Evidence-based Medicine Data Research Articles

Management of Chronic Heart Failure in Dialysis Patients: A Challenging but Rewarding Path.

Chronic heart failure (CHF) is a common complication and cause of death in dialysis patients. Although several clinical guidelines and expert consensus on heart failure (HF) in the general population have been issued in China and abroad, due to abnormal renal function or even no residual renal function (RRF) in dialysis patients, the high number of chronic complications, as well as the specificity, variability, and limitations of hemodialysis (HD) and peritoneal dialysis (PD) treatments, there are significant differences between dialysis patients and the general population in terms of the treatment and management of HF. The current studies are not relevant to all dialysis-combined HF populations, and there is an urgent need for high-quality studies on managing HF in dialysis patients to guide and standardize treatment. After reviewing the existing guidelines and literature, we focused on the staging and diagnosis of HF, management of risk factors, pharmacotherapy, and dialysis treatment in patients on dialysis. Based on evidence-based medicine and clinical trial data, this report reflects new perspectives and future trends in the diagnosis and treatment of HF in dialysis patients, which will further enhance the clinicians' understanding of HF in dialysis patients.

Guidelines for equipment and support for endoscopic examinations (part one)

The guidelines describe modern approaches to equipping and ensuring endoscopic examinations of the digestive and respiratory systems in accordance with the objectives of improving their quality, safety and efficiency. The focus is on improving endoscopic diagnostics of precancerous diseases and early cancer of the gastrointestinal tract and bronchi. Based on the analysis of evidence-based medicine data, modern conditions for equipping and ensuring endoscopic examinations from the minimum necessary to the expert level are provided, including conditions for integrating digital solutions into protocols and reports, including conditions for creating databases for artificial intelligence systems, as well as conditions for ensuring epidemiological safety in endoscopy. The guidelines are based on risk-oriented approaches and serve as a basis for an objective assessment and analysis of the risks of compliance of equipment and provision in endoscopy with modern requirements for the quality and safety of medical activities. The components of equipment and provision are presented in summary tables, which in practice can serve as checklists. Each component is also an evaluation parameter and can be assessed by qualitative (present or absent) and/or quantitative (% provision) indicators. The methodological recommendations are designed in accordance with the requirements of the current GOST R 6.30-2003: “Unified documentation systems. Unified system of organizational and administrative documentation. Requirements for the execution of documents” (updated on 05/25/2017), which states that this type of methodological product, based on positive experience, reveals the order and logic of setting up any methodology. The objectives of such documents include the promotion of the most effective and rational examples of practical actions applicable to a certain type of activity, according to which the terminology, style and volume of methodological recommendations are regulated.

Effectiveness and safety of drugs for the treatment of gastroparesis: evidence-based medicine data. Review

Gastroparesis is a motility disorder of the upper gastrointestinal tract, characterized by delayed emptying of the stomach from solid substances, in the absence of any mechanical signs of obstruction of the stomach or duodenum. The etiology of gastroparesis is heterogeneous, but there are three well‑known subtypes: diabetic, iatrogenic, resulting from upper gastrointestinal surgery or medication, and idiopathic gastroparesis. Despite recently updated guidelines for the management of patients with gastroparesis, this condition remains difficult to diagnose and treat. A recent systematic review and network meta‑analysis of randomized controlled trials (RCTs) evaluated the efficacy and safety of all drugs tested in patients with gastroparesis. The only FDA‑approved drug is metoclopramide, a dopamine D2 antagonist and weak 5‑HT4 agonist, which in gastroparesis is approved for a maximum of three months of treatment due to endocrine, cardiac, and neurologic side effects. The results of the conducted meta‑analysis confirmed the effectiveness of dopamine antagonists in gastroparesis. Domperidone has been the subject of a warning due to an increased risk of QT prolongation on the electrocardiogram, but pharmacoepidemiological data suggest that this is rare, and ventricular arrhythmia occurs only in 0.02% of patients treated with the drug. A meta‑analysis suggested that clebopride, another dopamine antagonist, is an effective drug for gastroparesis, ranking first among effects on global symptoms, although this was shown in only one RCT, and the drug is not yet available in many countries, including the USA. The tachykinin‑1 antagonists aprepitant and tradipitant ranked third and fifth, respectively, for effects on global symptoms of gastroparesis, but when examined for effects on global symptoms according to drug class, they ranked second. Although 5‑HT4 agonists have not been shown to be sufficiently effective, trials of velosetrag are ongoing, and prucalopride was superior to placebo in a one cross‑over study included in the meta‑analysis.

