Authors: Jacob Bodilsen, Quintino Giorgio D'Alessandris, Hilary Humphreys...

SCOPE

These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in children and adults.

METHODS

Key questions were developed, and a systematic review was carried out of all studies published since 1 January 1996, using the search terms 'brain abscess' OR 'cerebral abscess' as Mesh terms or text in electronic databases of PubMed, Embase, and the Cochrane registry. The search was updated on 29 September 2022. Exclusion criteria were a sample size <10 patients or publication in non-English language. Extracted data was summarized as narrative reviews and tables. Meta-analysis was carried out using a random effects model and heterogeneity was examined by I tests as well as funnel and Galbraith plots. Risk of bias was assessed using Risk Of Bias in Non-randomised Studies - of Interventions (ROBINS-I) (observational studies) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) (diagnostic studies). The Grading of Recommendations Assessment, Development and Evaluation approach was applied to classify strength of recommendations (strong or conditional) and quality of evidence (high, moderate, low, or very low).

QUESTIONS ADDRESSED BY THE GUIDELINES AND RECOMMENDATIONS

Magnetic resonance imaging is recommended for diagnosis of brain abscess (strong and high). Antimicrobials may be withheld until aspiration or excision of brain abscess in patients without severe disease if neurosurgery can be carried out within reasonable time, preferably within 24 hours (conditional and low). Molecular-based diagnostics are recommended, if available, in patients with negative cultures (conditional and moderate). Aspiration or excision of brain abscess is recommended whenever feasible, except for cases with toxoplasmosis (strong and low). Recommended empirical antimicrobial treatment for community-acquired brain abscess in immuno-competent individuals is a 3rd-generation cephalosporin and metronidazole (strong and moderate) with the addition of trimethoprim-sulfamethoxazole and voriconazole in patients with severe immuno-compromise (conditional and low). Recommended empirical treatment of post-neurosurgical brain abscess is a carbapenem combined with vancomycin or linezolid (conditional and low). The recommended duration of antimicrobial treatment is 6-8 weeks (conditional and low). No recommendation is offered for early transition to oral antimicrobials because of a lack of data, and oral consolidation treatment after ≥6 weeks of intravenous antimicrobials is not routinely recommended (conditional and very low). Adjunctive glucocorticoid treatment is recommended for treatment of severe symptoms because of perifocal oedema or impending herniation (strong and low). Primary prophylaxis with antiepileptics is not recommended (conditional and very low). Research needs are addressed.

Topics: Adult; Child; Humans; Anti-Infective Agents; Brain Abscess; Communicable Diseases

PubMed: 37648062
DOI: 10.1016/j.cmi.2023.08.016

Authors: Amir Qaseem, Lauri A Hicks, Itziar Etxeandia-Ikobaltzeta...

DESCRIPTION

This guideline updates the 2017 American College of Physicians (ACP) recommendations on pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults.

METHODS

The ACP Clinical Guidelines Committee based these recommendations on an updated systematic review of evidence and graded them using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.

AUDIENCE AND PATIENT POPULATION

The audience for this guideline includes all clinicians. The patient population includes adults with primary osteoporosis or low bone mass.

RECOMMENDATION 1A

RECOMMENDATION 1B

RECOMMENDATION 2A

RECOMMENDATION 2B

RECOMMENDATION 3

RECOMMENDATION 4

Topics: Adult; Female; Humans; Male; Bone Density Conservation Agents; Denosumab; Diphosphonates; Fractures, Bone; Osteoporosis; Physicians; RANK Ligand

PubMed: 36592456
DOI: 10.7326/M22-1034

Authors: Kiran Maski, Lynn Marie Trotti, Suresh Kotagal...

INTRODUCTION

This guideline establishes clinical practice recommendations for the treatment of central disorders of hypersomnolence in adults and children.

METHODS

The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine to develop recommendations and assign strengths to each recommendation, based on a systematic review of the literature and an assessment of the evidence using the GRADE process. The task force provided a summary of the relevant literature and the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations that support the recommendations. The AASM Board of Directors approved the final recommendations.

