-
1.
Walking for subjects with type 2 diabetes: A systematic review and joint AMD/SID/SISMES evidence-based practical guideline.
Moghetti, P, Balducci, S, Guidetti, L, Mazzuca, P, Rossi, E, Schena, F, , , , , ,
Nutrition, metabolism, and cardiovascular diseases : NMCD. 2020;(11):1882-1898
Abstract
AIMS: Regular exercise is considered a cornerstone in the management of type 2 diabetes mellitus (T2DM). It improves glucose control and cardiovascular risk factors, contributes to weight loss, and also improves general well-being, likely playing a role in the prevention of chronic complications of diabetes. However, compliance to exercise recommendations is generally inadequate in subjects with T2DM. Walking is the most ancestral form of physical activity in humans, easily applicable in daily life. It may represent, in many patients, a first simple step towards lifestyle changes. Nevertheless, while most diabetic patients do not engage in any weekly walking, exercise guidelines do not generally detail how to improve its use. The aims of this document are to conduct a systematic review of available literature on walking as a therapeutic tool for people with T2DM, and to provide practical, evidence-based clinical recommendations regarding its utilization in these subjects. DATA SYNTHESIS Analysis of available RCTs proved that regular walking training, especially when supervised, improves glucose control in subjects with T2DM, with favorable effects also on cardiorespiratory fitness, body weight and blood pressure. Moreover, some recent studies have shown that even short bouts of walking, used for breaking prolonged sitting, can ameliorate glucose profiles in diabetic patients with sedentary behavior. CONCLUSIONS There is sufficient evidence to recognize that walking is a useful therapeutic tool for people with T2DM. This document discusses theoretical and practical issues for improving its use. This article is co-published in the journals Sport Sciences for Health and Nutrition, Metabolism and Cardiovascular Diseases.
-
2.
A Review on Evidence-Based Treatments for Meibomian Gland Dysfunction.
Lam, PY, Shih, KC, Fong, PY, Chan, TCY, Ng, AL, Jhanji, V, Tong, L
Eye & contact lens. 2020;(1):3-16
Abstract
OBJECTIVES To evaluate recent studies on available therapies for meibomian gland dysfunction (MGD). METHODS A literature search on recent publications, within the last five years, concerning treatment options for MGD was performed. RESULTS A total of 35 articles were reviewed after curation by the authors for relevance. In general, all modalities of treatments were shown to have clinical efficacy in alleviating dry eye signs and symptoms, although the extent of improvement and persistency of outcomes varied between the different treatments. Evidence from published studies demonstrate that thermal pulsation produces the longest lasting effect per treatment, but it also incurs the highest per-treatment cost. Reusable methods for warm compress with lipid/semi-fluorinated alkane-containing eye drops are recommended as first-line treatment for mild-to-moderate dry eye patients, because this option is most technically feasible and cost-effective in clinical practice. Intense pulsed light (IPL) therapy and thermal pulsation may be suitable as second line for patients unresponsive to warm compress therapy; however, their respective limitations need to be considered. For refractory MGD with features of periductal fibrosis or severe blepharitis, supplementary treatment with meibomian gland probing or oral antibiotics may be used. CONCLUSIONS All eight forms of treatments, including self-applied eyelid warming, thermal pulsation, IPL, MG probing, antibiotics, lipid-containing eye drops, and perfluorohexyloctane, were effective against MGD, although with varying extent of clinical improvements. A better understanding on the mechanisms of actions may guide physicians to make better treatment decisions targeting the root causes.
-
3.
Multidisciplinary Management of Hepatic Hydrothorax in 2020: An Evidence-Based Review and Guidance.
Banini, BA, Alwatari, Y, Stovall, M, Ogden, N, Gershman, E, Shah, RD, Strife, BJ, Shojaee, S, Sterling, RK
Hepatology (Baltimore, Md.). 2020;(5):1851-1863
-
4.
Drugs to Prevent Bronchopulmonary Dysplasia: Effect of Baseline Risk on the Number Needed to Treat.
