Systematic evidence review and meta-analysis of outcomes associated with cancer genetic counseling.

PURPOSE: Genetic counseling (GC) is standard of care in genetic cancer risk assessment (GCRA). A rigorous assessment of the data reported from published studies is crucial to ensure the evidence-based implementation of GC. METHODS: We conducted a systematic review and meta-analysis of 17 patient-reported and health-services-related outcomes associated with pre- and post-test GC in GCRA in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. RESULTS: Twenty-five of 5393 screened articles met inclusion criteria. No articles reporting post-test GC outcomes met inclusion criteria. For patient-reported outcomes, pre-test GC significantly decreased worry, increased knowledge, and decreased perceived risk but did not significantly affect patient anxiety, depression, decisional conflict, satisfaction, or intent to pursue genetic testing. For health-services outcomes, pre-test GC increased correct genetic test ordering, reduced inappropriate services, increased spousal support for genetic testing, and expedited care delivery but did not consistently improve cancer prevention behaviors nor lead to accurate risk assessment. The GRADE certainty in the evidence was very low or low. No included studies elucidated GC effect on mortality, cascade testing, cost-effectiveness, care coordination, shared decision making, or patient time burden. CONCLUSION: The true impact of GC on relevant outcomes is not known low quality or absent evidence. Although a meta-analysis found that pre-test GC had beneficial effects on knowledge, worry, and risk perception, the certainty of this evidence was low according to GRADE methodology. Further studies are needed to support the evidence-based application of GC in GCRA.

Risk of Dental Implant Failures May Be Higher in Bruxers Than Nonbruxers.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Häggman-Henrikson B, Ali D, Aljamal M, Chrcanovic BR. Bruxism and dental implants: A systematic review and meta-analysis. J Oral Rehabil. 2024 Jan;51(1):202-217. 10.1111/joor.13567. Epub 2023 Aug 17. PMID: 37589382. SOURCE OF FUNDING: None. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

SMOKING MAY BE STRONGLY ASSOCIATED WITH PERI­IMPLANTITIS.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Reis INRD, do Amaral GCLS, Hassan MA, Villar CC, Romito GA, Spin-Neto R, Pannuti CM. The influence of smoking on the incidence of peri­implantitis: A systematic review and meta-analysis. Clin Oral Implants Res. 2023 Mar 20. doi:10.1111/clr.14066. Epub ahead of print. PMID: 36,939,434. SOURCE OF FUNDING: None reported. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

PROXIMAL CONTACT LOSS MAY BE A FREQUENT COMPLICATION IN IMPLANT-SUPPORTED RESTORATIONS.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Manicone PF, De Angelis P, Rella E, Papetti L, D'Addona A. Proximal Contact Loss in Implant-Supported Restorations: A Systematic Review and Meta-Analysis of Prevalence. J Prosthodont. 2022 Mar;31(3):201-209. doi:10.1111/jopr.13407. Epub 2021 Aug 5. PMID: 34263959 SOURCE OF FUNDING: Not reported. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

THE PROPORTION OF ORAL LICHEN PLANUS CASES WITH MALIGNANT TRANSFORMATION MAY BE HIGHER, THAN REPORTED TO DATE.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: González-Moles MÁ, Ramos-García P, Warnakulasuriya S. An appraisal of highest quality studies reporting malignant transformation of oral lichen planus based on a systematic review. Oral Dis. 2021 Nov;27(8):1908-1918. doi: 10.1111/odi.13741. Epub 2020 Dec 24. PMID: 33274561. SOURCE OF FUNDING: The Royal College of Physicians and Surgeons (RCPSG) provided logistic support for holding the expert symposium. Henry Schein Cares provided an educational grant for travel expenses for some of the invited experts. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Limited Evidence Suggests About One in Five Potentially Premalignant Oral Lesions Is Related to Human Papillomavirus.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Human papillomavirus prevalence in oral potentially malignant disorders: Systematic review and meta-analysis. de la Cour CD, Sperling CD, Belmonte F, Syrjänen S, Kjaer SK. Oral Dis. 2020 Mar 6. https://doi.org/10.1111/odi.13322. Epub ahead of print. PMID: 32144837. SOURCE OF FUNDING: None. The authors have no actual or potential conflicts of interest. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

