Treatments for hyperemesis gravidarum: A systematic review.

INTRODUCTION: Hyperemesis gravidarum affects 0.3%-3% of pregnant women each year and is the leading cause of hospitalization in early pregnancy. Previous systematic reviews of available treatments have found a lack of consistent evidence, and few studies of high quality. Since 2016, no systematic review has been conducted and an up-to date review is requested. In a recent James Lind Alliance collaboration, it was clear that research on effective treatments is a high priority for both patients and clinicians. MATERIAL AND METHODS: Searches without time limits were performed in the AMED, CINAHL, Cochrane Library, EMBASE, Medline, PsycINFO, and Scopus databases until June 26, 2023. Studies published before October 1, 2014 were identified from the review by O'Donnell et al., 2016. Selection criteria were randomized clinical trials and non-randomized studies of interventions comparing treatment of hyperemesis gravidarum with another treatment or placebo. Outcome variables included were: degree of nausea; vomiting; inability to tolerate oral fluids or food; hospital treatment; health-related quality of life, small-for-gestational-age infant; and preterm birth. Abstracts and full texts were screened, and risk of bias of the studies was assessed independently by two authors. Synthesis without meta-analysis was performed, and certainty of evidence was assessed using the GRADE approach. PROSPERO (CRD42022303150). RESULTS: Twenty treatments were included in 25 studies with low or moderate risk of bias. The certainty of evidence was very low for all treatments except for acupressure in addition to standard care, which showed a possible moderate decrease in nausea and vomiting, with low certainty of evidence. CONCLUSIONS: Several scientific knowledge gaps were identified. Studies on treatments for hyperemesis gravidarum are few, and the certainty of evidence for different treatments is either low or very low. To establish more robust evidence, it is essential to use validated scoring systems, the recently established diagnostic criteria, clear descriptions and measurements of core outcomes and to perform larger studies.

YouTube as a source of patient information on brain aneurysms: a content-quality and audience engagement analysis.

INTRODUCTION: The internet allows patients to access a vast amount of health information. We aimed to evaluate the credibility of YouTube videos that members of the public are accessing on brain aneurysms, and to evaluate what characteristics drive audience engagement. MATERIAL AND METHODS: The first 50 videos for each of the following search terms were taken for analysis: 'brain aneurysm', 'cerebral aneurysm' and 'intracranial aneurysm'. The quality of each video was evaluated by two neurosurgeons and two medical students independently using the Journal of the American Medical Association (JAMA) and the DISCERN instruments. Qualitative and quantitative video data was analysed for quality and audience engagement. Inter-rater agreement was ascertained. RESULTS: Out of a total of 150 videos, 70 met the inclusion criteria. The mean total DISCERN score was 36.5 ± 8.4 (out of 75 points), indicating that the videos were of poor quality. The mean JAMA score was 2.7 ± 0.7 (out of 4 points). Inter-rater agreement between the four raters was excellent (intraclass correlation coefficient 0.90 for DISCERN and 0.93 for JAMA). Most videos were uploaded by hospitals (50%) or educational health channels (30%). Videos had a higher number of average daily views when they included animation (P = 0.0093) and diagrams (P = 0.0422). CONCLUSIONS: YouTube is a poor source of patient information on brain aneurysms. Our quality and audience engagement analysis may help content creators (i.e. hospital staff and physicians) to create more holistic, educational and engaging medical videos concerning brain aneurysms. Physicians could usefully refer their patients to the highest quality videos that we have found.

Association between socioeconomic and health factors and edentulism in people aged 65 and older - a population-based survey.

AIMS: To study edentulism and use of dental services in a population-based sample of people aged 65 years and older from northern Sweden and western Finland. METHODS: In 2010, people aged 65, 70, 75 and 80 years who were living in one of 32 municipalities in northern Sweden and western Finland were invited to answer a questionnaire as part of the Gerontological Regional Database (GERDA) study ( n = 6099). The questionnaire contained items related to socioeconomic status, general health and edentulism. RESULTS: The prevalence of edentulism was 34.9% in Finland, compared with 20.6% in Sweden ( p < 0.001), 31.9% in rural areas, compared with 20.9% in urban areas ( p < 0.001), and 25% overall. The prevalence of edentulism rose from 17.8% in 65-year-olds, 23.8% in 70-year-olds, 33.5% in 75-year-olds and 37.3% in 80-year-olds ( p < 0.001), and was 23.8% in women, compared with 27% in men ( p < 0.001). In multivariate models, edentulism was associated with lower educational level (odds ratio (OR) 2.87, 95% confidence interval (CI) 2.31-3.58), low income level (OR 1.7, CI 1.09-1.47), residence in a rural area (OR 1.43, CI 1.23-1.66), male sex (OR 1.30, CI 1.12-1.52), dependence in instrumental activities of daily living (OR 1.48, CI 1.25-1.74), social isolation (OR 1.52, CI 1.17-1.98) and poor self-experienced health (OR 1.38, CI 1.17-1.62). CONCLUSIONS: One-quarter of the total sample was edentulous, with a higher prevalence of edentulism in Finland than in Sweden and in rural than in urban areas. Edentulism was associated with socioeconomic, psychological and health-related factors. These findings could be used to inform preventive measures and identify people aged 65 years and older who are in need of oral care.