Jensen, EA, Roberts, RS, Schmidt, B
The Journal of pediatrics. 2020;:244-247
Abstract
Infants born very preterm have a variable baseline risk of bronchopulmonary dysplasia (BPD). Using the example of evidence-based drug therapies to prevent BPD, we designed a visual aid that displays the "number needed to treat" with CIs for caffeine, vitamin A, and hydrocortisone over a range of baseline risks.
-
5.
Nutritional Approaches for the Management of Nonalcoholic Fatty Liver Disease: An Evidence-Based Review.
Parra-Vargas, M, Rodriguez-Echevarria, R, Jimenez-Chillaron, JC
Nutrients. 2020;(12)
Abstract
Nonalcoholic fatty liver disease (NAFLD) is on the rise worldwide representing a public health issue. Its coexistence with obesity and other metabolic alterations is highly frequent. Therefore, current therapy interventions for NAFLD are mainly focused on progressive weight loss through modulation of overall calorie intake with or without specific macronutrient adjustments. Furthermore, other relevant nutritional interventions are built on food selection and time-restricted eating. Since every strategy might bring different results, choosing the optimal diet therapy for a patient is a complicated task, because NAFLD is a multifactorial complex disease. Importantly, some factors need to be considered, such as nutrition-based evidence in terms of hepatic morphophysiological improvements as well as adherence of the patient to the meal plan and adaptability in their cultural context. Thus, the purpose of this review is to explore and compare the subtleties and nuances of the most relevant clinical practice guidelines and the nutritional approaches for the management of NAFLD with a special attention to tangible outcomes and long-term adherence.
-
6.
Development of an evidence-based decision aid on complementary and alternative medicine (CAM) and pain for parents of children with cancer.
Jong, MC, Boers, I, van Wietmarschen, H, Busch, M, Naafs, MC, Kaspers, GJL, Tissing, WJE
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2020;(5):2415-2429
-
-
Free full text
-
Abstract
PURPOSE To develop an evidence-based decision aid for parents of children with cancer and to help guide them in the use of complementary and alternative medicine (CAM) for cancer care. METHODS This study had a mixed research design. The needs of parents were investigated by survey and focus group. A systematic review and meta-analysis were performed on the effectiveness of CAM using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Clinical experts were interviewed and a decision aid on CAM treatment for pain was developed. RESULTS Parents emphasized the importance of reliable information on CAM, focusing primarily on communication and a broad spectrum of complaints related to cancer treatment. The decision aid on CAM for pain included five modalities based on 11 randomized control trials (RCTs): hypnotherapy, mind-body techniques, massage, healing touch, and music therapy. Meta-analysis could be performed on hypnotherapy, which significantly reduced cancer-related procedural pain compared with standard care (MD, - 1.37; 95% CI, - 1.60, - 1.15; P < 0.00001) and attention control (MD, - 1.13; 95% CI, - 1.34, - 0.94; P < 0.00001), and massage, demonstrating no effect on pain compared with standard care (MD, - 0.77; 95% CI, - 1.82, 0.28; P = 0.15). Research evidence and supplementary information from clinical practice and patient were incorporated in a website-based decision aid. CONCLUSIONS An evidence-based decision aid was developed to support parents of children with cancer in making decisions about CAM for pain management. Next steps will be to expand the website to include additional childhood cancer-related complaints and to evaluate its use in practice.
-
7.
Icosapent ethyl: Where will it fit into guideline-based medical therapy for high risk atherosclerotic cardiovascular disease?
Orringer, CE
Trends in cardiovascular medicine. 2020;(3):151-157
Abstract
Patients who are at high or very high risk for atherosclerotic cardiovascular disease (ASCVD) events derive the greatest benefit when clinicians prescribe evidence-based preventive therapies. The writing process used in the creation of the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol employed a thorough evaluation of the highest quality evidence, and synthesis of this evidence into actionable recommendations for ASCVD risk reduction. Clinical trials supporting the addition of ezetimibe, PCSK9 inhibitors, or both to evidence-based statins provide the basis for the updated recommendations for the preventive care of these patients. The publication in late 2018 of a randomized controlled trial supporting the net ASCVD risk reduction benefit of adding icosapent ethyl to statins in selected hypertriglyceridemic patients with clinical ASCVD and/or type 2 diabetes with multiple additional risk markers provides the rationale for incorporation of icosapent ethyl therapy into future ASCVD preventive care regimens.
