Hasil untuk "Other systems of medicine"

B. Schneider, J. Naidoo, B. Santomasso et al.

PURPOSE To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events (irAEs) in patients treated with immune checkpoint inhibitor (ICPi) therapy. METHODS A multidisciplinary panel of medical oncology, dermatology, gastroenterology, rheumatology, pulmonology, endocrinology, neurology, hematology, emergency medicine, nursing, trialists, and advocacy experts was convened to update the guideline. Guideline development involved a systematic literature review and an informal consensus process. The systematic review focused on evidence published from 2017 through 2021. RESULTS A total of 175 studies met the eligibility criteria of the systematic review and were pertinent to the development of the recommendations. Because of the paucity of high-quality evidence, recommendations are based on expert consensus. RECOMMENDATIONS Recommendations for specific organ system–based toxicity diagnosis and management are presented. While management varies according to the organ system affected, in general, ICPi therapy should be continued with close monitoring for grade 1 toxicities, except for some neurologic, hematologic, and cardiac toxicities. ICPi therapy may be suspended for most grade 2 toxicities, with consideration of resuming when symptoms revert ≤ grade 1. Corticosteroids may be administered. Grade 3 toxicities generally warrant suspension of ICPis and the initiation of high-dose corticosteroids. Corticosteroids should be tapered over the course of at least 4-6 weeks. Some refractory cases may require other immunosuppressive therapy. In general, permanent discontinuation of ICPis is recommended with grade 4 toxicities, except for endocrinopathies that have been controlled by hormone replacement. Additional information is available at www.asco.org/supportive-care-guidelines.

Wei Gao, S. Emaminejad, H. Nyein et al.

N. Thang, Truong Bach Chien, D. Cuong

Polymer-based hydrogels are hydrophilic polymer networks with crosslinks widely applied for drug delivery applications because of their ability to hold large amounts of water and biological fluids and control drug release based on their unique physicochemical properties and biocompatibility. Current trends in the development of hydrogel drug delivery systems involve the release of drugs in response to specific triggers such as pH, temperature, or enzymes for targeted drug delivery and to reduce the potential for systemic toxicity. In addition, developing injectable hydrogel formulations that are easily used and sustain drug release during this extended time is a growing interest. Another emerging trend in hydrogel drug delivery is the synthesis of nano hydrogels and other functional substances for improving targeted drug loading and release efficacy. Following these development trends, advanced hydrogels possessing mechanically improved properties, controlled release rates, and biocompatibility is developing as a focus of the field. More complex drug delivery systems such as multi-drug delivery and combination therapies will be developed based on these advancements. In addition, polymer-based hydrogels are gaining increasing attention in personalized medicine because of their ability to be tailored to a specific patient, for example, drug release rates, drug combinations, target-specific drug delivery, improvement of disease treatment effectiveness, and healthcare cost reduction. Overall, hydrogel application is advancing rapidly, towards more efficient and effective drug delivery systems in the future.

I. K. Zola

N. Halpern, S. Pastores

P. Marik, S. Pastores, D. Annane et al.

J. Shih, D. Krusienski, J. Wolpaw

António J. Salgado, R. Reis, N. Sousa et al.

F. Kolbinger, G. P. Veldhuizen, Jiefu Zhu et al.

The field of Artificial Intelligence (AI) holds transformative potential in medicine. However, the lack of universal reporting guidelines poses challenges in ensuring the validity and reproducibility of published research studies in this field. Based on a systematic review of academic publications and reporting standards demanded by both international consortia and regulatory stakeholders as well as leading journals in the fields of medicine and medical informatics, 26 reporting guidelines published between 2009 and 2023 were included in this analysis. Guidelines were stratified by breadth (general or specific to medical fields), underlying consensus quality, and target research phase (preclinical, translational, clinical) and subsequently analyzed regarding the overlap and variations in guideline items. AI reporting guidelines for medical research vary with respect to the quality of the underlying consensus process, breadth, and target research phase. Some guideline items such as reporting of study design and model performance recur across guidelines, whereas other items are specific to particular fields and research stages. Our analysis highlights the importance of reporting guidelines in clinical AI research and underscores the need for common standards that address the identified variations and gaps in current guidelines. Overall, this comprehensive overview could help researchers and public stakeholders reinforce quality standards for increased reliability, reproducibility, clinical validity, and public trust in AI research in healthcare. This could facilitate the safe, effective, and ethical translation of AI methods into clinical applications that will ultimately improve patient outcomes. Artificial Intelligence (AI) refers to computer systems that can perform tasks that normally require human intelligence, like recognizing patterns or making decisions. AI has the potential to transform healthcare, but research on AI in medicine needs clear rules so caregivers and patients can trust it. This study reviews and compares 26 existing guidelines for reporting on AI in medicine. The key differences between these guidelines are their target areas (medicine in general or specific medical fields), the ways they were created, and the research stages they address. While some key items like describing the AI model recurred across guidelines, others were specific to the research area. The analysis shows gaps and variations in current guidelines. Overall, transparent reporting is important, so AI research is reliable, reproducible, trustworthy, and safe for patients. This systematic review of guidelines aims to increase the transparency of AI research, supporting an ethical and safe progression of AI from research into clinical practice. Kolbinger, Veldhuizen et al. systematically review reporting guidelines for artificial intelligence (AI) methods in clinical research. They identify several essential, commonly recommended items on study design and model performance, while other items are specific to particular fields and research stages.

