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Conway AE, Kartha N, Maddukuri C, Shaker MS. Pearls for practice from the 2023 allergy immunology joint task force on practice parameters GRADE and institute of medicine based atopic dermatitis guidelines. Curr Opin Pediatr 2024; 36:570-580. [PMID: 38957084 DOI: 10.1097/mop.0000000000001381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW To review the updated 2023 Allergy Immunology Joint Task Force on Practice Parameters (JTFPP) GRADE and Institute of Medicine (IOM) Based Guidelines for the management of atopic dermatitis. RECENT FINDINGS Topical corticosteroids and/or calcineurin inhibitors are recommended in individuals with atopic dermatitis refractory to moisturizer alone and may be used to maintain remission after acute flare control is achieved. Calcineurin inhibitors are a class of immunosuppressants used to effectively manage different autoimmune disorders. Bleach baths and allergen immunotherapy may be beneficial for individuals with moderate-to-severe disease, while elimination diets, azathioprine, methotrexate, mycophenolate, and systemic corticosteroids are not recommended. Dupilumab is strongly recommended for refractory atopic dermatitis. Oral Janus kinase (JAK) inhibitors carry significant risks; however, this class of medicines may be considered in cases of severe or refractory atopic dermatitis with intolerance to dupilumab. Patient preferences regarding cost, availability, feasibility, and tolerability should be integrated into all treatment plans using a shared decision-making approach. SUMMARY The 2023 JTFPP Atopic Dermatitis Guidelines offer up-to-date guidance for the management of atopic dermatitis of varying severity in infants, children, and adults.
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Affiliation(s)
| | - Navya Kartha
- Akron Children's Hospital, Department of Pediatrics, Akron
| | | | - Marcus S Shaker
- Geisel School of Medicine at Dartmouth, Departments of Medicine and Pediatrics, Hanover
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, New Hampshire, USA
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2
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Lieberman JA, Chu DK, Ahmed T, Dribin TE, Abrams EM, Anagnostou A, Blumenthal KG, Boguniewicz M, Chase NM, Golden DBK, Hartog NL, Heimall JR, Ho T, Lawrence MG, Khan DA, Minniear TD, Mustafa SS, Oppenheimer JJ, Phillips EJ, Ramsey A, Rider NL, Schneider L, Shaker MS, Spergel JM, Stone CA, Stukus DR, Wang J, Greenhawt MJ. A systematic review and expert Delphi Consensus recommendation on the use of vaccines in patients receiving dupilumab: A position paper of the American College of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 2024; 133:286-294. [PMID: 38848870 DOI: 10.1016/j.anai.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Dupilumab is a monoclonal antibody that targets the interleukin (IL)-4 receptor alpha subunit, thus blocking the effects of IL-4 and IL-13, and has shown efficacy in treating various conditions including asthma, atopic dermatitis, eosinophilic esophagitis, and others. Because of its immune modulatory effects, clinical trials that studied dupilumab did not allow patients to receive live vaccines during the clinical trials because of an abundance of caution, and thus package inserts recommend that patients who are being treated with dupilumab should avoid live vaccines. Because dupilumab is now approved for use in patients from 6 months of age for the treatment of atopic dermatitis, this reported contraindication is now posing a clinical dilemma for patients and clinicians. OBJECTIVE To perform a systematic review of literature on the safety and efficacy of vaccinations in patients who are receiving dupilumab and to provide expert guidance on the use of vaccines in patients who are receiving dupilumab. METHODS A systematic review of the literature was performed, and an expert Delphi Panel was assembled. RESULTS The available literature on patients who received vaccinations while using dupilumab overall suggests that live vaccines are safe and that the vaccine efficacy, in general, is not affected by dupilumab. The expert Delphi panel agreed that the use of vaccines in patients receiving dupilumab was likely safe and effective. CONCLUSION Vaccines (including live vaccines) can be administered to patients receiving dupilumab in a shared decision-making capacity.
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Affiliation(s)
- Jay A Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center and LeBonheur Children's Hospital, Memphis, Tennessee.
| | - Derek K Chu
- Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Tasnuva Ahmed
- Department of Health Research Methods, Evidence, and Impact, Evidence in Allergy Group, McMaster University, Hamilton, Canada
| | - Timothy E Dribin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada
| | - Aikaterini Anagnostou
- Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark Boguniewicz
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colorado
| | - Nicole M Chase
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nicholas L Hartog
- Department of Allergy and Immunology, Corewell Health Helen DeVos Children's Hospital, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Jennifer R Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tina Ho
- Dermatology Section, Division of Immunology, Boston Children's Hospital and Harvard Medical school, Boston, Massachusetts
| | - Monica G Lawrence
- Departments of Medicine and Pediatrics, University of Virginia, Charlottesville, Virginia
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Timothy Dean Minniear
- Division of Pediatric Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee
| | - S Shahzad Mustafa
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Rochester Regional Health and the University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Elizabeth J Phillips
- Center for Drug Safety and Immunology, Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Allison Ramsey
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Rochester Regional Health and the University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Nicholas L Rider
- Section of Allergy & Immunology, Department of Health Systems & Implementation Science, The Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Lynda Schneider
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
| | - Marcus S Shaker
- Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cosby A Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David R Stukus
- Division of Allergy/Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Julie Wang
- Division of Allergy & Immunology, Department of Pediatrics, Icahn School of Medicine, Mount Sinai, New York
| | - Matthew J Greenhawt
- Section of Allergy & Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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Ferreira RM, Martins PN, Gonçalves RS. Non-pharmacological and non-surgical interventions to manage patients with knee osteoarthritis: An umbrella review 5-year update. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100497. [PMID: 39040626 PMCID: PMC11261791 DOI: 10.1016/j.ocarto.2024.100497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/17/2024] [Indexed: 07/24/2024] Open
Abstract
Objective This umbrella review aimed to summarize (and update) the effectiveness of non-pharmacological and non-surgical interventions for patients with knee osteoarthritis. Methods The study followed the PRISMA guidelines. Manual and electronic databases were searched, to identify systematic reviews, following the P (knee osteoarthritis) I (non-pharmacological and non-surgical treatments) C (pharmacological, surgical, placebo, no intervention, or other non-pharmacological/non-surgical conservative treatments) O (pain, function, quality of life, and other knee-specific measures) model. The quality of evidence was assessed using the R-AMSTAR checklist and GRADE principles. Results The search yielded 4086 records, of which 61 met the eligibility criteria. After evaluation with R-AMSTAR, four systematic reviews were excluded, resulting in 57 included systematic reviews, with an overall score of 29.6. The systematic reviews were published between 2018 and 2022 (29.8% in 2022), conducted in 19 countries (52.6% in China), and explored 24 distinct interventions. The systematic reviews encompassed 714 trials (mean of 13 ± 7.7 studies per systematic review), and 59,343 participants (mean 1041 ± 1002 per systematic review, and 82 ± 59.2 per study). The majority of participants were older obese women (61.6 ± 4.2 years, 30.2 ± 3.6 kg/m2, 70%, respectively). Conclusions Based on the systematic reviews findings, Diet Therapy, Patient Education, and Resistance Training are strongly supported as core interventions for managing patients with knee osteoarthritis. Aquatic Therapy, Balance Training, Balneology, Dietary Supplements, Extracorporeal Shockwave Therapy, and Tai Ji show moderate support. For other interventions, the evidence quality was low, results were mixed or inconclusive, or there was not sufficient efficacy to support their use.
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Affiliation(s)
- Ricardo Maia Ferreira
- Polytechnic Institute of Maia, N2i, Social Sciences, Education and Sport School, Avenida Carlos de Oliveira Campos, 4475-690 Maia, Portugal
- Polytechnic Institute of Coimbra, Coimbra Health School, Scientific-Pedagogical Unit of Physioterapy, Rua 5 de Outubro, São Martinho do Bispo, 3045-043 Coimbra, Portugal
- Sport Physical Activity and Health Research & Innovation Center (SPRINT), 4960-320 Melgaço, Portugal
| | - Pedro Nunes Martins
- Polytechnic Institute of Maia, N2i, Social Sciences, Education and Sport School, Avenida Carlos de Oliveira Campos, 4475-690 Maia, Portugal
| | - Rui Soles Gonçalves
- Polytechnic Institute of Coimbra, Coimbra Health School, Scientific-Pedagogical Unit of Physioterapy, Rua 5 de Outubro, São Martinho do Bispo, 3045-043 Coimbra, Portugal
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4
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Bousquet J, Schünemann HJ, Sousa-Pinto B, Zuberbier T, Togias A, Samolinski B, Bedbrook A, Czarlewski W, Hofmann-Apitius M, Litynska J, Vieira RJ, Anto JM, Fonseca JA, Brozek J, Bognanni A, Brussino L, Canonica GW, Cherrez-Ojeda I, Cruz AA, Vecillas LDL, Dykewicz M, Gemicioglu B, Giovannini M, Haahtela T, Jacobs M, Jacomelli C, Klimek L, Kvedariene V, Larenas-Linnemann DE, Louis G, Lourenço O, Leemann L, Morais-Almeida M, Neves AL, Nadeau KC, Nowak A, Palamarchuk Y, Palkonen S, Papadopoulos NG, Parmelli E, Pereira AM, Pfaar O, Regateiro FS, Savouré M, Taborda-Barata L, Toppila-Salmi SK, Torres MJ, Valiulis A, Ventura MT, Williams S, Yepes-Nuñez JJ, Yorgancioglu A, Zhang L, Zuberbier J, Abdul Latiff AH, Abdullah B, Agache I, Al-Ahmad M, Al-Nesf MA, Al Shaikh NA, Amaral R, Ansotegui IJ, Asllani J, Balotro-Torres MC, Bergmann KC, Bernstein JA, Bindslev-Jensen C, Blaiss MS, Bonaglia C, Bonini M, Bossé I, Braido F, Caballero-Fonseca F, Camargos P, Carreiro-Martins P, Casale T, Castillo-Vizuete JA, Cecchi L, Teixeira MDC, Chang YS, Loureiro CC, Christoff G, Ciprandi G, Cirule I, Correia-de-Sousa J, Costa EM, Cvetkovski B, de Vries G, Del Giacco S, Devillier P, Dokic D, Douagui H, Durham SR, Enecilla ML, Fiocchi A, Fokkens WJ, Fontaine JF, Gawlik R, Gereda JE, Gil-Mata S, Giuliano AFM, Gotua M, Gradauskiene B, Guzman MA, Hossny E, Hrubiško M, Iinuma T, Irani C, Ispayeva Z, Ivancevich JC, Jartti T, Jeseňák M, Julge K, Jutel M, Kaidashev I, Bennoor KS, Khaltaev N, Kirenga B, Kraxner H, Kull I, Kulus M, Kuna P, Kupczyk M, Kurchenko A, La Grutta S, Lane S, Miculinic N, Lee SM, Le Thi Tuyet L, Lkhagvaa B, Louis R, Mahboub B, Makela M, Makris M, Maurer M, Melén E, Milenkovic B, Mohammad Y, Moniuszko M, Montefort S, Moreira A, Moreno P, Mullol J, Nadif R, Nakonechna A, Navarro-Locsin CG, Neffen HE, Nekam K, Niedoszytko M, Nunes E, Nyembue D, O'Hehir R, Ollert M, Ohta K, Okamoto Y, Okubo K, Olze H, Padukudru MA, Palomares O, Pali-Schöll I, Panzner P, Palosuo K, Park HS, Passalacqua G, Patella V, Pawankar R, Pétré B, Pitsios C, Plavec D, Popov TA, Puggioni F, Quirce S, Raciborski F, Ramonaité A, Recto M, Repka-Ramirez S, Roberts G, Robles-Velasco K, Roche N, Rodriguez-Gonzalez M, Romualdez JA, Rottem M, Rouadi PW, Salapatas M, Sastre J, Serpa FS, Sayah Z, Scichilone N, Senna G, Sisul JC, Solé D, Soto-Martinez ME, Sova M, Sozinova O, Stevanovic K, Ulrik CS, Szylling A, Tan FM, Tantilipikorn P, Todo-Bom A, Tomic-Spiric V, Tsaryk V, Tsiligianni I, Urrutia-Pereira M, Rostan MV, Sofiev M, Valovirta E, Van Eerd M, Van Ganse E, Vasankari T, Vichyanond P, Viegi G, Wallace D, Wang DY, Waserman S, Wong G, Worm M, Yusuf OM, Zaitoun F, Zidarn M. Concepts for the Development of Person-Centered, Digitally Enabled, Artificial Intelligence-Assisted ARIA Care Pathways (ARIA 2024). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00682-2. [PMID: 38971567 DOI: 10.1016/j.jaip.2024.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/16/2024] [Accepted: 06/25/2024] [Indexed: 07/08/2024]
Abstract
The traditional healthcare model is focused on diseases (medicine and natural science) and does not acknowledge patients' resources and abilities to be experts in their own lives based on their lived experiences. Improving healthcare safety, quality, and coordination, as well as quality of life, is an important aim in the care of patients with chronic conditions. Person-centered care needs to ensure that people's values and preferences guide clinical decisions. This paper reviews current knowledge to develop (1) digital care pathways for rhinitis and asthma multimorbidity and (2) digitally enabled, person-centered care.1 It combines all relevant research evidence, including the so-called real-world evidence, with the ultimate goal to develop digitally enabled, patient-centered care. The paper includes (1) Allergic Rhinitis and its Impact on Asthma (ARIA), a 2-decade journey, (2) Grading of Recommendations, Assessment, Development and Evaluation (GRADE), the evidence-based model of guidelines in airway diseases, (3) mHealth impact on airway diseases, (4) From guidelines to digital care pathways, (5) Embedding Planetary Health, (6) Novel classification of rhinitis and asthma, (7) Embedding real-life data with population-based studies, (8) The ARIA-EAACI (European Academy of Allergy and Clinical Immunology) strategy for the management of airway diseases using digital biomarkers, (9) Artificial intelligence, (10) The development of digitally enabled, ARIA person-centered care, and (11) The political agenda. The ultimate goal is to propose ARIA 2024 guidelines centered around the patient to make them more applicable and sustainable.
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Affiliation(s)
- Jean Bousquet
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany; ARIA, Montpellier, France.
