Primary Search Terms Research Articles

Obesity and pain: a systematic review.

The current systematic review considered research published within the 10 years preceding June 2019, dealing with the topic of obesity and pain. Within the context of the complex biological and behavioral interrelationships among these phenomena, we sought to identify gaps in the literature and to highlight key targets for future transdisciplinary research. The overarching inclusion criteria were that the included studies could directly contribute to our understanding of these complex phenomena. We searched PubMed/Medline/Cochrane databases dating back 10 years, using the primary search terms "obesity" and "pain," and for a secondary search we used the search terms "pain" and "diet quality." Included studies (n = 70) are primarily human; however, some animal studies were included to enhance understanding of related basic biological phenomena and/or where human data were absent or significantly limited. Our overall conclusions highlight (1) the mechanisms of obesity-related pain (i.e., mechanical, behavioral, and physiological) and potential biological and behavioral contributors (e.g., gender, distribution of body fat, and dietary factors), (2) the requirement for accurate and reliable objective measurement, (3) the need to integrate biological and behavioral contributors into comprehensive, well-controlled prospective study designs.

Effects of Excessive Screen Time on Neurodevelopment, Learning, Memory, Mental Health, and Neurodegeneration: a Scoping Review

Evidence suggests that chronic sensory stimulation via excessive exposure to screen time may affect brain development in negative ways. Excessive smartphone use may increase the risk of cognitive, behavioral, and emotional disorders in adolescents and young adults that also has the potential to increase the risk of early onset dementia in late adulthood. This scoping review assessed theoretical and empirical evidence for the relationships between excessive screen time and (i) neurodevelopment, (ii) learning and memory, (iii) mental health, (iv) substance use disorders, and (v) neurodegeneration. Using Halas et al.’s (BMJ Open, 5(1), 1–6; 2015) five-stage scoping review methodology, we systematically identified articles meeting the following inclusion criteria: published in English between January 1999–July 2019; human or animal subjects; primary and secondary sources including original research, systematic reviews, meta-analyses, scoping reviews, and narrative reviews. Primary search terms focused on “smartphone,” “mental health,” “substance use,” “neurodevelopment,” and “neurodegeneration”; secondary search terms focused on “social media,” “anxiety,” “cannabis,” and “dementia”. We analyzed 44 articles across 16 countries in this review. Each article corresponded to one of four research questions investigating screen time and mental health (n = 13), mental health and substance use (n = 8), chronic stress and development (n = 14), and chronic stress and neurodegeneration (n = 9). Overall increased screen time is associated with negative outcomes such as lowered self-esteem, increased incidence and severity of mental health issues and addictions, slowed learning and acquisition, and an increased risk of premature cognitive decline. Future directions to better inform public policy should expand research methodologies and explore the prolonged effects of excessive screen time on cognition and mental health in diverse populations and contexts.

Effect of probiotics supplementation on glucose and oxidative stress in type 2 diabetes mellitus: a meta-analysis of randomized trials.

The role of oxidative stress in pathogenesis of diabetes is well established. In addition, an association between gut microbiota and type 2 diabetes mellitus (T2DM) is widely observed in previously published reports. This meta-analysis critically examines the association between gut microbiota, and oxidative stress in T2DM. A systematic search for clinical trials was performed in PubMed, Web of Science and Scopus web databases up to 1 Jan 2019. Primary search terms include "microbiota", "diabetes", and "oxidative stress". Study was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. All clinical trials that compared the effects of probiotic supplementations with a control group using end points serum levels of fasting blood sugar (FBS), hemoglobin A1C (HbA1C) and oxidative stress biomarkers were included. Two independent researchers screened the data extracted from the relevant studies. The pooled standardized mean difference (SMD) was estimated using the random or fixed effects model. Heterogeneity among the studies was assessed using Q-test. Overall, 13 randomized clinical trials (RCTs) involving 840 subjects with T2DM were included in the meta-analysis. The analysis showed that probiotics intake resulted in significant improvement in serum levels of FBS [SMD: -0.35, 95% CI: (-0.59, -0.12)], total antioxidant status (TAS) [SMD: 0.33, 95% CI: (0.11, 0.55)], total glutathione (GSH) [SMD: 0.41, 95% CI: (0.26, 0.56)] and malondialdehyde (MDA) [SMD: -0.54, 95% CI: (-0.83, -0.26)]. No significant improvement was found in HbA1C [SMD: -0.06, 95% CI:(-0.82, 0.69)], and nitric oxide (NO) [SMD:-0.24, 95% CI:(-1.10, 0.62)] levels. It seems that gut microbiota can exert beneficial effects in diabetic patients via altering oxidative stress' biomarkers. The beneficial effect of gut microbiota however was modest on FBS and non-significant on HbA1C. These results need to be confirmed by conducting more reliable RCTs. CRD42019134905. Graphical abstract Flow diagram of the study selection process.

