-
Neurosurgery Oct 2023Chiari I malformation (CIM) is characterized by descent of the cerebellar tonsils through the foramen magnum, potentially causing symptoms from compression or...
BACKGROUND
Chiari I malformation (CIM) is characterized by descent of the cerebellar tonsils through the foramen magnum, potentially causing symptoms from compression or obstruction of the flow of cerebrospinal fluid. Diagnosis and treatment of CIM is varied, and guidelines produced through systematic review may be helpful for clinicians.
OBJECTIVE
To perform a systematic review of the medical literature to answer specific questions on the diagnosis and treatment of CIM.
METHODS
PubMed and Embase were queried between 1946 and January 23, 2021, using the search strategies provided in Appendix I of the full guidelines.
RESULTS
The literature search yielded 430 abstracts, of which 79 were selected for full-text review, 44 were then rejected for not meeting the inclusion criteria or for being off-topic, and 35 were included in this systematic review.
CONCLUSION
Four Grade C recommendations were made based on Class III evidence, and 1 question had insufficient evidence. The full guidelines can be seen online at https://www.cns.org/guidelines/browse-guidelines-detail/2-symptoms .
Topics: Humans; Neurosurgeons; Arnold-Chiari Malformation; Patients; Evidence Gaps; Foramen Magnum
PubMed: 37646519
DOI: 10.1227/neu.0000000000002634 -
Critical Reviews in Oncology/hematology Oct 2023Women with breast cancer have an increased risk of primary ovarian cancer (BR→OV), and women with ovarian cancer have an increased risk of primary breast cancer... (Review)
Review
OBJECTIVE
Women with breast cancer have an increased risk of primary ovarian cancer (BR→OV), and women with ovarian cancer have an increased risk of primary breast cancer (OV→BR). This systematic review summarizes risk factors for developing BR→OV and OV→BR.
METHODS
We searched PubMed and Embase until June 2022.
RESULTS
We identified 23 articles meeting our inclusion criteria. Studies observed a lower risk of BR→OV for Black versus White women, alcohol consumption, radiotherapy and hormone therapy, BRCA2 versus BRCA1, and ER/PR positive versus negative breast tumors, and a higher risk with family history of breast/ovarian cancer, triple negative versus luminal breast cancer, and higher grade breast tumors. There was an increased risk of OV→BR with family history of cancer.
CONCLUSIONS
Tumor characteristics, and genetic and familial factors are associated with risk of BR→OV and OV→BR. These results could aid clinicians in decision-making for breast and ovarian cancer patients, including risk-reducing strategies.
Topics: Female; Humans; Mutation; Genes, BRCA2; Breast Neoplasms; Risk Factors; Ovarian Neoplasms
PubMed: 37541535
DOI: 10.1016/j.critrevonc.2023.104081 -
European Heart Journal May 2024The sex disparity in outcomes of patients with cardiovascular disease is well-described and has persisted across recent decades. While there have been several proposed... (Review)
Review
The sex disparity in outcomes of patients with cardiovascular disease is well-described and has persisted across recent decades. While there have been several proposed mechanisms to explain this disparity, there are limited data on female patient-physician sex concordance and its association with outcomes. The authors review the existing literature on the relationship between patient-physician sex concordance and clinical outcomes in patients with cardiovascular disease, the evidence of a benefit in clinical outcomes with female patient-physician sex concordance, and the possible drivers of such a benefit and highlight directions for future study.
