Review Of Use Research Articles

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes.

Direct access (DA) testing allows GPs to refer patients for investigation without consulting a specialist. The aim is to reduce waiting time for investigations and unnecessary appointments, enabling treatment to begin without delay. To establish the proportion of patients diagnosed with cancer and other diseases through DA testing, time to diagnosis, and suitability of DA investigations. Systematic review assessing the effectiveness of GP DA testing in adults. MEDLINE, Embase, and the Cochrane Library were searched. Where possible, study data were pooled and analysed quantitatively. Where this was not possible, the data are presented narratively. The authors identified 60 papers that met pre-specified inclusion criteria. Most studies were carried out in the UK and were judged to be of poor quality. The authors found no significant difference in the pooled cancer conversion rate between GP DA referrals and patients who first consulted a specialist for any test, except gastroscopy. There were also no significant differences in the proportions of patients receiving any non-cancer diagnosis. Referrals for testing were deemed appropriate in 66.4% of those coming from GPs, and in 80.9% of those from consultants; this difference was not significant. The time from referral to testing was significantly shorter for patients referred for DA tests. Patient and GP satisfaction with DA testing was consistently high. GP DA testing performs as well as, and on some measures better than, consultant triaged testing on measures of disease detection, appropriateness of referrals, interval from referral to testing, and patient and GP satisfaction.

General practitioner referrals to one-stop clinics for symptoms that could be indicative of cancer: a systematic review of use and clinical outcomes.

One-stop clinics provide comprehensive diagnostic testing in one outpatient appointment. They could benefit patients with conditions, such as cancer, whose outcomes are improved by early diagnosis, and bring efficiency savings for health systems. To assess the use and outcomes of one-stop clinics for symptoms where cancer is a possible diagnosis. Systematic review of studies reporting use and outcomes of one-stop clinics in primary care patients. We searched MEDLINE, Embase, and Cochrane Library for studies assessing one-stop clinics for adults referred after presenting to primary care with any symptom that could be indicative of cancer. Study selection was carried out independently in duplicate with disagreements resolved through discussion. Twenty-nine studies were identified, most were conducted in the UK and observational in design. Few included a comparison arm. A pooled comparison of the cancer conversion rate of one-stop and multi-stop clinics was only possible for breast symptoms, and we found no significant difference. One-stop clinics were associated with significant reductions in the interval from referral to testing (15 versus 75 days) and more patients diagnosed on the same day (79% versus 25%) compared to multi-stop pathways. The majority of patients and GPs found one-stop clinics to be acceptable. This review found one-stop clinics were associated with reduced time from referral to testing, increased same day diagnoses, and were acceptable to patients and GPs. Our conclusions are limited by high levels of heterogeneity, scarcity of comparator groups, and the overwhelmingly observational nature of included studies.

A Critical Review on Automated Test Case Generation for Conducting Combinatorial Testing Using Particle Swarm Optimization

In software development life cycle, testing plays the significant role to verify requirement specification, analysis, design, coding and to estimate the reliability of software system. A test manager can write a set of test cases manually for the smaller software systems. However, for the extensive software system, normally the size of test suite is large, and the test suite is prone to an error committed like omissions of important test cases, duplication of some test cases and contradicting test cases etc. When test cases are generated automatically by a tool in an intelligent way, test errors can be eliminated. In addition, it is even possible to reduce the size of test suite and thereby to decrease the cost & time of software testing.It is a challenging job to reduce test suite size. When there are interacting inputs of Software under Test (SUT), combinatorial testing is highly essential to ensure higher reliability from 72 % to 91 % or even more than that. A meta-heuristic algorithm like Particle Swarm Optimization (PSO) solves optimization problem of automated combinatorial test case generation. Many authors have contributed in the field of combinatorial test case generation using PSO algorithms.We have reviewed some important research papers on automated test case generation for combinatorial testing using PSO. This paper provides a critical review of use of PSO and its variants for solving the classical optimization problem of automatic test case generation for conducting combinatorial testing.

