A narrative review of telemedicine and its adoption across specialties.

Background and Objective: Telemedicine and video consultation are crucial advancements in healthcare, allowing remote delivery of care. Telemedicine, encompassing various technologies like wearable devices, mobile health, and telemedicine, plays a significant role in managing illnesses and promoting wellness. The corona virus disease 2019 (COVID-19) pandemic accelerated the adoption of telemedicine, ensuring convenient access to medical services while maintaining physical distance. Legislation has supported its integration into clinical practice and addressed compensation issues. However, ensuring clinical appropriateness and sustainability of telemedicine post-expansion has gained attention. We south to identify the most friendly and resistant specialties to telemedicine and to understand areas of interest within those specialties to grasp potential barriers to its use. Methods: We aimed to identify articles that incorporated telemedicine in any medical or surgical specialty and determine the adoption rate and intent of this new form of care. Additionally, a secondary search within these databases was conducted to analyze the advantages, disadvantages, and implementation of telemedicine in the healthcare system. Non-English articles and those without full text were excluded. The study selection and data collection process involved using search terms such as "medicine", "surgery", "specialties", "telemedicine", and "telemedicine". Key Content and Findings: Telemedicine adoption varies among specialties. The pandemic led to increased usage, with telemedicine consultations comprising 30.1% of all visits, but specialties like mental health, gastroenterology, and endocrinology showed higher rates of adoption compared to optometry, physical therapy, and orthopedic surgery. Conclusions: The data shows that telemedicine uptake varies by specialty and condition due to the need for physical exams. In-person visits still dominate new patient visits despite increased telemedicine use. Telemedicine cannot fully replace in-person care but has increased visit volume and is secure. The adoption of telemedicine is higher in medical practices than in surgical practices, with neurosurgery and urology leading. Further research is needed to assess telemedicine's suitability and effectiveness in different specialties and conditions.

CAR-T cell manufacturing landscape-Lessons from the past decade and considerations for early clinical development.

CAR-T cell therapies have consolidated their position over the last decade as an effective alternative to conventional chemotherapies for the treatment of a number of hematological malignancies. With an exponential increase in the number of commercial therapies and hundreds of phase 1 trials exploring CAR-T cell efficacy in different settings (including autoimmunity and solid tumors), demand for manufacturing capabilities in recent years has considerably increased. In this review, we explore the current landscape of CAR-T cell manufacturing and discuss some of the challenges limiting production capacity worldwide. We describe the latest technical developments in GMP production platform design to facilitate the delivery of a range of increasingly complex CAR-T cell products, and the challenges associated with translation of new scientific developments into clinical products for patients. We explore all aspects of the manufacturing process, namely early development, manufacturing technology, quality control, and the requirements for industrial scaling. Finally, we discuss the challenges faced as a small academic team, responsible for the delivery of a high number of innovative products to patients. We describe our experience in the setup of an effective bench-to-clinic pipeline, with a streamlined workflow, for implementation of a diverse portfolio of phase 1 trials.

The usefulness of artificial intelligence in breast reconstruction: a systematic review.

BACKGROUND: Artificial Intelligence (AI) offers an approach to predictive modeling. The model learns to determine specific patterns of undesirable outcomes in a dataset. Therefore, a decision-making algorithm can be built based on these patterns to prevent negative results. This systematic review aimed to evaluate the usefulness of AI in breast reconstruction. METHODS: A systematic review was conducted in August 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMBASE, SCOPUS, and Google Scholar online databases were queried to capture all publications studying the use of artificial intelligence in breast reconstruction. RESULTS: A total of 23 studies were full text-screened after removing duplicates, and twelve articles fulfilled our inclusion criteria. The Machine Learning algorithms applied for neuropathic pain, lymphedema diagnosis, microvascular abdominal flap failure, donor site complications associated to muscle sparing Transverse Rectus Abdominis flap, surgical complications, financial toxicity, and patient-reported outcomes after breast surgery demonstrated that AI is a helpful tool to accurately predict patient results. In addition, one study used Computer Vision technology to assist in Deep Inferior Epigastric Perforator Artery detection for flap design, considerably reducing the preoperative time compared to manual identification. CONCLUSIONS: In breast reconstruction, AI can help the surgeon by optimizing the perioperative patients' counseling to predict negative outcomes, allowing execution of timely interventions and reducing the postoperative burden, which leads to obtaining the most successful results and improving patient satisfaction.

