scholarly journals Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary

Neurology ◽  
2021 ◽  
Vol 97 (20) ◽  
pp. 942-957
Author(s):  
Tamara Pringsheim ◽  
Gregory S. Day ◽  
Don B. Smith ◽  
Alex Rae-Grant ◽  
Nicole Licking ◽  
...  
Keyword(s):  
Systematic Review ◽  
Parkinson Disease ◽  
Dopamine Agonists ◽  
Early Stage ◽  
Treatment Options ◽  
Immediate Release ◽  
Initial Therapy ◽  
Current Evidence ◽  
Motor Symptoms ◽  
Institute Of Medicine

Background and ObjectivesTo review the current evidence on the options available for initiating dopaminergic treatment of motor symptoms in early-stage Parkinson disease and provide recommendations to clinicians.MethodsA multidisciplinary panel developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine–compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence.ResultsInitial treatment with levodopa provides superior motor benefit compared to treatment with dopamine agonists, whereas levodopa is more likely than dopamine agonists to cause dyskinesia. The comparison of different formulations of dopamine agonists yielded little evidence that any one formulation or method of administration is superior. Long-acting forms of levodopa and levodopa with entacapone do not appear to differ in efficacy from immediate-release levodopa for motor symptoms in early disease. There is a higher risk of impulse control disorders associated with the use of dopamine agonists than levodopa. Recommendations on initial therapy for motor symptoms are provided to assist the clinician and patient in choosing between treatment options and to guide counseling, prescribing, and monitoring of efficacy and safety.

Exploring Nonmotor Neuropsychiatric Manifestations of Parkinson Disease in a Comprehensive Care Setting

2020 ◽  
pp. 089198872091552
Author(s):  
Amitha Dhingra ◽  
A. Umair Janjua ◽  
Laura Hack ◽  
Gabriella Waserstein ◽  
Justin Palanci ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Sleep Disturbances ◽  
Treatment Options ◽  
Symptom Relief ◽  
Comprehensive Care ◽  
Motor Symptoms ◽  
Treatment Models ◽  
Neuropsychiatric Manifestations ◽  
Treatment Plans ◽  
Comprehensive Care Model

Parkinson disease (PD) is a debilitating neurological condition that includes both motor symptoms and nonmotor symptoms (NMS). Psychiatric complaints comprise NMS and are collectively referred to as neuropsychiatric manifestations. Common findings include atypical depressive symptoms, anxiety, psychosis, impulse control disorder, deterioration of cognition, and sleep disturbances. Quality of life (QoL) of patients suffering from NMS is greatly impacted and many times can be more debilitating than motor symptoms of PD. We expand on knowledge gained from treatment models within a comprehensive care model that incorporates multidisciplinary specialists working alongside psychiatrists to treat PD. Insight into background, clinical presentations, and treatment options for patients suffering from neuropsychiatric manifestations of PD are discussed. Identifying symptoms early can help improve QoL, provide early symptom relief, and can assist tailoring treatment plans that limit neuropsychiatric manifestations.

scholarly journals Autologous protein solution: a promising solution for osteoarthritis?

2021 ◽  
Vol 6 (9) ◽  
pp. 716-726
Author(s):  
Hamid Rahmatullah Bin Abd Razak ◽  
Daniel Chew ◽  
Zepur Kazezian ◽  
Anthony M.J. Bull
Keyword(s):  
Early Stage ◽  
Autologous Blood ◽  
Treatment Options ◽  
White Blood Cells ◽  
Current Evidence ◽  
Protein Solution ◽  
Necrosis Factor Alpha ◽  
Knee Oa ◽  
Promising Solution ◽  
End Stage

