Scottish Intercollegiate Guidelines Network Research Articles

A systematic review, meta-analysis, and meta-regression amalgamating the driven approaches used to quantify dynamic cerebral autoregulation.

Numerous driven techniques have been utilized to assess dynamic cerebral autoregulation (dCA) in healthy and clinical populations. The current review aimed to amalgamate this literature and provide recommendations to create greater standardization for future research. The PubMed database was searched with inclusion criteria consisting of original research articles using driven dCA assessments in humans. Risk of bias were completed using Scottish Intercollegiate Guidelines Network and Methodological Index for Non-Randomized Studies. Meta-analyses were conducted for coherence, phase, and gain metrics at 0.05 and 0.10 Hz using deep-breathing, oscillatory lower body negative pressure (OLBNP), sit-to-stand maneuvers, and squat-stand maneuvers. A total of 113 studies were included, with 40 of these incorporating clinical populations. A total of 4126 participants were identified, with younger adults (18-40 years) being the most studied population. The most common techniques were squat-stands (n = 43), deep-breathing (n = 25), OLBNP (n = 20), and sit-to-stands (n = 16). Pooled coherence point estimates were: OLBNP 0.70 (95%CI:0.59-0.82), sit-to-stands 0.87 (95%CI:0.79-0.95), and squat-stands 0.98 (95%CI:0.98-0.99) at 0.05 Hz; and deep-breathing 0.90 (95%CI:0.81-0.99); OLBNP 0.67 (95%CI:0.44-0.90); and squat-stands 0.99 (95%CI:0.99-0.99) at 0.10 Hz. This review summarizes clinical findings, discusses the pros/cons of the 11 unique driven techniques included, and provides recommendations for future investigations into the unique physiological intricacies of dCA.

Transcranial Doppler Ultrasound and Concussion-Supplemental Symptoms with Physiology: A Systematic Review.

Sport-related concussion (SRC) can impair the cerebrovasculature both acutely and chronically. Transcranial Doppler (TCD) ultrasound assessment has the potential to illuminate the mechanisms of impairment and provide an objective evaluation of SRC. The current systematic review investigated studies employing TCD ultrasound assessment of intracranial arteries across three broad categories of cerebrovascular regulation: neurovascular coupling (NVC), cerebrovascular reactivity (CVR), and dynamic cerebral autoregulation (dCA). The current review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42021275627). The search strategy was applied to PubMed, as this database indexes all biomedical journals. Original articles on TCD for athletes with medically diagnosed SRC were included. Title/abstract and full-text screening were completed by three authors. Two authors completed data extraction and risk of bias using the Methodological Index for Non-Randomized Studies and Scottish Intercollegiate Guideline Network checklists. Of the 141 articles identified, 14 met the eligibility criteria. One article used an NVC challenge, eight assessed CVR, and six investigated dCA. Methodologies varied widely among studies, and results were heterogeneous. There was evidence of cerebrovascular impairment in all three domains roughly 2 days post-SRC, but the magnitude and recovery of these impairments were not clear. There was evidence that clinical symptom resolution occurred before cerebrovascular function, indicating that physiological deficits may persist despite clinical recovery and return to play. Collectively, this emphasizes an opportunity for the use of TCD to illuminate the cerebrovascular deficits caused by SRC. It also highlights that there is need for consistent methodological rigor when employing TCD in a SRC population.

Summary of the best evidence for the prevention and management of myasthenic crisis after thymectomy.

