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BMJ (Clinical Research Ed.) May 2024To determine the efficacy of psilocybin as an antidepressant compared with placebo or non-psychoactive drugs. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine the efficacy of psilocybin as an antidepressant compared with placebo or non-psychoactive drugs.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Five electronic databases of published literature (Cochrane Central Register of Controlled Trials, Medline, Embase, Science Citation Index and Conference Proceedings Citation Index, and PsycInfo) and four databases of unpublished and international literature (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, ProQuest Dissertations and Theses Global, and PsycEXTRA), and handsearching of reference lists, conference proceedings, and abstracts.
DATA SYNTHESIS AND STUDY QUALITY
Information on potential treatment effect moderators was extracted, including depression type (primary or secondary), previous use of psychedelics, psilocybin dosage, type of outcome measure (clinician rated or self-reported), and personal characteristics (eg, age, sex). Data were synthesised using a random effects meta-analysis model, and observed heterogeneity and the effect of covariates were investigated with subgroup analyses and metaregression. Hedges' g was used as a measure of treatment effect size, to account for small sample effects and substantial differences between the included studies' sample sizes. Study quality was appraised using Cochrane's Risk of Bias 2 tool, and the quality of the aggregated evidence was evaluated using GRADE guidelines.
ELIGIBILITY CRITERIA
Randomised trials in which psilocybin was administered as a standalone treatment for adults with clinically significant symptoms of depression and change in symptoms was measured using a validated clinician rated or self-report scale. Studies with directive psychotherapy were included if the psychotherapeutic component was present in both experimental and control conditions. Participants with depression regardless of comorbidities (eg, cancer) were eligible.
RESULTS
Meta-analysis on 436 participants (228 female participants), average age 36-60 years, from seven of the nine included studies showed a significant benefit of psilocybin (Hedges' g=1.64, 95% confidence interval (CI) 0.55 to 2.73, P<0.001) on change in depression scores compared with comparator treatment. Subgroup analyses and metaregressions indicated that having secondary depression (Hedges' g=3.25, 95% CI 0.97 to 5.53), being assessed with self-report depression scales such as the Beck depression inventory (3.25, 0.97 to 5.53), and older age and previous use of psychedelics (metaregression coefficient 0.16, 95% CI 0.08 to 0.24 and 4.2, 1.5 to 6.9, respectively) were correlated with greater improvements in symptoms. All studies had a low risk of bias, but the change from baseline metric was associated with high heterogeneity and a statistically significant risk of small study bias, resulting in a low certainty of evidence rating.
CONCLUSION
Treatment effects of psilocybin were significantly larger among patients with secondary depression, when self-report scales were used to measure symptoms of depression, and when participants had previously used psychedelics. Further research is thus required to delineate the influence of expectancy effects, moderating factors, and treatment delivery on the efficacy of psilocybin as an antidepressant.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42023388065.
Topics: Humans; Antidepressive Agents; Depression; Hallucinogens; Psilocybin; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 38692686
DOI: 10.1136/bmj-2023-078084 -
Gaceta Sanitaria 2024The problems posed by medical education in Spain are diverse. This paper analyzes the system currently used to select candidates who will be admitted to a public faculty... (Review)
Review
The problems posed by medical education in Spain are diverse. This paper analyzes the system currently used to select candidates who will be admitted to a public faculty of medicine in Spain and some issues arising from the unprecedented increase in both public and private medical schools in our country. The importance of generic competencies in today's medicine and the need to return to a core design in specialist training are other aspects that are discussed. The degree of development of advanced accreditation diplomas and areas of specific competence is also subject to analysis. Finally, the authors emphasize the importance of continuous professional development and the idea of professional recertification as a system that guarantees patients the quality of the care they receive.
Topics: Spain; Education, Medical; Humans; Accreditation; Schools, Medical; Clinical Competence; National Health Programs
PubMed: 38643057
DOI: 10.1016/j.gaceta.2024.102380 -
[Research progress of femoral bone tunnel positioning in anterior cruciate ligament reconstruction].Zhongguo Xiu Fu Chong Jian Wai Ke Za... Apr 2024To review the concept and methods of femoral bone tunnel positioning in anterior cruciate ligament (ACL) reconstruction, in order to provide a reference for clinical... (Review)
Review
OBJECTIVE
To review the concept and methods of femoral bone tunnel positioning in anterior cruciate ligament (ACL) reconstruction, in order to provide a reference for clinical treatment.