Review of use of Mysodelle as a method of induction of labour

Background: Mysodelle is a 200 mcg misoprostol, vaginal delivery system. It is a PGE1 analogue and accepted as a method of IOL by Scottish medicine consortium in 2014 (Medicines Health and Regulatory Authority; Wing et al., 2013).Aims: The main objective of this project was to determine efficacy of Mysodelle with regards to time interval between insertions to delivery. We also studied the safety profile of Mysodelle with regards to operative delivery rates, foetal concerns and incidence of hyperstimulation.Methodology: A protocol which outlined the criteria for suitability for the use of Mysodelle was developed. This method was used for IOL for primiparous women more than 38 weeks of gestations with unfavourable cervix and intact membranes with no foetal concerns on scan, i.e. suboptimal growth or reduced liquor. Mysodelle was left in situ for maximum duration of 24 hours and CTG was monitored every 4 hours. The data was collected prospectively over 1 year from January 2016.Results: We reviewed 50 women for the study period of one year. All women were primiparous with singleton term gestations between 38 + 5 weeks to term +11 days. The indications for IOL included postdates, reduced foetal movement, big baby and advanced maternal age. Following the use of Mysodelle, 55% of the women progressed to active labour and did not require oxytocin on labour ward. In 20% of the women, Mysodelle was removed for suspicious CTG or tachysystole. Four women failed IOL with Mysodelle. 14% women had hyperstimulation response to Mysodelle and needed terbutaline. 46% women had spontaneous vaginal delivery and 24% needed instrumental delivery. Remaining 30% patients delivered by caesarean section. The median time from Mysodelle administration to vaginal delivery was 21 hours (95% confidence interval 18.8–26.8 hours). There were no neonatal adverse outcomes.Conclusions: Results at AMH overall are in keeping with those from EXPEDITE study (Wing et al. 2013). It was found to be more efficacious in terms of insertion to delivery time, however, was associated with more tachysystole and hyperstimulation requiring terbutaline as previously highlighted in Cochrane review (Alfirevic and Weeks 2006; Hofmeyr et al. 2010). There was no increased risk of operative delivery or adverse neonatal outcome with the use of Mysodelle. A reduction in time to vaginal delivery and time to active labour associated with misoprostol vaginal delivery system may be an advantage for patients and the service (ISD Scotland 2013), but it needs to be seen if this benefit is offset due to increased requirements for foetal monitoring due to uterine tachysystole and hyperstimulation. MHRA have advised that Mysodelle can cause uterine tachysystole, that might not respond to tocolytic treatment. (MHRA medicine update 2018).

Does my child really need a CT Scan? A retrospective review of use of CT Scan in minor head trauma

Does my child really need a CT Scan? A retrospective review of use of CT Scan in minor head trauma

Complementary and Integrative Therapies in Psychiatry

Complementary and Integrative Therapies in Psychiatry

The efficiency of topical anesthetics as antimicrobial agents: A review of use in dentistry.

Topical anesthetics are commonly used in oral & maxillofacial surgery to control pain in the oral cavity mucosa before local anesthetic injection. These anesthetic agents come in many forms, developed for different usages, to minimize adverse reactions, and for optimal anesthetic efficiency. Earlier studies have revealed that these agents may also limit the growth of microorganisms in the area of anesthetic application. Many topical anesthetic agents show different levels of antimicrobial activity against various bacterial strains and Candida. The dosage of local anesthetic agent used in some clinical preparations is too low to show a significant effect on microbial activity. Efficiency of antimicrobial activity depends on the local anesthetic agent's properties of diffusion within the bloodstream and binding efficiency with cytoplasmic membrane, which is followed by disruption of the bacterial cell membrane. The antimicrobial properties of these agents may extend their usage in patients to both control pain and infection. To develop the topical local anesthetic optimal usage and antimicrobial effect, a collaborating antiseptic agent may be used to benefit the local anesthetic. However, more research is required regarding minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of topical local anesthetic agents with drug interaction between anesthetics and antiseptic agents.

Review of Use and Integration of Mobile Apps Into Psychiatric Treatments.

Mental health practitioners should understand the features of current, publicly available apps; the features of novel, research apps; and issues behind the integration of mobile apps and digital health services into clinical workflows. The review is based on a research literature and the authors' clinical and healthcare administration experiences. Articles searched-on telepsychiatry, telemental health, mobile mental health, informatics, cellular phone, ambulatory monitoring, telemetry, and algorithms-were restricted to 2016 and 2017. Technologies are used in a variety of clinical settings, including patients with varying mental illness severity, social supports, and technological literacy. Good practices for evaluating apps, understanding user needs, and training and educating users can increase success rates. Ethics and risk management should be considered. Mobile apps are versatile. Integrating apps into psychiatric treatment requires addressing both patient and clinical workflows, design and usability principles, accessibility, social concerns, and digital health literacy.