Myasthenic crisis (MC) may occur after thymectomy in patients with myasthenia gravis (MG), but effective preventive interventions can reduce the occurrence of this complication. Previous research on MC focused on risk factors, emergency treatment, etc., which was relatively scattered and did not form a comprehensive management framework. This study sought to retrieve and summarize the relevant evidence on the prevention and management of postoperative MC to provide a theoretical reference for clinical medical staff. According to the evidence pyramid model, relevant articles were retrieved from UpToDate, British Medical Journal (BMJ) Best Practice, World Health Organization (WHO), Scottish Intercollegiate Guidelines Network (SIGN), Guidelines International Network (GIN), Australian Joanna Briggs Institute (JBI) Healthcare Database, Medlive, PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang. The types of evidence included clinical guidelines, expert consensus articles, clinical decisions, systematic reviews, and randomized controlled trials (RCTs). The quality evaluations were conducted using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool for guidelines, the Australian JBI Evidence-Based Healthcare Center evaluation tool for expert consensus articles, the Critical Appraisal for Summaries of Evidence (CASE) evaluation tool for clinical decisions, the Assessment of Multiple Systematic Reviews (AMSTAR) evaluation tool for systematic reviews, and the Cochrane risk-of-bias tool for RCTs. A total of 12 articles were included in this study, including three clinical guidelines, three expert consensus articles, three clinical decisions, two systematic reviews, and one RCT. From these articles, we summarized 39 pieces of evidence on the prevention and management of postoperative MC. This study summarized the best evidence on the prevention and management of postoperative MC and provided to clinical staffs evidence-based clinical approaches to help reduce the incidence of this complication.

Alcohol use among children and adolescents with chronic pain. Scoping review

AimTo examine and map alcohol consumption in children and adolescents with chronic pain (CP). MethodA scoping review of international databases (CINAHL, WOS, PubMed, PsycINFO, Scopus, Embase, and MEDLINE) and grey literature was conducted between September 2022 and February 2023. Documents addressing the relationship between alcohol consumption and CP in children and adolescents, published in English and Spanish between 2012 and 2023, were included. Those papers with a population suffering from CP derived from neurodegenerative diseases, chronic infectious diseases or cognitive impairment were excluded. We assessed the level of evidence (LE) and the degree of recommendation (DR) of the studies included in accordance with the Scottish Intercollegiate Guidelines Network. Finally, 11 documents were considered out of the 479 reviewed. ResultsThe relationship between substance consumption and CP in adolescents is a scarcely investigated topic. While there is a trend towards lower rates of alcohol consumption in youth with pain, there is evidence suggesting an association, particularly in cases of intense pain. The use of various substances, both legal and illegal, for pain management underscores the importance of comprehensively addressing this phenomenon in this population. ConclusionsFurther research is needed to assess the relationship between alcohol consumption in children and adolescents with CP.

REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer.

The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports resection of BR-PDAC and, to a lesser extent, LA-PDAC. Guidelines outlining the selection and perioperative care for these patients are lacking. The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used to develop the REDISCOVER guidelines and create recommendations. The Delphi approach was used to reach consensus (agreement ≥80%) among experts. Recommendations were approved after a debate and vote among international experts in pancreatic surgery and pancreatic cancer management. A Validation Committee used the AGREE II-GRS tool to assess the methodological quality of the guidelines. Moreover, an independent multidisciplinary advisory group revised the statements to ensure adherence to non-surgical guidelines. Overall, 34 recommendations were created targeting centralization, training, staging, patient selection for surgery, possibility of surgery in uncommon scenarios, timing of surgery, avoidance of vascular reconstruction, details of vascular resection/reconstruction, arterial divestment, frozen section histology of perivascular tissue, extent of lymphadenectomy, anticoagulation prophylaxis and role of minimally invasive surgery. The level of evidence was however low for 29 of 34 clinical questions. Participants agreed that the most conducive mean to promptly advance our understanding in this field is to establish an international registry addressing this patient population ( https://rediscover.unipi.it/ ). The REDISCOVER guidelines provide clinical recommendations pertaining to pancreatectomy with vascular resection for patients with BR- and LA-PDAC, and serve as the basis of a new international registry for this patient population.

The Role of the Built Environment as a Therapeutic Intervention in Mental Health Facilities: A Systematic Literature Review.