Nicholas A. Carlisle, Peyton Miller, Gregory Pavela et al.

Purpose: Sexual and gender minority (SGM) people experience a higher prevalence of adverse health outcomes compared to their heterosexual and cisgender counterparts due, in part, to shame related to sexual orientation and gender identity. The purpose of this scoping review was to identify and synthesize empirical evidence of the effects of shame on SGM populations in the United States. Methods: Following PRISMA-ScR guidelines, we systematically searched for studies that were (1) peer-reviewed; (2) original research; (3) written in English; (4) quantitatively measuring shame; (5) among groups identifying as sexual minority, gender minority, or both; (6) within the United States. Results: We identified 22 studies meeting inclusion criteria, most of which were cross-sectional and focused on sexual minority men. Across studies, shame was consistently associated with exposure to distal and proximal stressors, general psychological processes (e.g., affective, social, and cognitive), health-compromising behaviors (e.g., substance use, sexual compulsivity), and adverse health outcomes. Notably, few studies focused on gender minority individuals, and subgroup or intersectional analyses were uncommon. Conclusion: The literature supports shame as an important correlate of health-related outcomes among SGM populations, but is limited by cross-sectional designs, heterogenous measurement approaches, and limited attention to subgroup differences. Future research should prioritize longitudinal and mechanistic studies, improve measurement harmonization, and evaluate established shame-reduction approaches with SGM-affirming adaptations and scalable delivery strategies to improve reach and advance health equity.

Kampanart Huanbutta, Napapat Rattanachitthawat, Anusorn Thampithak et al.

Alopecia, a common dermatological disorder characterized by hair loss, can significantly impact psychological well-being and self-esteem despite being non-life-threatening. Various factors, including genetics, hormonal imbalances, environmental stressors, and medical conditions, contribute to its development. Conventional treatments such as minoxidil and finasteride stimulate hair growth by prolonging the anagen phase or inhibiting dihydrotestosterone production but may cause adverse effects, prompting interest in alternative therapies. Recent studies have highlighted the potential of herbal medicines and phytochemicals such as epigallocatechin gallate from green tea, curcumin from turmeric, and essential oils like rosemary and peppermint for their anti-inflammatory, antioxidant, and hormonal-modulating properties. A combination of synthetic and natural therapies offers a promising synergistic approach, enhancing efficacy while reducing side effects. However, conventional topical formulations often face limitations in skin penetration and bioavailability. To address this, innovative transdermal drug delivery systems, including nanocarriers, liposomes, and microneedles, have been explored to enhance follicular targeting and improve therapeutic outcomes. This review summarizes recent advances in alopecia management, covering synthetic and herbal therapies, mechanisms of action, novel delivery strategies, evaluation methods, and commercial products. By integrating traditional remedies with modern technologies, future treatments may offer improved therapeutic outcomes and greater patient satisfaction.

M. Lionetto, R. Caricato, A. Calisi et al.

Acetylcholinesterase (AChE) is a key enzyme in the nervous system. It terminates nerve impulses by catalysing the hydrolysis of neurotransmitter acetylcholine. As a specific molecular target of organophosphate and carbamate pesticides, acetylcholinesterase activity and its inhibition has been early recognized to be a human biological marker of pesticide poisoning. Measurement of AChE inhibition has been increasingly used in the last two decades as a biomarker of effect on nervous system following exposure to organophosphate and carbamate pesticides in occupational and environmental medicine. The success of this biomarker arises from the fact that it meets a number of characteristics necessary for the successful application of a biological response as biomarker in human biomonitoring: the response is easy to measure, it shows a dose-dependent behavior to pollutant exposure, it is sensitive, and it exhibits a link to health adverse effects. The aim of this work is to review and discuss the recent findings about acetylcholinesterase, including its sensitivity to other pollutants and the expression of different splice variants. These insights open new perspective for the future use of this biomarker in environmental and occupational human health monitoring.

Saravu Rama Bhat Narahari

Ellen E. Kozelka, Stephanie C. Acquilano, Monirah Al-Abdulmunem et al.

The transition to and acceptance of digital mental health tools has been heralded as a paradigm shift for providing and accessing care. Yet, providers and clients express concerns over privacy, efficacy, and personalization, as well as their ability to assess the thousands of available digital tools. In response to these concerns and calls for support to address them, the authors developed the Technology Specialist program. After a successful feasibility study, the research team launched a pilot study in late 2021 amid continuing COVID-19 protocols, presuming the rapid adoption of technology during the pandemic would facilitate the incorporation of the Technology Specialist. Despite the success of the role, the shifts in care delivery at one community mental health center created and exposed barriers to the implementation and uptake of digital tools. In this paper, the authors describe key access barriers exposed through the implementation of the pilot at the client, provider, and organizational levels. These barriers highlight a shifting digital divide for access to digital mental health among people with serious mental illness. The re-framed method of contextual engagement presented here may help direct research and practice toward collaborative and equitable action strategies for long-term success in community health settings.

