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Current Status and Role of Artificial Intelligence in Anorectal Diseases and Pelvic Floor Disorders.JSLS : Journal of the Society of... 2024Anorectal diseases and pelvic floor disorders are prevalent among the general population. Patients may present with overlapping symptoms, delaying diagnosis, and... (Review)
Review
BACKGROUND
Anorectal diseases and pelvic floor disorders are prevalent among the general population. Patients may present with overlapping symptoms, delaying diagnosis, and lowering quality of life. Treating physicians encounter numerous challenges attributed to the complex nature of pelvic anatomy, limitations of diagnostic techniques, and lack of available resources. This article is an overview of the current state of artificial intelligence (AI) in tackling the difficulties of managing benign anorectal disorders and pelvic floor disorders.
METHODS
A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the PubMed database to identify all potentially relevant studies published from January 2000 to August 2023. Search queries were built using the following terms: AI, machine learning, deep learning, benign anorectal disease, pelvic floor disorder, fecal incontinence, obstructive defecation, anal fistula, rectal prolapse, and anorectal manometry. Malignant anorectal articles and abstracts were excluded. Data from selected articles were analyzed.
RESULTS
139 articles were found, 15 of which met our inclusion and exclusion criteria. The most common AI module was convolutional neural network. researchers were able to develop AI modules to optimize imaging studies for pelvis, fistula, and abscess anatomy, facilitated anorectal manometry interpretation, and improved high-definition anoscope use. None of the modules were validated in an external cohort.
CONCLUSION
There is potential for AI to enhance the management of pelvic floor and benign anorectal diseases. Ongoing research necessitates the use of multidisciplinary approaches and collaboration between physicians and AI programmers to tackle pressing challenges.
Topics: Humans; Pelvic Floor Disorders; Artificial Intelligence; Rectal Diseases; Anus Diseases; Manometry; Fecal Incontinence
PubMed: 38910957
DOI: 10.4293/JSLS.2024.00007 -
American Journal of Obstetrics and... Jun 2024To evaluate the association between cannabis use during pregnancy and the risk for long-term neuropsychiatric pathology in the offspring. (Review)
Review
OBJECTIVE
To evaluate the association between cannabis use during pregnancy and the risk for long-term neuropsychiatric pathology in the offspring.
DATA SOURCES
MEDLINE, EMBASE, and Cochrane library databases were systematically searched until January 22, 2024, with no language or date restrictions.
STUDY ELIGIBILITY CRITERIA
Studies were eligible for inclusion if they reported quantitative data on any long-term neuropsychiatric outcome in offspring whose mothers used cannabis during pregnancy for medical or recreational use, by any route and at any trimester, in comparison to offspring of women who abstained from cannabis use during pregnancy. All observational study designs were included in the analysis.
STUDY APPRAISAL AND SYNTHESIS METHODS
A systematic review and meta-analysis were performed according to the PRISMA and MOOSE guidelines. The data was extracted independently by two reviewers. The following offspring outcomes were of interest: attention-deficit/ hyperactivity disorder (ADHD), autism spectrum disorder (ASD), depression, anxiety, psychotic disorders, as well as cannabis and other substance use. Odds ratios (OR) and 95% confidence intervals (CI) were pooled for each neuropsychiatric outcome in the offspring of women exposed to cannabis during pregnancy compared with non-exposed. Data were pooled using random-effects models.
RESULTS
Eighteen eligible observational studies were included in the systematic review, and seventeen were included in the final quantitative analysis, representing 534,445 participants. After adjusting for confounders, the pooled OR for ADHD was 1.13 (95% CI 1.01-1.26); for ASD, the pooled OR was 1.04 (95% CI 0.74-1.46); for psychotic symptoms, the pooled OR was 1.29 (95% CI 0.97-1.72); for anxiety, the pooled OR was 1.34 (95% CI 0.79-2.29); for depression, the pooled OR was 0.72 (95% CI 0.11-4.57); and for offspring's cannabis use the pooled OR was 1.20 (95% CI 1.01-1.42).