Osteoarthritis (OA) is a global health issue with myriad pathophysiological factors and is one of the most common causes of chronic disability in adults due to pain and altered joint function. The end stage of OA develops from a destructive inflammatory cycle, driven by the pro-inflammatory cytokines interleukin-1β (IL-1β) and tumour necrosis factor alpha (TNFα). Owing to the less predictable results of total knee arthroplasty (TKA) in younger patients presenting with knee OA, there has been a surge in research evaluating less invasive biological treatment options, one of which is autologous protein solution (APS). APS is an autologous blood derivative obtained by using a proprietary device, made of APS separator, which isolates white blood cells (WBCs) and platelets in a small volume of plasma, and APS concentrator, which further concentrates platelets, WBCs and plasma proteins, resulting in a concentrated solution with high levels of growth factors including the anti-inflammatory mediators against IL-1β and TNFα. A single intraarticular injection of APS appears to be a promising solution for treatment of early-stage OA from current evidence, the majority of which comes from preclinical studies. More clinical studies are needed before APS can be widely accepted as a treatment modality for OA. Cite this article: EFORT Open Rev 2021;6:716-726. DOI: 10.1302/2058-5241.6.200040

scholarly journals Do psychological harms result from being labelled with an unexpected diagnosis of abdominal aortic aneurysm or prostate cancer through screening? A systematic review

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e017565 ◽  
Author(s):  
Anne R Cotter ◽  
Kim Vuong ◽  
Linda L Mustelin ◽  
Yi Yang ◽  
Malika Rakhmankulova ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Early Stage ◽  
Population Based ◽  
Psychological State ◽  
Current Evidence ◽  
Abdominal Aortic ◽  
Psychological Harm

ObjectiveA potential psychological harm of screening is unexpected diagnosis—labelling. We need to know the frequency and severity of this harm to make informed decisions about screening. We asked whether current evidence allows an estimate of any psychological harm of labelling. As case studies, we used two conditions for which screening is common: prostate cancer (PCa) and abdominal aortic aneurysm (AAA).DesignSystematic review with narrative synthesis.Data sources and eligibility criteriaWe searched the English language literature in PubMed, PsychINFO and Cumulative Index of Nursing and Allied Health Literature (CINAHL) for research of any design published between 1 January 2002 and 23 January 2017 that provided valid data about the psychological state of people recently diagnosed with early stage PCa or AAA. Two authors independently used explicit criteria to review and critically appraise all studies for bias, applicability and the extent to which it provided evidence about the frequency and severity of harm from labelling.Results35 quantitative studies (30 of PCa and 5 of AAA) met our criteria, 17 (48.6%) of which showed possible or definite psychological harm from labelling. None of these studies, however, had either appropriate measures or relevant comparisons to estimate the frequency and severity of psychological harm. Four PCa and three AAA qualitative studies all showed clear evidence of at least moderate psychological harm from labelling. Seven population-based studies found increased suicide in patients recently diagnosed with PCa.ConclusionsAlthough qualitative and population-based studies show that at least moderate psychological harm due to screening for PCa and AAA does occur, the current quantitative evidence is insufficient to allow a more precise estimation of frequency and severity. More sensitive measures and improved research designs are needed to fully characterise this harm. In the meantime, clinicians and recommendation panels should be aware of the occurrence of this harm.

scholarly journals Patients’ values and other decisional factors regarding treatment of hypercalcemia of malignancy: A Systematic Review Protocol

2021 ◽  
Author(s):  
Aya Bassatne ◽  
Maya Rahme ◽  
Thomas Piggott ◽  
Mohammad H Murad ◽  
Layal Hneiny ◽  
...  
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Drug Class ◽  
Treatment Options ◽  
Case Series ◽  
Pharmacological Therapy ◽  
Current Evidence ◽  
Drug Selection ◽  
Hypercalcemia Of Malignancy ◽  
Review Protocol