Capnography in the Emergency Department: A Review of Uses, Waveforms, and Limitations

BackgroundCapnography has many uses in the emergency department (ED) and critical care setting, most commonly cardiac arrest and procedural sedation. Objective of the ReviewThis review evaluates several indications concerning capnography beyond cardiac arrest and procedural sedation in the ED, as well as limitations and specific waveforms. DiscussionCapnography includes the noninvasive measurement of CO2, providing information on ventilation, perfusion, and metabolism in intubated and spontaneously breathing patients. Since the 1990s, capnography has been utilized extensively for cardiac arrest and procedural sedation. Qualitative capnography includes a colorimetric device, changing color on the amount of CO2 present. Quantitative capnography provides a numeric value (end-tidal CO2), and capnography most commonly includes a waveform as a function of time. Conditions in which capnography is informative include cardiac arrest, procedural sedation, mechanically ventilated patients, and patients with metabolic acidemia. Patients with seizure, trauma, and respiratory conditions, such as pulmonary embolism and obstructive airway disease, can benefit from capnography, but further study is needed. Limitations include use of capnography in conditions with mixed pathophysiology, patients with low tidal volumes, and equipment malfunction. Capnography should be used in conjunction with clinical assessment. ConclusionsCapnography demonstrates benefit in cardiac arrest, procedural sedation, mechanically ventilated patients, and patients with metabolic acidemia. Further study is required in patients with seizure, trauma, and respiratory conditions. It should only be used in conjunction with other patient factors and clinical assessment.

Review of Use of Standardized Patients in Psychiatric Nursing Education.

Simulations using standardized patients (SPs) are increasingly used to teach and assess competencies in psychiatric/mental health (PMH) nursing education. To advance the field, it is important to identify current knowledge, practice, and evidence. To determine the current knowledge, evidence, and practice of using SPs in PMH nursing education by conducting an integrative review of the empirical research on the use of SPs in PMH nursing education, and by providing a supplementary descriptive review of non-research articles on PMH simulations using SPs. A comprehensive search using electronic databases was conducted to identify both research and simulation description papers meeting inclusion criteria. The research literature was reviewed using an integrative review approach and a simple descriptive review of the non-research simulation literature was also conducted. Six research studies and 18 simulation description articles were included in the review. Although there are several PMH SP simulation descriptions in the literature, and anecdotal indications that they are a valuable educational tool, there is insufficient research evidence regarding their effectiveness as a method in psychiatric nursing education due to few published studies and methodological limitations of existing studies. Well-designed research studies are needed to develop an evidence base for this promising and increasingly employed teaching method.

Stem Cell Therapy for Chronic Pain Management: Review of Uses, Advances, and Adverse Effects

Background: This review article outlines the recent advances, uses, and adverse effects of cell-based therapy for chronic pain management. Cell based therapies are gaining increasing ground as novel treatment modalities for a variety of pain pathologies that include, but are not limited to, neuropathic pain and degenerative disc disease. As these treatment modalities become more common practice, we have focused our review to provide pain practitioners and other practicing physicians an understanding of the technology and to summarize key clinical data and existing clinical trials that are being pursued by clinical investigators worldwide. Objective: Review of stem cell technology and applications in pain management. Study Design: Narrative review. Methods: The Pubmed NCBI and EMBASE databases was utilized to review published reports of clinical studies reported from 2000 to 2015, and ClinicalTrials.gov (www. clinicaltrials.gov/ct2/search) search function was used to document ongoing clinical trials [keywords: “chronic pain,” “disc pain,” “cell therapy,” “osteoarthritis,” “neuropathic,” “stem cell”] currently active and recruiting patients. Results: Articles were screened by title, abstract, and full article review. They were then analyzed by specific clinical indications and appropriate data were presented based on critical analysis of those articles. Limitations: More studies looking at the systematic use of stem cells in pain management will be required to draw conclusions about the benefits of the technology. Conclusion: Though the data from existing studies look promising for the use of stem cells as a novel therapeutic strategy for discogenic pain, neuropathic pain, and osteoarthritis, additional clinical studies will be needed to validate the benefit of the technology for clinical use. However, we hope that this narrative review will help guide pain physicians in making informed decisions for their patients about the potential of cell-based therapy for treating chronic pain conditions. Key words: Stem cell therapy, chronic pain, clinical trials, disc pain, neuropathic pain, mesenchymal stem cells, osteoarthritis, pain management

Novel biomarkers for prostate cancer: An evidence-based review for use in clinical practice.

