Original Research Studies Research Articles

Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria

Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria Abstract: Objective: The suppression of physiological puberty using puberty-blocking pharmacological agents (PB) and prescribing cross-sex hormones (CSH) to minors with gender dysphoria (GD) is a current matter of discussion, and in some cases, PB and CSH are used in clinical practice for this particular population. Two systematic reviews (one on PB, one on CSH treatment) by the British National Institute for Clinical Excellence (NICE) from 2020 indicated no clear clinical benefit of such treatments regarding critical outcome variables. In particular, these two systematic NICE reviews on the use of PB and CSH in minors with GD detected no clear improvements of GD symptoms. Moreover, the overall scientific quality of the available evidence, as discussed within the above-mentioned two NICE reviews, was classified as "very low certainty" regarding modified GRADE criteria. Method: The present systematic review presents an updated literature search on this particular topic (use of PB and CSH in minors with GD) following NICE principles and PICO criteria for all relevant new original research studies published since the release of the two above-mentioned NICE reviews (updated literature search period was July 2020-August 2023). Results: The newly conducted literature search revealed no newly published original studies targeting NICE-defined critical and important outcomes and the related use of PB in minors with GD following PICO criteria. For CSH treatment, we found two new studies that met PICO criteria, but these particular two studies had low participant numbers, yielded no significant additional clear evidence for specific and clearly beneficial effects of CSH in minors with GD, and could be classified as "low certainty" tfollowing modified GRADE criteria. Conclusions: The currently available studies on the use of PB and CSH in minors with GD have significant conceptual and methodological flaws. The available evidence on the use of PB and CSH in minors with GD is very limited and based on only a few studies with small numbers, and these studies have problematic methodology and quality. There also is a lack of adequate and meaningful long-term studies. Current evidence doesn't suggest that GD symptoms and mental health significantly improve when PB or CSH are used in minors with GD. Psychotherapeutic interventions to address and reduce the experienced burden can become relevant in children and adolescents with GD. If the decision to use PB and/or CSH is made on an individual case-by-case basis and after a complete and thorough mental health assessment, potential treatment of possibly co-occurring mental health problems as well as after a thoroughly conducted and carefully executed individual risk-benefit evaluation, doing so as part of clinical studies or research projects, as currently done in England, can be of value in terms of generation of new research data. The electronic supplement (ESM) 1 is an adapted and abreviated English version of this work.

Data sources and applied methods for paclitaxel safety signal discernment.

Following the identification of a late mortality signal, the Food and Drug Administration (FDA) convened an advisory panel that concluded that additional clinical study data are needed to comprehensively evaluate the late mortality signal observed with the use of drug-coated balloons (DCB) and drug-eluting stent (DES). The objective of this review is to (1) identify and summarize the existing clinical and cohort studies assessing paclitaxel-coated DCBs and DESs, (2) describe and determine the quality of the available data sources for the evaluation of these devices, and (3) present methodologies that can be leveraged for proper signal discernment within available data sources. Studies and data sources were identified through comprehensive searches. original research studies, clinical trials, comparative studies, multicenter studies, and observational cohort studies written in the English language and published from January 2007 to November 2021, with a follow-up longer than 36 months, were included in the review. Data quality of available data sources identified was assessed in three groupings. Moreover, accepted data-driven methodologies that may help circumvent the limitations of the extracted studies and data sources were extracted and described. There were 39 studies and data sources identified. This included 19 randomized clinical trials, nine single-arm studies, eight registries, three administrative claims, and electronic health records. Methodologies focusing on the use of existing premarket clinical data, the incorporation of all contributed patient time, the use of aggregated data, approaches for individual-level data, machine learning and artificial intelligence approaches, Bayesian approaches, and the combination of various datasets were summarized. Despite the multitude of available studies over the course of eleven years following the first clinical trial, the FDA-convened advisory panel found them insufficient for comprehensively assessing the late-mortality signal. High-quality data sources with the capabilities of employing advanced statistical methodologies are needed to detect potential safety signals in a timely manner and allow regulatory bodies to act quickly when a safety signal is detected.

