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Journal of Clinical Oncology : Official... Feb 2022To provide guidance to clinicians regarding therapy for patients with brain metastases from solid tumors.
PURPOSE
To provide guidance to clinicians regarding therapy for patients with brain metastases from solid tumors.
METHODS
ASCO convened an Expert Panel and conducted a systematic review of the literature.
RESULTS
Thirty-two randomized trials published in 2008 or later met eligibility criteria and form the primary evidentiary base.
RECOMMENDATIONS
Surgery is a reasonable option for patients with brain metastases. Patients with large tumors with mass effect are more likely to benefit than those with multiple brain metastases and/or uncontrolled systemic disease. Patients with symptomatic brain metastases should receive local therapy regardless of the systemic therapy used. For patients with asymptomatic brain metastases, local therapy should not be deferred unless deferral is specifically recommended in this guideline. The decision to defer local therapy should be based on a multidisciplinary discussion of the potential benefits and harms that the patient may experience. Several regimens were recommended for non-small-cell lung cancer, breast cancer, and melanoma. For patients with asymptomatic brain metastases and no systemic therapy options, stereotactic radiosurgery (SRS) alone should be offered to patients with one to four unresected brain metastases, excluding small-cell lung carcinoma. SRS alone to the surgical cavity should be offered to patients with one to two resected brain metastases. SRS, whole brain radiation therapy, or their combination are reasonable options for other patients. Memantine and hippocampal avoidance should be offered to patients who receive whole brain radiation therapy and have no hippocampal lesions and 4 months or more expected survival. Patients with asymptomatic brain metastases with either Karnofsky Performance Status ≤ 50 or Karnofsky Performance Status < 70 with no systemic therapy options do not derive benefit from radiation therapy.Additional information is available at www.asco.org/neurooncology-guidelines.
Topics: Brain Neoplasms; Clinical Decision-Making; Consensus; Evidence-Based Medicine; Humans; Medical Oncology; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 34932393
DOI: 10.1200/JCO.21.02314 -
Schizophrenia Bulletin Apr 2024It has been proposed that cat ownership may be a risk-modifying factor for schizophrenia-related disorders and psychotic-like experiences (PLE). This study aimed to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
It has been proposed that cat ownership may be a risk-modifying factor for schizophrenia-related disorders and psychotic-like experiences (PLE). This study aimed to systematically review and meta-analyze publications that reported the relationship between cat ownership and schizophrenia-related outcomes.
METHODOLOGY
We searched Medline, Embase, CINAHL, Web of Science, and gray literature for publications between January 1, 1980, and May 30, 2023, regardless of geographical location and language. Backward citation search methods were used to locate additional articles. We included studies that reported original data on cat ownership and schizophrenia-related outcomes. We meta-analyzed estimates based on broad definitions (cat ownership, cat bites, and cat contact) with estimates with or without covariate adjustments. We pooled comparable estimates using random-effects models and assessed the risk of bias, heterogeneity, and study quality.
RESULTS
We identified 1915 studies, of which 106 were chosen for full-text review, ultimately resulting in the inclusion of 17 studies. We found an association between broadly defined cat ownership and increased odds of developing schizophrenia-related disorders. For the studies reporting unadjusted odds ratios (OR; n = 10), the pooled OR was 2.14 (95% CI: 1.29-3.55). Exclusion of one outlier study resulted in a pooled OR (n = 9) of 1.56 (95% CI: 1.27-1.92). For the studies reporting adjusted estimates (n = 5), the pooled OR was 2.44 (95% CI: 1.59-3.73). After excluding one study with suboptimal exposure/design features, the pooled adjusted OR (n = 4) was 2.40 (95% CI: 1.50-3.86). We were unable to aggregate the estimates for the PLE outcomes because of the broad range of measures.
CONCLUSIONS
Our findings provide support for the hypothesis that cat exposure is associated with an increased risk of broadly defined schizophrenia-related disorders; however, the findings related to PLE as an outcome are mixed. There is a need for more high-quality studies in this field.
PROSPERO REGISTRATION
PROSPERO 2023 CRD42023426974. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023426974.
Topics: Humans; Schizophrenia; Cats; Psychotic Disorders; Animals; Ownership; Pets
PubMed: 38041862
DOI: 10.1093/schbul/sbad168 -
Journal of Clinical Oncology : Official... Dec 2021To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events (irAEs) in patients treated with chimeric... (Meta-Analysis)
Meta-Analysis
PURPOSE
To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events (irAEs) in patients treated with chimeric antigen receptor (CAR) T-cell therapy.
