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Palliative & Supportive Care Oct 2023In palliative care, effective communication is essential to adequately meet the needs and preferences of patients and their relatives. Effective communication includes... (Review)
Review
OBJECTIVES
In palliative care, effective communication is essential to adequately meet the needs and preferences of patients and their relatives. Effective communication includes exchanging information, facilitates shared decision-making, and promotes an empathic care relationship. We explored the perspectives of patients with an advanced illness and their relatives on effective communication with health-care professionals.
METHODS
A systematic review was conducted. We searched Embase, Medline, Web of Science, CINAHL, and Cochrane for original empirical studies published between January 1, 2015 and March 4, 2021.
RESULTS
In total, 56 articles on 53 unique studies were included. We found 7 themes that from the perspectives of patients and relatives contribute to effective communication: (1) open and honest information. However, this open and honest communication can also trigger anxiety, stress, and existential disruption. Patients and relatives also indicated that they preferred (2) health-care professionals aligning to the patient's and relative's process of uptake and coping with information; (3) empathy; (4) clear and understandable language; (5) leaving room for positive coping strategies, (6) committed health-care professionals taking responsibility; and (7) recognition of relatives in their role as caregiver. Most studies in this review concerned communication with physicians in a hospital setting.
SIGNIFICANCE OF RESULTS
Most patients and relatives appreciate health-care professionals to not only pay attention to strictly medical issues but also to who they are as a person and the process they are going through. More research is needed on effective communication by nurses, in nonhospital settings and on communication by health-care professionals specialized in palliative care.
Topics: Humans; Palliative Care; Hospice and Palliative Care Nursing; Patients; Adaptation, Psychological; Communication
PubMed: 37646464
DOI: 10.1017/S1478951523001165 -
Journal of Clinical Medicine Sep 2023Direct access in physiotherapy (DAPT) occurs when a patient has the ability to self-refer to physical therapy without physician referral. This model of care in... (Review)
Review
Direct access in physiotherapy (DAPT) occurs when a patient has the ability to self-refer to physical therapy without physician referral. This model of care in musculoskeletal diseases (MSDs) has shown better outcomes than the traditional-based medical model of care that requires physician referral to access physiotherapist services. This traditional physician referral often results in a delay in care. Unfortunately, DAPT is still not permitted in many countries. The primary objective of this systematic review was to compare the effectiveness, safety, and the accuracy of DAPT compared to the physician-led model of care for the management of patients with musculoskeletal disorders. The secondary objective of the present study is to define the physiotherapists' characteristics or qualifications involved in DAPT. Databases searched included: Medline, Scopus and Web of Science. Databases were searched from their inception to July 2022. Research strings were developed according to the PICO model of clinical questions (patient, intervention, comparison, and outcome). Free terms or synonyms (e.g., physical therapy; primary health care; direct access; musculoskeletal disease; cost-effectiveness) and when possible MeSH (Medical Subject Headings) terms were used and combined with Boolean operators (AND, OR, NOT). Risk of bias assessment was carried out through Version 2 of the Cochrane risk-of-bias tool (ROB-2) for randomized controlled trials (RCTs) and the Newcastle Ottawa Scale (NOS) for observational studies. Authors conducted a qualitative analysis of the results through narrative analysis and narrative synthesis. The narrative analysis was provided for an extraction of the key concepts and common meanings of the different studies, while the summary narrative provided a textual combination of data. In addition, a quantitative analysis was conducted comparing the analysis of the mean and differences between the means. Twenty-eight articles met the inclusion criteria and were analyzed. Results show that DAPT had a high referral accuracy and a reduction in the rate of return visits. The medical model had a higher use of imaging, drugs, and referral to another specialist. DAPT was found to be more cost-effective than the medical model. DAPT resulted in better work-related outcomes and was superior when considering patient satisfaction. There were no adverse events noted in any of the studies. In regard to health outcomes, there was no difference between models. ROB-2 shows an intermediate risk of bias risk for the RCTs with an average of 6/9 points for the NOS scale for observational studies. DAPT is a safe, less expensive, reliable triage and management model of care that results in higher levels of satisfaction for patients compared to the traditional medical model. Prospero Registration Number: CRD42022349261.
