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Clinical Therapeutics Nov 2017While corticosteroids are relatively inexpensive and commonly used as treatment for a variety of conditions, long-term use is known to be associated with certain... (Review)
Review
PURPOSE
While corticosteroids are relatively inexpensive and commonly used as treatment for a variety of conditions, long-term use is known to be associated with certain toxicities. Prior systematic reviews have revealed an increased risk for costly adverse events (AEs), including bone fracture, infection, and gastrointestinal bleeding. The objective of this study was to conduct a systematic literature review of recent publications on the burden of long-term corticosteroid exposure, specifically, to summarize the AEs and economic impact of long-term corticosteroid use and to reveal data gaps for additional research.
METHODS
The Ovid search platform was used to access scientific literature databases. The search strategy targeted the use of corticosteroids and economic outcomes research. Articles were restricted to those published between 2007 and 2016 to cover publications since prior reviews; conference abstracts and articles assessing pediatrics were excluded. Titles and abstracts resulting from inclusion criteria were screened, and reviewers independently extracted relevant information from the relevant full-text articles.
FINDINGS
The literature review included 32 articles, with 75% focusing on autoimmune diseases, asthma, or lung diseases. Included articles were 14 database analyses, 6 simulations, 6 clinical trials, 3 systematic literature reviews, 2 patient surveys, and 1 chart review. Commonly-cited AEs associated with long-term corticosteroid exposure included hypertension (prevalence >30%); bone fracture (21%-30%); cataract (1%-3%); nausea, vomiting, and other gastrointestinal conditions (1%-5%); and metabolic issues (eg, weight gain, hyperglycemia, and type 2 diabetes; cases had 4-fold the risk of controls). Association of dose and duration with increased AE risk is not well-quantified. AEs like peptic ulcer and myocardial infarction are particularly costly to payers (1-year cost of $21,825 and $26,472, respectively, in year-2009 USD). The few articles assessing the economic impact of corticosteroid use have found dose-related increases in health care resource utilization and costs, with per-annum incremental costs relative to nonusers ranging from $5700 in low-dose users (<7.5 mg/d) to $29,000 in high-dose users (>15 mg/d). Adherence to treatment guidelines on avoiding AEs (eg, prescribing of oral bisphosphonates, calcium, and vitamin D) remains low.
IMPLICATIONS
Although doses of long-term corticosteroids have fallen over the past several decades in response to AEs, dose reduction may not be a sufficient solution. Numerous AEs, some very costly, persist among long-term corticosteroid users, suggesting a need for further research to fill current data gaps, as well as a potential need for alternative treatment options.
Topics: Adrenal Cortex Hormones; Asthma; Costs and Cost Analysis; Diabetes Mellitus, Type 2; Gastrointestinal Diseases; Humans; Outcome Assessment, Health Care; Time Factors
PubMed: 29055500
DOI: 10.1016/j.clinthera.2017.09.011 -
Antibiotics (Basel, Switzerland) Jan 2023Ventilator-associated pneumonia (VAP) remains a common risk in mechanically ventilated patients. Different care bundles have been proposed to succeed VAP reduction. We... (Review)
Review
Ventilator-associated pneumonia (VAP) remains a common risk in mechanically ventilated patients. Different care bundles have been proposed to succeed VAP reduction. We aimed to identify the combined interventions that have been used to by ICUs worldwide from the implementation of "Institute for Healthcare Improvement Ventilator Bundle", i.e., from December 2004. A search was performed on the PubMed, Scopus and Science Direct databases. Finally, 38 studies met our inclusion criteria. The most common interventions monitored in the care bundles were sedation and weaning protocols, semi-recumbent positioning, oral and hand hygiene, peptic ulcer disease and deep venus thrombosis prophylaxis, subglottic suctioning, and cuff pressure control. Head-of-bed elevation was implemented by almost all studies, followed by oral hygiene, which was the second extensively used intervention. Four studies indicated a low VAP reduction, while 22 studies found an over 36% VAP decline, and in ten of them, the decrease was over 65%. Four of these studies indicated zero or nearly zero after intervention VAP rates. The studies with the highest VAP reduction adopted the "IHI Ventilator Bundle" combined with adequate endotracheal tube cuff pressure and subglottic suctioning. Multifaced techniques can lead to VAP reduction at a great extent. Multidisciplinary measures combined with long-lasting education programs and measurement of bundle's compliance should be the gold standard combination.
