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The Journal of Hand Surgery Jun 2024Multiple interventions have been implemented to reduce opioid prescribing in upper extremity surgery. However, few studies have evaluated pain relief and patient...
PURPOSE
Multiple interventions have been implemented to reduce opioid prescribing in upper extremity surgery. However, few studies have evaluated pain relief and patient satisfaction as related to failure of these protocols. We sought to evaluate the efficacy of limited and nonopioid ("opioid-sparing") regimens for upper extremity surgery as it pertains to patient satisfaction, pain experienced, and need for additional refills/rescue analgesia.
METHODS
We aimed to systematically review randomized controlled trials of opioid-sparing approaches in upper extremity surgery. An initial search of studies evaluating opioid-sparing regimens after upper extremity surgery from the elbow distal yielded 1,320 studies, with nine meeting inclusion criteria. Patient demographics, surgery type, postoperative pain regimen, satisfaction measurements, and number of patients inadequately treated within each study were recorded. Outcomes were assessed using descriptive statistics.
RESULTS
Nine randomized controlled trials with 1,480 patients were included. Six of nine studies (67%) reported superiority or equivalence of pain relief with nonopioid or limited opioid regimens. However, across all studies, 4.2% to 25% of patients were not adequately treated by the opioid-sparing protocols. This includes four of seven studies (57%) assessing number of medication refills or rescue analgesia reporting increased pill consumption, refills, or rescue dosing with limited/nonopioid regimens. Five of six studies (83%) reporting satisfaction outcomes found no difference in satisfaction with pain control, medication strength, and overall surgical experience using opioid-sparing regimens.
CONCLUSIONS
Opioid-sparing regimens provide adequate pain relief for most upper extremity surgery patients. However, a meaningful number of patients on opioid-sparing regimens required greater medication refills and increased use of rescue analgesia. These patients also reported no difference in satisfaction compared with limited/nonopioid regimens.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic II.
Topics: Humans; Pain, Postoperative; Randomized Controlled Trials as Topic; Analgesics, Opioid; Patient Satisfaction; Hand; Analgesics, Non-Narcotic; Pain Measurement; Pain Management
PubMed: 38703147
DOI: 10.1016/j.jhsa.2024.02.007 -
Frontiers in Pharmacology 2024The purpose of the study was to comprehensively evaluate efficacy and safety of CDDP in patients with AMI undergoing PCI. A computerised search was conducted on the...
Effect of adjuvant therapy with compound danshen drip pill on inflammatory factors and cardiac function after percutaneous coronary intervention for acute myocardial infarction: a systematic review and meta-analysis.
The purpose of the study was to comprehensively evaluate efficacy and safety of CDDP in patients with AMI undergoing PCI. A computerised search was conducted on the CNKI, WF, VIP, CBM, PubMed, Embase, Web of Science, and Cochrane Library databases for RCTs of CDDP adjuvant therapy for AMI up to May 2023. STATA 17.0 was used to perform meta-analyses, sensitivity analyses, subgroup analyses, meta-regression, and publication bias assessments. TSA 0.9.5.10 Beta was used for trial sequential analysis (TSA). Evidence confidence of meta results was evaluated by GRADE (Grading of Recommendations Assessment, Development and Evaluation) according to the instructions. The results of the meta-analysis showed that CDDP combined with conventional western treatment (CWT) was superior to CWT in increasing LVEF and TCER and decreasing LVEDD, hs-CRP, IL-6 and TNF-α. The quality of evidence for TCER was moderate, LVEF, LVEDD, IL-6, and TNF-α were low. The TSA results showed that the total number of samples collected in this study met the requirements for meta-analysis and excluded the possibility of false positives, further confirming the efficacy of CDDP for the treatment of AMI undergoing PCI. Adjuvant treatment of AMI with CDDP has shown exciting and safe benefits in improving cardiac function and reducing inflammatory response in patients with AMI undergoing PCI, but the quality of some of the included studies was poor, and the results should be interpreted with caution until further confirmation by well-designed RCTs. Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/#recordDetails], identifier [CRD42023453293].
PubMed: 38689665
DOI: 10.3389/fphar.2024.1345897 -
Journal of Healthcare Informatics... Jun 2024As medication adherence represents a critical challenge in healthcare, pill and medication dispensers have gained increasing attention as potential solutions to promote...
