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International Journal of Chronic... 2024Inhaled corticosteroid (ICS) therapy has been demonstrated to reduce the risk of COPD exacerbations. It should only be prescribed to COPD patients who are not adequately... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Inhaled corticosteroid (ICS) therapy has been demonstrated to reduce the risk of COPD exacerbations. It should only be prescribed to COPD patients who are not adequately controlled by dual long-acting bronchodilator therapy and who have ≥2 exacerbations per year and a blood eosinophil count ≥300cells/µL. ICS therapy is widely prescribed outside guidelines to COPD patients, making ICS withdrawal an important consideration. This systematic review aims to provide an up-to-date analysis of the effect of ICS withdrawal on exacerbation frequency, change in lung function (FEV) and to determine the proportion of COPD patients who resume ICS therapy following withdrawal.
METHODS
Randomised controlled trials (RCTs) and observational studies which compared ICS withdrawal with ICS continuation treatment were included. Cochrane Central, Web of Science, CINHAL, Embase and OVID Medline were searched. Risk of bias was assessed using the Cochrane RoB2 tool and the Newcastle-Ottawa Scale. Quality assessment of RCTs was conducted using GRADE. Meta-analysis of post-hoc analyses of RCTs of ICS withdrawal, stratified by blood eosinophil count (BEC), was undertaken.
RESULTS
Ten RCTs (6642 patients randomised) and 6 observational studies (160,029 patients) were included in the results. When ICS was withdrawn and long-acting bronchodilator therapy was maintained, there was no consistent difference in exacerbation frequency or lung function change between the ICS withdrawal and continuation trial arms. The evidence for these effects was of moderate quality. There was insufficient evidence to draw a firm conclusion on the proportion of patients who resumed ICS therapy following withdrawal (estimated range 12-93% of the participants).
DISCUSSION
Withdrawal of ICS therapy from patients with COPD is safe and feasible but should be accompanied by maintenance of bronchodilation therapy for optimal outcomes.
Topics: Pulmonary Disease, Chronic Obstructive; Humans; Administration, Inhalation; Lung; Adrenal Cortex Hormones; Disease Progression; Forced Expiratory Volume; Treatment Outcome; Bronchodilator Agents; Randomized Controlled Trials as Topic; Observational Studies as Topic; Time Factors; Aged; Drug Administration Schedule; Risk Factors; Middle Aged; Female; Male
PubMed: 38919905
DOI: 10.2147/COPD.S436525 -
Journal of Physiotherapy Jun 2024In people with chronic obstructive pulmonary disease (COPD) who complete an exercise training program (ETP) offered at a sufficient dose to result in training-related...
Interventions with a clear focus on achieving behaviour change are important for maintaining training-related gains in people with chronic obstructive pulmonary disease: a systematic review.
QUESTIONS
In people with chronic obstructive pulmonary disease (COPD) who complete an exercise training program (ETP) offered at a sufficient dose to result in training-related gains, to what extent are these gains maintained 12 months after program completion? Do variables such as the application of behaviour change techniques moderate the maintenance of these training-related gains?
DESIGN
Systematic review, meta-analysis and meta-regression of randomised controlled trials.
PARTICIPANTS
People with stable COPD.
INTERVENTION
Trials were included if they applied ≥ 4 weeks of a whole-body ETP and reported outcome data immediately following program completion and 12 months after initial program completion. The control group received usual care that did not include a formal exercise training component.
OUTCOME MEASURES
Exercise tolerance, health-related quality of life and dyspnoea during activities of daily living.
DATA SOURCES
EMBASE, PEDro, PubMed and the Cochrane Library.