PubMed: 36830138
DOI: 10.3390/antibiotics12020227 -
MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy.Cancer May 2014Mucositis is a highly significant, and sometimes dose-limiting, toxicity of cancer therapy. The goal of this systematic review was to update the Multinational... (Review)
Review
BACKGROUND
Mucositis is a highly significant, and sometimes dose-limiting, toxicity of cancer therapy. The goal of this systematic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines for mucositis.
METHODS
A literature search was conducted to identify eligible published articles, based on predefined inclusion/exclusion criteria. Each article was independently reviewed by 2 reviewers. Studies were rated according to the presence of major and minor flaws as per previously published criteria. The body of evidence for each intervention, in each treatment setting, was assigned a level of evidence, based on previously published criteria. Guidelines were developed based on the level of evidence, with 3 possible guideline determinations: recommendation, suggestion, or no guideline possible.
RESULTS
The literature search identified 8279 papers, 1032 of which were retrieved for detailed evaluation based on titles and abstracts. Of these, 570 qualified for final inclusion in the systematic reviews. Sixteen new guidelines were developed for or against the use of various interventions in specific treatment settings. In total, the MASCC/ISOO Mucositis Guidelines now include 32 guidelines: 22 for oral mucositis and 10 for gastrointestinal mucositis. This article describes these updated guidelines.
CONCLUSIONS
The updated MASCC/ISOO Clinical Practice Guidelines for mucositis will help clinicians provide evidence-based management of mucositis secondary to cancer therapy.
Topics: Amifostine; Analgesics; Anti-Infective Agents; Anti-Inflammatory Agents; Anti-Ulcer Agents; Antineoplastic Agents; Cryotherapy; Cytokines; Esophagitis; Evidence-Based Medicine; Humans; Hyperbaric Oxygenation; Intercellular Signaling Peptides and Proteins; Low-Level Light Therapy; Mucositis; Neoplasms; Oral Hygiene; Phototherapy; Proctitis; Protective Agents; Radiation-Protective Agents; Radiotherapy; Stomatitis; Sucralfate
PubMed: 24615748
DOI: 10.1002/cncr.28592 -
BMC Oral Health Mar 2020High incidence of treatable oral conditions has been reported among palliative patients. However, a large proportion of palliative patients lose their ability to...
BACKGROUND
High incidence of treatable oral conditions has been reported among palliative patients. However, a large proportion of palliative patients lose their ability to communicate their sufferings. Therefore, it may lead to under-reporting of oral conditions among these patients. This review systematically synthesized the published evidence on the presence of oral conditions among palliative patients, the impact, management, and challenges in treating these conditions.
METHODS
An integrative review was undertaken with defined search strategy from five databases and manual search through key journals and reference list. Studies which focused on oral conditions of palliative patients and published between years 2000 to 2017 were included.
RESULTS
Xerostomia, oral candidiasis and dysphagia were the three most common oral conditions among palliative patients, followed by mucositis, orofacial pain, taste change and ulceration. We also found social and functional impact of having certain oral conditions among these patients. In terms of management, complementary therapies such as acupuncture has been used but not well explored. The lack of knowledge among healthcare providers also posed as a challenge in treating oral conditions among palliative patients.
CONCLUSIONS
This review is first in its kind to systematically synthesize the published evidence regarding the impact, management and challenges in managing oral conditions among palliative patients. Although there is still lack of study investigating palliative oral care among specific group of patients such as patients with dementia, geriatric or pediatric advanced cancer patients, this review has however provided baseline knowledge that may guide health care professionals in palliative settings.
Topics: Aged; Child; Humans; Mouth Diseases; Oral Health; Oral Ulcer; Palliative Care; Terminally Ill; Xerostomia
PubMed: 32188452
DOI: 10.1186/s12903-020-01075-w -
Nursing Open Nov 2022Pressure injuries (PIs) are one of the most common complications related to immobility, especially in hospitalized patients, which lead to increased morbidity, infection... (Meta-Analysis)
Meta-Analysis Review
AIM
Pressure injuries (PIs) are one of the most common complications related to immobility, especially in hospitalized patients, which lead to increased morbidity, infection and overall decreased quality of life. Arginine supplementation may prevent the development of PIs. This study has summarized the findings of studies on the effect of arginine supplementation on PI healing.
DESIGN
Systematic review and meta-analysis.
METHODS
This study was conducted on online electronic databases including PubMed, Scopus, Web of Science, Google Scholar and Embase to identify relevant clinical trial studies up to September 2020. The pooled effect size of arginine supplement effects on PI was evaluated with standard mean difference (SMD) with 95% confidence interval (CI).