ДОКАЗАТЕЛЬНАЯ МЕДИЦИНА: ОЧЕВИДНЫЕ ДОСТОИНСТВА И СКРЫТЫЕ НЕДОСТАТКИ

The article covers basic information on the comparative evaluation of drugs efficacy and safety from the standpoint of both clinical experience and evidence-based medicine. It is emphasized that despite all its advantages evidencebased medicine does not contradict the "opinion-based medicine". There have been presented the basic rules for conducting randomized clinical trials referred to as the most modern method of evidence collection. The main criteria of evidence are described. At the same time, it is emphasized that evidence-based medicine has its drawbacks. The main of them - is inability to transfer the results obtained in a clinical trial to the treatment of all patients with the disease in question. The principle of comparing results between clinical trial and real-world data (RWD / RWE) is described – the project RCT DUPLICATE. The author’s opinion on the main drawbacks in conducting and reporting clinical trials is presented. A number of ethical issues in clinical trials is evaluated. The author claims that the selection of optimal treatment strategy for a particular patient should rely on combination of evidence-based medicine, clinical experience, and historical data as well.

Pharmacotherapeutic comparison of beta blockers (bisoprolol, carvedilol, nebivolol): focus on modern data of evidence-based medicine

Pharmacotherapeutic comparison of beta blockers (bisoprolol, carvedilol, nebivolol): focus on modern data of evidence-based medicine

TEACHING CLINICAL PHARMACOLOGY OF UNDERGRADUATE MEDICAL STUDENTS IN EUROPE: CURRENT TRENDS AND PROSPECTS. Review

Relevance. Among the professional competencies, a graduate of a medical faculty should not only determine drugs for the treatment of typical diseases, but also be able to correct errors in prescribing; warn, identify and report adverse drug reactions; advise patients on the correct intake of drug, etc., providing effective, safe and economically justified pharmacotherapy. These professional competencies are acquired when studying the discipline "Clinical pharmacology”.
 Objective – to consider the current data on teaching of the discipline "Clinical pharmacology" to students of medical faculties in European institutions of higher education.
 Methods. Analysis of data presented in PubMed using the keywords "clinical pharmacology", "undergraduate education", "medical".
 Results. Clinical pharmacology, as an educational discipline, is based on the data of evidence-based medicine and modern treatment standards, but at the same time teaches the personalized use of drugs (based on deep knowledge of pharmacokinetics and pharmacogenetics), while the patient receives the "right" drug, in the "right" dose, which allows you to minimize the risk of side effects and reduce adherence to therapy. Every £1 invested in clinical pharmacology saves £6 by reducing prescribing errors and adverse drug reactions, tackling polypharmacy and more.
 In 2018, European experts in clinical pharmacology and therapeutics reached a consensus on the key learning outcomes of students of medical faculties, - 34 competencies were developed (knowledge with 20 subcategories, skills with 11 subcategories, attitudes – with 3 subcategories), a plan for an integrated context-oriented European educational program in clinical pharmacology and therapy.
 Conclusions. The developed system of problem-oriented, integrated into the educational program of medicine, study of “Clinical pharmacology and therapy" in European institutions of higher education allows to ensure a uniform standard of prescription of drugs by graduates of medical faculties.

Cardiac rehabilitation and secondary prevention after acute myocardial infarction: a modern view on the problem

Cardiovascular diseases remain a heavy socioeconomic burden in the modern world, claiming up to four million lives annually, including one million of the Russian population. Most often, cardiovascular mortality is associated with chronic coronary heart disease and its complications. Despite the progress in the treatment of acute coronary syndrome in the acute disease phase, the problem of recurrent coronary events and associated adequate rehabilitation remains unresolved. Modern Russian and European recommendations for cardiovascular rehabilitation present the main directions of secondary prevention of myocardial infarction, which summarize the global and Russian evidence-based medicine data on the problem and are based on the principles of phasing, continuity, succession, and multidisciplinary approach to the patient management. This review focuses on the problems and shortcomings of secondary prevention and cardiac rehabilitation at the patient, doctor, and healthcare system levels. In addition, contemporary approaches to their elimination are described. The necessity and importance of individual training and informing patients and the formation of their sustainable commitment to a healthy lifestyle and therapeutic and preventive measures prescribed by modern guidelines on this issue are emphasized.