RESULTS
Nineteen randomised trials with 2,103 participants were found, of which 12 had a sufficiently similar design to be meta-analysed. At 12 months after ETP completion, compared with the control group, the experimental group demonstrated better exercise tolerance (SMD 0.48, 95% CI 0.19 to 0.77) and quality of life (SMD 0.22, 95% CI 0.03 to 0.41) with no clear effect on dyspnoea. Meta-regression using data from all 19 trials demonstrated that the magnitude of between-group differences at the 12-month follow-up was moderated by: behaviour change being a core aim of the strategies implemented following completion of the ETP; the experimental group receiving more behaviour change techniques during the program; and the magnitude of between-group change achieved from the program.
CONCLUSION
At 12 months after completion of an ETP of ≥ 4 weeks, small gains were maintained in exercise tolerance and health-related quality of life. Applying behaviour change techniques with a clear focus on participants integrating exercise into daily life beyond initial program completion is important to maintain training-related gains.
REGISTRATION
CRD42020193833.
PubMed: 38918084
DOI: 10.1016/j.jphys.2024.06.003 -
Journal of Medical Internet Research Jun 2024Cancer has emerged as a considerable global health concern, contributing substantially to both morbidity and mortality. Recognizing the urgent need to enhance the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cancer has emerged as a considerable global health concern, contributing substantially to both morbidity and mortality. Recognizing the urgent need to enhance the overall well-being and quality of life (QOL) of cancer patients, a growing number of researchers have started using online mindfulness-based interventions (MBIs) in oncology. However, the effectiveness and optimal implementation methods of these interventions remain unknown.
OBJECTIVE
This study evaluates the effectiveness of online MBIs, encompassing both app- and website-based MBIs, for patients with cancer and provides insights into the potential implementation and sustainability of these interventions in real-world settings.
METHODS
Searches were conducted across 8 electronic databases, including the Cochrane Library, Web of Science, PubMed, Embase, SinoMed, CINAHL Complete, Scopus, and PsycINFO, until December 30, 2022. Randomized controlled trials involving cancer patients aged ≥18 years and using app- and website-based MBIs compared to standard care were included. Nonrandomized studies, interventions targeting health professionals or caregivers, and studies lacking sufficient data were excluded. Two independent authors screened articles, extracted data using standardized forms, and assessed the risk of bias in the studies using the Cochrane Bias Risk Assessment Tool. Meta-analyses were performed using Review Manager (version 5.4; The Cochrane Collaboration) and the meta package in R (R Foundation for Statistical Computing). Standardized mean differences (SMDs) were used to determine the effects of interventions. The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was used to assess the potential implementation and sustainability of these interventions in real-world settings.
RESULTS
Among 4349 articles screened, 15 (0.34%) were included. The total population comprised 1613 participants, of which 870 (53.9%) were in the experimental conditions and 743 (46.1%) were in the control conditions. The results of the meta-analysis showed that compared with the control group, the QOL (SMD 0.37, 95% CI 0.18-0.57; P<.001), sleep (SMD -0.36, 95% CI -0.71 to -0.01; P=.04), anxiety (SMD -0.48, 95% CI -0.75 to -0.20; P<.001), depression (SMD -0.36, 95% CI -0.61 to -0.11; P=.005), distress (SMD -0.50, 95% CI -0.75 to -0.26; P<.001), and perceived stress (SMD -0.89, 95% CI -1.33 to -0.45; P=.003) of the app- and website-based MBIs group in patients with cancer was significantly alleviated after the intervention. However, no significant differences were found in the fear of cancer recurrence (SMD -0.30, 95% CI -1.04 to 0.44; P=.39) and posttraumatic growth (SMD 0.08, 95% CI -0.26 to 0.42; P=.66). Most interventions were multicomponent, website-based health self-management programs, widely used by international and multilingual patients with cancer.
CONCLUSIONS
App- and website-based MBIs show promise for improving mental health and QOL outcomes in patients with cancer, and further research is needed to optimize and customize these interventions for individual physical and mental symptoms.
TRIAL REGISTRATION
PROSPERO CRD42022382219; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=382219.
