Health sciences review (Oxford, England)最新文献

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.

The use of novel biomarkers to predict future atrial fibrillation (AF) risk may aid decision making with anti-coagulant therapy for stroke prevention. The purpose of our study was to determine whether quantitative echocardiography, blood tests, imaging, anthropometry are predictive of atrial fibrillation. Electrocardiography was not the scope of this review.

Incremental increases in atrial volume and atrial diameter were most commonly associated with AF development. Likewise, incremental Brain Natriuretic Peptide (BNP) and N-terminal pro-(BNP) levels also correlate with AF risk. Anthropometric predictors such as BMI, lean mass and fat mass were also predictive of AF. Of studies reporting stroke topology, the presence of cortical infarcts, posterior circulation infarcts, multi-territory infarcts were independently predictive of AF.

Newer echocardiographic techniques such as atrial and ventricular strain analysis were shown to be predictive of AF in multiple studies. Use of these biomarkers in composite scoring systems may accurately predict AF development and further help stratify patients that may benefit from anticoagulation for stroke prevention.

Globally, antimicrobial (AMR) or multi-drug resistance (MDR) constitutes a current health challenge that is predicted to cause increased infections rates with adverse socioeconomic impacts through increase in healthcare costs. In addition, the group of Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp. (ESKAPE) pathogens cause debilitating infections (community and nosocomial) and are classed as priority 1 AMR pathogens. This systematic report therefore aimed at providing detailed coverage of new targets for novel antimicrobials development against MDR ESKAPE pathogens to mitigate future AMR spread and improve current public health indices. The prevalent ESKAPE bacterial group show high resistance to quinolones, lactams, cephalosporins, carbapenems and other antibiotic groups, and ability to form biofilms linked to various quorum sensing systems (QSSs) that boost their virulence. These QS pathways have become viable targets in drug design efforts for new antimicrobials development. Also, since antibiotics discovery and development has waned in the past decade, the emergence of advanced computational modelling technologies in drug design, repurposing and development efforts may yet bridge the gap. As such, in this work we provided a comprehensive and systematic overview using relevant, included data and findings on ESKAPE pathogens, their QSSs to target for novel antimicrobial agents’ development, the contributions of computational tools at the heart of novel antimicrobial advancements and their roles in bioprospecting and developing novel ‘druggable’ candidates and therapies with anti-biofilm, and anti-quorum sensing activities to mitigate AMR, biofilm and QS-related pathogenicity factors.

The study evaluated the current state and accessibility of tertiary healthcare services in rural Australia. A systematic literature review from 2010 to 2022 was undertaken, utilising databases such as PubMed, MEDLINE, Cochrane Library, ProQuest, and Google Scholar. The PRISMA method was employed to retrieve an initial total of 4768 papers. Upon removal of 2806 duplicates and 1587 irrelevant records, 1962 articles were screened. From these, 375 were assessed for eligibility, leading to the inclusion of eleven studies in the systematic review. Criteria for exclusion included a focus on primary and secondary healthcare, absence of peer review, and unclear methodology.

A collective survey of 230,339 individuals, focusing on access to tertiary healthcare in rural and remote areas of Australia, was reported in the chosen studies. Several barriers to healthcare access for rural populations were identified, including lack of informed leadership, inadequate clinical governance, limited awareness of modern care models, suboptimal workforce planning and resource utilisation, incorrect risk perception, and insufficient community engagement.

In conclusion, there is an urgent need to address healthcare disparities and improve service accessibility in Australia's rural and remote areas.