This systematic literature review synthesizes and assesses empirical research concerning the use of the built environment as a therapeutic intervention in adult mental health inpatient facilities. The review explores the impact of facility design on patient outcomes. There is a growing recognition that the built environment in mental health facilities must strike a balance between ensuring safety and providing a therapeutic atmosphere. A review addressing how facility design contributes to this therapeutic environment is warranted. Database searches were conducted in CINAHL, Embase, PsychInfo, PubMed, and Web of Science from inception up to March 10, 2022. The Scottish Intercollegiate Guidelines Network (SIGN50) critical appraisal checklists were used to assess the quality of included studies. Of the 44 peer-reviewed studies identified from nine countries, several factors emerged as vital for the therapeutic environment in mental health inpatient facilities. These included personal spaces prioritizing privacy and control of the environment, daylight-optimized spaces, versatile communal areas promoting activities and interaction, designated areas for visits and spiritual/contemplative reflection, homelike environments, the inclusion of artwork in units, open nursing stations, and dedicated female-only areas. Yet, there is a need for research yielding stronger evidence-based designs harmonizing with therapeutic needs. This review offers initial guidance on designing mental health facilities that foster a therapeutic environment, while highlighting that the influence of facility design on mental health inpatients is considerably under-researched.

Summary of the best evidence for the prevention of nasal injury in preterm infants with nasal noninvasive ventilation.

Due to immaturity, the nose of preterm infants can easily be injured, by even a short application of a nasal device. However, 20% to 60% of preterm infants suffer nasal damage while using nasal continuous positive airway pressure (NCPAP) due to weak skin tissue, prolonged use of nasal device, and improper nursing practices, leading to increased risk of infection and decreased compliance and tolerance. In this study, we retrieved, obtained and integrated the related evidences of prevention of nasal injury in premature infants with nasal noninvasive ventilation to provide reference for clinical practice. We searched the relevant guidelines, expert consensus, evidence summaries and systematic reviews in the databases and guideline websites of the National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), the Agency for Health care Research and Quality (AHRQ), Guidelines International Network (GIN), the World Health Organization (WHO) guideline websites, Registered Nurses' Association of Ontario (RANO), Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), European Pressure Ulcer Advisory Panel (EPUAP), Yi Maitong, British Medical Journal best-practice, Cochrane Library, UpToDate, Embase, PubMed, China National Knowledge Infrastructure (CNKI), Wanfang. The search was limited to the time of library establishment to February 2023. In total, 16 articles were included, including six guidelines, three expert consensuses, two evidence summaries and five systematic reviews. Twenty-eight pieces of evidence were summarized from six aspects: risk assessment, ventilation and connection, skin protection, skin assessment, training and support, and continuous quality improvement. This study summarized the best evidence for the prevention of nasal injury in premature infants through nasal noninvasive ventilation. It is suggested that nurses should consider the actual clinical situation when applying the suggestions from the evidence, formulate corresponding nursing measures, and reduce the occurrence of nasal injury in premature infants.

Effectiveness of functional or biomechanical bandages with athletic taping and kinesiotaping in subjects with chronic ankle instability: a systematic review and meta-analysis.