| | - Holger J Schünemann
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany; Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Bernardo Sousa-Pinto
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE-Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany; Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alkis Togias
- Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Md
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Martin Hofmann-Apitius
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Bonn, Germany
| | - Justyna Litynska
- Evidence Prime, Kracow, Poland; Gynecological and Obstetrician Polyclinic, District Hospital, Białystok, Poland
| | - Rafael José Vieira
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE-Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Josep M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain; Department of Experimental Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; Department of Epidemiology & Public Health, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Joao A Fonseca
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE-Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jan Brozek
- Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Antonio Bognanni
- Department of Health Research Methods, Evidence, and Impact & Department of Medicine, Evidence in Allergy group, McMaster University, Hamilton, ON, Canada
| | - Luisa Brussino
- Department of Medical Sciences, University of Torino, Torino, Italy; Allergy and Clinical Immunology Unit, Mauriziano Hospital, Torino, Italy
| | - G Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Asthma & Allergy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ivan Cherrez-Ojeda
- Research Center 'Respiralab', Universidad Espíritu Santo, Samborondón, Ecuador; Department of Allergology & Pulmonology, Respiralab Research Group, Guayaquil, Guayas, Ecuador
| | - Alvaro A Cruz
- Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil
| | - Leticia de Las Vecillas
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Mark Dykewicz
- Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, Mo
| | - Bilun Gemicioglu
- Department of Pulmonary Diseases, and Institute of Pulmonology & Tuberculosis, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Mattia Giovannini
- Department of Health Sciences, University of Florence, Florence, Italy; Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - Marc Jacobs
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Bonn, Germany
| | - Cristina Jacomelli
- "Respiriamo Insieme" Association, Asthma & Allergy Center, Padova, Italy
| | - Ludger Klimek
- Department of Otolaryngology, Head & Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany; Center for Rhinology and Allergology, Allergology & Rhinology Department, Wiesbaden, Germany
| | - Violeta Kvedariene
- Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Desiree E Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | - Gilles Louis
- Department of Public Health, University of Liège, Liège, Belgium
| | - Olga Lourenço
- Faculty of Health Sciences and CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Lucas Leemann
- Department of Political Science, University of Zürich, Zürich, Switerland
| | | | - Ana Luisa Neves
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College, London, United Kingdom
| | - Kari C Nadeau
- Department of Environmental Health, Harvard TH Chan School of Public Health and Department of Medicine, Division of Allergy and Inflammation, Beth Israel Deaconess Hospital, Boston, Mass
| | - Artur Nowak
- Evidence Prime, Kracow, Poland; Gynecological and Obstetrician Polyclinic, District Hospital, Białystok, Poland
| | - Yuliia Palamarchuk
- Finnish Meteorological Institute (FMI), Atmospheric Composition Research, Helsinki, Finland
| | - Susanna Palkonen
- EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | | | - Elena Parmelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Asthma & Allergy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ana Margarida Pereira
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; PaCeIT-Patient Centered Innovation and Technologies, Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - Oliver Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Center for Innovative Biomedicine and Biotechnology (CIBB), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; UBIAir-Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Marine Savouré
- Université de Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, Rennes, France
| | - Luis Taborda-Barata
- Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal; UBIAir-Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Sanna K Toppila-Salmi
- Department of Allergy, Skin and Allergy Hospital, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Otorhinolaryngology, University of Eastern Finland and the North Savo Wellbeing Services County, Kuopio, Finland
| | - Maria J Torres
- Allergy Unit, Málaga Regional University Hospital of Málaga, Malaga University, ARADyAL, Malaga, Spain
| | - Arunas Valiulis
- Clinic of Children's Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania; Clinic of Asthma, Allergy, and Chronic Lung Diseases, Asthma & Allergy Department, Vilnius, Lithuania
| | - Maria Teresa Ventura
- Allergy and Clinical Immunology, University of Bari Medical School, Bari, Italy; Institute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy
| | - Sian Williams
- International Primary Care Respiratory Group IPCRG, Edinburgh, United Kingdom
| | - Juan J Yepes-Nuñez
- School of Medicine, Universidad de los Andes, Bogotá, DC, Colombia; Pulmonology Service, Internal Medicine Section, Fundación Santa Fe de Bogotá, University Hospital, Bogotá, DC, Colombia
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital and Beijing Institute of Otolaryngology, Beijing, China
| | - Jaron Zuberbier
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Baharudin Abdullah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Maryam Ali Al-Nesf
- Adult Allergy and Immunology Division-Hamad Medical Corporation, Doha, Qatar
| | - Nada A Al Shaikh
- Otolaryngology Head & Neck Surgery Department, Mouwasat Hospital, Dammam, Saudi Arabia
| | - Rita Amaral
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE-Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Cardiovascular and Respiratory Sciences, Porto Health School, Polytechnic Institute of Porto, Porto, Portugal; Department of Women's and Children's Health, Paediatric Research, Uppsala University, Uppsala, Sweden
| | - Ignacio J Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
| | - Julijana Asllani
- Department of Internal Medicine, University of Medicine, Tirana, Albania
| | | | - Karl-Christian Bergmann
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Jonathan A Bernstein
- Division of Immunology, Allergy and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Center, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Michael S Blaiss
- Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, Ga
| | - Cristina Bonaglia
- Institute "Bona Sforza", University for Linguistic Mediators, Bari, Italy
| | - Matteo Bonini
- Department of Cardiovascular and Respiratory Sciences, Universita Cattolica del Sacro Cuore, Rome, Italy; Department of Neurological, ENT and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli-IRCCS, Rome, Italy; National Heart and Lung Institute (NHLI), Imperial College London, London, United Kingdom
| | | | - Fulvio Braido
- Respiratory Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy; Respiratory & Allergy Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Paulo Camargos
- Department of Pediatrics, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Pedro Carreiro-Martins
- NOVA Medical School/Comprehensive Health Research Centre (CHRC), Lisbon, Portugal; Serviço de Imunoalergologia, Centro Hospitalar Universitário de Lisboa Central/ULS São José, Lisbon, Portugal
| | - Thomas Casale
- Division of Allergy/Immunology, University of South Florida, Tampa, Fla
| | - José-Antonio Castillo-Vizuete
- Department of Respiratory Medicine, Hospital Universitari Dexeus, Barcelona, Spain; The Group of Rhinitis, Rhinosinusitis and Nasal Polyps, Area of Asthma, SEPAR, Barcelona, Spain
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - Maria do Ceu Teixeira
- Dr Agostinho Neto University hospital, Epidemiology Department, Praia, Cabo Verde; Immunology, Cabo Verde University, Faculty of Medicine, Praia, Cabo Verde
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Seoul National University Bundang Hospital, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Claudia Chaves Loureiro
- Department of Pneumology, Coimbra University Hospital, Faculty of Medicine, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research, CIBB, Coimbra, Portugal
| | - George Christoff
- Faculty of Public Health, Sofia Medical University, Sofia, Bulgaria
| | - Giorgio Ciprandi
- Casa di Cura Villa Montallegro, Allergology Department, Genova, Italy
| | - Ieva Cirule
- Latvian Association of Allergists, University Children Hospital, Riga, Latvia
| | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Elisio M Costa
- CINTESIS@RISE, Biochemistry Lab, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing, University of Porto, Porto, Portugal
| | - Biljana Cvetkovski
- Woolcock Institute of Medical Research, Quality Use of Respiratory Medicine, Sydney, NSW, Australia
| | | | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
| | - Philippe Devillier
- VIM Suresnes, UMR 0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | - Dejan Dokic
- Medical Faculty Skopje, University Clinic of Pulmology and Allergy, Skopje, Republic of Macedonia
| | - Habib Douagui
- Service de Pneumo-Allergologie, Centre Hospitalo-Universitaire de Béni-Messous, Algiers, Algeria
| | - Stephen R Durham
- Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Alessandro Fiocchi
- Allergy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, the Netherlands
| | | | - Radoslaw Gawlik
- Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia in Katowice, Katowice, Poland
| | - Jose E Gereda
- Clínica Ricardo Palma, Allergy & Immunology Department, Lima, Peru
| | - Sara Gil-Mata
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE-Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Antonio F M Giuliano
- Department of Internal Medicine 'A. Murri' and Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | - Maia Gotua
- Center of Allergy and Immunology, David Tvildiani Medical University, Tbilisi, Georgia
| | - Brigita Gradauskiene
- Department of Immunology and Allergology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Maria Antonieta Guzman
- Immunology and Allergy Division, Clinical Hospital, University of Chile, Santiago, Chile
| | - Elham Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Martin Hrubiško
- Department of Clinical Immunology and Allergy, Oncology Institute of St Elisabeth, Bratislava, Slovakia
| | - Tomohisa Iinuma
- Department of Otorhinolaryngology, Chiba University, Chiba, Japan
| | - Carla Irani
- Department of Internal Medicine and Infectious Diseases, St Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Zhanat Ispayeva
- Department of Allergology and Clinical Immunology, Kazakhstan Association of Allergology and Clinical Immunology, Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Tuomas Jartti
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, University of Turku, Turku University Hospital, Turku, Finland
| | - Miloš Jeseňák
- Department of Pulmonology and Phthisiology, Department of Pediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovakia; Institute of Clinical Immunology and Allergology, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia
| | - Kaja Julge
- Institute of Clinical Medicine, Children's Clinic, Tartu University, Tartu, Estonia
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland; ALL-MED Medical Research Institute, Department of Clinical Immunology, Wroclaw, Poland
| | - Igor Kaidashev
- Poltava State Medical University, Immunology & Allergology Department, Poltava, Ukraine
| | - Kazi S Bennoor
- Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
| | | | - Bruce Kirenga
- Makerere University Lung Institute, Pulmonology Medicine Department, Kampala, Uganda
| | - Helga Kraxner
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Sach's Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Marek Kulus
- Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Maciej Kupczyk
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Andriy Kurchenko
- Department of Clinical and Laboratory Immunology, Allergology and Medical Genetics, Bogomolets National Medical University, Kyiv, Ukraine
| | - Stefania La Grutta
- Institute of Translational Pharmacology (IFT)-National Research Council (CNR), Palermo, Italy
| | - Stephen Lane
- Respiratory Medicine, Trinity College, Dublin, Ireland; Respiratory Physician & Allergist, Professorial Respiratory Centre, Tallaght University Hospital & Peamount Healthcare, Dublin, Ireland
| | - Neven Miculinic
- Croatian Pulmonary Society, Clinical Center for Pulmonary Diseases, Zagreb, Croatia
| | - Sang Min Lee
- Dankook University Hospital, ENT Department, Cheonan, Republic of Korea
| | - Lan Le Thi Tuyet
- Asthma, COPD Outpatient Care Unit, University Medical Center, Hô-Chi-Minh City, Vietnam
| | - Battur Lkhagvaa
- Mongolian National University of Medical Sciences, Health Department, Ulan Bator, Mongolia
| | - Renaud Louis
- Department of Pulmonary Medicine, CHU Liège, Liège, Belgium; GIGA I3 Research Group, University of Liège, Liège, Belgium
| | - Bassam Mahboub
- Rashid Hospital, DUBAI Health, Dubai, UAE; Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, UAE
| | - Mika Makela
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - Michael Makris
- Allergy Unit "D Kalogeromitros", 2nd Department of Dermatology and Venereology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Eric Melén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Sach's Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Branislava Milenkovic
- Clinic for Pulmonary Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbian Association for Asthma and COPD, Belgrade, Serbia
| | - Yousser Mohammad
- National Center for Research in Chronic Respiratory Diseases, Collaborating with WHO-EMRO Tishreen University School of Medicine, Latakia, Syria; Al-Sham Private University, Pharmacy Department, Damascus, Syria
| | - Marcin Moniuszko
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Stephen Montefort
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, MSD, Malta
| | - Andre Moreira
- EPIUnit-Institute of Public Health, University of Porto, and Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal; Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain; Clinical & Experimental Respiratory Immunoallergy, FRCB-IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - Rachel Nadif
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France; Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Alla Nakonechna
- Clinical Immunology and Allergy Unit, Sheffield Teaching Hospitals, Sheffield, United Kingdom; University of Liverpool, Liverpool, United Kingdom
| | - Cecilia Gretchen Navarro-Locsin
- Department of Otolaryngology-Head & Neck Surgery, St Luke's Medical Center, Quezon City, Philippines; Division of Surgery, Philippine Children's Medical Center, Quezon City, Philippines
| | - Hugo E Neffen
- Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina
| | - Kristof Nekam
- Hungarian Allergy Association, Allergy & Immunology Department, Budapest, Hungary
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - Elizabete Nunes
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Dieudonné Nyembue
- ENT Department, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Robyn O'Hehir
- Allergy, Asthma and Clinical Immunology, Alfred Health and Department of Immunology, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Markus Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg; Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Ken Ohta
- Japan Antituberculosis Association (JATA), Fukujuji Hospital, Tokyo, Japan
| | - Yoshitaka Okamoto
- Chiba Rosai Hospital, ENT Department, Chiba, Japan; Chiba University Hospital, Department of Otolaryngology, Head and Neck Surgery, Chiba, Japan
| | - Kimihiro Okubo
- Deparment of Otolaryngology, Nippon Medical School, Tokyo, Japan
| | - Heidi Olze
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mahesh Anand Padukudru
- Department of Respiratory Medicine, JSS Medical College, JSSAHER Mysuru, Karnataka, India
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain
| | - Isabella Pali-Schöll
- Institute of Pathophysiology and Allergy Research, Medical University Vienna, Vienna, Austria; Interuniversity Messerli Research Institute of the University of Veterinary Medicine and Medical University Vienna, Vienna, Austria
| | - Petr Panzner
- Department of Immunology and Allergology, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Kati Palosuo
- Department of Allergology, University of Helsinki and Hospital for Skin and Allergic Diseases, Helsinki, Finland
| | - Hae S Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy; Agency of Health ASL, Division of Allergy and Clinical Immunology, Department of Medicine, Salerno, Italy; Postgraduate Programme in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Benoît Pétré
- Department of Public Health, University of Liège, Liège, Belgium
| | | | - Davor Plavec
- Prima Nova, Healthcare Institution, Zagreb, Croatia; Medical Faculty, University JJ Strossmayer of Osijek, Osijek, Croatia
| | - Todor A Popov
- Clinic of Occupational Diseases, University Hospital Sveti Ivan Rilski, Sofia, Bulgaria
| | - Francesca Puggioni
- IRCCS Humanitas Research Center, Personalized Medicine Asthma & Allergy, Rozzano, Milan, Italy
| | - Santiago Quirce
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Filip Raciborski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Agné Ramonaité
- Department of Pulmonology and Allergology, Klaipeda National Hospital, Klaipeda, Lithuania; Vilnius University Medical Faculty, Department of Political Behaviour and Institutions, Vilnius, Lithuania
| | - Marysia Recto
- Division of Adult and Pediatric Allergy and Immunology, University of the Philippines - Philippines General Hospital, Manila, Philippines
| | - Susana Repka-Ramirez
- Department of Allergy, Clinics Hospital, National University, San Lorenzo, Paraguay
| | - Graham Roberts
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom; The David Hide Asthma and Allergy Centre, St Mary's Hospital, Isle of Wight, United Kingdom; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Karla Robles-Velasco
- Research Center 'Respiralab', Universidad Espíritu Santo, Samborondón, Ecuador; Department of Allergology & Pulmonology, Respiralab Research Group, Guayaquil, Guayas, Ecuador
| | - Nicolas Roche
- Pneumologie, AP-HP Centre Université de Paris Cité, Hôpital Cochin, Paris, France; UMR 1016, Institut Cochin, Paris, France; Inserm, Epidemiology Department, CESP, Villejuif, France
| | | | - Joel A Romualdez
- Faculty of Medicine & Surgery, University of Santo Tomas, Manila, Philippines
| | - Menachem Rottem
- Division of Allergy, Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Philip W Rouadi
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon; Department of Otorhinolaryngology-Head and Neck Surgery, Dar Al Shifa Hospital, Salmiya, Kuwait
| | | | - Joaquin Sastre
- Allergy Service, Fundacion Jimenez Diaz, Autonoma University of Madrid, CIBERES-ISCIII, Madrid, Spain
| | - Faradiba S Serpa
- Asthma Reference Center-School of Medicine of Santa Casa de Misericórdia of Vitória, Espírito Santo, Brazil
| | - Zineb Sayah
- SMAIC Société Marocaine d'Allergologie et Immunologie Clinique, Rabat, Morocco
| | | | - Gianenrico Senna
- Asthma-Allergy Unit, University Hospital of Verona, Verona, Italy
| | - Juan Carlos Sisul
- Clínica Sisul, Allergy & Asthma, Medical Director, CLINICA SISUL, FACAAI, SPAAI, Asuncion, Paraguay
| | - Dirceu Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - Manuel E Soto-Martinez
- Division of Respiratory Medicine, Department of Pediatrics, Hospital Nacional de Niños, Universidad de Costa Rica, San Jose, Costa Rica
| | - Milan Sova
- Department of Respiratory Medicine and Tuberculosis, University Hospital, Brno, Czech Republic
| | - Olga Sozinova
- Head of Laboratory of Atmospheric processes and Aerobiology, University of Latvia, Riga, Latvia
| | - Katarina Stevanovic
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anna Szylling
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Frances M Tan
- Department of Pediatrics, Victor R Potenciano Medical Center, Mandaluyong, Philippines
| | - Pongsakorn Tantilipikorn
- Department of Otolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ana Todo-Bom
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Vesna Tomic-Spiric
- Clinic of Allergology and Immunology, University Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladyslav Tsaryk
- Department of Clinical and Laboratory Immunology, Allergology and Medical Genetics, Bogomolets National Medical University, Kyiv, Ukraine
| | - Ioanna Tsiligianni
- International Primary Care Respiratory Group IPCRG, Aberdeen, United Kingdom; Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | | | - Marylin Valentin Rostan
- Pediatrics, Allergy & Immunology, Latín American Society of Allergy, Asthma & immunology (SLAAi), Montevideo, Uruguay
| | - Mikhail Sofiev
- Finnish Meteorological Institute (FMI), Atmospheric Composition Research, Helsinki, Finland
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Immunology, University of Turku, Turku, Finland
| | | | - Eric Van Ganse
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Pneumologie et Medicine Respiratoire, Groupement Hospitalier Nord, Hôpital de la Croix Rousse, Lyon, France
| | - Tuula Vasankari
- FiLHA, Finnish Lung Health Association, Helsinki, Finland; Department of Clinical Medicine, Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Pakit Vichyanond
- Division of Allergy and Immunology, Department of Pediatrics, Siriraj Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand
| | - Giovanni Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - Dana Wallace
- Nova Southeastern University, College of Allopathic Medicine, Fort Lauderdale, Fla
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - Gary Wong
- Department of Paediatrics, Prince of Wales Hospital, Hong Kong, SAR, China
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Allergy and Venerology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Osman M Yusuf
- The Allergy and Asthma Institute, Allergy & Asthma Department, Islamabad, Pakistan
| | - Fares Zaitoun
- Clemenceau Medical Center DHCC, Lebanese-American University, Dubai, UAE
| | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic Diseases, Pulmonary & Allergy Department, Golnik, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Freedman RA, Caswell-Jin JL, Hassett M, Somerfield MR, Giordano SH. Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer-Cyclin-Dependent Kinase 4 and 6 Inhibitors: ASCO Guideline Rapid Recommendation Update. J Clin Oncol 2024; 42:2233-2235. [PMID: 38768407 DOI: 10.1200/jco.24.00886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024] Open
Abstract
ASCO Rapid Recommendation Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options. Guidelines and updates are not intended to substitute for independent professional judgment of the treating provider and do not account for individual variation among patients. See appendix for disclaimers and other important information (Appendix 1 and Appendix 2, online only).
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Huang Q, Wang Y, Wang X, Xiang Z, Wang H, Wang A, Liu W, Gu Y. Efficacy and Safety of Snap Needles in the Treatment of Postoperative Hemorrhoidal Pain: A Systematic Review and Meta-Analysis. J Pain Res 2024; 17:2015-2028. [PMID: 38863870 PMCID: PMC11164817 DOI: 10.2147/jpr.s464176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/04/2024] [Indexed: 06/13/2024] Open
Abstract
Purpose The aim of this study is to evaluate the efficacy and safety of Snap Needles (SN) in the management of Postoperative Hemorrhoidal Pain (POHP). Patients and Methods A systematic search was conducted in various databases, including EMBASE, Web of Science, PubMed, WanFang database, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), and China Science and Technology Journal Database (VIP), spanning from their inception to August 2023, to identify relevant randomized controlled trials (RCTs) on SN for POHP. The primary outcome measure was the Visual Analog Scale (VAS), while secondary outcomes encompassed the Total Effective Rate (TER), Wound Healing Time (WHT), Pain Relief Time (PRT), Pain Disappearance Time (PDT), and Adverse Events (AEs). The Cochrane Risk of Bias Tool was employed to assess the quality of individual studies. A meta-analysis was conducted using RevMan 5.4.1 software. Results The meta-analysis included 11 RCTs involving 1188 POHP patients, with an overall assessment of study quality ranging from very low to moderate. The findings revealed that the SN group exhibited significant improvements in treatment outcomes when compared to the control group (CG). These improvements were reflected in reduced VAS scores (mean difference [MD] = -1.10, 95% confidence interval [CI]: -1.31, -0.89, P < 0.05), shorter WHT (MD = -2.55, 95% CI: -3.02, -2.09, P < 0.05), quicker PRT (MD = -7.99, 95% CI: -8.48, -7.49, P < 0.05), fewer AEs (risk ratio [RR] = 0.38, 95% CI: 0.22, 0.67, P < 0.05), improved TER (RR = 1.18, 95% CI: 1.09, 1.27, P < 0.05), and faster PDT (MD = 19.24, 95% CI: 14.17, 24.31, P < 0.05). Conclusion The use of SN appears to yield favorable outcomes in the treatment of POHP, and is potentially an alternative therapy to western drug therapy.