PubMed: 37762773
DOI: 10.3390/jcm12185832 -
Cureus Oct 2023A herniated disc in the spine is a condition during which a nucleus pulposus is displaced from intervertebral space. It is a common cause of back pain. The patients who... (Review)
Review
A herniated disc in the spine is a condition during which a nucleus pulposus is displaced from intervertebral space. It is a common cause of back pain. The patients who experience pain related to a herniated disc often remember an inciting event that caused their pain. This activity reviews the evaluation and management of lumbar disc herniation and discusses the role of the healthcare team in evaluating and improving care for patients with this condition. Data sources were PubMed/Medline and Embase. Our review investigated English-language articles (from 2010 to 2023) according to the PRISMA guidelines. Overall, there were seven articles. Surveys and analyses of national databases were the most widely used methods (n=7). The search identified 777 studies; 7 were eligible for inclusion in the analysis. Further understanding of spinal disc herniation and treatment protocols may help improve evaluation and management in the future. Our research covered a range of management options. Disc herniation is a frequent problem for internists, emergency department doctors, nurse practitioners, and primary care physicians. To manage efficiently, an interprofessional team is needed. The first course of treatment is conservative, with paracetamol and anti-inflammatories being frequently used to relieve pain. A chemist must supervise the use of opioid analgesics in certain situations. Although surgery is sometimes the final option, patients frequently have neurological damage and lingering discomfort. In circumstances where physical treatment is not working, MRI interpretation becomes necessary. Primary care physicians or mental health professionals should handle back pain as it is frequently linked to mental health issues. Results can be enhanced by regular exercise and preserving a healthy body weight.
PubMed: 38034203
DOI: 10.7759/cureus.47908 -
Arthritis & Rheumatology (Hoboken, N.J.) Oct 2023Haemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS) are life-threatening systemic hyperinflammatory syndromes that can develop in most...
The 2022 EULAR/ACR Points to Consider at the Early Stages of Diagnosis and Management of Suspected Haemophagocytic Lymphohistiocytosis/Macrophage Activation Syndrome (HLH/MAS).
OBJECTIVE
Haemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS) are life-threatening systemic hyperinflammatory syndromes that can develop in most inflammatory contexts. They can progress rapidly, and early identification and management are critical for preventing organ failure and mortality. This effort aimed to develop evidence-based and consensus-based points to consider to assist clinicians in optimising decision-making in the early stages of diagnosis, treatment and monitoring of HLH/MAS.
METHODS
A multinational, multidisciplinary task force of physician experts, including adult and paediatric rheumatologists, haematologist/oncologists, immunologists, infectious disease specialists, intensivists, allied healthcare professionals and patients/parents, formulated relevant research questions and conducted a systematic literature review (SLR). Delphi methodology, informed by SLR results and questionnaires of experts, was used to generate statements aimed at assisting early decision-making and optimising the initial care of patients with HLH/MAS.
RESULTS
The task force developed 6 overarching statements and 24 specific points to consider relevant to early recognition of HLH/MAS, diagnostic approaches, initial management and monitoring of HLH/MAS. Major themes included the simultaneous need for prompt syndrome recognition, systematic evaluation of underlying contributors, early intervention targeting both hyperinflammation and likely contributors, careful monitoring for progression/complications and expert multidisciplinary assistance.
CONCLUSION
These 2022 EULAR/American College of Rheumatology points to consider provide up-to-date guidance, based on the best available published data and expert opinion. They are meant to help guide the initial evaluation, management and monitoring of patients with HLH/MAS in order to halt disease progression and prevent life-threatening immunopathology.
Topics: Adult; Child; Humans; Lymphohistiocytosis, Hemophagocytic; Macrophage Activation Syndrome; Consensus; Physicians; Advisory Committees
PubMed: 37486733
DOI: 10.1002/art.42636 -
American Journal of Translational... 2023Human society has entered the age of artificial intelligence, medical practice and medical education are undergoing profound changes. Artificial intelligence (AI) is now... (Review)
Review
BACKGROUND
Human society has entered the age of artificial intelligence, medical practice and medical education are undergoing profound changes. Artificial intelligence (AI) is now applied in many industries, particularly in healthcare and medical education, where it deeply intersects. The purpose of this paper is to overview the current situation and problems of "AI+medicine/medical" education and to provide our own perspective on the current predicament.
METHODS
We searched PubMed, Embase, Cochrane and CNKI databases to assess the literature on AI+medical/medical education from 2017 to July 2022. The main inclusion criteria include literature describing the current situation or predicament of "AI+medical/medical education".
RESULTS
Studies have shown that the current application of AI in medical education is focused on clinical specialty training and continuing education, with the main application areas being radiology, diagnostics, surgery, cardiology, and dentistry. The main role is to assist physicians to improve their efficiency and accuracy. In addition, the field of combining AI with medicine/medical education is steadily expanding, and the most urgent need is for policy makers, experts in the medical field, AI and education, and experts in other fields to come together to reach consensus on ethical issues and develop regulatory standards. Our study also found that most medical students are positive about adding AI-related courses to the existing medical curriculum. Finally, the quality of research on "AI+medical/medical education" is poor.
CONCLUSION
In the context of the COVID-19 pandemic, our study provides an innovative systematic review of the latest "AI+medicine/medical curriculum". Since the AI+medicine curriculum is not yet regulated, we have made some suggestions.
