Recent Evidence-based Recommendations Research Articles

Efficacy of Essential Oils in Relieving Cancer Pain: A Systematic Review and Meta-Analysis.

Over 80% of patients affected by cancer develops cancer-related pain, one of the most feared consequences because of its intractable nature, particularly in the terminal stage of the disease. Recent evidence-based recommendations on integrative medicine for the management of cancer pain underline the role of natural products. The present systematic review and meta-analysis aims at appraising for the first time the efficacy of aromatherapy in cancer pain in clinical studies with different design according to the most updated Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 recommendations. The search retrieves 1002 total records. Twelve studies are included and six are eligible for meta-analysis. The present study demonstrates significant efficacy of the use of essential oils in the reduction of the intensity of pain associated with cancer (p < 0.00001), highlighting the need for earlier, more homogeneous, and appropriately designed clinical trials. Good certainty body of evidence is needed for effective and safe management of cancer-related pain using essential oils by establishment of a step-by-step preclinical-to-clinical pathway to provide a rational basis for clinical use in integrative oncology. PROSPERO registration: CRD42023393182.

An Update on Antiphospholipid Syndrome.

To review the recent available evidence on epidemiology, pathogenesis, clinical phenotypes, and management of antiphospholipid syndrome (APS) and summarize potential future research perspectives. Accumulating evidence has further expanded our understanding of the disease, including new data about the incidence and prevalence of APS, novel pathways supporting the role of thrombo-inflammation in APS including platelet, monocyte and endothelial cell activation, pro-inflammatory cytokine and chemokine production, complement activation, neutrophil extracellular trap release, and type I interferon gene expression that could yield to new potential treatment targets, better identification of criteria and non-criteria clinical phenotypes, antiphospholipid antibody profiles and their associations with clinical outcomes, prognostic tools, and treatment strategies based on recent evidence-based recommendations for patients with thrombotic and obstetric APS, with or without systemic lupus erythematosus. Ongoing research efforts and international collaborations enhance our knowledge of this rare and often devastating syndrome and help improve patient care and health outcomes.

A Survey on Stretching Practices in Women and Men from Various Sports or Physical Activity Programs.

Recommendations for prescribing stretching exercises are regularly updated. It appears that coaches progressively follow the published guidelines, but the real stretching practices of athletes are unknown. The present study aimed to investigate stretching practices in individuals from various sports or physical activity programs. A survey was completed online to determine some general aspects of stretching practices. The survey consisted of 32 multiple-choice or open-ended questions to illustrate the general practices of stretching, experiences and reasons for stretching. In total, 3546 questionnaires were analyzed (47.3% women and 52.7% men). Respondents practiced at the national/international level (25.2%), regional level (29.8%), or recreationally (44.9%). Most respondents (89.3%) used stretching for recovery (74.9%) or gains of flexibility (57.2%). Stretching was generally performed after training (72.4%). The respondents also indicated they performed stretching as a pre-exercise routine (for warm-up: 49.9%). Static stretching was primarily used (88.2%) but when applied for warm-up reasons, respondents mostly indicated performing dynamic stretching (86.2%). Only 37.1% of the respondents indicated being supervised. Finally, some gender and practice level differences were noticed. The present survey revealed that the stretching practices were only partly in agreement with recent evidence-based recommendations. The present survey also pointed out the need to improve the supervision of stretching exercises.

Critically Ill Pediatric Oncology Patients: What the Intensivist Needs to Know? Pediatric Critical Care Medicine

Cancer is an evolving cause of morbidity and mortality in children worldwide. In recent decades, there has been a significant increase in the survival of children with cancer, after applying new methods and treatment protocols in practice. However, the complexity of the disease itself, as well as the intensity and toxicity of treatment is such that many children require admission to the pediatric intensive care unit (PICU) which should be well equipped and led by personnel who have adequate training and expertise to provide optimum care to these complex patients. Most oncology patients who require PICU admission categorized into oncological emergencies, and/or decompensation from treatment and its side effects. In this study, we provide a summary of the essential and most recent evidence-based recommendations from published reviews and articles to aid PICU physicians and to ensure the best treatment and outcome possible for the children with such disease.How to cite this article: Al Haj Moussa A, Maaz AUR, Faqih N, Sundaram M. Critically Ill Pediatric Oncology Patients: What the Intensivist Needs to Know? Pediatric Critical Care Medicine. Indian J Crit Care Med 2020;24(12):1256–1263.

Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Antinfective Therapy.

Acute bone and joint infections (BJIs) in children may clinically occur as osteomyelitis (OM) or septic arthritis (SA). In clinical practice, one-third of cases present a combination of both conditions. BJIs are usually caused by the haematogenous dissemination of septic emboli carried to the terminal blood vessels of bone and joints from distant infectious processes during transient bacteraemia. Early diagnosis is the cornerstone for the successful management of BJI, but it is still a challenge for paediatricians, particularly due to its nonspecific clinical presentation and to the poor specificity of the laboratory and imaging first-line tests that are available in emergency departments. Moreover, microbiological diagnosis is often difficult to achieve with common blood cultures, and further investigations require invasive procedures. The aim of this narrative review is to provide the most recent evidence-based recommendations on appropriate antinfective therapy in BJI in children. We conducted a review of recent literature by examining the MEDLINE (Medical Literature Analysis and Retrieval System Online) database using the search engines PubMed and Google Scholar. The keywords used were “osteomyelitis”, OR “bone infection”, OR “septic arthritis”, AND “p(a)ediatric” OR “children”. When BJI diagnosis is clinically suspected or radiologically confirmed, empiric antibiotic therapy should be started as soon as possible. The choice of empiric antimicrobial therapy is based on the most likely causative pathogens according to patient age, immunisation status, underlying disease, and other clinical and epidemiological considerations, including the local prevalence of virulent pathogens, antibiotic bioavailability and bone penetration. Empiric antibiotic treatment consists of a short intravenous cycle based on anti-staphylococcal penicillin or a cephalosporin in children aged over 3 months with the addition of gentamicin in infants aged under 3 months. An oral regimen may be an option depending on the bioavailability of antibiotic chosen and clinical and laboratory data. Strict clinical and laboratory follow-up should be scheduled for the following 3–5 weeks. Further studies on the optimal therapeutic approach are needed in order to understand the best first-line regimen, the utility of biomarkers for the definition of therapy duration and treatment of complications.

Turkish Neonatal Society guideline on prevention and management of bronchopulmonary dysplasia.

Scientific and technological advances in perinatology and neonatology have led to an increased rate of survival and decreased incidences of various neonatal morbidities. However, the incidence of bronchopulmonary dysplasia has remained almost the same for years in very-low-birth-weight preterm infants. Although bronchopulmonary dysplasia is the leading cause of chronic respiratory morbidity in small preterms, no substantial improvement has been achieved in prevention and treatment strategies to date. Currently, postnatal very-low-dose corticosteroids, caffeine, and vitamin A seem to be the drugs of choice, and stem cell therapy appears to be the most promising treatment modality for the future. In this guideline, which was prepared by the Turkish Neonatal Society, recent evidence-based recommendations for the prevention and treatment of bronchopulmonary dysplasia are summarized.

Treatment of tardive dyskinesia with tetrabenazine or valbenazine: a systematic review

Up to 30% of patients taking antipsychotics may develop tardive dyskinesia (TD). Recent evidence-based recommendations demonstrate an unmet need for effective TD management. This systematic review was designed to update the evidence for TD treatment, comparing two vesicular monoamine transporter 2 (VMAT2) inhibitors, tetrabenazine and valbenazine. Of 487 PubMed/Embase search results, 11 studies met the review criteria. Valbenazine efficacy was demonstrated in rigorously designed clinical trials that meet the guidelines for AAN Class I evidence. Due to differences in study designs and a lack of standardized and controlled trials with tetrabenazine, a formal meta-analysis comparing the agents was not possible. However, valbenazine appears to have fewer side effects and a more favorable once-daily dosing regimen for the treatment of TD.

Critical Care of Brain Reperfusion.