METHODS
The relevant literature on the concept and methods of femoral bone tunnel positioning in ACL reconstruction in domestic and international research was extensively reviewed.
RESULTS
The position of the femoral bone tunnel is a key factor in determining the prognosis of ACL reconstruction. The concept of femoral bone tunnel positioning in ACL reconstruction has experienced isometric reconstruction, anatomical reconstruction, Ribbon-like theory, I.D.E.A.L. theory, and nearly isometric reconstruction theory. The femoral bone tunnel positioning technique is also changing with the in-depth study of the anatomy and biomechanics of the ACL, and each bone tunnel positioning technique has its own advantages and disadvantages. Over-The-Top technique is now mainly used for ACL revision; the clock-face positioning method is basically no longer applicable due to the large error, poor stability, and low retrievability; the bone landmarks positioning method (the lateral condyle of the femur's Resident's ridge and bifurcation ridge, and the the apex of the deep cartilage), which is now mostly used clinically due to the more constant anatomical landmarks. The quadrant method under X-ray fluoroscopy is more cumbersome to implement intraoperatively, so it is mainly used for academic research; computer navigation-assisted positioning has gradually become popular in recent years, which is highly accurate, avoids the influence of human factors on the positioning of the bone tunnel, and has a very good prospect of application; three-dimensional printing-assisted positioning technology, which is accurate in positioning, with a high degree of reproducibility and a short learning curve.
CONCLUSION
The concept of femoral bone tunnel positioning for ACL reconstruction has undergone several evolutions, reflecting the deepening of the understanding of ACL and the improvement of the clinical results of reconstruction. The precision, personalization, and intelligence of positioning techniques are the focus of current and future development.
Topics: Humans; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Biomechanical Phenomena; Femur; Knee Joint; Reproducibility of Results; Tibia
PubMed: 38632073
DOI: 10.7507/1002-1892.202401121 -
Frontiers in Psychology 2024This is a review of a range of empirical studies that use digital text algorithms to predict and model response patterns from humans to Likert-scale items, using texts... (Review)
Review
This is a review of a range of empirical studies that use digital text algorithms to predict and model response patterns from humans to Likert-scale items, using texts only as inputs. The studies show that statistics used in construct validation is predictable on sample and individual levels, that this happens across languages and cultures, and that the relationship between variables are often semantic instead of empirical. That is, the relationships among variables are given a priori and evidently computable as such. We explain this by replacing the idea of "nomological networks" with "semantic networks" to designate computable relationships between abstract concepts. Understanding constructs as nodes in semantic networks makes it clear why psychological research has produced constant average explained variance at 42% since 1956. Together, these findings shed new light on the formidable capability of human minds to operate with fast and intersubjectively similar semantic processing. Our review identifies a categorical error present in much psychological research, measuring representations instead of the purportedly represented. We discuss how this has grave consequences for the empirical truth in research using traditional psychometric methods.
PubMed: 38577112
DOI: 10.3389/fpsyg.2024.1308098 -
Therapeutic Advances in Ophthalmology 2024New developments in artificial intelligence, particularly with promising results in early detection and management of keratoconus, have favorably altered the natural... (Review)
Review
BACKGROUND
New developments in artificial intelligence, particularly with promising results in early detection and management of keratoconus, have favorably altered the natural history of the disease over the last few decades. Features of artificial intelligence in different machine such as anterior segment optical coherence tomography, and femtosecond laser technique have improved safety, precision, effectiveness, and predictability of treatment modalities of keratoconus (from contact lenses to keratoplasty techniques). These options ingrained in artificial intelligence are already underway and allow ophthalmologist to approach disease in the most non-invasive way.
OBJECTIVES
This study comprehensively describes all of the treatment modalities of keratoconus considering machine learning strategies.
DESIGN
A multidimensional comprehensive systematic narrative review.
