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JAMA Network Open Mar 2024Multiple strategies integrating magnetic resonance imaging (MRI) and clinical data have been proposed to determine the need for a prostate biopsy in men with suspected... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Multiple strategies integrating magnetic resonance imaging (MRI) and clinical data have been proposed to determine the need for a prostate biopsy in men with suspected clinically significant prostate cancer (csPCa) (Gleason score ≥3 + 4). However, inconsistencies across different strategies create challenges for drawing a definitive conclusion.
OBJECTIVE
To determine the optimal prostate biopsy decision-making strategy for avoiding unnecessary biopsies and minimizing the risk of missing csPCa by combining MRI Prostate Imaging Reporting & Data System (PI-RADS) and clinical data.
DATA SOURCES
PubMed, Ovid MEDLINE, Embase, Web of Science, and Cochrane Library from inception to July 1, 2022.
STUDY SELECTION
English-language studies that evaluated men with suspected but not confirmed csPCa who underwent MRI PI-RADS followed by prostate biopsy were included. Each study had proposed a biopsy plan by combining PI-RADS and clinical data.
DATA EXTRACTION AND SYNTHESIS
Studies were independently assessed for eligibility for inclusion. Quality of studies was appraised using the Quality Assessment of Diagnostic Accuracy Studies 2 tool and the Newcastle-Ottawa Scale. Mixed-effects meta-analyses and meta-regression models with multimodel inference were performed. Reporting of this study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline.
MAIN OUTCOMES AND MEASURES
Independent risk factors of csPCa were determined by performing meta-regression between the rate of csPCa and PI-RADS and clinical parameters. Yields of different biopsy strategies were assessed by performing diagnostic meta-analysis.
RESULTS
The analyses included 72 studies comprising 36 366 patients. Univariable meta-regression showed that PI-RADS 4 (β-coefficient [SE], 7.82 [3.85]; P = .045) and PI-RADS 5 (β-coefficient [SE], 23.18 [4.46]; P < .001) lesions, but not PI-RADS 3 lesions (β-coefficient [SE], -4.08 [3.06]; P = .19), were significantly associated with a higher risk of csPCa. When considered jointly in a multivariable model, prostate-specific antigen density (PSAD) was the only clinical variable significantly associated with csPCa (β-coefficient [SE], 15.50 [5.14]; P < .001) besides PI-RADS 5 (β-coefficient [SE], 9.19 [3.33]; P < .001). Avoiding biopsy in patients with lesions with PI-RADS category of 3 or less and PSAD less than 0.10 (vs <0.15) ng/mL2 resulted in reducing 30% (vs 48%) of unnecessary biopsies (compared with performing biopsy in all suspected patients), with an estimated sensitivity of 97% (vs 95%) and number needed to harm of 17 (vs 15).
CONCLUSIONS AND RELEVANCE
These findings suggest that in patients with suspected csPCa, patient-tailored prostate biopsy decisions based on PI-RADS and PSAD could prevent unnecessary procedures while maintaining high sensitivity.
Topics: Male; Humans; Magnetic Resonance Imaging; Prostatic Neoplasms; Prostate-Specific Antigen; Prostate; Biopsy
PubMed: 38551559
DOI: 10.1001/jamanetworkopen.2024.4258 -
Clinical Child and Family Psychology... Sep 2023Infants can acquire fears vicariously by observing parents' fearful reactions to novel stimuli in everyday situations (i.e., modeling). To date, no systematic or... (Meta-Analysis)
Meta-Analysis Review
Infants can acquire fears vicariously by observing parents' fearful reactions to novel stimuli in everyday situations (i.e., modeling). To date, no systematic or meta-analytic review examined the role of modeling in parent-child transmission of fear and avoidance in early life. In our systematic review and meta-analysis, we aimed to investigate the effect of modeling parents' fearful reactions on infants' acquisition of fear and avoidance of novel stimuli and explore the moderation of this effect by child behavioral inhibition (BI) and parent trait anxiety. The search conducted in Web Of Science, Pubmed, Embase, and PsycINFO revealed 23 eligible studies for the systematic review and 19 for the meta-analysis. Eligible studies included published studies that measured infant fear and avoidance (infants aged up to 30 months) of novel stimuli following exposure to parental fearful expressions. Meta-analysis findings revealed a significant causal effect of modeling of parental fear on infants' fear [g = .44] and avoidance of novel stimuli [g = .44]. The findings support moderation by child BI on infant avoidance (not fear) acquisition, with the effects being larger for infants with higher BI. However, this moderation was only found, when including both experimental and correlational studies (p > .05), but not when exclusively including experimental studies (p = .17). This meta-analysis provides support for early parent-to-offspring fear transmission: a causal small to medium effect of parents' fearful reactions was shown on infants' fear and avoidance of novel stimuli. Elucidating parent-to-offspring anxiety transmission pathways can inform us about potential fear reduction and prevention strategies.