As medication adherence represents a critical challenge in healthcare, pill and medication dispensers have gained increasing attention as potential solutions to promote adherence and improve patient outcomes. Following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) methodology, we carried out a systematic literature review on papers indexed in Scopus and PubMed, which present solutions for pill or medication dispensers. Given the importance of user acceptance for these solutions, the research questions of the survey are driven by a human-centered perspective. We first provide an overview of the different solutions, classifying them according to their stage of development. We then analyze each solution considering its hardware/software architecture. Finally, we review the characteristics of user interfaces designed for interacting with pill and medication dispensers and analyze the involvement of different types of users in dispenser management. On the basis of this analysis, we draw findings and indications for future research that are aimed to provide insights to healthcare professionals, researchers, and designers who are interested in developing and using pill and medication dispensers.
PubMed: 38681758
DOI: 10.1007/s41666-024-00161-w -
Kidney360 Jun 2024The prevalence of polypharmacy in patients with CKD was over 80%. Polypharmacy was highest in patients with a kidney transplant and those receiving dialysis.... (Meta-Analysis)
Meta-Analysis Review
KEY POINTS
The prevalence of polypharmacy in patients with CKD was over 80%. Polypharmacy was highest in patients with a kidney transplant and those receiving dialysis. Polypharmacy is associated with worse clinical outcomes, lower quality of life, and medication-related problems in patients with CKD.
BACKGROUND
Despite the high prevalence of polypharmacy in patients with CKD, the extent of polypharmacy across patients with (different stages of) CKD, as well as the association with clinical outcomes remains unknown. This systematic review aimed to evaluate the prevalence of polypharmacy in (different subgroups of) patients with CKD and assess the association between polypharmacy and patient-important outcomes.
METHODS
MEDLINE, Embase, and the Cochrane Library were searched from inception until July 2022. Studies that reported the prevalence of polypharmacy, medication use, or pill burden in patients with CKD (including patients receiving dialysis and kidney transplant recipients) and their association with patient-important outcomes (., mortality, kidney failure, quality of life [QoL], and medication nonadherence) were included. Two reviewers independently screened title and abstract and full texts, extracted data, and assessed risk of bias. Data were pooled in a random-effects single-arm meta-analysis.
RESULTS
In total, 127 studies were included (CKD 3–5 =39, dialysis: =38, kidney transplant =13, different CKD stages =37). The pooled prevalence of polypharmacy, based on 63 studies with 484,915 patients, across all patients with CKD was 82% (95% confidence interval, 76% to 86%), and the pooled mean number of prescribed medications was 9.7 (95% confidence interval, 8.4 to 11.0). The prevalence of polypharmacy was higher in patients who received dialysis or a kidney transplant compared with patients with CKD 3–5 but did not differ between studies with regards to region or patients' mean age or sex. In patients with CKD, polypharmacy was associated with a higher risk of all-cause mortality, kidney failure, faster eGFR decline, lower QoL, and higher medication nonadherence, adverse drug reactions, and potentially inappropriate medications.
CONCLUSIONS
The prevalence of polypharmacy in patients with CKD was over 80%, and highest in patients with a kidney transplant and those receiving dialysis. No causes of heterogeneity were identified, indicating that polypharmacy is an issue for all patients with CKD. Polypharmacy is associated with worse clinical outcomes, lower QoL, and medication-related problems in patients with CKD.
CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER:
PROSPERO (CRD42022331941).
Topics: Humans; Polypharmacy; Renal Insufficiency, Chronic
PubMed: 38661553
DOI: 10.34067/KID.0000000000000447 -
Frontiers in Pharmacology 2024Amidst rising global burden of depression and the associated challenges with conventional antidepressant therapies, there is a growing interest in exploring the...
Amidst rising global burden of depression and the associated challenges with conventional antidepressant therapies, there is a growing interest in exploring the efficacy and safety of alternative treatments. This study uses a Bayesian network meta-analysis to rigorously evaluate the therapeutic potential of Chinese herbal medicines in the treatment of depression, focusing on their comparative efficacy and safety against standard pharmacological interventions. Five databases (PubMed, Wanfang Data, EMBASE, CNKI, and the Cochrane Library) and grey literature were searched from inception to end of July 2023 to identify studies that assessed the efficacy and safety of Chinese herbal medicines in treating depression. The response rate, Hamilton Depression Scale (HAMD) scores, and rates of adverse events were assessed through both direct and indirect comparisons. Data extraction and risk of bias assessment were meticulously performed. Statistical analysis used Markov chain Monte Carlo methods, with effect size estimates provided as odd ratios and their 95% confidence intervals. A total of 198 RCTs involving 8,923 patients were analyzed, assessing 17 Chinese herbal medicines. Surface Under the Cumulative Ranking results indicated that the top three treatments with the best response rate were possibly , , and ; the top three treatments on the reduction of HAMD scores were , , and ; and the top three treatments with the lowest adverse effects rates were , , and . Interestingly, commonly used synthetic drugs such as , , , , , and , not only appeared to be less effective than specific Chinese herbal medicines (, , , , and ), but they were also related to substantially higher risk of adverse events. Our findings elucidate the promising therapeutic potential of Chinese herbal medicines as viable alternatives in the treatment of depression, with certain herbs demonstrating enhanced efficacy and safety profiles. The outcomes of this study advocate for the integration of these alternative modalities into contemporary depression management paradigms. However, it underscores the necessity for larger, methodologically robust trials to further validate and refine these preliminary findings. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023452109.