PubMed: 37560249
DOI: No ID Found -
The Journal of Allergy and Clinical... Aug 2023Allergic rhinitis (AR) is associated with significant clinical and socioeconomic burdens. It is a frequent risk factor for other atopic diseases, such as asthma. Thus, a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Allergic rhinitis (AR) is associated with significant clinical and socioeconomic burdens. It is a frequent risk factor for other atopic diseases, such as asthma. Thus, a comprehensive updated description of the epidemiology of AR in the pediatric population is needed to understand its implications better.
OBJECTIVE
To determine the incidence, prevalence, and epidemiology of AR among children over the past 10 years.
METHODS
We conducted a systematic review and meta-analysis using a protocol registered and published with the International Prospective Register of Systematic Reviews (Register No. CRD42022332667). We searched databases, registers, and Web sites for cohort or cross-sectional studies published between 2012 and 2022, evaluating the epidemiology (incidence or prevalence) of AR in the pediatric population. We assessed study quality of and risk for bias using items derived from the Strengthening the Reporting of Observational Studies in Epidemiology statement.
RESULTS
Twenty-two studies were included in the analysis. The overall prevalence of physician-diagnosed AR was 10.48%, the overall prevalence of self-reported current (past 12 months) AR was 18.12%, and the overall prevalence of self-reported lifetime AR was 19.93%. The incidence could not be determined. The analysis of prevalence of AR over time showed a rising trend in physician-diagnosed AR over the years (8.39% in 2012 to 2015 vs 19.87% in 2016 to 2022).
CONCLUSIONS
Allergic rhinitis has significant impacts on the pediatric population, with an increasing trend for diagnosed AR over the years. Further investigations concerning the incidence, comorbidities, diagnosis, and treatment are needed to provide a complete overview of the disease as well as its burden and management.
Topics: Humans; Child; Cross-Sectional Studies; Rhinitis, Allergic; Asthma; Comorbidity; Risk Factors; Prevalence
PubMed: 37236349
DOI: 10.1016/j.jaip.2023.05.016 -
Journal of Clinical Oncology : Official... Aug 2023To update ASCO-College of American Pathologists (CAP) recommendations for human epidermal growth factor receptor 2 (HER2) testing in breast cancer. The Panel is aware...
PURPOSE
To update ASCO-College of American Pathologists (CAP) recommendations for human epidermal growth factor receptor 2 (HER2) testing in breast cancer. The Panel is aware that a new generation of antibody-drug conjugates (ADCs) targeting the HER2 protein is active against breast cancers that lack protein overexpression or gene amplification.
METHODS
An Update Panel conducted a systematic literature review to identify signals for updating recommendations.
RESULTS
The search identified 173 abstracts. Of five potential publications reviewed, none constituted a signal for revising existing recommendations.
RECOMMENDATIONS
The 2018 ASCO-CAP recommendations for HER2 testing are affirmed.
DISCUSSION
HER2 testing guidelines have focused on identifying HER2 protein overexpression or gene amplification in breast cancer to identify patients for therapies that disrupt HER2 signaling. This update acknowledges a new indication for trastuzumab deruxtecan when HER2 is not overexpressed or amplified but is immunohistochemistry (IHC) 1+ or 2+ without amplification by in situ hybridization. Clinical trial data on tumors that tested IHC 0 are limited (excluded from DESTINY-Breast04), and evidence is lacking that these cancers behave differently or do not respond similarly to newer HER2 ADCs. Although current data do not support a new IHC 0 versus 1+ prognostic or predictive threshold for response to trastuzumab deruxtecan, this threshold is now relevant because of the trial entry criteria that supported its new regulatory approval. Therefore, while it is premature to create new result categories of HER2 expression (eg, HER2-Low, HER2-Ultra-Low), best practices to distinguish IHC 0 from 1+ are now clinically relevant. This Update affirms prior HER2 reporting recommendations and offers a new HER2 testing reporting comment to highlight the current relevance of IHC 0 versus 1+ results and best practice recommendations to distinguish these often subtle differences.Additional information is available at www.asco.org/breast-cancer-guidelines.
Topics: Humans; Female; Breast Neoplasms; In Situ Hybridization, Fluorescence; Pathologists; Receptor, ErbB-2; Biomarkers, Tumor
PubMed: 37284804
DOI: 10.1200/JCO.22.02864 -
Chest Aug 2023Respiratory failure is a significant concern in neuromuscular diseases (NMDs). This CHEST guideline examines the literature on the respiratory management of patients...
BACKGROUND
Respiratory failure is a significant concern in neuromuscular diseases (NMDs). This CHEST guideline examines the literature on the respiratory management of patients with NMD to provide evidence-based recommendations.