The aim of the study was to analyze the effects of functional or biomechanical bandages, whether elastic or inelastic, in Chronic Ankle Instability (CAI). This review used PubMed, WoS, SCOPUS, and CINAHL following PRISMA and registering in Prospero. Main PICOS: (1) CAI; (2) intervention, functional/biomechanical bandages; (3) comparison, taping effect versus placebo/no taping, or another functional taping; (4) outcomes, improvement of CAI functionality (dynamic/static balance, ankle kinematic, perception, agility and motor control, endurance and strength; (5) experimental and preexperimental studies. The meta-analyses considered mean and s.d. of the results per variable; effect size (ES) of each study and for each type of intervention. Homogeneity (Q), heterogeneity (H 2 and I 2), and 95% CI were calculated. In total, 28 studies were selected. Significant differences were found for dynamic balance (66.66%) and static balance (87.5%), ankle kinematics (75.00%), perceptions (88.88%), plantar flexor strength (100%), muscle activity (66.6%), endurance (100%), functional performance (100%), and gait (66.6%). The main results of meta-analyses (eight studies) are as follows - h/M ratio soleus, ES: 0.080, 95% CI: -5.219-5.379; h/M ratio peroneus, ES: 0.070, 95% CI: -6.151-6.291; posteromedial KT, ES: 0.042 95% CI: -0.514-0.598; posteromedial-overall, ES: -0.006 95% CI: -1.071-0.819; mSEBT-KT, ES: 0.057 95% CI: -0.281-0.395; mSEBT-overall, ES: -0.035 95% CI: -0.190-0.590. All biomechanical or functional bandages, whether elastic or inelastic, applied in CAI were favorable, highlighting patient perception, dynamic and static balance, kinematics and agility and motor control, for its effectiveness and evidence. Thus, bandages increase ankle functionality. The meta-analyses found no statistical significance. Clinically, soleus muscle activity, h-reflex/M-responses using fibular reposition with rigid tape, and dynamic balance with combined kinesiotaping during the modified star excursion balance test and with the posteromedial direction found improvements. Level of evidence according to Scottish Intercollegiate Guidelines Network: 1+. Level of evidence according to the Oxford Centre for Evidence-Based Medicine 2011: 1.

Factors that affect powered wheelchair use for an adult population: a systematic review

Purpose The purpose of the review was to explore current factors affecting the use of a powered wheelchair for an adult person a with a disability. Materials and Methods This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Information about the characteristics of the studies (type, setting) and perceived barriers and facilitators to powered wheelchair use were extracted using a data extraction sheet. Data synthesis was achieved using narrative synthesis. The quality of the included studies was assessed using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields (SQAC) and the CASP checklist (Critical Appraisal Skills Programme), Centre for Evidence-Based Medicine, SIGN (Scottish Intercollegiate Guidelines Network). Results Fifteen studies qualified for inclusion in the review. The narrative synthesis produced a conceptual map of reported factors affecting the usability of a powered wheelchair. Conclusions This review demonstrates that powered wheelchair use is a multifaceted and multidisciplinary phenomenon that is dependent on numerous interconnected factors including individual adjustment, stakeholder cooperation, societal attitudes, functional performance, and environmental features. Based on the review findings, there are several applied learning outcomes and practical applications to the powered wheelchair prescription and provision.

Effectiveness of Non-Pharmacological Therapy on Physical Symptoms in Patients With Persistent Concussion Symptoms: A Systematic Review.

This systematic review provides a comprehensive overview on the effectiveness of rehabilitation on physical symptoms in patients of all ages with persistent concussion symptoms. PubMed, MEDLINE®, Cochrane library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase were searched from January 1, 2012 to September 1, 2023 using terms related to physical post-concussion symptoms. Eligible articles were critically appraised using the Scottish Intercollegiate Guidelines Network (SIGN) and the Quality Assessment Tool. The Grading of Recommendations Assessment, Development, and Evaluation system was applied to rate the quality of evidence. Thirty-two articles were included. Preliminary evidence suggests that transcranial magnetic stimulation improves symptoms in adults, specifically headaches. Young adults reported a significant decrease in physical symptoms following sub-symptom aerobic training as well as cervical spine manual therapy. Tentatively, adults demonstrated improvements in headache symptoms following neurofeedback sessions, and progressive muscle relaxation resulted in a decrease in monthly headaches. Multimodal therapy in adults produced significant change in physical symptoms when compared with usual care. However, no further reduction in physical symptoms was observed when adult patients received a program of care that afforded cervicovestibular rehabilitation with symptom-limited exercise compared with a symptom-limited exercise program alone. Cognitive behavioral therapy demonstrated inconsistent findings for its effects on physical symptoms, specifically headaches. Veterans had a significant change in post-concussive symptoms, specifically headaches, following 3-month use of an interactive smartphone application as compared with standard care. Finally, in a pediatric population, the use of melatonin did not produce any changes in physical persistent concussion symptoms as compared with placebo. Preliminary evidence suggests that various forms of rehabilitative therapies can improve persistent physical concussive symptoms. However, given the methodological limitations in the majority of trials, the results need to be interpreted with caution.