Evaluation of PHASES Score for Predicting Rupture of Intracranial Aneurysms: Significance of Aneurysm Size.

BACKGROUND: Recent data have identified that certain risk factors for rupture differ between small and larger intracranial aneurysms (IAs). Such differing risk factors make up 5 out of the 6 predictor variables used in the PHASES score, which raises the question on whether IA size has a significant effect on the score's performance. METHODS: Patients who were diagnosed with an IA incidentally or due to a subarachnoid hemorrhage between 2015 and 2023 were selected for potential inclusion. The median IA size of the cohort was chosen as the cutoff point to categorize small and large (6 mm). The PHASES score was calculated for all patients, and a receiver operating characteristic curve analysis was performed to evaluate the classification accuracy of PHASES in predicting rupture for small and large IAs. RESULTS: A total of 677 IAs were included. Among the IAs, 400 (58.9%) presented as UIAs and 279 (41.0%) as subarachnoid hemorrhage. The average PHASES score was 2.9 and 6.5 for small (n = 322) and large (n = 355) IAs, respectively. The PHASES score performed significantly lower for predicting rupture in smaller IAs (area under the curve: 0.634) compared with the larger (area under the curve: 0.741) (P = 0.00083). CONCLUSIONS: PHASES was shown to underperform on small IAs. The decision to treat small unruptured IAs remains highly controversial, and the development of a new score to estimate the annual rupture rate while accounting for IA morphology is of great need. Our findings can help encourage future researchers to develop such a score.

Risk Factors for Ischemic Stroke After Revascularization Surgery in Patients with Moyamoya Disease: An Age-Stratified Comparative Meta-Analysis.

BACKGROUND: Patients who undergo revascularization surgery for moyamoya disease may develop postoperative ischemic stroke (pIS). Several studies have sought to identify risk factors; however, the findings remain highly inconsistent. METHODS: PubMed, Scopus, and Web of Science were used to extract references. The first phase of screening required the studies to be in English, involve patients surgically treated for moyamoya disease, and report pIS. The second phase required the studies to provide ≥10 patients and include a control group. RESULTS: All 22 studies were rated as high quality. Univariate analysis identified pediatrics <3 years of age as a risk factor for pIS (odds ratio [OR], 7.60; P < 0.0001). Among adult patients only, diabetes (OR, 2.10; P = 0.005), a Suzuki grade greater than 3 (OR, 1.74; P = 0.005), mean intraoperative systolic blood pressure (OR, 1.04; P < 0.0001), mean intraoperative diastolic blood pressure (OR, 1.04; P = 0.002), and revascularization in the left hemisphere (OR, 2.09; P = 0.001) were risk factors. Among both age groups, preoperative ischemic stroke (OR, 2.59; P < 0.00001) was a risk factor for pIS. Additionally, perioperative antiplatelet drug administration was a protective factor for specifically acute postoperative white thrombus among adult patients (OR, 0.35; P = 0.002). CONCLUSIONS: In addition to the methods discussed that can mitigate the risk of pIS, the risk factors identified in our analysis may be of great value among surgeons for identifying high-risk patients in order to apply prophylactic measures, as well as scheduling longer and more frequent follow-up visits.

Experiences of eating disorders from the perspectives of patients, family members and health care professionals: a meta-review of qualitative evidence syntheses.

BACKGROUND: Eating disorders are serious conditions that cause major suffering for patients and their families. Better knowledge about perceptions of eating disorders and their treatment, and which factors that facilitate or hinder recovery, is desired in order to develop the clinical work. We aimed to explore and synthesise experiences of eating disorders from the perspectives of those suffering from an eating disorder, their family members and health care professionals through an overarching meta-review of systematic reviews in the field. METHODS: A systematic literature search was conducted in the databases PubMed, PsycInfo, Scopus, and CINAHL. Inclusion criteria were systematic reviews of qualitative research on experiences, perceptions, needs, or desires related to eating disorders from the perspective of patients, family members or health care professionals. Systematic reviews that fulfilled the inclusion criteria were assessed for relevance and methodological limitations by at least two researchers independently. The key findings were analysed and synthesised into themes. RESULTS: We identified 17 systematic reviews that met our inclusion criteria. Of these, 13 reviews reported on the patients' perspective, five on the family members' perspective, and three on the health care professionals' perspective. The study population in the reviews was predominantly girls and young women with anorexia nervosa, whilst systematic reviews focusing on other eating disorders were scarce. The findings regarding each of the three perspectives resulted in themes that could be synthesised into three overarching themes: 1) being in control or being controlled, 2) balancing physical recovery and psychological needs, and 3) trusting relationships. CONCLUSIONS: There were several similarities between the views of patients, family members and health care professionals, especially regarding the significance of building trustful therapeutic alliances that also included family members. However, the informants sometimes differed in their views, particularly on the use of the biomedical model, which was seen as helpful by health care professionals, while patients and family members felt that it failed to address their psychological distress. Acknowledging these differences is important for the understanding of anorexia nervosa and other eating disorders, and may help clinicians to broaden treatment approaches to meet the expectations of patients and family members.

