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Minerva Chirurgica Jun 2020Abdominal pain (AP) is one of the most frequent clinical condition observed in elderly patients. The differential diagnosis is wide and definitive diagnosis is often...
INTRODUCTION
Abdominal pain (AP) is one of the most frequent clinical condition observed in elderly patients. The differential diagnosis is wide and definitive diagnosis is often difficult due to delayed symptoms, altered laboratory parameters, pre-existing medical disorders, abuse of drugs and in absence of an accurate medical history.
EVIDENCE ACQUISITION
A systematic literature review was carried out through PubMed database for studies published in the last ten years. The following search string was used: {("geriatric"[Title] OR "older"[Title] OR "aged"[Title] OR "elderly"[Title]) AND ((("abdomen"[Title] AND "acute"[Title]) OR "acute abdomen"[Title] OR ("acute"[Title] AND "abdomen"[Title])) OR ("abdominal"[Title] AND "pain"[title]) OR "abdominal pain"[Title])}. Full articles and abstracts were included. Case reports, commentaries, editorials and letters were excluded from the analysis.
EVIDENCE SYNTHESIS
As the age of people presenting AP advances, both rates of surgical procedures and mortality rate increase.
CONCLUSIONS
A systematic approach based on the organization of differential diagnoses into categories, may provide a helpful framework by the combined use of history-taking, physical examination, and results of diagnostic studies. In elderly patients admitted to the emergency department, a crucial role is played by a prompt use of radiological investigations in order to discriminate between older subjects admitted to the emergency department with abdominal pain and pathological cases requiring immediate surgical treatment.
Topics: Abdomen, Acute; Abdominal Pain; Acute Disease; Aged; Aged, 80 and over; Aneurysm, Ruptured; Aortic Aneurysm, Abdominal; Appendicitis; Diagnosis, Differential; Emergency Service, Hospital; Female; Humans; Intestinal Obstruction; Male; Mesenteric Ischemia; Sex Factors
PubMed: 32550726
DOI: 10.23736/S0026-4733.20.08266-8 -
Obstetrics and Gynecology Jan 2015To obtain precise estimates of endometrial cancer risk associated with a family history of endometrial cancer or cancers at other sites. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To obtain precise estimates of endometrial cancer risk associated with a family history of endometrial cancer or cancers at other sites.
DATA SOURCES
For the systematic review, we used PubMed to search for all relevant studies on family history and endometrial cancer that were published before December 2013. Medical Subject Heading terms "endometrial neoplasm" and "uterine neoplasm" were used in combination with one of the key phrases "family history," "first-degree," "familial risk," "aggregation," or "relatedness."
METHODS OF STUDY SELECTION
Studies were included if they were case-control or cohort studies that investigated the association between a family history of cancer specified to site and endometrial cancer. Studies were excluded if they were review or editorial articles or not translated into English or did not define family history clearly or used spouses as control participants.
TABULATION, INTEGRATION, AND RESULTS
We included 16 studies containing 3,871 women as cases and 49,475 women as controls from 10 case-control studies and 33,510 women as cases from six cohort studies. We conducted meta-analyses to estimate the pooled relative risk (95% confidence interval [CI]) of endometrial cancer associated with a first-degree family history of endometrial, colorectal, breast, ovarian, and cervical cancer to be: 1.82 (1.65-1.98), 1.17 (1.03-1.31), 0.96 (0.88-1.04), 1.13 (0.85-1.41), and 1.19 (0.83-1.55), respectively. We estimated cumulative risk of endometrial cancer to age 70 years to be 3.1% (95% CI 2.8-3.4) for women with a first-degree relative with endometrial cancer and the population-attributable risk to be 3.5% (95% CI 2.8-4.2).
CONCLUSION
Women with a first-degree family history of endometrial cancer or colorectal cancer have a higher risk of developing endometrial cancer than those without a family history. This study is likely to be of clinical relevance to inform women of their risk of endometrial cancer.