METHODS
A multidisciplinary panel of medical oncology, neurology, hematology, emergency medicine, nursing, trialists, and advocacy experts was convened to develop the guideline. Guideline development involved a systematic literature review and an informal consensus process. The systematic review focused on evidence published from 2017 to 2021.
RESULTS
The systematic review identified 35 eligible publications. Because of the paucity of high-quality evidence, recommendations are based on expert consensus.
RECOMMENDATIONS
The multidisciplinary team issued recommendations to aid in the recognition, workup, evaluation, and management of the most common CAR T-cell-related toxicities, including cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, B-cell aplasia, cytopenias, and infections. Management of short-term toxicities associated with CAR T cells begins with supportive care for most patients, but may require pharmacologic interventions for those without adequate response. Management of patients with prolonged or severe CAR T-cell-associated cytokine release syndrome includes treatment with tocilizumab with or without a corticosteroid. On the basis of the potential for rapid decline, patients with moderate to severe immune effector cell-associated neurotoxicity syndrome should be managed with corticosteroids and supportive care.Additional information is available at www.asco.org/supportive-care-guidelines.
Topics: Cytokine Release Syndrome; Disease Management; Drug-Related Side Effects and Adverse Reactions; Humans; Immunotherapy, Adoptive; Neoplasms; Practice Guidelines as Topic; Prognosis
PubMed: 34724386
DOI: 10.1200/JCO.21.01992 -
World Neurosurgery Mar 2022Optimal outcomes after large-vessel occlusion (LVO) stroke are highly dependent on prompt diagnosis, effective communication, and treatment, making LVO an attractive... (Review)
Review
BACKGROUND
Optimal outcomes after large-vessel occlusion (LVO) stroke are highly dependent on prompt diagnosis, effective communication, and treatment, making LVO an attractive avenue for the application of artificial intelligence (AI), specifically machine learning (ML). Our objective is to conduct a systematic review to describe existing AI applications for LVO strokes, delineate its effectiveness, and identify areas for future AI applications in stroke treatment and prognostication.
METHODS
A systematic review was conducted by searching the PubMed, Embase, and Scopus databases. After deduplication, studies were screened by title and abstract. Full-text studies were screened for final inclusion based on prespecified inclusion and exclusion criteria. Relevant data were extracted from each study.
RESULTS
Of 11,512 resultant articles, 40 were included. Of 30 studies with reported ML algorithms, the most commonly used ML algorithms were convolutional neural networks in 10 (33.3%), support vector machines in 10 (33.0%), and random forests in 9 (30.0%). Studies examining triage favored direct transport to a stroke center and predicted improved outcomes. ML techniques proved vastly accurate in identifying LVO on computed tomography. Applications of AI to patient selection for thrombectomy are lacking, although some studies determine individual patient eligibility for endovascular treatment with high accuracy. ML algorithms have reasonable accuracy in predicting clinical and angiographic outcomes and associated factors.
CONCLUSIONS
AI has shown promise in the diagnosis and triage of patients with acute stroke. However, the role of AI in the management and prognostication remains limited and warrants further research to help in decision support.
Topics: Arterial Occlusive Diseases; Artificial Intelligence; Brain Ischemia; Humans; Ischemic Stroke; Stroke; Thrombectomy; Triage
PubMed: 34896351
DOI: 10.1016/j.wneu.2021.12.004 -
BMC Psychiatry Feb 2018There is increasing recognition of the therapeutic function pets can play in relation to mental health. However, there has been no systematic review of the evidence... (Review)
Review
BACKGROUND
There is increasing recognition of the therapeutic function pets can play in relation to mental health. However, there has been no systematic review of the evidence related to the comprehensive role of companion animals and how pets might contribute to the work associated with managing a long-term mental health condition. The aim of this study was to explore the extent, nature and quality of the evidence implicating the role and utility of pet ownership for people living with a mental health condition.
METHODS
A systematic search for studies exploring the role of companion animals in the management of mental health conditions was undertaken by searching 9 databases and undertaking a scoping review of grey literature from the earliest record until March 2017. To be eligible for inclusion, studies had to be published in English and report on primary data related to the relationship between domestic animal ownership and the management of diagnosable mental health conditions. Synthesis of qualitative and quantitative data was undertaken in parallel using a narrative synthesis informed by an illness work theoretical framework.