Topics: Infant; Humans; Anxiety; Parents; Anxiety Disorders; Inhibition, Psychological
PubMed: 37500947
DOI: 10.1007/s10567-023-00448-1 -
Pharmacology & Therapeutics Apr 2024Melanoma is the most aggressive form of skin cancer, representing approximately 4% of all cutaneous neoplasms and accounting for up to 80% of deaths. Advanced stages of... (Review)
Review
Melanoma is the most aggressive form of skin cancer, representing approximately 4% of all cutaneous neoplasms and accounting for up to 80% of deaths. Advanced stages of melanoma involve metastatic processes and are associated with high mortality and morbidity, mainly due to the rapid dissemination and heterogeneous responses to current therapies, including immunotherapy. Immune checkpoint inhibitors (ICIs) are currently used in the treatment of metastatic melanoma (MM) and despite being linked to an increase in patient survival, a high percentage of them still do not benefit from it. Accordingly, the number of therapeutic regimens for MM patients using ICIs either alone or in combination with other therapies has increased, together with the need for reliable biomarkers that can both predict and monitor response to ICIs. In this context, circulating biomarkers, such as DNA, RNA, proteins, and cells, have emerged due to their ability to reflect disease status. Moreover, blood tests are minimally invasive and provide an attractive option to detect biomarkers, avoiding stressful medical procedures. This systematic review aims to evaluate the possibility of a non-invasive biomarker signature that can guide therapeutic decisions. The studies reported here offer valuable insight into how circulating biomarkers can have a role in personalized treatments for melanoma patients receiving ICIs therapy, emphasizing the need for rigorous clinical trials to confirm findings and establish standardized procedures.
Topics: Humans; Melanoma; Skin Neoplasms; Immunotherapy; Biomarkers
PubMed: 38367867
DOI: 10.1016/j.pharmthera.2024.108613 -
Cureus Dec 2023We aim to investigate the potential of laparoscopic ultrasonography (LUS) as a replacement for intraoperative cholangiography (IOC) in the context of laparoscopic... (Review)
Review
We aim to investigate the potential of laparoscopic ultrasonography (LUS) as a replacement for intraoperative cholangiography (IOC) in the context of laparoscopic cholecystectomy focusing on various aspects related to both techniques. We made our search through PubMed, Web of Science, Cochrane Library, and Scopus, with the use of the following search strategy: ("laparoscopic ultrasonography" OR LUS OR "laparoscopic US" OR "laparoscopic ultrasound") AND ("laparoscopic cholecystectomy" OR LC). We incorporated diverse studies that addressed our topic, offering data on the identification of biliary anatomy and variations, the utilization of laparoscopic ultrasound in cholecystitis, the detection of common bile duct stones, and the criteria utilized to assess the accuracy of LUS. A total of 1526 articles were screened and only 20 were finally included. This systematic review assessed LUS and IOC techniques in cholecystectomy. IOC showed higher failure rates due to common duct catheterization challenges, while LUS had lower failure rates, often linked to factors like steatosis. Cost-effectiveness comparisons favored LUS over IOC, potentially saving patients money. LUS procedures were quicker due to real-time imaging, while IOC required more time and personnel. Bile duct injuries were discussed, highlighting LUS limitations in atypical anatomies. LUS aided in diagnosing crucial conditions, emphasizing its relevance post surgery. Surgeon experience significantly impacted outcomes, regardless of the technique. A previous study discussed that LUS's learning curve was steeper than IOC's, with proficient LUS users adjusting practices and using IOC selectively. Highlighting LUS's benefits and limitations in cholecystectomy, we stress its value in complex anatomical situations. LUS confirms no common bile duct stones, avoiding cannulation. LUS and IOC equally detect common bile duct stones and visualize the biliary tree. LUS offers safety, speed, cost-effectiveness, and unlimited use. Despite the associated expenses and learning curve, the enduring benefits of using advanced probes in LUS imaging suggest that it could surpass traditional IOC. The validation of this potential advancement relies heavily on incorporating modern probe studies. Our study could contribute to the medical literature by evaluating their clinical validity, safety, cost-effectiveness, learning curve, patient outcomes, technological advancements, and potential impact on guidelines and recommendations for clinical professionals.