CONCLUSIONS
Prenatal cannabis exposure is not associated with an increased risk of ASD, psychotic symptoms, anxiety, or depression in offspring. However, it may slightly elevate the risk of ADHD and predispose offspring to cannabis consumption. Despite these findings, caution is warranted regarding cannabis use during pregnancy. Further research is imperative, especially given the increasing potency of cannabis in recent years.
PubMed: 38908654
DOI: 10.1016/j.ajog.2024.06.014 -
American Journal of Preventive Medicine Jun 2024As patients become increasingly involved in healthcare decision-making, it is important to examine the drivers behind patient choice of doctor (PCOD); the initial... (Review)
Review
INTRODUCTION
As patients become increasingly involved in healthcare decision-making, it is important to examine the drivers behind patient choice of doctor (PCOD); the initial decision can have lasting impacts on patients' trust in providers and outcomes. However, limited studies have explored PCOD relative to socioeconomic status (SES) or health disparity. This review identified similar preferences and varied decision criteria in PCOD across SES groups.
METHODS
PubMed, PsycINFO, Web of Science, and relevant cross-references were searched for articles published between January 2007-September 2022. Papers were screened using Covidence. Included studies examined PCOD by income and/or educational levels. Analysis was performed in 2022-2023.
RESULTS
From 4,449 search results, 29 articles were selected (16 countries, 14 medical specialties, total of 32,651 participants). Higher-SES individuals ranked physician characteristics (e.g., qualifications, empathy) or performance more important than cost or convenience. Lower-SES individuals often had to prioritize logistical factors (e.g., insurance coverage, distance) due to resource constraints and gaps in knowledge or awareness about options. Despite differing healthcare systems, such divergence in PCOD were relatively consistent across countries. Some patients, especially females and disadvantaged groups, favored gender-concordant physicians for intimate medical matters (e.g., gynecologist); this partiality was not limited to conservative cultures. Few researchers investigated the outcomes of PCOD and indicated that lower-SES populations inadvertently chose, experienced, or perceived lower quality care.
DISCUSSION
Patients' decision criteria varied by SES, even under national systems intended for universal access, indicating the impacts of social determinants and structural inequities. Health education supporting patient decision-making and research on how SES affects PCOD and outcomes could help reduce health disparity.
PubMed: 38906427
DOI: 10.1016/j.amepre.2024.06.012 -
Danish Medical Journal Jun 2024In orthopaedics, anterior cruciate ligament (ACL) reconstructions are among the most common surgical interventions. Two methods are preferably used: autografts from the... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
In orthopaedics, anterior cruciate ligament (ACL) reconstructions are among the most common surgical interventions. Two methods are preferably used: autografts from the hamstring tendon (HT) or patella tendon (PT). The purpose of this meta-analysis was to compare these two methods when returning to sports.
METHODS
Eleven studies were included based on a literature search conducted in PubMed. The primary outcome was return to preinjury sport level in athletes. Post-operative results such as the Lysholm score, the International Knee Documentation Committee (IKDC) subjective score, the Tegner Activity Score and KT-1000 arthrometry and autograft re-rupture rates were analysed as secondary outcomes.
RESULTS
The analysis showed no significant difference in return to preinjury sports level at a two-year follow-up between patients operated with hamstring or patella autograft. Considering the secondary outcomes, no significant differences were recorded in Lysholm score, IKDC score or re-rupture rate. The Tegner Activity Scale demonstrated a significantly higher activity level in the PT group than in the HT group (OR 0.79, p = 0.003). At the two-year follow-up, the KT-1000 arthrometer analysis also showed a significant difference in laxity, which was higher for the HT autografts (OR -0.31, p = 0.02).
CONCLUSION
This study showed no significant differences between hamstring and patella autografts. Even so, the choice of method when operated for ACL rupture remains crucial for the individual and should be a weighted decision made jointly by the patient and the physician.