Topics: Breast Neoplasms; Carcinoma; Case-Control Studies; Colorectal Neoplasms; Endometrial Neoplasms; Female; Humans; Ovarian Neoplasms; Risk Assessment; Uterine Cervical Neoplasms
PubMed: 25560109
DOI: 10.1097/AOG.0000000000000563 -
Annals of Internal Medicine Mar 2013Medication reconciliation identifies and resolves unintentional discrepancies between patients' medication lists across transitions in care. The purpose of this review... (Review)
Review
Medication reconciliation identifies and resolves unintentional discrepancies between patients' medication lists across transitions in care. The purpose of this review is to summarize evidence about the effectiveness of hospital-based medication reconciliation interventions. Searches encompassed MEDLINE through November 2012 and EMBASE and the Cochrane Central Register of Controlled Trials through July 2012. Eligible studies evaluated the effects of hospital-based medication reconciliation on unintentional discrepancies with nontrivial risks for harm to patients or 30-day postdischarge emergency department visits and readmission. Two reviewers evaluated study eligibility, abstracted data, and assessed study quality. Eighteen studies evaluating 20 interventions met the selection criteria. Pharmacists performed medication reconciliation in 17 of the 20 interventions. Most unintentional discrepancies identified had no clinical significance. Medication reconciliation alone probably does not reduce postdischarge hospital utilization but may do so when bundled with interventions aimed at improving care transitions.
Topics: Emergency Service, Hospital; Humans; Medical History Taking; Medication Reconciliation; Patient Discharge; Patient Readmission; Patient Safety; Pharmacists; Professional Role; Risk Assessment
PubMed: 23460096
DOI: 10.7326/0003-4819-158-5-201303051-00006 -
The Bone & Joint Journal May 2020Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It...
Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It includes the piriformis syndrome, the gemelli-obturator internus syndrome, the ischiofemoral impingement syndrome, and the proximal hamstring syndrome. The concept of the deep gluteal syndrome extends our understanding of posterior hip pain due to nerve entrapment beyond the traditional model of the piriformis syndrome. Nevertheless, there has been terminological confusion and the deep gluteal syndrome has often been undiagnosed or mistaken for other conditions. Careful history-taking, a physical examination including provocation tests, an electrodiagnostic study, and imaging are necessary for an accurate diagnosis. After excluding spinal lesions, MRI scans of the pelvis are helpful in diagnosing deep gluteal syndrome and identifying pathological conditions entrapping the nerves. It can be conservatively treated with multidisciplinary treatment including rest, the avoidance of provoking activities, medication, injections, and physiotherapy. Endoscopic or open surgical decompression is recommended in patients with persistent or recurrent symptoms after conservative treatment or in those who may have masses compressing the sciatic nerve. Many physicians remain unfamiliar with this syndrome and there is a lack of relevant literature. This comprehensive review aims to provide the latest information about the epidemiology, aetiology, pathology, clinical features, diagnosis, and treatment. Cite this article: 2020;102-B(5):556-567.
Topics: Combined Modality Therapy; Diagnosis, Differential; Diagnostic Imaging; Electrodiagnosis; Humans; Medical History Taking; Physical Examination; Piriformis Muscle Syndrome; Pudendal Nerve; Sciatic Nerve; Sciatica
PubMed: 32349600
DOI: 10.1302/0301-620X.102B5.BJJ-2019-1212.R1 -
International Journal of Environmental... Dec 2018Abdominal aortic aneurysm (AAA) represents an important public health problem with a prevalence between 1.3% and 12.5%. Several population-based randomized trials have... (Meta-Analysis)
Meta-Analysis
Abdominal aortic aneurysm (AAA) represents an important public health problem with a prevalence between 1.3% and 12.5%. Several population-based randomized trials have evaluated ultrasound screening for AAA providing evidence of a reduction in aneurysm-related mortality in the screened population. The aim of our study was to perform a systematic review and meta-analysis of the risk factors for AAA. We conducted a systematic review of observational studies and we performed a meta-analysis that evaluated the following risk factors: gender, smoking habits, hypertension, coronary artery disease and family history of AAA. Respect to a previous a meta-analysis we added the funnel plot to examine the effect sizes estimated from individual studies as measure of their precision; sensitivity analysis to check the stability of study findings and estimate how the overall effect size would be modified by removal of one study; cumulative analysis to evaluate the trend between studies in relation to publication year. Abdominal aortic aneurysm prevalence is higher in smokers and in males. On the other hand, while diabetes is a risk factor for many cardiovascular diseases, it is not a risk factor for AAA. In addition, it is important to underline that all countries, where AAA screening was set up, had high income level and the majority belong to Western Europe (United Kingdom, Sweden, Italy, Poland, Spain and Belgium). Abdominal aortic aneurysm screening is fundamental for public health. It could avoid deaths, ruptures, and emergency surgical interventions if abdominal aortic aneurysm was diagnosed early in the population target for screening.