Риск-ориентированные подходы к эндоскопической диагностике рака ЖКТ в медицинских организациях первичного звена (на примере ГАУЗ СО ГБ № 1 г. Нижний Тагил)

Early detection of gastrointestinal cancer is an actual public health problem. The implementation of the modern endoscopic diagnostic methods based on the progressive digital technologies significantly reduce the risks of diagnostic errors and contributes to the effective solution of that problem. P u r p o s e : to clarify the possibilities of the early detection of gastrointestinal cancer by equipping the endoscopy unit of the city district hospital with the modern digital endoscopes, including devices with zoom functions – ZOOM. M a t e r i a l s a n d m e t h o d s . The article analyzes the statistical data of the work of the endoscopy unit of Nizniy Tagil State city hospital № 1 from 2013 to 2022 (except 2020–21, when the hospital was completely redesigned as a COVID-hospital). R e s u l t s . A clear relationship between the increase in the number of detected oncopathologies of the gastrointestinal tract and the modern technical equipment of the endoscopic units under the modernization of primary health care program in the Sverdlovsk region in 2021 is presented. Based on risk-based approaches and evidence-based medicine data, the importance expert-class equipment in the routine endoscopic practice in the primary healthcare district hospital for diagnosing gastrointestinal cancer at an early stage is shown. Modern approaches to optical endoscopic diagnostics are analyzed, as well as the potential risks of diagnostic errors associated with technical equipment and possible measures to reduce these risks for further improvement of primary endoscopic diagnostics aimed at detecting gastrointestinal cancer in the early stages are determined, the expediency of equipping endoscopic units of primary care medical organizations with endoscopes inreached magnification functions – ZOOM, as well as photo and video recording of digital images with the possibility of archiving, color printing and further expert analysis of endoscopic images. C o n s e q u e n c e . From the presented statistical data, it is clearly seen how with the improvement of the equipment quality, the detection of gastrointestinal cancer of various localizations is growing.

Analysis of the list and availability of medicines used for the treatment of atopic dermatitis in Ukraine

The prevalence of atopic dermatitis (AD) is growing rapidly among the population, treatment protocols need to be reviewed, taking into account evidence-based medicine data and the introduction of new drugs and new forms in the country's market.
 The aim of this study was to analyse the pharmaceutical component of treatment protocols in Ukraine, to conduct a comparative analysis of the list of medicines registered on the pharmaceutical market on 2022 (also in comparison with 2016). To determine the socio-economic affordability of TCGS for the treatment of AD at the regional level based on the availability ratio.
 The objects of the study were topical glucocorticosteroids (TGCS) preparations according to the State Register of Medicines of Ukraine and the online resource «Apteka online». Analysis methods: information analysis, content analysis, marketing analysis, systematization and generalization.
 The study of domestic protocols and the British recommendations for the treatment of AD showed that TGCS with evidence-based effectiveness are prescribed as first-line drugs, but domestic documents for the treatment of AD from 2016 need to be revised, taking into account actual evidence-based data. The results of this study of the TGCS assortment showed that as of February 1, 2022, there were 13 INN TGCS for the treatment of AD, corresponding to 104 trade names (TN) on the Ukrainian market. In 2016–2022, the assortment of TGKS increased in terms of TN by 10.6%, while imports grew by 16.1%, which indicates a positive trend in the segment. It was revealed that, compared with 2016, there is a negative trend of reducing the number of domestic producers of TCGS by 18.1%. Consequently, the share of imported TGCS preparations is 62.5%, which contributes to the growth of treatment costs.
 An analysis of the assortment of TKGS according to the dosage form of the release shows that the main share among domestic drugs is ointments for, and for imported drugs – cream, but very small amounts in the form of lotions, emulsions. It was found that two medicines are low available: methylprednisolone aceponate, bemethasone, medicines have an average availability: mometasone furoate, bemethasone (lotion). It was revealed that the majority of domestically produced drugs are available to patients. It has been established that the range of TGCS in the treatment of AD is import-dependent, 5 INNs are not available in domestic production.
 It has been substantiated that pharmacist should be aware of new TGCS, the features and duration of their administration in order to ensure good pharmaceutical care for the effective treatment of AD.