The current paper brings together existing knowledge on experiences of eating disorders. We were interested in the views of patients, family members and health care professionals. A literature search identified 17 systematic reviews which addressed these questions. The identified research focused mainly on girls and young women with anorexia nervosa, while research on other eating disorders was limited. Overall, this review suggests that it is important to acknowledge that patients, family members and health care professionals may have different experiences and views regarding treatment of eating disorders, and that it is important to consider all these views in the development of the care of eating disorders.

Can abstract screening workload be reduced using text mining? User experiences of the tool Rayyan.

BACKGROUND: One time-consuming aspect of conducting systematic reviews is the task of sifting through abstracts to identify relevant studies. One promising approach for reducing this burden uses text mining technology to identify those abstracts that are potentially most relevant for a project, allowing those abstracts to be screened first. OBJECTIVES: To examine the effectiveness of the text mining functionality of the abstract screening tool Rayyan. User experiences were collected. METHODS: Rayyan was used to screen abstracts for 6 reviews in 2015. After screening 25%, 50%, and 75% of the abstracts, the screeners logged the relevant references identified. A survey was sent to users. RESULTS: After screening half of the search result with Rayyan, 86% to 99% of the references deemed relevant to the study were identified. Of those studies included in the final reports, 96% to 100% were already identified in the first half of the screening process. Users rated Rayyan 4.5 out of 5. DISCUSSION: The text mining function in Rayyan successfully helped reviewers identify relevant studies early in the screening process.

Behavioral activation in acute inpatient psychiatry: a multiple baseline evaluation.

BACKGROUND AND OBJECTIVES: The present study employed a multiple baseline study design with repeated measures to explore clinical outcomes, therapy mechanisms, and feasibility of Behavioral Activation for persons admitted to inpatient psychiatry. METHODS: Six adult inpatients with depressive symptoms and different psychiatric disorders were randomized to different lengths of baseline standard inpatient treatment. Subsequently a 5-day, 10-session Behavioral Activation protocol was added. Daily self-report outcome and process measures were administered and supplemented with hourly self-reports and clinician assessments before and after each study phase. RESULTS: After a relatively stable baseline, at least four participants showed marked gradual improvements both in terms of outcome as well as activation and avoidance as Behavioral Activation was initiated. The temporal relation between process and outcome differed somewhat across metrics. In most instances however, change in activation and avoidance either coincided or preceded decreased depression. LIMITATIONS: We did not include some relatively common disorders, did not control for the effects of increased attention, did not investigate treatment integrity, and did not conduct follow-up after discharge. Raters were not blind and measures were mainly focused on depressive symptoms. All received concurrent medical treatment. CONCLUSIONS: This preliminary study further supports the promise of Behavioral Activation as an inpatient treatment for persons with a variety of psychiatric disorders. Results also lends preliminary support for the purported mechanisms of Behavioral Activation.

Low umbilical artery vascular flow resistance and fetal outcome.

BACKGROUND: An abnormally high [above mean + 2 standard deviations (SD)] umbilical artery (UA) pulsatility index (PI) indicates impaired fetal outcome, whereas the impact of an "abnormally" low (below mean -2 SD) PI is unknown. METHODS: Perinatal outcome was compared between cases with a UA PI less than mean -2 SD (group A: high-risk cases selected from a database, n = 330; group B: unselected cases, n = 39) and unselected controls (group C) with a PI within mean +/- 2 SD (n = 863) at Doppler velocimetry. Groups B and C were retrieved from a population-based sample. The unpaired t-test, Mann-Whitney U-test, chi(2)-test and Fisher's exact probability test were used for statistical comparisons with a two-tailed p < 0.05 being significant. RESULTS: No significant differences were found between group A vs. group C and group B vs. group C regarding perinatal mortality, Apgar scores at 1, 5 or 10 min, or arterial or venous cord blood pH. Postterm pregnancy in group A carried no additional risk. For obvious reasons, operative delivery and neonatal intensive care were more common in group A than in group C, but no such differences were found between groups B and C. The mean birthweight was 3.7% higher in group B than in group C (p = 0.049). CONCLUSIONS: Deeming a UA PI below the lower reference limit as "abnormally" low is a statistical definition that was not reflected by a biological imperfection. Instead, a low UA PI promoted fetal growth.