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The Milbank Quarterly 2004This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? It... (Review)
Review
This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). This article discusses (1) a parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, (2) clear knowledge gaps where further research should be focused, and (3) a robust and transferable methodology for systematically reviewing health service policy and management. Both the model and the method should be tested more widely in a range of contexts.
Topics: Diffusion of Innovation; Evidence-Based Medicine; Health Facility Administration; Models, Organizational; State Medicine; United Kingdom
PubMed: 15595944
DOI: 10.1111/j.0887-378X.2004.00325.x -
Pulmonology 2021Evidence suggests lungs as the organ most affected by coronavirus disease 2019 (COVID-19). The literature on previous coronavirus infections reports that patients may... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Evidence suggests lungs as the organ most affected by coronavirus disease 2019 (COVID-19). The literature on previous coronavirus infections reports that patients may experience persistent impairment in respiratory function after being discharged. Our objective was to determine the prevalence of restrictive pattern, obstructive pattern and altered diffusion in patients post-COVID-19 infection and to describe the different evaluations of respiratory function used with these patients.
METHODS
A systematic review was conducted in five databases. Studies that used lung function testing to assess post-infection COVID-19 patients were included for review. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence.
RESULTS
Of the 1973 reports returned by the initial search, seven articles reporting on 380 patients were included in the data synthesis. In the sensitivity analysis, we found a prevalence of 0.39 (CI 0.24-0.56, p < 0.01, I = 86%), 0.15 (CI 0.09-0.22, p = 0.03, I = 59%), and 0.07 (CI 0.04-0.11, p = 0.31, I = 16%) for altered diffusion capacity of the lungs for carbon monoxide (DL), restrictive pattern and obstructive pattern, respectively.
CONCLUSION
Post-infection COVID-19 patients showed impaired lung function; the most important of the pulmonary function tests affected was the diffusion capacity.
Topics: COVID-19; Forced Expiratory Volume; Humans; Lung; Pulmonary Diffusing Capacity; Respiratory Function Tests; SARS-CoV-2; Total Lung Capacity; Vital Capacity; Post-Acute COVID-19 Syndrome
PubMed: 33262076
DOI: 10.1016/j.pulmoe.2020.10.013 -
Current Drug Metabolism 2016Coenzyme Q10 (CoQ10) is an endogenous lipid-soluble benzoquinone compound that functions as a diffusible electron carrier in the electron transport chain. It is... (Review)
Review
OBJECTIVE
Coenzyme Q10 (CoQ10) is an endogenous lipid-soluble benzoquinone compound that functions as a diffusible electron carrier in the electron transport chain. It is prevalent in all human tissues and organs, although it is mainly biosynthesised and concentrated in tissues with high energy turnover. The aim of this review was to perform an exhaustive analysis of the influence and effects of CoQ10 supplementation on parameters related to exercise in healthy humans, and to clarify the current state of knowledge of this field of study, presenting the relevant data in a systematic manner.
METHOD
This paper describes a transversal descriptive systematic review of published research in this field; the study was conducted using a method adapted from the PRISMA guidelines. The inclusion criteria applied were based on the PICO (population, intervention, comparison, and outcome) model.
RESULTS
The database search performed yielded 372 citations. Finally, 13 studies met all the inclusion criteria and were incorporated in the present review.
CONCLUSION
CoQ10 has properties related to bioenergetic and antioxidant activity; thus, it is intimately involved in energy production and in the prevention of peroxidative damage to membrane phospholipids and of free radical-induced oxidation. These properties make it suitable as a dietary supplement to improve cellular bioenergetics and to inhibit certain age-related pathologies.
Topics: Antioxidants; Dietary Supplements; Energy Metabolism; Exercise; Exercise Tolerance; Humans; Non-Randomized Controlled Trials as Topic; Oxidative Stress; Randomized Controlled Trials as Topic; Ubiquinone; Vitamins
PubMed: 26526835
DOI: 10.2174/1389200216666151103115654 -
Intensive Care Medicine Oct 2020To assess the ability of clinical examination, blood biomarkers, electrophysiology, or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC)... (Review)
Review
PURPOSE
To assess the ability of clinical examination, blood biomarkers, electrophysiology, or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict poor neurological outcome, defined as death, vegetative state, or severe disability (CPC 3-5) at hospital discharge/1 month or later, in comatose adult survivors from cardiac arrest (CA).