Does the Wim Hof Method have a beneficial impact on physiological and psychological outcomes in healthy and non-healthy participants? A systematic review.

Wim Hof, also known as the iceman, developed a method called Wim Hof Method (WHM) which he claims to have several benefits on physical and mental health. The aim of this systematic review is to identify and synthesise the results of the studies conducted on WHM on physiological and psychological health-related outcomes. This systematic review followed the PRISMA guidelines for systematic reviews. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42022333209. Medline and Web of Science were searched and included studies from January 1, 2014, to July 4, 2022. Studies were included if they met the predetermined inclusion/exclusion criteria. Inclusion criteria included RCTs and cohort studies published in peer-reviewed journals, studies conducted on healthy individuals and people with pre-existing medical conditions (adolescents and adults over the age of 14), studies that included all three pillars (breathing, cold exposure, and commitment) of the WHM, and studies that only focused on Wim Hof breathing method (WHBM). Exclusion criteria included studies that discussed WHM but are not original experimental research or are not peer-reviewed, studies that included children under the age of 14, and studies that used methods similar to WHM, but not actually WHM, such as tummo meditation. The articles were assessed for risk of bias using RoB 2.0 and Scottish Intercollegiate Guidelines Network (SIGN) tools. The effects of WHM were categorised into physiological or psychological related outcomes and narrative synthesis was conducted. Nine papers were included in this review which consisted of eight individual trials. The findings suggest that the WHM may reduce inflammation in healthy and non-healthy participants as it increases epinephrine levels, causing an increase in interleukin-10 and a decrease in pro-inflammatory cytokines. Additionally, effect of WHBM on exercise performance showed mixed findings. Effects on respiratory parameters of minute ventilation, tidal volume, and breathing frequency were mixed following bouts of exercise. Taken together, the findings of this review show promising use of WHM in the inflammatory response category. The focus of future studies should further investigate the benefits of WHM in non-healthy participants with inflammatory disorders and explore the use of Wim Hof breathing method to enhance exercise performance.

COVID-19 Infection Is Associated With Loss of Muscle Strength

Introduction: Coronavirus disease 2019 (COVID-19) is a respiratory and multisystem infection accompanied by risk for multisystemic problems. Recent research proposed a risk for skeletal muscle weakness among those who experienced COVID-19 infection. The purpose of this systematic review is to identify if muscle strength impairment follows COVID-19 infection. Methods: This systematic review of the literature complied with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the design of the review was registered prospectively with International Prospective Register of Systematic Reviews (PROSPERO). To reveal appropriate studies, PubMed, CINAHL, and Cochrane Database of Systematic Reviews were searched. Risk of bias was measured through the Scottish Intercollegiate Guidelines Network, Methodology Checklist 3: Cohort studies. Results: Included were 6 studies with a total of 659 participants with COVID-19 infection (mean age: 59.8 years), all of whom were hospitalized or in a nursing facility. Risk of bias assessment revealed that 5 of the studies were of acceptable methodological quality and 1 was of high quality. Four of the studies measured strength using hand-grip dynamometry, 3 studies measured strength using handheld dynamometry, and 1 study measured performance on the 1-minute sit-to-stand test. Across all studies the results showed some degree of a decrease in skeletal muscle strength. Discussion: Those with more severe COVID-19 infections were at greater risk for weakness within skeletal muscles. Two studies measured performance by larger muscles (ie, those with greater cross-sectional size) and identified that larger muscles were at greater risk for weakness. Conclusion: People recovering from a COVID-19 infection are at risk for experiencing muscle weakness. Clinicians should measure strength among patients who have had COVID-19 infection, including the performance of larger muscles.