One- versus two-stage transposed brachiobasilic arteriovenous fistulae: A review of the current state of the art.

In the absence of suitable cephalic vein, the brachiobasilic vein complex represents the best option for arteriovenous access. However, the basilic vein is too deep to cannulate and requires transposition to be accessible. Transposition can be performed during fistula creation (single-stage BBTx) or at a second operation after initial fistula creation (two-stage brachiobasilic transposition (BBTx)). The best approach is unknown. A PubMed search using "Basilic vein transposition" as the primary search term was performed to identify articles addressing this controversy. Meta-analysis was then performed using those papers that provided the inspected data points with student's t-test used to compare maturation and patency rates between the groups. A total of 37 manuscripts were judged of adequate quality for analysis. Based on the available data, overall maturation rates, 1-year primary patency rates, and overall complication rates seem to be equivalent between single- and two-stage BBTx, while 1-year secondary patency is greater in the two-stage group (79% vs 85%). A large prospective randomized clinical trial with clear definitions of maturity, patency, and complications is needed to definitively answer the question of whether one strategy is better than the other.

Austere Foreign Body Injuries in Children and Adolescents: A Characterization of Penile, Rectal, and Vaginal Injuries Presenting to Emergency Departments in the United States From 2008 to 2017.

Pediatric foreign body (FB) injuries to the nasal, aural, and/or oral cavities are well documented. Description of austere foreign body (AFB) injuries involving the rectum, vagina, or penis eludes the current pediatric literature. Austere FBs can be difficult to identify and have the potential to cause serious consequences. We aim to characterize AFB injuries by children and adolescents presenting to emergency departments (EDs) in the United States. The National Electronic Injury Surveillance System was queried to include subjects aged 0 to 25 years using a primary search term for diagnosis of foreign body from the period of January 2008 to January 2017. The consumer product and the body part involved (ie, rectal, vaginal, penile) were analyzed. Taylor series linearization generated national estimates. A trend analysis was performed using the Cochrane Armitage test of trend. There were 27,755 (95% confidence interval, 21,170-34,338) national estimated childhood ED visits for suspected AFB injuries during 2008 to 2017 including an estimated 7756 vaginal FBs, 7138 penile FBs, and 8359 rectal FBs (RFBs). Over the timeline, there was a significant up trend in the frequency of annual RFBs (P < 0.01). Austere FB injuries appear to cluster around age of 7 years. Most AFB injuries are able to be treated and released from the ED. It appears that RFB injury frequencies are rising and tend to require more frequent admission. Providers must be vigilant in the diagnosis and management of these potentially hazardous injury types.

Aorto-atrial fistula formation and therapy.

Aorta-atrial fistulas (AAF) are a rare but complex pathological condition. These fistulas are characterised by aberrant blood flow between the aorta and either atrium. In the present manuscript, we present a comprehensive overview of the clinical characteristics, formation and treatment of this condition. A literature review was conducted using PubMed. Aorta-Atrial Fistula was used as the primary search term. The clinical presentation of AAF encompasses a wide range of signs and symptoms of heart failure including dyspnoea, chest pain, palpitations, fatigue, weakness coughing or oedema. Causes of fistulas can be congenital or acquired, whilst diagnosis is normally achieved via echocardiography or MRI. Due to the low incidence of AAF, no clinical trials have been performed in AAF patients and treatment strategies are based on expert opinion and consensus amongst the treating physicians. Uncorrected AAF may continue to impose a risk of progression to overt heart failure. The repair of an AAF can either be surgical or percutaneous. AAF is a relatively rare but very serious condition. Clinicians should consider the possibility of AAF, when a new continuous cardiac murmur occurs, especially in patients with a history of cardiac surgery or with signs of heart failure. Closure of the AAF fistula tract is generally recommended. Further studies are required to define optimal therapeutic strategies, but these are hindered by the rarity of the occurrence of this disorder.