Topics: Humans; Return to Sport; Anterior Cruciate Ligament Reconstruction; Hamstring Tendons; Patellar Ligament; Anterior Cruciate Ligament Injuries; Autografts; Transplantation, Autologous; Treatment Outcome
PubMed: 38903025
DOI: 10.61409/A09230599 -
The British Journal of General Practice... Jun 2024Suicide is a major public health issue and is the leading cause of death of men under the age of 50 in the UK. Patients are more likely to visit their GP in the month...
BACKGROUND
Suicide is a major public health issue and is the leading cause of death of men under the age of 50 in the UK. Patients are more likely to visit their GP in the month leading up to a suicide attempt, thus highlighting the key role GPs play in suicide prevention.
AIM
The aim of this systematic scoping review was to explore the current qualitative research on GPs' perspectives of suicide prevention in primary care.
METHOD
This review was reported in accordance with PRISMA-ScR guidance. A three-step search strategy was used. Articles at full-text review were assessed for their inclusion in the study against predetermined eligibility criteria (English language, qualitative in nature, and a focus on GPs' perspectives of suicide prevention). Data was extracted using a standardised form and a narrative approach was used to describe the main themes elicited from the studies.
RESULTS
There were 2210 articles screened. Twelve studies from seven countries were included at full text review. The majority of studies used semi-structured interviews (=9) and transcripts were analysed using variations of thematic analysis. Four main themes were elicited from the included studies: challenges to managing suicidal behaviour, fragmented relationships with mental health services, personal attitudes of GPs regarding suicidal behaviour, and identified needs to improve suicide prevention in primary care.
CONCLUSION
The challenges experienced by GPs when managing suicidal behaviour are well documented. More work is needed to explore what approaches GPs find effective in managing suicidal behaviour, especially in younger patients.
Topics: Humans; Suicide Prevention; Attitude of Health Personnel; General Practitioners; Qualitative Research; Primary Health Care; Mental Health Services; Suicide
PubMed: 38902057
DOI: 10.3399/bjgp24X737433 -
Archives of Physical Medicine and... Jun 2024To conduct a systematic review and meta-analysis to understand the difference in objectively measured physical activities (PA) between children with and without... (Review)
Review
OBJECTIVE
To conduct a systematic review and meta-analysis to understand the difference in objectively measured physical activities (PA) between children with and without developmental coordination disorder (DCD).
DATA SOURCES
A systematic literature search from four databases (PubMed, Science Direct, Web of Science, and Cochrane library) was conducted in July 2023.
STUDY SELECTION
Studies that met the following criteria were considered: (1) the studies should classified children with DCD based on DSM-IV, DSM-IV-TR, or DSM-V diagnosis criteria, (2) the studies aimed to evaluate PA using objective measurements and provided the amount of time spent in PA and/or SB, (3) a control group of TD children was recruited, (4) the full-text article was written in English.
DATA EXTRACTION
The following data from all included studies were extracted: the first author's surname and published year, study design, country, total sample size, the measure of PA, the intensity of PA, categories of PA level and main finding(s).
DATA SYNTHESIS
12 articles met the inclusion criteria for the systematic review, 10 of which were further entered into the meta-analysis. Overall mean difference in moderate to vigorous PA (MVPA) between two groups was -0.17 (95% CI: -0.25 to -0.09, I = 48.7%, p = 0.029). When subgroup analysis of age was further conducted (i.e., school-aged vs. preschool), a significant pooled effect size with no heterogeneity was found in school-aged children (i.e., 6-14 years old) (standardized mean difference (SMD) = -0.27, 95% CI: -0.38 to -0.16, I = 43.1%, p = 0.08).
CONCLUSIONS
Children with DCD spent significantly less time participating in MVPA, specifically those children aging between 6 and 14 years. These findings help raise the awareness for the parents and physicians toward insufficient participation in PA in children with DCD.
PubMed: 38901628
DOI: 10.1016/j.apmr.2024.06.002 -
Journal of Medical Internet Research Jun 2024Despite the well-documented health benefits associated with wearable monitoring devices (WMDs), adherence among community-dwelling older adults remains low. By providing... (Review)
Review
Effects of Peer- or Professional-Led Support in Enhancing Adherence to Wearable Monitoring Devices Among Community-Dwelling Older Adults: Systematic Review of Randomized Controlled Trials.