RECOMMENDATIONS

The following recommendations are intended to guide clinicians in choosing a specific treatment for central disorders of hypersomnolence in adults and children. Each recommendation statement is assigned a strength ("strong" or "conditional"). A "strong" recommendation (ie, "We recommend…") is one that clinicians should follow under most circumstances. A "conditional" recommendation (ie, "We suggest…") is one that requires that the clinician use clinical knowledge and experience and strongly consider the individual patient's values and preferences to determine the best course of action. Under each disorder, strong recommendations are listed in alphabetical order followed by the conditional recommendations in alphabetical order. The section on adult patients with hypersomnia because of medical conditions is categorized based on the clinical and pathological subtypes identified in ICSD-3. The interventions in all the recommendation statements were compared to no treatment.

1

We recommend that clinicians use modafinil for the treatment of narcolepsy in adults. (STRONG).

2

We recommend that clinicians use pitolisant for the treatment of narcolepsy in adults. (STRONG).

3

We recommend that clinicians use sodium oxybate for the treatment of narcolepsy in adults. (STRONG).

4

We recommend that clinicians use solriamfetol for the treatment of narcolepsy in adults. (STRONG).

5

We suggest that clinicians use armodafinil for the treatment of narcolepsy in adults. (CONDITIONAL).

6

We suggest that clinicians use dextroamphetamine for the treatment of narcolepsy in adults. (CONDITIONAL).

7

We suggest that clinicians use methylphenidate for the treatment of narcolepsy in adults. (CONDITIONAL).

8

We recommend that clinicians use modafinil for the treatment of idiopathic hypersomnia in adults. (STRONG).

9

We suggest that clinicians use clarithromycin for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL).

10

We suggest that clinicians use methylphenidate for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL).

11

We suggest that clinicians use pitolisant for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL).

12

We suggest that clinicians use sodium oxybate for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL).

13

We suggest that clinicians use lithium for the treatment of Kleine-Levin syndrome in adults. (CONDITIONAL).

14

We suggest that clinicians use armodafinil for the treatment of hypersomnia secondary to dementia with Lewy bodies in adults. (CONDITIONAL).

15

We suggest that clinicians use modafinil for the treatment of hypersomnia secondary to Parkinson's disease in adults. (CONDITIONAL).

16

We suggest that clinicians use sodium oxybate for the treatment of hypersomnia secondary to Parkinson's disease in adults. (CONDITIONAL).

17

We suggest that clinicians use armodafinil for the treatment of hypersomnia secondary to traumatic brain injury in adults. (CONDITIONAL).

18

We suggest that clinicians use modafinil for the treatment of hypersomnia secondary to traumatic brain injury in adults. (CONDITIONAL).

19

We suggest that clinicians use modafinil for the treatment of hypersomnia secondary to myotonic dystrophy in adults. (CONDITIONAL).

20

We suggest that clinicians use modafinil for the treatment of hypersomnia secondary to multiple sclerosis in adults. (CONDITIONAL).

21

We suggest that clinicians use modafinil for the treatment of narcolepsy in pediatric patients. (CONDITIONAL).

22

We suggest that clinicians use sodium oxybate for the treatment of narcolepsy in pediatric patients. (CONDITIONAL).

CITATION

Maski K, Trotti LM, Kotagal S, et al. Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline. . 2021;17(9):1881-1893.

Topics: Adult; Child; Disorders of Excessive Somnolence; Humans; Idiopathic Hypersomnia; Modafinil; Narcolepsy; Sleep; United States

PubMed: 34743789
DOI: 10.5664/jcsm.9328

Review

Authors: Michael Howell, Alon Y Avidan, Nancy Foldvary-Schaefer...

INTRODUCTION

This guideline establishes clinical practice recommendations for the management of rapid eye movement sleep behavior disorder (RBD) in adults.

METHODS

The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine to develop recommendations and assign strengths based on a systematic review of the literature and an assessment of the evidence using Grading of Recommendations, Assessment, Development and Evaluation methodology. The task force provided a summary of the relevant literature and the certainty of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations that support the recommendations. The AASM Board of Directors approved the final recommendations.

GOOD PRACTICE STATEMENT

The following good practice statement is based on expert consensus, and its implementation is necessary for the appropriate and effective management of patients with RBD: It is critically important to help patients maintain a safe sleeping environment to prevent potentially injurious nocturnal behaviors. In particular, the removal of bedside weapons, or objects that could inflict injury if thrown or wielded against a bed partner, is of paramount importance. Sharp furniture like nightstands should be moved away or their edges and headboard should be padded. To reduce the risk of injurious falls, a soft carpet, rug, or mat should be placed next to the bed. Patients with severe, uncontrolled RBD should be recommended to sleep separately from their partners, or at the minimum, to place a pillow between themselves and their partners.