RESULTS
Eight studies met the inclusion criteria for this meta-analysis with 196 patients. PIs were significantly improved with Arginine supplementation (SMD: -0.6; CI 95%: -0.9 to -0.3, I : 72.5%, p = .001). Subgroup analysis showed that administering Arginine supplement more than 15 g/day had more beneficial effects on the healing of PIs (SMD: -2.8; CI 95%: -4.08 to -1.52, I : 54.7%, p = .138).
CONCLUSIONS
Our findings suggest that the administration of Arginine supplement in patients with PIs can accelerate the healing of this type of ulcer. Arginine is a supplement, and primary treatment is still needed to optimize PI healing. Therefore, arginine supplementation in addition to primary treatment seems to be an appropriate approach for the healing of PIs. Further well-designed studies are necessary to prevent the development of PIs compared to their primary treatment.
Topics: Humans; Arginine; Dietary Supplements; Enteral Nutrition; Quality of Life; Wound Healing; Pressure Ulcer
PubMed: 34170617
DOI: 10.1002/nop2.974 -
Evidence-based Complementary and... 2022Oral ulcer (OU) is a common oral mucosal disease manifested with obvious pain. In some studies, the efficacy of acupuncture in OU has been confirmed, but systematic... (Review)
Review
BACKGROUND
Oral ulcer (OU) is a common oral mucosal disease manifested with obvious pain. In some studies, the efficacy of acupuncture in OU has been confirmed, but systematic reviews and meta-analyses for them are lacking. Our aim is to evaluate the efficacy of acupuncture in the treatment of OU.
METHODS
We searched the literature from eight databases from their inception to December 2021. We included randomized controlled trials of acupuncture for the treatment of oral ulcer. The meta-analysis was carried out using Review Manager 5.3 and Stata 16.0. The main outcomes were the effective rate and the recurrence rate, the secondary outcomes were the visual analogue score (VAS) and the ulcer healing time.
RESULTS
Totally, 18 studies were finally included in the meta-analysis, including 1,422 patients. In meta-analyses, we found that in comparison with Western medicine, acupuncture can improve effective rate (OR = 5.40, 95% CI: 3.40 to 8.58), reduce the ulcer recurrence rate (OR = 0.21, 95% CI: 0.13 to 0.33), and relieve the ulcer pain (MD = -2.26, 95% CI: -4.27to-0.24). In addition, compared with Western medicine, acupuncture plus Western medicine also can improve effective rate (OR = 2.95, 95% CI: 1.48 to 5.85). Compared with the Chinese medicine, the acupuncture plus Chinese medicine can improve the effective rate (OR = 8.26, 95% CI: 3.61 to 18.88) and relieve the ulcer pain (MD = -1.85, 95% CI: -2.51 to -1.19).
CONCLUSION
Acupuncture may be more effective than Western medicine in terms of efficacy rate, and acupuncture combined with Western or Chinese medicine may have the potential to reduce the recurrence of ulcer and relieve the ulcer pain. However, due to limited evidence, higher quality and more rigorously designed clinical trials with larger sample sizes will be needed to further confirm our findings.
PubMed: 36397997
DOI: 10.1155/2022/6082179 -
Impact of evidence-based bundles on ventilator-associated pneumonia prevention: A systematic review.Journal of Infection in Developing... Feb 2023This review aimed at investigating the impact of bundle components on the prevention of ventilator-associated pneumonia (VAP) in adults and the elderly.
INTRODUCTION
This review aimed at investigating the impact of bundle components on the prevention of ventilator-associated pneumonia (VAP) in adults and the elderly.
METHODOLOGY
The databases consulted were PubMed, EBSCO, and Scielo. The terms Bundle and Pneumonia were searched in combination. The original articles were selected in Spanish and English; published between January 2008 and December 2017. After eliminating the duplicate papers, an analysis of the titles and the abstracts was performed in order to select the assessed articles. A total of 18 articles were included in this review that were evaluated according to the following criteria: research reference, country of data collection, type of study, characteristics of the studied patients, analysis and intervention performed, bundle items investigated and their results, and research outcome.
RESULTS
Four bundle items were presented in all the investigated papers. 61% of those works were considered from seven to eight bundle items. Daily evaluation of sedation interruption and daily assessment for verifying extubation condition, head-of-bed elevation at 30 degrees, cuff pressure monitoring, coagulation prophylaxis, and oral hygiene were the most reported bundle items. One study described the increased mortality of patients under mechanical ventilation when omitted the bundle items of oral hygiene and stress ulcer prophylaxis. Head-of-bed elevation at 30 degrees was the item reported in 100% of the studied papers.
CONCLUSIONS
Existing research demonstrated that VAP reduction occurred when bundle items were performed for adults and the elderly. Four works showed the relevance of team education as a central approach to the event reduction related to the ventilator.