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Affiliation(s)
- Qinqin Huang
- Department of Traditional Chinese Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, 261042, People’s Republic of China
- College of Traditional Chinese Medicine, Weifang Medical University, Weifang, 261000, People’s Republic of China
- Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, 261042, People’s Republic of China
| | - Yun Wang
- Department of Traditional Chinese Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, 261042, People’s Republic of China
- College of Traditional Chinese Medicine, Weifang Medical University, Weifang, 261000, People’s Republic of China
- Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, 261042, People’s Republic of China
| | - Xiaobao Wang
- Department of Traditional Chinese Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, 261042, People’s Republic of China
| | - Zhenhua Xiang
- Department of Traditional Chinese Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, 261042, People’s Republic of China
| | - Haixia Wang
- Department of Traditional Chinese Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, 261042, People’s Republic of China
- College of Traditional Chinese Medicine, Weifang Medical University, Weifang, 261000, People’s Republic of China
| | - Aiju Wang
- Department of Traditional Chinese Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, 261042, People’s Republic of China
| | - Weiguo Liu
- Department of Traditional Chinese Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, 261042, People’s Republic of China
| | - Yuming Gu
- Department of Traditional Chinese Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, 261042, People’s Republic of China
- College of Traditional Chinese Medicine, Weifang Medical University, Weifang, 261000, People’s Republic of China
- Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, 261042, People’s Republic of China
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Gordan JD, Kennedy EB, Abou-Alfa GK, Beal E, Finn RS, Gade TP, Goff L, Gupta S, Guy J, Hoang HT, Iyer R, Jaiyesimi I, Jhawer M, Karippot A, Kaseb AO, Kelley RK, Kortmansky J, Leaf A, Remak WM, Sohal DPS, Taddei TH, Wilson Woods A, Yarchoan M, Rose MG. Systemic Therapy for Advanced Hepatocellular Carcinoma: ASCO Guideline Update. J Clin Oncol 2024; 42:1830-1850. [PMID: 38502889 DOI: 10.1200/jco.23.02745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 03/21/2024] Open
Abstract
PURPOSE To update an evidence-based guideline to assist in clinical decision-making for patients with advanced hepatocellular carcinoma (HCC). METHODS ASCO convened an Expert Panel to update the 2020 guideline on systemic therapy for HCC. The panel updated the systematic review to include randomized controlled trials (RCTs) published through October 2023 and updated recommendations. RESULTS Ten new RCTs met the inclusion criteria and were added to the evidence base. RECOMMENDATIONS Atezolizumab + bevacizumab (atezo + bev) or durvalumab + tremelimumab (durva + treme) may be offered first-line for patients with advanced HCC, Child-Pugh class A liver disease, and Eastern Cooperative Oncology Group performance status 0-1. Where there are contraindications to these therapies, sorafenib, lenvatinib, or durvalumab may be offered first-line. Following first-line treatment with atezo + bev, second-line therapy with a tyrosine kinase inhibitor (TKI), ramucirumab (for patients with alpha-fetoprotein [AFP] ≥400 ng/mL), durva + treme, or nivolumab + ipilimumab (nivo + ipi) may be recommended for appropriate candidates. Following first-line therapy with durva + treme, second-line therapy with a TKI is recommended. Following first-line treatment with sorafenib or lenvatinib, second-line therapy options include cabozantinib, regorafenib for patients who previously tolerated sorafenib, ramucirumab (AFP ≥400 ng/mL), nivo + ipi, or durvalumab; atezo + bev or durva + treme may be considered for patients who did not have access to these therapies in the first-line setting, and do not have contraindications. Pembrolizumab or nivolumab are also options for appropriate patients following sorafenib or lenvatinib. Third-line therapy may be considered in Child-Pugh class A patients with good PS, using one of the agents listed previously that has a nonidentical mechanism of action with previously received therapy. A cautious approach to systemic therapy is recommended for patients with Child-Pugh class B advanced HCC. Further guidance on choosing between options is included within the guideline.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
- John D Gordan
- University of California, San Francisco, San Francisco, CA
| | | | - Ghassan K Abou-Alfa
- Memorial Sloan Kettering Cancer Center and Weill Medical College at Cornell University, New York, NY
- Trinity College Dublin Medical School, Dublin, Ireland
| | | | | | | | - Laura Goff
- Vanderbilt Ingram Cancer Center, Nashville, TN
| | | | | | | | - Renuka Iyer
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | | | | | | | - R Kate Kelley
- University of California, San Francisco, San Francisco, CA
| | | | - Andrea Leaf
- VA New York Harbor Healthcare System, Brooklyn, NY
| | - William M Remak
- California Hepatitis C Task Force, California Chronic Care Coalition, FAIR Foundation, San Francisco, CA
| | | | - Tamar H Taddei
- Yale University School of Medicine and VA Connecticut Healthcare System, West Haven, CT
| | | | | | - Michal G Rose
- Yale Cancer Center and VA Connecticut Healthcare System, West Haven, CT
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Yu W, Chen D, Ding X, Qiao L, Zhang L, Gao X, Yan Y, Mo W, Ma J, Yin M. A critical appraisal of clinical practice guidelines on surgical treatments for spinal metastasis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1868-1898. [PMID: 38407614 DOI: 10.1007/s00586-023-08127-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 02/27/2024]
Abstract
PURPOSE As an important treatment for spinal metastasis, surgery has strict applicable conditions. Although various organizations have formulated different guidelines on surgical treatment for spinal metastasis (SM), there are certain differences in the content, standardization and quality of the guidelines and it is necessary to make a critical appraisal of them. We aim to systematically review and appraise the current guidelines on surgical treatments of SM and summarize the related recommendations with the quality evaluation of supporting evidence, as to provide a reference for the standardization of surgical treatment plans, and help clinical front-line medical workers can make safe and effective clinical decisions faster. METHODS We searched Pubmed, Web of Science, and Embase for three major databases and online guideline databases. According to certain inclusion and exclusion criteria, the latest guidelines on the surgical treatment of SM were sorted out. AGREE II was used to evaluated the guideline's quality, and we extracted and compared the recommended treatment content of each guideline with evaluating by the evidence-grading scale. RESULTS Eight guidelines from 2013 to 2019 were included. Seven guidelines are comprehensive guidelines and one related to the reconstructive surgery of SM. Five guidelines were evaluated as "recommended," and three guidelines were evaluated as "recommended with modifications." Regarding the indications of surgery with SM, four guidelines, seven guidelines, seven guidelines, three guidelines and three guidelines recommended surgical treatment for patients with SM with intractable pain, mechanical instability, metastatic epidural spinal cord compression (MESCC), recurrent spinal metastasis (RSM), and survival predication, respectively. Regarding the surgical strategies, three guidelines recommended minimally invasive therapy but had strict indications. Six guidelines and five guidelines recommend palliative surgery and with receiving radiation therapy, respectively. For the aggressive surgery, only one guideline recommended to apply to patients in good general conditions who has isolated symptomatic SM. Regarding the surgical reconstructions, one guideline didn't recommend iliac bone graft and three guidelines recommended PMMA bone cement. CONCLUSION Most of the guidelines do not provide clear criteria for surgical application and provide more of a basic framework. The level of evidence for these surgical recommendations ranges from LOE B to D, and almost all guidelines recommend vertebroplasty and kyphoplasty, but for palliative and more aggressive surgery, which recommended to personalize specific surgical strategies with multidisciplinary collaboration.
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Affiliation(s)
- Wenlong Yu
- Department of Orthopedic, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Dingbang Chen
- Department of Orthopedic Oncology, Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Xing Ding
- Department of Orthopedic, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Liang Qiao
- Department of Orthopedic, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Luosheng Zhang
- Department of Orthopedic Oncology, Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Xin Gao
- Department of Orthopedic Oncology, Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Yinjie Yan
- Department of Orthopedic, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Wen Mo
- Department of Orthopedic, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Junming Ma
- Department of Orthopedic, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Mengchen Yin
- Department of Orthopedic, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
- Department of Orthopedic Oncology, Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China.
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Burstein HJ, DeMichele A, Fallowfield L, Somerfield MR, Henry NL. Endocrine and Targeted Therapy for Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer-Capivasertib-Fulvestrant: ASCO Rapid Recommendation Update. J Clin Oncol 2024; 42:1450-1453. [PMID: 38478799 DOI: 10.1200/jco.24.00248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 04/19/2024] Open
Abstract
ASCO Rapid Recommendation Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options. Guidelines and updates are not intended to substitute for independent professional judgment of the treating provider and do not account for individual variation among patients. See appendix for disclaimers and other important information (Appendix 1 and Appendix 2, online only).
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10
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Su X, Zhao Z, Zhang W, Tian Y, Wang X, Yuan X, Tian S. Sedation versus general anesthesia on all-cause mortality in patients undergoing percutaneous procedures: a systematic review and meta-analysis. BMC Anesthesiol 2024; 24:126. [PMID: 38565990 PMCID: PMC10985877 DOI: 10.1186/s12871-024-02505-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The comparison between sedation and general anesthesia (GA) in terms of all-cause mortality remains a subject of ongoing debate. The primary objective of our study was to investigate the impact of GA and sedation on all-cause mortality in order to provide clarity on this controversial topic. METHODS A systematic review and meta-analysis were conducted, incorporating cohort studies and RCTs about postoperative all-cause mortality. Comprehensive searches were performed in the PubMed, EMBASE, and Cochrane Library databases, with the search period extending until February 28, 2023. Two independent reviewers extracted the relevant information, including the number of deaths, survivals, and risk effect values at various time points following surgery, and these data were subsequently pooled and analyzed using a random effects model. RESULTS A total of 58 studies were included in the analysis, with a majority focusing on endovascular surgery. The findings of our analysis indicated that, overall, and in most subgroup analyses, sedation exhibited superiority over GA in terms of in-hospital and 30-day mortality. However, no significant difference was observed in subgroup analyses specific to cerebrovascular surgery. About 90-day mortality, the majority of studies centered around cerebrovascular surgery. Although the overall pooled results showed a difference between sedation and GA, no distinction was observed between the pooled ORs and the subgroup analyses based on RCTs and matched cohort studies. For one-year all-cause mortality, all included studies focused on cardiac and macrovascular surgery. No difference was found between the HRs and the results derived from RCTs and matched cohort studies. CONCLUSIONS The results suggested a potential superiority of sedation over GA, particularly in the context of cardiac and macrovascular surgery, mitigating the risk of in-hospital and 30-day death. However, for the longer postoperative periods, this difference remains uncertain. TRIAL REGISTRATION PROSPERO CRD42023399151; registered 24 February 2023.
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Affiliation(s)
- Xuesen Su
- The First College for Clinical Medicine, Shanxi Medical University, No. 56 Xinjian South Road, Taiyuan, Shanxi, People's Republic of China
| | - Zixin Zhao
- College of Anesthesia, Shanxi Medical University, No. 56 Xinjian South Road, Taiyuan, Shanxi, People's Republic of China
| | - Wenjie Zhang
- Department of Anesthesiology, First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Taiyuan, Shanxi, People's Republic of China
| | - Yihe Tian
- John Muir College, University of California San Diego, 8775 Costa Verde Blvd, San Diego, CA, USA
| | - Xin Wang
- Department of Anesthesiology, First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Taiyuan, Shanxi, People's Republic of China
| | - Xin Yuan
- Department of Anesthesiology, First Hospital of Shanxi Medical University, No. 85 Jiefang South Road, Taiyuan, Shanxi, People's Republic of China
| | - Shouyuan Tian
- College of Anesthesia, Shanxi Medical University, No. 56 Xinjian South Road, Taiyuan, Shanxi, People's Republic of China.
- Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences No. 3, Workers' New Village, Xinghualing District, Taiyuan, Shanxi, People's Republic of China.
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Stephen E, Conway AE, Codispoti CD, Abrams E, Lieberman JA, Ledford D, Pongdee T, Shaker M. Patient-Centered Practice Guidelines: GRADEing Evidence to Incorporate Certainty, Balance Between Benefits and Harms, Equity, Feasibility, and Cost-Effectiveness. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00269-1. [PMID: 38467331 DOI: 10.1016/j.jaip.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 03/13/2024]
Abstract
The practice of medicine in recent years has emphasized the use of evidence-based clinical guidelines to help inform treatment decisions. Since its development in 2004, the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach has offered a systematic process for reviewing and summarizing the certainty of evidence found in the medical literature regarding various treatment options. To develop truly patient-centered care guidelines, this appraisal of the certainty of evidence must be combined with an understanding of the balance between benefits and harms, patient preferences, equity, feasibility, cost-effectiveness, and policy implications. This review examines each of these domains in detail, exploring the process and benefits of developing relevant, patient-focused guidelines directly applicable to the practice of modern medicine.
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Affiliation(s)
- Ellen Stephen
- Department of Internal Medicine, Division of Allergy, Rush University Medical Center, Chicago, Ill
| | | | - Christopher D Codispoti
- Department of Internal Medicine, Division of Allergy, Rush University Medical Center, Chicago, Ill
| | - Elissa Abrams
- Department of Pediatrics, Section of Allergy and Immunology, University of Manitoba, Winnipeg, Man, Canada
| | - Jay A Lieberman
- Department of Pediatrics, The University of Tennessee Health Sciences Center, Memphis, Tenn
| | - Dennis Ledford
- Division of Allergy and Immunology, Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Thanai Pongdee
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | - Marcus Shaker
- Department of Pediatrics and Internal Medicine, Dartmouth Geisel School of Medicine, Hanover, NH; Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Lebanon, NH.
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Bos S, Murray J, Marchetti M, Cheng GS, Bergeron A, Wolff D, Sander C, Sharma A, Badawy SM, Peric Z, Piekarska A, Pidala J, Raj K, Penack O, Kulkarni S, Beestrum M, Linke A, Rutter M, Coleman C, Tonia T, Schoemans H, Stolz D, Vos R. ERS/EBMT clinical practice guidelines on treatment of pulmonary chronic graft- versus-host disease in adults. Eur Respir J 2024; 63:2301727. [PMID: 38485149 DOI: 10.1183/13993003.01727-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/21/2024] [Indexed: 04/02/2024]
Abstract
Chronic graft-versus-host disease (cGvHD) is a common complication after allogeneic haematopoietic stem cell transplantation, characterised by a broad disease spectrum that can affect virtually any organ. Although pulmonary cGvHD is a less common manifestation, it is of great concern due to its severity and poor prognosis. Optimal management of patients with pulmonary cGvHD is complicated and no standardised approach is available. The purpose of this joint European Respiratory Society (ERS) and European Society for Blood and Marrow Transplantation task force was to develop evidence-based recommendations regarding the treatment of pulmonary cGvHD phenotype bronchiolitis obliterans syndrome in adults. A multidisciplinary group representing specialists in haematology, respiratory medicine and methodology, as well as patient advocates, formulated eight PICO (patient, intervention, comparison, outcome) and two narrative questions. Following the ERS standardised methodology, we conducted systematic reviews to address these questions and used the Grading of Recommendations Assessment, Development and Evaluation approach to develop recommendations. The resulting guideline addresses common therapeutic options (inhalation therapy, fluticasone-azithromycin-montelukast, imatinib, ibrutinib, ruxolitinib, belumosudil, extracorporeal photopheresis and lung transplantation), as well as other aspects of general management, such as lung functional and radiological follow-up and pulmonary rehabilitation, for adults with pulmonary cGvHD phenotype bronchiolitis obliterans syndrome. These recommendations include important advancements that could be incorporated in the management of adults with pulmonary cGvHD, primarily aimed at improving and standardising treatment and improving outcomes.
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Affiliation(s)
- Saskia Bos
- Dept of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John Murray
- Dept of Haematology and Transplant Unit, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Monia Marchetti
- Dept of Haematology, Azienda Ospedaliera Nazionale SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Guang-Shing Cheng
- Division of Clinical Research, Fred Hutchinson Cancer Research Center and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Washington, Seattle, WA, USA
| | - Anne Bergeron
- Dept of Pulmonology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Daniel Wolff
- Dept of Medicine III, Haematology and Oncology, University Hospital Regensburg, Regensberg, Germany
| | - Clare Sander
- Dept of Respiratory Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Akshay Sharma
- Dept of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sherif M Badawy
- Dept of Pediatrics, Division of Haematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zinaida Peric
- Dept of Haematology, University Hospital Zagreb, Zagreb, Croatia
- TCWP (Transplant Complications Working Party) of the EBMT
| | - Agnieszka Piekarska
- Dept of Haematology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - Joseph Pidala
- Dept of Medical Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Kavita Raj
- Dept of Haematology, University College London Hospital NHS Foundation Trust, London, UK
| | - Olaf Penack
- TCWP (Transplant Complications Working Party) of the EBMT
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Dept of Hematology, Oncology and Tumorimmunology, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Samar Kulkarni
- Dept of Haematology and Transplant Unit, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Molly Beestrum
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Matthew Rutter
- ERS Patient Advocacy Committee
- Dept of Respiratory Physiology, Addenbrooke's Hospital, Cambridge, UK
| | | | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Hélène Schoemans
- Dept of Haematology, University Hospitals Leuven, Leuven, Belgium
- Dept of Public Health and Primary Care, ACCENT VV, KU Leuven - University of Leuven, Leuven, Belgium
| | - Daiana Stolz
- Clinic of Respiratory Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Contributed equally as senior author
| | - Robin Vos
- Dept of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Contributed equally as senior author
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13
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Zhang Y, Zhang L. Current challenges with adherence to pharmacotherapy in allergic rhinitis. Expert Opin Pharmacother 2024; 25:335-338. [PMID: 38602452 DOI: 10.1080/14656566.2024.2336082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Yuan Zhang
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Luo Zhang
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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14
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Licina A, Silvers A, Thien C. Association between frailty and clinical outcomes in patients undergoing craniotomy-systematic review and meta-analysis of observational studies. Syst Rev 2024; 13:73. [PMID: 38396006 PMCID: PMC10885452 DOI: 10.1186/s13643-024-02479-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Frailty in patients undergoing craniotomy may affect perioperative outcomes. There have been a number of studies published in this field; however, evidence is yet to be summarized in a quantitative review format. We conducted a systematic review and meta-analysis to examine the effects of frailty on perioperative outcomes in patients undergoing craniotomy surgery. METHODS Our eligibility criteria included adult patients undergoing open cranial surgery. We searched MEDLINE via Ovid SP, EMBASE via Ovid SP, Cochrane Library, and grey literature. We included retrospective and prospective observational studies. Our primary outcome was a composite of complications as per the Clavien-Dindo classification system. We utilized a random-effects model of meta-analysis. We conducted three preplanned subgroup analyses: patients undergoing cranial surgery for tumor surgery only, patients undergoing non-tumor surgery, and patients older than 65 undergoing cranial surgery. We explored sources of heterogeneity through a sensitivity analysis and post hoc analysis. RESULTS In this review of 63,159 patients, the pooled prevalence of frailty was 46%. The odds ratio of any Clavien-Dindo grade 1-4 complication developing in frail patients compared to non-frail patients was 2.01 [1.90-2.14], with no identifiable heterogeneity and a moderate level of evidence. As per GradePro evidence grading methods, there was low-quality evidence for patients being discharged to a location other than home, length of stay, and increased mortality in frail patients. CONCLUSION Increased frailty was associated with increased odds of any Clavien-Dindo 1-4 complication. Frailty measurements may be used as an integral component of risk-assessment strategies to improve the quality and value of neurosurgical care for patients undergoing craniotomy surgery. ETHICS AND DISSEMINATION Formal ethical approval is not needed, as primary data were not collected. SYSTEMATIC REVIEW REGISTRATION PROSPERO identification number: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=405240.
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Affiliation(s)
- Ana Licina
- Victorian Heart Hospital, Melbourne, Victoria, Australia.
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15
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Riggioni C, Ricci C, Moya B, Wong D, van Goor E, Bartha I, Buyuktiryaki B, Giovannini M, Jayasinghe S, Jaumdally H, Marques-Mejias A, Piletta-Zanin A, Berbenyuk A, Andreeva M, Levina D, Iakovleva E, Roberts G, Chu D, Peters R, du Toit G, Skypala I, Santos AF. Systematic review and meta-analyses on the accuracy of diagnostic tests for IgE-mediated food allergy. Allergy 2024; 79:324-352. [PMID: 38009299 DOI: 10.1111/all.15939] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/28/2023]
Abstract
The European Academy of Allergy and Clinical Immunology (EAACI) is updating the Guidelines on Food Allergy Diagnosis. We aimed to undertake a systematic review of the literature with meta-analyses to assess the accuracy of diagnostic tests for IgE-mediated food allergy. We searched three databases (Cochrane CENTRAL (Trials), MEDLINE (OVID) and Embase (OVID)) for diagnostic test accuracy studies published between 1 October 2012 and 30 June 2021 according to a previously published protocol (CRD42021259186). We independently screened abstracts, extracted data from full texts and assessed risk of bias with QUADRAS 2 tool in duplicate. Meta-analyses were undertaken for food-test combinations for which three or more studies were available. A total of 149 studies comprising 24,489 patients met the inclusion criteria and they were generally heterogeneous. 60.4% of studies were in children ≤12 years of age, 54.3% were undertaken in Europe, ≥95% were conducted in a specialized paediatric or allergy clinical setting and all included oral food challenge in at least a percentage of enrolled patients, in 21.5% double-blind placebo-controlled food challenges. Skin prick test (SPT) with fresh cow's milk and raw egg had high sensitivity (90% and 94%) for milk and cooked egg allergies. Specific IgE (sIgE) to individual components had high specificity: Ara h 2-sIgE had 92%, Cor a 14-sIgE 95%, Ana o 3-sIgE 94%, casein-sIgE 93%, ovomucoid-sIgE 92/91% for the diagnosis of peanut, hazelnut, cashew, cow's milk and raw/cooked egg allergies, respectively. The basophil activation test (BAT) was highly specific for the diagnosis of peanut (90%) and sesame (93%) allergies. In conclusion, SPT and specific IgE to extracts had high sensitivity whereas specific IgE to components and BAT had high specificity to support the diagnosis of individual food allergies.