Over the last few decades, the management of acute ischemic stroke has undergone significant advancements with the introduction of intravenous thrombolysis and more recently punctuated by the success of endovascular mechanical thrombectomy trials for large vessel occlusion. These advancements have transformed the practice of neurocritical care. In this review, we present a case-based discussion of common brain reperfusion techniques with an emphasis on complication recognition and management. The article encompasses recent evidence-based recommendations as well as some of our own institutional protocols.

Evidence-based medicine in the diagnosis and management of hand osteoarthritis

To outline the Diagnosis and Management of HOA depending essentially on the recent Evidence-Based Recommendations (EBR) and literature. EBR for the Diagnosis of HOA, according to: risk factors, clinical, subsets, differential diagnosis, images and laboratory tests, is mentioned in details with Levels of Evidence. Also EBR for the Management of HOA developed through three Delphi rounds, according to: general, non-pharmacological, pharmacological, invasive, surgical, with levels of evidence is given through the lecture. The results of 3 Delphi rounds, for Diagnosis: 108, for Management of HOA: 309 literature depending on Evidence-Based Medicine and Hierarchy with Levels of Evidence is presented. Pain relief, restoration of function remain the primary treatment objectives. These are best achieved by a combination of pharmacological & nonpharmacological treatment especially by application of PRM procedures. Surgery remains the last resort for restoration of function if all else fails.

Update on Newborn Bathing

The skin, along with other organ systems, makes rapid changes as the newborn moves from an intrauterine aquatic environment to an extrauterine atmospheric environment. Some of these changes include the development of an acid mantle and an increase in skin hydration.While skin care and bathing practices have traditionally been based on the patient’s culture, regional customs and anecdotal experience, recent evidence-based recommendations have been made and will be presented in this article (AWHONN, 2013). Hopefully, with further research and the incorporation of evidence-based recommendations into skin care of the infant, we will see improved skin health and a decrease in skin disease in infancy and childhood.

EAACI Food Allergy and Anaphylaxis Guidelines. Protecting consumers with food allergies: understanding food consumption, meeting regulations and identifying unmet needs.

Individuals suffering from IgE-mediated food allergy usually have to practise life-long food allergen avoidance. This document aims to provide an overview of recent evidence-based recommendations for allergen risk assessment and management in the food industry and discusses unmet needs and expectations of the food allergic consumer in that context. There is a general duty of care on the food industry and obligations in European Union legislation to reduce and manage the presence of allergens alongside other food hazards. Current evidence enables quantification of allergen reference doses used to set-up reliable food safety management plans for some foods. However, further work is required to include a wider variety of foods and to understand the impact of the food matrix as well as additional factors which affect the progression and severity of symptoms as a function of dose. Major concerns have been raised by patients, carers and patient groups about the use of precautionary 'may contain' labelling to address the issue of unintended presence of allergens; these therefore need to be reconsidered. New and improved allergen detection methods should be evaluated for their application in food production. There is an urgent requirement for effective communication between healthcare professionals, patient organizations, food industry representatives and regulators to develop a better approach to protecting consumers with food allergies.