BACKGROUND
Despite the well-documented health benefits associated with wearable monitoring devices (WMDs), adherence among community-dwelling older adults remains low. By providing guidance on the purpose and benefits of using WMDs, facilitating goal-setting aligned with the device's features, promoting comprehension of the health data captured by the device, and assisting in overcoming technological challenges, peers and health care professionals can potentially enhance older adults' adherence to WMDs. However, the effectiveness of such support mechanisms in promoting adherence to WMDs among older adults remains poorly understood.
OBJECTIVE
The aims of this systematic review were to examine the effects of peer- or professional-led intervention programs designed to improve adherence to WMDs among community-dwelling older adults and to identify the intervention components that may positively influence the effects of the intervention.
METHODS
We conducted a comprehensive search across 7 electronic databases (Cochrane Central Register of Controlled Trials [CENTRAL], PubMed, EMBASE, PsycINFO, British Nursing Index, Web of Science, and CINAHL) to identify articles published between January 1, 2010, and June 26, 2023. We specifically targeted randomized controlled trials that examined the impact of peer- or professional-led interventions on enhancing adherence to WMDs among individuals aged 60 years and older residing in the community. Two independent reviewers extracted data from the included studies and assessed the potential risk of bias in accordance with the Cochrane Risk of Bias tool for randomized trials, version 2.
RESULTS
A total of 10,511 studies were identified through the database search. Eventually, we included 3 randomized controlled trials involving 154 community-dwelling older adults. The participants had a mean age of 65 years. Our review revealed that increasing awareness of being monitored and implementing the SystemCHANGE approach, a habit change tool focusing on personal goals and feedback, were effective strategies for enhancing adherence to WMDs among older adults. All of the included studies exhibited a low risk of bias.
CONCLUSIONS
By collaboratively designing specific goals related to WMDs with health care professionals, including nurses and physicians, older adults exhibited a higher likelihood of adhering to the prescribed use of WMDs. These goal-setting tools provided a framework for structure and motivation, facilitating the seamless integration of WMDs into their daily routines. Researchers should prioritize interventions that target awareness and goal-setting as effective approaches to enhance adherence to WMDs among older adults, thereby maximizing the realization of associated health benefits.
Topics: Humans; Aged; Independent Living; Wearable Electronic Devices; Randomized Controlled Trials as Topic; Patient Compliance; Peer Group; Middle Aged; Female; Male; Aged, 80 and over
PubMed: 38900546
DOI: 10.2196/53607 -
Health Informatics Journal 2024Primary studies have demonstrated that despite being useful, most of the drug-drug interaction (DDI) alerts generated by clinical decision support systems are overridden... (Meta-Analysis)
Meta-Analysis
Primary studies have demonstrated that despite being useful, most of the drug-drug interaction (DDI) alerts generated by clinical decision support systems are overridden by prescribers. To provide more information about this issue, we conducted a systematic review and meta-analysis on the prevalence of DDI alerts generated by CDSS and alert overrides by physicians. The search strategy was implemented by applying the terms and MeSH headings and conducted in the MEDLINE/PubMed, EMBASE, Web of Science, Scopus, LILACS, and Google Scholar databases. Blinded reviewers screened 1873 records and 86 full studies, and 16 articles were included for analysis. The overall prevalence of alert generated by CDSS was 13% (CI95% 5-24%, -value <0.0001, I^2 = 100%), and the overall prevalence of alert override by physicians was 90% (CI95% 85-95%, -value <0.0001, I^2 = 100%). This systematic review and meta-analysis presents a high rate of alert overrides, even after CDSS adjustments that significantly reduced the number of alerts. After analyzing the articles included in this review, it was clear that the CDSS alerts physicians about potential DDI should be developed with a focus on the user experience, thus increasing their confidence and satisfaction, which may increase patient clinical safety.