Topics: Adult; Humans; Aged; Pneumonia, Ventilator-Associated; Intensive Care Units; Respiration, Artificial; Ventilators, Mechanical; Peptic Ulcer
PubMed: 36897895
DOI: 10.3855/jidc.12202 -
The Cochrane Database of Systematic... Nov 2020Chronic venous insufficiency (CVI) is a condition in which veins are unable to transport blood unidirectionally towards the heart. CVI usually occurs in the lower limbs.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Chronic venous insufficiency (CVI) is a condition in which veins are unable to transport blood unidirectionally towards the heart. CVI usually occurs in the lower limbs. It might result in considerable discomfort, with symptoms such as pain, itchiness and tiredness in the legs. Patients with CVI may also experience swelling and ulcers. Phlebotonics are a class of drugs often used to treat CVI. This is the second update of a review first published in 2005.
OBJECTIVES
To assess the efficacy and safety of phlebotonics administered orally or topically for treatment of signs and symptoms of lower extremity CVI.
SEARCH METHODS
The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and the World Health Organization International Clinical Trials Registry Platform and Clinicaltrials.gov trials register up to 12 November 2019. We searched the reference lists of the articles retrieved by electronic searches for additional citations. We also contacted authors of unpublished studies.
SELECTION CRITERIA
We included randomised, double-blind, placebo-controlled trials (RCTs) assessing the efficacy of phlebotonics (rutosides, hidrosmine, diosmine, calcium dobesilate, chromocarbe, Centella asiatica, disodium flavodate, French maritime pine bark extract, grape seed extract and aminaftone) in patients with CVI at any stage of the disease.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data and assessed the quality of included RCTs. We estimated the effects of treatment by using risk ratios (RRs), mean differences (MDs) and standardized mean differences (SMDs), according to the outcome assessed. We calculated 95% confidence intervals (CIs) and percentage of heterogeneity (I). Outcomes of interest were oedema, quality of life (QoL), assessment of CVI and adverse events. We used GRADE criteria to assess the certainty of the evidence.
MAIN RESULTS
We identified three new studies for this update. In total, 69 RCTs of oral phlebotonics were included, but only 56 studies (7690 participants, mean age 50 years) provided quantifiable data for the efficacy analysis. These studies used different phlebotonics (28 on rutosides, 11 on hidrosmine and diosmine, 10 on calcium dobesilate, two on Centella asiatica, two on aminaftone, two on French maritime pine bark extract and one on grape seed extract). No studies evaluating topical phlebotonics, chromocarbe, naftazone or disodium flavodate fulfilled the inclusion criteria. Moderate-certainty evidence suggests that phlebotonics probably reduce oedema slightly in the lower legs, compared with placebo (RR 0.70, 95% CI 0.63 to 0.78; 13 studies; 1245 participants); and probably reduce ankle circumference (MD -4.27 mm, 95% CI -5.61 to -2.93 mm; 15 studies; 2010 participants). Moderate-certainty evidence shows that phlebotonics probably make little or no difference in QoL compared with placebo (SMD -0.06, 95% CI -0.22 to 0.10; five studies; 1639 participants); and similarly, may have little or no effect on ulcer healing (RR 0.94, 95% CI 0.79 to 1.13; six studies; 461 participants; low-certainty evidence). Thirty-seven studies reported on adverse events. Pooled data suggest that phlebotonics probably increase adverse events slightly, compared to placebo (RR 1.14, 95% CI 1.02 to 1.27; 37 studies; 5789 participants; moderate-certainty evidence). Gastrointestinal disorders were the most frequently reported adverse events. We downgraded our certainty in the evidence from 'high' to 'moderate' because of risk of bias concerns, and further to 'low' because of imprecision.
AUTHORS' CONCLUSIONS
There is moderate-certainty evidence that phlebotonics probably reduce oedema slightly, compared to placebo; moderate-certainty evidence of little or no difference in QoL; and low-certainty evidence that these drugs do not influence ulcer healing. Moderate-certainty evidence suggests that phlebotonics are probably associated with a higher risk of adverse events than placebo. Studies included in this systematic review provided only short-term safety data; therefore, the medium- and long-term safety of phlebotonics could not be estimated. Findings for specific groups of phlebotonics are limited due to small study numbers and heterogeneous results. Additional high-quality RCTs focusing on clinically important outcomes are needed to improve the evidence base.