Exploring strategies for pet owners experiencing homelessness: A rapid scoping review

Abstract Approximately 10% of homeless individuals keep pets, but little information exists on specific interventions for this population. The aim of this rapid review is to describe what is currently known about intervention strategies for improving the health of homeless pet owners and their companion animals to identify knowledge gaps and inform future research and interventions. A database search of PubMed and Embase was conducted, and relevant articles were divided into primary research studies and “white papers” reporting proposed or attempted interventions, with each group analyzed separately. Common intervention strategies found across the literature were then summarized in narrative form. Nineteen articles fit the inclusion criteria, including 6 original research studies, 9 case reports and 4 narrative reviews. From analysis of these articles, 5 common intervention strategies emerged, including: (1) Free veterinary clinics, (2) Joint human/animal clinics, (3) Stigma reduction, (4) Interdisciplinary relationships and (5) Pet-friendly lodging. Studies on this population exhibited significant heterogeneity, and further program evaluation is needed to recommend intervention best practices. Joint human/animal clinics and interdisciplinary partnerships are promising avenues for evaluating interventions and improving health outcomes.

Systemic Antibiotic Use in Acute Irreversible Pulpitis: Evaluating Clinical Practices and Molecular Insights.

This scoping review systematically evaluates the use of systemic antibiotics in treating acute irreversible pulpitis, integrating clinical practice patterns with recent molecular insights. We analyzed clinical evidence on antibiotic prescription trends among dental professionals and examined molecular research advancements in relation to pulpitis. This review is intended to bridge the gap between clinical practice and molecular research, guiding more evidence-based approaches to treating acute irreversible pulpitis. Electronic databases were searched for relevant articles published in English based on the objective of the review. A second search using all identified keywords and index terms was undertaken across all the included databases. In addition, a reference list of identified articles was searched. Studies including original research, systematic reviews, meta-analyses, clinical trials, and observational and retrospective studies, all written in English and published from 2010 onwards, were included, and an analysis of the text words contained in the titles and abstracts of the retrieved papers and of the index terms used to describe the articles was performed. A total of N = 53 articles were selected. Altogether, N = 43 (76.79%) articles were cross-sectional studies, N = 4 (11.11%) were systematic reviews, and N = 3 (5.36%) were guidelines. The most frequent level of evidence was level VI (N = 43 (76.79%). The mean percentage of dentists who prescribed antibiotics to treat acute irreversible pulpitis was 23.89 ± 23.74% (range: 0.05-75.7). Similarly, for specialists, it was 22.41 ± 15.64 (range 2.2-50.4), and the percentage for undergraduates was 17.52 ± 20.59 (range 0-62.6). The significant developments in research models for pulpitis research and the characterisation of biomarkers have led to better management strategies. Concurrently, significant advancements in molecular research provide new understandings of pulpitis, suggesting alternative therapeutic approaches. Although there are guidelines available, increased rates of antibiotic prescription are still prevalent around the globe.

Advancements in cardiac structures segmentation: a comprehensive systematic review of deep learning in CT imaging.