Topics: Decision Support Systems, Clinical; Humans; Drug Interactions; Medical Order Entry Systems; Medication Errors
PubMed: 38899788
DOI: 10.1177/14604582241263242 -
Journal of the American Heart... Jul 2024Physician transfer is an alternate option to patient transfer for expedient performance of mechanical thrombectomy in patients with acute ischemic stroke. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Physician transfer is an alternate option to patient transfer for expedient performance of mechanical thrombectomy in patients with acute ischemic stroke.
METHODS AND RESULTS
We conducted a systematic review to identify studies that evaluate the effect of physician transfer in patients with acute ischemic stroke who undergo mechanical thrombectomy. A search of PubMed, Scopus, and Web of Science was undertaken, and data were extracted. A statistical pooling with random-effects meta-analysis was performed to examine the odds of reduced time interval between stroke onset and recanalization, functional independence, death, and angiographic recanalization. A total of 12 studies (11 nonrandomized observational studies and 1 nonrandomized controlled trial) were included, with a total of 1894 patients. Physician transfer was associated with a significantly shorter time interval between stroke onset and recanalization with a pooled mean difference estimate of -62.08 (95% CI, -112.56 to -11.61]; =0.016; 8 studies involving 1419 patients) with high between-study heterogeneity in the estimates (=90.6%). The odds for functional independence at 90 days were significantly higher (odds ratio, 1.29 [95% CI, 1.00-1.66]; =0.046; 7 studies with 1222 patients) with physician transfer with low between-study heterogeneity (=0%). Physician transfer was not associated with higher odds of near-complete or complete angiographic recanalization (odds ratio, 1.18 [95% CI, 0.89-1.57; =0.25; =2.8%; 11 studies with 1856 subjects).
CONCLUSIONS
Physician transfer was associated with a significant reduction in the mean of time interval between symptom onset and recanalization and increased odds for functional independence at 90 days with physician transfer compared with patient transfer among patients who undergo mechanical thrombectomy.
Topics: Humans; Patient Transfer; Ischemic Stroke; Thrombectomy; Time-to-Treatment; Time Factors; Treatment Outcome
PubMed: 38899767
DOI: 10.1161/JAHA.123.031906 -
Indian Journal of Dermatology,... Jun 2024Background Janus kinase (JAK)/tyrosine kinase 2 (TYK2) inhibitors are novel treatments for moderate-to-severe plaque psoriasis. Objective To perform a network... (Review)
Review
Background Janus kinase (JAK)/tyrosine kinase 2 (TYK2) inhibitors are novel treatments for moderate-to-severe plaque psoriasis. Objective To perform a network meta-analysis to compare the efficacy and safety of TYK2 inhibitors with other oral drugs in moderate-to-severe psoriasis. Methods Eligible randomised clinical trials (RCTs) were identified from public databases (published before November 2, 2023). Random-effect frequentist network meta-analysis was performed with ranking based on the surface under the cumulative ranking curve (SUCRA) of Physician's Global Assessment of "clear" or "almost clear" (PGA 0/1), 75% reduction from baseline in Psoriasis Area and Severity Index (PASI-75). Results Twenty RCTs containing 7,564 patients with moderate-to-severe psoriasis were included. Deucravacitinib at all dose levels (except for 3 mg every other day) and tofacitinib (10 mg BID) ranked best in achieving PGA 0/1 and PASI-75 at 12- 16 weeks. Tofacitinib (10 mg BID) was considered the most unsafe. Analysis of Ranking according to efficacy and safety showed deucravacitinib (3 mg QD and 3 mg BID) was the best treatment. Analysis of Ranking according to efficacy and safety showed deucravacitinib (3 mg QD and 3 mg BID) was the best treatment. Limitations Insufficiency of eligible data and no long-term follow-up data. Conclusion Deucravacitinib showed superior efficacy and safety for treating moderate-to-severe psoriasis over other included drugs.
PubMed: 38899421
DOI: 10.25259/IJDVL_775_2023