Topics: Aortic Aneurysm, Abdominal; Coronary Artery Disease; Female; Humans; Hypertension; Male; Medical History Taking; Risk Factors; Sex Factors; Smoking
PubMed: 30544688
DOI: 10.3390/ijerph15122805 -
BMC Medical Education Sep 2015This paper is an up-to-date systematic review on educational interventions addressing history taking. The authors noted that despite the plethora of specialized training... (Review)
Review
BACKGROUND
This paper is an up-to-date systematic review on educational interventions addressing history taking. The authors noted that despite the plethora of specialized training programs designed to enhance students' interviewing skills there had not been a review of the literature to assess the quality of each published method of teaching history taking in undergraduate medical education based on the evidence of the program's efficacy.
METHODS
The databases PubMed, PsycINFO, Google Scholar, opengrey, opendoar and SSRN were searched using key words related to medical education and history taking. Articles that described an educational intervention to improve medical students' history-taking skills were selected and reviewed. Included studies had to evaluate learning progress. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).
RESULTS
Seventy-eight full-text articles were identified and reviewed; of these, 23 studies met the final inclusion criteria. Three studies applied an instructional approach using scripts, lectures, demonstrations and an online course. Seventeen studies applied a more experiential approach by implementing small group workshops including role-play, interviews with patients and feedback. Three studies applied a creative approach. Two of these studies made use of improvisational theatre and one introduced a simulation using Lego® building blocks. Twenty-two studies reported an improvement in students' history taking skills. Mean MERSQI score was 10.4 (range 6.5 to 14; SD = 2.65).
CONCLUSIONS
These findings suggest that several different educational interventions are effective in teaching history taking skills to medical students. Small group workshops including role-play and interviews with real patients, followed by feedback and discussion, are widespread and best investigated. Feedback using videotape review was also reported as particularly instructive. Students in the early preclinical state might profit from approaches helping them to focus on interview skills and not being distracted by thinking about differential diagnoses or clinical management. The heterogeneity of outcome data and the varied ways of assessment strongly suggest the need for further research as many studies did not meet basic methodological criteria. Randomized controlled trials using external assessment methods, standardized measurement tools and reporting long-term data are recommended to evaluate the efficacy of courses on history taking.
Topics: Education, Medical; Humans; Medical History Taking; Students, Medical; Teaching
PubMed: 26415941
DOI: 10.1186/s12909-015-0443-x -
Avicenna Journal of Phytomedicine 2023This study was performed to provide an updated systematic review of herbal medicines and phytochemicals used for treatment of the pediatric patients with attention-... (Review)
Review
OBJECTIVE
This study was performed to provide an updated systematic review of herbal medicines and phytochemicals used for treatment of the pediatric patients with attention- deficit/hyperactivity disorder (ADHD).
MATERIALS AND METHODS
International electronic databases, including Scopus, PubMed, ScienceDirect, and Google Scholar were investigated from 1st January 2000 to late October 2021. Interventional studies published in English language, including randomized controlled trials (RCTs) or open-label clinical studies, which evaluated the effect of herbal medicines and phytochemicals on pediatric ADHD were included in this review.
RESULTS
Fifteen studies met the inclusion criteria. Several pieces of evidence support the efficacy of L. and Pycnogenol; mainly inconclusive evidence could be found for L L., and ginseng. The results showed that while L. was ineffective for ADHD, L L, and (Mill.) D.A.Webb had similar efficacy compared to methylphenidate (MPH).
CONCLUSION
A number of herbal medicines appear to be relatively safe and provide potential efficacy in amelioration of ADHD. However, due to lack of adequate reports of RCTs, no definitely specific recommendations could been made so far.
PubMed: 37663386
DOI: 10.22038/AJP.2022.21115 -
The Clinical Journal of Pain Dec 2001Can either a history of previous similar injury, including recurrence of injury, or an individual's symptoms, including time off work, predict chronic pain and/or... (Review)
Review
OBJECTIVE
Can either a history of previous similar injury, including recurrence of injury, or an individual's symptoms, including time off work, predict chronic pain and/or chronic pain disability?