DATA SOURCES AND METHODS
A comprehensive search was done in the five main electronic databases (PubMed, Scopus, Web of Science, Embase, and Cochrane), without language and time or type of study restrictions. Afterward, eligible articles were selected by screening the titles and abstracts based on main mesh keywords. For potentially eligible articles, the full text was also reviewed.
RESULTS
Artificial intelligence demonstrates promise in keratoconus diagnosis and clinical management, spanning early detection (especially in subclinical cases), preoperative screening, postoperative ectasia prediction after keratorefractive surgery, and guiding surgical decisions. The majority of studies employed a solitary machine learning algorithm, whereas minor studies assessed multiple algorithms that evaluated the association of various keratoconus staging and management strategies. Last but not least, AI has proven effective in guiding the implantation of intracorneal ring segments in keratoconus corneas and predicting surgical outcomes.
CONCLUSION
The efficient and widespread clinical translation of machine learning models in keratoconus management is a crucial goal of potential future approaches to better visual performance in keratoconus patients.
TRIAL REGISTRATION
The article has been registered through PROSPERO, an international database of prospectively registered systematic reviews, with the ID: CRD42022319338.
PubMed: 38516169
DOI: 10.1177/25158414241232258 -
La Tunisie Medicale Dec 2023Access to medication is a major public health issue worldwide and can be considered as an indicator of the quality of public health services in a country.
INTRODUCTION
Access to medication is a major public health issue worldwide and can be considered as an indicator of the quality of public health services in a country.
AIM
To evaluate patient satisfaction with the services provided by the external pharmacy in the drug distribution circuit in public healthcare facilities in Tunisia.
METHODS
To achieve this goal, a satisfaction survey was conducted on a sample of 200 patients at the external pharmacies of two university hospitals in Tunis, namely the La Rabta University Hospital and the Charles Nicolle University Hospital.
RESULTS
This survey revealed that despite the efforts made by the state and the importance of the drug market in Tunisia, 80% of patients reported difficulties in finding their medication in the healthcare facilities where they consult, and more than 60% are forced to obtain them from private pharmacies. The survey also highlighted a contrast between the quality of services provided by the external hospital pharmacy and those of private pharmacies. Indeed, only 25% of the surveyed patients were satisfied with the services provided by the external pharmacy. Although this satisfaction was conditioned by several factors, the main concern of the patients remained the availability of medication. In fact, with little difference in terms of care, 80.5% of the participants favored the idea of transferring the services provided by the external pharmacy to private pharmacies.
CONCLUSION
In summary, this study has highlighted the need to rethink the drug supply and distribution system and to explore alternative approaches to significantly improve access to medication and the quality of services provided by external pharmacies in Tunisian public hospitals.
Topics: Humans; Pharmacies; Tunisia; Pharmacy; Delivery of Health Care; Surveys and Questionnaires
PubMed: 38477198
DOI: No ID Found -
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi =... Feb 2024Parkinson's disease patients have early vocal cord damage, and their voiceprint characteristics differ significantly from those of healthy individuals, which can be used...
Parkinson's disease patients have early vocal cord damage, and their voiceprint characteristics differ significantly from those of healthy individuals, which can be used to identify Parkinson's disease. However, the samples of the voiceprint dataset of Parkinson's disease patients are insufficient, so this paper proposes a double self-attention deep convolutional generative adversarial network model for sample enhancement to generate high-resolution spectrograms, based on which deep learning is used to recognize Parkinson's disease. This model improves the texture clarity of samples by increasing network depth and combining gradient penalty and spectral normalization techniques, and a family of pure convolutional neural networks (ConvNeXt) classification network based on Transfer learning is constructed to extract voiceprint features and classify them, which improves the accuracy of Parkinson's disease recognition. The validation experiments of the effectiveness of this paper's algorithm are carried out on the Parkinson's disease speech dataset. Compared with the pre-sample enhancement, the clarity of the samples generated by the proposed model in this paper as well as the Fréchet inception distance (FID) are improved, and the network model in this paper is able to achieve an accuracy of 98.8%. The results of this paper show that the Parkinson's disease recognition algorithm based on double self-attention deep convolutional generative adversarial network sample enhancement can accurately distinguish between healthy individuals and Parkinson's disease patients, which helps to solve the problem of insufficient samples for early recognition of voiceprint data in Parkinson's disease. In summary, the method effectively improves the classification accuracy of small-sample Parkinson's disease speech dataset and provides an effective solution idea for early Parkinson's disease speech diagnosis.
