Health sciences review (Oxford, England)最新文献

The self-awareness technique is instrumental in increasing the efficacy of the brain's innate ability to adapt to change via neuroplasticity and self-directing clarity while improving neuro-network paths. The human brain is plastic and capable of modifiability and change, enabling pathway connectivity. This adaptability is affected by both DNA polymorphic antecedents and positive or negative environmental-induced epigenetic-induced alteration of protein transcription. The peripheral part of the brain, capable of neuroplasticity, enables the brain to change and adapt itself to new situations and novel ideas. The brain's neuroplasticity, a capability of the nervous system to change and adapt to external and internal stimuli, can reach a higher efficacy level by applying the awareness integration therapeutical theory. Awareness Integration Theory (AIT) is an evidence-based technique that guides and directs the process of examining thoughts, emotions, behaviors, obstacles, and resistance to plasticity while providing pathways to clarity and self-directed neuroplasticity. By restructuring cognitive/emotional schemas and linking to behavioral pathways, AIT-based therapy expectedly helps create new neural network paths, leading to a renewed functional neural connectivity. As a trauma-releasing approach, AIT revolves around core beliefs, emotions, and bodily attributes to access original memories and moves toward the integration of functional neural networks.

Psychogenic non-epileptic seizures (PNES) are such class of pseudo-neurological disorder which finds home nowhere whether its psychology, neurology or psychiatry and thus always a state of confusion continues among PNES patients that where to seek for assistance, though patients with PNES are first reported in neurology department because it mimics epileptic seizures. The main reason behind PNES is psychological turmoil but recent studies have come up with biological and social aspects also. Therefore, till today debate behind PNES's etiology persist. Thus, in this report we done an educational review of etiology of PNES briefly considering all three aspects i.e. psychological, biological and social ensuring an eclectic professional help to devise any diagnostic and management plan for PNES patients.

Levetiracetam (LEV) is not frequently recommended as a preventative medication for seizures after intracerebral hemorrhage (ICH). Although there are differing opinions among clinicians, current recommendations do not support its use. We aim to assess the effectiveness of LEV in seizure prophylaxis in patients with ICH. We systematically searched PUBMED, SCOPUS, and other databases. Clinical trials and observational studies that enrolled patients in Spontaneous ICH and provided independent data on LEV were included. The pooled proportions of reported findings were determined using the random-effects model and forest plots were created. We identified six studies with a total of 1,166 patients for the analyses of primary and secondary outcomes. There were no significant differences in the total frequency of seizures between LEV treatment and placebo (OR=0.52; 95% CI-0.21–1.31; P=0.17) and also LEV treatment did not lower the death rate. (OR=1.14, 95% CI-0.57–2.26, P- 0.71). In half of the investigations (n=3), the poor clinical outcomes were defined using the mRS (i.e. score >3). The results showed that taking the placebo resulted in worse outcomes (OR-6.24, 95% CI-3.97-9.81, P.00001). Overall, there were no appreciable differences between LEV and placebo regarding the change in NIHSS of less than 25 (MID, 1.98; 95%CI, 0.15–4.12; P=0.07). However, these two trials showed a significant amount of heterogeneity (I2=83%). LEV did not significantly reduce mortality and seizure occurrences on average than those on other anti-epileptic medications. Our study is the first to analyze the efficacy of this newer-generation anti-epileptic drug for seizure prophylaxis in patients with ICH.

The rapidly expanding older population across Low- and Middle-Income Countries (LMICs) underscores the urgent need to strengthen the health systems. However, the extent of service coverage and healthcare workforce allocation strategies for geriatric and palliative care in LMICs remains inadequately explored. To address this, we conducted this systematic review, following the standard guidelines, to synthesize available data from four databases spanning 2011 to 2022. Utilizing the Risk of Bias Assessment tool for non-randomized studies (ROBANS) for quantitative studies and the JBI (formerly known as Joanna Briggs Institute) checklist for qualitative research, we assessed the risk of bias and the quality in the included studies. Despite a comprehensive search, only three eligible studies were found, revealing a scarcity of research. The identified challenges include deficiencies in leadership, governance, financing, and essential resources, leading to compromised service coverage. The health workforce, often limited and lacking inadequate training, exacerbates the situation. Our evidence synthesis proposes some potential solutions such as telemedicine and cross-country collaboration through distance learning mechanisms to address these issues. The findings and recommendations from this review offer valuable insights applicable across various healthcare service contexts within LMICs and advocate for more health systems research in this topic area.