Maintenance And Reliever Therapy (MART) for young people with asthma

Maintenance and reliever therapy (MART) is one device, which serves as both preventer and reliever. In children and young people, the choice is more limited in terms of device and this is called Symbicort MART (SMART). One of the most common modifiable factors for optimal asthma control at any age is adherence to prescribed preventer therapy ( British Thoracic Society(BTS)/Scottish Intercollegiate Guideline Network (SIGN), 2019 ). As young patients grow and take increasing responsibility for their own health, perfect adherence can feel impossible for the developing brain (and with this, the ability to effectively analyse risk). As health professionals, it can be easy to focus on the adherence issue as a failure to organise, and to assume all have the capacity to optimally administer a medication twice daily. What we are increasingly learning through the multiple health inequality and psychosocial workstreams is that there are families who are fundamentally less likely to achieve this, even with additional support from their health team, due to an actual or perceived inability to deal with the modifiable factors highlighted by BTS/SIGN.

PP121 Assessment Of Heart Rate Characteristics Analysis

IntroductionThe heart rate characteristics (HRC) analysis is a technique for predicting and monitoring neonatal infectious diseases in infants with a risk for infectious disease, such as sepsis, using the HRC index based on the electrocardiogram (ECG) data transmitted from a HeRO® device connected to an ECG monitor.MethodsThe assessments were performed via a systematic review. Searching five databases (KoreaMed, Ovid-MEDLINE, Ovid-EMBASE, and Cochrane) yielded 284 related studies. Two reviewers independently assessed the quality of these studies, using the Scottish Intercollegiate Guidelines Network checklist and the assessment results were described based on the results of the quality appraisal and level of evidence.ResultsThe safety and effectiveness of the technique were assessed based on eight non-Korean studies (one randomized controlled trial (RCT), five cohort studies, one case-control study, one case series). The four studies that reported area under the curve (AUC) values, the timing of the analysis and AUC values (0.67– 0.75) were inconsistent among the studies. The elevation of the HRC index prior to the diagnosis of an infectious disease was not observed for meningitis or for multiple infectious diseases. In addition, although the group with additional monitoring using the technique had a significantly lower mortality rate, whether the HRC index had a direct impact on the infection prevention activities and the possibility of bias arising from the researchers’ precautionary treatment based on the clinical symptoms and other test results as well as the actual time of disease onset are unknown.ConclusionsTherefore, the committee presented the following recommendations based on the available evidence and expert opinion. HRC analysis is a safe technique for predicting and monitoring neonatal infectious diseases in infants with a risk for infectious disease, such as sepsis, using the HRC index based on the ECG data transmitted from a HeRO® device connected to an ECG monitor; however, further research is needed to determine its effectiveness (Level of evidence C, Technology category II-a).

Adherence to National Asthma Guidelines in the Acute Care Setting: A Retrospective Cohort Study.

Peak flow is a crucial but simple test used to categorize the severity of an episode of an acute exacerbation of asthma.It should be regularly done in all the patients who present with asthma acute exacerbation in the emergency department. The British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) guidelines stipulate peak flow use as one of the main tools to categorize acute asthma into moderate, severe, and life-threatening asthma. The BTS and SIGN guidelines also state peak flow is to be utilized in monitoring the disease and to guide in treating patients with acute asthma. This study aims to identify the adherence to BTS/SIGN guidelines around the use of peak expiratory flow rate (PEFR) in assessing the severity of patients presenting with acute exacerbation of asthma in a district general hospital. The retrospective cohort study involved collating data between October 2022 and February 2023 from our hospital electronic system. The data collected about the use of PEFR and whether the patients were being classified by severity in presentation following this was compared to the BTS/SIGN 158 asthma guidelines. Following this, the data analysis was done using IBM SPSS Statistics for Windows, Version 21.0 (Released 2012; IBM Corp., Armonk, New York, United States). Data from 92 patients were collated. PEFR was recorded for 29.3% (n=27) of patients and acute exacerbation of asthma severity was documented in merely 17.4% (n=16) patients. The results indicate a significant proportion of the patient cohort analyzed did not have peak flow readings, there is clear room for improvement, and further intervention is needed in order for the department to adhere to the gold standard guidelines (i.e., BTS/SIGN 158), and thus improve the management and monitoring of acute asthma exacerbations. Future directions can include departmental education, posters as a reminder, and prompts on the electronic system used to alert users to check PEFR when a diagnosis of acute asthma exacerbation is documented.