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Affiliation(s)
- Carmen Riggioni
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore City, Singapore
| | - Cristian Ricci
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-WEst University, Potchefstroom, South Africa
| | - Beatriz Moya
- Department of Allergy, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria, Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Dominic Wong
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Evi van Goor
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Elkerliek Hospital, Helmond, The Netherlands
| | - Irene Bartha
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Betul Buyuktiryaki
- Division of Pediatric Allergy, Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Sashini Jayasinghe
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Hannah Jaumdally
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Andreina Marques-Mejias
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Alexandre Piletta-Zanin
- Division of Pediatric Specialties, Department of Women, Children and Adolescents, Geneva University Hospitals, Geneva, Switzerland
| | - Anna Berbenyuk
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Margarita Andreeva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Daria Levina
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ekaterina Iakovleva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Graham Roberts
- Clinical and Experimental Sciences and Human Development in Health, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK
| | - Derek Chu
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Peters
- Murdoch Children's Research Institute Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - George du Toit
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Isabel Skypala
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Alexandra F Santos
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
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16
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Shaker M, Golden DBK. More than 80 years of excellence and collaboration in allergy … and just getting started. Ann Allergy Asthma Immunol 2024; 132:3-4. [PMID: 38123280 DOI: 10.1016/j.anai.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Marcus Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Medicine and Pediatrics, Dartmouth Geisel School of Medicine, Hanover, New Hampshire.
| | - David B K Golden
- Division of Allergy-Clinical Immunology, Johns Hopkins School of Medicine, Baltimore, Maryland
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17
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Singer EA, Rumble RB, Rathmell WK, Van Veldhuizen PJ. Management of Metastatic Renal Clear Cell Cancer: ASCO Guideline Rapid Recommendation Update. J Clin Oncol 2023; 41:5184-5186. [PMID: 37812756 DOI: 10.1200/jco.23.01977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 10/11/2023] Open
Abstract
ASCO Rapid Recommendation Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options. See the Appendix for disclaimers and other important information (Appendix 1 and Appendix 2, online only).
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Affiliation(s)
- Eric A Singer
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
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18
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Del Rivero J, Perez K, Kennedy EB, Mittra ES, Vijayvergia N, Arshad J, Basu S, Chauhan A, Dasari AN, Bellizzi AM, Gangi A, Grady E, Howe JR, Ivanidze J, Lewis M, Mailman J, Raj N, Soares HP, Soulen MC, White SB, Chan JA, Kunz PL, Singh S, Halfdanarson TR, Strosberg JR, Bergsland EK. Systemic Therapy for Tumor Control in Metastatic Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors: ASCO Guideline. J Clin Oncol 2023; 41:5049-5067. [PMID: 37774329 DOI: 10.1200/jco.23.01529] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 10/01/2023] Open
Abstract
PURPOSE To develop recommendations for systemic therapy for well-differentiated grade 1 (G1) to grade 3 (G3) metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs). METHODS ASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS Eight randomized controlled trials met the inclusion criteria for the systematic review. RECOMMENDATIONS Somatostatin analogs (SSAs) are recommended as first-line systemic therapy for most patients with G1-grade 2 (G2) metastatic well-differentiated GI-NETs. Observation is an option for patients with low-volume or slow-growing disease without symptoms. After progression on SSAs, peptide receptor radionuclide therapy (PRRT) is recommended as systematic therapy for patients with somatostatin receptor (SSTR)-positive tumors. Everolimus is an alternative second-line therapy, particularly in nonfunctioning NETs and patients with SSTR-negative tumors. SSAs are standard first-line therapy for SSTR-positive pancreatic (pan)NETs. Rarely, observation may be appropriate for asymptomatic patients until progression. Second-line systemic options for panNETs include PRRT (for SSTR-positive tumors), cytotoxic chemotherapy, everolimus, or sunitinib. For SSTR-negative tumors, first-line therapy options are chemotherapy, everolimus, or sunitinib. There are insufficient data to recommend particular sequencing of therapies. Patients with G1-G2 high-volume disease, relatively high Ki-67 index, and/or symptoms related to tumor growth may benefit from early cytotoxic chemotherapy. For G3 GEP-NETs, systemic options for G1-G2 may be considered, although cytotoxic chemotherapy is likely the most effective option for patients with tumor-related symptoms, and SSAs are relatively ineffective. Qualifying statements are provided to assist with treatment choice. Multidisciplinary team management is recommended, along with shared decision making with patients, incorporating their values and preferences, potential benefits and harms, and other characteristics and circumstances, such as comorbidities, performance status, geographic location, and access to care.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | - Sandip Basu
- Bhabha Atomic Research Centre, Tata Memorial Hospital, Mumbai, India
| | | | | | | | | | | | | | | | | | | | - Nitya Raj
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | - Simron Singh
- Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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19
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Blumenthal KG, Greenhawt M, Phillips EJ, Agmon-Levin N, Golden DBK, Shaker M. An Update in COVID-19 Vaccine Reactions in 2023: Progress and Understanding. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3305-3318. [PMID: 37414339 DOI: 10.1016/j.jaip.2023.06.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
It has been 3 years since the coronavirus disease 2019 (COVID-19) pandemic was initially declared, and 2 years have passed since the first COVID-19 vaccines were introduced. Since then, 13.2 billion COVID-19 vaccine doses have been administered worldwide, largely with multiple doses of messenger RNA vaccines. Although mild local and systemic adverse effects after COVID-19 vaccination are common, serious adverse effects following immunization are rare, particularly when compared with the large number of vaccine doses administered. Immediate and delayed reactions are relatively common and present similarly to allergic and hypersensitivity reactions. Despite this, reactions generally do not commonly recur, cause sequelae, or contraindicate revaccination. In this Clinical Management Review, we provide an updated perspective of COVID-19 vaccine reactions, their spectrum and epidemiology, and recommended approaches to evaluation and management.
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Affiliation(s)
- Kimberly G Blumenthal
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; The Mongan Institute, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Matthew Greenhawt
- Department of Pediatrics, Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Denver, Colo
| | - Elizabeth J Phillips
- Center for Drug Safety and Immunology, Departments of Medicine, Dermatology, Pharmacology, Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tenn
| | - Nancy Agmon-Levin
- The Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH
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20
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Wang M, Liu H, Chen Y, Yu J, Lin J, Sun Z, Li J, Bai G, Wen F, Xie Y, Wang J, Yang J, Li S. Guideline on treating community-acquired pneumonia with Chinese patent medicines. Pharmacol Res 2023; 196:106919. [PMID: 37722517 DOI: 10.1016/j.phrs.2023.106919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/20/2023]
Abstract
Community-acquired pneumonia (CAP) is one of the most common infectious diseases, and its morbidity and mortality increase with age. Resistance and mutations development make the use of anti-infective therapy challenging. Chinese patent medicines (CPMs) are often used to treat CAP in China and well tolerable. However, currently there are no evidence-based guideline for the treatment of CAP with CPMs, and the misuse of CPMs is common. Therefore, we established a guideline panel to develop this guideline. We identified six clinical questions through two rounds of survey, and we then systematically searched relevant evidence and performed meta-analyses, evidence summaries and GRADE decision tables to draft recommendations, which were then voted on by a consensus panel using the Delphi method. Finally, we developed ten recommendations based on evidence synthesis and expert consensus. For the treatment of severe CAP in adults, we recommend Tanreqing injection, Reduning injection, Xuebijing injection, Shenfu injection, and Shenmai injection respectively. For the treatment of non-severe CAP in adults, we recommend Tanreqing injection, Reduning injection, Lianhua Qingwen capsule/granule, Qingfei Xiaoyan Pill and Shufeng Jiedu capsule respectively. CPMs have great potential to help in the fight against CAP worldwide, but more high-quality studies are still needed to strengthen the evidence.
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Affiliation(s)
- Minghang Wang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450046, China; Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases co-constructed by Henan province & Education Ministry of P.R. China, Zhengzhou 450000, China
| | - Huiguo Liu
- Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yaolong Chen
- China Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730030, China; Chinese GRADE Center, Lanzhou, China
| | - Jiajie Yu
- Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610000, China; The Chinese Cochrane Center, Chengdu, China
| | | | - Zengtao Sun
- The Second Affiliated Hospital of Tianjin University of Chinese Medicine, Tianjin, China
| | - Jiansheng Li
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450046, China; Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases co-constructed by Henan province & Education Ministry of P.R. China, Zhengzhou 450000, China
| | - Gang Bai
- Nankai University, Tianjin 300193, China
| | - Fuqiang Wen
- Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610000, China; The Chinese Cochrane Center, Chengdu, China
| | - Yang Xie
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450046, China; Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases co-constructed by Henan province & Education Ministry of P.R. China, Zhengzhou 450000, China
| | - Jianxin Wang
- Standardization Project Management Office of China Association of Traditional Chinese Medicine, Beijing 100061, China
| | - Jiang Yang
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases co-constructed by Henan province & Education Ministry of P.R. China, Zhengzhou 450000, China
| | - Suyun Li
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450046, China; Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases co-constructed by Henan province & Education Ministry of P.R. China, Zhengzhou 450000, China.
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21
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Wang L, Peng JL, Chen AL. Effect of robotic-assisted gait training on gait and motor function in spinal cord injury: a protocol of a systematic review with meta-analysis. BMJ Open 2023; 13:e070675. [PMID: 37739462 PMCID: PMC10533792 DOI: 10.1136/bmjopen-2022-070675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/16/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Robotic-assisted gait training (RAGT) has been reported to be effective in rehabilitating patients with spinal cord injury (SCI). However, studies on RAGT showed different results due to a varied number of samples. Thus, summarising studies based on robotic-related factors is critical for the accurate estimation of the effects of RAGT on SCI. This work aims to search for strong evidence showing that using RAGT is effective in treating SCI and analyse the deficiencies of current studies. METHODS AND ANALYSIS The following publication databases were electronically searched in December 2022 without restrictions on publication year: MEDLINE, Cochrane Library, Web of Science, Embase, PubMed, the Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure. Various combinations of keywords, including 'motor disorders', 'robotics', 'robotic-assisted gait training', 'Spinal Cord Injuries', 'SCI' and 'gait analysis' were used as search terms. All articles on randomised controlled trials (excluding retrospective trials) using RAGT to treat SCI that were published in English and Chinese and met the inclusion criteria were included. Outcomes included motor function, and gait parameters included those assessed by using the instrumented gait assessment, the Berg Balance Scale, the 10-m walk speed test, the 6-min walk endurance test, the functional ambulation category scale, the Walking index of SCI and the American Spinal Injury Association assessment scale. Research selection, data extraction and quality assessment were conducted independently by two reviewers to ensure that all relevant studies were free from personal bias. In addition, the Cochrane risk-of-bias assessment tool was used to assess the risk of bias. Review Manager V.5.3 software was used to produce deviation risk maps and perform paired meta-analyses. ETHICS AND DISSEMINATION Ethics approval is not required for systematic reviews and network meta-analyses. The results will be submitted to a peer-reviewed journal or presented at a conference. PROSPERO REGISTRATION NUMBER CRD42022319555.
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Affiliation(s)
- Lei Wang
- Department of Rehabilitation Medicine, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Jin-Lin Peng
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ai-Lian Chen
- Department of Rehabilitation Medicine, Hunan Provincial People's Hospital, Changsha, Hunan, China
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22
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de'Angelis N, Schena CA, Marchegiani F, Reitano E, De Simone B, Wong GYM, Martínez-Pérez A, Abu-Zidan FM, Agnoletti V, Aisoni F, Ammendola M, Ansaloni L, Bala M, Biffl W, Ceccarelli G, Ceresoli M, Chiara O, Chiarugi M, Cimbanassi S, Coccolini F, Coimbra R, Di Saverio S, Diana M, Dioguardi Burgio M, Fraga G, Gavriilidis P, Gurrado A, Inchingolo R, Ingels A, Ivatury R, Kashuk JL, Khan J, Kirkpatrick AW, Kim FJ, Kluger Y, Lakkis Z, Leppäniemi A, Maier RV, Memeo R, Moore EE, Ordoñez CA, Peitzman AB, Pellino G, Picetti E, Pikoulis M, Pisano M, Podda M, Romeo O, Rosa F, Tan E, Ten Broek RP, Testini M, Tian Wei Cheng BA, Weber D, Sacco E, Sartelli M, Tonsi A, Dal Moro F, Catena F. 2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery. World J Emerg Surg 2023; 18:45. [PMID: 37689688 PMCID: PMC10492308 DOI: 10.1186/s13017-023-00513-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/21/2023] [Indexed: 09/11/2023] Open
Abstract
Iatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France
- Faculty of Medicine, University of Paris Cité, Paris, France
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France.
| | - Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France
| | - Elisa Reitano
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Research Institute Against Digestive Cancer (IRCAD), 67000, Strasbourg, France
| | - Belinda De Simone
- Department of Minimally Invasive Surgery, Guastalla Hospital, AUSL-IRCCS Reggio, Emilia, Italy
| | - Geoffrey Yuet Mun Wong
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
| | - Aleix Martínez-Pérez
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Vanni Agnoletti
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Filippo Aisoni
- Department of Morphology, Surgery and Experimental Medicine, Università Degli Studi Di Ferrara, Ferrara, Italy
| | - Michele Ammendola
- Science of Health Department, Digestive Surgery Unit, University "Magna Graecia" Medical School, Catanzaro, Italy
| | - Luca Ansaloni
- Department of General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Miklosh Bala
- Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, Jerusalem, Israel
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Graziano Ceccarelli
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Italy
| | - Marco Ceresoli
- General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Riverside, CA, USA
| | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | - Michele Diana
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Research Institute Against Digestive Cancer (IRCAD), 67000, Strasbourg, France
| | | | - Gustavo Fraga
- Department of Trauma and Acute Care Surgery, University of Campinas, Campinas, Brazil
| | - Paschalis Gavriilidis
- Department of HBP Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Angela Gurrado
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | - Riccardo Inchingolo
- Unit of Interventional Radiology, F. Miulli Hospital, 70021, Acquaviva Delle Fonti, Italy
| | - Alexandre Ingels
- Department of Urology, Henri Mondor Hospital, University of Paris Est Créteil (UPEC), 94000, Créteil, France
| | - Rao Ivatury
- Professor Emeritus, Virginia Commonwealth University, Richmond, VA, USA
| | - Jeffry L Kashuk
- Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, University of Portsmouth, Southwick Hill Road, Cosham, Portsmouth, UK
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, EG23T2N 2T9, Canada
| | - Fernando J Kim
- Division of Urology, Denver Health Medical Center, Denver, CO, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology - Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ronald V Maier
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Riccardo Memeo
- Unit of Hepato-Pancreato-Biliary Surgery, General Regional Hospital "F. Miulli", Acquaviva Delle Fonti, Bari, Italy
| | - Ernest E Moore
- Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Carlos A Ordoñez
- Division of Trauma and Acute Care Surgery, Fundación Valle del Lili, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Gianluca Pellino
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Manos Pikoulis
- 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Michele Pisano
- 1st General Surgery Unit, Department of Emergency, ASST Papa Giovanni Hospital Bergamo, Bergamo, Italy
| | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | | | - Fausto Rosa
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | | | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Emilio Sacco
- Department of Urology, Università Cattolica del Sacro Cuore Di Roma, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Alfredo Tonsi
- Digestive Diseases Department, Royal Sussex County Hospital, University Hospitals Sussex, Brighton, UK
| | - Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy.
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23
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Yanchar N, Tardif PA, Freire G, Bérubé M, Stelfox HT, Beaudin M, Stang A, Beno S, Weiss M, Labrosse M, Zemek R, Gagnon IJ, Beaulieu E, Berthelot S, Turgeon AF, Lauzier F, Gabbe B, Moore L. Clinical practice guideline recommendations for pediatric solid organ injury care: A Systematic Review. J Trauma Acute Care Surg 2023; 95:442-450. [PMID: 37272747 DOI: 10.1097/ta.0000000000004015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Observed variations in the management of pediatric solid organ injuries (SOIs) may be due to difficulty in finding and integrating recommendations from multiple clinical practice guidelines (CPGs) with heterogeneous methodological approaches. We aimed to systematically review CPG recommendations for pediatric SOIs. METHODS We conducted a systematic review of CPGs including at least one recommendation targeting pediatric SOI populations, using Medical Analysis and Retrieval System Online, Excerpta Medica dataBASE, Web of Science, and websites of clinical organizations. Pairs of reviewers independently assessed eligibility, extracted data, and evaluated the quality of CPGs using the Appraisal of Guidelines Research and Evaluation II tool. We synthesized recommendations from moderate to high-quality CPGs using a recommendations matrix based on Grades of Recommendation, Assessment, Development, and Evaluation criteria. RESULTS We identified eight CPGs, including three rated moderate or high quality. Methodological weaknesses included lack of stakeholder involvement beyond surgeons, consideration of applicability (e.g., implementation tools), and clarity around the definition of pediatric populations. Five of the 15 recommendations from moderate to high-quality CPGs were based on moderate quality evidence or were rated as strong; these reflected nonoperative management and angioembolization for renal injuries and required length of stay for liver and spleen injuries. CONCLUSION We identified 15 recommendations on pediatric SOI management from 3 moderate or high-quality CPGs, but only one third were based on at least moderate-quality evidence or were rated as strong. Our results prompt the following recommendations for future CPG development or updates: (1) include all types of clinicians involved in the care of pediatric SOIs and patient and family representatives in the process, (2) develop clear definitions of the target population, and (3) provide advice and tools to promote implementation. Results also underline the urgent need for more rigorous research to support strong evidence-based recommendations in this population. LEVEL OF EVIDENCE Systematic Review/Meta-analysis; Level III.
