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The Korean Journal of Internal Medicine Sep 2019About 21% of adults with osteoarthritis (OA) are diagnosed with concomitant depression in addition to chronic pain. Duloxetine, an anti-depressant medication, has been... (Meta-Analysis)
Meta-Analysis
About 21% of adults with osteoarthritis (OA) are diagnosed with concomitant depression in addition to chronic pain. Duloxetine, an anti-depressant medication, has been recently approved for managing Knee OA. We performed a systematic review to ascertain the efficacy and safety of duloxetine for OA. We searched MEDLINE, EMBASE, Web of Science, Google Scholar, and the Cochrane Database from inception to December 2018. Randomized clinical trials (RCTs) assessing the efficacy and/or safety of duloxetine versus placebo in OA patients were included. Data extraction and quality assessment were undertaken by two independent reviewers. Seven RCTs (n = 2,102 participants) met our inclusion criteria, and five RCTs (n = 1,713) were eligible for meta-analysis. The results of our analyses indicate that duloxetine has statistically significant, moderate benefits on pain, function, and quality of life in knee OA patients for up to 13 weeks. Reported incidences of gastrointestinal adverse events were three to four times higher in participants who received duloxetine versus placebo. Duloxetine may be an effective treatment option for individuals with knee OA, but use of the drug is associated with a significantly higher risk of adverse events. Patient preferences and clinicians' judgment must be considered before the initiation of duloxetine.
Topics: Aged; Antirheumatic Agents; Duloxetine Hydrochloride; Female; Humans; Male; Middle Aged; Osteoarthritis, Knee; Quality of Life; Remission Induction; Risk Factors; Treatment Outcome
PubMed: 30871298
DOI: 10.3904/kjim.2018.460 -
Diagnostics (Basel, Switzerland) Jan 2024Artificial intelligence (AI) has emerged as a transformative force in various sectors, including medicine and healthcare. Large language models like ChatGPT showcase... (Review)
Review
Artificial intelligence (AI) has emerged as a transformative force in various sectors, including medicine and healthcare. Large language models like ChatGPT showcase AI's potential by generating human-like text through prompts. ChatGPT's adaptability holds promise for reshaping medical practices, improving patient care, and enhancing interactions among healthcare professionals, patients, and data. In pandemic management, ChatGPT rapidly disseminates vital information. It serves as a virtual assistant in surgical consultations, aids dental practices, simplifies medical education, and aids in disease diagnosis. A total of 82 papers were categorised into eight major areas, which are G1: treatment and medicine, G2: buildings and equipment, G3: parts of the human body and areas of the disease, G4: patients, G5: citizens, G6: cellular imaging, radiology, pulse and medical images, G7: doctors and nurses, and G8: tools, devices and administration. Balancing AI's role with human judgment remains a challenge. A systematic literature review using the PRISMA approach explored AI's transformative potential in healthcare, highlighting ChatGPT's versatile applications, limitations, motivation, and challenges. In conclusion, ChatGPT's diverse medical applications demonstrate its potential for innovation, serving as a valuable resource for students, academics, and researchers in healthcare. Additionally, this study serves as a guide, assisting students, academics, and researchers in the field of medicine and healthcare alike.
PubMed: 38201418
DOI: 10.3390/diagnostics14010109 -
Asian Journal of Andrology 2016A systematic review was conducted to identify and qualitatively analyze the methods as well as recommendations of Clinical Practice Guidelines (CPG) and Best Practice... (Review)
Review
A systematic review was conducted to identify and qualitatively analyze the methods as well as recommendations of Clinical Practice Guidelines (CPG) and Best Practice Statements (BPS) concerning varicocele in the pediatric and adolescent population. An electronic search was performed with the MEDLINE, EMBASE, Science Direct, and Scielo databases, as well as guidelines' Web sites until September 2015. Four guidelines were included in the qualitative synthesis. In general, the recommendations provided by the CPG/BPS were consistent despite the existence of some gaps across the studies. The guidelines issued by the American Urological Association (AUA) and American Society for Reproductive Medicine (ASRM) did not provide evidence-based levels for the recommendations given. Most of the recommendations given by the European Association of Urology (EAU) and European Society of Pediatric Urology (ESPU) were derived from nonrandomized clinical trials, retrospective studies, and expert opinion. Among all CPG/BPS, only one was specifically designed for the pediatric population. The studied guidelines did not undertake independent cost-effectiveness and risk-benefit analysis. The main objectives of these guidelines were to translate the best evidence into practice and provide a framework of standardized care while maintaining clinical autonomy and physician judgment. However, the limitations identified in the CPG/BPS for the diagnosis and management of varicocele in children and adolescents indicate ample opportunities for research and future incorporation of higher quality standards in patient care.
