized the recommendations based on the target population and available resources. The paper discusses demographic factors, dietary habits, and lifestyle influences contributing to gallstone formation. Gallstones are categorized into cholesterol and pigment types, with varying prevalences across regions. Many individuals with gallstones remain asymptomatic, but complications can lead to serious and potentially life-threatening conditions. Diagnosis relies on history, physical examination, laboratory tests, and transabdominal ultrasound. Specific predictive factors help categorize patients into high, moderate, or low probability groups for CBD stones. Evidence-based recommendations for gallstone diagnosis and management are presented, emphasizing individualized treatment plans. Surgical interventions, nonsurgical treatments like oral litholysis with UDCA, and stenting are discussed. The management of gallstones in pregnant women is also addressed, considering the potential risks and appropriate treatment options during pregnancy.