Segmentation of cardiac structures is an important step in evaluation of the heart on imaging. There has been growing interest in how artificial intelligence (AI) methods-particularly deep learning (DL)-can be used to automate this process. Existing AI approaches to cardiac segmentation have mostly focused on cardiac MRI. This systematic review aimed to appraise the performance and quality of supervised DL tools for the segmentation of cardiac structures on CT. Embase and Medline databases were searched to identify related studies from January 1, 2013 to December 4, 2023. Original research studies published in peer-reviewed journals after January 1, 2013 were eligible for inclusion if they presented supervised DL-based tools for the segmentation of cardiac structures and non-coronary great vessels on CT. The data extracted from eligible studies included information about cardiac structure(s) being segmented, study location, DL architectures and reported performance metrics such as the Dice similarity coefficient (DSC). The quality of the included studies was assessed using the Checklist for Artificial Intelligence in Medical Imaging (CLAIM). 18 studies published after 2020 were included. The DSC scores median achieved for the most commonly segmented structures were left atrium (0.88, IQR 0.83-0.91), left ventricle (0.91, IQR 0.89-0.94), left ventricle myocardium (0.83, IQR 0.82-0.92), right atrium (0.88, IQR 0.83-0.90), right ventricle (0.91, IQR 0.85-0.92), and pulmonary artery (0.92, IQR 0.87-0.93). Compliance of studies with CLAIM was variable. In particular, only 58% of studies showed compliance with dataset description criteria and most of the studies did not test or validate their models on external data (81%). Supervised DL has been applied to the segmentation of various cardiac structures on CT. Most showed similar performance as measured by DSC values. Existing studies have been limited by the size and nature of the training datasets, inconsistent descriptions of ground truth annotations and lack of testing in external data or clinical settings. [www.crd.york.ac.uk/prospero/], PROSPERO [CRD42023431113].

Reviewing the interdecadal dynamics of micropollutants in the Tanzanian coastal zone from 2002 to 2022.

The Tanzanian coast is a vastly diversified ecosystem offering ecological, cultural, and economic services. However, anthropogenic and environmental stressors threaten its productivity and sustainability, prompting extensive research to understand the contamination extent, sources, and impacts. This review covers 77 original field research studies published between 2002 and 2022, focusing on the Tanzanian coastal area. A summary of information on the occurrences, levels, distributions, sources, and impacts of organic and inorganic micropollutants in environmental and biological compartments is provided. The studies were further discussed based on their research focus, where seven key areas were identified, which included the types of micropollutants analyzed, the parameters sampled, the locations investigated, and the crucial conclusions reached. The aim was to evaluate the research trends and identify gaps for future investigations. The studies reveal varying contamination levels, from low to severe, encompassing metals, persistent organic pollutants, pesticide residues, nutrients, and microbial contaminants. However, data gaps exist for micropollutant concentrations in ambient air, microplastics, pharmaceuticals, and emerging contaminants of concern. With increasing urbanization and socio-economic activities, the review emphasizes the necessity for solution-based research to remove and control micropollutants in the area. Addressing these challenges is crucial for sustaining the diverse ecological nature of this vital coastal system.

Prevalence of Bruxism in alcohol abusers: a systematic review conducted according to PRISMA guidelines and the cochrane handbook for systematic reviews of interventions

BackgroundBruxism, a common oral parafunctional behavior characterized by the grinding or clenching of teeth, is a multifactorial condition with potentially detrimental effects on oral health and overall well-being. In recent years, there has been growing interest in understanding the relationship between bruxism and alcohol abuse, as both are prevalent issues that may share underlying factors and exacerbate each other. This systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, aims to evaluate the frequency of bruxism among individuals with alcohol abuse.MethodsA comprehensive search of electronic databases, including PubMed, Lilacs, Scopus and Web of Science, will be conducted to identify relevant studies published up to the knowledge cutoff date in January 2023. The search strategy will include keywords related to bruxism, alcohol abuse, and their synonyms. Inclusion criteria will encompass original research studies, such as observational, cross-sectional, cohort, and case-control studies, as well as clinical trials, that examine the relationship between bruxism and alcohol abuse. Two independent reviewers will perform the study selection, data extraction, and quality assessment, with discrepancies resolved by consensus.ResultsThe systematic review will present a summary of the identified studies, including the study design, characteristics of the study populations, and key findings related to the association between bruxism and alcohol abuse. The potential mechanisms underlying this relationship will also be explored. Subgroup analyses and the quality of evidence will be assessed. Finally, the implications of this association for clinical practice and further research will be discussed.ConclusionsThis systematic review will contribute to a better understanding of the interplay between bruxism and alcohol abuse, shedding light on potential risk factors, mechanisms, and clinical implications. The findings may have significant implications for the prevention, management, and treatment of bruxism, particularly in individuals with a history of alcohol abuse.

Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care

Globally, health care systems face challenges in managing health care costs while maintaining access to hospital care, quality of care, and a good work balance for caregivers. Electronic consultations (e-consultations)-defined as asynchronous, consultative communication between family physicians and hospital specialists-may offer advantages to face these challenges. To provide a quantitative synthesis of the association of e-consultation with access to hospital care and the avoidance of hospital referrals. A systematic search through PubMed, MEDLINE, and Embase was conducted. Eligible studies included original research studies published from January 2010 to March 2023 in English, Dutch, or German that reported on outcomes associated with access to hospital care and the avoidance of hospital referrals. Reference lists of included articles were searched for additional studies. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scores were assigned to assess quality of evidence. The search strategy resulted in 583 records, of which 72 studies were eligible for data extraction after applying exclusion criteria. Most studies were observational, focused on multispecialty services, and were performed in either Canada or the US. Outcomes on access to hospital care and the avoidance of referrals indicated that e-consultation was associated with improved access to hospital care and an increase in avoided referrals to the hospital specialist, although outcomes greatly differed across studies. GRADE scores were low or very low across studies. In this systematic review of the association of e-consultation with access to hospital care and the avoidance of hospital referrals, results indicated that the use of e-consultation has greatly increased over the years. Although e-consultation was associated with improved access to hospital care and avoidance of hospital referrals, it was hard to draw a conclusion about these outcomes due to heterogeneity and lack of high-quality evidence (eg, from randomized clinical trials). Nevertheless, these results suggest that e-consultation seems to be a promising digital health care implementation, but more rigorous studies are needed; nonrandomized trial designs should be used, and appropriate outcomes should be chosen in future research on this topic.

Team-based learning (TBL) in clinical disciplines for undergraduate medical students—a scoping review

BackgroundTeam-based learning (TBL) is an evidence-based pedagogical method that has been used in undergraduate medical education since 2001. However, its use in clinical disciplines is rarely reported, and the impact of its implementation is not known. The aim of this study was to explore and map the published literature on the impact of implementing TBL in clinical disciplines in undergraduate medical education.MethodsA comprehensive search of Medline, Education Resources Information Center (ERIC), and Web of Science databases was performed on November 24, 2021 and updated April 6, 2023, using relevant Medical Subject Headings (MeSH) and free-text terms. Original research studies reporting on the implementation of TBL in clinical disciplines in undergraduate medical education published in peer-reviewed English language journals were included irrespective of their methodological design.ResultsThe initial search identified 2,383 records. Of these, 49 met the inclusion criteria. Most of the studies (n = 44, 90%) described the implementation of a modified version of TBL in which one or more TBL steps were missing, and one study had undefined protocol for the implementation. The most reported outcomes were knowledge acquisition (n = 38, 78%) and students’ satisfaction or attitudes toward TBL (n = 34, 69%). Despite some differences in their results, the studies found that implementing TBL is associated with increased knowledge acquisition (n = 19, 39%), student engagement (n = 6, 12%), and student satisfaction (n = 31, 63%).ConclusionsMost of the studies reported positive results in students’ satisfaction and students’ engagement, whilst the results on knowledge acquisition and retention were more contradictory. In most of the studies, TBL was implemented in a modified form and diverse comparators were used. The methodological quality also varied. Thus, no unequivocal conclusions could be drawn regarding the value of implementing TBL in clinical disciplines. More studies with rigorous methodologies are needed in this field.

Top cited articles in Oral Radiology: A bibliometric network analysis.

The present study aimed to identify and analyze the 100 top-cited articles published in oral radiology. Web of Science was used to conduct a comprehensive search from inception until 22 November 2023 in dental radiology. Basic information of the 100 top-cited articles was recorded. Biblioshiny and VOSviewer tools were employed for conducting thematic map and author keyword, title, and abstract terms analysis to elucidate the research trends and hotspots. Elsevier Scopus database was also used for citation comparisons. The citation count for the 101 most-cited articles ranged from 105-587. Most of them were original research studies with observational design conducted in diagnosis, dose, geometric measurements, and image analysis topics. Cone beam computed tomography was the most studied radiologic technique as author keyword co-occurrence analysis revealed and appeared as a basic theme for the transdisciplinary research field's development. While making infant steps, artificial intelligence was adequately represented in top cited list, as it received increasing citation numbers in very few years, concentrating the highest citation densities. Bibliometric analysis of the most affecting publications in oral radiology depicts the science's evolution and enhances the understanding of scientific research progress. Key words:Bibliometrics, citation analysis, oral radiology, top-cited.