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Affiliation(s)
- Natalie Yanchar
- From the Department of Surgery (N.Y.), University of Calgary, Calgary; Population Health and Optimal Health Practices Research Unit (P.-A.T., M.B., S.B., A.F.T., F.L., L.M.), Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus); Department of Social and Preventative Medicine (L.M.), Université Laval, Quebec City, Quebec; Division of Emergency Medicine, Department of Paediatrics (G.F.), University of Toronto, Toronto; Faculty of Nursing (M.Bérubé), Université Laval, Quebec City, Quebec; Departments of Critical Care Medicine (H.T.S.), Medicine (H.T.S.), and Community Health Sciences (H.T.S.), O'Brien Institute for Public Health, University of Calgary, Calgary; Department of Paediatric Surgery (M.Beaudin), Sainte-Justine Hospital, Université de Montréal, Montreal, Quebec; Pediatrics, Emergency Medicine, and Community Health Sciences (A.S.), Cumming School of Medicine, University of Calgary, Calgary, Alberta; Division of Emergency Medicine (S.B.), Hospital for Sick Children, University of Toronto, Toronto, Ontario; Centre Mère-Enfant Soleil du CHU de Québec (M.W.), Transplant Quebec, Quebec City, Quebec; Division of Emergency Medicine, Department of Pediatrics (M.L.), CHU Sainte-Justine, Université de Montréal, Montreal; Department of Pediatrics (R.Z.), Children's Hospital of Eastern Ontario, Ottawa; Division of Pediatric Emergency Medicine (I.J.G.), McGill University Health Centre, Montreal Children's Hospital, Montréal; Département de Pédiatrie (E.B.), Faculté de Médecine, Centre Hospitalier Universitaire de Québec, and Department of Anesthesiology and Critical Care Medicine (A.F.T., F.L.), Division of Critical Care Medicine, Université Laval, Quebec City, Quebec, Canada; and School of Public Health and Preventive Medicine (B.G.), Monash University, Melbourne, Victoria, Australia
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Greenhawt M, Dribin TE, Abrams EM, Shaker M, Chu DK, Golden DBK, Akin C, Anagnostou A, ALMuhizi F, Alqurashi W, Arkwright P, Baldwin JL, Banerji A, Bégin P, Ben-Shoshan M, Bernstein J, Bingemann TA, Bindslev-Jensen C, Blumenthal K, Byrne A, Cahill J, Cameron S, Campbell D, Campbell R, Cavender M, Chan ES, Chinthrajah S, Comberiati P, Eastman JJ, Ellis AK, Fleischer DM, Fox A, Frischmeyer-Guerrerio PA, Gagnon R, Garvey LH, Grayson MH, Isabwe GAC, Hartog N, Hendron D, Horner CC, Hourihane JO, Iglesia E, Kan M, Kaplan B, Katelaris CH, Kim H, Kelso JM, Khan DA, Lang D, Ledford D, Levin M, Lieberman JA, Loh R, Mack DP, Mazer B, Mody K, Mosnaim G, Munblit D, Mustafa SS, Nanda A, Nathan R, Oppenheimer J, Otani IM, Park M, Pawankar R, Perrett KP, Peter J, Phillips EJ, Picard M, Pitlick M, Ramsey A, Rasmussen TH, Rathkopf MM, Reddy H, Robertson K, Rodriguez Del Rio P, Sample S, Sheshadri A, Sheik J, Sindher SB, Spergel JM, Stone CA, Stukus D, Tang MLK, Tracy JM, Turner PJ, Vander Leek TK, Wallace DV, Wang J, Wasserman S, Weldon D, Wolfson AR, Worm M, Yacoub MR. Updated guidance regarding the risk of allergic reactions to COVID-19 vaccines and recommended evaluation and management: A GRADE assessment and international consensus approach. J Allergy Clin Immunol 2023; 152:309-325. [PMID: 37295474 PMCID: PMC10247143 DOI: 10.1016/j.jaci.2023.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
This guidance updates 2021 GRADE (Grading of Recommendations Assessment, Development and Evaluation) recommendations regarding immediate allergic reactions following coronavirus disease 2019 (COVID-19) vaccines and addresses revaccinating individuals with first-dose allergic reactions and allergy testing to determine revaccination outcomes. Recent meta-analyses assessed the incidence of severe allergic reactions to initial COVID-19 vaccination, risk of mRNA-COVID-19 revaccination after an initial reaction, and diagnostic accuracy of COVID-19 vaccine and vaccine excipient testing in predicting reactions. GRADE methods informed rating the certainty of evidence and strength of recommendations. A modified Delphi panel consisting of experts in allergy, anaphylaxis, vaccinology, infectious diseases, emergency medicine, and primary care from Australia, Canada, Europe, Japan, South Africa, the United Kingdom, and the United States formed the recommendations. We recommend vaccination for persons without COVID-19 vaccine excipient allergy and revaccination after a prior immediate allergic reaction. We suggest against >15-minute postvaccination observation. We recommend against mRNA vaccine or excipient skin testing to predict outcomes. We suggest revaccination of persons with an immediate allergic reaction to the mRNA vaccine or excipients be performed by a person with vaccine allergy expertise in a properly equipped setting. We suggest against premedication, split-dosing, or special precautions because of a comorbid allergic history.
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Affiliation(s)
- Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
| | - Timothy E Dribin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Immunology, The University of Manitoba, Winnipeg, Canada
| | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Dartmouth Geisel School of Medicine, Hanover, NH
| | - Derek K Chu
- Faculty of Medicine, and the Department of McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada; The Research Institute of St. Joe's Hamilton, Hamilton, Canada; Evidence in Allergy Group, McMaster University Medical Centre, Hamilton, Canada
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Bethesda
| | - Cem Akin
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan School, Ann Arbor, Mich
| | - Akterini Anagnostou
- Section of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Tex
| | - Faisal ALMuhizi
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Security Forces Hospital Program, Riyadh, Arabia
| | - Waleed Alqurashi
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Arkwright
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom
| | - James L Baldwin
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan School, Ann Arbor, Mich
| | - Aleena Banerji
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Philippe Bégin
- Centre Hospital Universitaire Sainte-Justine, Montreal, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center-Montreal Children's Hospital, Montreal, Canada
| | - Jonathan Bernstein
- Division of Immunology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Theresa A Bingemann
- Division of Allergy, Immunology, and Rheumatology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Center, Odense Research Centre for Anaphylaxis, Odense, Denmark
| | - Kim Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Aideen Byrne
- Department of Paediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Julia Cahill
- University of Alberta, Faculty of Medicine, Calgary, Canada
| | - Scott Cameron
- Allergy Victoria, Victoria, British Columbia, Canada
| | | | - Ronna Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester
| | | | - Edmond S Chan
- Division of Allergy and Immunology, BC Children's Hospital, The University of British Columbia, Vancouver, Canada
| | - Sharon Chinthrajah
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, Calif
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Jacqueline J Eastman
- Corewell Health Allergy and Immunology, Grand Rapids, Mich; Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | - David M Fleischer
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Adam Fox
- Guys's and St Tomas's Hospital National Health Service Foundation Trust, London, Mass
| | - Pamela A Frischmeyer-Guerrerio
- Laboratory of Allergic Diseases, Food Allergy Research Section, National Institutes of Allergy and Infectious Diseases, the National Institutes of Health, Bethesda, Md
| | - Remi Gagnon
- Clinique Spécialisée en Allergie de la Capitale, Québec, Canada
| | - Lene H Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mitchell H Grayson
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ghislaine Annie Clarisse Isabwe
- Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center-Montreal Children's Hospital, Montreal, Canada
| | - Nicholas Hartog
- Corewell Health Allergy and Immunology, Grand Rapids, Mich; Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - David Hendron
- Access Health Care Physicians LLC, New Port Richey, Fla
| | - Caroline C Horner
- Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Mo
| | | | - Edward Iglesia
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | | | - Blanka Kaplan
- Division of Allergy and Immunology, Northwell Health, New York, NY
| | | | - Harold Kim
- Faculty of Medicine, and the Department of McMaster University, Hamilton, Canada; Division of Clinical Immunology and Allergy, Department of Medicine, Western University, St Joseph's Health Care, London (Canada), Mass
| | - John M Kelso
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
| | - David A Khan
- Division of Allergy and Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - David Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dennis Ledford
- Division of Allergy and Immunology, Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Michael Levin
- Division of Paediatric Allergology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jay A Lieberman
- Division of Allergy and Immunology, The University of Tennessee, Memphis, Tenn
| | - Richard Loh
- Immunology Department, Perth Children's Hospital, Perth, Australia
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Canada; Halton Pediatric Allergy, Burlington, Canada
| | - Bruce Mazer
- Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center-Montreal Children's Hospital, Montreal, Canada
| | - Ketan Mody
- Elite Sports Medicine Institute Ltd, Westmont, Ill
| | - Gisele Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill
| | - Daniel Munblit
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, Mass
| | - S Shahzad Mustafa
- Rochester Regional Health, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Anil Nanda
- Division of Allergy and Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Tex; Asthma and Allergy Center, Lewisville and Flower Mound, Dallas, Tex
| | | | - John Oppenheimer
- University of Medicine and Dentistry of New Jersey, Rutgers University School of Medicine, New Brunswick, NJ
| | - Iris M Otani
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, Calif
| | - Miguel Park
- Division of Allergic Diseases, Mayo Clinic, Rochester
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Kirsten P Perrett
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill; Population Allergy Group and the Centre for Food and Allergy Research, Murdoch Children's Research Institute, University of Melbourne, University of Melbourne, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Jonny Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town and the Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town
| | - Elizabeth J Phillips
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Matthieu Picard
- Hôspital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada
| | | | - Allison Ramsey
- Rochester Regional Health, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Trine Holm Rasmussen
- Department of Dermatology and Allergy Center, Odense Research Centre for Anaphylaxis, Odense, Denmark
| | | | - Hari Reddy
- Allergy, Asthma and Immunology Center of Alaska, Anchorage, Alaska; Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash
| | - Kara Robertson
- Division of Clinical Immunology and Allergy, St Joseph's Health Care, London (Canada), Mass; Schulich School of Medicine and Dentistry, Western University, St Joseph's Health Care, London (Canada), Mass
| | | | | | - Ajay Sheshadri
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Javed Sheik
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, Calif
| | - Sayantani B Sindher
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, Calif
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Cosby A Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - David Stukus
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Mimi L K Tang
- Department of Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - James M Tracy
- Allergy, Asthma, and Immunology Associates PC, Omaha, Neb; Department of Pediatrics, University of Nebraska School of Medicine, Omaha, Neb
| | - Paul J Turner
- Imperial College Healthcare National Health Service Trust, London, Mass; Royal Brompton and Harefield National Health Service Foundation Trust, London, Mass
| | - Timothy K Vander Leek
- Pediatric Allergy and Immunology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Dana V Wallace
- Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, Fla
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY; Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Susan Wasserman
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Canada
| | - David Weldon
- Baylor Scott and White Clinic, College Station, Tex
| | - Anna R Wolfson
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Margitta Worm
- Division of Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mona-Rita Yacoub
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Segrate, Milan, Italy
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Vasiliu O. Therapeutic management of atypical antipsychotic‑related metabolic dysfunctions using GLP‑1 receptor agonists: A systematic review. Exp Ther Med 2023; 26:355. [PMID: 37324512 PMCID: PMC10265718 DOI: 10.3892/etm.2023.12054] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Metabolic disorders (MDs) like obesity, dyslipidemia, and type 2 diabetes are more frequently observed in patients diagnosed with psychiatric disorders undergoing treatment with antipsychotics, particularly atypical agents, than in the general population. The second generation of antidiabetics (SGAD) has been associated with cardiovascular benefits in large clinical trials which represent an important advantage over first-generation agents and might be of interest in the psychiatric population where multiple risk factors for cardiovascular disease (e.g., smoking, lack of exercise, and lack of healthy diet) are common occurrences. Therefore, this systematic review focused on the evaluation of the glucagon-like peptide-1 receptor agonists (GLP1-RAs), as a representative of the SGAD, to determine whether these agents may be recommended in patients with psychiatric disorders and MDs. For analysis, three electronic databases and clinical trial registers were explored for papers published between January 2000 and November 2022. After applying the inclusion and exclusion criteria, 20 clinical and preclinical trials, therapeutic guidelines, and meta-analyses were reviewed, and clinical recommendations were formulated. The large majority of the reviewed data (nine papers) were graded 'moderate' based on the GRADE criteria. The efficacy and tolerability of liraglutide and exenatide in the management of antipsychotic-induced MDs were supported by evidence of average quality, while the results regarding other GLP-1RAs were not sufficient to formulate a recommendation for their administration in this specific population. Clozapine and olanzapine had the most negative consequences on body weight, glycemic, and lipid metabolism. Therefore, careful monitoring of metabolic parameters is required when these are prescribed. Liraglutide and exenatide may be recommended as augmentative agents to metformin therapy, especially in patients receiving these two atypical antipsychotics, but most of the reviewed data supported the efficacy of GLP-1RAs only during the treatment administration. The two follow-up studies retrieved in the literature reported modest effects after GLP-1RA discontinuation after 1 year; therefore, long-term monitoring of metabolic parameters is required. More research is needed, and three randomized clinical trials are already ongoing, to evaluate the effects of GLP-1RAs in decreasing body weight, but also on other important metabolic variables, such as HbA1c status, fasting glucose levels, and lipid levels in patients receiving antipsychotic treatment.
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Affiliation(s)
- Octavian Vasiliu
- Department of Psychiatry, 'Dr. Carol Davila' University Emergency Central Military Hospital, 010816 Bucharest, Romania
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Ferrante AN, Keller BK, Flury JS, Harnik MA, grosse Holtforth M, Wertli MM. Effectiveness of Communication Strategies in the Management of Chronic Postsurgical Pain: Protocol for a Systematic Review and Meta-Analysis. J Pain Res 2023; 16:1907-1913. [PMID: 37303695 PMCID: PMC10254707 DOI: 10.2147/jpr.s401685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/13/2023] [Indexed: 06/13/2023] Open
Abstract
Purpose To describe the details of a systematic review to assess the current evidence about the efficacy of communication strategies on the prevention of chronic postsurgical pain (CPSP). Methods The protocol for this systematic review was based on the Cochrane Handbook methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) recommendations. A systematic search of the literature on electronic databases Medline, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science (from the inception to 19 June 2022) was carried out using predefined search terms to identify relevant studies. This review will include randomized clinical trials or observational studies. The search strategy consisted of keywords and index terms related to "clinician", "communication" or "post-surgical pain". Inclusion criteria are as follows: randomized clinical trials or observational studies using a parallel group design that assess the efficacy of communication interventions in patients undergoing surgery and that assess pain and pain-related disability. We considered interventions that included any type of written, verbal, and non-verbal communication in combination with other interventions or without. Control groups may include no communication intervention or another intervention distinctly different. We excluded studies with follow-up duration of less than 3 months, patients aged <18 years, and studies for which no reviewer had language proficiency (eg, Chinese, Korean). Descriptive statistics will be used to summarize quantitative findings. Meta-analysis will only be considered if at least three studies used the same outcome with comparable interventions, as we expect a wide heterogeneity of study population and settings. Conclusion This systematic review and meta-analysis will be an important source for clinicians and researchers to understand the influence of communication to prevent CPSP. Study Registration This protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO). Registration number: CRD42021241596.
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Affiliation(s)
- Asha-Naima Ferrante
- Department of General Internal Medicine, University Hospital of Bern, Inselspital, University of Bern, Bern, 3010, Switzerland
- Department of Psychology, University of Bern, Bern, 3012, Switzerland
| | - Barbara K Keller
- Department of General Internal Medicine, University Hospital of Bern, Inselspital, University of Bern, Bern, 3010, Switzerland
| | - Julian S Flury
- Department of General Internal Medicine, University Hospital of Bern, Inselspital, University of Bern, Bern, 3010, Switzerland
| | - Michael A Harnik
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin grosse Holtforth
- Department of Psychology, University of Bern, Bern, 3012, Switzerland
- Psychosomatic Competence Center, University Hospital of Bern, Inselspital, University of Bern, Bern, 3010, Switzerland
| | - Maria M Wertli
- Department of General Internal Medicine, University Hospital of Bern, Inselspital, University of Bern, Bern, 3010, Switzerland
- Department of Internal Medicine, Kantonsspital Baden, Baden, 5404, Switzerland
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Burstein HJ, DeMichele A, Somerfield MR, Henry NL. Testing for ESR1 Mutations to Guide Therapy for Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer: ASCO Guideline Rapid Recommendation Update. J Clin Oncol 2023:JCO2300638. [PMID: 37196213 DOI: 10.1200/jco.23.00638] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 05/19/2023] Open
Abstract
ASCO Rapid Recommendations Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options. See the Appendix for disclaimers and other important information (Appendix 1 and Appendix 2, online only).
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Zeng G, Zhong W, Chaussy CG, Tiselius HG, Xu C, Turney B, Turk C, Tailly GG, Preminger GM, Akpinar H, Petrik A, Bernardo N, Wiseman O, Farahat Y, Budia A, Jones DK, Beltran Suarez E, De Marco F, Mazzon G, Lv J, Natchagande G, Guven S, Ibrahim TAA, Xu H, Xie L, Ye Z, Sarica K. International Alliance of Urolithiasis Guideline on Shockwave Lithotripsy. Eur Urol Focus 2023; 9:513-523. [PMID: 36435718 DOI: 10.1016/j.euf.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/04/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022]
Abstract
Different international associations have proposed their own guidelines on urolithiasis. However, the focus is primarily on an overview of the principles of urolithiasis management rather than step-by-step technical details for the procedure. The International Alliance of Urolithiasis (IAU) is releasing a series of guidelines on the management of urolithiasis. The current guideline on shockwave lithotripsy (SWL) is the third in the IAU guidelines series and provides a clinical framework for urologists and technicians performing SWL. A total of 49 recommendations are summarized and graded, covering the following aspects: indications and contraindications; preoperative patient evaluation; preoperative medication; prestenting; intraoperative analgesia or anesthesia; intraoperative position; stone localization and monitoring; machine and energy settings; intraoperative lithotripsy strategies; auxiliary therapy following SWL; evaluation of stone clearance; complications; and quality of life. The recommendations, tips, and tricks regarding SWL procedures summarized here provide important and necessary guidance for urologists along with technicians performing SWL. PATIENT SUMMARY: For kidney and urinary stones of less than 20 mm in size, shockwave lithotripsy (SWL) is an approach in which the stone is treated with shockwaves applied to the skin, without the need for surgery. Our recommendations on technical aspects of the procedure provide guidance for urologists and technicians performing SWL.
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Affiliation(s)
- Guohua Zeng
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China.
| | - Wen Zhong
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Christian G Chaussy
- University of Munich, Munich, Germany; University of Regensburg, Regensburg, Germany
| | - Hans Göran Tiselius
- Division of Urology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Changbao Xu
- The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ben Turney
- Department of Urology, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Christian Turk
- Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria
| | | | - Glenn M Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Haluk Akpinar
- Department of Urology, Florence Nightingale Hospitals Group, Istanbul, Turkey
| | - Ales Petrik
- Department of Urology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Norberto Bernardo
- Department of Urology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | - Oliver Wiseman
- Department of Urology, Cambridge University Hospitals, Cambridge, UK
| | - Yasser Farahat
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Alberto Budia
- Department of Urology, La Fe Polytechnic University Hospital, Valencia, Spain
| | - David K Jones
- Department of Pharmacology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Edgar Beltran Suarez
- Department of Urology, Specialty Hospital La Raza, National Medical Center of the Mexican Institute of Social Security, Mexico City, Mexico
| | - Ferdinando De Marco
- Urology Division, Istituto Neurotraumatologico Italiano-Grottaferrata, Rome, Italy
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Jianlin Lv
- Department of Urology, Jiangning Hospital, Nanjing Medical University, Nanjing, China
| | | | - Selcuk Guven
- Urology Department, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | | | - Hanfeng Xu
- Department of Urology, First Affiliated Hospital of University of South China, Henyang, China
| | - Lei Xie
- Department of Urology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kemal Sarica
- Department of Urology, Biruni University Medical School, Istanbul, Turkey.
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Wang L, Li KP, Liu Y, Yin S, Zhu PY. Perioperative and oncologic outcomes of transperitoneal versus retroperitoneal laparoscopic radical nephrectomy for large-volume renal carcinoma (> 7 cm): a systematic review and pooled analysis of comparative outcomes. World J Surg Oncol 2023; 21:86. [PMID: 36894912 PMCID: PMC9997016 DOI: 10.1186/s12957-023-02967-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Recently, there has been a significant amount of debate concerning the question of whether laparoscopic surgery should be performed transperitoneally or retroperitoneally for treating large renal tumors. AIM The purpose of this research is to conduct a comprehensive review and meta-analysis of the previous research on the safety and efficacy of transperitoneal laparoscopic radical nephrectomy (TLRN) and retroperitoneal laparoscopic radical nephrectomy (RLRN) in the treatment of large-volume renal malignancies. METHODS An extensive search of the scientific literature was carried out utilizing PubMed, Scopus, Embase, SinoMed, and Google Scholar in order to locate randomized controlled trials (RCTs) and prospective and retrospective studies that compared the effectiveness of RLRN versus TLRN in the treatment of for large renal malignancies. For the purpose of comparing the oncologic and perioperative outcomes of the two techniques, data were taken from the research studies that were included and pooled together. RESULTS A total of 14 studies (five RCTs and nine retrospective studies) were incorporated into this meta-analysis. The overall RLRN had an association with significantly shorter operating time (OT) (MD [mean difference]: - 26.57; 95% CI [confidence interval]: - 33.39 to - 19.75; p < 0.00001); less estimated blood loss (EBL) (MD: - 20.55; CI: - 32.86 to - 8.23; p = 0.001); faster postoperative intestinal exhaust (MD: - 0.65; CI: - 0.95 to - 0.36; p < 0.00001). The terms of length of stay (LOS) (p = 0.26), blood transfusion (p = 0.26), conversion rate (p = 0.26), intraoperative complications (p = 0.5), postoperative complications (p = 0.18), local recurrence rate (p = 0.56), positive surgical margin (PSM) (p = 0.45), and distant recurrence rate (p = 0.7) did not show any differences. CONCLUSIONS RLRN provides surgical and oncologic results similar to TLRN, with potential advantages regarding shorter OT, EBL, and postoperative intestinal exhaust. Due to the high heterogeneity among the studies, long-term randomized clinical trials are required to obtain more definitive results.