The Relevance of Skin Biopsies in General Internal Medicine: Facts and Myths.

IntroductionNon-dermatology medical specialties may refer patients for skin biopsies, searching for a particular diagnosis. However, the diagnostic impact of the skin biopsy is not clearly established. This article aims to assess the indications for, and evaluate the clinical relevance of, skin biopsies in non-dermatology medical specialties.MethodsA questionnaire was sent to 23 non-dermatology specialty departments in a university medical center, requesting a list of indications for skin biopsies, as well as to 10 staff dermatologists to collect the indications of skin biopsies requested by non-dermatology specialties. Once the indications were collected, a literature search was performed to evaluate their clinical value and relevance.ResultsEleven non-dermatology specialties provided a list of skin biopsy indications, to which staff dermatologists added seven more indications. A literature search revealed evidence-based medicine data for six diseases, that is, amyloidosis, peripheral autonomic neuropathy, Sneddon’s syndrome, intravascular lymphoma, sarcoidosis, and chronic graft-versus-host disease. Results were questionable concerning infectious endocarditis, acute graft-versus-host-disease, and the lupus band test. Skin biopsy were not evidenced as useful for the diagnosis of calciphylaxis, systemic scleroderma, Behçet’s disease, or hypermobile Ehlers–Danlos syndrome. For the diagnosis of Alport’s syndrome, pseudoxanthoma elasticum, and vascular Ehlers–Danlos syndrome, skin biopsy is currently outperformed by genetic analyses. For diagnoses such as Henoch–Schönlein purpura and Sjögren’s syndrome, skin biopsy represents an additional item among other diagnostic criteria.ConclusionThe usefulness of skin biopsy as requested by non-dermatology specialties is only evidenced for amyloidosis, peripheral autonomic neuropathy, Sneddon’s syndrome, intravascular lymphoma, sarcoidosis, chronic graft-versus-host-disease, Henoch–Schönlein purpura, and Sjögren’s syndrome.

Патогенетична терапія когнітивних розладів і деменції з доведеною ефективністю

Стаття присвячена проблемі когнітивних розладів. Докладно описана їх класифікація. Також надана характеристика деменції і зроблено акцент на питаннях медикаментозного лікування деменції на підставі даних доказової медицини.

Фитотерапия инфекционно-воспалительных заболеваний верхних дыхательных путей в амбулаторной терапевтической и общей врачебной практике

Acute respiratory infections (ARIs) are the most common reason of outpatient visits for internal medicine ambulatory care. As a rule, ARIs are induced by various serotypes of respiratory viruses that cause diseases with very similar clinical symptoms and, thus, it is impossible to make an accurate etiological diagnosis. At the same time, the therapeutic approaches are usually the same and include impact on different pathogenetic components of the inflammation process which, among other things, can be achieved by using herbal medicinal products known for a wide range of effects — immunomodulatory, antiseptic, antibacterial, antiviral and anti-inflammatory. The review is focused on the use of herbal medicines for the treatment of infectious & inflammatory upper airway diseases. The evidence-based medicine data have proven the efficacy and safety of phytomedicines, and therefore they can be administered for the treatment of acute rhinosinusitis and tonsillopharyngitis associated with acute viral respiratory tract infections, as well as within the combined therapy of recurrent and chronic diseases of the nose and paranasal sinuses. As shown, their use reduces the severity and duration of symptoms in patients with acute rhinosinusitis and tonsillopharyngitis. It is emphasized that herbal medications may have beneficial effects on microbiota composition of the pharynx, decreasing the pharyngeal mucosa contamination with true and opportunistic pathogens KEYWORDS: acute respiratory infections, upper airways, mucociliary clearance, tonsillopharyngitis, rhinosinusitis, phytotherapy. FOR CITATION: Stremoukhov A.A., Zaplatnikov A.L., Vlasova N.L., Smirnova M.A. Phytotherapy of infectious & inflammatory upper airway diseases in outpatient care and general practitioner settings. Russian Medical Inquiry. 2022;6(8):419–426 (in Russ.). DOI: 10.32364/2587- 6821-2022-6-8-419-426.