Topics: Humans; Cardiovascular Diseases; Female; Male; Physician-Patient Relations; Sex Factors; Treatment Outcome
PubMed: 38551446
DOI: 10.1093/eurheartj/ehae121 -
Cureus Sep 2023Due to the increased burden of chronic medical conditions in recent years, artificial intelligence (AI) is suggested in the medical field to optimize health care.... (Review)
Review
Due to the increased burden of chronic medical conditions in recent years, artificial intelligence (AI) is suggested in the medical field to optimize health care. Physicians could implement these automated problem-solving tools for their benefit, reducing their workload, assisting in diagnostics, and supporting clinical decision-making. These tools are being considered for future medical assistance in real life. A literature review was performed to assess the impact of AI on the patient population with chronic medical conditions, using standardized guidelines. A MeSH strategy was created, and the database was searched for appropriate studies using specific inclusion and exclusion criteria. The online database yielded 93 results from various databases, of which 10 moderate to high-quality studies were selected to be included in our systematic review after removing the duplicates, screening titles, and articles. Of the 10 studies, nine recommended using AI after considering the potential limitations such as privacy protection, medicolegal implications, and psychosocial aspects. Due to its non-fatigable nature, AI was found to be of immense help in image recognition. It was also found to be valuable in various disciplines related to administration, physician burden, and patient adherence. The newer technologies of Chatbots and eHealth applications are of great help when used safely and effectively after proper patient education. After a careful review conducted by our team members, it is safe to conclude that implementing AI in daily clinical practice could potentiate the cognitive ability of physicians and decrease the workload through various automated technologies such as image recognition, speech recognition, and voice recognition due to its unmatchable speed and non-fatigable nature when compared to clinicians. Despite its vast benefits to the medical field, a few limitations could hinder its effective implementation into real-life practice, which requires enormous research and strict regulations to support its role as a physician's aid. However, AI should only be used as a medical support system, in order to improve the primary outcomes such as reducing waiting time, healthcare costs, and workload. AI should not be meant to replace physicians.
PubMed: 37900468
DOI: 10.7759/cureus.46066 -
Seminars in Arthritis and Rheumatism Oct 2023To assess real-world comparative effectiveness studies of biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs) in adults with... (Review)
Review
OBJECTIVE
To assess real-world comparative effectiveness studies of biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs) in adults with rheumatoid arthritis (RA) through a systematic review.
METHODS
We searched Medline for journal articles (2001-2021) and Embase® for abstracts presented at the European Alliance of Associations for Rheumatology and American College of Rheumatology (ACR) 2020 and 2021 annual meetings on non-randomized studies comparing the effectiveness of b/tsDMARDs using ACR-recommended disease activity measures, measures of functional status, and patient-reported outcomes (HAQ, PROMIS PF, patient pain, Patient and Physician Global Assessment of disease activity). Methodological heterogeneity between studies precluded meta-analyses. Risk of bias was assessed using the Cochrane Risk Of Bias In Non-randomized Studies of Interventions-I tool.
RESULTS
Of 1283 records screened, 68 were selected for data extraction, of which 1 was excluded due to critical risk of bias. Most studies were multicenter observational cohort/registry studies (n = 60) and were published between 2011 and 2021 (n = 60). Mean or median reported RA duration was between 6 and 15 years. Disease Activity Score in 28 joints (46 studies), Clinical Disease Activity Index (37 studies), and Health Assessment Questionnaire-Disability Index (32 studies) were the most common outcomes used in clinical practice, with regional differences identified. The most common comparison was between tumor necrosis factor inhibitors (TNFis) and non-TNFi bDMARDs (35 studies). There were no evident differences between b/tsDMARDs in clinical effectiveness.
CONCLUSION
This systematic review summarizing real-world evidence from a very large number of global studies found there are many effective options for the treatment of RA, but relatively less evidence to support the use of any one b/tsDMARD or drug class over another. Treatment for patients with RA should be tailored to suit individual clinical profiles. Further research is needed to identify whether specific patient subgroups may benefit from specific drug classes.
Topics: Humans; Arthritis, Rheumatoid; Antirheumatic Agents; Treatment Outcome; Biological Products; Multicenter Studies as Topic
PubMed: 37573754
DOI: 10.1016/j.semarthrit.2023.152249 -
International Angiology : a Journal of... Dec 2023Chronic venous disease (CVD) can lead to considerable morbidity and impact health-related quality of life (HRQoL). The aim of this review was twofold: (i) to provide a...
INTRODUCTION
Chronic venous disease (CVD) can lead to considerable morbidity and impact health-related quality of life (HRQoL). The aim of this review was twofold: (i) to provide a deeper understanding of how CVD affects HRQoL (physical, psychological and social functioning), and (ii) to review the impact of evidence-based veno-active drugs (VADs) on HRQoL.