PubMed: 38283459
DOI: 10.7759/cureus.51192 -
Journal of Immigrant and Minority Health Dec 2023Stigma reduces access to alcohol and other drug (AOD) support. This systematic review explored perceptions and experiences of stigma associated with AOD use among... (Review)
Review
Stigma reduces access to alcohol and other drug (AOD) support. This systematic review explored perceptions and experiences of stigma associated with AOD use among migrant and ethnic minority groups. Qualitative studies published in English were identified using six databases. Two reviewers screened and critically appraised articles using the Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies. Data were synthesised using best fit framework synthesis. Twenty-three studies were included. Stigma drivers and facilitators included stereotypes, socio-cultural norms, legal responses and precarious lived experiences. Stigma intersected with gender, citizenship, race and ethnicity and manifested though shame, exclusion, secondary stigma and discrimination in treatment. Outcomes and impacts included avoidance of services, emotional distress, isolation and loneliness. This review identified similar stigma experiences to other populations, however outcomes were complicated by precarious lived experiences and multiple stigmatised identities. Multi-level interventions are required to reduce AOD-related stigma for migrant and ethnic minority groups.
Topics: Humans; Ethnicity; Minority Groups; Ethnic and Racial Minorities; Transients and Migrants; Qualitative Research
PubMed: 36976449
DOI: 10.1007/s10903-023-01468-3 -
Open Forum Infectious Diseases Sep 2023Blood culture contamination may lead to misdiagnosis, overutilization of antibiotics, and prolonged length of stay. Blood specimen diversion devices can reduce...
Diagnostic Stewardship: A Systematic Review and Meta-analysis of Blood Collection Diversion Devices Used to Reduce Blood Culture Contamination and Improve the Accuracy of Diagnosis in Clinical Settings.
BACKGROUND
Blood culture contamination may lead to misdiagnosis, overutilization of antibiotics, and prolonged length of stay. Blood specimen diversion devices can reduce contamination rates during blood culture collection procedures. We performed a systematic literature review and meta-analysis evaluating the influence of blood specimen diversion devices in blood culture contamination rates.
METHODS
We searched Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane, Scopus, and Web of Science, from database inception to 1 March 2023, for studies evaluating the impact of a diversion device on blood culture contamination. Blood culture contamination was a positive blood culture with microorganisms not representative of true bacteremia, but rather introduced during collection or processing the blood sample. Random-effects models were used to obtain pooled mean differences, and heterogeneity was assessed using the test.
RESULTS
Of 1768 screened studies, 12 met inclusion criteria for this systematic literature review. Of them, 9 studies were included in the meta-analysis. Studies were substantially heterogeneous, but stratified analyses considering only high-quality studies revealed that venipuncture using a diversion device was associated with a significant reduction in blood culture contamination in comparison to the standard procedure of collection (pooled odds ratio [OR], 0.26 [95% confidence interval {CI}, .13-.54]; = 19%). Furthermore, the stratified analysis showed that the adoption of a diversion device did not reduce the detection of true infection (pooled OR, 0.85 [95% CI, .65-1.11]; = 0%).
CONCLUSIONS
Blood culture diversion devices was associated with decreased contamination rates and could improve quality of care, reduce costs, and avoid unnecessary antibiotic use.
PubMed: 37674630
DOI: 10.1093/ofid/ofad433 -
International Journal of Nursing Studies Mar 2024Low back pain is a major public health problem worldwide, and there exists evidence that cognitive functional therapy may help improve patients' health condition.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Low back pain is a major public health problem worldwide, and there exists evidence that cognitive functional therapy may help improve patients' health condition. However, the utilization of cognitive functional therapy for low back pain is limited, and its clinical efficacy remains unclear.
OBJECTIVES
To determine the efficacy of cognitive functional therapy in the management of disability, pain intensity, and fear-avoidance beliefs in low back pain patients.
DESIGN
Systematic review and meta-analysis.