PubMed: 38633609
DOI: 10.3389/fphar.2024.1295564 -
JAMA Dermatology Apr 2024Hirsutism represents a significant concern for women with polycystic ovary syndrome (PCOS), with deleterious psychological effects warranting acknowledgment and a clear...
IMPORTANCE
Hirsutism represents a significant concern for women with polycystic ovary syndrome (PCOS), with deleterious psychological effects warranting acknowledgment and a clear imperative to provide effective management. To our knowledge, this is the first review to exclusively examine the effectiveness of laser and light-based therapies in addressing hirsutism in women with PCOS.
OBJECTIVE
To synthesize the existing literature regarding the effectiveness of laser and light hair reduction therapies, either as stand-alone treatments or in combination with systemic agents, in treating hirsutism for women with PCOS.
EVIDENCE REVIEW
A systematic literature review was performed using MEDLINE, Embase, EMCARE, and CINAHL according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Articles written in English, reporting on patients who met pre-established inclusion criteria were selected. Objective and subjectively measured outcomes relating to the effect of laser or light-based hair reduction therapies on hirsutism were abstracted. Heterogeneity among included studies precluded a meta-analysis, necessitating a narrative synthesis.
FINDINGS
Six studies reporting data on 423 individual patients with PCOS who underwent laser or light-based hair reduction therapies were included: 4 randomized clinical trials and 2 cohort studies. Alexandrite laser demonstrated significant improvements in hirsutism severity and psychological outcomes, particularly at high-fluence application. Alexandrite laser was also found to be more effective than intense pulsed light (IPL). The combination of diode laser with either metformin or combined oral contraceptive pill was superior to the application of diode laser alone, just as the addition of metformin to IPL demonstrated superior results to IPL treatment alone. Overall, most interventions were well tolerated. The overall certainty of evidence across all outcomes and comparisons was limited in part due to the observational nature of some studies.
CONCLUSIONS AND RELEVANCE
This systematic review highlights the potential of laser and light hair reduction therapies, both as stand-alone treatments and in combination with other pharmacological agents in PCOS. However, this review was limited by low certainty of the evidence, few studies evaluating effectiveness and safety in those with skin of color, and heterogeneity in outcome assessment. Future studies are needed to provide more robust evidence among diverse individuals with PCOS and hirsutism.
PubMed: 38630483
DOI: 10.1001/jamadermatol.2024.0623 -
Journal of Orthopaedic Surgery and... Apr 2024To analyze the risk factors of proximal junctional kyphosis (PJK) after correction surgery in patients with adolescent idiopathic scoliosis (AIS). (Meta-Analysis)
Meta-Analysis
AIM
To analyze the risk factors of proximal junctional kyphosis (PJK) after correction surgery in patients with adolescent idiopathic scoliosis (AIS).
METHODS
PubMed, Medline, Embase, Cochrane Library, Web of Science, CNKI, and EMCC databases were searched for retrospective studies utilizing all AIS patients with PJK after corrective surgery to collect preoperative, postoperative, and follow-up imaging parameters, including thoracic kyphosis (TK), lumbar lordosis (LL), proximal junctional angle (PJA), the sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), pelvic incidence-lumbar lordosis (PI-LL), sacral slope (SS), rod contour angle (RCA) and upper instrumented vertebra (UIV).