Prostate cancer is a heterogeneous disease with disparate outcomes. Traditional clinical parameters are limited in their ability to differentiate between these cases, and there is uncertainty regarding management strategies. A number of novel biomarkers have emerged, but how best to use them at the point of care remains confusing. In the present review, we describe the most common novel biomarkers, their key supporting literature, and propose a meaningful algorithm for their use in clinical practice. To identify commercially available prostate cancer diagnostic tests, we carried out a PubMed literature search (through May 2016). Only English-language studies were included. We restricted our search to studies published within the past 10 years in order to focus our review on novel data. Secondary sources were also examined. We identified 12 novel biomarkers and categorized them into broad areas of clinical practice: (i) early diagnosis and screening; (ii) staging and primary treatment selection; (iii) post-treatment risk stratification; (iv) advanced disease prognosis and treatment response; and (v) emerging tests. Most validation studies rely on small retrospective cohorts and carry a high risk of bias; furthermore, most cohorts are restricted to Caucasians, with little to no representation of other geographic, racial or ethnic populations. Novel biomarkers for prostate cancer management, while potentially helpful, should not replace standard clinical information and physician judgment. They are currently best suited to serve as an adjunct to existing management tools. Clinicians should have a sound grasp of each biomarker-based test's indications and limitations.

Sarilumab: First Global Approval.

Sarilumab (Kevzara™) is a fully human IgG1 monoclonal antibody that binds specifically to both soluble and membrane-bound interleukin (IL)-6 receptors (sIL-6Rα and mIL-6Rα) and thereby inhibits IL-6-mediated signalling through these receptors. Subcutaneous sarilumab is approved in Canada for the treatment of adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response to one or more biological or non-biological disease-modifying anti-rheumatic drugs. It is under regulatory review for use in rheumatoid arthritis in other countries, including in the EU, USA and Japan. Sarilumab is also under phase II investigation for the treatment of juvenile idiopathic arthritis. This article summarizes the milestones in the development of sarilumab leading to its first global approval for the treatment of rheumatoid arthritis.

The digital pill

Compliance with prescription medication regimens is poor in patients who suffer from chronic conditions as well as from diseases that affect public health. It is thought that improving medication adherence can have a profound effect on patient health, though medication compliance remains a problem despite the availability of many modalities. Recently, digitalizing medication adherence was made possible by Proteus Digital Health, Inc using an ingestible sensor that emits an electric field upon digestion. This signal is detected by an externally worn adhesive monitor, which records the time at which the signal is received, along with other biometric markers such as heart rate. This system is currently under United States Food and Drug Administration (FDA) review for use in a combination pill that also contains aripiprazole, a partial dopamine agonist used for the treatment of certain serious psychiatric conditions. Digitalizing medication adherence can have tremendous applications in all fields of medicine, though issues of drug costs, patient privacy, and patient autonomy may need to be addressed.

Systematic literature review of use of blood glucose monitoring in phase III clinical studies of insulin analogs.

BackgroundSafe and effective insulin therapy for diabetes mellitus requires initial dose titration and regular adjustments based on blood glucose (BG) monitoring. Our objective was to explore the use of BG measurement in phase-III clinical studies of insulin analogs. These studies provide safety and efficacy information for regulatory authorities and are the basis for insulin analog regulatory approval.MethodsA systematic review of phase-III studies of rapid-acting insulin analogs (insulin lispro, insulin aspart and insulin glulisine) and pre-mixed insulin analogs (biphasic insulin aspart and insulin lispro mix) was conducted. Studies were identified using manufacturers’ databases. Search for reports was performed in Medline and registry of clinical trials (clinicaltrials.gov). The European Medicines Agency was contacted to provide Clinical Study Reports.ResultsForty-five studies were included. Regular BG measurements were reported in 100 % of the studies and were performed by either self-monitoring of blood glucose (SMBG) alone in 84 %, laboratory alone in 7 %, and both SMBG and laboratory in 9 % of studies. In total, 93 % of the studies reported SMBG. Most studies (91 %) reported insulin therapy adjustments based on BG measurements.ConclusionsThe findings suggest that BG monitoring and specifically SMBG are co-dependent technologies with insulin analogs. BG measurement is used in most phase-III registration studies for establishing safe and efficacious insulin administration and is recommended in the insulin labels. The indispensable role of SMBG in treatment of insulin-dependent patients should receive attention from health care payers to assess and reimburse SMBG along with insulin to avoid adverse events from inappropriate insulin administration and associated costs.

Benzodiazepine Use, Misuse, and Harm at the Population Level in Canada: A Comprehensive Narrative Review of Data and Developments Since 1995.