Abstract Background: Hypercalcemia of malignancy is the second most common cause of hypercalcemia and is associated with significant morbidity and mortality. Several treatment options are available including pharmacological therapy with bisphosphonates, denosumab, glucocorticoids, and calcimimetics, as well as conventional therapy with hydration and possibly calcitonin. While guidelines have previously considered treatment effects, no guideline has yet considered a range of contextual factors impacting recommendations for the management. Objective: The aim of this study is to summarize the available evidence on important decisional factors for the development of guidelines for the treatment of hypercalcemia of malignancy. These include patient’s values and preferences, cost, acceptability, feasibility, and equity. Methods/Design: This is a systematic review of observational studies, case series, trials, reviews and qualitative studies involving treatment of adult patients with hypercalcemia of malignancy. We developed and executed two independent search strategies using five databases: Pubmed, Medline (OVID), Embase.com, CINAHL (EBSCO) and Cochrane, and reviewed their combined output. Two reviewers screened titles and abstracts and full texts and will implement data abstraction from relevant studies independently and in duplicate. The outcomes of interest are the decisional factors that influence drug selection, with possible subgroup analyses by drug class or etiology of hypercalcemia of malignancy. We will present the data collected in a narrative and thematic approach. Discussion: This systematic review will identify important treatment decisional factors, and will assist guidelines panels, physicians and patients to decide on therapeutic options based on the current evidence.

scholarly journals A systematic review of cognitive behavior therapy and dialectical behavior therapy for adolescent eating disorders

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Emily N. Vogel ◽  
Simar Singh ◽  
Erin C. Accurso
Keyword(s):  
Systematic Review ◽  
Eating Disorders ◽  
Behavior Therapy ◽  
Dialectical Behavior Therapy ◽  
Cognitive Behavior Therapy ◽  
Treatment Options ◽  
Current Evidence ◽  
Evidence Based ◽  
Cognitive Behavior ◽  
Adolescent Eating Disorders

Abstract Background Eating disorders have serious psychological and physical consequences. Current evidence-based treatments for adolescents with eating disorders have modest effects, underscoring the need to improve current treatment approaches. Cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT) have been proposed as alternative treatment options, with burgeoning research in this area. This review aims to summarize and critically analyze the current literature on the feasibility, acceptability, effectiveness, and efficacy of CBT and DBT for adolescent eating disorders, and then proposes areas of future research. Methods PsycINFO and PubMed were searched using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify studies examining the feasibility, acceptability, effectiveness and/or efficacy of CBT or DBT for adolescent eating disorders. Results Eligible studies (N = 50; CBT: n = 40, DBT: n = 10) indicated that both treatments are reasonably feasible, acceptable, and possibly effective for adolescent eating disorders across diagnoses and levels of care, though efficacy trials are lacking. Conclusions CBT and DBT demonstrate promise as alternatives to family-based approaches for adolescent eating disorders. Adequately powered trials to establish the effectiveness and efficacy of CBT and DBT are needed, particularly ones that compare these treatments against other leading approaches. Plain English summary Despite high rates of relapse and likelihood for severe and enduring illness, there is a dearth of evidence-based treatment options for adolescents with eating disorders. Potentially viable but less well-studied treatments for adolescents with eating disorders include cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT). This systematic review of CBT and DBT for adolescent eating disorders focuses on feasibility (i.e., how easy it was to implement the treatment), acceptability (i.e., how well the intervention was received by patients and therapists), effectiveness (i.e., how well the intervention performed under routine, real-world circumstances), and efficacy (i.e., how well the intervention performed in highly-controlled research settings). This review concludes that research supports the feasibility and acceptability of these approaches, as well as preliminary evidence of their effectiveness. However, the field is lacking studies that systematically compare CBT and DBT to other evidence-based approaches. Recommendations to advance research on CBT and DBT for adolescent eating disorders are provided, including a call for efficacy studies that clarify their performance compared to other leading approaches.

scholarly journals 589 Role of Liver Support Systems in The Management of Post Hepatectomy Liver Failure: A Meta-Analysis and Systematic Review of Literature

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Pufal ◽  
A Lawson ◽  
J Hodson ◽  
M Bangash ◽  
J Patel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Failure ◽  
Support Systems ◽  
Meta Analysis ◽  
Treatment Options ◽  
Treatment Modalities ◽  
Current Evidence ◽  
Liver Support ◽  
Molecular Adsorbent Recirculating System