RESULTS
Nineteen retrospective studies were included in this meta-analysis, including 550 patients in the intervention group and 3456 patients in the control group. Overall, sex (OR 1.40, 95% CI (1.08, 1.83), P = 0.01), larger preoperative TK (WMD 6.82, 95% CI (5.48, 8.16), P < 0.00001), larger follow-up TK (WMD 8.96, 95% CI (5.62, 12.30), P < 0.00001), larger postoperative LL (WMD 2.31, 95% CI (0.91, 3.71), P = 0.001), larger follow-up LL (WMD 2.51, 95% CI (1.19, 3.84), P = 0.0002), great change in LL (WMD - 2.72, 95% CI (- 4.69, - 0.76), P = 0.006), larger postoperative PJA (WMD 4.94, 95% CI (3.62, 6.26), P < 0.00001), larger follow-up PJA (WMD 13.39, 95% CI (11.09, 15.69), P < 0.00001), larger postoperative PI-LL (WMD - 9.57, 95% CI (- 17.42, - 1.71), P = 0.02), larger follow-up PI-LL (WMD - 12.62, 95% CI (- 17.62, - 7.62), P < 0.00001), larger preoperative SVA (WMD 0.73, 95% CI (0.26, 1.19), P = 0.002), larger preoperative SS (WMD - 3.43, 95% CI (- 4.71, - 2.14), P < 0.00001), RCA (WMD 1.66, 95% CI (0.48, 2.84), P = 0.006) were identified as risk factors for PJK in patients with AIS. For patients with Lenke 5 AIS, larger preoperative TK (WMD 7.85, 95% CI (5.69, 10.00), P < 0.00001), larger postoperative TK (WMD 9.66, 95% CI (1.06, 18.26), P = 0.03, larger follow-up TK (WMD 11.92, 95% CI (6.99, 16.86), P < 0.00001, larger preoperative PJA (WMD 0.72, 95% CI (0.03, 1.41), P = 0.04, larger postoperative PJA (WMD 5.54, 95% CI (3.57, 7.52), P < 0.00001), larger follow-up PJA (WMD 12.42, 95% CI 9.24, 15.60), P < 0.00001, larger follow-up SVA (WMD 0.07, 95% CI (- 0.46, 0.60), P = 0.04), larger preoperative PT (WMD - 3.04, 95% CI (- 5.27, - 0.81), P = 0.008, larger follow-up PT (WMD - 3.69, 95% CI (- 6.66, - 0.72), P = 0.02) were identified as risk factors for PJK.
CONCLUSION
Following corrective surgery, 19% of AIS patients experienced PJK, with Lenke 5 contributing to 25%. Prior and post-op measurements play significant roles in predicting PJK occurrence; thus, meticulous, personalized preoperative planning is crucial. This includes considering individualized treatments based on the Lenke classification as our future evaluation standard.
Topics: Humans; Adolescent; Scoliosis; Lordosis; Retrospective Studies; Kyphosis; Sacrum; Risk Factors; Spinal Fusion; Postoperative Complications; Thoracic Vertebrae
PubMed: 38566085
DOI: 10.1186/s13018-024-04638-7 -
Clinical and Applied... 2024Cerebral venous sinus thrombosis (CVST) is a rare neurovascular condition that has been observed in individuals with coronavirus disease 2019 (COVID-19). This systematic...
Cerebral venous sinus thrombosis (CVST) is a rare neurovascular condition that has been observed in individuals with coronavirus disease 2019 (COVID-19). This systematic review aimed to explore the sex differences and characteristics of concurrent COVID-19 and CVST cases. A total of 212 CVST patients were included in the study. Women with CVST had a slightly higher mean age compared to men (47.359 years vs 46.08 years). Women were more likely to report symptoms such as fever (56.1%) and decreased sense of smell or taste (71.4%), while men more frequently experienced nausea or vomiting (55.6%), headache (62.9%), and seizures (72%). Notably, current smokers, who were predominantly men, had a higher occurrence of CVST. On the other hand, women had a higher likelihood of CVST risk factors such as oral contraceptive pill (OCP) use and autoimmune diseases. Treatment approaches also showed sex-based differences. Unfractionated heparin was administered more often to women with CVST (63.2%). The in-hospital mortality rate for CVST patients was 21.3%, with men having a significantly higher mortality rate than women (65.2% vs 34.8%, = .027). Survival analysis revealed that factors such as smoking history, diabetes mellitus, hypertension, OCP use, COVID-19 symptoms, CVST symptoms, and the need for intubation significantly influenced survival outcomes. Understanding these sex differences in COVID-19-related CVST is crucial for accurate diagnosis and effective management, ultimately leading to improved patient outcomes. Our findings highlight the importance of considering sex as a factor in the evaluation and treatment of individuals with COVID-19 and concurrent CVST.
Topics: Humans; Male; Female; Middle Aged; Heparin; Sex Characteristics; Sinus Thrombosis, Intracranial; COVID-19; Risk Factors
PubMed: 38551022
DOI: 10.1177/10760296241240748 -
PloS One 2024Despite conflicting findings in the current literature regarding the correlation between contraceptives and maternal health consequences, statistical analyses indicate... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Despite conflicting findings in the current literature regarding the correlation between contraceptives and maternal health consequences, statistical analyses indicate that family planning may decrease the occurrence of such outcomes. Consequently, it is crucial to assess the capability of family planning to mitigate adverse maternal health outcomes.