Tingting Jiang, Jianli Li, Lei Meng et al.

Background: Postoperative gastrointestinal dysfunction (PGD) is a common complication in patients undergoing gastrointestinal surgery. Several studies have evaluated the effect of transcutaneous electrical acupoint stimulation (TEAS) on PGD, so we conducted a systematic review and meta-analysis to better understand these studies methodologic limitations and summarize clinical effects. Methods: Articles (published from January 2010 to April 2022) were searched from the following databases: Wanfang Database, China National Knowledge Infrastructure (CNKI), Cochrane Library, PubMed, Web of Science and Embase. Two authors conducted literature selection, data extraction and statistical analysis independently. This meta-analysis used RevMan 5.4 software to implement statistical analysis and applied Cochrane bias risk tool to assess methodologic weaknesses of included articles. We assessed the effect of TEAS on time to first flatus, first defecation and bowel sound recovery through meta-analyses using a random-effects model. Results: The meta-analysis included 10 articles including 1497 patients. This study showed that TEAS could effectively promote postoperative gastrointestinal function recovery by analyzing the time to first flatus (MD−14.81 h, 95% CI −15.88 to −13.75 h), time to first defecation (MD−14.68 h, 95% CI −20.59 to −8.76 h), time to bowel sound recovery (MD−5.79 h, 95% CI −10.87 to −0.71 h), length of hospital stay (MD−1.48d, 95% CI −1.86 to −1.11d), and the incidence of postoperative nausea and vomiting (PONV) (OR 0.41, 95% CI 0.29–0.58). In addition, we assessed the quality of the articles and found small sample sizes and lower methodological quality in some articles. Conclusion: Our meta-analysis revealed that TEAS could be a nonpharmacological treatment for PGD in patients after gastrointestinal surgery. However, positive findings should be treated carefully and future studies with high quality and large samples are needed to support this results.

B S Prasad, Basavaraj R Tubaki, Divya Khare

Pattaraporn Khongboon, Jiraporn Kespichayawatt

Purpose – This study assesses the prevalence of accidental falls in Thailand's older adult population and the contingent influences surrounding this prevalence. Design/methodology/approach – Data were drawn from the Cross-Sectional National Surveys of Older Persons in Thailand, pooling of four survey datasets which took place in 2007, 2011, 2014 and 2017. Stratified two-stage sampling was employed. Interviews were conducted with sample sizes of 11,370, 11,061, 13,775 and 12,457 senior citizens, aged 60 and above, in the respective survey years. Further investigation was conducted on subjects who reported to be of good health and without any disability, yet experienced accidental falls. The prevalence of accidental falls was examined, and variable aspects concerning fall risk were assessed with probability-weighted multiple logistic regression. Findings – The average prevalence of accidental falls from the four surveys was 4.7%. Significant risk factors identified were advanced age, being female, living in a rural residence, having worked in the previous 7 days, lack of/excessive exercise, alcohol consumption, smoking and having an outdoor lavatory. Originality/value – Accidental falls tend to increase among community-dwelling seniors aged 60 and above. Falls increase with age and are more common among the women in that demographic. Findings suggest the need for government and local agencies to consider tailoring some public health approaches to the prevention of accidental falls. This study also highlights the necessity of proper work environment maintenance to prevent these falls.

Arantza Vitoria, Alicia Laborda, Carolina Serrano-Casorrán et al.

<b>Background:</b> There are different indications for endovascular surgery in horses, mainly the treatment of guttural pouch mycosis. Traditionally, these procedures are carried out by open arteriotomy of the common carotid artery (CCA), although less invasive percutaneous ultrasound-guided carotid access (PUGCA) has been described in experimental horses. In human medicine, commercial closure systems are used to seal these arterial puncture sites and reduce complications. The aims of this study are to retrospectively describe our experience with PUGCA in clinical cases and to report, for the first time, the use of the commercial vascular closure device Angio-Seal after PUGCA in horses. <b>Methods:</b> Retrospective study of clinical case records. Collected parameters, including the feasibility of the PUGCA and variables related to the safety and efficacy of the use of the Angio-Seal. <b>Results:</b> Twelve PUGCA procedures in 11 horses were included. In all cases, the artery was effectively accessed, and the planned procedure could be performed. In two cases, haematoma/bleeding due to incorrect use of the Angio-Seal was recorded. This complication rate (16.66%) was lower than that obtained in other studies using PUGCA in horses, but where the puncture was sealed by manual compression only. <b>Main limitations:</b> A control group of clinical cases with PUGCA but without using Angio-Seal is not available. <b>Conclusions:</b> Clinical data confirm previous experimental results, which showed that PUGCA is safe and effective in horses. The Angio-Seal system, regardless of possible complications due to incorrect use, can be used safely and effectively in horses. Further studies comparing arterial access site management using manual compression or Angio-Seal would be necessary to state if its routine use in horses is advisable.

F. Lobelo, M. Stoutenberg, A. Hutber

C. Brennen