INDOCYANINE GREEN-MEDIATED PHOTODYNAMIC THERAPY MAY BE AN EFFECTIVE ADJUNCT TO NON-SURGICAL PERIODONTAL THERAPY AT 3- AND 6-MONTHS POST-THERAPY.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Bashir NZ, Singh HA, Virdee SS. Indocyanine green-mediated antimicrobial photodynamic therapy as an adjunct to periodontal therapy: a systematic review and meta-analysis. Clin Oral Investig. 2021 Mar 12. doi: 10.1007/s00784-021-03871-2. Epub ahead of print. PMID: 33710461. SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

ACCESS FLAPS MAY RESULT IN GREATER POCKET REDUCTION THAN SUBGINGIVAL DEBRIDEMENT FOR DEEP POCKETS BUT MAY NOT BE BENEFICIAL FOR SHALLOW TO MODERATELY DEEP POCKETS.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Sanz-Sánchez I, Montero E, Citterio F, Romano F, Molina A, Aimetti M. Efficacy of access flap procedures compared to subgingival debridement in the treatment of periodontitis. A systematic review and meta-analysis. J Clin Periodontol. 2020 Jul;47 Suppl 22:282-302. doi:10.1111/jcpe.13259. PMID: 31,970,821. SOURCE OF FUNDING: This systematic review was self-funded. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Systemic Intake of Proton Pump Inhibitors and Selective Serotonin Reuptake Inhibitors May Be Associated With Implant Failure.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Medication-related dental implant failure: Systematic review and meta-analysis. Chappuis V, Avila-Ortiz G, Araújo MG, Monje A. Clin Oral Implants Res 2018;29 Suppl 16:55-68. SOURCE OF FUNDING: None. The authors declared no conflict of interest. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Individuals With Gastroesophageal Reflux Disease or Symptoms May Have Increased Odds of Erosive Tooth Wear.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: The association between erosive toothwear and gastro-oesophageal reflux-related symptoms and disease: A systematic review and meta-analysis. Jordão HWT, Coleman HG, Kunzmann AT, McKenna G. J Dent 2020. https://doi.org/10.1016/j.jdent.2020.103284. SOURCE OF FUNDING: None. The authors declared no conflict of interest. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Smoking May Increase the Risk of Periapical Periodontitis.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: The association between smoking and periapical periodontitis: a systematic review. Aminoshariae A, Kulild J, Gutmann J.Clin Oral Investig 2020;24(2):533-545. https://doi.org/10.1007/s00784-019-03094-6. SOURCE OF FUNDING: None. The authors declared no conflict of interest. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Pharmacokinetic and Pharmacodynamic Properties of a Micro-Dose Nasal Spray Formulation of Desmopressin (AV002) in Healthy Water-Loaded Subjects.

PURPOSE: Antidiuretic therapy with desmopressin for nocturia has been hampered by formulations with high doses, low bioavailability and variable pharmacokinetics. AV002 (SER120), a novel, emulsified, microdose desmopressin nasal spray, with a permeation enhancer (cylcopentadecanolide), was developed to have pharmacokinetic characteristics suitable for nocturia treatment. METHODS: Twelve healthy subjects participated in an open-label, dose-escalating study. Water-loaded subjects were sequentially dosed every 48 h with AV002 0.5, 1.0, 2.0 µg and 0.12 µg desmopressin subcutaneous (SC) bolus injection. RESULTS: AV002 intranasal administration produced a time-to-maximum concentration (Tmax) between 15 and 30 min and a maximum concentration (Cmax) <10 pg/mL. Cmax and area under the curve showed dose proportionality. Coefficient of variation for AV002 was similar to that observed for the SC dose. Bioavailability of AV002 was approximately 8% compared to SC injection. AV002 demonstrated pharmacodynamic effects within 20 min of dosing and showed increasing magnitude and duration with escalating doses. AV002 2.0 µg had maximum median urine osmolality of 629 mOsm/kg and median urine output ≤2 mL/min for 5-6 h. CONCLUSIONS: AV002 demonstrated rapid absorption, high bioavailability, limited duration of action, and low coefficient of variation, suggesting it may be a suitable formulation for nocturia treatment. Trial registration not required (single-center, phase 1).