METHODS
PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews (January 2013-April 2020) were searched. Sensitivity and false-positive rate (FPR) for each predictor were calculated. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed.
RESULTS
Ninety-four studies (30,200 patients) were included. Bilaterally absent pupillary or corneal reflexes after day 4 from ROSC, high blood values of neuron-specific enolase from 24 h after ROSC, absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) or unequivocal seizures on electroencephalogram (EEG) from the day of ROSC, EEG background suppression or burst-suppression from 24 h after ROSC, diffuse cerebral oedema on brain CT from 2 h after ROSC, or reduced diffusion on brain MRI at 2-5 days after ROSC had 0% FPR for poor outcome in most studies. Risk of bias assessed using the QUIPS tool was high for all predictors.
CONCLUSION
In comatose resuscitated patients, clinical, biochemical, neurophysiological, and radiological tests have a potential to predict poor neurological outcome with no false-positive predictions within the first week after CA. Guidelines should consider the methodological concerns and limited sensitivity for individual modalities. (PROSPERO CRD42019141169).
Topics: Adult; Coma; Evoked Potentials, Somatosensory; Heart Arrest; Humans; Hypothermia, Induced; Prognosis; Survivors
PubMed: 32915254
DOI: 10.1007/s00134-020-06198-w -
Medicina (Kaunas, Lithuania) Nov 2020Androgens play a significant role in the development of male reproductive organs. The clinical use of synthetic testosterone derivatives, such as nandrolone, is focused...
Androgens play a significant role in the development of male reproductive organs. The clinical use of synthetic testosterone derivatives, such as nandrolone, is focused on maximizing the anabolic effects and minimizing the androgenic ones. Class II anabolic androgenic steroids (AAS), including nandrolone, are rapidly becoming a widespread group of drugs used both clinically and illicitly. The illicit use of AAS is diffused among adolescent and bodybuilders because of their anabolic proprieties and their capacity to increase tolerance to exercise. This systematic review aims to focus on side effects related to illicit AAS abuse, evaluating the scientific literature in order to underline the most frequent side effects on AAS abusers' bodies. A systematic review of the scientific literature was performed using the PubMed database and the keywords "nandrolone decanoate". The inclusion criteria for articles or abstracts were English language and the presence of the following words: "abuse" or "adverse effects". After applying the exclusion and inclusion criteria, from a total of 766 articles, only 148 were considered eligible for the study. The most reported adverse effects (found in more than 5% of the studies) were endocrine effects (18 studies, 42%), such as virilization, gynecomastia, hormonal disorders, dyslipidemia, genital alterations, and infertility; cardiovascular dysfunctions (six studies, 14%) such as vascular damage, coagulation disorders, and arteriosus hypertension; skin disorders (five studies, 12%) such as pricking, acne, and skin spots; psychiatric and mood disorders (four studies, 9%) such as aggressiveness, sleep disorders and anxiety; musculoskeletal disorders (two studies, 5%), excretory disorders (two studies, 5%), and gastrointestinal disorders (two studies, 5%). Based on the result of our study, the most common adverse effects secondary to the abuse of nandrolone decanoate (ND) involve the endocrine, cardiovascular, skin, and psychiatric systems. These data could prove useful to healthcare professionals in both sports and clinical settings.
Topics: Adolescent; Anabolic Agents; Androgens; Exercise; Humans; Male; Nandrolone; Nandrolone Decanoate
PubMed: 33187340
DOI: 10.3390/medicina56110606 -
International Journal of Geriatric... Dec 2014Late-life depression (LLD) is the association with more cerebrovascular susceptibilities and white matter damage that can be assessed with diffusion tensor imaging... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Late-life depression (LLD) is the association with more cerebrovascular susceptibilities and white matter damage that can be assessed with diffusion tensor imaging (DTI). To better understand the white matter pathological alterations in LLD, we conducted a systematic review and meta-analysis.