Current data of evidence-based medicine on laparoscopic gastrectomy for gastric cancer

<h3></h3> В систематическом обзоре представлены актуальные данные о лапароскопической дистальной резекции желудка (ЛДР) и лапароскопической гастрэктомии (ЛГ) по сравнению с открытыми оперативными вмешательствами. В результате поиска данных в базах EMBASE и Pubmed путем систематического разграничения было найдено 257 рандомизированных (РКИ) и нерандомизированных (не-РКИ) исследований, описанных в 1034 статьях. Проведен сравнительный анализ технических возможностей, интра- и послеоперационного периодов, онкологических результатов (R0, количество удаленных лимфатических узлов), осложнений и летальности, а также долгосрочного онкологического исхода между группами больных ранним и распространенным раком желудка. Всего найдено 10 РКИ и 6 не-РКИ (общее число пациентов 4329), которые исследовали ЛДР и ЛГ при раннем раке желудка (2010 лапароскопических и 2319 открытых операций). С точки зрения осуществимости, интраоперационного исхода, онкологических результатов, летальности и долгосрочного онкологического исхода существенных различий с открытыми операциями не обнаружено. У пациентов после ЛДР и ЛГ отмечено значительно более быстрое раннее послеоперационное восстановление с меньшим количеством осложнений. Однако продолжительность лапароскопических операций достоверно больше, чем открытых операций. При распространенном раке желудка в 6 РКИ (общее число пациентов 2806) не обнаружено существенной разницы между ЛДР (<i>n</i>=1410) и открытой операцией (<i>n</i>=1369). Уровень доказательности при исследовании ЛДР в группе больных распространенным раком желудка был ниже (2—, 2+). В настоящее время проведено 6 не-РКИ (общее число пациентов 1090: ЛГ — 539 и ОГ — 551), которые показали сопоставимые результаты с ЛДР. Тем не менее высококачественные РКИ пока недоступны. Лапароскопическая гастрэктомия по сравнению с открытой гастрэктомией характеризуется более ранним послеоперационным восстановлением при онкологической эквивалентности.

Вторичная профилактика у пациентов с ишемической болезнью сердца после реваскуляризации миокарда

Objective of the Review: Help the doctor in a conversation with the patient to additionally motivate him to follow the recommendations for secondary prevention in the period after myocardial revascularization. Key points. The article discusses the main risk factors that contribute to the progression of cardiovascular diseases (overweight and obesity, smoking, physical inactivity, depression and anxiety, dyslipidemia, diabetes mellitus, arterial hypertension), as well as various methods of secondary prevention after myocardial revascularization, based on modern data of evidence-based medicine: weight loss, regular physical training, psychopharmacotherapy, high adherence to drug therapy. Conclusion. Conducting secondary prevention measures is extremely important for patients after myocardial revascularization, since the progression of coronary artery atherosclerosis continues after surgery. Therefore, in the postoperative period, the likelihood of developing cardiovascular events, in particular, early periprocedural myocardial infarction, stent thrombosis, and late restenosis, remains. Optimal drug and non-drug preventive measures improve the quality of life and improve the prognosis in this category of patients. Keywords: ischemic heart disease, cardiovascular disease, secondary prevention, myocardial revascularization, healthy lifestyle.

Modern strategies of antithrombotic therapy in patients with multifocal atherosclerosis

The manuscript is devoted to the problem of selection of antithrombotic therapy in the management of patients with multifocal atherosclerosis. The leading role of cerebrovascular pathology in the structure of mortality and causes of disability is noted. The questions of etiology and pathogenesis of acute cerebrovascular accident are considered. The pathogenetic subtypes of ischemic stroke and the criteria for their diagnosis were analyzed. The important role of antithrombotic therapy in the prevention of noncardioembolic stroke is presented. Considering the evidence-based medicine data based on the analysis of randomized trials results, modern strategies of antithrombotic therapy were demonstrated. A comparative analysis of the clinical trials results was carried out. New ideas about the benefits of combination therapy with acetylsalicylic acid at a dose of 100 mg/day and with rivaroxaban 2.5 mg twice daily, established in the COMPASS study, are presented.