Clinical Manual of Child and Adolescent Psychopharmacology, Second Edition

Back to table of contents Previous article Next article Communications and UpdatesFull AccessClinical Manual of Child and Adolescent Psychopharmacology, Second EditionSarah M. Fayad, M.D.Sarah M. FayadSearch for more papers by this author, M.D.Published Online:1 Mar 2013https://doi.org/10.1176/appi.ajp.2013.13010005AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail edited by McVoyMolly, M.D., and FindlingRobert L., M.D., M.B.A. Washington, DC, American Psychiatric Publishing, 2013, 484 pp., $79.00.Pediatric psychopharmacology is a highly controversial topic that has garnered significant attention. Much research has been conducted on this topic in recent years, and the field is rapidly changing. As such, many clinicians continue to search for a comprehensive, reliable, and up-to-date reference to turn to while in their busy clinics. Written and edited by leading experts in the field of child and adolescent psychiatry, the second edition of the Clinical Manual of Child and Adolescent Psychopharmacology is an excellent resource. This reference manual is replete with the most recent evidence-based recommendations for the treatment of children with emotional and behavioral disturbances. Each chapter contains a succinct review of the latest research, along with valuable tables and clinical pearls. There is also an ample reference section included in every chapter to provide the reader with additional reliable resources.The manual begins, quite appropriately, with a chapter that discusses developmental aspects of pediatric psychopharmacology. There are excellent tables that provide information on Food and Drug Administration (FDA)-approved indications and off-label use of specific medications. In addition, there are tables that detail the role of cytochrome P450 enzymes and their relationship with these agents. Most importantly, the author of this section discusses safety, ethical issues, and regulatory aspects associated with prescribing psychotropic medications in this vulnerable population.Following this, the manual is then aptly separated into chapters based on diagnosis. There are specific chapters on attention deficit hyperactivity disorder, disruptive behavior disorders and aggression, anxiety disorders, major depressive disorder, bipolar disorder, autism and other pervasive developmental disorders, tic disorders, and early schizophrenia and psychotic illnesses.Each of these chapters provides especially useful tables about the pharmacologic agents discussed, and frequently there is discussion about their use in acute, continuation, and maintenance treatment. The tables also provide starting doses, typical doses, and duration of action. There are data regarding randomized controlled trials that are expertly summarized. In the chapter on pediatric bipolar disorder, there is an excellent table that details common side effects and then provides intervention strategies. Another nice feature seen in this manual is the discussion of the importance of nonmedication interventions and the role of the family, support groups, parent management training, and specific types of psychotherapy.Two particularly helpful chapters are that of major depressive disorder and autism and other pervasive developmental disorders. Each of these topics has been somewhat contentious for various reasons. In recent years, antidepressants have been closely examined in the child and adolescent population due to an increased risk of suicidal ideation and behavior. This manual provides an exceptional discussion about the use of these medications in this age group. The authors address the increased risk of spontaneously reported suicide adverse events and provide expert guidance on how to interpret the findings and assess the limitations from the FDA-sponsored meta-analysis. The chapter on autism and other pervasive developmental disorders guides readers toward innovative pharmacologic treatment strategies based on target symptoms, such as irritability, motor hyperactivity, and inattention and repetitive behaviors, while emphasizing the importance of a multimodal treatment approach.In summary, this manual is a particularly good resource for the busy, practicing clinician at a time in which new evidence is rapidly emerging in the field. It is heavily supported by relevant and up-to-date research and will serve to expertly guide clinicians as they treat a vulnerable population.Gainesville, Fla.Dr. Fayad is an Adjunct Clinical Postdoctoral Fellow in psychiatric neuromodulation, Department of Neurology, University of Florida, Gainesville, Fla.The author reports no financial relationships with commercial interests. FiguresReferencesCited byDetailsCited ByNone Volume 170Issue 3 March 2013Pages 344-344 Metrics PDF download History Accepted 1 January 2013 Published online 1 March 2013 Published in print 1 March 2013

Exercise-Induced Dyspnea in College-Aged Athletes

Purpose: Shortness of breath or difficulty breathing during exercise is referred to as exercise-induced dyspnea (EID), and is a common complaint from athletes. The purpose of this study was to assess the prevalence of EID among college aged athletes and to explore the medical encounters, including diagnostic testing, arising from this complaint. Method: We surveyed intercollegiate (n=122) and club sport (n=103) athletes regarding their experience with EID, including medical diagnoses, diagnostic procedures, environmental factors, and treatment effectiveness. Results: Fifty-two percent of respondents (n=112) reported episodes of EID. Intercollegiate and club sport athletes did not differ in regard to the prevalence of EID, utilization of health provider services, or diagnoses. Sixty-six percent of respondents with EID reported a physician visit secondary to EID with resulting diagnoses of asthma, EIB, allergies, stress reaction, and vocal cord dysfunction, or a combination of two or more of these conditions. Less than 30% of those diagnosed with asthma and/or EIB reported a diagnosis based on a pulmonary function test. Conclusions and Recommendations: EID is a common, yet complex, condition that appears to be as prevalent in club sports as it is in intercollegiate athletics. Asthma and exercise-induced bronchospasm (EIB) are the most familiar diagnoses associated with EID, though many conditions present with similar symptoms. Objective diagnostic testing was not commonly reported among college-aged athletes with asthma or EIB in this study. This finding conflicts with recent evidence-based recommendations for objective testing for athletes with EID to ensure appropriate and effective treatment plans.