Topics: Adolescent; Child; Cost-Benefit Analysis; Humans; Male; Practice Guidelines as Topic; Risk Assessment; Varicocele
PubMed: 26680032
DOI: 10.4103/1008-682X.169559 -
Obesity Reviews : An Official Journal... Jan 2023This narrative systematic review examined effectiveness of interventions during pregnancy and up to 2 years of age in improving energy balance-related behaviors or... (Review)
Review
The effectiveness of interventions during the first 1,000 days to improve energy balance-related behaviors or prevent overweight/obesity in children from socio-economically disadvantaged families of high-income countries: a systematic review.
This narrative systematic review examined effectiveness of interventions during pregnancy and up to 2 years of age in improving energy balance-related behaviors or prevent overweight/obesity in children from families experiencing socio-economic disadvantage. We identified 24 interventions, from 33 articles, since 1990. Overall, despite their heterogeneity and variability in internal and external validity, there was some evidence of beneficial impact of interventions on obesity risk (4/15), and associated behaviors, e.g.: breastfeeding (9/18), responsive feeding (11/16), diet (7/8), sedentary (1/3) and movement (4/7) behaviors, and sleep (1/2). The most effective interventions aimed at promoting breastfeeding commenced antenatally; this was similar for the prevention of obesity, provided the intervention continued for at least 2 years postnatally and was multi-behavioral. Effective interventions were more likely to target first-time mothers and involve professional delivery agents, multidisciplinary teams and peer groups. Among ethnic/racial minorities, interventions delivered by lay agents had some impact on dietary behavior but not weight outcomes. Co-creation with stakeholders, including parents, and adherence to theoretical frameworks were additional ingredients for more pragmatic, inclusive, non-judgmental, and effective programs. The growing body of evidence on obesity prevention interventions targeting families experiencing socio-economic disadvantage is promising for reducing early inequalities in obesity risk.
Topics: Child; Pregnancy; Female; Humans; Overweight; Pediatric Obesity; Developed Countries; Diet; Breast Feeding
PubMed: 36394375
DOI: 10.1111/obr.13524 -
The Annals of Thoracic Surgery Aug 2022The United Kingdom National Institute for Health and Care Excellence guidelines recommend that patients and professionals make shared decisions between surgery and... (Review)
Review
BACKGROUND
The United Kingdom National Institute for Health and Care Excellence guidelines recommend that patients and professionals make shared decisions between surgery and stereotactic ablative radiotherapy (SABR) when treating early-stage non-small cell lung cancer (NSCLC). Variation by center suggests treatment decisions may be disproportionately influenced by clinician judgment and treatment availability rather than by patient preference. This systematic review critically evaluates studies of patient and clinician preferences for treatment of early-stage NSCLC.
METHODS
Primary empirical research up to April 30, 2020, was identified from searches of MEDLINE, Embase, PsycInfo, and Web of Science databases. Data extracted included study characteristics and methods, preferences for NSCLC treatment, and involvement in decision making and risk of bias using the Mixed Methods Appraisal Tool. Findings were synthesized using descriptive data and narrative synthesis.
RESULTS
Included in the review were 23 studies, of which 18 measured patient preferences, 4 clinician preferences, and 1 both clinician and patient preferences. Patients and clinicians were both most likely to prefer a collaborative role in treatment decisions. Most patients did not recall there being a choice between surgery or SABR options and thus experienced minimal decisional conflict.
CONCLUSIONS
For professionals to support patients in making informed, value-based decisions about NSCLC treatments, better quality evidence is needed of the clinical and quality of life trade-offs for both surgery and SABR.
Topics: Carcinoma, Non-Small-Cell Lung; Decision Making; Decision Making, Shared; Humans; Lung Neoplasms; Neoplasm Staging; Quality of Life; Small Cell Lung Carcinoma
PubMed: 33581150
DOI: 10.1016/j.athoracsur.2021.01.046 -
PloS One 2014Non-surgical interventions for adolescents with idiopathic scoliosis remain highly controversial. Despite the publication of numerous reviews no explicit methodological... (Review)
Review
BACKGROUND
Non-surgical interventions for adolescents with idiopathic scoliosis remain highly controversial. Despite the publication of numerous reviews no explicit methodological evaluation of papers labeled as, or having a layout of, a systematic review, addressing this subject matter, is available.
OBJECTIVES
Analysis and comparison of the content, methodology, and evidence-base from systematic reviews regarding non-surgical interventions for adolescents with idiopathic scoliosis.
DESIGN
Systematic overview of systematic reviews.
METHODS
Articles meeting the minimal criteria for a systematic review, regarding any non-surgical intervention for adolescent idiopathic scoliosis, with any outcomes measured, were included. Multiple general and systematic review specific databases, guideline registries, reference lists and websites of institutions were searched. The AMSTAR tool was used to critically appraise the methodology, and the Oxford Centre for Evidence Based Medicine and the Joanna Briggs Institute's hierarchies were applied to analyze the levels of evidence from included reviews.