Topics: Adult; Female; Humans; Male; Internet; Internet-Based Intervention; Mindfulness; Neoplasms; Quality of Life
PubMed: 38917445
DOI: 10.2196/47704 -
Journal of Pharmacy & Bioallied Sciences Apr 2024Immediate implant placement into a fresh extraction socket has been developed as a consistent treatment, allowing for a reduction in the duration of time necessary for... (Review)
Review
BACKGROUND
Immediate implant placement into a fresh extraction socket has been developed as a consistent treatment, allowing for a reduction in the duration of time necessary for prosthetic rehabilitation. The study will evaluate the clinical and radiologic outcomes of implants placed immediately for a 10-year follow-up period.
AIM
The aim of this systematic review is to evaluate the durability of the immediate implant in periodontally compromised individual placement.
METHODS
Studies reporting clinical and radiologic implant outcomes from periodontally compromised individuals who were treated and followed periodontal and implant maintenance for ≥5 years were considered eligible for the review. Screening of the articles, data extraction, and quality assessment were conducted independently and in duplicate.
RESULTS
There were 99 papers, and of them, 55 were excluded after title/abstract assessment. The full texts of 28 potentially eligible publications were screened, but only seven studies met the inclusion criteria.
CONCLUSIONS
The study confirms that immediate implant therapy is safe, effective, and predictable for successful osseointegration and long-term functioning in periodontally compromised individuals, with minimal differences in clinical and radiographic outcomes.
PubMed: 38882765
DOI: 10.4103/jpbs.jpbs_1115_23 -
Italian Journal of Pediatrics Jun 2024The purpose of this study was to review the literature on the clinical use of voriconazole (VRC) in pediatric patients. MEDLINE, Embase, PubMed, Web of Science, and... (Review)
Review
The purpose of this study was to review the literature on the clinical use of voriconazole (VRC) in pediatric patients. MEDLINE, Embase, PubMed, Web of Science, and Cochrane Library were searched from January 1, 2000, to August 15, 2023 for relevant clinical studies on VRC use in pediatric patients. Data were collected based on inclusion and exclusion criteria, and a systematic review was performed on recent research related to the use of VRC in pediatric patients. This systematic review included a total of 35 observational studies among which there were 16 studies investigating factors influencing VRC plasma trough concentrations (C) in pediatric patients, 14 studies exploring VRC maintenance doses required to achieve target range of C, and 11 studies focusing on population pharmacokinetic (PPK) research of VRC in pediatric patients. Our study found that the C of VRC were influenced by both genetic and non-genetic factors. The optimal dosing of VRC was correlated with age in pediatric patients, and younger children usually required higher VRC doses to achieve target C compared to older children. Establishing a PPK model for VRC can assist in achieving more precise individualized dosing in children.
Topics: Voriconazole; Humans; Antifungal Agents; Child; Dose-Response Relationship, Drug; Mycoses
PubMed: 38853280
DOI: 10.1186/s13052-024-01684-z -
Journal of UOEH 2024The need for improved nutrition in older adults requiring care has been acknowledged, but, to the best of our knowledge, there is a lack of systematic review and... (Review)
Review
The need for improved nutrition in older adults requiring care has been acknowledged, but, to the best of our knowledge, there is a lack of systematic review and integration of nutritional care studies with older adults in nursing homes. This scoping review aimed to examine the scope and nature of nutritional care research for older adults in nursing homes and to identify research gaps, following the guidelines of the Joanna Briggs Institute. We found varied nutritional care for older adults living in nursing homes, including individualized sessions, such as nutrition counseling, the addition of foods and preparations for increased nutritional intake, and the maintenance of an eating environment, such as feeding assistance and calling. The nutritional care identified in this scoping review also included studies that have improved the nutritional status of older adults in nursing homes by implementing educational programs for care staff. For future research on effective nutritional care for older adults in nursing homes, we suggest evaluating both short- and long-term intervention effects with an adequate sample size.