METHOD
A comprehensive study search of Pubmed, Web of Science, Medline, CINAHL, Embase, PsycINFO, and the Cochrane Library databases was conducted from their inception to August 14th, 2023. Two researchers independently conducted the literature search and data extraction. All statistical analysis was performed using Stata Version 17.0.
RESULTS
A total of eight randomized controlled trials were included. In the short-term, cognitive functional therapy significantly improved disability (7 studies, SMD = -1.05, 95 % CI = -1.74 to -0.35, I = 95.37 %, GRADE = very low), pain intensity (7 studies, SMD = -1.02, 95 % CI = -1.89 to -0.15, I = 97.21 %, GRADE = very low), and fear-avoidance beliefs (4 studies, SMD = -0.89, 95 % CI = -1.30 to -0.47, I = 82.49 %, GRADE = very low). In the medium-term, cognitive functional therapy also significantly improved disability (3 studies, SMD = -0.48, 95 % CI = -0.82 to -0.14, I = 77.97 %, GRADE = very low), pain intensity (3 studies, SMD = -0.34, 95 % CI = -0.58 to -0.10, I = 55.55 %, GRADE = very low), and fear-avoidance beliefs (2 studies, SMD = -0.62, 95 % CI = -1.19 to -0.04, I = 88.24 %, GRADE = very low). In the long-term, cognitive functional therapy significantly improved disability (4 studies, SMD = -0.54, 95 % CI = -0.95 to -0.13, I = 85.87 %, GRADE = very low) and fear-avoidance beliefs (3 studies, SMD = -0.76, 95 % CI = -1.17 to -0.34, I = 80.34 %, GRADE = very low).
CONCLUSION
Cognitive functional therapy might be effective in reducing disability and fear-avoidance beliefs at any of short-, medium- and long-term follow-ups, and reducing pain at short- and medium-term follow-ups. No definitive conclusions can be drawn about the impact of cognitive functional therapy on low back pain patients due to the very low certainty evidence base. Additional rigorous randomized controlled trials are needed to further confirm these findings.
REGISTRATION NUMBER
CRD42022287123 (PROSPERO).
Topics: Humans; Low Back Pain; Chronic Pain; Cognitive Behavioral Therapy; Fear; Cognition
PubMed: 38219428
DOI: 10.1016/j.ijnurstu.2023.104679 -
Journal of Clinical Medicine Sep 2023Dysfunctions of the lumbosacral area and related pain syndromes, such as chronic low back pain (CLBP), are among the most common musculoskeletal problems in modern... (Review)
Review
Dysfunctions of the lumbosacral area and related pain syndromes, such as chronic low back pain (CLBP), are among the most common musculoskeletal problems in modern society. The purpose of this study was to evaluate the effectiveness of isolated myofascial release techniques (MFR) in the treatment of CLBP in adults. PubMed, Web of Science, Scopus, and Cochrane Library databases were searched for studies published from 1 January 2013 to 1 March 2023. We included English-language randomized controlled trials evaluating the effect of isolated MFR performed by a specialist on adults with CLBP. Only studies with a comparison group without treatment or with sham MFR were included. A total of 373 studies were detected, of which 6 studies were finally included in this review. There was a total of 397 CLBP patients aged 18-60 in all study groups. The studies evaluated the effects of a series of MFR treatments as well as a single intervention. After applying a series of treatments, a statistically significant reduction in pain intensity, improvement in the range of motion, reduction in the level of functional disability and fear-avoidance beliefs, as well as a decrease in the activity of paraspinal muscles at maximum trunk flexion were demonstrated. A single, 40-min complex intervention involving tissues at various depths significantly reduced the level of pain, improved the range of motion, and reduced the resting activity of paraspinal muscles in the standing position, but did not affect postural stability. The use of a single 5 min MFR technique did not affect pain intensity and sensitivity and functional disability. The findings suggest that the use of a series of isolated MFR improves the condition of patients with CLBP by reducing the intensity of pain, improving functional efficiency, and reducing the activity of the paraspinal muscles in the position of maximum forward bend. The use of a single intervention containing a set of techniques covering superficial and deep tissue also reduces the intensity of pain, improves mobility, and reduces the resting activity of the paraspinal muscles in a standing position. Given the small number of eligible studies with limitations, conclusions should be interpreted with caution and avoid overgeneralizing the benefits of isolated MFR based on limited or mixed evidence.