-
8.
Problems lowering the study quality in traditional medicine, introspection from an example of meta-analysis of acupuncture.
Chen, Q, Wang, Q, Ding, S, Li, S, Zhang, Y, Chen, S, Lin, X, Li, C, Asakawa, T
BMC complementary medicine and therapies. 2020;(1):41
Abstract
BACKGROUND Most randomized controlled trials (RCTs) of traditional medicine (such as traditional Chinese medicine (TCM), psychotherapy or behavioral therapy, and dietary interventions, etc.) have reported that they could not provide convincing evidence to support the efficacy because of the low quality of their studies. Here, we aimed to determine the underlying problems of the study quality using standards of evidence-based medicine (EBM) to evaluate the efficacy of traditional medicine. METHODS We conducted an example of meta-analysis to evaluate the efficacy of acupuncture, a classical treatment of TCM, for treatment of intracerebral hemorrhage (ICH). The quality of the included studies was evaluated by using a Jadad score. RESULTS A total of 24 Chinese RCTs that enrolled 1815 patients with ICH were included. Although the results suggested that acupuncture had good efficacy for relief of neurological deficits and improvement of the activities of daily living despite the high heterogeneity of the included studies, the low quality of the included literature reduced the worthiness of the evidence. Two systematic problems (lack of blinding and allocation concealment and high heterogeneity) and one non-systematic problem (lack of reports on adverse events and follow-up) of the TCM studies were found in this illustrational meta-analysis. We believed that other interventions of traditional medicine also suffer from these problems. CONCLUSIONS Non-systematic problems can be improved by perfecting the experimental design, educating the researcher, and improving the reporting system. However, systematic problems are derived from the characteristics of traditional medicine that are difficult to be corrected. We propose that adoption of objective indexes might be a better solution to improve the systematic problems of traditional medicine. We summarized the problems and the underlying solutions, which may contribute to improve the study quality of systematic review in traditional medicine, strictly complying with the principles of EBM.
-
9.
AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia.
Rockey, DC, Altayar, O, Falck-Ytter, Y, Kalmaz, D
Gastroenterology. 2020;(3):1097-1119
-
10.
Evidence-Based Data About Prevalence and Risk of Malignancy of Thyroid Incidentalomas Detected by Different PET Radiopharmaceuticals.
Signore, G, Albano, D, Giovanella, L, Bertagna, F, Treglia, G
Current radiopharmaceuticals. 2020;(2):89-93
Abstract
BACKGROUND To date, several meta-analyses and systematic reviews have reported data about the prevalence and risk of malignancy of thyroid incidentalomas detected by different PET radiopharmaceuticals. OBJECTIVE This article aims to summarize the published evidence-based data about the prevalence and risk of malignancy of thyroid incidentalomas detected by different PET radiopharmaceuticals. METHODS A comprehensive computer literature search of systematic reviews and meta-analyses published up to July 2019 in PubMed/MEDLINE and Cochrane library databases regarding the prevalence and risk of malignancy of thyroid incidentalomas detected by different PET radiopharmaceuticals was carried out. RESULTS We have summarized the data about prevalence and risk of malignancy of thyroid incidentalomas detected by different PET radiopharmaceuticals (fluorine-18 fluorodeoxyglucose, radiolabelled choline and prostate-specific membrane antigen) taking into account 8 evidence-based articles. CONCLUSION Evidence-based data demonstrated that thyroid incidentalomas detected by different PET radiopharmaceuticals are not infrequent and their risk of malignancy is not negligible, in particular if focal pattern is evident at PET, thus requiring further clinical and instrumental evaluation.