Topics: Humans; Parkinson Disease; Algorithms; Neural Networks, Computer; Recognition, Psychology; Speech
PubMed: 38403600
DOI: 10.7507/1001-5515.202304011 -
Gaceta Sanitaria Feb 2024To analyse the perceptions and experiences of young people in Spain about sexual violence (SV), its possible causes, victims and perpetrators..
OBJECTIVE
To analyse the perceptions and experiences of young people in Spain about sexual violence (SV), its possible causes, victims and perpetrators..
METHOD
Qualitative study based on semi-structured interviews with 22 young people between 18 and 24 years old. A qualitative content analysis was carried out.
RESULTS
In the juvenile narratives, the lack of definition and accuracy about what SV is stands out, except for mentioning rape, lack of consent and use of force in sexual relations. The girls, self-perceived as the main victims, also break with these narratives by providing a broader vision and gender inequalities related. In general, the most prevailed idea is that VS is perpetrated by men against women in heterosexual relationships inside and outside the couple. Regarding explanations, references coexist to both contextual factors (linked to gender inequalities and the social construction of sexual relationships) and behavioural factors (which includes the viewing of pornography). Tentatively proposals for improvement related to sexual and affective education emerge.
CONCLUSIONS
In the perceptions of the young people, ambiguity seems to coexist with explicit references to the different ways in which it manifests itself and the influence of gender inequalities. Sex and life experience appear to influence these narratives. It is necessary to promote a more critical perspective on the social construction of SV and intimate relationships in the young population.
PubMed: 38401370
DOI: 10.1016/j.gaceta.2024.102371 -
Neuropsychologia Apr 2024Embodied cognition theories predict a functional involvement of sensorimotor processes in language understanding. In a preregistered experiment, we tested this idea by...
Embodied cognition theories predict a functional involvement of sensorimotor processes in language understanding. In a preregistered experiment, we tested this idea by investigating whether interfering with primary motor cortex (M1) activation can change how people construe meaning from action language. Participants were presented with sentences describing actions (e.g., "turning off the light") and asked to choose between two interpretations of their meaning, one more concrete (e.g., "flipping a switch") and another more abstract (e.g., "going to sleep"). Prior to this task, participants' M1 was disrupted using repetitive transcranial magnetic stimulation (rTMS). The results yielded strong evidence against the idea that M1-rTMS affects meaning construction (BF > 30). Additional analyses and control experiments suggest that the absence of effect cannot be accounted for by failure to inhibit M1, lack of construct validity of the task, or lack of power to detect a small effect. In sum, these results do not support a causal role for primary motor cortex in building meaning from action language.
Topics: Humans; Transcranial Magnetic Stimulation; Motor Cortex; Language; Cognition
PubMed: 38395339
DOI: 10.1016/j.neuropsychologia.2024.108832 -
Cell Communication and Signaling : CCS Feb 2024The phenomenon of phase separation is quite common in cells, and it is involved in multiple processes of life activities. However, the current research on the... (Review)
Review
The phenomenon of phase separation is quite common in cells, and it is involved in multiple processes of life activities. However, the current research on the correlation between protein modifications and phase separation and the interference with the tendency of phase separation has some limitations. Here we focus on several post-translational modifications of proteins, including protein phosphorylation modification at multiple sites, methylation modification, acetylation modification, ubiquitination modification, SUMOylation modification, etc., which regulate the formation of phase separation and the stability of phase separation structure through multivalent interactions. This regulatory role is closely related to the development of neurodegenerative diseases, tumors, viral infections, and other diseases, and also plays essential functions in environmental stress, DNA damage repair, transcriptional regulation, signal transduction, and cell homeostasis of living organisms, which provides an idea to explore the interaction between novel protein post-translational modifications and phase separation. Video Abstract.
Topics: Phase Separation; Protein Processing, Post-Translational; Ubiquitination; Phosphorylation; Proteins; Acetylation
PubMed: 38347544
DOI: 10.1186/s12964-023-01380-1