Injury remains a significant global health concern, with early major haemorrhage (MH) being a leading cause of preventable death. However, the absence of a standardised definition for MH hinders research comparability and optimal clinical decision-making.

This scoping review aims to explore and categorise the published definitions of MH in adults following injury.

A systematic search of the Medline (OVID) database and additional sources was conducted following established guidelines. Peer-reviewed articles published in English up to March 2023 were included if they related to injury, and critically unwell adult patients, and included reference to bleeding or haemorrhage.

Out of 191 identified articles, 50 were included in the final analysis. These studies spanned from 2006 to 2023 and were conducted in various geographic locations. No consistent definition of MH was identified. Definitions of MH fell into six distinct categories: receipt of blood products, physiological parameters, scoring systems, clinical gestalt, observed bleeding (CT or clinical), and composite definitions. The ‘receipt of blood products’ category was the most frequent definition category, with massive transfusion (MT) ‘received’ being the most common definition of MH. Composite definitions and definitions involving the use of physiological parameters were also commonly employed.

Our scoping review identified wide heterogeneity in the definition of MH following injury. The absence of a standardised definition for MH poses a significant challenge to both injury research and clinical practice. Addressing this gap is crucial in improving systems of trauma care and outcomes for critically bleeding patients.

During the last years, the COVID-19 pandemic determined different clinical and radiological scenarios, sometimes difficult to manage, in particular in breast units. On these bases, we tried to understand what we have learned and how to improve the management of breast cancer screening and breast cancer patients.

We included a total number of 16 studies. Most published papers about managing breast units during the spread of COVID-19 were editorial, followed by original articles and reviews. Even if the COVID spread followed a bimodal distribution, most papers were published during the first wave, without significant improvement in 2021 and 2022, and were published in journals belonging to general speciality, followed by surgical and radiological journals.

One of the most common topics reported in the final included studies is prioritizing patients in the clinical setting according to individual characteristics (first of all, age), risk factors, and time since the last imaging examination. For biopsies, prioritization has been suggested according to the risk of malignant lesions. In the screening setting, this was suspended in most reported studies, also for BRCA+ patients, and then resumed with different modalities according to different centres. Moreover, some proposed the establishment of mobile units for screening or the decentralization of more screening mammograms to smaller clinics or hospital admittance for screening patients via telemedicine.

The majority of analyzed papers underlined that all patients, before admittance into the diagnostic rooms, should be screened for suspicious symptoms directly on-site or by asking by phone. In the case of patients with a high suspicion of COVID-19 infection, some papers proposed to delay all breast imaging studies and others to use dedicated departments or areas of the cancer center. In this setting, telemedicine for radiologists has also been suggested. Moreover, other suggestions should be considered: reducing patients' time in the hospital, increasing the distance between patients in the waiting room, and creating additional waiting areas.

Objective

The objective was to conduct a scoping review of interventions on health outcomes among pediatric populations with a variety of health conditions with comparison groups where at least one group was receiving telehealth services during a period within the COVID-19 pandemic.

Methods

Utilizing the PubMed, Embase, PsycInfo, and CINAHL databases, peer-reviewed studies in English on health outcomes following interventions where at least one group was receiving telehealth services were identified. Interventions could have either quasi-experimental designs with at least two groups or randomized designs. No limitations were placed on the health outcomes included in this review. Studies were restricted to those conducted during a period within the COVID-19 pandemic (i.e., published until December 5, 2022). The reporting in this registered scoping review was guided by the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement Extension for Scoping Reviews (PRISMA-ScR). For the purpose of data charting, information on participant descriptive characteristics and intervention strategies, outcomes, and findings was extracted.

Results

Ten articles met the criteria from our search on December 5, 2022. Various conditions were represented, such as autism spectrum disorder, Duchenne muscular dystrophy, Tourette syndrome, and other physical, mental, and developmental disorders. A total of 4 studies were randomized-controlled trials (RCTs), and the remaining 6 had quasi-experimental designs. Comparison groups received in-person visits, mixed-mode services, different telehealth services, or wait-list interventions. In 6 out of the 8 studies with defined outcomes that were quantified, children receiving telehealth services had statistically significant better health outcomes compared to those in control groups. In 2 of these 8 studies, children receiving telehealth services had either better though not statistically significant health outcomes or had similar health outcomes compared to those in control groups. Examples of health outcome improvements with telehealth use were lower hyperactivity levels, increased muscular strength, and a decrease in tic severity.