The rise of cholesterol testing: how much is unnecessary

Laboratory testing has increased dramatically over recent decades, which is a consequence particularly of repeat testing or monitoring, as either a response to treatment or follow-up. To assess rates of measurement of lipid levels (total cholesterol, high-density lipoprotein, triglyceride) for diagnosis and monitoring over the last 20 years. Audit of electronic database. A single region in the UK (Oxfordshire). Specimens from individual patients were matched over time. All tests that were the third or more in a 3-year period were considered to be for monitoring, while the first and second were considered to be for diagnosis. As recent evidence-based recommendations suggest that frequent monitoring of cholesterol may reflect measurement error rather than true changes, between one and three tests in each 3-year period were considered to be 'necessary'. Over the 20 years from 1987 there has been a more than 15-fold rise in the overall number of lipid tests requested. After a small decline in the early 1990s, testing rose steadily after publication of several large statin trials, particularly tests requested in primary rather than secondary care. Repeat testing (likely to be for monitoring) rose from 24% of tests (1993-1995) to 61% (2005-2007), with between 42% and 79% of tests in 2005-2007 possibly being unnecessary. Mean cholesterol values declined over time from 1996 onwards. In the last decade, the number of cholesterol tests performed in Oxfordshire has risen dramatically. Much of this appears to be for monitoring purposes rather than case finding or risk assessment. The majority of cholesterol tests requested may be unnecessary.

Evidenzbasierte Empfehlungen der „European League Against Rheumatism“ zur Diagnostik und Therapie der Gicht

Gout cannot be regarded a benign disease, as it is unfortunately often misunderstood. In view of the lack of recent evidence-based recommendations for the diagnosis and management of gout, the European League Against Rheumatism (EULAR) decided to commission a task force to develop such recommendations. A literature search was performed to comprehensively assess the clinical and epidemiological aspects, diagnostic tools, as well as effectiveness of therapeutic measures and the overall management. Subsequently, consensus among the participating experts should be achieved by applying a Delphi process. As a result of this project 10 recommendations for diagnosis of gout as well as 12 recommendations with respect to the management of the disease could be elaborated. Gout can be regarded as a disease with excellent prognosis in the light of the diagnostic and therapeutic possibilities available. However, this only holds true if all these possibilities are applied in the appropriate manner in daily routine. It constituted the primary goal of the EULAR project to deliver a substantial contribution to improve routine care of affected patients.

The primary prevention of heart disease in women through health behavior change promotion in primary care

Purpose To summarize recent evidence-based recommendations for physical activity promotion, dietary improvement, and tobacco cessation from the U.S. Preventive Services Task Force (USPSTF) and the Task Force on Community Preventive Services (CTF), and examine their applicability to the primary prevention of cardiovascular disease (CVD) in women through primary care interventions. Methods For the behaviors cited, USPSTF and CTF recommendations and their associated systematic evidence reviews (SERs) were retrieved. Individual articles from the USPSTF healthy diet and physical activity SERs that met our inclusion criteria were systematically examined to determine the applicability of this research to women. We supplemented findings from these sources with comprehensive federal research summaries and SERs from focused searches of systematic review databases relevant to primary CVD prevention in women through healthy behavior change. Main findings The USPSTF strongly recommends primary care interventions for tobacco cessation. Strong CTF recommendations for multicomponent systems supports for clinicians, telephone support for quitters, and reduced patient costs for effective cessation therapies guide complementary approaches to assist clinicians. The USPSTF recommends intensive behavioral dietary counseling by specialists for high-risk CVD patients, but found insufficient evidence to recommend for routine healthy diet or physical activity promotion in primary care. The evidence base for these recommendations generally applies to women. Better reporting of gender and minority subgroup outcomes will assist more in-depth understanding of potential differences in either the processes or outcomes of behavior change interventions. Conclusions Primary care clinicians, including obstetrician-gynecologists, can contribute to preventing CVD in women through implementing credible evidence-based recommendations for clinical interventions in tobacco and healthy diet. Researchers can further our understanding of gender-specific issues in healthy behavior interventions by reporting process and outcome data for gender and minority subgroups.