rational clinical examination systematic review

IMPORTANCE: Delayed diagnosis of a dislocated hip in infants can lead to complex childhood surgery, interruption to family life, and premature osteoarthritis. OBJECTIVE: To evaluate the diagnostic accuracy of clinical examination in identifying dislocated hips in infants. DATA SOURCES: Systematic search of CINAHL, Embase, MEDLINE, and the Cochrane Library from the inception of each database until October 31, 2023. STUDY SELECTION: The 9 included studies reported the diagnostic accuracy of the clinical examination (index test) in infants aged 3 months or younger and a diagnostic hip ultrasound (reference test)...

IMPORTANCE: The accuracy of screening tests for alcohol use disorder (defined as a problematic pattern of alcohol use leading to clinically significant impairment or distress) requires reassessment to align with the latest definition in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5). OBJECTIVE: To assess the diagnostic accuracy of screening tools in identifying individuals with alcohol use disorder as defined in the DSM-5. DATA SOURCES AND STUDY SELECTION: The databases of MEDLINE and Embase were searched (January 2013-February 2023) for original studies on the diagnostic accuracy of brief screening tools to identify alcohol use disorder according to the DSM-5 definition...

OBJECTIVE: Drug utilization studies (DUS) provide a framework for drug utilization at the national or targeted population level and important information on unmet medical needs, particularly in assessing the rationality of drug use. We aimed to systematically review DUS conducted in Turkiye. METHODS: We examined 162 DUS with an accessible full-text, published as "research articles" and conducted in Turkiye between 2000 and 2021 using medical records and prescription data...

BACKGROUND Rationing of nursing care (RONC) has been associated with poor patient outcomes and is a growing concern in healthcare. The aim of this systematic study was to investigate the connection between patient safety and the RONC. MATERIAL AND METHODS A thorough search of electronic databases was done to find research that examined the relationship between restricting nurse services and patient safety. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines...

Exosomes are nanoscale extracellular vesicles secreted by cells and enclosed by a lipid bilayer membrane containing various biologically active cargoes such as proteins, lipids, and nucleic acids. Engineered exosomes generated through genetic modification of parent cells show promise as drug delivery vehicles, and they have been demonstrated to have great therapeutic potential for treating cancer, cardiovascular, neurological, and immune diseases, but systematic knowledge is lacking regarding optimization of drug loading and assessment of delivery efficacy...

INTRODUCTION: This is a systematic review of prescribing, clinical, patient-reported, and health utilization outcomes of goal-directed medication reviews in older adults. METHODS: A systematic review was conducted using MEDLINE, EMBASE, SCOPUS and CINAHL databases to identify studies examining outcomes of goal-directed medication reviews in humans, with mean/median age ≥ 60 years and in English. RESULTS: Seventeen out of 743 articles identified were included...

OBJECTIVE: The development of serious games for mental wellbeing is a topic of growing interest. The increase in acceptance of games as a mainstream entertainment medium combined with the immersive qualities of games provides opportunities for meaningful support and intervention in mental wellbeing. METHOD: We conducted a systematic review and exploratory meta-analysis to examine if aspects of the interventions influenced outcomes as measured via overall effect sizes...

The neurological manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, including spontaneous spinal hemorrhage (SSH), are diverse. SSH is a detrimental neurosurgical event requiring immediate medical attention. We aimed to investigate the association between SARS-CoV-2 and SSH and delineate a rational clinical approach. The authors searched PubMed, Scopus, Web of Science, and Google Scholar for studies published up to January 25, 2023, on SSH and SARS-CoV-2 infection. For each dataset, the authors performed pooled estimates examining three outcomes of interest: (1) early post-intervention neurological status, (2) mortality, and (3) post-intervention neurological rehabilitation outcomes...

BACKGROUND: Both small-quantity (SQ) and medium-quantity (MQ) lipid-based nutrient supplements (LNS) have been used for prevention of child undernutrition. A meta-analysis of 14 trials of SQ-LNS vs no LNS showed effects on length-for-age (LAZ, +0.14 (95% confidence interval 0.11, 0.16)) and weight-for-length (WLZ, +0.08 (0.06, 0.10)) z-scores, as well as prevalence ratios (95% CI) for stunting (LAZ<-2, 0.88 (0.85, 0.91)) and wasting (WLZ < -2, 0.86 (0.80, 0.93)). However, little is known about the effects of MQ-LNS on growth...

BACKGROUND: The disease burden of gastrointestinal disease (GD) in China is high, with significant variation across provinces. A comprehensive agreed set of indicators could guide rational resource allocation to support better GD outcomes. METHODS: This study collected data from multiple sources, including national surveillance, surveys, registration systems, and scientific research. Literature reviews and Delphi methods were used to obtain monitoring indicators; the analytic hierarchy process was used to determine indicator weights...