A concept analysis of health literacy.

To propose a conceptual definition of health literacy incorporating system demands, burdens, and complexities that are a critical part of patients' level of health literacy. Health literacy is used frequently in health care and often is confused with patients' reading and comprehension levels. Walker and Avant's concept analysis method was used. Cochrane Library, Cumulative Index of Nursing and Health Literature, OVID, PubMed, EBSCO Host databases, and Google Scholar. The primary Search terms and MeSH terms used were health literacy, patient education, patient engagement, patient activation, health communication, health promotion, and nursing. Empirical and nonempirical articles published in English were reviewed. Ten systematic literature reviews were included. A new definition of health literacy is provided based on four components that include: system demands, burdens, and complexities; measurable components, processes and outcomes; the dynamic nature of health literacy; and demonstration of the direct relationship of informed decisions to informed actions. Defining attributes, antecedents, and consequences are identified. Implications for nursing practice, education, and research are given. Because health literacy is a dynamic and quickly changing concept, further exploration and evolution of the concept is warranted as empirical research and theoretical literature emerge.

Scientific evidence for the management of dentin caries lesions in pediatric dentistry: A systematic review and network meta-analysis.

BackgroundA systematic quantitative evaluation of the available evidence of the treatment for caries lesions in primary teeth that considers how different caries progressions lead to the need for distinct interventions might provide additional useful information for clinical evidence-based decision making. The aim of this systematic review and network meta-analysis was to verify the effect of the treatments on caries lesion arrestment (CLA) or the success rate (SR) of dentin caries lesion treatments in the primary teeth.MethodsA search was conducted using the MEDLINE/PubMed, Web of Science and Scopus databases through December 2017. The primary search terms used in combination were primary teeth, caries lesion and restoration. The grey literature was also screened, as were the reference lists of eligible studies. A search of prospective studies with at least 12 months of follow up that compared different techniques was performed. The exclusion criteria were the absence of a comparison group; no evaluation of different restorative techniques; the evaluation of other outcomes unrelated to this review; and the recruitment of specific patient. The risk of bias was evaluated by the tools: the Cochrane Handbook for Systematic Reviews of Interventions and ROBINS-I. A network meta-analyses and meta-analyses were conducted considering CLA or SR as outcomes according to the surface involved and the depth of progression.ResultsOf the 1671 potentially eligible studies, 15 were included. For occlusal surfaces, only two studies presented data regarding the outer half of the dentin, with conventional restorative treatment (CRT) using composite resin showing superior results; five studies presented data regarding the depth of caries lesions, and CRT with compomer resulted in the best results. Seven studies considered occlusoproximal surfaces, and the Hall technique showed the best SR among the evaluated treatments. Finally, two annual applications of silver diamine fluoride showed the best nonrestorative approach to arrest caries lesions on occlusal and smooth surfaces.Discussion/ConclusionsThe treatments for dentin caries lesions in primary teeth depend on the depth of progression and the surface involved. However, few of the included studies provided evidence to strongly recommend the best treatment option.OtherFunding: FAPESP; Systematic review registration number—PROSPERO CRD42016037784.