A scoping review of qualitative studies on sexual and reproductive health and rights in Uganda: Exploring factors at multiple levels.

Uganda is burdened by high unintended and teen pregnancies, high sexually transmitted infections, and harm caused by unsafe abortion. Explore factors influencing sexual and reproductive health and rights (SRHR) in Uganda by synthesizing evidence from qualitative studies using a scoping review. Original qualitative peer-reviewed research studies published between 2002 and 2023 in any language exploring factors influencing SRHR in Uganda. Eight databases searched using qualitative/mixed methods search filters and no language limits. Information extracted included author, article title, publication year, study aims, participant description, data collection type, sample size, main findings, factors at the individual, interpersonal, community, and policy levels, implications for SRHR in Uganda, and study limitations. Quality of the selected articles was assessed using the Critical Appraisal Skills Programme tool. One hundred seventy-three studies met inclusion criteria. At the individual level, knowledge and attitudes toward SRHR, risky sexual behavior, and access to maternal SRHR services were identified as critical factors influencing health outcomes. Interpersonal factors included communication with sexual partners and relationships with family, school, and community members. Healthcare organization factors included adolescent access to education, SRHR services, and HIV prevention. Cultural and social factors included gendered norms and male involvement in SRHR. Policy-level factors included the importance of aligning policy and practice. Multiple factors at individual, interpersonal, community, healthcare, cultural, and policy levels were found to influence SRHR in Uganda. The findings suggest that interventions targeting multiple levels of the socio-ecological system may be necessary to improve SRHR outcomes. This review highlights the need for a holistic approach that considers the broader socio-ecological context. Reducing identified gaps in the literature, particularly between policy and practice related to SRHR, is urgently needed in Uganda. We hope this review will inform the development of policies and interventions to improve SRHR outcomes.

Epileptic Network Surgery: From Network Basis to Clinical Practice

Epilepsy is a common chronic neurologic disorder, with about 30%‐40% of patients suffering from recurrent seizures despite receiving enough antiseizure medication. Growing evidence of extensive structural and functional research has revealed that epilepsy is a network disorder, and the network investigation is crucial in the presurgical evaluation. This narrative review is aimed at providing an overview of the conceptual development of epileptic surgery, the epileptic network formation, and the network‐oriented strategy in clinical practice. We searched the PubMed database before October 2022 with no language or regional restrictions for studies of network exploration in epilepsy patients. The study eligibility criteria were original connectivity or network research studies using neuroimaging or neurophysiological approaches, focusing on seizure localization, neuropsychological evaluation, neuromodulation, or surgical prognosis. The initial search revealed 2046 studies. The selection process presented 746 papers that meet the inclusion criteria. The results indicated that epilepsy was characterized by the alternation of brain networks, which account for the clinical, electrographic, and neurocognitive phenomena related to human seizures and changes across different disease stages. Hubs have garnered significant attention due to their extensive connections, which make them prone to facilitating the spread of seizures to various brain regions. Unlike the seizure onset zone, the removal of the majority of these ictogenic nodes demonstrated a significant correlation with positive outcomes. Therefore, performing a network analysis during the epilepsy presurgical evaluation seems essential and will influence surgical decisions. It is hoped that studying the network of epilepsy will enhance our ability to determine the most appropriate surgical strategy for patients with epilepsy, thus contributing to success in terms of effective seizure control with maximal sparing or even improvement of brain functioning.

Aging and Olfactory Training: A Scoping Review.