BACKGROUND: The clinical features and predictors of Clostridioides difficile infection overlap with many conditions. OBJECTIVES: We performed a systematic review to evaluate the diagnostic utility of clinical features (clinical examination, risk factors, laboratory tests, and radiographic findings) associated with C. difficile. METHODS: Systematic review and meta-analysis of diagnostic features for C. difficile. DATA SOURCES: MEDLINE, EMBASE, CINAHL, and Cochrane databases were searched up to September 2021...

OBJECTIVE: This study aimed to examine how adages, aphorisms, and proverbs arise in psychiatric management and psychotherapy and how they might be used to assist assessment and treatment. METHODS: A selective narrative literature review was conducted to supplement clinical observations and case vignettes. RESULTS: Adages appear to act as heuristic cognitive structures that serve as shortcuts for assessing situations, educating, persuading, aiding emotional self-regulation, and influencing courses of action...

IMPORTANCE: Guidelines recommend that all children and adolescents with hypertension undergo evaluation for secondary causes. Identifying clinical factors associated with secondary hypertension may decrease unnecessary testing for those with primary hypertension. OBJECTIVE: To determine the utility of the clinical history, physical examination, and 24-hour ambulatory blood pressure monitoring for differentiating primary hypertension from secondary hypertension in children and adolescents (aged ≤21 years)...

OBJECTIVES: Autosomal dominant hypocalcaemia 1 (ADH1) is a rare autosomal dominant genetic disease, due to the activating mutations of the calcium-sensing receptor ( CASR ) gene. The current paper presents a severe case of ADH1 with intellectual backwardness, and systematically reviews the reported 17 ADH1 patients in China. CASE PRESENTATION: A 7 years old boy with recurrent seizures over 1 year was admitted at Yuying children' hospital, the clinical centre of south province of Zhejiang...

Traditional Chinese medicine (TCM) has a history of over 2000 years in treating infectious diseases, among which the clinical treatment of the common cold (colds) and influenza (flu) is the most widespread and well-established. It is difficult to tell the difference between a cold and the flu based on the symptoms alone. The flu vaccine protects against influenza, but there is no vaccine or specific medication to protect against the common cold. Due to the lack of a reliable scientific basis, TCM has not received sufficient attention in Western medicine...

Disruptive behaviour disorders (DBDs) in childhood include conduct disorder (CD) and oppositional defiant disorder (ODD). Though psychological therapies are considered to be the first-line treatment for DBDs, many patients require adjunctive pharmacotherapy for the control of specific symptoms, such as aggression. Three prior systematic reviews have examined the evidence for the use of antipsychotics in DBDs and have concluded that their efficacy is marginal and limited by adverse effects. This paper has two objectives: (i) to summarize the findings of existing systematic reviews of antipsychotics for the management of DBDs in children and adolescents (2012-2017), and (ii) to provide an update to these reviews by examining recent clinical trials of antipsychotics in this population, published in the period from 2 January 2017 to 10 October 2022...

Nowadays the problem of comorbidity is still relevant. In this review, we describe clinical cases of the disease of the neuromuscular junction (myasthenia gravis (MG) generalized form) and the demyelinating disease of the central nervous system (DD CNS) (multiple sclerosis, neuromyelitis optica spectrum disorder (NMOSD), etc.) combinations registered in our practice with precise pathogenetic analysis. Although the number of the described associations is growing every year, the exact development mechanisms of this cross syndrome as well as the nature of the association between the discussed autoimmune diseases remain unknown...

IMPORTANCE: Acute infectious conjunctivitis is characterized by ocular redness and discharge, and is a common clinical entity. Evidence-based tools to aid the clinical diagnosis of viral vs bacterial conjunctivitis are lacking and may contribute to overprescribing of topical antibiotics. OBJECTIVE: To determine the relative prevalence of viral vs bacterial conjunctivitis in adults and children, and to determine which symptoms or signs are suggestive of a viral vs bacterial etiology...

BACKGROUND: Behavior change interventions that aim to improve rational antibiotic use in prescribers and users have been widely conducted in both high- and LMICs. However, currently, no review has systematically examined challenges unique to LMICs and offered insights into the underlying contextual factors that influence these interventions. We adopted an implementation research perspective to systematically synthesize the implementation barriers and facilitators in LMICs. METHODS: We conducted literature searches in five electronic databases and identified studies that involved the implementation of behavior change interventions to improve appropriate antibiotic use in prescribers and users in LMICs and reported implementation barriers and facilitators...

INTRODUCTION: Serological markers such as anti-double stranded (ds)DNA antibodies and complement fractions C3/C4, are integral components of disease activity assessment in patients with systemic lupus erythematosus (SLE). However, it remains uncertain whether treatment should aim at restoration of serological abnormalities. OBJECTIVES: To analyze and critically appraise the literature on the prognostic impact of active lupus serology despite clinical disease quiescence...