Ultrasensitive detection of Ag+ and Ce3+ ions using highly fluorescent carboxyl-functionalized carbon nitride nanoparticles.

The fluorescence quenching of carboxyl-rich g-C3N4 nanoparticles was found to be selective to Ag+ and Ce3+ with a limit of detection as low as 30 pM for Ag+ ions. A solid-state thermal polycondensation reaction was used to produce g-C3N4 nanoparticles with distinct green fluorescence and high water solubility. Dynamic light scattering indicated an average nanoparticle size of 95 nm. The photoluminescence absorption and emission maxima were centered at 405 nm and 540 nm respectively which resulted in a large Stokes shift. Among different metal ion species, the carboxyl-rich g-C3N4 nanoparticles were selective to Ag+ and Ce3+ ions, as indicated by strong fluorescence quenching. The PL sensing of mixtures of Ag+/Ce3+ and Ce3+ followed static Stern-Volmer kinetics with the Stern-Volmer constants determined to be 74.18 ×10^3 M-1 and 27.2 ×10^3 M-1 respectively. The PL sensing of Ag+ followed modified Stern-Volmer kinetics. Sensing was also demonstrated using commercial filter paper functionalized with g-C3N4 nanoparticles, enabling practical on-site applications. .

Development and evaluation of best practice advisory alert for patient eligibility in a hospital-at-home program: A multicenter retrospective study.

BACKGROUND: Hospital-at-home (HaH) is a growing model of care that has been shown to improve patient outcomes, satisfaction, and cost-effectiveness. However, selecting appropriate patients for HaH is challenging, often requiring burdensome manual screening by clinicians. To facilitate HaH enrollment, electronic health record (EHR) tools such as best practice advisories (BPAs) can be used to alert providers of potential HaH candidates. OBJECTIVE: To describe the development and implementation of a BPA for identifying HaH eligible patients in Mayo Clinic's Advanced Care at Home (ACH) program, and to evaluate the provider response and the patient characteristics that triggered the BPA. DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective multicenter study of hospitalized patients who triggered the BPA notification for ACH eligibility between March and December 2021 at Mayo Clinic in Jacksonville, FL and Mayo Clinic Health System in Eau Claire, WI. We extracted demographic and diagnosis data from the patients as well as characteristics of the providers who received the BPA notification. INTERVENTION: The BPA was developed based on the ACH inclusion and exclusion criteria, which were derived from clinical guidelines, literature review, and expert consensus. The BPA was integrated into the EHR and displayed a pop-up message to the provider when a patient met the criteria for ACH eligibility. The provider could choose to refer the patient to ACH, dismiss the notification, or defer the decision. MAIN OUTCOMES AND MEASURES: The main outcomes were the number and proportion of BPA notifications that resulted in a referral to ACH, and the number and proportion of referrals that were accepted by the ACH clinical team and transferred to ACH. We also analyzed the factors associated with the provider's decision to refer or not refer the patient to ACH, such as the provider's role, location, and specialty. RESULTS: During the study period, 8962 notifications were triggered for 2847 patients. Providers opted to refer 711 (11.4%) of the total notifications linked to 324 unique patients. After review by the ACH clinical team, 31 of the 324 referrals (9.6%) met clinical and social criteria and were transferred to ACH. In multivariable analysis, Wisconsin nurses, physician assistants, and in-training personnel had lower odds of referring the patients to ACH when compared to attending physicians.

Machine Learning Algorithms Predict Long-Term Postoperative Opioid Misuse: A Systematic Review.