PubMed: 37834787
DOI: 10.3390/jcm12196143 -
Knee Surgery, Sports Traumatology,... Sep 2023To evaluate the overall evidence of published health-economic evaluation studies on meniscus tear treatment. (Review)
Review
PURPOSE
To evaluate the overall evidence of published health-economic evaluation studies on meniscus tear treatment.
METHODS
Our systematic review focuses on health-economic evaluation studies of meniscus tear treatment interventions found in PubMed and Embase databases. A qualitative, descriptive approach was used to analyze the studies' results and systematically report them following PRISMA guidelines. The health-economic evaluation method for each included study was categorized following one of the four approaches: partial economic evaluation (PEE), cost-effectiveness analysis (CEA), cost-benefit analysis (CBA), or cost-utility analysis (CUA). The quality of each included study was assessed using the Consensus on Health Economic Criteria (CHEC) list. Comparisons of input variables and outcomes were made, if applicable.
RESULTS
Sixteen studies were included; of these, six studies performed PEE, seven studies CUA, two studies CEA, and one study combined CBA, CUA, and CEA. The following economic comparisons were analyzed and showed the respective comparative outcomes: (1) meniscus repair was more cost-effective than arthroscopic partial meniscectomy (meniscectomy) for reparable meniscus tear; (2) non-operative treatment or physical therapy was less costly than meniscectomy for degenerative meniscus tear; (3) physical therapy with delayed meniscectomy was more cost-effective than early meniscectomy for meniscus tear with knee osteoarthritis; (4) meniscectomy without physical therapy was less costly than meniscectomy with physical therapy; (5) meniscectomy was more cost-effective than either meniscus allograft transplantation or meniscus scaffold procedure; (6) the conventional arthroscopic instrument cost was lower than laser-assisted arthroscopy in meniscectomy procedures.
CONCLUSION
Results from this review suggest that meniscus repair is the most cost-effective intervention for reparable meniscus tears. Physical therapy followed by delayed meniscectomy is the most cost-effective intervention for degenerative meniscus tears. Meniscus scaffold should be avoided, especially when implemented on a large scale.
LEVEL OF EVIDENCE
Systematic review of level IV studies.
Topics: Humans; Cost-Benefit Analysis; Meniscectomy; Osteoarthritis, Knee; Meniscus; Arthroscopy; Menisci, Tibial
PubMed: 36637478
DOI: 10.1007/s00167-022-07278-8 -
BMJ Open Mar 2024This review aims to determine the prevalence of pregnancy termination and its determinant factors in Ethiopia. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This review aims to determine the prevalence of pregnancy termination and its determinant factors in Ethiopia.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Relevant articles were retrieved from databases such as PubMed, EMBASE, Medline and other search engines.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
The research design for this study had no restrictions, allowing for the inclusion of cross-sectional and case-control studies that examined the prevalence or determinants of pregnancy termination. However, case reports, case series, reviews, editorials and studies published as abstracts only were excluded from the analysis.
DATA EXTRACTION AND SYNTHESIS
The review was precisely in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, and the quality of the review was assessed using the Joanna Briggs Institute critical appraisal checklist. Heterogeneity was indicated by the p value for I statistics less than 0.05. Data were entered into Microsoft Excel, and the analysis was conducted by using Stata V.16.
RESULTS
The pooled prevalence of pregnancy termination in Ethiopia was 21.52% (95% CI 15.01% to 28.03%). Women who had their first sexual initiation before the age of 18 (OR 1.78; 95% CI 1.13 to 2.82, p=0.14), had irregular menstrual bleeding (OR 1.86; 95% CI 1.25 to 2.77, p=0.76), being a student (OR 4.85; 95% CI 1.98 to 11.91, p=0.20) and had multiple sexual partners (OR 4.88; 95% CI 3.43 to 6.93, p=0.33) were significantly associated with pregnancy termination.
CONCLUSIONS
One in five women terminated their pregnancies, which is higher than in other sub-Saharan countries. Being a student, irregular menstrual bleeding, early initiation of sexual intercourse and multiple sexual partners were determinants of pregnancy termination. Special attention is needed in avoiding early sexual initiation and in reducing sexual risk behaviours.
Topics: Pregnancy; Female; Humans; Ethiopia; Prevalence; Cross-Sectional Studies; Abortion, Induced; Sexual Behavior
PubMed: 38485172
DOI: 10.1136/bmjopen-2023-073799