EVIDENCE ACQUISITION
For the effect of CVD on HRQoL, information was gathered during an Expert Consensus Meeting, during which data were presented from both the patient and physician perspective assessed with validated quality-of-life measures. For the impact of VADs on HRQoL, a systematic literature review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases were searched for real world evidence or randomized-controlled trials (RCT) vs. placebo, reporting data on the influence of VADs on HRQoL in patients with CVD.
EVIDENCE SYNTHESIS
CVD can negatively affect daily life in a number of areas related to pain, physical function and social activities. The impact of CVD on HRQoL begins early in the disease and for patients the emotional burden of the disease is as high as the physical burden. In contrast, physicians tend to overestimate the physical impact. The database search yielded 184 unique records, of which 19 studies reporting on VADs and HRQoL in patients with CVD met the inclusion criteria (13 observational and 6 RCTs). Micronized purified flavonoid fraction (MPFF) was the most represented agent, associated with 12/19 studies (2 RCTs and 10 observational). Of the 6 RCTs, only MPFF, aminaphthone and low-dose diosmin provided statistically significant evidence for improvement on HRQoL compared with placebo; for the other VADs improvements in HRQoL were not statistically different from placebo. MPFF was also associated with improvements in HRQoL in the observational studies, across all CEAP clinical classes, as monotherapy or in combination with other conservative therapy, and for all aspects of HRQoL: physical, psychological, and social. Real-world data for the other VADs were scarce. Ruscus extract, sulodexide and a semi-synthetic diosmin were each represented by a single observational study and these limited data were associated with statistically significant improvements compared with baseline in overall and subdomain scores across the range of CEAP clinical classes.
CONCLUSIONS
CVD can impair patients' HRQoL significantly at all stages of the disease. MPFF has the greatest evidence base of clinical use in both RCT and real-world observational studies for effectiveness on HRQoL and is recognized by international guidelines. The complete video presentation of the work is available online at www.minervamedica.it (Supplementary Digital Material 1: Supplementary Video 1, 5 min, 194 MB).
Topics: Humans; Diosmin; Vascular Diseases; Veins; Pain; Flavonoids; Quality of Life; Chronic Disease; Observational Studies as Topic
PubMed: 38015554
DOI: 10.23736/S0392-9590.23.05108-8 -
Human Resources For Health Apr 2024A robust workforce of locum tenens (LT) physicians is imperative for health service stability. A systematic review was conducted to synthesize current evidence on the... (Review)
Review
A robust workforce of locum tenens (LT) physicians is imperative for health service stability. A systematic review was conducted to synthesize current evidence on the strategies used to facilitate the recruitment and retention of LT physicians. English articles up to October 2023 across five databases were sourced. Original studies focusing on recruitment and retention of LT's were included. An inductive content analysis was performed to identify strategies used to facilitate LT recruitment and retention. A separate grey literature review was conducted from June-July 2023. 12 studies were retained. Over half (58%) of studies were conducted in North America. Main strategies for facilitating LT recruitment and retention included financial incentives (83%), education and career factors (67%), personal facilitators (67%), clinical support and mentorship (33%), and familial considerations (25%). Identified subthemes were desire for flexible contracts (58%), increased income (33%), practice scouting (33%), and transitional employment needs (33%). Most (67%) studies reported deterrents to locum work, with professional isolation (42%) as the primary deterrent-related subtheme. Grey literature suggested national physician licensure could enhance license portability, thereby increasing the mobility of physicians across regions. Organizations employ five main LT recruitment facilitators and operationalize these in a variety of ways. Though these may be incumbent on local resources, the effectiveness of these approaches has not been evaluated. Consequently, future research should assess LT the efficacy of recruitment and retention facilitators. Notably, the majority of identified LT deterrents may be mitigated by modifying contextual factors such as improved onboarding practices.