Topics: Nursing Homes; Humans; Aged; Nutritional Status; Nutrition Therapy
PubMed: 38839291
DOI: 10.7888/juoeh.46.227 -
Frontiers in Pharmacology 2024The efficacy of Chinese herbal medicine (CHM) in managing irritable bowel syndrome with diarrhea (IBS-D) accompanied by anxiety and depression remains uncertain. Thus, a...
Exploration of the mechanism of Traditional Chinese Medicine for anxiety and depression in patients with diarrheal irritable bowel syndrome based on network pharmacology and meta-analysis.
BACKGROUND
The efficacy of Chinese herbal medicine (CHM) in managing irritable bowel syndrome with diarrhea (IBS-D) accompanied by anxiety and depression remains uncertain. Thus, a systematic review was carried out employing meta-analysis and network pharmacology to ascertain the efficacy and underlying mechanisms of CHM therapy.
METHODS
By conducting a systematic review, including literature search, screening, and data extraction, we identified 25 randomized controlled trials to assess CHM's effectiveness in treating irritable bowel syndrome alongside anxiety and depression. Network pharmacology was utilized to scrutinize the metabolite utility of CHM in addressing this condition. Potential primary mechanisms were synthesized using information sourced from the PubMed database.
RESULTS
Twenty-five studies, including 2055 patients, were analyzed, revealing significant treatment efficacy for IBS-D in the trial group compared to controls [OR = 4.01, 95% CI (2.99, 5.36), I = 0%] Additionally, treatment for depression [SMD = -1.08, 95% CI (-1.30, -0.86), < 0.00001, I = 68%; SDS: SMD = -1.69, 95% CI (-2.48, -0.90), < 0.0001, I = 96%] and anxiety [HAMA: SMD = -1.29, 95% CI (-1.68, -0.91), < 0.00001, I = 89%; SAS: SMD = -1.75, 95% CI (-2.55, -0.95), < 0.00001, I = 96%] significantly improved in the trial group. Furthermore, the trial group exhibited a significantly lower disease relapse rate [OR = 0.30, 95% CI (0.20, 0.44), < 0.00001, I = 0%]. CHM treatment consistently improved IBS severity (IBS-SSS) and symptom scores. Network pharmacology analysis identified key chemical metabolites in traditional Chinese medicine formulations, including Beta-sitosterol, Stigmasterol, Quercetin, Naringenin, Luteolin, Kaempferol, Nobiletin, Wogonin, Formononetin, and Isorhamnetin. Utilizing the STRING database and Cytoscape v3.9.0 software, a protein-protein interaction (PPI) network revealed the top eight key targets: IL-6, TNF, PPARG, PTGS2, ESR1, NOS3, MAPK8, and AKT1, implicated in anti-inflammatory responses, antioxidant stress modulation, and neurotransmitter homeostasis maintenance.
CONCLUSION
Chinese Herbal Medicine (CHM) offers a promising and safe treatment approach for patients dealing with Diarrheal Irritable Bowel Syndrome (IBS-D) accompanied by anxiety and depression; thus, indicating its potential for practical implementation. The most active metabolites of CHM could simultaneously act on the pathological targets of IBS-D, anxiety, and depression.The diverse scope of CHM's therapeutic role includes various aspects and objectives, underscoring its potential for broad utilization.