RESULTS
A total of 17 studies were included in the review. Quantitative evidence relating to the benefits of pet ownership was mixed with included studies demonstrating positive, negative and neutral impacts of pet ownership. Qualitative studies illuminated the intensiveness of connectivity people with companion animals reported, and the multi-faceted ways in which pets contributed to the work associated with managing a mental health condition, particularly in times of crisis. The negative aspects of pet ownership were also highlighted, including the practical and emotional burden of pet ownership and the psychological impact that losing a pet has.
CONCLUSION
This review suggests that pets provide benefits to those with mental health conditions. Further research is required to test the nature and extent of this relationship, incorporating outcomes that cover the range of roles and types of support pets confer in relation to mental health and the means by which these can be incorporated into the mainstay of support for people experiencing a mental health problem.
Topics: Animals; Emotions; Human-Animal Bond; Humans; Mental Disorders; Mental Health; Narration; Pets; Qualitative Research
PubMed: 29402247
DOI: 10.1186/s12888-018-1613-2 -
Osteoarthritis and Cartilage Open Jun 2023Genicular artery embolization (GAE) is a novel, minimally invasive procedure for treatment of knee osteoarthritis (OA). This meta-analysis investigated the safety and... (Review)
Review
OBJECTIVE
Genicular artery embolization (GAE) is a novel, minimally invasive procedure for treatment of knee osteoarthritis (OA). This meta-analysis investigated the safety and effectiveness of this procedure.
DESIGN
Outcomes of this systematic review with meta-analysis were technical success, knee pain visual analog scale (VAS; 0-100 scale), WOMAC Total Score (0-100 scale), retreatment rate, and adverse events. Continuous outcomes were calculated as the weighted mean difference (WMD) versus baseline. Minimal clinically important difference (MCID) and substantial clinical benefit (SCB) rates were estimated in Monte Carlo simulations. Rates of total knee replacement and repeat GAE were calculated using life-table methods.
RESULTS
In 10 groups (9 studies; 270 patients; 339 knees), GAE technical success was 99.7%. Over 12 months, the WMD ranged from -34 to -39 at each follow-up for VAS score and -28 to -34 for WOMAC Total score (all p < 0.001). At 12 months, 78% met the MCID for VAS score; 92% met the MCID for WOMAC Total score, and 78% met the SCB for WOMAC Total score. Higher baseline knee pain severity was associated with greater improvements in knee pain. Over 2 years, 5.2% of patients underwent total knee replacement and 8.3% received repeat GAE. Adverse events were minor, with transient skin discoloration as the most common (11.6%).
CONCLUSIONS
Limited evidence suggests that GAE is a safe procedure that confers improvement in knee OA symptoms at established MCID thresholds. Patients with greater knee pain severity may be more responsive to GAE.
PubMed: 36865988
DOI: 10.1016/j.ocarto.2023.100342 -
Expert Review of Neurotherapeutics Jan 2020: The American Psychiatric Association included Internet gaming disorder (IGD) in the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders, and the...
: The American Psychiatric Association included Internet gaming disorder (IGD) in the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders, and the World Health Organization included gaming disorder in the 11th revision of the International Classification of Diseases. These recent updates suggest significant concern related to the harms of excessive gaming.: This systematic review provides an updated summary of the scientific literature on treatments for IGD. Inclusion criteria were that studies: 1) evaluate the effectiveness of an intervention for IGD or excessive gaming; 2) use an experimental design (i.e. multi-armed [randomized or nonrandomized] or pretest-posttest); 3) include at least 10 participants per group; and 4) include an outcome measure of IGD symptoms or gaming duration. The review identified 22 studies evaluating treatments for IGD: 8 evaluating medication, 7 evaluating cognitive behavioral psychotherapy, and 7 evaluating other interventions and psychosocial treatments.: Even with the recent uptick in publication of such clinical trials, methodological flaws prevent strong conclusions about the efficacy of any treatment for IGD. Additional well-designed clinical trials using common metrics for assessing IGD symptoms are needed to advance the field.