METHODS
We searched MEDLINE, EMBASE, PsycINFO, PubMed, and Google Scholar databases for DTI studies comparing patients with LLD and healthy controls. For each study, details regarding participants, imaging methods, and results were extracted. Fractional anisotropy, an index of white matter integrity, was the dependent variable for group comparison. Effect sizes indicating the degree of group difference were estimated by random-effects meta-analysis.
RESULTS
A total of 15 eligible studies were included in the qualitative systematic review, nine of which were suitable for quantitative meta-analyses for the dorsolateral prefrontal cortex (DLPFC), corpus callosum, cingulum, and uncinate fasciculus (UF). Compared with the healthy control group, the LLD group showed lower fractional anisotropy in the DLPFC and UF with a large and a medium effect size, respectively, although heterogeneity and publication bias were found in the DLPFC.
CONCLUSION
Diffusion tensor imaging studies of LLD consistently showed reduced anisotropy in the DLPFC and UF of patients with LLD. These damaged regions are located with the frontostriatal and limbic networks. Thus, our findings showed that the disruption of frontal and frontal-to-limbic white matter tracts contributes to the pathogenesis of LLD.
Topics: Aged; Anisotropy; Case-Control Studies; Depressive Disorder; Diffusion Tensor Imaging; Frontal Lobe; Humans; Limbic System; White Matter
PubMed: 24798480
DOI: 10.1002/gps.4129 -
Cancer Research and Treatment Jul 2023We intend to evaluate the efficacy of salvage treatments for relapsed or refractory diffuse large B-cell lymphoma (R/R DLBCL) through meta-analysis. (Meta-Analysis)
Meta-Analysis
Efficacy of Salvage Treatments in Relapsed or Refractory Diffuse Large B-Cell Lymphoma Including Chimeric Antigen Receptor T-Cell Therapy: A Systematic Review and Meta-Analysis.
PURPOSE
We intend to evaluate the efficacy of salvage treatments for relapsed or refractory diffuse large B-cell lymphoma (R/R DLBCL) through meta-analysis.
MATERIALS AND METHODS
R/R DLBCL trials were divided into two groups based on eligibility for autologous stem-cell transplantation (ASCT), and meta-analysis of each group was performed. Random effects models were used to estimate the 1-year progression-free survival (PFS) rate, and chimeric antigen receptor (CAR) T-cell therapy was used as reference treatment.
RESULTS
Twenty-six ASCT-eligible cohorts from 17 studies comprising 2,924 patients and 59 ASCT-ineligible cohorts from 53 studies comprising 3,617 patients were included in the pooled analysis. In the ASCT-eligible group, the pooled 1-year PFS rate was 0.40 (95% confidence interval [CI], 0.15 to 0.65) for the CAR T-cell group and 0.34 (95% CI, 0.30 to 0.37) for the group with chemotherapy followed by ASCT intention. The two treatments were not significantly different in meta-regression analysis. In the ASCT-ineligible group, the pooled 1-year PFS was 0.40 (95% CI, 0.35 to 0.46) for CAR T-cell, and the highest primary outcome was 0.47 (95% CI, 0.37 to 0.57) for the tafasitamab group. CAR T-cell therapy showed significantly better outcomes than chemotherapy and therapies based on ibrutinib, lenalidomide, and selinexor. However, loncastuximab, polatuzumab plus bendamustine and rituximab, and the tafasitamab group showed no different efficacy than CAR T-cell therapy after adjusting for median number of previous lines of treatment.
CONCLUSION
Although several regimens were crudely grouped for classification, CAR T-cell therapy did not outperform chemotherapy followed by ASCT in the second-line setting or several recently developed agents in the ASCT-ineligible setting.