Benzodiazepines are commonly prescribed psycho-pharmaceuticals (e.g., for anxiety, tension, and insomnia); they are generally considered safe but have potential adverse effects. Benzodiazepine use in Canada versus internationally is comparably high, yet no recent comprehensive review of use, misuse, or related (e.g., morbidity, mortality) harm at the population level exists; the present review aimed to fill this gap. We searched four key scientific literature databases (Medline, CINAHL, EBM Reviews, and Web of Science) with relevant search terms, and collected relevant "gray literature" (e.g., survey, monitoring, government reports) data published in 1995-2015. Two reviewers conducted data screening and extraction; results were categorized and narratively summarized by key sub-topics. Levels of benzodiazepine use in the general population have been relatively stable in recent years; medical use is generally highest among older adults. Rates of non-medical use are fairly low in general but higher in marginalized (e.g., street drug use) populations; high and/or inappropriate prescribing appears common in older adults. Benzodiazepines are associated with various morbidity outcomes (e.g., accidents/injuries, cognitive decline, sleep disturbances, or psychiatric issues), again commonly observed in older adults; moreover, benzodiazepines are identified as a contributing factor in suicides and poisoning deaths. Overall there is a substantial benzodiazepine-related health problem burden-although lower than that for other psycho-medications (e.g., opioids)-in Canada, mainly as a result of overuse and/or morbidity. National benzodiazepine prescription guidelines are lacking, and few evaluated interventions to reduce benzodiazepine-related problems exist. There is a clear need for reducing inappropriate benzodiazepine use and related harm in Canada through improved evidence-based practice as well as monitoring and control.

Session 409 - Science or Snake Oil?: Review of Use of Testosterone and Vitamins/Nutrients in the Elderly

Session 409 - Science or Snake Oil?: Review of Use of Testosterone and Vitamins/Nutrients in the Elderly

A Scoping Review of Clinical Practice Improvement Methodology Use in Rehabilitation

Context The Clinical Practice Improvement (CPI) approach is a methodological and quality improvement approach that has emerged and is gaining in popularity. However, there is no systematic description of its use or the determinants of its practice in rehabilitation settings. Method We performed a scoping review of the use of CPI methodology in rehabilitation settings. Results A total of 103 articles were reviewed. We found evidence of 13 initiatives involving CPI with six different populations. A total of 335 citations of determinants were found, with 68.7% related to CPI itself. Little information was found about what type of external and internal environment, individual characteristics and implementation process might facilitate or hinder the use of CPI. Conclusion Given the growing popularity of this methodological approach, CPI initiatives would gain from increasing knowledge of the determinants of its success and incorporating them in future implementation.

FLUORIDE: A REVIEW OF USE AND EFFECTS ON HEALTH.

Introduction:Appropriate oral health care is fundamental for any individual’s health. Dental caries is still one of the major public health problems. The most effective way of caries prevention is the use of fluoride.Aim:The aim of our research was to review the literature about fluoride toxicity and to inform physicians, dentists and public health specialists whether fluoride use is expedient and safe.Methods:Data we used in our review were systematically searched and collected from web pages and documents published from different international institutions.Results:Fluoride occurs naturally in our environment but we consume it in small amounts. Exposure can occur through dietary intake, respiration and fluoride supplements. The most important factor for fluoride presence in alimentation is fluoridated water. Methods, which led to greater fluoride exposure and lowered caries prevalence, are considered to be one of the greatest accomplishments in the 20th century`s public dental health. During pregnancy, the placenta acts as a barrier. The fluoride, therefore, crosses the placenta in low concentrations. Fluoride can be transmitted through the plasma into the mother’s milk; however, the concentration is low. The most important action of fluoride is topical, when it is present in the saliva in the appropriate concentration. The most important effect of fluoride on caries incidence is through its role in the process of remineralization and demineralization of tooth enamel. Acute toxicity can occur after ingesting one or more doses of fluoride over a short time period which then leads to poisoning. Today, poisoning is mainly due to unsupervised ingestion of products for dental and oral hygiene and over-fluoridated water.Conclusion:Even though fluoride can be toxic in extremely high concentrations, it`s topical use is safe. The European Academy of Paediatric Dentistry (EAPD) recommends a preventive topical use of fluoride supplements because of their cariostatic effect.

Conductive energy devices: a review of use and deaths in the United States.

Conductive energy devices (CEDs) have been temporally associated with morbidity and mortality in police work, but the frequency of use and of complications is not certain. This is a literature review using PubMed and Google Scholar searches to identify population-based CED studies, studies reporting morbidity and mortality with CEDs, and studies in healthy volunteers. Recent studies indicate that CEDs are used approximately 83 to 338 times per million population per year in the United States. The subjects have a typical profile, including young men with belligerent or bizarre behavior who often have a psychiatric disorder or are intoxicated with drugs. The mortality estimates range from 0.0% to 1.4% of subjects controlled with CEDs. Limited information from autopsy studies indicates that death is frequently associated with confounding factors, especially intoxication with illicit drugs. Conductive energy devices are used frequently during police work and are associated with a low but definite mortality rate. The use of CEDs and the management of at-risk subjects need more study.