Decreased olfactory function commonly occurs alongside the aging process. Research suggests olfactory training (OT) has the potential to improve olfactory and cognitive function in individuals with and without olfactory dysfunction. The degree to which these benefits extend into older age and among those with cognitive impairment (i.e., people with dementia and mild cognitive impairment) is less clear. The purpose of the current review was to investigate the extent to which OT affects olfactory function, cognition, and well-being among older people. A scoping review of the literature was conducted in PubMed, Embase, EbscoHost, and SCOPUS. Articles were considered eligible for original research studies with human populations, included adults aged 55 and older, performed any type of OT, and included a form of olfactory testing. The data from the included studies were synthesized and presented narratively. A total of 23 studies were included. The results suggest that OT provides multiple benefits to older adults, including those with cognitive impairment. Particularly, OT was associated with measurable changes in olfactory function, improved cognitive function, specifically semantic verbal fluency and working memory, reduced depressive symptoms, and protection from cognitive decline. The findings suggest that benefits from OT extend beyond changes in olfactory function and include improved cognitive function, amelioration of depressive symptoms, and protection from cognitive decline. Future research is needed across specific participant groups, including those with differentiated types of dementia, to investigate the olfactory and cognitive benefits of OT.

PERSPECTIVES OF GERIATRIC FELLOWS TOWARD SCHOLARLY ACTIVITY

Abstract Previous research conducted nearly two decades ago found that almost half of geriatricians published during their fellowships. About 17% of these geriatricians also indicated a need for further training in scholarly activity. However, it is unclear what barriers and facilitators to participating in scholarly activity geriatric fellows currently face. Our objective was to assess perceived barriers, facilitators, and attitudes toward scholarly activity among current geriatric fellows in ACGME-accredited programs. We conducted a survey of current geriatric fellows from September 2022 to November 2022. An online survey was emailed to geriatric fellows and geriatric program coordinators, when geriatric fellow emails were not publicly available, to assess fellows’ perceived barriers, facilitators, and attitudes toward scholarly activity. We used descriptive statistics to assess geriatric fellows’ perceptions of scholarly activity. Our sample (n=36) was mostly women (61.1%). The most common scholarly activities fellows planned to participate in during fellowship included quality improvement projects (80.6%), case report/series (44.4%), or original research studies (44.4%). The most common perceived major barriers reported were the short duration of fellowship (69.4%) and lack of training to conduct scholarly activity (58.3%). Lastly, about 44.4% of fellows reported being extremely or very enthusiastic and 50% reported being somewhat enthusiastic about participating in research during their fellowship. Most fellows reported plans for at least one type of scholarly activity and reported at least being somewhat enthusiastic about participating in research, however, barriers were identified. A follow-up email survey will be distributed at the completion of fellowship to assess changes in fellow perspectives.

#98 : Autologous Platelet-Rich Plasma Administration’s Efficacy in Patients with Low Ovarian Reserve: A Systematic Review and Meta-Analysis

Background and Aims: Autologous platelet-rich plasma (PRP) as a novel therapeutic approach has been utilized in multiple aspects of medicine because it contains stem cells and growth factors. There is still controversy over the effectiveness of this strategy in managing infertile women with low ovarian reserve due to the lack of evidence-based studies. This study aimed to systematically investigate and meta-analyze the best available evidence from clinical trials evaluating the impact of autologous platelet-rich plasma on low ovarian reserve. Methods: Systematic searches in electronic databases including PubMed, Cochrane, and Google Scholar use relevant search terms. We included infertile women with low ovarian reserve in single-arm clinical trials. Ovarian reserve parameters were measured before and after PRP injection into the ovaries. Data were extracted from each eligible study, then pooled (meta-analysis). The risk of bias (RoB) was evaluated using RoB 2 assessment tools. Results: Three hundred and one articles were collected and excluded, leaving six eligible studies, then classified into two subgroups: poor ovarian response (POR) and primary ovarian insufficiency (POI). Following PRP injection, infertile women showed an improvement in ovarian reserve. There was a significant increase in anti-Mullerian hormone (AMH) level (MD = 0.12, 95% CI [0.005; 0.23], I2=99%, subgroup differences p=0.33), a significant increase in antral follicle count (AFC) (MD = 1.88, 95% CI [0.86; 2.89], I2=93%, subgroup differences p=0.67), with a non-significant reduction in follicle-stimulating hormone (FSH) level (MD = 0.32, 95% CI [0.18; 0.46], I2=94%, subgroup differences p=0.02). According to the RoB’s assessment, the original research studies’ overall quality was a low risk of bias. Conclusions: Autologous platelet-rich plasma may increase AMH and AFC, but not FSH. Although it was discovered beneficial in enhancing ovarian reserve and effective for ovarian rejuvenation, further research with a large number of samples and strong evidence is still required.