Topics: Humans; Receptors, Chimeric Antigen; Immunotherapy, Adoptive; Combined Modality Therapy; Antineoplastic Combined Chemotherapy Protocols; Salvage Therapy; Neoplasm Recurrence, Local; Hematopoietic Stem Cell Transplantation; Lymphoma, Large B-Cell, Diffuse
PubMed: 36915243
DOI: 10.4143/crt.2022.1658 -
Antibiotics (Basel, Switzerland) Sep 2022In patients that are admitted to intensive care units (ICUs), the clinical outcome of severe infections depends on several factors, as well as the early administration... (Review)
Review
In patients that are admitted to intensive care units (ICUs), the clinical outcome of severe infections depends on several factors, as well as the early administration of chemotherapies and comorbidities. Antimicrobials may be used in off-label regimens to maximize the probability of therapeutic concentrations within infected tissues and to prevent the selection of resistant clones. Interestingly, the literature clearly shows that the rate of tissue penetration is variable among antibacterial drugs, and the correlation between plasma and tissue concentrations may be inconstant. The present review harvests data about tissue penetration of antibacterial drugs in ICU patients, limiting the search to those drugs that mainly act as protein synthesis inhibitors and disrupting DNA structure and function. As expected, fluoroquinolones, macrolides, linezolid, and tigecycline have an excellent diffusion into epithelial lining fluid. That high penetration is fundamental for the therapy of ventilator and healthcare-associated pneumonia. Some drugs also display a high penetration rate within cerebrospinal fluid, while other agents diffuse into the skin and soft tissues. Further studies are needed to improve our knowledge about drug tissue penetration, especially in the presence of factors that may affect drug pharmacokinetics.
PubMed: 36139972
DOI: 10.3390/antibiotics11091193 -
Obesity Reviews : An Official Journal... Mar 2022Obesity is a major global health problem leading to serious complications. It has been consistently associated with alterations in brain structure. Diffusion tensor... (Review)
Review
Obesity is a major global health problem leading to serious complications. It has been consistently associated with alterations in brain structure. Diffusion tensor imaging is used to examine brain white matter microstructure by assessing the dynamics of water diffusion in white matter tracts. Fractional anisotropy and mean diffusivity are two parameters measuring the directionality and rate of diffusion, respectively. Changes in these indices associated with obesity have been previously reported in numerous fiber tracts. This systematic review investigates microstructural white matter alterations in obesity using diffusion tensor imaging. A computerized search was performed in PubMed, Web of Science, and Livivo databases. Based on the inclusion/exclusion criteria, 31 cross-sectional studies comparing individuals with obesity and lean controls were identified. The studies included mixed-gender samples of children, young, middle-aged, and older adults. The majority of included studies reported decreased fractional anisotropy and increased mean diffusivity associated with elevated body mass index, suggesting white matter abnormalities. Nevertheless, a pattern of alterations is inconsistent across studies. This could be explained by several potential biases assessed by the National Institute of Health quality assessment tool. Furthermore, a direct assessment of body fat is recommended for a more accurate characterization of the brain-body relationship.
Topics: Aged; Anisotropy; Brain; Child; Cross-Sectional Studies; Diffusion Tensor Imaging; Humans; Middle Aged; Obesity; White Matter
PubMed: 34908217
DOI: 10.1111/obr.13388 -
Head & Neck Mar 2015The purpose of this study was for us to review diagnostic accuracy of diffusion-weighted imaging (DWI) in primary head and neck squamous cell carcinomas (HNSCCs),... (Review)
Review
BACKGROUND
The purpose of this study was for us to review diagnostic accuracy of diffusion-weighted imaging (DWI) in primary head and neck squamous cell carcinomas (HNSCCs), detection of metastatic lymph nodes, and recurrences.
METHODS
A systematic review for studies concerning DWI was performed.
RESULTS
Ten studies fulfilled inclusion criteria. All studies showed significant higher "apparent diffusion coefficient" (ADC) in benign compared to malignant lesions. ADC thresholds for optimal discrimination varied. In detection of primary HNSCC, the accuracy of DWI ranged from 66% to 86%. In metastatic lymph nodes, the accuracy of DWI was 85% to 91% and the negative predictive value (NPV) was higher than 91%. For recurrences, the accuracy of DWI was 78% to 100% and the NPV ranged from 77% to 100%.
CONCLUSION
DWI showed consistent high accuracy and high NPV. However, available literature is sparse and varying ADC thresholds were reported. Compared to current imaging techniques, DWI showed the most potential in lymph node staging and detection of recurrences.
Topics: Carcinoma, Squamous Cell; Diffusion Magnetic Resonance Imaging; Female; Head and Neck Neoplasms; Humans; Male; Squamous Cell Carcinoma of Head and Neck; Total Quality Management
PubMed: 24347513
DOI: 10.1002/hed.23575