Abstract Aim Post hepatectomy liver failure (PHLF) is a rare but serious complication following liver resection. PHLF is associated with high mortality of up to 50% in severe cases. With limited treatment options available, there is a need to evaluate the role of systems that support the function of the liver as treatment modalities following PHLF development. Method The aim of this study was to review the literature and summarise the role of liver support systems (LSS) in the management of PHLF. Publications of interest were identified using systematically designed searches. Following screening, data from the relevant publications were extracted, pooled where possible, and analysed. Results Systematic review identified ten studies, which used either Plasma Exchange (PE) or Molecular Adsorbent Recirculating System (MARS) as LSS after PHLF development. The sample sizes of included studies were small, ranging from N = 2 to N = 13. Across all studies, the pooled 90-day mortality rate was 40% (95% CI: 15% - 68%). However, there was substantial heterogeneity (I2=64%), likely since the studies used a variety of definitions for PHLF and had different selection criteria for patient eligibility for LSS treatment. Conclusions Despite potential benefits, the current evidence is insufficient to recommend LSS for the routine management of severe PHLF, with the current literature consisting of only a limited number of studies. There is a definite need for larger, multicentre, prospective studies evaluating the conventional and newer modalities of support systems with a view to improve the outcomes in this group of patients.

Treatment options for unstable ankle fractures in older adults: A systematic review and meta-analysis

Trauma ◽  
2020 ◽  
pp. 146040862093797
Author(s):  
Andrew Grazette ◽  
Catrin Wigley ◽  
Andrew Metcalfe
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Internal Fixation ◽  
Open Reduction ◽  
Meta Analysis ◽  
Treatment Options ◽  
Ankle Fractures ◽  
Treatment Modalities ◽  
Current Evidence ◽  
Treatment Groups

Background Ankle fractures are the third most common fracture in the elderly. Patients over 60 years are more severely affected by these injuries than their younger counterparts and have a higher rate of complications regardless of the management strategy. Traditional management strategies for unstable ankle fractures include plaster immobilisation and open reduction and internal fixation, with newer modalities such as intramedullary fixation becoming increasingly popular. The aim of this review is to establish the best current evidence for or against different treatment strategies. Methods A systematic review and meta-analysis of randomised controlled trials comparing treatment options for unstable ankle fractures in adults over 55 was conducted, with the primary outcome being functional assessment score at 6–12 months (Olerud and Molander Ankle Score). Secondary outcomes were adverse events including infection and re-operation. Results The search strategies identified 426 articles. After screening and full text review, four papers met the inclusion and exclusion criteria, providing data on 754 ankle fractures. Alternative treatment groups were tibio-talo-calcaneal nail, fibular nail and casting and were compared to open reduction and internal fixation. Meta-analysis of the data showed no difference in Olerud and Molander Ankle Score between treatment modalities at 6–12 months. There was, however, a significant reduction in the incidence of adverse events (OR 0.59 (0.44, 0.81)) and wound infection (0.13 (0.05, 0.31)) in the alternative treatment groups compared to open reduction and internal fixation. Conclusion The current evidence shows no significant difference between treatment modalities for ankle fractures in older adults in terms of functional outcome. Open reduction and internal fixation has a higher rate of adverse events and wound infection when compared to alternative treatments. Therefore, surgery should be carefully considered and if undertaken, in a select patient cohort other treatment modalities, such as intramedullary fixation should be considered.

Apathy in untreated early-stage Parkinson disease: Relationship with other non-motor symptoms

2014 ◽  
Vol 29 (14) ◽  
pp. 1796-1801 ◽  
Author(s):  
Kathy Dujardin ◽  
Carole Langlois ◽  
Lucie Plomhause ◽  
Anne-Sophie Carette ◽  
Marie Delliaux ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Early Stage ◽  
Motor Symptoms ◽  
Non Motor Symptoms

scholarly journals Reducing negative emotions in children using social robots: systematic review

2021 ◽  
pp. archdischild-2020-320721
Author(s):  
Brenda Kimbembi Maleco Littler ◽  
Tourkiah Alessa ◽  
Paul Dimitri ◽  
Christine Smith ◽  
Luc de Witte
Keyword(s):  
Systematic Review ◽  
Web Of Science ◽  
Early Stage ◽  
Evidence Base ◽  
Social Robots ◽  
Hospital Environment ◽  
Current Evidence ◽  
Different Types ◽  
Clinical Environments ◽  
Outpatient Appointments