PRM125 - SYSTEMATIC REVIEW OF META-MODELING APPLICATIONS AND OPPORTUNITIES FOR ADVANCED ANALYSES WITH HEALTH ECONOMIC MODELS

Meta-models, also known as surrogate models or emulators, are used to negate runtime issues with analyzing computational demanding simulation models in several fields of research. This study aimed to create awareness of the potential of applying meta-modeling methods in health economics by providing an overview of previous meta-modeling applications in this context. A systematic literature search was performed on PubMed using primary search terms on meta-modeling, surrogate modeling, and emulators, combined with well-known, previously used terms on modeling, simulation, and health economics. Studies were initially assessed based on title and abstract, and subsequently based on full-text, and excluded if no meta-modeling methods were applied or if a meta-modeling study did not relate to: health economics, health logistics, or epidemiology. The sample was enriched by cross-referencing from the full text of the included publications. The final sample was analyzed to identify general study characteristics and meta-modeling specific information, such as the applied meta-modeling technique and design of experiments. Included publications (n=13) used meta-models to negate runtime issues with analyzing both cohort-based and patient-level simulation models. Performed analyses using meta-models included: model calibration (n=1, 8%), deterministic sensitivity analysis (n=4, 31%), probabilistic sensitivity analysis (n=1), value of information analysis (n=5, 38%), or optimization (n=1). Another reason to apply meta-modeling methods was to extrapolate a simulation model to other countries (n=1). Applied meta-modeling techniques varied considerably between studies, with linear regression being most frequently applied (n=7, 54%). Although it has great potential to enable computational demanding analyses of health economic models, meta-modeling in health economics is still in its infancy, as illustrated by the limited number of identified applications and the relatively simple meta-modeling methods applied. Comprehensive guidance specific to health economics is needed to provide modelers with the information and tools needed to unleash the full potential of meta-models.

Missing Evidence: Exploring Unpublished Trials in Victoria, Australia

Background: Clinical trial registries were established to improve the transparency and completeness of clinical trial reporting and a number of policies have been introduced to encourage or mandate their use. While prospective trial registration has been endorsed in Australia, there is currently no legal requirement for researchers to register or communicate findings from clinical trials. There has also been, to the best of our knowledge, no analysis previously undertaken on publication rates for clinical trials performed in Australia. Aim: We aimed to determine the proportion of clinical trials that remain 'unpublished' in Victoria, Australia´s second most populous state, between 2009 and 2013. Methods: We used data reported to Cancer Council Victoria's Cancer Trials Management Scheme (CTMS) between 2009 and 2013, to identify trials that had recruited a new patient or recorded any follow-up patient activity in the specified time period. Using this data, we conducted a systematic search of ClinicalTrials.gov , the Australia and New Zealand Clinical Trials Registry (ANZCTR), PubMed and Google for records of the trial. Trial registration numbers, acronyms and scientific titles were used as primary search terms. Results were characterized by type of publication (i.e., whether it was an accredited scientific paper or other) and source location. Results: Of the trials reported to the CTMS between 2009 and 2013, 777 trials were included in this investigation; the majority (58.8%) were randomized controlled trials (RCTs). Compared with previously published findings, communication of trial results in this study was high; 70% of trials published results in an accredited scientific journal and a further 10% in alternate form, such as a conference abstract or media release. Publication rates were higher for trials with a commercial sponsor (85%) compared with trials sponsored by a cooperative group (77%). Nearly 8% of trials in this study had not been registered on an international clinical trials register. Only 39% of unregistered trials had published results. Of the registered trials, those registered on ClinicalTrials.gov were more likely to be published (86%) compared with trials listed on ANZCTR (68%). Between 2009 and 2013 , 8% of trials registered on ClinicalTrials.gov , in our data set, were terminated; 70% of these trials published results. Conclusion: Although the rate at which clinical trial findings were published in Victoria was higher in this investigation compared with equivalent overseas data, trials registered on ClinicalTrials.gov were more likely to publish results than unregistered trials or trials registered on ANZCTR. This suggests a potential need for trial registration and publication guidelines in Australia, similar to that of the United States where the requirements and procedures for submitting registration and summary result information for clinical trials on ClinicalTrials.gov have been compulsory for the last decade.

The state of the science in paediatric pain management practices in low-middle income countries: An integrative review.