OBJECTIVES
This review investigates the effects of modern contraceptive use on maternal health.
SEARCH METHODS
This systematic review is registered on Prospero (CRD42022332783). We searched numerous databases with an upper date limit of February 2022 and no geographical boundaries.
SELECTION CRITERIA
We included observational studies, including cross-sectional, cohort, case-control studies, and non-RCT with a comparison group. We excluded systematic reviews, scoping reviews, narrative reviews, and meta-analyses from the body of this review.
MAIN RESULTS
The review included nineteen studies, with five studies reporting a reduction in maternal mortality linked to increased access to family planning resources and contraceptive use. Another three studies examined the impact of contraception on the risk of preeclampsia and our analysis found that preeclampsia risk was lower by approximately 6% among contraceptive users (95% CI 0.82-1.13) compared to non-users. Two studies assessed the effect of hormonal contraceptives on postpartum glucose tolerance and found that low-androgen contraception was associated with a reduced risk of gestational diabetes (OR 0.84, 95% CI 0.58-1.22), while DMPA injection was possibly linked to a higher risk of falling glucose status postpartum (OR 1.42, 95% CI 0.85-2.36). Two studies evaluated high-risk pregnancies and births in contraceptive users versus non-users, with the risk ratio being 30% lower among contraceptive users of any form (95% CI 0.61, 0.80). None of these results were statistically significant except the latter. In terms of adverse maternal health outcomes, certain contraceptives were found to be associated with ectopic pregnancy and pregnancy-related venous thromboembolism through additional analysis.
Topics: Pregnancy; Humans; Female; Family Planning Services; Pre-Eclampsia; Cross-Sectional Studies; Contraception; Contraceptives, Oral, Hormonal; Glucose
PubMed: 38498424
DOI: 10.1371/journal.pone.0294475 -
Medicine Mar 2024The efficacy and safety of Xiaoyao Pill combined with Western medicine in the treatment of schizophrenia are still inconclusive. This meta-analysis summarized relevant... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The efficacy and safety of Xiaoyao Pill combined with Western medicine in the treatment of schizophrenia are still inconclusive. This meta-analysis summarized relevant studies to compare the efficacy and safety of Xiaoyao Pill combined with Western medicine and Western medicine alone in the treatment of schizophrenia, aiming to provide guidance for clinical treatment.
METHODS
In this meta-analysis, we searched PubMed, Embase, Cochrane Library, CNKI, Wanfang, CQVIP, and CBM databases from the establishment of the databases to August 2023. The study proposed to include studies that reported combination of Xiaoyao Pill with Western medicine and Western medicine alone in the treatment of schizophrenia, excluding published literature, unpublished literature, literature with incomplete or inadequate information, animal experiments, literature reviews and systematic studies. Data were analyzed using Review manager 5.3.
RESULTS
About 9 studies (6 RCTs and 3 case-control studies) were included in this meta-analysis. The sample size ranged from 60 to 128, with a total of 779 patients, including 395 in the combined treatment group and 384 in the control group. Pooled results showed that the total effective rate of combined treatment group was significantly higher than that of Western medicine alone (OR = 4.21, 95% CI: 1.50-11.83, P = .006). Positive and Negative Syndrome Scale (PANSS) (-) (MD = -2.30, 95% CI: -3.72 ~ -0.89, P = .001) and PANSS (+) (MD = -2.60, 95% CI: -3.34 ~ -1.86, P < .00001) of combined treatment group were all significantly lower than that of Western medicine alone. Additionally, PRL levels of combined treatment group was significantly lower than that of Western medicine alone (MD = -28.78, 95% CI: -42.20 ~ -15.35, P < .0001). However, there was no significant difference in BPRS and total PANSS between combined treatment group and Western medicine alone group. Notably, pooled results showed that there was no significant difference in incidence of adverse events between combined treatment group and Western medicine alone group.
CONCLUSION
The effective rate of Xiaoyao Pill combined with Western medicine in the treatment of schizophrenia is higher than that of Western medicine alone, which can effectively relieve the positive and negative symptoms of schizophrenia, and can significantly reduce the level of PRL. In the treatment of schizophrenia, clinicians can give priority to Xiaoyao Pill combined with Western medicine therapy.
Topics: Humans; Schizophrenia; Drugs, Chinese Herbal; Case-Control Studies
PubMed: 38457544
DOI: 10.1097/MD.0000000000037226