INTRODUCTION: A steadily rising opioid pandemic has left the US suffering significant social, economic, and health crises. Machine learning (ML) domains have been utilized to predict prolonged postoperative opioid (PPO) use. This systematic review aims to compile all up-to-date studies addressing such algorithms' use in clinical practice. METHODS: We searched PubMed/MEDLINE, EMBASE, CINAHL, and Web of Science using the keywords "machine learning," "opioid," and "prediction." The results were limited to human studies with full-text availability in English. We included all peer-reviewed journal articles that addressed an ML model to predict PPO use by adult patients. RESULTS: Fifteen studies were included with a sample size ranging from 381 to 112898, primarily orthopedic-surgery-related. Most authors define a prolonged misuse of opioids if it extends beyond 90 days postoperatively. Input variables ranged from 9 to 23 and were primarily preoperative. Most studies developed and tested at least two algorithms and then enhanced the best-performing model for use retrospectively on electronic medical records. The best-performing models were decision-tree-based boosting algorithms in 5 studies with AUC ranging from .81 to .66 and Brier scores ranging from .073 to .13, followed second by logistic regression classifiers in 5 studies. The topmost contributing variable was preoperative opioid use, followed by depression and antidepressant use, age, and use of instrumentation. CONCLUSIONS: ML algorithms have demonstrated promising potential as a decision-supportive tool in predicting prolonged opioid use in post-surgical patients. Further validation studies would allow for their confident incorporation into daily clinical practice.

Recommendations for risk allele evidence curation, classification, and reporting from the ClinGen Low Penetrance/Risk Allele Working Group.

PURPOSE: Genetic variants at the low end of the penetrance spectrum have historically been challenging to interpret because their high population frequencies exceed the disease prevalence of the associated condition, leading to a lack of clear segregation between the variant and disease. There is currently substantial variation in the classification of these variants, and no formal classification framework has been widely adopted. The Clinical Genome Resource Low Penetrance/Risk Allele Working Group was formed to address these challenges and promote harmonization within the clinical community. METHODS: The work presented here is the product of internal and community Likert-scaled surveys in combination with expert consensus within the Working Group. RESULTS: We formally recognize risk alleles and low-penetrance variants as distinct variant classes from those causing highly penetrant disease that require special considerations regarding their clinical classification and reporting. First, we provide a preferred terminology for these variants. Second, we focus on risk alleles and detail considerations for reviewing relevant studies and present a framework for the classification these variants. Finally, we discuss considerations for clinical reporting of risk alleles. CONCLUSION: These recommendations support harmonized interpretation, classification, and reporting of variants at the low end of the penetrance spectrum.

Long-term survival after cardiac arrest in patients undergoing emergent coronary angiography.

AIM: To determine long-term survival of patients after cardiac arrest undergoing emergent coronary angiography and therapeutic hypothermia. METHODS: We analysed data from patients treated within the regional STEMI Network from January 2015 to December 2020. The primary endpoint was all-cause mortality at median follow-up. Secondary endpoints were periprocedural complications (arrhythmias, pulmonary edema, cardiogenic shock, mechanical complication, stent thrombosis, reinfarction, bleeding) and 6-month all-cause death. A landmark analysis was performed, studying two time periods; 0-6 months and beyond 6 months. RESULTS: From a total of 24,125 patients in the regional STEMI network, 494 patients who suffered from cardiac arrest were included and divided into two groups: treated with (n = 119) and without therapeutic hypothermia (n = 375). At median follow-up (16.0 [0.2-33.3] months), there was no difference in the adjusted mortality rate between groups (51.3 % with hypothermia vs 48.0 % without hypothermia; HRadj1.08 95%CI [0.77-1.53]; p = 0.659). There was a higher frequency of bleeding in the hypothermia group (6.7 % vs 1.1 %; ORadj 7.99 95%CI [2.05-31.2]; p = 0.002), without difference for the rest of periprocedural complications. At 6-month follow-up, adjusted all-cause mortality rate was similar between groups (46.2 % with hypothermia vs 44.5 % without hypothermia; HRadj1.02 95%CI [0.71-1.47]; p = 0.900). Also, no differences were observed in the adjusted mortality rate between 6 months and median follow-up (9.4 % with hypothermia vs 6.3 % without hypothermia; HRadj2.02 95%CI [0.69-5.92]; p = 0.200). CONCLUSIONS: In a large cohort of patients with cardiac arrest within a regional STEMI network, those treated with therapeutic hypothermia did not improve long-term survival compared to those without hypothermia.

Predicting Cardiopulmonary Arrest with Digital Biomarkers: A Systematic Review.