Assessment of off-label prescribing: profile, evidence and evolution

ObjectiveThe objectives of the study were to describe the extent and profile of off-label prescriptions, to evaluate the level of evidence supporting these indications, to assess the research activity in these conditions, and to determine to what extent these were authorized as new indications five years after the application. MethodsA cross-sectional study including all applications conducted in the Hospital Universitario Reina Sofía in Córdoba during 2010. Analysis: level of evidence according to the criteria by SIGN-NICE (Scottish Intercollegiate Guidelines Network, National Institute for Health and Care Excellence) and CEBM (Centre for Evidence-based Medicine), registered clinical trials (source: ClinicalTrials.gov), and review of product specifications and monthly newsletters from the Spanish Agency of Medicines and Medical Devices. ResultsThere were 190 applications for off-label prescription for 82 different indications. The most requested medications were: tacrolimus, mycophenolate, colistimethate and everolimus; the immunosuppressant group had the highest number of uses for non-approved indications. Out of the applications, 52.4% were based on some clinical trial, while the rest had a low level of evidence (observational studies and case reports). We have found on-going clinical trials for 67% of the indications, but new indications in their product specifications have only been authorized for nine drugs (bevacizumab, deferasirox, everolimus, lenalidomide, methotrexate, sildenafil, sorafenib, raltegravir and tenofovir). ConclusionsWe have detected a major volume of off-label prescription without good supporting evidence, which identifies these indications and medications as interesting research lines, but that require follow-up in terms of effectiveness and costs.

Advice following a possible first seizure: what do patients attending for EEG remember?

PurposeThis study was designed to assess the knowledge of patients following their first seizure or blackout of unknown cause. We aimed to compare the advice our cohort of patients recalled against that suggested in the current literature. Background5 % of the population will experience a non- febrile seizure in their lifetime. Education and advice for the patient and their family is an important aspect of their care. MethodAfter reviewing the recommended guidelines from both the Scottish Intercollegiate Guidelines Network and the National Institute for Health and Care Excellence, a questionnaire was developed. From 1st May 2020 to 1st September 2022, a questionnaire was given to eligible patients attending St. James's Hospital for an electroencephalogram (EEG) following their first possible seizure or blackout of unknown cause. The patients were provided with a list of topics and were asked to select which, if any, were discussed with them. ResultsA total of 50 eligible adults participated in the study. Driving was the topic most frequently recalled as having been discussed at 66 % followed by family education. ConclusionIt has been recognised that patients remember as little as a fifth of information initially discussed, failing to recall 40–80 % of content within medical encounters and our study supports this. This highlights the need to review the information delivered and how this is achieved as well as using new methods to help increase the retention of this vital information.

Summary of best evidence for self-management in postoperative osteoporotic fracture patients

