Yuri T. Jadotte

Solar cheilosis: An ominous precursor: Part I. Diagnostic insights

Squamous cell carcinoma (SCC) of the lower lip is a deadly nonmelanoma skin cancer. Its precursor, a distinctive cutaneous neoplasia analogous to cervical dysplasia, is known by the confusing term actinic cheilitis. Solar cheilosis (SC) is a more appropriate designation. It represents incipient SCC in situ. SC is widely recognized as an ultraviolet light-induced precancer of the lower lip that is typically seen in light-skinned individuals and others with poorly pigmented lower lips. Lip SCC is one of the most common malignancies of the oral cavity. SCC is much more likely to metastasize from the lip than cutaneous surfaces, with a 5-year overall survival rate of less than 75%. SC results from long-term exposure to ultraviolet radiation. The occurrence of SC is dose-dependent and is influenced by the patients solar exposure, age, genetic predisposition, geographic latitude of residence, occupation, leisure activities, and use of lip protective agents. Molecular abnormalities of SC are similar to those of actinic keratosis and facilitate the evolution to SCC. A high degree of clinical suspicion should be maintained, given the malignant nature of this condition. Ulceration and nodularity often indicate progression to SCC. We performed a Medline and Google Scholar search for all articles related to actinic cheilitis, actinic cheilosis, SC, actinic keratosis, solar keratosis, premalignant oral disease, and lip SCC, and have also evaluated many other articles and book chapters. One hundred forty-two peer-reviewed articles were identified as being of particular value. Pertinent facts were selected and analyzed.

Diagnostic test accuracy: methods for systematic review and meta-analysis

ABSTRACTSystematic reviews are carried out to provide an answer to a clinical question based on all available evidence (published and unpublished), to critically appraise the quality of studies, and account for and explain variations between the results of studies. The Joanna Briggs Institute specializes in providing methodological guidance for the conduct of systematic reviews and has developed methods and guidance for reviewers conducting systematic reviews of studies of diagnostic test accuracy. Diagnostic tests are used to identify the presence or absence of a condition for the purpose of developing an appropriate treatment plan. Owing to demands for improvements in speed, cost, ease of performance, patient safety, and accuracy, new diagnostic tests are continuously developed, and there are often several tests available for the diagnosis of a particular condition. In order to provide the evidence necessary for clinicians and other healthcare professionals to make informed decisions regarding the optimum test to use, primary studies need to be carried out on the accuracy of diagnostic tests and the results of these studies synthesized through systematic review. The Joanna Briggs Institute and its international collaboration have updated, revised, and developed new guidance for systematic reviews, including systematic reviews of diagnostic test accuracy. This methodological article summarizes that guidance and provides detailed advice on the effective conduct of systematic reviews of diagnostic test accuracy.

Solar cheilosis: An ominous precursor: Part II. Therapeutic perspectives

The differential diagnosis of SC includes malignant, premalignant, metastatic, inflammatory, and eczematoid disorders, along with photodermatoses and a few rare but important disorders of the lower lip. Current treatment options include topical, ablative, and surgical therapies. Several clinical challenges are also addressed, including the issue of obtaining a high-yield diagnostic biopsy specimen while minimizing patient morbidity, field-directed treatment for SC, and strategies for combination therapy.

Conducting systematic reviews of economic evaluations.

Background:In 2012, a working group was established to review and enhance the Joanna Briggs Institute (JBI) guidance for conducting systematic review of evidence from economic evaluations addressing a question(s) about health intervention cost-effectiveness. Objectives:The objective is to present the outcomes of the working group. Methods:The group conducted three activities to inform the new guidance: review of literature on the utility/futility of systematic reviews of economic evaluations and consideration of its implications for updating the existing methodology; assessment of the critical appraisal tool in the existing guidance against criteria that promotes validity in economic evaluation research and two other commonly used tools; and a workshop. Results:The debate in the literature on the limitations/value of systematic review of economic evidence cautions that systematic reviews of economic evaluation evidence are unlikely to generate one size fits all answers to questions about the cost-effectiveness of interventions and their comparators. Informed by this finding, the working group adjusted the framing of the objectives definition in the existing JBI methodology. The shift is away from defining the objective as to determine one cost-effectiveness measure toward summarizing study estimates of cost-effectiveness and informed by consideration of the included study characteristics (patient, setting, intervention component, etc.), identifying conditions conducive to lowering costs and maximizing health benefits. The existing critical appraisal tool was included in the new guidance. The new guidance includes the recommendation that a tool designed specifically for the purpose of appraising model-based studies be used together with the generic appraisal tool for economic evaluations assessment to evaluate model-based evaluations. The guidance produced by the group offers reviewers guidance for each step of the systematic review process, which are the same steps followed in JBI reviews of other types of evidence. Discussion:The updated JBI guidance will be useful for researchers wanting to synthesize evidence about economic questions, either as stand-alone reviews or part of comprehensive or mixed method evidence reviews. Although the updated methodology produced by the work of the working group has improved the JBI guidance for systematic reviews of economic evaluations, there are areas where further work is required. These include adjusting the critical appraisal tool to separate out questions addressing intervention cost and effectiveness measurement; providing more explicit guidance for assessing generalizability of findings; and offering a more robust method for evidence synthesis that facilitates achieving the more ambitious review objectives.

Disparities in Cardiac Rehabilitation Participation in the United States: A SYSTEMATIC REVIEW AND META-ANALYSIS.