Examine the state of the science for pain management in children living in low-middle income countries (LMIC). Significant challenges exist in pain management for children living in LMIC. An integrative review was conducted using PRISMA guidelines for quality of reporting. Literature searches were completed using Medline, PubMed, Scopus, and CINAHL databases for publications between January 2006 and August 2016 using MeSH and primary search terms pain and LMIC. Full text publications were evaluated using GRADE criterion and methodology specific evaluation tools. Of 1510 publications identified, 31 met the criteria for inclusion. Data were categorized into three broad themes: (1) magnitude of the pain problem with subthemes describing the burden of and resources for paediatric pain management; (2) perceptions, experience, and practices for managing pain in children residing in LMIC with subthemes addressing health care providers, parent/caregiver and children, respectively; and (3) pain management practices with pain assessment and treatment strategies as subthemes. Current data on paediatric pain management in LMIC are limited with respect to describing the burden of pain, children's pain perceptions and experiences, and pain management practices. Rigorous investigations are needed to expand knowledge and address the pervasive problem of pain for children in LMIC.

Systematic Review of the Effectiveness of Hypnosis for the Management of Headache

Migraine is a complex neurological condition that causes a range of symptoms, the most common of which is a severe headache. The aim of this systematic review of the literature is to determine the efficacy of hypnosis in the treatment of migraine. A systematic search of 4 scientific databases was conducted using the primary search terms migraine, headache, hypnosis, and hypnotherapy. A total of 8 studies were identified that examined hypnotic techniques either alone or in combination with other nonpharmaceutical techniques, such as visual imagery, relaxation, and pain-displacement techniques. This study demonstrates that hypnotherapy and relaxation techniques are effective in reducing short- and long-term headache activity in migraine sufferers.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Anal Squamous Cell Cancers (Revised 2018).

The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Clinical Practice Guidelines Committee is composed of society members who are chosen

Bibliometric Analysis of Lean, Agile, and Leagile Supply Chains in Automobile Industry (1990 - 2017)

This article describes how organizations embrace various supply chain strategies aiming at effective and efficient performance outcomes for gaining competitive advantage. The authors conducted an extensive search for academic publications on lean, agile, and leagile (hybrid) supply chains in context with automobile industries, published since year 1990 in reliable repositories such as Google Scholar, Scopus and ResearchGate. None of these papers used bibliometric analysis on the topic. This paper systematically maps, publications on lean, agile, and legal strategies in automobile industry published during 1990–2017. A five-step process is followed, namely (i) defining appropriate search terms, (ii) initial search results, (iii) refinement of search results, (iv) initial data, statistics, and (v) data analysis; adopted for inclusion of relevant documents for publication and citation analysis. Selected documents include primary search term ‘automobile' along with associated secondary terms such as ‘lean', ‘agile', ‘lean and agile', and ‘leagile' as part of the title, abstract, or keywords. The analysis finds several documents on lean or agile strategies, but only one document exists on ‘leagile' paradigm. Maximum articles are contributed on engineering subjects followed by business, management and accounting and computer sciences. Large publication and high citation counts were observed for lean from United States and Chinese authors, whereas Indian authors contributed in agile studies. This article identifies areas of current research interests discussing crucial contributions by several authors' and provides potential directions for further research investigations in the field.

#Frailty: A snapshot Twitter report on frailty knowledge translation.

The objectives of this short report are to: (i) explore #Frailty Twitter activity over a six-month period; and (ii) provide a snapshot Twitter content analysis of #Frailty usage. A mixed-method study was conducted to explore Twitter data related to frailty. The primary search term was #Frailty. Objective 1: data were collected using Symplur analytics, including variables for total number of tweets, unique tweeters (users) and total number of impressions. Objective 2: a retrospectively conducted snapshot content analysis of 1500 #Frailty tweets was performed using TweetReach™ . Over a six-month period (1 January 2017-31 June 2017), there was a total of 6545 #Frailty tweets, generating 14.8 million impressions across 3986 participants. Of the 1500 tweets (814 retweets; 202 replies; 484 original tweets), 56% were relevant to clinical frailty. The main contributors ('who') were as follows: the public (29%), researchers (25%), doctors (21%), organisations (18%) and other allied health professionals (7%). Tweet main message intention ('what') was public health/advocacy (41%), social communication (28%), research-based evidence/professional education (24%), professional opinion/case studies (15%) and general news/events (7%). Twitter is increasingly being used to communicate about frailty. It is important that thought leaders contribute to the conversation. There is potential to leverage Twitter to promote and disseminate frailty-related knowledge and research.