Osteoporotic fracture as a serious complication of osteoporosis which is usually treated surgically, and its recovery is closely related to one's own behavior and lifestyle, and is a long-term, complex management process that often requires the individual to self-manage many health-related factors. ObjectiveTo gather and synthesize the most robust evidence regarding self-management in patients with postoperative osteoporotic fractures, in order to provide scientific, evidence-based guidance for clinical healthcare professionals to assist postoperative patients in self-management efforts, and to assist patients in optimizing their self-management practices and behavioral norms. MethodsBased on the “6 S” pyramid model of evidence resources (System, Summaries, Synopses of synthesis, Syntheses, Synopses of studies, Studies), we searched the Up To Date, BMJ Best Practice, The Cochrane Library, Australian Joanna Briggs Institute JBI Evidence-Based Medicine Center Healthcare Database, National Institute for Health and Clinical Excellence (NICE), Guidelines International Network (GIN), National Guideline Clearinghouse (NGC) and Scottish Intercollegiate Guide lines Network (SIGN), MedPulse, Embase, PubMed, CINAHL, Web of Science, SinoMed, Chinese Medical Journal Full Text Database, CNKI, Wanfang Data Knowledge Service Platform, and VIP database, etc, The search period for clinical decision-making, systematic evaluation, clinical guidelines, evidence summaries and expert consensus on self-management of postoperative osteoporotic fracture patients, and it was from the establishment of the database to 18 February 2023. To ensure the quality of the literature, three researchers strictly screened the literature according to the literature inclusion and exclusion criteria, and two or more researchers independently evaluated the quality of the included literature, and extracted and integrated the relevant evidence. ResultsThirteen documents were finally included, including 4 clinical practice guidelines, 5 expert consensus, 2 recommended practices, 1 systematic evaluation, and 1 clinical decision report. The research team summarized the evidence in 6 dimensions: multidisciplinary teamwork, management of daily living, management of treatment adherence, management of exercise, management of fall prevention and subsequent fracture, and management of emotions, and 33 pieces of evidence were extracted. ConclusionThe study summarized 33 best evidence of self-management in postoperative osteoporotic fracture patients, which provides a scientific and reasonable self-management program for postoperative patients, and also provides important reference and information for clinical healthcare professionals to provide more comprehensive and scientific self-management health education to patients.

Spanish consensus on the management of chronic rhinosinusitis with nasal polyps (POLIposis NAsal / POLINA 2.0).

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a high prevalent and burdensome disease for individuals and health systems which management involves many specialties: otorhinolaryngology, allergology, pulmonology, primary care, pharmacy, and paediatrics. A multidisciplinary approach and the participation of the patient in decision making are essential, both for the diagnosis and for the therapeutic strategy. The authors of the consensus aim to translate the current knowledge into an easy-to-read practical guide and emphasize those aspects in which there is still discussion or unmet needs due to the lack of proper scientific evidence. An iterative approach for the development of an evidence-based systematic review with recommendations was used, using a standard quality assessment scheme (Scottish Intercollegiate Guidelines Network -SIGN- and National Institute for Health and Care Excellence -NICE-), and a critical evaluation of the guideline has been carried out through the instrument Appraisal of Guidelines for Research and Evaluation (AGREE II) and Recommendation Excellence (AGREE REX). Based on the foregoing, the POLINA has been considered a guideline of good quality by an independent agency. The POLINA consensus contributes with new schemes for the definition of control, therapeutic management including severity evaluation and surgery, and indications for biologic use and response. Finally, this guideline focuses on the research unmet needs in CRSwNP.

Suppression of sweet taste-related responses by plant-derived bioactive compounds and eating. Part II: A systematic review in animals

This article, the second in a two-part series, continues the discussion on the nature of the relationship between the level of sweet taste suppression and eating behaviour, but in animal rather human subjects. In particular, the aim was to review the scientific literature on the impact that bioactive compounds that decrease oral sweet sensations have on intake, preference and physiological status in preclinical studies. This review was registered in the International Prospective Register of Systematic Reviews and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Scottish Intercollegiate Guidelines Network and covered original papers included in Web of Science, PubMed, Scopus, Food Science Source and Food Science and technology abstracts. We identified 28 peer-reviewed English-language studies that fit the topic and met the inclusion criteria. We identified three plant species, Gymnema sylvestre, Hovenia dulcis, and Ziziphus jujuba, that possess acute sweetness-inhibitory properties. When administered orally, these plants reduced neural responses to sweet stimuli and decreased consumption. However, studies on the longer-term effects of antisweet activity remain to be conducted. Translating the valuable insights into the mechanisms underlying the relationship between sweet taste impairment and eating behaviour into practical clinical applications are discussed.