Limited Evidence Suggests That Patients With Recurrent Aphthous Stomatitis May Benefit From Using Sodium Lauryl Sulfate-free Dentifrices.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Effect of sodium lauryl sulfate on recurrent aphthous stomatitis: A systematic review. Alli BY, Erinoso OA, Olawuyi AB. J Oral Pathol Med. 2019;48(5):358-64. SOURCE OF FUNDING: None. The authors declared no conflict of interest. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data from double-blind randomized controlled trials.

Facilitating factors in same-day discharge after pediatric laparoscopic appendectomy.

BACKGROUND: Appendicitis has been cited to be the most common abdominal disorder that requires acute care surgery in the pediatric population. Enhanced Recovery After Surgery protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery. Such pathways have been found to enhance quality of care for surgical patients as well as improve recovery and shorten hospital stays. The purpose of this study was to determine the key factors that facilitate same-day discharge (SDD) and early return to normal activities after laparoscopic appendectomies in children. METHODS: This is a single-center retrospective chart review of pediatric patients (<18 y old) who underwent appendectomies for acute appendicitis from January 2015 to April 2017. The patient population was divided into two groups: those with SDD and those who were discharged one or more days after surgery. SDD was defined as discharge less than 24 h of surgical admission. Patient factors, including prehospital, preoperative, perioperative, and postoperative factors, were compared and analyzed between the two groups and statistically evaluated using Fisher's exact test for categorical data and student t-test for continuous variables. RESULTS: Two hundred forty eight patients were found under International Classification of Diseases-9 and International Classification of Diseases-10 codes for acute appendicitis. Of these, 63 were excluded due to perforated appendicitis, nonoperative management, interval appendectomies, or misdiagnosis. The remaining 185 had laparoscopic appendectomies; 59.5% (n = 110) were SDDs and 40.5% (n = 75) stayed more than one day. No significant difference was found for time between emergency room arrival and surgical admission (5.27 versus 5.4 h; P = 08.) but SDD patients had a significantly shorter time between surgical admission and operation (5.8 versus 11.4 h; P <0.001). SDD patients and non-SDD patients had no significant difference in rate of complications (0% versus 1.3%; P = 0.4). There was no significant difference in readmission rates between the two groups (2.7% versus 2.7%; P = 1). Total hospital charges, which indirectly reflect costs, were significantly less for SDD ($29,195 versus $33,703; P <0.001). CONCLUSIONS: Surgical leadership can be effective in facilitating SDD without increasing readmission rates or complications and helps reduce hospital costs, decreases chances of nosocomial infection, and increases patient and family satisfaction.

Development of the Impact of Nighttime Urination (INTU) questionnaire to assess the impact of nocturia on health and functioning.

AIMS: This study describes development of the Impact of Nighttime Urination (INTU) questionnaire to assess nocturia impacts on health and functioning. METHODS: Development of the questionnaire followed an iterative patient-directed process as recommended by current guidance for patient-reported outcome (PRO) measures. An initial 15-item questionnaire was devised based on reviewing the published literature, and then modified through four rounds of semi-structured interviews of 28 individuals with nocturia. In each round, open-ended concept elicitation, followed by cognitive debriefing, was used to assess the questionnaire. Items were modified based on participants' responses and incorporated into the next round of interviews. RESULTS: In all rounds, participants reported that their experiences were easy to recall and report on a daily basis and that the burden of completing the questionnaire was low. The final questionnaire has a same-day recall period. It includes six daytime impact items-having limited concentration, a sense of feeling tired, difficulty getting things done, irritability, not feeling rested, and drowsiness-and four items that measure the nighttime impact of nocturia-patient concern, waking up too early, difficulty getting enough sleep, and feeling bothered by having to get up at night to void. Responses follow a 5- or 4-point scale. The final INTU captures the key concepts associated with nocturia as confirmed by cognitive debriefing. CONCLUSIONS: Development of the 10-item INTU, a nocturia-specific PRO measure, was based on direct input and feedback from patients and has demonstrated that it captures the patient-reported impacts of nocturia.