Topics: 4-Aminobenzoic Acid; Angioedemas, Hereditary; Calcium Dobesilate; Centella; Chronic Disease; Diosmin; Edema; Hematologic Agents; Humans; Leg; Leg Ulcer; Middle Aged; Phytotherapy; Pinus; Plant Extracts; Quality of Life; Randomized Controlled Trials as Topic; Rutin; Venous Insufficiency; para-Aminobenzoates
PubMed: 33141449
DOI: 10.1002/14651858.CD003229.pub4 -
The American Journal of Medicine Oct 2022The role of antisecretory drugs for the prevention of upper gastrointestinal bleeding in patients using anticoagulants is unclear. We investigated this question in a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The role of antisecretory drugs for the prevention of upper gastrointestinal bleeding in patients using anticoagulants is unclear. We investigated this question in a systematic review and meta-analysis.
METHODS
We searched Embase, PubMed, Web of Science, Scopus, the Cochrane Library, and clinicaltrials.gov thru April 2021 for controlled randomized trials and observational studies evaluating the association of proton pump inhibitors (PPIs) or H2-receptor antagonists with overt upper gastrointestinal bleeding in patients using anticoagulants. Independent duplicate review, data extraction, and risk of bias assessment were performed. Observational studies were included only if they provided results controlled for at least 2 variables. Meta-analyses were performed using random effects models.
RESULTS
Six observational studies and 1 randomized trial were included. All but 1 study had low risk of bias. None of the studies excluded patients with concomitant aspirin or nonsteroidal anti-inflammatory drug use. For PPIs, the pooled relative risk of upper gastrointestinal bleeding was 0.67 (95% confidence interval 0.61, 0.74) with low statistical heterogeneity (I = 15%). Individual studies showed greater treatment effect in patients with higher risk for upper gastrointestinal bleeding (eg, nonsteroidal anti-inflammatory drug or aspirin use, elevated bleeding risk score). A single observational study evaluating the association of H2-receptor antagonists with upper gastrointestinal bleeding found a relative risk of 0.69 (95% confidence interval 0.24-2.02).
CONCLUSIONS
Evidence drawn mostly from observational studies with low risk of bias demonstrate that PPIs reduce upper gastrointestinal bleeding in patients prescribed oral anticoagulants. The benefit appears to be most clearcut and substantial in patients with elevated risk of upper gastrointestinal bleeding.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Aspirin; Gastrointestinal Agents; Gastrointestinal Hemorrhage; Histamine H2 Antagonists; Humans; Observational Studies as Topic; Proton Pump Inhibitors
PubMed: 35679879
DOI: 10.1016/j.amjmed.2022.05.031 -
Lasers in Medical Science May 2017The aim of this systematic review was to assess a potential benefit of laser use in the treatment of recurrent aphthous stomatitis (RAS). The primary outcome variables... (Meta-Analysis)
Meta-Analysis Review
The aim of this systematic review was to assess a potential benefit of laser use in the treatment of recurrent aphthous stomatitis (RAS). The primary outcome variables were pain relief, duration of wound healing and reduction in episode frequency. A PICO approach was used as a search strategy in Medline, Embase and Cochrane databases. After scanning and excluding titles, abstracts and full texts, 11 studies (ten RCTs and one non-randomised controlled trial) were included. Study selection and data extraction was done by two observers. Study participants varied between 7-90 for the laser and 5-90 for the control groups. Laser treatment included Nd:YAG laser ablation, CO laser applied through a transparent gel (non-ablative) and diode laser in a low-level laser treatment (LLLT) mode. Control groups had placebo, no therapy or topical corticosteroid treatment. Significant pain relief immediately after treatment was found in five out of six studies. Pain relief in the days following treatment was recorded in seven studies. The duration of RAS wound healing was also reduced in five studies. However, criteria of evaluation differed between the studies. The episode frequency was not evaluated as only one study addressed this outcome parameter, but did not discriminate between the study (LLLT) and control (corticosteroid) groups. Jadad scores (ranging from 0 to 5) for quality assessment of the included studies range between 0 and 2 (mean = 1.0) for studies analysing pain relief and between 0 and 3 (mean = 1.1) for studies evaluating wound healing. The use of lasers (CO laser, Nd:YAG laser and diode laser) to relieve symptoms and promote healing of RAS is a therapeutic option. More studies for laser applications are necessary to demonstrate superiority over topical pharmaceutical treatment and to recommend a specific laser type, wavelength, power output and applied energy (ablative versus photobiomodulation).
Topics: Humans; Laser Therapy; Lasers, Gas; Lasers, Semiconductor; Lasers, Solid-State; Pain; Recurrence; Stomatitis, Aphthous; Wound Healing
PubMed: 28345122
DOI: 10.1007/s10103-017-2184-z