Knowledge and attitude towards chronic musculoskeletal pain treated with osteopathy, a systematic review

Background: Chronic pain is a common clinical feature that accompanies osteopathy. Knowledge and attitudes of both patients and their treating clinicians would influence the patients’ outcomes and pain control. Objective: This systematic review will provide an understanding of the knowledge and attitudes of patients and clinicians towards musculoskeletal pain accompanying osteopathy. Method: Different keywords were used to search the medical literature, including: “knowledge” OR “Attitude” AND “Osteopathy” AND “Pain” AND “patient” OR “clinician.” The search databases included Medline, Embase PubMed, and SCOPUS. The following step was reviewing the results to ensure that they were original research articles that examined the knowledge and attitudes about chronic musculoskeletal pain with osteopathy. All the eligible studies needed to mention the type of participants examined (either patients or clinicians). Result: A total of 89 studies were obtained. After removing review articles and choosing original research studies solely, 11 studies appeared from the filtration process. Eight research articles were eligible. All the included studies had a quantitative cross-sectional design. Only health care professionals were asked about osteopathy, where all the studies included osteopaths from different countries, except one study that included physiotherapists. Osteopaths knew about the benefits of osteopathy, particularly for lower back pain; however, their knowledge about biopsychosocial factors requires improvement. Conclusion: Knowledge about osteopathy benefits for controlling chronic musculoskeletal pain should be improved even among osteopaths. Awareness campaigns about osteopathy are also needed for patients in orthopedic and physiotherapy clinics. Keywords: Knowledge, Attitude, Chronic pain, Musculoskeletal, Osteopathy.

Deep brain stimulation for chronic pain: a systematic review and meta-analysis

BackgroundDeep brain stimulation (DBS) has shown promise in effectively treating chronic pain. This study aimed to assess the efficacy of DBS in this context.MethodsWe conducted a systematic literature search using PubMed, Scopus, and Web of Science, following the PRISMA guidelines. A well-constructed search strategy was utilized. Our literature search identified two groups of subjects: one group underwent DBS specifically for chronic pain treatment (DBS-P), while the second group received DBS for other indications (DBS-O), such as Parkinson’s disease or dystonia, with pain perception investigated as a secondary outcome in this population. Meta-analysis was performed using R version 4.2.3 software. Heterogeneity was assessed using the tau^2 and I^2 indices, and Cochran’s Q-test was conducted.ResultsThe analysis included 966 patients in 43 original research studies with chronic pain who underwent DBS (340 for DBS-P and 625 for DBS-O). Subgroup analysis revealed that DBS-P exhibited a significant effect on chronic pain relief, with a standardized mean difference (SMD) of 1.65 and a 95% confidence interval (CI) of [1.31; 2.00]. Significant heterogeneity was observed among the studies, with an I^2 value of 85.8%. However, no significant difference was found between DBS-P and DBS-O subgroups. Subgroup analyses based on study design, age, pain diseases, and brain targets demonstrated varying levels of evidence for the effectiveness of DBS across different subgroups. Additionally, meta-regression analyses showed no significant relationship between age or pain duration and DBS effectiveness for chronic pain.ConclusionThese findings significantly contribute to the expanding body of knowledge regarding the utility of DBS in the management of chronic pain. The study underscores the importance of conducting further research to enhance treatment outcomes and elucidate patient-specific factors that are associated with treatment response.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=428442, identifier CRD42023428442.