Development of a new patient-reported outcome (PRO) measure on the Impact of Nighttime Urination (INTU) in patients with nocturia-Psychometric validation.

AIMS: To psychometrically evaluate the Impact of Nighttime Urination (INTU) questionnaire, a new patient-reported outcome measure developed to assess the impact of nocturia on health and functioning in a multicenter, behavioral modification (fluid restriction) study. METHODS: Participants aged 50-95 years with at least two voiding episodes/night for ≥6 months completed voiding diaries and the INTU on 3 consecutive days during weeks 1 and 2 (same day recall) and completed the Pittsburgh Sleep Quality Index (PSQI) and Nocturia Quality of Life Questionnaire (N-QOL) at baseline and days 8 and 15. Psychometric evaluations of the INTU were conducted. RESULTS: Rasch analysis showed the INTU to be a unidimensional construct, with most items located on the severe end of the symptom severity continuum. In addition to an Overall Impact Score (10 items), exploratory factor analysis affirmed by confirmatory factor analysis identified two domains: Daytime (six items) and Nighttime (four items) Impact Scores (comparative fit index = 0.968; root mean square error of approximation = 0.08). Concurrent validity met prespecified hypotheses, indicating similarity of concepts with the PSQI (correlation [r] = 0.627) and N-QOL (r = -0.784) total scores. The INTU differentiated among patients with different nocturic episode frequencies (P < 0.05 for all three summary scores). Statistically significant decreases were observed in mean Overall and Nighttime Impact Scores at week 2 versus week 1 in responders, indicating that the instrument can detect changes in response to symptom improvements. CONCLUSIONS: The INTU questionnaire demonstrated robust measurement properties and is a suitable tool for assessing the patient-reported impact of nocturia on health and functioning.

The Convergence of Two Epidemics: Vitamin D Deficiency in Obese School-aged Children.

PROBLEM: Vitamin D deficiency (VDD) and obesity are two interrelated global epidemics that affect school-aged children. This article will review the relationship between VDD and obesity in school-aged children and implications it has for the pediatric nurse (PN). ELIGIBILITY CRITERIA: Original articles of studies, review articles and meta-analyses were selected from the past 5years and pooled for review. These included obese school-aged children who had vitamin D insufficiency. The latest guidelines concerning the issue were also included. SAMPLE: Children 6-12years of age with obesity and vitamin D insufficiency. RESULTS: This review strongly implies obesity in children being a strong risk factor for VDD. Prevention of VDD starts with lifestyle changes and adequate dietary intake of fortified foods and current screening recommendations for VDD are inconsistent. Vitamin D supplementation is recommended with inadequate intake or deficient serum 25-hydroxyvitamin D levels or signs of hypocalcemia. Supplementation doses differ based on whether VDD is being prevented or being treated and in obese children, the Endocrine Society recommends a dose that is two to three times higher than for normal weight children. Subclinical signs and symptoms of VDD include musculoskeletal pain, fractures, reduced bone density and reduced immunity. CONCLUSIONS: Whereas obesity is a strong risk factor for VDD, more research is needed to clarify the role of VDD as a risk factor for obesity. IMPLICATIONS: The PN plays an essential role in preventing, screening for, assessing for, treating and counseling on VDD in obese school-aged children.

Human Mesenchymal Stem (Stromal) Cells Promote the Resolution of Acute Lung Injury in Part through Lipoxin A4.