Ethnobotany of Medicinal Plants Used to Treat Leishmaniasis in Ethiopia: A Systematic Review

Background: Leishmaniasis is an infectious tropical vector born disease imposing high burden in developing countries including Ethiopia. Its treatment is still using pentavalent antimonial which have been used for several years and prone to drug resistance. Other alternative drugs like amphotericin B also have horrible side effects. Therefore, new drugs are urgently needed and drug screening efforts should be encouraged. No review has been done that broadly indicates medicinal plants used to treat leishmaniasis. The aim of this review was to provide an overview of the Ethnobotany of medicinal plants used to treat leishmaniasis in Ethiopia. Materials and methods: Databases (Pub Med, Google Scholar, Research Gate, and Hinari) were searched for published articles on the Ethnobotany of medicinal plants used to treat leishmaniasis in Ethiopia without restriction in the year of publication or methodology. Some studies were also identified with manual Google search. Primary search terms were “Leishmania review”, “Leishmaniasis” “Ethiopia”, “medicinal plants” and “Ethnobotany”. Studies that did not contain full ethnobotanical data on to medicinal plants traditionally used to treat Leishmaniasis and plants which are out of flora list of Ethiopia were excluded from this review. Results: The database search produced a total of 206 articles. After adjustment for duplicates and inclusion and exclusion criteria, 11 articles were found appropriate for the review. Majority o the studies were qualitative in nature and some were mixed type. None of the medicinal plants traditionally used to treat leishmaniasis in Ethiopia are confirmed scientifically. Of the 28 plants identified from the various studies, 53.6% were herbs and the common plant part used was leaf (44.8%) followed by latex (20.7%). Majority of the plant remedies were given topically (75.7%). Cutaneous leishmaniasis comprises high percentage of leishmania infection treated by traditional medicinal plants. Conclusion: Varity of medicinal plants have been used by Ethiopian people of different cultures to treat leishmaniasis. Most of the plants were herbs and the commonly used plant part was leaf. Majority of prepared remedies were applied externally to the affected part. There is an urgent need to conduct clinical trials on such plants to support traditional claims and to analyze molecular and cellular mechanisms involved.

Hyperacusis in chronic pain: neural interactions between the auditory and nociceptive systems

Objective: Sensory disturbances are common in chronic pain patients. Hyperacusis can be an especially debilitating experience. Here, we review published work on how the auditory and nociceptive systems might interact in chronic pain syndromes to produce pain-hyperacusis. Design: Literature review. Study sample: The PubMed and Scopus databases were searched for relevant articles published between 2000 and 2017 using the primary search terms “hyperacusis”/“hyperacousis” and “pain”. Ten papers were found using this strategy. Supplementary sources were identified by browsing textbooks and the reference lists of identified articles. Results: The importance of central mechanisms in pain-hyperacusis was highlighted in the 10 selected papers. Hyperacusis is a significant but under-recognised symptom in conditions such as complex regional pain syndrome and fibromyalgia, and an integral feature of migraine. Conclusions: Nociceptive circuits become hypersensitive in acute and chronic pain; this sensitivity spreads from the periphery to spinal neurons and higher centres in the brain, leading to hyperalgesia or spontaneous pain even in the absence of peripheral nociceptive input. This “central sensitisation” may alter activity at sensory convergence points in the thalamus and brainstem centres such as the locus coeruleus, and give rise to hyperacusis in certain pain syndromes.

Self-medication practice in Ethiopia: a systematic review.