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Affiliation(s)
- Li Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Kun-Peng Li
- Department of Urology, Affiliated Hospital of Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Ying Liu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Shan Yin
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Ping-Yu Zhu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
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A Synopsis of Guidance for Allergic Rhinitis Diagnosis and Management From ICAR 2023. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:773-796. [PMID: 36894277 DOI: 10.1016/j.jaip.2023.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 03/09/2023]
Abstract
An updated edition of the International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR) has recently been published. This consensus document, which included the participation of 87 primary authors and 40 additional consultant authors, who critically appraised evidence on 144 individual topics concerning allergic rhinitis, provides guidance for health care providers using the evidence-based review with recommendations (EBRR) methodology. This synopsis highlights topical areas including pathophysiology, epidemiology, disease burden, risk and protective factors, evaluation and diagnosis, aeroallergen avoidance and environmental controls, single and combination pharmacotherapy options, allergen immunotherapy (subcutaneous, sublingual, rush, cluster), pediatric considerations, alternative and emerging therapies, and unmet needs. Based on the EBRR methodology, ICAR:AR includes strong recommendations for the treatment of allergic rhinitis: (1) for the use of newer generation antihistamines compared with first-generation alternatives, intranasal corticosteroid, intranasal saline, combination therapy with intranasal corticosteroid plus intranasal antihistamine for patients not responding to monotherapy, and subcutaneous immunotherapy and sublingual tablet immunotherapy in properly selected patients; (2) against the use of oral decongestant monotherapy and routine use of oral corticosteroids.
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Bouça-Machado T, Bouwense SAW, Brand M, Demir IE, Frøkjær JB, Garg P, Hegyi P, Löhr JM, de-Madaria E, Olesen SS, Pandanaboyana S, Pedersen JB, Rebours V, Sheel A, Singh V, Smith M, Windsor JA, Yadav D, Drewes AM. Position statement on the definition, incidence, diagnosis and outcome of acute on chronic pancreatitis. Pancreatology 2023; 23:143-150. [PMID: 36746714 DOI: 10.1016/j.pan.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/09/2023] [Accepted: 01/23/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Acute on chronic pancreatitis (ACP) is a relatively common condition, but there are significant gaps in our knowledge on the definition, incidence, diagnosis, treatment and prognosis. METHODS A systematic review that followed PICO (Population; Intervention; Comparator; Outcome) recommendation for quantitative questions and PICo (Population, Phenomenon of Interest, Context) for qualitative research was done to answer 10 of the most relevant questions about ACP. Quality of evidence was judged by the GRADE criteria (Grades of Recommendation, Assessment, Development and Evaluation). The manuscript was sent for review to 12 international experts from various disciplines and continents using a Delphi process. RESULTS The quality of evidence, for most statements, was low to very low, which means that the recommendations in general are only conditional. Despite that, it was possible to reach strong levels of agreement by the expert panel for all 10 questions. A new consensus definition of ACP was reached. Although common, the real incidence of ACP is not known, with alcohol as a major risk factor. Although pain dominates, other non-specific symptoms and signs can be present. Serum levels of pancreatic enzymes may be less than 3 times the upper limit of normal and cross-sectional imaging is considered more accurate for the diagnosis in many cases. It appears that it is less severe and with a lower mortality risk than acute pancreatitis. CONCLUSIONS Although the evidence base is poor, this position statement provides a foundation from which to advance management of ACP.
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Affiliation(s)
| | - Stefan A W Bouwense
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Martin Brand
- Department of Surgery, University of Pretoria, Pretoria, South Africa
| | - Ihsan Ekin Demir
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Pramod Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary. Centre for Translational Medicine, Division of Pancreatic Diseases, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - J-Matthias Löhr
- Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Enrique de-Madaria
- Gastroenterology Department, Dr. Balmis General University Hospital, ISABIAL, Alicante, Spain
| | - Søren Schou Olesen
- Mech-Sense & Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Jan Bech Pedersen
- Department of Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Vinciane Rebours
- Pancreatology Department and Digestive Oncology, Beaujon Hospital, AP-HP, Clichy, Paris-Cité University, Paris, France
| | - Andrea Sheel
- Institute of Translational Medicine, University of Liverpool, United Kingdom
| | - Vikesh Singh
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Martin Smith
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, Gauteng, South Africa
| | - John A Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh and UPMC, Pittsburgh, PA, USA
| | - Asbjørn Mohr Drewes
- Mech-Sense & Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
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Moy B, Rumble RB, Carey LA. Chemotherapy and Targeted Therapy for Endocrine-Pretreated or Hormone Receptor-Negative Metastatic Breast Cancer: ASCO Guideline Rapid Recommendation Update. J Clin Oncol 2023; 41:1318-1320. [PMID: 36626701 DOI: 10.1200/jco.22.02807] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
ASCO Rapid Recommendations Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options.
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Affiliation(s)
| | | | - Lisa A Carey
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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GRADE Use in Evidence Syntheses Published in High-Impact-Factor Gynecology and Obstetrics Journals: A Methodological Survey. J Clin Med 2023; 12:jcm12020446. [PMID: 36675377 PMCID: PMC9866985 DOI: 10.3390/jcm12020446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 01/09/2023] Open
Abstract
Objective: To identify and describe the certainty of evidence of gynecology and obstetrics systematic reviews (SRs) using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Method: Database searches of SRs using GRADE, published between 1 January 2016 to 31 December 2020, in the 10 "gynecology and obstetrics" journals with the highest impact factor, according to the Journal Citation Report 2019. Selected studies included those SRs using the GRADE approach, used to determine the certainty of evidence. Results: Out of 952 SRs, ninety-six SRs of randomized control trials (RCTs) and/or nonrandomized studies (NRSs) used GRADE. Sixty-seven SRs (7.04%) rated the certainty of evidence for specific outcomes. In total, we identified 946 certainty of evidence outcome ratings (n = 614 RCT ratings), ranging from very-low (42.28%) to low (28.44%), moderate (17.65%), and high (11.63%). High and very low certainty of evidence ratings accounted for 2.16% and 71.60% in the SRs of NRSs, respectively, compared with 16.78% and 26.55% in the SRs of RCTs. In the SRs of RCTs and NRSs, certainty of evidence was mainly downgraded due to imprecision and bias risks. Conclusions: More attention needs to be paid to strengthening GRADE acceptance and building knowledge of GRADE methods in gynecology and obstetrics evidence synthesis.
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Shaker M, Mauger D, Fuhlbrigge AL. Value-Based, Cost-Effective Care: The Role of the Allergist-Immunologist. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:132-139. [PMID: 35944893 DOI: 10.1016/j.jaip.2022.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 01/11/2023]
Abstract
Asthma and allergic disease impact millions of patients and are associated with high costs. Up to 30% of all medical care involves wasted spending. Across the spectrum of care provided by the allergist-immunologist, there are opportunities to improve value and reduce medical waste. Several examples highlight this reality. Evidence suggests that most patients may receive cost-effective care in the management of chronic spontaneous urticaria without the need for laboratory testing. For patients with asthma, although a single maintenance and reliever therapy approach may be cost-effective, insurance-mandated therapy changes are not, and may harm patients. Biologics may be very effective in improving asthma control but are too expensive for this indication-as demonstrated by cost-effectiveness analyses and highlighted by the Institute of Clinical and Economic Review, which concluded that the value-based price for asthma biologics ranges between $6500 and 14,3000 per year. Early introduction may prevent food allergy, but screening before first introduction is neither necessary nor cost-effective, although early salvage food oral immunotherapy may result in improved quality of life and cost savings. Evidence does not support the presence of allergic disease as a risk factor for anaphylaxis to coronavirus disease 2019 vaccination, and risk-stratified vaccination approaches do not appear cost-effective. Allergen immunotherapy is a very cost-effective treatment option. The practice of allergy-immunology has continued to evolve in recent years and can provide a leading example of high-value practice.
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Affiliation(s)
- Marcus Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH.
| | - David Mauger
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, The Pennsylvania State University, State College, Pa
| | - Anne L Fuhlbrigge
- Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colo
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Podda M, De Simone B, Ceresoli M, Virdis F, Favi F, Wiik Larsen J, Coccolini F, Sartelli M, Pararas N, Beka SG, Bonavina L, Bova R, Pisanu A, Abu-Zidan F, Balogh Z, Chiara O, Wani I, Stahel P, Di Saverio S, Scalea T, Soreide K, Sakakushev B, Amico F, Martino C, Hecker A, de'Angelis N, Chirica M, Galante J, Kirkpatrick A, Pikoulis E, Kluger Y, Bensard D, Ansaloni L, Fraga G, Civil I, Tebala GD, Di Carlo I, Cui Y, Coimbra R, Agnoletti V, Sall I, Tan E, Picetti E, Litvin A, Damaskos D, Inaba K, Leung J, Maier R, Biffl W, Leppaniemi A, Moore E, Gurusamy K, Catena F. Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document. World J Emerg Surg 2022; 17:52. [PMID: 36224617 PMCID: PMC9560023 DOI: 10.1186/s13017-022-00457-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background In 2017, the World Society of Emergency Surgery published its guidelines for the management of adult and pediatric patients with splenic trauma. Several issues regarding the follow-up of patients with splenic injuries treated with NOM remained unsolved.
Methods Using a modified Delphi method, we sought to explore ongoing areas of controversy in the NOM of splenic trauma and reach a consensus among a group of 48 international experts from five continents (Africa, Europe, Asia, Oceania, America) concerning optimal follow-up strategies in patients with splenic injuries treated with NOM.
Results Consensus was reached on eleven clinical research questions and 28 recommendations with an agreement rate ≥ 80%. Mobilization after 24 h in low-grade splenic trauma patients (WSES Class I, AAST Grades I–II) was suggested, while in patients with high-grade splenic injuries (WSES Classes II–III, AAST Grades III–V), if no other contraindications to early mobilization exist, safe mobilization of the patient when three successive hemoglobins 8 h apart after the first are within 10% of each other was considered safe according to the panel. The panel suggests adult patients to be admitted to hospital for 1 day (for low-grade splenic injuries—WSES Class I, AAST Grades I–II) to 3 days (for high-grade splenic injuries—WSES Classes II–III, AAST Grades III–V), with those with high-grade injuries requiring admission to a monitored setting. In the absence of specific complications, the panel suggests DVT and VTE prophylaxis with LMWH to be started within 48–72 h from hospital admission. The panel suggests splenic artery embolization (SAE) as the first-line intervention in patients with hemodynamic stability and arterial blush on CT scan, irrespective of injury grade. Regarding patients with WSES Class II blunt splenic injuries (AAST Grade III) without contrast extravasation, a low threshold for SAE has been suggested in the presence of risk factors for NOM failure. The panel also suggested angiography and eventual SAE in all hemodynamically stable adult patients with WSES Class III injuries (AAST Grades IV–V), even in the absence of CT blush, especially when concomitant surgery that requires change of position is needed. Follow-up imaging with contrast-enhanced ultrasound/CT scan in 48–72 h post-admission of trauma in splenic injuries WSES Class II (AAST Grade III) or higher treated with NOM was considered the best strategy for timely detection of vascular complications. Conclusion This consensus document could help guide future prospective studies aiming at validating the suggested strategies through the implementation of prospective trauma databases and the subsequent production of internationally endorsed guidelines on the issue.
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Affiliation(s)
- Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy.
| | - Belinda De Simone
- Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France
| | - Marco Ceresoli
- General and Emergency Surgery Department, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Francesco Virdis
- Trauma and Acute Care Surgery Department, Niguarda Hospital, Milan, Italy
| | - Francesco Favi
- Department of Emergency and Trauma Surgey, Bufalini Trauma Center, Cesena, Italy
| | - Johannes Wiik Larsen
- Department of Gastrointestinal Surgery, Stavanger University Hospital University of Bergen, Stavanger, Norway
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | | | - Nikolaos Pararas
- Department of General Surgery, Dr Sulaiman Al Habib/Alfaisal University, Riyadh, Saudi Arabia
| | - Solomon Gurmu Beka
- School of Medicine and Health Science, University of Otago, Wellington Campus, Wellington, New Zealand
| | - Luigi Bonavina
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Raffaele Bova
- Department of Emergency and Trauma Surgey, Bufalini Trauma Center, Cesena, Italy
| | - Adolfo Pisanu
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Fikri Abu-Zidan
- Department of Applied Statistics, The Research Office, College of Medicine and Health Sciences United Arab Emirates University, Abu Dhabi, UAE
| | - Zsolt Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Osvaldo Chiara
- Trauma and Acute Care Surgery Department, Niguarda Hospital, Milan, Italy
| | | | - Philip Stahel
- Department of Surgery, East Carolina University, Brody School of Medicine, Greenville, USA
| | - Salomone Di Saverio
- Department of Surgery, San Benedetto del Tronto Hospital, AV5, San Benedetto del Tronto, Italy
| | - Thomas Scalea
- Shock Trauma Center, University of Maryland School of Medicine, Baltimore, USA
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital University of Bergen, Stavanger, Norway
| | - Boris Sakakushev
- Research Institute of Medical University Plovdiv/University Hospital St George Plovdiv, Plovdiv, Bulgaria
| | - Francesco Amico
- Trauma Service, John Hunter Hospital, Newcastle, Australia.,The University of Newcastle, Newcastle, Australia
| | - Costanza Martino
- Department of Anesthesiology and Acute Care, Umberto I Hospital of Lugo, Ausl della Romagna, Lugo, Italy
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Nicola de'Angelis
- Unit of General Surgery, Henri Mondor Hospital, UPEC, Créteil, France
| | - Mircea Chirica
- Service de Chirurgie Digestive, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Joseph Galante
- Trauma Department, University of California, Davis, Sacramento, CA, USA
| | - Andrew Kirkpatrick
- General, Acute Care and Trauma Surgery Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Emmanouil Pikoulis
- General Surgery, Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Denis Bensard
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Luca Ansaloni
- Unit of General Surgery, San Matteo Hospital, Pavia, Italy
| | - Gustavo Fraga
- Division of Trauma Surgery, University of Campinas, Campinas, SP, Brazil
| | - Ian Civil
- Director of Trauma Services, Auckland City Hospital, Auckland, New Zealand
| | | | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Raul Coimbra
- Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Ibrahima Sall
- Department of General Surgery, Military Teaching Hospital, Hôpital Principal Dakar, Dakar, Senegal
| | - Edward Tan
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Andrey Litvin
- Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russia
| | | | - Kenji Inaba
- University of Southern California, Los Angeles, USA
| | - Jeffrey Leung
- Division of Surgery and Interventional Science, University College London (UCL), London, UK.,Milton Keynes University Hospital, Milton Keynes, UK
| | | | - Walt Biffl
- Division of Trauma and Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, La Jolla, CA, USA
| | - Ari Leppaniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ernest Moore
- Ernest E. Moore Shock Trauma Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, University College London (UCL), London, UK
| | - Fausto Catena
- Department of Emergency and Trauma Surgey, Bufalini Trauma Center, Cesena, Italy
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Schena CA, de’Angelis GL, Carra MC, Bianchi G, de’Angelis N. Antimicrobial Challenge in Acute Care Surgery. Antibiotics (Basel) 2022; 11:1315. [PMID: 36289973 PMCID: PMC9598495 DOI: 10.3390/antibiotics11101315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 12/07/2022] Open
Abstract
The burden of infections in acute care surgery (ACS) is huge. Surgical emergencies alone account for three million admissions per year in the United States (US) with estimated financial costs of USD 28 billion per year. Acute care facilities and ACS patients represent boost sanctuaries for the emergence, development and transmission of infections and multi-resistant organisms. According to the World Health Organization, healthcare-associated infections affected around 4 million cases in Europe and 1.7 million in the US alone in 2011 with 39,000 and 99,000 directly attributable deaths, respectively. In this scenario, antimicrobial resistance arose as a public-health emergency that worsens patients' morbidity and mortality and increases healthcare costs. The optimal patient care requires the application of comprehensive evidence-based policies and strategies aiming at minimizing the impact of healthcare associated infections and antimicrobial resistance, while optimizing the treatment of intra-abdominal infections. The present review provides a snapshot of two hot topics, such as antimicrobial resistance and systemic inflammatory response, and three milestones of infection management, such as source control, infection prevention, and control and antimicrobial stewardship.
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Affiliation(s)
- Carlo Alberto Schena
- Unit of Digestive and HPB Surgery, CARE Department, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Gian Luigi de’Angelis
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| | - Maria Clotilde Carra
- Rothschild Hospital, AP-HP, Université Paris Cité, U.F.R. of Odontology, 75006 Paris, France
| | - Giorgio Bianchi
- Unit of Digestive and HPB Surgery, CARE Department, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Nicola de’Angelis
- Unit of Digestive and HPB Surgery, CARE Department, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
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Garje R, Rumble RB, Parikh RA. Systemic Therapy Update on 177Lutetium-PSMA-617 for Metastatic Castration-Resistant Prostate Cancer: ASCO Rapid Recommendation. J Clin Oncol 2022; 40:3664-3666. [DOI: 10.1200/jco.22.01865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
ASCO Rapid Recommendations Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options.
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Affiliation(s)
- Rohan Garje
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | - Rahul A. Parikh
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL
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Moy B, Rumble RB, Carey LA. Chemotherapy and Targeted Therapy for Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer That Is Either Endocrine-Pretreated or Hormone Receptor-Negative: ASCO Guideline Rapid Recommendation Update. J Clin Oncol 2022; 40:3088-3090. [PMID: 35926153 DOI: 10.1200/jco.22.01533] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
ASCO Rapid Recommendations Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options.
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Affiliation(s)
| | | | - Lisa A Carey
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Ambe PC, Kugler CM, Breuing J, Grohmann E, Friedel J, Hess S, Pieper D. The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy - A systematic review and meta-analysis. Colorectal Dis 2022; 24:904-917. [PMID: 35297146 DOI: 10.1111/codi.16118] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/15/2022] [Accepted: 03/08/2022] [Indexed: 12/12/2022]
Abstract
AIM This systematic review and meta-analysis aimed to investigate the effect of preoperative stoma site marking on stoma-related complications in patients with intestinal ostomy. METHODS MEDLINE, Embase, CENTRAL, CINHAL, and Google Scholar were searched up to August 2021 for randomised controlled trials (RCTs) and nonrandomised studies of interventions (NRSI) that involved patients with intestinal ostomies comparing preoperative stoma site marking to no marking and which reported at least one patient-relevant outcome. Outcomes were prioritised by stakeholder involvement. Random-effects meta-analyses produced odds ratios (ORs) or standardised mean differences (SMD) and 95% confidence intervals (CIs). The ROBINS-I tool and the GRADE approach were used to assess the risk of bias and certainty of evidence, respectively. RESULTS This review included two RCTs and 25 NRSI. The risk of bias was high in RCTs and serious to critical in NRSI. Although preoperative site marking reduced stoma-related complications (OR: 0.45, 95% CI: [0.31-0.65]), dependence on professional or unprofessional care (narrative synthesis), and increased health-related quality of life (SMD: 1.13 [0.38-1.88]), the evidence is very uncertain. Preoperative site marking may probably reduce leakage (OR: 0.14 [0.06-0.37]) and may decrease dermatological complications (OR: 0.38 [0.29-0.50]) and surgical revision (OR: 0.09 [0.02-0.49]). The confidence in the cumulative evidence was moderate to very low. CONCLUSION Despite low quality evidence, preoperative stoma site marking can prevent stoma-related complications and should be performed in patients undergoing gastrointestinal surgery given that this intervention poses no harm to patients.