PURPOSE: Phase 2 cardiac rehabilitation (CR) is a class I recommendation for all patients following an acute cardiac event or cardiac surgery according to the The American Heart Association and the American College of Cardiology Foundation. Studies have shown that there are differences in cardiac rehabilitation participation rates between sociodemographic groups. The purpose of this systematic review and meta-analyses was to synthesize quantitative data on the relationship between outpatient cardiac rehabilitation (OCR) attendance and various sociodemographic factors. METHODS: We conducted a search of PubMed, PsycINFO, CINAHL, Google Scholar, Dissertations & Theses A&I, and conference abstracts for observational studies conducted in the United States that fit our inclusion criteria. A total of 21 studies were included in our final review and meta-analyses. RESULTS: Our meta-analyses showed that overall, attenders were younger than nonattenders (mean difference=−3.74 years, 95% CI =−5.87 to −1.61) and the odds of participation were lower among females (OR = 0.59; 95% CI = 0.51-0.69), individuals with a high school degree or less (OR = 0.67; 95% CI = 0.50-0.91), and the uninsured or self-payers (OR = 0.32; 95% CI = 0.14-0.71). Full- or part-time employees were more likely to participate than those not employed (OR = 1.45; 95% CI = 1.08-1.95). CONCLUSIONS: Our systematic review and meta-analyses showed that there are significant sociodemographic disparities in CR participation. On the basis of this knowledge, clinicians and policy makers should focus on identifying and eliminating barriers to participation.

Acute Delirium: Differentiation and Care

The health care costs for patients with delirium were estimated to be more than double the costs for patients without delirium and potentially exceeded the costs for falls, diabetes mellitus, and hip fractures; yet the fluctuating nature of the condition makes it a difficult condition for health professionals to recognize and treat. The key, then, is in recognition and prevention.

Complementary and alternative medicine treatments for atopic eczema (Protocol)

The objectives are as follows: To assess the effects of complementary and alternative medicine treatments for atopic eczema.

The factors influencing utilization of hospital services by adult sickle cell disease patients: a systematic review protocol

REVIEW QUESTION / OBJECTIVE The research question is: what are the modifiable and non-modifiable factors that influence the utilization of hospital services by adult sickle cell disease patients? The objective of this systematic review is to determine what modifiable and non-modifiable factors influence utilization of hospital services by adult sickle cell disease patients. INCLUSION CRITERIA Types of participants The review will consider studies that include adult Sickle cell disease patients of both sexes who have utilized hospital services. The review will include adult Sickle cell disease patients who have visited emergency department s, been admitted to the hospital from the emergency department s or been admitted directly to the hospital from the community. This review will include adult Sickle cell disease patients who have utilized hospital services for acute or emergent care. The review will exclude participants who have utilized hospital services for elective treatments in order to determine factors that may be exclusive to the use of hospital services for acute care. Types of intervention(s)/phenomena of interest This review will consider studies that explore factors that influence utilization of hospital services (such as the frequency of emergency department visits and inpatient admissions among adult Sickle cell disease patients, and the risk of high utilization of hospital services). The factors will include non-modifiable (age, sex, ethnicity, Sickle cell disease genotype) and modifiable factors, such as socioeconomic (education, income, insurance status, availability of outpatient care), psychological (anxiety, depression, perceived optimism, perceived discrimination) and disease-related factors (Hgb level, presence of complications, presence TRUNCATED AT 250 WORDS

The effectiveness of non-pharmacological multi-component interventions for the prevention of delirium in hospitalized older adult patients: a systematic review

Background:Delirium, an acute and fluctuating decline in attention and cognition, is a common problem in hospitalized older patients, resulting in poor clinical outcomes including functional decline, falls, nursing home placement, and death. Objective:The aim was to synthesize the best available evidence on non-pharmacological multi-component interventions for prevention of delirium in hospitalized non-intensive care older adults. Methods:Systematic review types of participants were adults hospitalized in a non-intensive care setting, 60 years and over, and identified as at risk for delirium or experiencing delirium. Types of intervention(s)/phenomena of interest. Studies considered evaluated non-pharmacological, multi-component interventions for the prevention of delirium in the hospitalized older adult when compared to usual care. Types of outcomes. Outcomes considered included incidence of delirium, duration of delirium, and severity of delirium. This review considered randomized controlled trials, controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, and case controlled studies. A three-step strategy was utilized to find both published and unpublished studies published in English between 1990 and 2013. The JBI Critical Appraisal Checklists for Randomized Control Trial/Pseudo-randomized Control Trial and Comparable Cohort/Case-Controlled Studies were used to assess methodological quality. Data were extracted using the standardized data extraction tools from JBI. Meta-analysis was conducted for the following outcomes: incidence of delirium, duration of delirium, and severity of delirium, including subgroup analysis. Results:Ten research articles were included. Patients who received multi-component interventions had 31% lower risk of developing delirium [(RR 0.69, at 95% CI 0.60, 0.78), p < 0.0001]. These interventions were found to lessen the duration and severity of delirium, although these findings were non significant. Discussion:The use of non-pharmacological, multi-component interventions in older patients in areas other than critical care can lower the risk of delirium. Conclusion:This systematic review provides Level 2 evidence on the effectiveness of non-pharmacological, multi-component interventions for the prevention of delirium in older patients in non-ICU settings.

Indoor Tanning Practices of Colorado High School Students

For the first time, the 2013 Colorado Youth Risk Behavior Survey assessed indoor tanning practices of Colorado high school students. The survey revealed that girls are more likely to use indoor tanning devices than boys and that the majority of students who tan do so once or twice annually. Health care professionals and policymakers should focus on these groups in efforts to curtail indoor tanning and the associated risk of skin cancer in youth.