BackgroundSelf-medication patterns vary among different populations, and are influenced by many factors. No review has been done that comprehensively expresses self-medication practice in Ethiopia. The aim of this study was to provide an overview of the literature on self-medication practice in Ethiopia.Materials and methodsDatabases (PubMed, Google Scholar, ResearchGate, and Hinari) were searched for published studies on the practice of self-medication in Ethiopia without restriction in the year of publication or methodology. Some studies were also identified through manual Google search. Primary search terms were “self medication”, “Ethiopia”, “self care”, “non-prescription”, “OTC drug use”, “drug utilization”, and “drug hoarding”. Studies that measured knowledge only or attitude only or beliefs only and did not determine the practice of self-medication were excluded.ResultsThe database search produced a total of 450 papers. After adjustment for duplicates and inclusion and exclusion criteria, 21 articles were found suitable for the review. All studies were cross-sectional in nature. The prevalence of self-medication varied from 12.8% to 77.1%, with an average of 36.8%. Fever/headache, gastrointestinal tract diseases, and respiratory diseases were the commonest illnesses/symptoms for which self-medication was taken. The major reasons for practicing self-medication were previous experience of treating a similar illness and feeling that the illness was mild. Analgesics/antipyretics, antimicrobials, gastrointestinal drugs, and respiratory drugs were the common drug classes used in self-medication. Mainly, these drugs were obtained from drug-retail outlets. The use of self-medication was commonly suggested by pharmacy professionals and friends/relatives.ConclusionSelf-medication practice is prevalent in Ethiopia and varies in different populations and regions of the country. Some of the self-medication practices are harmful and need prompt action. Special attention should be given to educating the public and health care providers on the types of illnesses that can be self-diagnosed and self-treated and the types of drugs to be used for self-medication.

Evaluating the statistical methodology of randomized trials on dentin hypersensitivity management.

The present study aimed to evaluate the characteristics and quality of statistical methodology used in clinical studies on dentin hypersensitivity management. An electronic search was performed for data published from 2009 to 2014 by using PubMed, Ovid/MEDLINE, and Cochrane Library databases. The primary search terms were used in combination. Eligibility criteria included randomized clinical trials that evaluated the efficacy of desensitizing agents in terms of reducing dentin hypersensitivity. A total of 40 studies were considered eligible for assessment of quality statistical methodology. The four main concerns identified were i) use of nonparametric tests in the presence of large samples, coupled with lack of information about normality and equality of variances of the response; ii) lack of P-value adjustment for multiple comparisons; iii) failure to account for interactions between treatment and follow-up time; and iv) no information about the number of teeth examined per patient and the consequent lack of cluster-specific approach in data analysis. Owing to these concerns, statistical methodology was judged as inappropriate in 77.1% of the 35 studies that used parametric methods. Additional studies with appropriate statistical analysis are required to obtain appropriate assessment of the efficacy of desensitizing agents.

Molecular-Directed Treatment of Differentiated Thyroid Cancer: Advances in Diagnosis and Treatment.

Thyroid cancer incidence is increasing, and when fine-needle aspiration biopsy results are cytologically indeterminate, the diagnosis is often still established only after thyroidectomy. Molecular marker testing may be helpful in guiding patient-oriented and tailored management of thyroid nodules and thyroid cancer. To summarize available data on the use of molecular testing to improve the diagnosis and prognostication of thyroid cancer. A MEDLINE review was conducted using the primary search terms molecular, thyroid cancer, thyroid nodule, and gene expression classifier in search strings. Articles were restricted to those published between January 1, 2010, and June 1, 2015, inclusive of adult humans, and reported in the English language only. Of 867 titles screened, 67 articles were further identified for review of the full text. The 2 most studied molecular marker testing techniques for indeterminate thyroid nodules include gene expression classifier analysis and evaluation for somatic mutations or rearrangements that are commonly found in thyroid cancer (7-gene panel). Nodules with benign results on gene expression classifier analysis can be associated with less than a 5% risk of cancer and may be observed, while nodules with positive results on the 7-gene panel may have a higher risk of cancer (80%-100%) and definitive surgery can be recommended. However, cancer prevalence and geographic variations in histologic subtypes may affect accuracy and clinical applicability of both tests. Molecular marker tests such as ThyroSeq version 2.1 are more comprehensive, but they need further validation. Preoperative risk stratification using molecular markers also may be used to better define the optimal extent of thyroidectomy for patients with thyroid cancer. Molecular markers potentially can augment the diagnostic specificity of fine-needle aspiration biopsy to better differentiate cytologically indeterminate nodules that can be safely observed from cytologically indeterminate nodules that may be associated with differentiated thyroid cancer. Long-term follow-up data are still needed; in the end, patient preference regarding the relative risks and benefits of molecular testing is at the crux of decision making.