Using machine learning or deep learning models in a hospital setting to detect inappropriate prescriptions: a systematic review

ObjectivesThe emergence of artificial intelligence (AI) is catching the interest of hospital pharmacists. A massive collection of health data is now available to train AI models and hold the promise...

Consensus on the diagnosis and management of patients with type 2 myocardial infarction: an international Delphi study

Abstract Background Type 2 myocardial infarction occurs due to a reduction in myocardial oxygen supply or an increase in demand without evidence of atherosclerotic plaque rupture. It is common representing around 20% of myocardial infarctions (1-4). Outcomes are poor with up to one third alive at five years, with cardiovascular outcomes comparable to type 1 myocardial infarction (1,5,6). Despite this, there are no evidence-based guidelines to guide assessment and management for clinicians. Purpose To gain consensus on the assessment and management of type 2 myocardial infarction from an international group of experts. Methods A systematic review of type 2 myocardial infarction was undertaken to identify the corresponding or senior author of all original research studies. We identified 73 experts from multiple clinical specialties. A three-round international eDelphi study was circulated, with round one consisting of open questioning to generate statements for deductive analysis. Consensus was defined a priori as >70% agreement on a 5-point Likert scale. Statements for which no consensus could be obtained were adapted and recirculated in round three (Figure 1). Results Of the 68 experts contacted there was a 56% (38/68), 54% (37/68) and 72% (49/68) response rate in round one, two and three, respectively. Consensus was achieved on 64% (43/67) of statements. Consensus varied across the following domains i) definition and diagnosis 42% (5/12), ii) risk stratification 75% (3/4), iii) assessment of coronary artery disease and cardiac function 50% (9/18), iv) specialty management 60% (6/10), v) treatment and secondary prevention 100% (9/9) and vi) communication and rehabilitation 79% (11/15). The panel agreed that all patients should undergo echocardiography (mean [SD] 2.08 [1.23]) and CT coronary imaging or a functional test should be performed on those with intermediate probability of future cardiovascular events (mean [SD] 1.81 [0.52]). Over 90% of the panel agreed that both patient and clinician understanding of type 2 myocardial infarction was poor and that further randomised controlled trials are need to direct care. Conclusion There remains uncertainty regarding the current definition of type 2 myocardial infarction and overall patient and clinician understanding was thought to be poor. However, it is generally accepted that the mainstay of management should be on the identification of coronary artery disease and left ventricular impairment with optimisation of therapies with proven benefit. Management should involve an individualised assessment and the multidisciplinary team.

Performance of tunnelled, non-cuffed central venous catheters in infants: A scoping review.

To summarise and critique existing knowledge and evidence relating to the utility, and post-insertion complications surrounding tunnelled non-cuffed central venous catheters (tncCVCs) in infants. A scoping review of original research studies reporting the use of, and post-insertion complications associated with, tncCVCs in infants was completed. MeSH terms were used to formulate a systematic search, and data were extracted using a customised data extraction form. Data were analysed descriptively across key themes based on the research questions. Study quality was evaluated using the Mixed Methods Appraisal Tool. The systematic search generated 3994 studies, of which 9 studies met final inclusion criteria. Studies included 644 tncCVCs in infants based in the USA, Europe and Australia. Most studies were retrospective cohort studies. The most common vein of insertion, where individually specified, was the internal jugular (n = 177). Tunnel length, where reported, was 2.5-5 cm. Infection rates were most commonly reported (eight studies), with results ranging from 0 to 12.8%, and device dislodgements of up to 20% reported. Participant follow-up and definition of complications varied greatly between studies. Study quality across all papers was sound. This review has identified only a small number of studies, with small participant numbers, reporting the performance of tncCVCs in infants. Definitions of complications measured varied significantly between studies, and vastly different patient follow-up protocols were reported. Further larger-scale studies on the performance of tncCVC, employing internationally recognised reporting standards is warranted to ensure clinicians can make informed choices for medication and infusion delivery.