Conclusion

Health outcome improvements with telehealth use tended to be similar to or superior than those in the control group. Additional investigations, especially RCTs, are advised.

Therapeutic applications of small interfering RNAs (siRNAs) have recently facilitated advancements in the biopharmaceutical industry, expanding opportunities for pharmacological intervention to targets previously deemed “undruggable.” Hence, determining rational design principles to inform the selection of effective siRNA sequences and appropriate chemical modifications has been a significant undertaking in the field. To accelerate the process of empirical siRNA design, machine learning (ML) techniques have been applied to the problem of siRNA efficacy prediction. This systematic review provides a comprehensive, yet succinct overview of advancements in this ML task by examining the evolution of model architectures trained to predict siRNA efficacy, features selected to represent individual samples and inform predictions, and the challenges associated with the use of ML in the context of therapeutic siRNA discovery. Consensus and conflict throughout the literature are discussed, promoting a nuanced understanding of this problem. Finally, the vast potential for future directions is addressed, supporting further research in computational biomedicine.

Pompe disease is a lysosomal storage disease characterized by impaired glycogen breakdown due to an acid α-glucosidase (GAA) enzyme deficiency. Without therapy, children with the severe infantile form do not survive past their first year of life. POMBILITI which is intended to treat late-onset Pompe disease. The enzyme cipaglucosidase alfa-atga, which is produced from Chinese Hamster Ovary (CHO) cells, is a component of this novel drug. This enzyme is produced using a highly developed process known as perfusion methodology. Recombinant human α-glucosidase (rhGAA) is expressed and produced in CHO cells using the perfusion process. This drug helps to treat Pompe disease by the breakdown of glycogen within lysosomes. Late-onset Pompe disease is characterized by a deficiency in Alpha glucosidase, leading to the accumulation of glycogen within lysosomes and subsequent cellular dysfunction. POMBILITI's targeted approach involves the administration of the rhGAA enzyme, providing a therapeutic replacement for the deficient natural enzyme. This drug aims to restore the normal physiological function of lysosomes, thereby mitigating the impact of Pompe disease on affected individuals. The current study is focused on the drug cipaglucosidase alfa-atga which the FDA has approved for the treatment of Pompe disease on 28 September 2023.

Background

Full-thickness rectal prolapse remains a challenging pathology to correct surgically with significant recurrence rates. Among perineal approaches, the proctosigmoidectomy with levatorplasty, commonly referred to as the Altemeier procedure is frequently performed. The addition of levatorplasty has been postulated to improve recurrence rates, however, its efficacy varies across studies. The aim of this study was to systematically review recurrence rates following proctosigmoidectomy with levatorplasty, and to meta-analyze pooled data comparing recurrence rates between proctosigmoidectomy with and without a levatorplasty.

Methods

A search of EMBASE, OVID Medline, and CENTRAL was performed from database inception to October 2021 aimed at identifying studies investigating recurrences of rectal prolapse following proctosigmoidectomy with levatorplasty. Primary endpoint was recurrence of rectal prolapse. Articles that did not report this endpoint or did not evaluate proctosigmoidectomy with levatorplasty were excluded. A pairwise meta-analysis was performed using Mantel-Haenszel random effects.

Results

From 200 citations, 14 primary studies met inclusion criteria. A total of 620 patients (88.9% female, mean age: 71 years) underwent proctosigmoidectomy with levatorplasty, and 117 without levatorplasty. Of the patients undergoing levatorplasty, 86 (13.8%) experienced a recurrence. Mean follow up was 46 months. Meta-analysis comparing recurrence rates between proctosigmoidectomy with and without levatorplasty demonstrated no significant difference (RR 0.80, 0.92, 95% CI 0.32–2.59, P = 0.87, I² = 77%). Narrative review of postoperative quality of life metrics demonstrated decreased incontinence with levatorplasty as measured by Wexner and ICIQ-SIF scores.

Discussion

The addition of a levatorplasty does not significantly reduce the risk of recurrent rectal prolapse after proctosigmoidectomy, however it may improve postoperative continence.