RECOMMENDATIONS

The following recommendations, with medications listed in alphabetical order, are a guide for clinicians in choosing a specific treatment for RBD in adults. Each recommendation statement is assigned a strength ("strong" or "conditional"). A "strong" recommendation (ie, "We recommend…") is one that clinicians should follow under most circumstances. A "conditional" recommendation (ie, "We suggest…") is one that requires that the clinician use clinical knowledge and experience and strongly consider the patient's values and preferences to determine the best course of action.

UNLABELLED

.

UNLABELLED

1. The AASM suggests that clinicians use clonazepam (vs no treatment) for the treatment of isolated RBD in adults. (CONDITIONAL).

UNLABELLED

2. * The AASM suggests that clinicians use immediate-release melatonin (vs no treatment) for the treatment of isolated RBD in adults. (CONDITIONAL).

UNLABELLED

3. * The AASM suggests that clinicians use pramipexole (vs no treatment) for the treatment of isolated RBD in adults. (CONDITIONAL).

UNLABELLED

4. The AASM suggests that clinicians use transdermal rivastigmine (vs no treatment) for the treatment of isolated RBD in adults with mild cognitive impairment. (CONDITIONAL).

UNLABELLED

.

UNLABELLED

5. * The AASM suggests that clinicians use clonazepam (vs no treatment) for the treatment of secondary RBD due to medical condition in adults. (CONDITIONAL).

UNLABELLED

6. * The AASM suggests that clinicians use immediate-release melatonin (vs no treatment) for the treatment of secondary RBD due to medical condition in adults. (CONDITIONAL).

UNLABELLED

7. The AASM suggests that clinicians use transdermal rivastigmine (vs no treatment) for the treatment of secondary RBD due to medical condition (Parkinson disease) in adults. (CONDITIONAL).

UNLABELLED

8. * The AASM suggests that clinicians use deep brain stimulation (DBS; vs no treatment) for the treatment of secondary RBD due to medical condition in adults. (CONDITIONAL).

UNLABELLED

.

UNLABELLED

9. * The AASM suggests that clinicians use drug discontinuation (vs drug continuation) for the treatment of drug-induced RBD in adults. (CONDITIONAL).

UNLABELLED

* The Recommendations section of this paper includes remarks that provide additional context to guide clinicians with implementation of this recommendation.

CITATION

Howell M, Avidan AY, Foldvary-Schaefer N, et al. Management of REM sleep behavior disorder: an American Academy of Sleep Medicine clinical practice guideline. 2023;19(4):759-768.

Topics: Adult; Humans; United States; Clonazepam; REM Sleep Behavior Disorder; Melatonin; Rivastigmine; Sleep

PubMed: 36515157
DOI: 10.5664/jcsm.10424

Authors: Susheel P Patil, Indu A Ayappa, Sean M Caples...

INTRODUCTION

This guideline establishes clinical practice recommendations for positive airway pressure (PAP) treatment of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines in the evaluation and treatment of sleep-disordered breathing in adults.

METHODS

The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of clinically significant benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted recommendations from prior guidelines as "good practice statements" that establish the basis for appropriate and effective treatment of OSA. The AASM Board of Directors approved the final recommendations.

GOOD PRACTICE STATEMENTS

The following good practice statements are based on expert consensus, and their implementation is necessary for appropriate and effective management of patients with OSA treated with positive airway pressure: (1) Treatment of OSA with PAP therapy should be based on a diagnosis of OSA established using objective sleep apnea testing. (2) Adequate follow-up, including troubleshooting and monitoring of objective efficacy and usage data to ensure adequate treatment and adherence, should occur following PAP therapy initiation and during treatment of OSA.