Previous studies demonstrated that bone marrow-derived mesenchymal stem (stromal) cells (MSCs) reduce the severity of acute lung injury in animal models and in an ex vivo perfused human lung model. However, the mechanisms by which MSCs reduce lung injury are not well understood. In the present study, we tested the hypothesis that human MSCs promote the resolution of acute lung injury in part through the effects of a specialized proresolving mediator lipoxin A4 (LXA4). Human alveolar epithelial type II cells and MSCs expressed biosynthetic enzymes and receptors for LXA4. Coculture of human MSCs with alveolar epithelial type II cells in the presence of cytomix significantly increased the production of LXA4 by 117%. The adoptive transfer of MSCs after the onset of LPS-induced acute lung injury (ALI) in mice led to improved survival (48 h), and blocking the LXA4 receptor with WRW4, a LXA4 receptor antagonist, significantly reversed the protective effect of MSCs on both survival and the accumulation of pulmonary edema. LXA4 alone improved survival in mice, and it also significantly decreased the production of TNF-α and MIP-2 in bronchoalveolar lavage fluid. In summary, these experiments demonstrated two novel findings: human MSCs promote the resolution of lung injury in mice in part through the proresolving lipid mediator LXA4, and LXA4 itself should be considered as a therapeutic for acute respiratory distress syndrome.

Delirium is a Strong Predictor of Mortality in Patients Receiving Non-invasive Positive Pressure Ventilation.

PURPOSE: Non-invasive positive pressure ventilation (NIPPV) has gained popularity over the years in the treatment of acute respiratory failure (ARF). Preliminary evidence suggests that delirium is an important factor contributing to NIPPV failure and death. This study was conducted to evaluate delirium and other associated factors of deaths in patients with ARF requiring the use of NIPPV. METHODS: A prospective observational study was conducted in a specialised NIPPV unit. Consecutive patients admitted for ARF requiring NIPPV were assessed by a psychiatrist for presence of delirium using the Diagnostic and Statistical Manual Version IV (DSM-IV). APACHE II score, co-morbidities-, and lung function were also assessed. Patients were followed until their deaths for a minimum of 1 year. Univariate and multivariate Cox's regression analyses were performed to explore predictive factors for death. RESULTS: A total of 153 subjects were recruited, 49 (32.0 %) of whom had delirium. On univariate analysis, higher APACHE II score, lower BMI, presence of delirium, higher Charlson's co-morbidity index but not FEV1 were associated with earlier death. On multivariate analysis, delirium (HR 4.4; 95 % CI 2.6-7.4; p < 0.001) and lower BMI (HR 0.92; 95 % CI 0.86-0.98; p = 0.013) were independently associated with earlier death within 1 year. CONCLUSIONS: There is a high prevalence of delirium in patients requiring NIPPV. The presence of delirium is a strong predictor of mortality. There is strong need to identify and manage these high-risk patients to improve their mortality. The collaboration between psychiatrists and physicians should be strengthened.

Mannitol to prevent cisplatin-induced nephrotoxicity in patients with squamous cell cancer of the head and neck (SCCHN) receiving concurrent therapy.

PURPOSE: The purpose of this study is to compare the incidence and severity of nephrotoxicity in patients receiving cisplatin with saline hydration vs. saline hydration with mannitol. METHODS: Retrospective chart review of all patients receiving a starting dose of cisplatin 100 mg/m(2) with concurrent radiation for SCCHN between January 1, 2009 and March 1, 2013. All patients received pre and post hydration each with 1 l of 0.9 % saline. The mannitol group received 12.5 g of mannitol in the prehydration fluid. The primary outcome was to compare the rate of grade 3 or greater serum creatinine (SCr) increase in patients receiving saline hydration vs. the addition of mannitol; additional parameters of interest included creatinine clearance, electrolyte disturbances, dose changes, and discontinuation of cisplatin. RESULTS: Data from 139 patients (80 % male) with a median age of 56 years (range 22 to 75 years) were collected; 88 received mannitol and 51 received saline alone. On multivariable analysis, the mannitol group was less likely to have grade 3 SCr increase than saline only group (OR 0.16; 95 % CI 0.04-0.65; p value = 0.01). There were no grade 4 SCr increase events. Rates of hypomagnesemia and hypokalemia were similar across groups. Grade 3 hyponatremia was more likely to occur in the mannitol group as compared to saline alone group (41 vs 22 %; p = 0.026). CONCLUSION: The addition of mannitol to saline hydration decreased the incidence of grade 3 increases in SCr in this cohort of patients and may increase rates of hyponatremia. Further investigations of methods to lessen cisplatin-induced nephrotoxicity are needed.