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Affiliation(s)
- Peter C Ambe
- GFO Kliniken Rhein-Berg, Vinzenz Pallotti Hospital, Bergisch Gladbach, Germany.,Department of Health, Witten/Herdecke University, Witten, Germany
| | | | - Jessica Breuing
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | | | - Julia Friedel
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany.,University of Cologne, Cologne, Germany
| | - Simone Hess
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
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40
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Lithopoulos A, Bayley M, Curran D, Fischer L, Knee C, Lauzon J, Nevison M, Velikonja D, Marshall S. Protocol for a living systematic review for the management of concussion in adults. BMJ Open 2022; 12:e061282. [PMID: 35835532 PMCID: PMC9289038 DOI: 10.1136/bmjopen-2022-061282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Concussion/mild traumatic brain injury (mTBI) often presents initially with disabling symptoms that resolve, but for an unfortunate minority some of these symptoms may become prolonged. Although research into diagnosis and interventions for concussion is increasing, study quality overall remains low. A living systematic review that is updated as evidence becomes available is the ideal research activity to inform a living guideline targeting clinicians and patients. The purpose of this paper is to present the protocol of an ongoing living systematic review for the management of adult concussion that will inform living guidelines building off the Guideline for Concussion/Mild Traumatic Brain Injury and Persistent Symptoms: third Edition. METHODS AND ANALYSIS The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol guidelines were followed in the reporting of this systematic review protocol. We are including English peer-reviewed observational studies, trials, qualitative studies, systematic reviews and clinical practice guidelines related to diagnosis/assessment or treatment of adult concussion. Future searches will be conducted at minimum every 6 months using the following databases: MEDLINE ALL, EMBASE, Cochrane, PsycInfo and CINAHL. The data are managed in the Covidence website. Screening, data extraction and risk-of-bias assessments are being done through multiple raters working independently. Multiple validated tools are being used to assess risk of bias, and the tool applied matches the document or study design (eg, Downs and Black Scale for healthcare interventions). Many concussion experts in various clinical disciplines from across North America have volunteered to examine the evidence in order to make recommendations for the living guidelines. ETHICS AND DISSEMINATION No ethical approval is necessary because primary data are not collected. The results will be disseminated through peer-reviewed publications and on the living guidelines website once built. PROSPERO REGISTRATION NUMBER CRD42022301786.
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Affiliation(s)
- Alexander Lithopoulos
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Rehabilitation Centre, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Mark Bayley
- Hull-Ellis Concussion Research Center, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Dorothyann Curran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Rehabilitation Centre, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Lisa Fischer
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Knee
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Rehabilitation Centre, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Julia Lauzon
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Rehabilitation Centre, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Margaret Nevison
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Rehabilitation Centre, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Diana Velikonja
- Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Shawn Marshall
- Ottawa Hospital Rehabilitation Centre, Ottawa Hospital, Ottawa, Ontario, Canada
- Physical Medicine and Rehabilitation, Bruyere Continuing Care, Ottawa, Ontario, Canada
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41
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Rathmell WK, Rumble RB, Van Veldhuizen PJ, Al-Ahmadie H, Emamekhoo H, Hauke RJ, Louie AV, Milowsky MI, Molina AM, Rose TL, Siva S, Zaorsky NG, Zhang T, Qamar R, Kungel TM, Lewis B, Singer EA. Management of Metastatic Clear Cell Renal Cell Carcinoma: ASCO Guideline. J Clin Oncol 2022; 40:2957-2995. [PMID: 35728020 DOI: 10.1200/jco.22.00868] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To provide recommendations for the management of patients with metastatic clear cell renal cell carcinoma (ccRCC). METHODS An Expert Panel conducted a systematic literature review to obtain evidence to guide treatment recommendations. RESULTS The panel considered peer-reviewed reports published in English. RECOMMENDATIONS The diagnosis of metastatic ccRCC should be made using tissue biopsy of the primary tumor or a metastatic site with the inclusion of markers and/or stains to support the diagnosis. The International Metastatic RCC Database Consortium risk criteria should be used to inform treatment. Cytoreductive nephrectomy may be offered to select patients with kidney-in-place and favorable- or intermediate-risk disease. For those who have already had a nephrectomy, an initial period of active surveillance may be offered if they are asymptomatic with a low burden of disease. Patients with favorable-risk disease who need systemic therapy may be offered an immune checkpoint inhibitor (ICI) in combination with a vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI); patients with intermediate or poor risk should be offered a doublet regimen (no recommendation was provided between ICIs or an ICI in combination with a VEGFR TKI). For select patients, monotherapy with either an ICI or a VEGFR TKI may be offered on the basis of comorbidities. Interleukin-2 remains an option, although selection criteria could not be identified. Recommendations are also provided for second- and subsequent-line therapy as well as the treatment of bone metastases, brain metastases, or the presence of sarcomatoid features. Participation in clinical trials is highly encouraged for patients with metastatic ccRCC.Additional information is available at www.asco.org/genitourinary-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | - Alexander V Louie
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON.,American Society for Therapeutic Radiology and Oncology Representative, Toronto, ON
| | | | | | - Tracy L Rose
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Shankar Siva
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH.,American Society for Therapeutic Radiology and Oncology Representative, Cleveland, OH
| | - Tian Zhang
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | | | | | - Bryan Lewis
- KidneyCan, Philadelphia, PA.,Patient Representative, Philadelphia, PA
| | - Eric A Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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42
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Abate LG, Bayable SD, Fetene MB. Evidence-based perioperative diagnosis and management of pulmonary embolism: A systematic review. Ann Med Surg (Lond) 2022; 77:103684. [PMID: 35638051 PMCID: PMC9142630 DOI: 10.1016/j.amsu.2022.103684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background The diagnosis and treatment of pulmonary embolism have multi-modal approach based on specificity, sensitivity, availability of the machine, and associated risks of imaging modalities. Aim This review aimed to provide shreds of evidence that improve perioperative diagnosis and management of suspected pulmonary embolism. Methods The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline 2020. After a clear criteria has been established an electronic searching database was conducted using PubMed, Google Scholar, Cochrane library, and Cumulative Index of Nursing and Allied Health Literature (CINAHL), with Key search terms included:('pulmonary embolism' AND' anesthesia management ', 'anticoagulation' AND 'pulmonary embolism', 'thrombolysis 'AND 'pulmonary embolism', 'surgery' AND' pulmonary embolism'), were used to draw the evidence.The quality of literatures were categorized based on WHO 2011 level of evidence and degree of recommendation, in addition, the study is registered with research registry unique identifying number (UIN) of reviewregistry1318." and has high quality based on AMSTAR2 assessment criteria. Results A totally of 27 articles were included [guidelines (n = 3), Cochrane (=5), systemic reviews (n = 7), meta-analyses (=2), RCT (n = 4), cohort studies (n = 3), and cross-sectional study (n = 3) and illegible articles identified from searches of the electronic databases were imported into the ENDNOTE software version X7.1 and duplicates were removed. Discussion Currently divergent and contradictory approaches are implemented in diagnosis and management for patients suspected of pulmonary embolism. Conclusion All perioperative patients, especially trauma victims, prostate or orthopedic surgery, malignancy, immobility, and obesity; smokers; and oral contraceptive users, antipsychotic medications are at increased risk of venous thromboembolism and need special caution during surgery and anesthesia.
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Affiliation(s)
- Lamesgen Geta Abate
- Department of Anaesthesia, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
- Advanced Clinical Anesthesia and Critical Care, Ethiopia
| | - Samuel Debas Bayable
- Department of Anaesthesia, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
- Advanced Clinical Anesthesia and Critical Care, Ethiopia
| | - Melaku Bantie Fetene
- Department of Anaesthesia, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
- Advanced Clinical Anesthesia and Critical Care, Ethiopia
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43
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McNeely ML, Harris SR, Dolgoy ND, Al Onazi MM, Parkinson JF, Radke L, Kostaras X, Dennett L, Ryan JA, Dalzell MA, Kennedy A, Capozzi L, Towers A, Campbell KL, Binkley J, King K, Keast D. Update to the Canadian clinical practice guideline for best-practice management of breast cancer-related lymphedema: study protocol. CMAJ Open 2022; 10:E338-E347. [PMID: 35414596 PMCID: PMC9007443 DOI: 10.9778/cmajo.20210038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND One of the more frequent complications following treatment for breast cancer, lymphedema is a substantial swelling of the arm, breast and chest wall that occurs on the side where lymph nodes were removed. The aim of this work is to update recommendations on the prevention, diagnosis and management of lymphedema related to breast cancer. METHODS We present the protocol for an update of the 2001 clinical practice guideline on lymphedema from the Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. We will use a patient-oriented research approach with a focus on self-management and the positive health model to inform the updated guideline development. The methods proposed will be undertaken with consideration of the standards outlined in the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. The literature will be appraised by evaluating existing guidelines from other countries, the evidence from systematic reviews and meta-analyses and direct evidence from clinical studies. We will manage competing interests according to Guidelines International Network principles. Recommendations will be presented using an actionable statement format and will be linked to the level of evidence along with any relevant considerations used in formulation. A draft of the guideline will be produced by the steering committee then sent out to international experts and stakeholder groups for feedback. INTERPRETATION The primary benefit of this clinical guideline will be to improve the quality of care of women with breast cancer-related lymphedema. Findings will be disseminated at national and international conferences and through webinars and educational videos hosted on the websites of the supporting organizations.
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Affiliation(s)
- Margaret Lynn McNeely
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont.
| | - Susan R Harris
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Naomi D Dolgoy
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Mona M Al Onazi
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Joanna F Parkinson
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Lori Radke
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Xanthoula Kostaras
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Liz Dennett
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Jean Ann Ryan
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Mary-Ann Dalzell
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Anna Kennedy
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Lauren Capozzi
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Anna Towers
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Kristin L Campbell
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Jill Binkley
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - Karen King
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
| | - David Keast
- Department of Physical Therapy (McNeely, Dolgoy, Al Onazi, Parkinson), University of Alberta; Cross Cancer Institute (McNeely, King), Alberta Health Services, Edmonton, Alta.; patient representative (Harris), Vancouver, BC; patient representative (Kennedy), Toronto, Ont.; patient representative (Binkley), Atlanta, Ga.; Department of Physical Therapy (Harris, Campbell), University of British Columbia, Vancouver, BC; Rehabilitation Oncology Department (Radke), Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alta.; Guideline Resource Unit (Kostaras), Cancer Care Alberta, Alberta Health Services, Edmonton, Alta.; University of Alberta Libraries (Dennett), University of Alberta, Edmonton, Alta.; Lymphedema Program (Ryan), Eastern Health, St. John's, Nfld.; Oncology Division (Dalzell), Canadian Physiotherapy Association, Montréal, Que.; Pathways Magazine (Kennedy), Canadian Lymphedema Framework, Toronto, Ont.; Faculty of Kinesiology (Capozzi), University of Calgary, Calgary, Alta.; Department of Clinical Neurosciences (Capozzi), Faculty of Medicine, University of Calgary, Calgary, Alta.; Gerard Bronfman Department of Oncology (Towers), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; TurningPoint Breast Cancer Rehabilitation (Binkley), Atlanta, Ga.; Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute (Keast), St. Joseph's Health Care, London, Ont
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Bonini S, Fiorito S. Are health care policies for COVID-19 evidence-based? Allergy 2022; 77:2290-2291. [PMID: 35353906 PMCID: PMC9111449 DOI: 10.1111/all.15297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Sergio Bonini
- Institute of Translational PharmacologyItalian National Research CouncilRomeItaly
| | - Silvana Fiorito
- Institute of Translational PharmacologyItalian National Research CouncilRomeItaly
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Licina DA, Silvers DA. Perioperative Multimodal Analgesia for Adults undergoing surgery of the Spine- Systematic Review and Meta-analysis of Three or More Modalities. World Neurosurg 2022; 163:11-23. [PMID: 35346882 DOI: 10.1016/j.wneu.2022.03.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Multimodal analgesia is a strategy which may be employed to improve pain management in the perioperative period in patients undergoing surgery of the spine. However, there is no review evidence available on quantitative models of multimodal analgesia within this clinical setting. We conducted a systematic review and meta-analysis to examine the impact of maximal (three or more analgesic agents) multimodal analgesic medication in patients undergoing surgery of the spine. METHODS We included randomized controlled trials (RCT's) evaluating the use of three or more multimodal analgesia components (maximal multi modal analgesia) in patients undergoing spinal surgery. We excluded patients receiving neuraxial or regional analgesia. The control group consisted of placebo, standard care (any therapeutic modality including two or less analgesic components). Primary outcomes were post-operative pain scores at rest, at twenty-four, and forty eight hours. We searched the MEDLINE via Ovid SP; EMBASE via Ovid SP; and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). We used Cochrane's standard methods. RESULTS We identified consistently improved analgesic endpoints across all pre-determined primary and secondary outcomes. A total of eleven eligible studies evaluated the primary outcome of pain at rest at twenty four hours. Patients receiving maximal multimodal analgesia were identified to have lower pain scores with an average of MD [-1.03], p<0.00001. Length of hospital stay was decreased in patients receiving multimodal analgesia MD [-0.55], p<0.00001. CONCLUSION Perioperative maximal multimodal analgesia consistently improves visual analogue scale outcomes in adult population in the immediate post-operative period, with a moderate quality of evidence. There is significant decrease in hospital length of stay in patients receiving maximal multimodal analgesia with a high level of evidence and no statistical heterogeneity.
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Maurer M, Magerl M, Betschel S, Aberer W, Ansotegui IJ, Aygören-Pürsün E, Banerji A, Bara NA, Boccon-Gibod I, Bork K, Bouillet L, Boysen HB, Brodszki N, Busse PJ, Bygum A, Caballero T, Cancian M, Castaldo AJ, Cohn DM, Csuka D, Farkas H, Gompels M, Gower R, Grumach AS, Guidos-Fogelbach G, Hide M, Kang HR, Kaplan AP, Katelaris CH, Kiani-Alikhan S, Lei WT, Lockey RF, Longhurst H, Lumry W, MacGinnitie A, Malbran A, Martinez Saguer I, Matta Campos JJ, Nast A, Nguyen D, Nieto-Martinez SA, Pawankar R, Peter J, Porebski G, Prior N, Reshef A, Riedl M, Ritchie B, Sheikh FR, Smith WB, Spaeth PJ, Stobiecki M, Toubi E, Varga LA, Weller K, Zanichelli A, Zhi Y, Zuraw B, Craig T. The international WAO/EAACI guideline for the management of hereditary angioedema - The 2021 revision and update. World Allergy Organ J 2022; 15:100627. [PMID: 35497649 PMCID: PMC9023902 DOI: 10.1016/j.waojou.2022.100627] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/05/2021] [Accepted: 12/21/2021] [Indexed: 12/21/2022] Open
Abstract
Hereditary Angioedema (HAE) is a rare and disabling disease for which early diagnosis and effective therapy are critical. This revision and update of the global WAO/EAACI guideline on the diagnosis and management of HAE provides up-to-date guidance for the management of HAE. For this update and revision of the guideline, an international panel of experts reviewed the existing evidence, developed 28 recommendations, and established consensus by an online DELPHI process. The goal of these recommendations and guideline is to help physicians and their patients in making rational decisions in the management of HAE with deficient C1-inhibitor (type 1) and HAE with dysfunctional C1-inhibitor (type 2), by providing guidance on common and important clinical issues, such as: 1) How should HAE be diagnosed? 2) When should HAE patients receive prophylactic on top of on-demand treatment and what treatments should be used? 3) What are the goals of treatment? 4) Should HAE management be different for special HAE patient groups such as children or pregnant/breast feeding women? 5) How should HAE patients monitor their disease activity, impact, and control? It is also the intention of this guideline to help establish global standards for the management of HAE and to encourage and facilitate the use of recommended diagnostics and therapies for all patients.