RECOMMENDATIONS

The following recommendations are intended as a guide for clinicians using PAP to treat OSA in adults. A STRONG (ie, "We recommend…") recommendation is one that clinicians should follow under most circumstances. A CONDITIONAL recommendation (ie, "We suggest…") reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding any specific care must be made by the treating clinician and the patient, taking into consideration the individual circumstances of the patient, available treatment options, and resources. (1) We recommend that clinicians use PAP, compared to no therapy, to treat OSA in adults with excessive sleepiness. (STRONG) (2) We suggest that clinicians use PAP, compared to no therapy, to treat OSA in adults with impaired sleep-related quality of life. (CONDITIONAL) (3) We suggest that clinicians use PAP, compared to no therapy, to treat OSA in adults with comorbid hypertension. (CONDITIONAL) (4) We recommend that PAP therapy be initiated using either APAP at home or in-laboratory PAP titration in adults with OSA and no significant comorbidities. (STRONG) (5) We recommend that clinicians use either CPAP or APAP for ongoing treatment of OSA in adults. (STRONG) (6) We suggest that clinicians use CPAP or APAP over BPAP in the routine treatment of OSA in adults. (CONDITIONAL) (7) We recommend that educational interventions be given with initiation of PAP therapy in adults with OSA. (STRONG) (8) We suggest that behavioral and/or troubleshooting interventions be given during the initial period of PAP therapy in adults with OSA. (CONDITIONAL) (9) We suggest that clinicians use telemonitoring-guided interventions during the initial period of PAP therapy in adults with OSA. (CONDITIONAL).

Topics: Adult; GRADE Approach; Humans; Positive-Pressure Respiration; Sleep Apnea, Obstructive; Treatment Outcome; United States

PubMed: 30736887
DOI: 10.5664/jcsm.7640

Authors: Jack D Edinger, J Todd Arnedt, Suzanne M Bertisch...

INTRODUCTION

This guideline establishes clinical practice recommendations for the use of behavioral and psychological treatments for chronic insomnia disorder in adults.

METHODS

The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine and sleep psychology to develop recommendations and assign strengths based on a systematic review of the literature and an assessment of the evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The task force evaluated a summary of the relevant literature and the quality of evidence, the balance of clinically relevant benefits and harms, patient values and preferences, and resource use considerations that underpin the recommendations. The AASM Board of Directors approved the final recommendations.

RECOMMENDATIONS

The following recommendations are intended as a guide for clinicians in choosing a specific behavioral and psychological therapy for the treatment of chronic insomnia disorder in adult patients. Each recommendation statement is assigned a strength ("strong" or "conditional"). A "strong" recommendation (ie, "We recommend…") is one that clinicians should follow under most circumstances. A "conditional" recommendation is one that requires that the clinician use clinical knowledge and experience, and to strongly consider the patient's values and preferences to determine the best course of action. 1. We recommend that clinicians use multicomponent cognitive behavioral therapy for insomnia for the treatment of chronic insomnia disorder in adults. (STRONG). 2. We suggest that clinicians use multicomponent brief therapies for insomnia for the treatment of chronic insomnia disorder in adults. (CONDITIONAL). 3. We suggest that clinicians use stimulus control as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL). 4. We suggest that clinicians use sleep restriction therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL). 5. We suggest that clinicians use relaxation therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL). 6. We suggest that clinicians not use sleep hygiene as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL).

Topics: Academies and Institutes; Adult; Cognitive Behavioral Therapy; GRADE Approach; Humans; Sleep; Sleep Initiation and Maintenance Disorders; United States

PubMed: 33164742
DOI: 10.5664/jcsm.8986

Authors: Balaraju Battu, Talal Rahwan

A fundamental question in social and biological sciences is whether self-governance is possible when individual and collective interests are in conflict. Free riding poses a major challenge to self-governance, and a prominent solution to this challenge has been altruistic punishment. However, this solution is ineffective when counter-punishments are possible and when social interactions are noisy. We set out to address these shortcomings, motivated by the fact that most people behave like conditional cooperators-individuals willing to cooperate if a critical number of others do so. In our evolutionary model, the population contains heterogeneous conditional cooperators whose decisions depend on past cooperation levels. The population plays a repeated public goods game in a moderately noisy environment where individuals can occasionally commit mistakes in their cooperative decisions and in their imitation of the role models' strategies. We show that, under moderate levels of noise, injecting a few altruists into the population triggers positive reciprocity among conditional cooperators, thereby providing a novel mechanism to establish stable cooperation. More broadly, our findings indicate that self-governance is possible while avoiding the detrimental effects of punishment, and suggest that society should focus on creating a critical amount of trust to harness the conditional nature of its members.

Topics: Humans; Cooperative Behavior; Punishment; Game Theory; Altruism; Social Interaction

PubMed: 36681708
DOI: 10.1038/s41598-023-28372-y

Authors: Kristian Bernt Karlson, Frank Popham, Anders Holm...