PubMed: 38835657
DOI: 10.3389/fphar.2024.1404738 -
Cureus Jun 2024Ulcerative colitis (UC) is an inflammatory disorder affecting the colon, and typically, during the disease course, the condition may exacerbate, relapse, and remit. One... (Review)
Review
Ulcerative colitis (UC) is an inflammatory disorder affecting the colon, and typically, during the disease course, the condition may exacerbate, relapse, and remit. One of the most successful lines for inducing and maintaining clinical remission in subjects with UC is biological therapy with anti-tumor necrosis factor α (anti-TNF) agents, including adalimumab (ADA) and infliximab (IFX). This meta-analysis is an attempt to obtain complementary information driven by real-world experience (RWE) concerning the efficacy and safety of two of the most popular anti-TNFs in treating UC. This is a systematic review and meta-analysis of RWE studies comparing ADA and IFX as naïve anti-TNF agents for the treatment of subjects with UC. Studies were obtained by searching Scopus, Google Scholar, the Cochrane Central Register of Controlled Trials, Embase, and the PubMed Central databases. Patients treated with IFX showed significantly higher induction responses. No statistically significant difference was found in the comparison of response in the maintenance treatment period. Higher overall adverse events were related to IFX treatment, with serious adverse events that were nonsignificantly higher in the ADA-treated group. In conclusion, IFX demonstrated significantly higher induction responses compared to ADA in patients with moderate-to-severe UC. IFX was associated with higher overall adverse events, whereas serious adverse events were non-significantly higher in the ADA-treated group. IFX may be favored as a first-line agent for its induction efficacy, and the choice between IFX and ADA should be individualized based on comprehensive clinical evaluation.
PubMed: 38835557
DOI: 10.7759/cureus.61547 -
Frontiers in Cellular and Infection... 2024Sporotrichosis is a subcutaneous mycosis caused by fungi of the genus sp. Phenotypic and genotypic differences have been associated with their geographic distribution,... (Review)
Review
INTRODUCTION
Sporotrichosis is a subcutaneous mycosis caused by fungi of the genus sp. Phenotypic and genotypic differences have been associated with their geographic distribution, virulence, or clinical manifestation of sporotrichosis. In the past decade, the interest in identifying species of the sp. has been increasing, due to its epidemiological importance and, in consequence, is important to know how to preserve them for future studies, in culture collection.
AIMS
The purposes of this study were to analyze the global distribution of environmental isolates and/or causal agents of sporotrichosis identified by polyphasic taxonomy, with mandatory use of molecular identification, and to evaluate the percentages and distribution of isolates stored in culture collections.
METHODS
A systematic review of articles on animal and human sporotrichosis and/or environmental isolation of the fungus, from 2007 to 2023, was done. Results: Our results demonstrated that, , , and were the most identified species. With respect to the deposit and maintenance of species, we observed that only 17% of the strains of sp. isolated in the world are preserved in a culture collection.
CONCLUSIONS
This systematic review confirmed a difficulty in obtaining the frequency of species stored in culture collection and insufficient data on the molecular identification mainly of animal sporotrichosis and isolation of sp. in environmental samples.
Topics: Sporothrix; Sporotrichosis; Animals; Humans; Environmental Microbiology; Preservation, Biological
PubMed: 38828263
DOI: 10.3389/fcimb.2024.1382508 -
Frontiers in Psychiatry 2024Arts therapies offer effective non-pharmacological intervention for Sleep Initiation and Maintenance Disorders (SIMDs), encompassing both passive and active modalities....
INTRODUCTION
Arts therapies offer effective non-pharmacological intervention for Sleep Initiation and Maintenance Disorders (SIMDs), encompassing both passive and active modalities. This review assesses their effectiveness and ethical considerations, focusing on music therapy, meditation, and Tai Chi.
METHODS
Following PRISMA guidelines, a detailed search across PubMed, the Cochrane Library, Web of Science, and CNKI identified 17 relevant RCTs. Utilizing the Joanna Briggs Institute (JBI) quality criteria and the PICO(S) framework for data extraction ensured methodological integrity.
RESULTS
Analysis shows arts therapies significantly improve sleep quality. Music therapy and meditation yield immediate benefits, while Tai Chi and Qigong require longer commitment for significant outcomes.
DISCUSSION
The link between SIMDs and mental health issues like anxiety, stress, and depression suggests arts therapies not only enhance sleep quality but also address underlying mental health conditions. The evidence supports a wider adoption of arts therapies in treating SIMDs due to their dual benefits.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, ID: CRD42024506393.
PubMed: 38818021
DOI: 10.3389/fpsyt.2024.1386529