Sleep-related breathing disorders in patients with heart failure: current aspects of treatment. Part II

The second part of the review highlights treatments for different types of sleep apnea in patients with heart failure. In both obstructive and central sleep apnea, ventilatory support during sleep takes a special place in treatment. Therefore, the review details the role of different ventilation modes (in particular, CPAP therapy and adaptive servo-ventilation), analyzes available evidence-based medicine data. The role of low-flow oxygen therapy, surgical treatment, implantable devices, specific therapy (theophylline, acetazolamide) in the treatment of central sleep apnea is also shown, and a novel method of treating central sleep apnea is considered — phrenic nerve stimulation.

Фармакологічна корекція стрес-індукованих вегетативних порушень та інсомнії у дітей

У статті наведено механізми розвитку стрес-індукованої вегетативної дисфункції й інсомнії. Обговорюється можливість застосування при даних станах комплексного препарату Сілента. Детально розглядаються фармакодинаміка його компонентів і дані доказової медицини щодо їх застосування. Описано механізми стрес-лімітуючої дії магнію (антагонізм щодо глутаматного рецептора) та L-триптофану (джерело утворення нікотинамідних коферментів, серотоніну й мелатоніну). Комбінація екстрактів квіток ромашки аптечної, листя меліси лікарської, суцвіть липи широколистої гармонізує баланс збудливих і гальмівних процесів у центральній нервовій системі; зменшує психоемоційне напруження, дратівливість, тривожність, страхи, психовегетативні прояви та інсомнію.

Проблема боли в нижней части спины с позиции доказательной медицины

В статье рассмотрены актуальность и распространенность проблемы боли в нижней части спины, описаны факторы риска данной патологии. С позиции доказательной медицины, с опорой на данные современных клинических руководств и исследований освещены особенности диагностического подхода, дифференциальной диагностики и терапевтических вмешательств при боли в нижней части спины в зависимости от ее длительности и течения.

SARS-CoV-2 and pediatric encephalopathy: Google analytics and predictive modeling

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is rare in children and possesses distinctive clinical features. Aims and Objectives: The primary objective is to bring clinicians,’ researchers,’ and epidemiologists’ attention to pediatric encephalopathy as part of the clinical manifestations of SARS-CoV-2 in children. Materials and Methods: Google analytics aimed to explore the spatial-temporal (geographic-chronological) mapping of SARS-CoV-2 in conjunction with pediatric encephalopathy and encephalitis. We retrieved longitudinal data from Google Trends, for one year starting from December 2019, by deploying five search topics; “SARS-CoV-2,” “Coronavirus disease 2019, COVID-19” “Pediatric Encephalopathy,” “Pediatric Encephalitis,” and “Encephalitis in Children.” Results: Spatio-temporal mapping was most conclusive for “COVID-19” and “Severe acute respiratory syndrome coronavirus 2.” Internet users were least interested in topics related to pediatric encephalopathy and encephalitis in children; potentially, reflecting the rarity of these entities in SARS-CoV-2 infections in children. We are also reporting a case of atypical SARS-CoV-2 in an 8-year-old child, in which pediatric encephalopathy occurred in a PCR-confirmed COVID-19 case. Conclusion: Google analytics reconciled with the case report. SARS-CoV-2 in children may present with neurological rather than respiratory manifestations, which is atypical and rare. We are conveying two key messages; (1) pediatricians can collaborate with data scientists to realize evidence-based pediatric medicine and (2) digital data are worthy of exploration to guide subsequent rigor research, including randomized controlled trials and meta-analytics.

Evolution of Clinical Trials in Ovarian Cancer Management over the Past 20 Years: Never Settle Down, Always Go Beyond.

Purpose A practice synthesis of available evidence-based medicine data in ovarian cancer (OC), aiming to provide directions for future research. Materials and Methods We performed a systematic review. PubMed was searched for relevant OC trials between January 2000 and December 2019. Results Out of 865 references screened, 199 trials were found eligible for inclusion. Most trials were multicenter (83.9%). There was a trend reduction in the number of patients enrolled/per study over the years. Studies testing targeted/biological therapies dominated the second decade (60 trials in 2010–2019 versus 2 trials in 2000–2009). The proportion of trials with positive survival and clinical outcomes significantly increased from 23.8% in early 2000s to 54.1% in the last 5 years. Trials with histology/molecular biomarker criteria were more likely to meet progression-free survival endpoint than those without these selection criteria (69.2% versus 32.6%). Conclusion This systematic review suggests a trend of increased positive studies, mainly linked to precision medicine.