This article presents two ways of quantifying confounding using logistic response models for binary outcomes. Drawing on the distinction between marginal and conditional odds ratios in statistics, we define two corresponding measures of confounding (marginal and conditional) that can be recovered from a simple standardization approach. We investigate when marginal and conditional confounding may differ, outline why the method by Karlson, Holm, and Breen recovers conditional confounding under a "no interaction"-assumption, and suggest that researchers may measure marginal confounding by using inverse probability weighting. We provide two empirical examples that illustrate our standardization approach.

PubMed: 37873547
DOI: 10.1177/0049124121995548

Authors: Michael T Smith, Christina S McCrae, Joseph Cheung...

INTRODUCTION

The purpose of this guideline is to establish clinical practice recommendations for the use of actigraphy in adult and pediatric patients with suspected or diagnosed sleep disorders or circadian rhythm sleep-wake disorders.

METHODS

The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine to develop recommendations and assigned strengths based on a systematic review of the literature and an assessment of the evidence using the GRADE process. The task force provided a summary of the relevant literature and the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations that support the recommendations. The AASM Board of Directors approved the final recommendations.

RECOMMENDATIONS

The following recommendations are intended as a guide for clinicians using actigraphy in evaluating patients with sleep disorders and circadian rhythm sleep-wake disorders, and only apply to the use of FDA-approved devices. Each recommendation statement is assigned a strength ("Strong" or "Conditional"). A "Strong" recommendation (ie, "We recommend…") is one that clinicians should follow under most circumstances. A "Conditional" recommendation (ie, "We suggest…") reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding any specific care must be made by the treating clinician and the patient, taking into consideration the individual circumstances of the patient, available treatment options, and resources. We suggest that clinicians use actigraphy to estimate sleep parameters in adult patients with insomnia disorder. (Conditional). We suggest that clinicians use actigraphy in the assessment of pediatric patients with insomnia disorder. (Conditional). We suggest that clinicians use actigraphy in the assessment of adult patients with circadian rhythm sleep-wake disorder. (Conditional). We suggest that clinicians use actigraphy in the assessment of pediatric patients with circadian rhythm sleep-wake disorder. (Conditional). We suggest that clinicians use actigraphy integrated with home sleep apnea test devices to estimate total sleep time during recording (in the absence of alternative objective measurements of total sleep time) in adult patients suspected of sleep-disordered breathing. (Conditional). We suggest that clinicians use actigraphy to monitor total sleep time prior to testing with the Multiple Sleep Latency Test in adult and pediatric patients with suspected central disorders of hypersomnolence. (Conditional). We suggest that clinicians use actigraphy to estimate total sleep time in adult patients with suspected insufficient sleep syndrome. (Conditional). We recommend that clinicians use actigraphy in place of electromyography for the diagnosis of periodic limb movement disorder in adult and pediatric patients. (Strong).

Topics: Academies and Institutes; Actigraphy; Humans; Sleep Disorders, Circadian Rhythm; Sleep Medicine Specialty; Sleep Wake Disorders; United States

PubMed: 29991437
DOI: 10.5664/jcsm.7230

Authors: Kuang-Yao Lee, Dingjue Ji, Lexin Li...

Graphical modeling of multivariate functional data is becoming increasingly important in a wide variety of applications. The changes of graph structure can often be attributed to external variables, such as the diagnosis status or time, the latter of which gives rise to the problem of dynamic graphical modeling. Most existing methods focus on estimating the graph by aggregating samples, but largely ignore the subject-level heterogeneity due to the external variables. In this article, we introduce a conditional graphical model for multivariate random functions, where we treat the external variables as conditioning set, and allow the graph structure to vary with the external variables. Our method is built on two new linear operators, the conditional precision operator and the conditional partial correlation operator, which extend the precision matrix and the partial correlation matrix to both the conditional and functional settings. We show that their nonzero elements can be used to characterize the conditional graphs, and develop the corresponding estimators. We establish the uniform convergence of the proposed estimators and the consistency of the estimated graph, while allowing the graph size to grow with the sample size, and accommodating both completely and partially observed data. We demonstrate the efficacy of the method through both simulations and a study of brain functional connectivity network.

PubMed: 37193511
DOI: 10.1080/01621459.2021.1924178