Topics: Humans; Physicians, Family; Workforce; Employment; Motivation; Rural Health Services
PubMed: 38627735
DOI: 10.1186/s12960-024-00906-z -
Open Forum Infectious Diseases Nov 2023Since the identification of severe fever with thrombocytopenia syndrome virus (SFTSV) in 2010, there has been an increase in reported cases in China and other Asian... (Review)
Review
Since the identification of severe fever with thrombocytopenia syndrome virus (SFTSV) in 2010, there has been an increase in reported cases in China and other Asian countries. Cardiac abnormalities are highly prevalent in SFTS patients. We searched 5 Chinese and international databases for published SFTS articles and extracted patient characteristics, cardiac complications, electrocardiography findings, and imaging findings. Twenty-seven studies were identified, covering 1938 patients and 621 cardiac abnormalities. Arrhythmia was the most prevalent, reported in 24 studies and 525 cases, with a prevalence of 27.09%. The 2 major types of arrhythmias were bradycardia and atrial fibrillation. Heart failure was the second most prevalent abnormality, with 77 cases. Changes in the ST segment and T wave were the most common. Valve regurgitation, reduced ejection fraction, and pericardial effusion were also documented. We recommend that physicians pay close attention to newly onset arrhythmia and structural heart disease in SFTS patients.
PubMed: 37937042
DOI: 10.1093/ofid/ofad509 -
Dermatologic Surgery : Official... Jul 2024Melasma is a common chronic, relapsing pigmentary disorder that causes psychological impact. Chemical peels are a well-known therapeutic modality used for accelerating... (Review)
Review
BACKGROUND
Melasma is a common chronic, relapsing pigmentary disorder that causes psychological impact. Chemical peels are a well-known therapeutic modality used for accelerating the treatment of melasma.
OBJECTIVE
To review the published evidence on the efficacy and safety of chemical peels in the treatment of melasma.
METHODS
A systematic review was done. A meta-analysis could not be done due to the heterogeneity of data.
RESULT
The authors conducted a PubMed search and included prospective case series of more than 10 cases and randomized controlled trials (RCTs) that have studied the safety and/or efficacy of chemical peel in melasma. Out of 24 studies, 9 were clinical/comparative trials and 15 were RCTs. The total sample size was 1,075. The duration of the study varied from 8 to 36 weeks. Only 8 studies were split face. All studies used self-assessment, physician global assessment, and Melasma Area and Severity Index (MASI) for quantifying the results. Glycolic acid was found to be the most safe and effective in melasma.
CONCLUSION
Chemical peels were found to be safe and effective in the management of melasma.
Topics: Melanosis; Humans; Chemexfoliation; Glycolates; Treatment Outcome; Keratolytic Agents
PubMed: 38530985
DOI: 10.1097/DSS.0000000000004167 -
Plastic and Reconstructive Surgery Jul 2023Since the initial introduction by Tonnard in 2013, numerous studies have reported positive findings after employing nanofat; however, concerns exist regarding its...
BACKGROUND
Since the initial introduction by Tonnard in 2013, numerous studies have reported positive findings after employing nanofat; however, concerns exist regarding its effects and mechanisms, and various methods to generate nanofat also remain unclear. The systematic review was conducted to evaluate the efficacy of sole nanofat grafting in plastic and reconstructive surgery.
METHODS
The MEDLINE, Embase, Cochrane Central, Web of Science, and Scopus databases were searched for studies related to sole nanofat grafting in plastic and reconstructive surgery (November 23rd, 2022). Outcomes of interest were all clinical results on humans or animals.
RESULTS
Twelve studies were included, and no meta-analysis was conducted due to the clinical heterogeneity of the studies. In general, included studies had a low level of evidence. Six studies (n=253) showed significant improvements in scar characteristics via evaluation of the POSAS scales, FACE-Q scale, physician assessment, patient satisfaction, or VSS scale. Four studies described its benefits in skin rejuvenation (wrinkles, fine rhytides, pigmentation, or discoloration) via photographs, questionnaires, or indentation indices. Histological evaluation illustrated overall increases of skin thickness, collagen, and elastic fibers. Three experimental studies showed beneficial effects of nanofat on fat grafting, diabetic wound healing, and hair growth with compelling histological evidence. No severe complication was reported.
CONCLUSION
Sole nanofat grafting shows potential benefits in scar treatment and anti-aging with conclusive histological evidence. Clinical studies about fat grafting, wound healing, or hair growth should be conducted, based on the foundation in this systematic review. Nanofat grafting could be a practical and safe procedure.
PubMed: 37400953
DOI: 10.1097/PRS.0000000000010905