Abstract We set out to evaluate quality of reporting of data related to external validity from randomized controlled trials (RCTs) assessing treatment interventions for active venous leg ulcers. Using a systematic review study design, we identified 144 full‐text RCTs of treatment interventions, where the wound was assessed and published in English from 1998 to 2018. We found that the median study sample size was 75.5. Weighted mean wound size was 13.22 cm 2 and weighted mean wound duration was 22.20 months. Forty‐six (32%) reported numbers screened for eligibility and 27 (19%) reported the number who declined to participate; 19 (13%) reported on patient ethnicity; 60 (42%) reported comorbidities; and 5 (4%) reported current medication use. When reported, 60/102 (59%) excluded patients with an ankle‐brachial pressure index <0.8; 68/135 (50%) were conducted in Europe, 6/135 (4%) in Asia, and 74/104 (71%) were conducted in outpatient facilities; 3 (2%) reported socioeconomic factors and 88 (61%) reported on adverse events. We concluded that there is inadequate reporting of data related to external validity in reports of RCTs assessing venous leg ulcers treatment interventions. Significant variability exists in the ankle‐brachial pressure index cutoff point for inclusion or exclusion, making generalizability difficult to assess.
Medulloblastoma (MB) is one of the most prevalent forms of malignant brain cancer observed within pediatric patients and is particularly difficult to diagnose and treat due to the anatomical localization of tumors near the brainstem. Currently, there are four molecular classifications of MBL: WNT, SHH, Group 3, and Group 4 tumor subgroups. Wingless-type (WNT) mutant tumors are the least common, often caused by mutations in the CTNNB1 gene that plays a crucial role in the wingless cell signaling pathway, yet associates with the best prognosis as compared to all other MBL subtypes. Sonic hedgehog (SHH) mutant tumors arise due to continued release of Shh from purkinje cells, and an uninhibited proliferation response by granular neuronal precursors (GNPs). Group 3 and 4 MBL subgroups are still a molecularly heterogeneous class of tumors, with Group 3 MBL being highly associated with metastasis upon diagnosis, and more prevalently characterized by MYC amplification and activation. Group 4 MBL tumors comprise approximately 40% of all MBL, and remain remarkably heterogeneous with respect to somatic mutations of genes such as KDM6A, OTX2, ZMYM3, with an approximate 80% of tumors harboring chromosome 17 copy number alterations. While a majority of MBL cases cannot be linked to a single protein coding gene alteration, the role of non-coding RNAs, such as miRNAs, seems quite promising as a genetic marker to further sub-categorize MBL at the molecular level. Furthermore, miRNA-based therapy is proving to be a promising treatment to curb the growth of a number of cancer types within the clinic, with particular miRNAs under investigation including miR-34a, miR-211, and miR-584-5p. These miRNAs are known to induce cell cycle arrest in mouse models and demonstrate anti-tumorigenic properties in vitro, meriting further investigation of miRNA-based clinical trials for pediatric MBL patients.
Living with diabetic foot ulceration can have a significant impact on a person’s physical and psychological health. All members of the multidisciplinary team have a responsibility to consider the importance of wellbeing assessment and to be mindful of a number of suggested approaches.
Introduction: Intravenous therapy and medicines (IVTM) are the most common invasive interventions in use in healthcare. Prescribed IVTM play an essential role in the treatment of illness, management of chronic conditions and in maintaining health and wellbeing. The intravenous (IV) route is the administration of concentrated medications (diluted or undiluted) directly into peripherally or centrally inserted vascular access devices. Medication safety is a key priority and best practice standards are required to guide the safe preparation and administration of IVTM.Methods: We will conduct a systematic review of the literature pertaining to the preparation and administration of intravenous therapy and medicines. Our search will include studies concerned with the preparation and/or administration of IVTM via peripheral or central vascular access devices. We will be guided by the preferred reporting items for systematic review and meta-analysis (PRISMA) in this review. Literature will include all trial designs, national/international guidelines, and expert consensus opinion made available in English from 2009 to present day.Conclusions: We will synthesise the evidence concerning safe and effective preparation and administration of intravenous therapy and medicines to inform the development of a national guideline for healthcare professionals in Ireland. The availability of up-to-date, contemporaneous evidence-based practice standards will ensure quality and safety for service-users.Registration: This study has been submitted to PROSPERO and we are awaiting confirmation of registration.
Serotonin (5-HT3) receptor antagonists are commonly used to decrease nausea and vomiting for surgery patients. We conducted a systematic review on the comparative efficacy of 5-HT3 receptor antagonists.Searches were done in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify studies comparing 5-HT3 receptor antagonists with each other, placebo, and/or combined with other antiemetic agents for patients undergoing surgical procedures. Screening search results, data abstraction, and risk of bias assessment were conducted by two reviewers independently. Random-effects pairwise meta-analysis and network meta-analysis (NMA) were conducted. PROSPERO registry number: CRD42013003564.Overall, 450 studies and 80,410 patients were included after the screening of 7,608 citations and 1,014 full-text articles. Significantly fewer patients experienced nausea with any drug relative to placebo, except for ondansetron plus metoclopramide in a NMA including 195 RCTs and 24,230 patients. Significantly fewer patients experienced vomiting with any drug relative to placebo except for palonosetron plus dexamethasone in NMA including 238 RCTs and 12,781 patients. All agents resulted in significantly fewer patients with postoperative nausea and vomiting versus placebo in a NMA including 125 RCTs and 16,667 patients.Granisetron plus dexamethasone was often the most effective antiemetic, with the number needed to treat ranging from two to nine.
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