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Affiliation(s)
- Marcus Maurer
- Institute of Allergology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Frauhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Markus Magerl
- Institute of Allergology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Frauhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | | | - Werner Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Ignacio J. Ansotegui
- Department of Allergy & Immunology, Hospital Quironsalúd Bizkaia, Bilbao-Errandio, Spain
| | - Emel Aygören-Pürsün
- Center for Children and Adolescents, University Hospital Frankfurt, Frankfurt, Germany
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA, United States
| | - Noémi-Anna Bara
- Romanian Hereditary Angioedema Expertise Centre, Mediquest Clinical Research Center, Sangeorgiu de Mures, Romania
| | - Isabelle Boccon-Gibod
- National Reference Center for Angioedema (CREAK), Angioedema Center of Reference and Excellence (ACARE), Grenoble Alpes, France
- University Hospital, Grenoble, France
| | - Konrad Bork
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Laurence Bouillet
- National Reference Center for Angioedema (CREAK), Angioedema Center of Reference and Excellence (ACARE), Grenoble Alpes, France
- University Hospital, Grenoble, France
| | | | - Nicholas Brodszki
- Department of Pediatric Immunology, Childrens Hospital, Skåne University Hospital, Lund, Sweden
| | - Paula J. Busse
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Anette Bygum
- Clinical Institute, University of Southern Denmark, Odense, Denmark
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Teresa Caballero
- Allergy Department, Hospital Universitario La Paz, IdiPaz, CIBERER U754, Madrid, Spain
| | - Mauro Cancian
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
| | | | - Danny M. Cohn
- Department of Vascular Medicine, Amsterdam UMC/University of Amsterdam, Amsterdam, the Netherlands
| | - Dorottya Csuka
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University, Budapest, Hungary
| | - Henriette Farkas
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University, Budapest, Hungary
| | - Mark Gompels
- Clinical Immunology, North Bristol NHS Trust, Bristol, United Kingdom
| | - Richard Gower
- Marycliff Clinical Research, Principle Research Solutions, Spokane, WA, United States
| | - Anete S. Grumach
- Clinical Immunology, Centro Universitario FMABC, Sao Paulo, Brazil
| | | | - Michihiro Hide
- Department of Dermatology, Hiroshima Citizens Hospital, Hiroshima, Japan
- Department of Dermatology, Hiroshima University, Hiroshima, Japan
| | - Hye-Ryun Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Allen P. Kaplan
- Division of Pulmonary, Critical Care, Allergy and Immunology, Medical University of South Carolina, Charleston, SC, United States
| | - Constance H. Katelaris
- Department of Medicine, Campbelltown Hospital and Western Sydney University, Sydney, NSW, Australia
| | | | - Wei-Te Lei
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Richard F. Lockey
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Hilary Longhurst
- Department of Immunology, Auckland District Health Board and Department of Medicine, University of Auckland, Auckland, New Zealand
| | - William Lumry
- Internal Medicine, Allergy Division, University of Texas Health Science Center, Dallas, TX, United States
| | - Andrew MacGinnitie
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Alejandro Malbran
- Unidad de Alergia, Asma e Inmunología Clínica, Buenos Aires, Argentina
| | | | | | - Alexander Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine Charité–Universitätsmedizin, Berlin, Germany
- Corporate Member of Free University of Berlin, Humboldt University of Berlin, Berlin Institute of Health, Berlin, Germany
| | - Dinh Nguyen
- Respiratory, Allergy and Clinical Immunology Unit, Internal Medicine Department, Vinmec Healthcare System, College of Health Sciences, VinUniversity, Hanoi, Viet Nam
| | | | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Jonathan Peter
- Division of Allergy and Clinical Immunology, University of Cape Town, Cape Town, South Africa
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Grzegorz Porebski
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | - Nieves Prior
- Allergy, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Avner Reshef
- Angiedema Center, Barzilai University Medical Center, Ashkelon, Israel
| | - Marc Riedl
- Division of Rheumatology, Allergy and Immunology, University of California San Diego, La Jolla, CA, USA
| | - Bruce Ritchie
- Departments of Medicine and Medical Oncology, University of Alberta, Edmonton, AB, Canada
| | - Farrukh Rafique Sheikh
- Section of Adult Allergy & Immunology, Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - William B. Smith
- Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Peter J. Spaeth
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| | - Marcin Stobiecki
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | - Elias Toubi
- Division of Allergy and Clinical Immunology, Bnai Zion Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lilian Agnes Varga
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University, Budapest, Hungary
| | - Karsten Weller
- Institute of Allergology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Frauhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Andrea Zanichelli
- Department of Internal Medicine, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco-University of Milan, Milan, Italy
| | - Yuxiang Zhi
- Department of Allergy and Clinical Immunology, Bejing Union Medical College Hospital, Chinese Academy of Medical Sciences, Bejing, China
| | - Bruce Zuraw
- University of California, San Diego, San Diego, CA, United States
| | - Timothy Craig
- Departments of Medicine and Pediatrics, Penn State University, Hershey, PA, USA
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Louis R, Satia I, Ojanguren I, Schleich F, Bonini M, Tonia T, Rigau D, Ten Brinke A, Buhl R, Loukides S, Kocks JWH, Boulet LP, Bourdin A, Coleman C, Needham K, Thomas M, Idzko M, Papi A, Porsbjerg C, Schuermans D, Soriano JB, Usmani OS. European Respiratory Society Guidelines for the Diagnosis of Asthma in Adults. Eur Respir J 2022; 60:2101585. [PMID: 35169025 DOI: 10.1183/13993003.01585-2021] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/10/2022] [Indexed: 12/20/2022]
Abstract
Although asthma is very common affecting 5-10% of the population, the diagnosis of asthma in adults remains a challenge in the real world that results in both over- and under-diagnosis. A task force (TF) was set up by the European Respiratory Society to systematically review the literature on the diagnostic accuracy of tests used to diagnose asthma in adult patients and provide recommendation for clinical practice.The TF defined eight PICO (Population, Index, Comparator, and Outcome) questions that were assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach, The TF utilised the outcomes to develop an evidenced-based diagnostic algorithm, with recommendations for a pragmatic guideline for everyday practice that was directed by real-life patient experiences.The TF support the initial use of spirometry followed, and if airway obstruction is present, by bronchodilator reversibility testing. If initial spirometry fails to show obstruction, further tests should be performed in the following order: FeNO, PEF variability or in secondary care, bronchial challenge. We present the thresholds for each test that are compatible with a diagnosis of asthma in the presence of current symptoms.The TF reinforce the priority to undertake spirometry and recognise the value of measuring blood eosinophils and serum IgE to phenotype the patient. Measuring gas trapping by body plethysmography in patients with preserved FEV1/FVC ratio deserves further attention. The TF draw attention on the difficulty of making a correct diagnosis in patients already receiving inhaled corticosteroids, the comorbidities that may obscure the diagnosis, the importance of phenotyping, and the necessity to consider the patient experience in the diagnostic process.
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Affiliation(s)
- Renaud Louis
- CHU de Liege University Hospital Centre Ville, Liege, Belgium
- First author, Task force chair
| | - Imran Satia
- McMaster University, Hamilton, Canada
- All authors contributed equally
| | - Inigo Ojanguren
- Vall d'Hebron University Hospital Barcelona, Barcelona, Spain
- All authors contributed equally
| | - Florence Schleich
- Department of Pulmonary Medicine, University of Liege, Liège, Belgium
- All authors contributed equally
| | - Matteo Bonini
- Sapienza University of Rome, Rome, Italy
- All authors contributed equally
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - David Rigau
- Iberoamerican Cochrane Centre, Barcelona, Spain
| | - Anne Ten Brinke
- CHU de Liege University Hospital Centre Ville, Liege, Belgium
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | | | | | - Louis-Philippe Boulet
- Pneumologie, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec, Canada
| | | | | | | | - Mike Thomas
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Marco Idzko
- Department of Respiratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Celeste Porsbjerg
- Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen NV, Denmark
| | - Daniel Schuermans
- Respiratory Division, Academic Hospital UZBrussel, Brussels, Belgium
| | - Joan B Soriano
- Universidad Autónoma de Madrid, Hospital Universitario de la Princesa, Madrid, Spain
| | - Omar S Usmani
- Asthma Lab, National Heart and Lung Institute, London, UK
- Corresponding author, Task force co-chair
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48
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Maurer M, Magerl M, Betschel S, Aberer W, Ansotegui IJ, Aygören‐Pürsün E, Banerji A, Bara N, Boccon‐Gibod I, Bork K, Bouillet L, Boysen HB, Brodszki N, Busse PJ, Bygum A, Caballero T, Cancian M, Castaldo A, Cohn DM, Csuka D, Farkas H, Gompels M, Gower R, Grumach AS, Guidos‐Fogelbach G, Hide M, Kang H, Kaplan AP, Katelaris C, Kiani‐Alikhan S, Lei W, Lockey R, Longhurst H, Lumry WB, MacGinnitie A, Malbran A, Martinez Saguer I, Matta JJ, Nast A, Nguyen D, Nieto‐Martinez SA, Pawankar R, Peter J, Porebski G, Prior N, Reshef A, Riedl M, Ritchie B, Rafique Sheikh F, Smith WR, Spaeth PJ, Stobiecki M, Toubi E, Varga LA, Weller K, Zanichelli A, Zhi Y, Zuraw B, Craig T. The international WAO/EAACI guideline for the management of hereditary angioedema-The 2021 revision and update. Allergy 2022; 77:1961-1990. [PMID: 35006617 DOI: 10.1111/all.15214] [Citation(s) in RCA: 155] [Impact Index Per Article: 77.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/22/2021] [Accepted: 12/08/2021] [Indexed: 12/11/2022]
Abstract
Hereditary angioedema (HAE) is a rare and disabling disease for which early diagnosis and effective therapy are critical. This revision and update of the global WAO/EAACI guideline on the diagnosis and management of HAE provides up-to-date guidance for the management of HAE. For this update and revision of the guideline, an international panel of experts reviewed the existing evidence, developed 28 recommendations, and established consensus by an online DELPHI process. The goal of these recommendations and guideline is to help physicians and their patients in making rational decisions in the management of HAE with deficient C1 inhibitor (type 1) and HAE with dysfunctional C1 inhibitor (type 2), by providing guidance on common and important clinical issues, such as: (1) How should HAE be diagnosed? (2) When should HAE patients receive prophylactic on top of on-demand treatment and what treatments should be used? (3) What are the goals of treatment? (4) Should HAE management be different for special HAE patient groups such as children or pregnant/breast-feeding women? and (5) How should HAE patients monitor their disease activity, impact, and control? It is also the intention of this guideline to help establish global standards for the management of HAE and to encourage and facilitate the use of recommended diagnostics and therapies for all patients.
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Affiliation(s)
- Marcus Maurer
- Institute of Allergology Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin Germany
| | - Markus Magerl
- Institute of Allergology Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin Germany
| | | | - Werner Aberer
- Department of Dermatology Medical University of Graz Graz Austria
| | | | - Emel Aygören‐Pürsün
- Center for Children and Adolescents University Hospital Frankfurt Frankfurt Germany
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology Massachusetts General Hospital Boston Massachusetts USA
| | - Noémi‐Anna Bara
- Romanian Hereditary Angioedema Expertise CentreMediquest Clinical Research Center Sangeorgiu de Mures Romania
| | - Isabelle Boccon‐Gibod
- National Reference Center for Angioedema (CREAK) Angioedema Center of Reference and Excellence (ACARE) Grenoble Alpes University Hospital Grenoble France
| | - Konrad Bork
- Department of Dermatology University Medical CenterJohannes Gutenberg University Mainz Germany
| | - Laurence Bouillet
- National Reference Center for Angioedema (CREAK) Angioedema Center of Reference and Excellence (ACARE) Grenoble Alpes University Hospital Grenoble France
| | | | - Nicholas Brodszki
- Department of Pediatric Immunology Childrens HospitalSkåne University Hospital Lund Sweden
| | | | - Anette Bygum
- Clinical Institute University of Southern Denmark Odense Denmark
- Department of Clinical Genetics Odense University Hospital Odense Denmark
| | - Teresa Caballero
- Allergy Department Hospital Universitario La PazIdiPaz, CIBERER U754 Madrid Spain
| | - Mauro Cancian
- Department of Systems Medicine University Hospital of Padua Padua Italy
| | | | - Danny M. Cohn
- Department of Vascular Medicine Amsterdam UMC/University of Amsterdam Amsterdam The Netherlands
| | - Dorottya Csuka
- Department of Internal Medicine and Haematology Hungarian Angioedema Center of Reference and Excellence Semmelweis University Budapest Hungary
| | - Henriette Farkas
- Department of Internal Medicine and Haematology Hungarian Angioedema Center of Reference and Excellence Semmelweis University Budapest Hungary
| | - Mark Gompels
- Clinical Immunology North Bristol NHS Trust Bristol UK
| | - Richard Gower
- Marycliff Clinical ResearchPrinciple Research Solutions Spokane Washington USA
| | | | | | - Michihiro Hide
- Department of Dermatology Hiroshima Citizens Hospital Hiroshima Japan
- Department of Dermatology Hiroshima University Hiroshima Japan
| | - Hye‐Ryun Kang
- Department of Internal Medicine Seoul National University College of Medicine Seoul Korea
| | - Allen Phillip Kaplan
- Division of Pulmonary, Critical Care, Allergy and Immunology Medical university of South Carolina Charleston South Carolina USA
| | - Constance Katelaris
- Department of Medicine Campbelltown Hospital and Western Sydney University Sydney NSW Australia
| | | | - Wei‐Te Lei
- Division of Allergy, Immunology, and Rheumatology Department of Pediatrics Mackay Memorial Hospital Hsinchu Taiwan
| | - Richard Lockey
- Division of Allergy and Immunology Department of Internal Medicine Morsani College of MedicineUniversity of South Florida Tampa Florida USA
| | - Hilary Longhurst
- Department of Immunology Auckland District Health Board and Department of MedicineUniversity of Auckland Auckland New Zealand
| | - William B. Lumry
- Internal Medicine Allergy Division University of Texas Health Science Center Dallas Texas USA
| | - Andrew MacGinnitie
- Division of Immunology Department of Pediatrics Boston Children's HospitalHarvard Medical School Boston Massachusetts USA
| | - Alejandro Malbran
- Unidad de Alergia, Asma e Inmunología Clínica Buenos Aires Argentina
| | | | | | - Alexander Nast
- Department of Dermatology, Venereology and Allergology Division of Evidence‐Based Medicine Charité ‐ Universitätsmedizin Berlincorporate member of Free University of BerlinHumboldt University of Berlin, and Berlin Institute of Health Berlin Germany
| | - Dinh Nguyen
- Respiratory, Allergy and Clinical Immunology Unit Internal Medicine Department Vinmec Healthcare System College of Health SciencesVinUniversity Hanoi Vietnam
| | | | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Jonathan Peter
- Division of Allergy and Clinical Immunology University of Cape Town Cape Town South Africa
- Allergy and Immunology Unit University of Cape Town Lung Institute Cape Town South Africa
| | - Grzegorz Porebski
- Department of Clinical and Environmental Allergology Jagiellonian University Medical College Krakow Poland
| | - Nieves Prior
- Allergy Hospital Universitario Severo Ochoa Madrid Spain
| | - Avner Reshef
- Angioderma CenterBarzilai University Medical Center Ashkelon Israel
| | - Marc Riedl
- Division of Rheumatology, Allergy and Immunology University of California San Diego La Jolla California USA
| | - Bruce Ritchie
- Departments of Medicine and Medical Oncology University of Alberta Edmonton AB Canada
| | - Farrukh Rafique Sheikh
- Section of Adult Allergy & Immunology Department of Medicine King Faisal Specialist Hospital & Research Centre Riyadh Saudi Arabia
| | - William R. Smith
- Clinical Immunology and Allergy Royal Adelaide Hospital Adelaide SA Australia
| | - Peter J. Spaeth
- Institute of PharmacologyUniversity of Bern Bern Switzerland
| | - Marcin Stobiecki
- Department of Clinical and Environmental Allergology Jagiellonian University Medical College Krakow Poland
| | - Elias Toubi
- Division of Allergy and Clinical Immunology Bnai Zion Medical CenterAffiliated with Rappaport Faculty of MedicineTechnion‐Israel Institute of Technology Haifa Israel
| | - Lilian Agnes Varga
- Department of Internal Medicine and Haematology Hungarian Angioedema Center of Reference and Excellence Semmelweis University Budapest Hungary
| | - Karsten Weller
- Institute of Allergology Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin Germany
| | - Andrea Zanichelli
- Department of Internal Medicine ASST Fatebenefratelli Sacco Ospedale Luigi Sacco‐University of Milan Milan Italy
| | - Yuxiang Zhi
- Department of Allergy and Clinical Immunology Bejing Union Medical College Hospital & Chinese Academy of Medical Sciences Bejing China
| | - Bruce Zuraw
- University of California, San Diego San Diego California USA
| | - Timothy Craig
- Departments of Medicine and Pediatrics Penn State University Hershey Pennsylvania USA
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Gosling CJ, Cartigny A, Mellier BC, Solanes A, Radua J, Delorme R. Efficacy of psychosocial interventions for Autism spectrum disorder: an umbrella review. Mol Psychiatry 2022; 27:3647-3656. [PMID: 35790873 PMCID: PMC9708596 DOI: 10.1038/s41380-022-01670-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The wide range of psychosocial interventions designed to assist people with Autism Spectrum Disorder (ASD) makes it challenging to compile and hierarchize the scientific evidence that supports the efficacy of these interventions. Thus, we performed an umbrella review of published meta-analyses of controlled clinical trials that investigated the efficacy of psychosocial interventions on both core and related ASD symptoms. METHODS Each meta-analysis that was identified was re-estimated using a random-effects model with a restricted maximum likelihood estimator. The methodological quality of included meta-analyses was critically appraised and the credibility of the evidence was assessed algorithmically according to criteria adapted for the purpose of this study. RESULTS We identified a total of 128 meta-analyses derived from 44 reports. More than half of the non-overlapping meta-analyses were nominally statistically significant and/or displayed a moderate-to-large pooled effect size that favored the psychosocial interventions. The assessment of the credibility of evidence pointed out that the efficacy of early intensive behavioral interventions, developmental interventions, naturalistic developmental behavioral interventions, and parent-mediated interventions was supported by suggestive evidence on at least one outcome in preschool children. Possible outcomes included social communication deficits, global cognitive abilities, and adaptive behaviors. Results also revealed highly suggestive indications that parent-mediated interventions improved disruptive behaviors in early school-aged children. The efficacy of social skills groups was supported by suggestive evidence for improving social communication deficits and overall ASD symptoms in school-aged children and adolescents. Only four meta-analyses had a statistically significant pooled effect size in a sensitivity analysis restricted to randomized controlled trials at low risk of detection bias. DISCUSSION This umbrella review confirmed that several psychosocial interventions show promise for improving symptoms related to ASD at different stages of life. However, additional well-designed randomized controlled trials are still required to produce a clearer picture of the efficacy of these interventions. To facilitate the dissemination of scientific knowledge about psychosocial interventions for individuals with ASD, we built an open-access and interactive website that shares the information collected and the results generated during this umbrella review. PRE-REGISTRATION PROSPERO ID CRD42020212630.
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Affiliation(s)
- Corentin J. Gosling
- Paris Nanterre University, DysCo Laboratory, F-92000 Nanterre, France ,grid.508487.60000 0004 7885 7602Université de Paris, Laboratoire de Psychopathologie et Processus de Santé, F-92100 Boulogne-Billancourt, France ,grid.5491.90000 0004 1936 9297Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Ariane Cartigny
- grid.508487.60000 0004 7885 7602Université de Paris, Laboratoire de Psychopathologie et Processus de Santé, F-92100 Boulogne-Billancourt, France ,grid.413235.20000 0004 1937 0589Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris, France
| | | | - Aleix Solanes
- grid.10403.360000000091771775Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain
| | - Joaquim Radua
- grid.10403.360000000091771775Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain ,grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK ,grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Richard Delorme
- grid.413235.20000 0004 1937 0589Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris, France ,grid.428999.70000 0001 2353 6535Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
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Hospital volume-outcome relationship in total knee arthroplasty: a systematic review and dose-response meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2862-2877. [PMID: 34494124 PMCID: PMC9309153 DOI: 10.1007/s00167-021-06692-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/06/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE This systematic review and dose-response meta-analysis aimed to investigate the relationship between hospital volume and outcomes for total knee arthroplasty (TKA). METHODS MEDLINE, Embase, CENTRAL and CINAHL were searched up to February 2020 for randomised controlled trials and cohort studies that reported TKA performed in hospitals with at least two different volumes and any associated patient-relevant outcomes. The adjusted effect estimates (odds ratios, OR) were pooled using a random-effects, linear dose-response meta-analysis. Heterogeneity was quantified using the I2-statistic. ROBINS-I and the GRADE approach were used to assess the risk of bias and the confidence in the cumulative evidence, respectively. RESULTS A total of 68 cohort studies with data from 1985 to 2018 were included. The risk of bias for all outcomes ranged from moderate to critical. Higher hospital volume may be associated with a lower rate of early revision ≤ 12 months (narrative synthesis of k = 7 studies, n = 301,378 patients) and is likely associated with lower mortality ≤ 3 months (OR = 0.91 per additional 50 TKAs/year, 95% confidence interval [0.87-0.95], k = 9, n = 2,638,996, I2 = 51%) and readmissions ≤ 3 months (OR = 0.98 [0.97-0.99], k = 3, n = 830,381, I2 = 44%). Hospital volume may not be associated with the rates of deep infections within 1-4 years, late revision (1-10 years) or adverse events ≤ 3 months. The confidence in the cumulative evidence was moderate for mortality and readmission rates; low for early revision rates; and very low for deep infection, late revision and adverse event rates. CONCLUSION An inverse volume-outcome relationship probably exists for some TKA outcomes, including mortality and readmissions, and may exist for early revisions. Small reductions in unfavourable outcomes may be clinically relevant at the population level, supporting centralisation of TKA to high-volume hospitals. LEVEL OF EVIDENCE III. REGISTRATION NUMBER The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42019131209 available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131209 ).
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