RESULTS
From 469 citations, twenty one papers were included for analysis. Five reviews assessed the effectiveness of scoliosis-specific exercise treatments, four assessed manual therapies, five evaluated bracing, four assessed different combinations of interventions, and one evaluated usual physical activity. Two reviews addressed the adverse effects of bracing. Two papers were high quality Cochrane reviews, Three were of moderate, and the remaining sixteen were of low or very low methodological quality. The level of evidence of these reviews ranged from 1 or 1+ to 4, and in some reviews, due to their low methodological quality and/or poor reporting, this could not be established.
CONCLUSIONS
Higher quality reviews indicate that generally there is insufficient evidence to make a judgment on whether non-surgical interventions in adolescent idiopathic scoliosis are effective. Papers labeled as systematic reviews need to be considered in terms of their methodological rigor; otherwise they may be mistakenly regarded as high quality sources of evidence.
PROTOCOL REGISTRY NUMBER
CRD42013003538, PROSPERO.
Topics: Adolescent; Evidence-Based Medicine; Humans; Review Literature as Topic; Scoliosis; Treatment Outcome
PubMed: 25353954
DOI: 10.1371/journal.pone.0110254 -
BMC Medical Education Jul 2022There is significant variability in the performance and outcomes of invasive medical procedures such as percutaneous coronary intervention, endoscopy, and bronchoscopy....
BACKGROUND
There is significant variability in the performance and outcomes of invasive medical procedures such as percutaneous coronary intervention, endoscopy, and bronchoscopy. Peer evaluation is a common mechanism for assessment of clinician performance and care quality, and may be ideally suited for the evaluation of medical procedures. We therefore sought to perform a systematic review to identify and characterize peer evaluation tools for practicing clinicians, assess evidence supporting the validity of peer evaluation, and describe best practices of peer evaluation programs across multiple invasive medical procedures.
METHODS
A systematic search of Medline and Embase (through September 7, 2021) was conducted to identify studies of peer evaluation and feedback relating to procedures in the field of internal medicine and related subspecialties. The methodological quality of the studies was assessed. Data were extracted on peer evaluation methods, feedback structures, and the validity and reproducibility of peer evaluations, including inter-observer agreement and associations with other quality measures when available.
RESULTS
Of 2,135 retrieved references, 32 studies met inclusion criteria. Of these, 21 were from the field of gastroenterology, 5 from cardiology, 3 from pulmonology, and 3 from interventional radiology. Overall, 22 studies described the development or testing of peer scoring systems and 18 reported inter-observer agreement, which was good or excellent in all but 2 studies. Only 4 studies, all from gastroenterology, tested the association of scoring systems with other quality measures, and no studies tested the impact of peer evaluation on patient outcomes. Best practices included standardized scoring systems, prospective criteria for case selection, and collaborative and non-judgmental review.
CONCLUSIONS
Peer evaluation of invasive medical procedures is feasible and generally demonstrates good or excellent inter-observer agreement when performed with structured tools. Our review identifies common elements of successful interventions across specialties. However, there is limited evidence that peer-evaluated performance is linked to other quality measures or that feedback to clinicians improves patient care or outcomes. Additional research is needed to develop and test peer evaluation and feedback interventions.
Topics: Bronchoscopy; Endoscopy; Feedback; Humans; Peer Review, Health Care; Percutaneous Coronary Intervention; Prospective Studies; Reproducibility of Results; Surgical Procedures, Operative
PubMed: 35906652
DOI: 10.1186/s12909-022-03652-9 -
Environmental Health Perspectives Oct 2014Synthesizing what is known about the environmental drivers of health is instrumental to taking prevention-oriented action. Methods of research synthesis commonly used in... (Review)
Review
BACKGROUND
Synthesizing what is known about the environmental drivers of health is instrumental to taking prevention-oriented action. Methods of research synthesis commonly used in environmental health lag behind systematic review methods developed in the clinical sciences over the past 20 years.
OBJECTIVES
We sought to develop a proof of concept of the "Navigation Guide," a systematic and transparent method of research synthesis in environmental health.
DISCUSSION
The Navigation Guide methodology builds on best practices in research synthesis in evidence-based medicine and environmental health. Key points of departure from current methods of expert-based narrative review prevalent in environmental health include a prespecified protocol, standardized and transparent documentation including expert judgment, a comprehensive search strategy, assessment of "risk of bias," and separation of the science from values and preferences. Key points of departure from evidence-based medicine include assigning a "moderate" quality rating to human observational studies and combining diverse evidence streams.