(1) Background: Telemetry units allow the continuous monitoring of vital signs and ECG of patients. Such physiological indicators work as the digital signatures and biomarkers of disease that can aid in detecting abnormalities that appear before cardiac arrests (CAs). This review aims to identify the vital sign abnormalities measured by telemetry systems that most accurately predict CAs. (2) Methods: We conducted a systematic review using PubMed, Embase, Web of Science, and MEDLINE to search studies evaluating telemetry-detected vital signs that preceded in-hospital CAs (IHCAs). (3) Results and Discussion: Out of 45 studies, 9 met the eligibility criteria. Seven studies were case series, and 2 were case controls. Four studies evaluated ECG parameters, and 5 evaluated other physiological indicators such as blood pressure, heart rate, respiratory rate, oxygen saturation, and temperature. Vital sign changes were highly frequent among participants and reached statistical significance compared to control subjects. There was no single vital sign change pattern found in all patients. ECG alarm thresholds may be adjustable to reduce alarm fatigue. Our review was limited by the significant dissimilarities of the studies on methodology and objectives. (4) Conclusions: Evidence confirms that changes in vital signs have the potential for predicting IHCAs. There is no consensus on how to best analyze these digital biomarkers. More rigorous and larger-scale prospective studies are needed to determine the predictive value of telemetry-detected vital signs for IHCAs.

CO2 Photoreduction Activity Enhancement and Unexpected Observation of Carbon Monoxide Adsorbates on the Surface of TiO2 Nanotube Arrays Synthesized in Formamide Electrolytes.

TiO2 nanotube arrays grown through electrochemical anodization in a formamide-based electrolyte (TNTA-FA) exhibited a whole host of unusual properties compared to nanotubes grown in the conventional ethylene glycol-based electrolyte (TNTA-EG). TNTA-FA exhibited shorter phonon lifetimes, lower lattice strain, more visible light absorption, lower work function, and a highly unusual adsorbate structure consisting of physisorbed and chemisorbed CO along with linearly adsorbed CO2 and various monodentate and bidentate carbonate species. The observation of adsorbed CO in the dark is highly unusual and indicates spontaneous deoxygenation of CO2 on the surface of TNTA-FA. The significance of this finding is that the formation of CO2•- is no longer the rate-limiting bottleneck for the reduction of CO2 on TNTA-FA surfaces as it is for all TiO2 surfaces. TNTA-FA samples are strongly colored (inclusive of a fluorescent green color) and consist of rounded, vertically oriented hollow cylinders as opposed to the honeycomb-like morphology of TNTA-EG arranged in an approximate triangular lattice. The photocatalytic activity was tested through the CO2 photoreduction and dye degradation tests. Formamide-based nanotubes outperformed the EG-based nanotubes by almost 1.7 and 2 times, respectively, in CO2 reduction and dye degradation tests done on methylene blue, brilliant green, and rhodamine B dyes. These results are attributed to stronger surface band bending in TNTA-FA which facilitates more efficient separation of photogenerated electron-hole pairs.

Mesenchymal Stromal Cell Healing Outcomes in Clinical and Pre-Clinical Models to Treat Pressure Ulcers: A Systematic Review.

BACKGROUND: Despite numerous measures used to prevent pressure ulcers, their growing prevalence in recent years is expected to continue as the population ages. This review aims to report the outcomes of the regenerative potential of MSCs in treating pressure ulcers, assessing the effectiveness of MSCs in treating pressure ulcers. METHODS: A computerized search for articles on animal models that use MSCs as primary therapy to treat pressure ulcers, published from conception to present, was conducted using PubMed, MEDLINE, Embase, and CINAHL. Our search yielded 52 articles, narrowed to 44 after excluding duplicates. RESULTS: Out of 52 articles collected from four databases, 11 met the inclusion criteria. A total of 11 articles published between 2008 and 2020 met the inclusion criteria. Eight studies were observational descriptive papers in animal models, and three were prospective. Six studies used autologous MSCs, while five used allogenic MSCs. Three studies were conducted in humans, and the remaining eight were conducted in animals. The most common method of cell delivery was an intradermal injection in the margins of the ulcer. All studies reported positive results, including improved wound healing, reduced inflammation, and improved tissue regeneration. CONCLUSIONS: MSCs have shown promising results in treating pressure ulcers in animal and clinical trials. The combination of MSCs and scaffold materials has also been studied and found to be effective in wound healing. A standardized human wound model has been proposed further to investigate the efficacy of cell-based therapies for chronic wounds. However, more research is needed to determine the best quantity of cells to apply for pressure ulcers and to ensure the safety and efficacy of these treatments in clinical settings.