METHODOLOGY
The literature search identified one systematic review and six observational studies (5 low back pain and 1 chronic shoulder pain) to provide evidence about these questions.
RESULTS
Only one study evaluated subjects before a painful event. Other studies evaluated subjects over a range of time from onset of pain, including some selected for clinic treatment. This variability as well as the use of different outcome measures without blinding limited the quality of the evidence.
CONCLUSIONS
The studies provide moderate evidence (level 2) that a history of previous similar pain predicts subsequent reports of pain and limited evidence (level 3) that a history of similar pain predicts poorer outcomes after recurrent injury. The studies also provide moderate evidence (level 2) that longer duration of pain predicts the occurrence of subsequent reports of pain and limited evidence (level 3) that longer time off work before treatment predicts poorer activity and poorer participation outcomes after recurrent injury.
Topics: Absenteeism; Chronic Disease; Disabled Persons; Forecasting; Humans; Medical Records; Pain; Recurrence; Wounds and Injuries
PubMed: 11783827
DOI: 10.1097/00002508-200112001-00007 -
The American Journal of Geriatric... Apr 2017We carried out a systematic review and meta-analysis to evaluate whether history of bipolar disorder (BD) increases the risk of dementia. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
We carried out a systematic review and meta-analysis to evaluate whether history of bipolar disorder (BD) increases the risk of dementia.
METHODS
We searched PubMed and Scopus to identify studies that evaluated the risk of dementia in individuals with a history of BD. A total of 6 studies including 3,026 individuals with history of BD and 191,029 non-BD individuals were included in the meta-analysis.
RESULTS
History of BD significantly increased the risk of diagnosis of dementia (pooled odds ratio: 2.36; 95% confidence interval: 1.36-4.09; z = 3.07, p < 0.001). Evidence of heterogeneity and of publication bias in the analysis was found.
CONCLUSION
History of BD is associated with significantly higher risk of dementia in older adults. Future studies are necessary to evaluate the potential mediators of this association and to evaluate interventions that may reduce the risk of dementia in this population.
Topics: Bipolar Disorder; Comorbidity; Dementia; Humans; Risk
PubMed: 28161155
DOI: 10.1016/j.jagp.2016.11.014 -
American Journal of Public Health Apr 2016To describe salient epidemiological characteristics of Zika virus outbreaks across the world and to examine the clinical presentations, complications, and atypical... (Review)
Review
OBJECTIVES
To describe salient epidemiological characteristics of Zika virus outbreaks across the world and to examine the clinical presentations, complications, and atypical manifestations related to their occurrence in recent history.
METHODS
We conducted a systematic review of the literature by searching through MEDLINE, Embase, and Global Health Library, as well as the epidemiological bulletins and alerts from the World Health Organization, the Pan American Health Organization, and the European Centre for Disease Prevention and Control over the period 1954 to 2016.
RESULTS
The search yielded 547 records. We retained 333 for further analysis, to which we added 11 epidemiological bulletins from various sources. Of these, we systematically reviewed 52 articles and reports, revealing some epidemiological features and patterns of spread of the Zika virus worldwide, as well as pathological outcomes suspected to be linked to Zika outbreaks. Neurologic disorders among zika patients were similar in Brazil and French Polynesia but a causal link is not established. Incidence of zika infection in pregnant women is not known. In Brazil, during the zika outbreak the incidence of microcephaly increased more than 20 times. Among 35 infants with microcephaly, born from women suspected to have Zika infection during pregnancy in northeast Brazil, 74% of the mothers reported rash during the first and second trimester.
CONCLUSIONS
On February 1, 2016, The World Health Organization declared the ongoing Zika crisis an emergency and that, although not yet scientifically proven, the link between the virus and growing numbers of microcephaly cases was "strongly suspected." However, the causal relationship between zika and microcephaly is not universally accepted. Public Health Implications. The current situation with regard to Zika is not encouraging, because there is no vaccine, no treatment, and no good serological test, and vector control remains a challenge.
Topics: Adult; Animals; Brazil; Disease Outbreaks; Female; Global Health; History, 20th Century; History, 21st Century; Humans; Infant; Microcephaly; Nervous System Diseases; Pregnancy; World Health Organization; Zika Virus; Zika Virus Infection
PubMed: 26959260
DOI: 10.2105/AJPH.2016.303112