BackgroundFor many children, visiting the hospital can lead to a state of increased anxiety. Social robots are being explored as a possible tool to reduce anxiety and distress in children attending a clinical or hospital environment. Social robots are designed to communicate and interact through movement, music and speech.ObjectiveThis systematic review aims at assessing the current evidence on the types of social robots used and their impact on children’s anxiety or distress levels when visiting the hospital for outpatient appointments or planned admissions.MethodsDatabases such as MEDLINE, PubMed, IEEE Xplore, Web of Science, PsychINFO and Google Scholar were queried for papers published between January 2009 and August 2020 reporting the use of social robots interacting with children in hospital or clinical environments.ResultsA total of 10 studies were located and included. Across these 10 studies, 7 different types of robots were used. Anxiety and distress were found to be reduced in the children who interacted with a social robot.ConclusionsOverall, the evidence suggests that social robots hold a promising role in reducing levels of anxiety or distress in children visiting the hospital. However, research on social robots is at an early stage and requires further studies to strengthen the evidence base.

scholarly journals INFLUENCE OF NOVEL CORONAVIRUS DISEASE (COVID-19) ON PARKINSONS DISEASE: SYSTEMATIC REVIEW

2021 ◽  
Author(s):  
Vikash Jaiswal ◽  
Danah Alquraish ◽  
Shavy Nagpal ◽  
DATTATREYA MUKHERJEE ◽  
Prakriti Singh Shrestha ◽  
...  
Keyword(s):  
Systematic Review ◽  
Parkinson Disease ◽  
Measles Virus ◽  
Dopamine Neurons ◽  
Motor Symptoms ◽  
Parkinsons Disease ◽  
Neurological Outcomes ◽  
Novel Coronavirus ◽  
The Impact

Background: The novel Coronavirus (COVID 19) infection has affected the population with various medical issues including the underlying neurological comorbidities such as Parkinson disease. COVID 19 is found to bind with the host angiotensin-converting enzyme 2 (ACE2) receptors for viral entry. ACE2 receptors are normally expressed in various body surfaces as well as in the neurons and glial cells where they act as an entry port to SARS-CoV-2 infection to invade the central nervous system (CNS). ACE2 are also highly expressed in dopamine neurons which might worsen the outcome in terms of motor symptoms in PD with the treatment course. It may lead to an indirect response via immune-mediated cytokine storms and propagate through CNS leading to damage. Parkinsons disease has also been noticed due to certain post viral infections apart from COVID-19 such as, HSV, Influenza virus A, Measles virus, Cytomegalovirus and Mumps (Olsen et al, 2018). We aim to provide a thorough review on neurological outcomes and impact of COVID-19 in Parkinson disease. Methods: A systematic review was conducted to analyze the impact of COVID 19 in patients with Parkinson disease (> 21 yo). Systematic literature search was done using PubMed, Science Direct, Google Scholar and Cochrane databases. PRISMA guidelines were followed summarized in Fig. 3 for study acquisition. Results: Of the Parkinsons patients that were tested positive for SARS-CoV 2, worsening of motor symptoms were reported along with other COVID 19 symptoms (Fig. 4 and 5). These symptoms include bradykinesia, tremors, gait disturbances, delirium and dementia and severe spasms of arms and legs. Encephalopathy was also one of the main symptoms presented in two of the studies. Increased mortality rates were identified for those who were hospitalized due to COVID-19 and PD when compared to other patients. Conclusion: Parkinsons disease may experience substantial worsening of motor and non motor symptoms during COVID 19. Due to the novelty of the virus, studies were reported from recent years and further extensive studies are needed to explore more about the disease severity and neurological outcomes when compared to other non-PD patients. Authors identify this as a limitation for this paper. Additional studies are needed to understand the role of ACE2 in increasing vulnerability to viruses and role of ACE inhibitors as treatment modality.

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