CONCLUSIONS
The Navigation Guide methodology is a systematic and rigorous approach to research synthesis that has been developed to reduce bias and maximize transparency in the evaluation of environmental health information. Although novel aspects of the method will require further development and validation, our findings demonstrated that improved methods of research synthesis under development at the National Toxicology Program and under consideration by the U.S. Environmental Protection Agency are fully achievable. The institutionalization of robust methods of systematic and transparent review would provide a concrete mechanism for linking science to timely action to prevent harm.
Topics: Bias; Decision Support Techniques; Environmental Health; Hazardous Substances; Humans; Interdisciplinary Communication; Review Literature as Topic
PubMed: 24968373
DOI: 10.1289/ehp.1307175 -
The Cochrane Database of Systematic... Dec 2010Enhancing health equity has now achieved international political importance with endorsement from the World Health Assembly in 2009. The failure of systematic reviews... (Review)
Review
BACKGROUND
Enhancing health equity has now achieved international political importance with endorsement from the World Health Assembly in 2009. The failure of systematic reviews to consider effects on health equity is cited by decision-makers as a limitation to their ability to inform policy and program decisions.
OBJECTIVES
To systematically review methods to assess effects on health equity in systematic reviews of effectiveness.
SEARCH STRATEGY
We searched the following databases up to July 2 2010: MEDLINE, PsychINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Index to Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on October 7 2010.
SELECTION CRITERIA
We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities.
DATA COLLECTION AND ANALYSIS
Data were extracted using a pre-tested form by two independent reviewers. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews.
MAIN RESULTS
Thirty-four methodological studies were included. The methods used by these included studies were: 1) Targeted approaches (n=22); 2) gap approaches (n=12) and gradient approach (n=1). Gender or sex was assessed in eight out of 34 studies, socioeconomic status in ten studies, race/ethnicity in seven studies, age in seven studies, low and middle income countries in 14 studies, and two studies assessed multiple factors across health inequity may exist.Only three studies provided a definition of health equity. Four methodological approaches to assessing effects on health equity were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (all 34 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (12/34 studies); 3) analytic approaches (10/34 studies); and 4) applicability assessment (11/34 studies). Both analytic and applicability approaches were not reported transparently nor in sufficient detail to judge their credibility.
AUTHORS' CONCLUSIONS
There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to assess and report effects on health equity in systematic reviews.
Topics: Age Factors; Developing Countries; Ethnology; Health Status Disparities; Humans; Racial Groups; Research Design; Review Literature as Topic; Sex Factors; Socioeconomic Factors
PubMed: 21154402
DOI: 10.1002/14651858.MR000028.pub2 -
Journal of Medical Internet Research Oct 2022When investigating voice disorders a series of processes are used when including voice screening and diagnosis. Both methods have limited standardized tests, which are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
When investigating voice disorders a series of processes are used when including voice screening and diagnosis. Both methods have limited standardized tests, which are affected by the clinician's experience and subjective judgment. Machine learning (ML) algorithms have been used as an objective tool in screening or diagnosing voice disorders. However, the effectiveness of ML algorithms in assessing and diagnosing voice disorders has not received sufficient scholarly attention.
OBJECTIVE
This systematic review aimed to assess the effectiveness of ML algorithms in screening and diagnosing voice disorders.
METHODS
An electronic search was conducted in 5 databases. Studies that examined the performance (accuracy, sensitivity, and specificity) of any ML algorithm in detecting pathological voice samples were included. Two reviewers independently selected the studies, extracted data from the included studies, and assessed the risk of bias. The methodological quality of each study was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool via RevMan 5 software (Cochrane Library). The characteristics of studies, population, and index tests were extracted, and meta-analyses were conducted to pool the accuracy, sensitivity, and specificity of ML techniques. The issue of heterogeneity was addressed by discussing possible sources and excluding studies when necessary.
RESULTS
Of the 1409 records retrieved, 13 studies and 4079 participants were included in this review. A total of 13 ML techniques were used in the included studies, with the most common technique being least squares support vector machine. The pooled accuracy, sensitivity, and specificity of ML techniques in screening voice disorders were 93%, 96%, and 93%, respectively. Least squares support vector machine had the highest accuracy (99%), while the K-nearest neighbor algorithm had the highest sensitivity (98%) and specificity (98%). Quadric discriminant analysis achieved the lowest accuracy (91%), sensitivity (89%), and specificity (89%).
CONCLUSIONS
ML showed promising findings in the screening of voice disorders. However, the findings were not conclusive in diagnosing voice disorders owing to the limited number of studies that used ML for diagnostic purposes; thus, more investigations are needed. While it might not be possible to use ML alone as a substitute for current diagnostic tools, it may be used as a decision support tool for clinicians to assess their patients, which could improve the management process for assessment.
TRIAL REGISTRATION
PROSPERO CRD42020214438; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=214438.
Topics: Algorithms; Humans; Machine Learning; Supervised Machine Learning; Voice Disorders
PubMed: 36239999
DOI: 10.2196/38472