Topics: Cognitive Behavioral Therapy; Humans; Internet Addiction Disorder; Psychosocial Intervention; Video Games
PubMed: 31544539
DOI: 10.1080/14737175.2020.1671824 -
Veterinary Sciences Dec 2021Pet ownership, the most common human-animal interaction, is believed to bestow positive health benefits onto pet owners. However, there is limited research on... (Review)
Review
Pet ownership, the most common human-animal interaction, is believed to bestow positive health benefits onto pet owners. However, there is limited research on substantiating these assertions. The aim of this review was to systematically identify, evaluate, and summarize primary research on the relationship between cat and/or dog ownership and cardiovascular disease (CVD), type 2 diabetes (T2D), and obesity to inform future research on pet ownership and chronic disease. How pet ownership was defined/measured, and identification of the chronic disease variables and health behaviors most often measured were emphasized. Two researchers independently searched PubMed and Web of Science, where One Health literature are mostly likely to be indexed, for peer-reviewed literature on pet ownership and CVD, T2D, and obesity. A review of 4541 titles and abstracts for relevance resulted in 34 manuscripts eligible for full-text review. Two researchers assessed each eligible manuscript and extracted data only from those that met the inclusion criteria (n = 14). Ten studies on CVD, four studies on obesity, and zero studies on T2D met the study criteria. The CVD and obesity variables varied and were not well described. The relationship between pet ownership and CVD and obesity varied (positive, negative, mixed effects, and no effect). Generalizability lacked across all studies: most studies were with Non-Hispanic White populations. Other areas of weakness were quality of study outcomes and instrument validity. Operationalization of pet ownership varied (from no verification to confirmed pet registration). Integration of the evidence-based influence of the human-animal connection through pet ownership on CVD and obesity may make prevention, mitigation, and treatment strategies more robust.
PubMed: 34941860
DOI: 10.3390/vetsci8120333 -
Social Psychiatry and Psychiatric... Oct 2022Several publications explored a relationship between pet ownership and lower levels of loneliness and social isolation. However, to the best of our knowledge, no... (Review)
Review
PURPOSE
Several publications explored a relationship between pet ownership and lower levels of loneliness and social isolation. However, to the best of our knowledge, no systematic review has yet synthesized the evidence on these associations. Thus, this systematic review aims to evaluate the findings regarding the relations between pet ownership, loneliness, and social isolation.
METHODS
PubMed, CINAHL, and PsycInfo were searched in January 2022. Observational studies relying on appropriate instruments to assess the exposure and the outcome variables were included. Two reviewers independently executed study selection, data extraction, and quality assessment.
RESULTS
n = 24 studies were included. Among adult samples, the studies examining the relationship between pet ownership and social isolation found that owning a pet was associated with lower levels of social isolation. Concerning loneliness, studies that were conducted after the outbreak of COVID-19 mostly showed that pet ownership can contribute to lower levels of loneliness, but did not reveal an overall significant association until then. In turn, the studies that examined child and adolescent samples suggest that pet ownership was related to reduced loneliness before COVID-19. Furthermore, most of the studies did not reveal any differences between dogs, cats, and other kinds of pets regarding their relationship to loneliness and social isolation.
CONCLUSION
All in all, only a part of the studies detected a significant association between pet ownership, loneliness and social isolation. However, the COVID-19 pandemic seemed to strengthen this relationship, so that future research is required to assess the longevity of this potential effect.
Topics: Animals; COVID-19; Dogs; Humans; Loneliness; Ownership; Pandemics; Social Isolation
PubMed: 35816194
DOI: 10.1007/s00127-022-02332-9 -
Veterinary Sciences Dec 2021Pet ownership is the most common form of human-animal interaction, and anecdotally, pet ownership can lead to improved physical and mental health for owners. However,... (Review)
Review
Pet ownership is the most common form of human-animal interaction, and anecdotally, pet ownership can lead to improved physical and mental health for owners. However, scant research is available validating these claims. This study aimed to review the recent peer reviewed literature to better describe the body of knowledge surrounding the relationship between pet ownership and mental health. A literature search was conducted in May 2020 using two databases to identify articles that met inclusion/exclusion criteria. After title review, abstract review, and then full article review, 54 articles were included in the final analysis. Of the 54 studies, 18 were conducted in the general population, 15 were conducted in an older adult population, eight were conducted in children and adolescents, nine focused on people with chronic disease, and four examined a specific unique population. Forty-one of the studies were cross-sectional, 11 were prospective longitudinal cohorts, and two were other study designs. For each of the articles, the impact of pet ownership on the mental health of owners was divided into four categories: positive impact ( = 17), mixed impact ( = 19), no impact ( = 13), and negative impact ( = 5). Among the reviewed articles, there was much variation in population studied and study design, and these differences make direct comparison challenging. However, when focusing on the impact of pet ownership on mental health, the results were variable and not wholly supportive of the benefit of pets on mental health. Future research should use more consistent methods across broader populations and the development of a pet-ownership survey module for use in broad, population surveys would afford a better description of the true relationship of pet ownership and mental health.
PubMed: 34941859
DOI: 10.3390/vetsci8120332