STUDY DESIGN AND METHODS
An expert panel conducted a systematic review addressing the respiratory management of NMD and applied the Grading of Recommendations, Assessment, Development, and Evaluations approach for assessing the certainty of the evidence and formulating and grading recommendations. A modified Delphi technique was used to reach a consensus on the recommendations.
RESULTS
Based on 128 studies, the panel generated 15 graded recommendations, one good practice statement, and one consensus-based statement.
INTERPRETATION
Evidence of best practices for respiratory management in NMD is limited and is based primarily on observational data in amyotrophic lateral sclerosis. The panel found that pulmonary function testing every 6 months may be beneficial and may be used to initiate noninvasive ventilation (NIV) when clinically indicated. An individualized approach to NIV settings may benefit patients with chronic respiratory failure and sleep-disordered breathing related to NMD. When resources allow, polysomnography or overnight oximetry can help to guide the initiation of NIV. The panel provided guidelines for mouthpiece ventilation, transition to home mechanical ventilation, salivary secretion management, and airway clearance therapies. The guideline panel emphasizes that NMD pathologic characteristics represent a diverse group of disorders with differing rates of decline in lung function. The clinician's role is to add evaluation at the bedside to shared decision-making with patients and families, including respect for patient preferences and treatment goals, considerations of quality of life, and appropriate use of available resources in decision-making.
Topics: Humans; Quality of Life; Respiration, Artificial; Noninvasive Ventilation; Respiratory Insufficiency; Physicians
PubMed: 36921894
DOI: 10.1016/j.chest.2023.03.011 -
Annals of the Rheumatic Diseases Jan 2024To develop treat-to-target (T2T) recommendations in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR).
OBJECTIVES
To develop treat-to-target (T2T) recommendations in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR).
METHODS
A systematic literature review was conducted to retrieve data on treatment targets and outcomes in GCA/PMR as well as to identify the evidence for the effectiveness of a T2T-based management approach in these diseases. Based on evidence and expert opinion, the task force (29 participants from 10 countries consisting of physicians, a healthcare professional and a patient) developed recommendations, with consensus obtained through voting. The final level of agreement was provided anonymously.
RESULTS
Five overarching principles and six-specific recommendations were formulated. Management of GCA and PMR should be based on shared decisions between patient and physician recognising the need for urgent treatment of GCA to avoid ischaemic complications, and it should aim at maximising health-related quality of life in both diseases. The treatment targets are achievement and maintenance of remission, as well as prevention of tissue ischaemia and vascular damage. Comorbidities need to be considered when assessing disease activity and selecting treatment.
CONCLUSION
These are the first T2T recommendations for GCA and PMR. Treatment targets, as well as strategies to assess, achieve and maintain these targets have been defined. The research agenda highlights the gaps in evidence and the need for future research.
Topics: Humans; Giant Cell Arteritis; Polymyalgia Rheumatica; Quality of Life; Comorbidity
PubMed: 36828585
DOI: 10.1136/ard-2022-223429 -
Journal of Cosmetic Dermatology Aug 2023Thread lifting procedures for facial rejuvenation have made great strides with the development of absorbable threads. Although they have gained fame among plastic... (Review)
Review
BACKGROUND
Thread lifting procedures for facial rejuvenation have made great strides with the development of absorbable threads. Although they have gained fame among plastic surgeons and dermatologists, there have been very few studies published in scientific articles on the effects of absorbable threads in facial rejuvenation, as well as few studies published by aesthetic physicians. The most effective and efficient techniques to determine the adequate place to insert the reabsorbable thread, and the different ways to evaluate the effectiveness of these aesthetic procedures, are still unknown.
OBJECTIVES
This review aims to identify, in the scientific literature, the evaluation techniques for a safe and correct insertion of PDO threads in facial rejuvenation procedures.
METHODOLOGY
A review of scientific literature was performed using the following list of keywords, descriptors, or thesauri: PDO threads, aesthetics, facial rejuvenation. Scopus, PubMed, and Web of Science databases were used for the literature search. Articles from years 2012-2022 were selected. The reference lists of the identified articles were included. (16) out of (35) articles associated with the topic were selected. Simple and compound searches were performed with the keywords and very few rigorous studies about the use of PDO threads for aesthetic procedures were found.
RESULTS
Very few rigorous scientific studies on the use of PDO threads for facial rejuvenation procedures were found. There is a strong theoretical and methodological gap on this subject, and, also, on the evaluation techniques that could be used for the safe and correct insertion of the threads.
CONCLUSION
The bibliographic information found shows a huge theoretical and methodological gap in the subject of procedures for facial rejuvenation with PDO threads, as well as the techniques and tools employed to guarantee the correct insertion of the threads.
Topics: Humans; Esthetics; Face; Rejuvenation; Rhytidoplasty; Cosmetic Techniques
PubMed: 37021458
DOI: 10.1111/jocd.15709