A Review on the Management of Peripheral Neuropathic Pain Following Breast Cancer.

Postmastectomy pain syndrome (PMPS) is a common and debilitating form of postsurgical pain with neuropathic characteristics, presenting as burning, stabbing, or pulling sensations after mastectomy, lumpectomy, or other breast procedures. With a prevalence of 31%, the risk factors for PMPS include younger age, psychosocial factors, radiotherapy, axillary lymph node dissection, and a history of chronic pain. This review evaluates the pharmacological and surgical options for managing PMPS. Pharmacological treatment options include antidepressants, gabapentinoids, levetiracetam, capsaicin, and topical lidocaine. Procedural and surgical options include fat grafting, nerve blocks, radiofrequency ablation, peripheral nerve surgery, serratus plane block, and botulinum toxin injections. Despite the variety of therapeutic options available for patients, further randomized trials are required to conclude whether these treatments reduce the intensity of neuropathic pain in patients with PMPS. In particular, comparative studies and the inclusion of patients across a range of pain intensities will be essential to developing a treatment algorithm for PMPS. In conclusion, current management for these patients should be tailored to their individual requirements.

Time-resolved radioluminescence of the Cu(I) cluster Cu4I62-. Different responses to photo, X-ray, ß-ray and α-particle excitation.

Time-resolved radioluminescence (TRRL) properties of the Cu(I) cluster Cu4I62- upon pulsed X-ray, ß-ray or α-particle excitation are described. The longer (>2 µs) TRRL component displays exponential decay comparable to pulsed UV excitation; however, temporal behaviour at shorter times indicates that high local excited state density provides an alternative decay channel.

Correction: 'Redox-mediated carbon monoxide release from a manganese carbonyl-implications for physiological CO delivery by CO releasing moieties' (2021), by Barrett et al.

[This corrects the article DOI: 10.1098/rsos.211022.][This corrects the article DOI: 10.1098/rsos.211022.].

Benefits and Challenges of Remote Patient Monitoring as Perceived by Health Care Practitioners: A Systematic Review.

BACKGROUND: Remote patient monitoring (RPM), or telemonitoring, offers ways for health care practitioners to gather real-time information on the physiological conditions of patients. As telemedicine, and thus telemonitoring, is becoming increasingly relevant in today's society, understanding the practitioners' opinions is crucial. This systematic review evaluates the perspectives and experiences of health care practitioners with telemonitoring technologies. METHODS: A database search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the selection of articles measuring health care practitioners' perspectives and experiences with RPM technologies published between 2017 and 2021. Only articles written in English were included. No statistical analysis was performed and thus this is a qualitative review. RESULTS: A total of 1605 studies were identified after the initial search. After applying the inclusion and exclusion criteria of this review's authors, 13 articles were included in this review. In all, 2351 practitioners' perspectives and experience utilizing RPM technology in a variety of medical specialties were evaluated through close- and open-ended surveys. Recurring themes emerged for both the benefits and challenges. Common benefits included continuous monitoring of patients to provide prompt care, improvement of patient self-care, efficient communication, increased patient confidence, visualization of health trends, and greater patient education. Challenges comprised increased workload, higher patient anxiety, data inaccuracy, disorienting technology, financial issues, and privacy concerns. CONCLUSION: Health care practitioners generally believe that RPM is feasible for application. Additionally, there is a consensus that telemonitoring strategies will become increasingly relevant. However, there are still drawbacks to the technology that need to be considered.

Evaluating the exoscope as an alternative to the operating microscope in plastic surgery.

BACKGROUND: Microsurgery is most commonly used in the anastomosis of vessels, flap harvesting, lymphedema, and nerve reconstruction, among others. During the 1920s the first microscope was invented by Nylen and Holmgren, quickly becoming the gold standard for microsurgery. However, technological advances have come forth in the form of exoscopes. METHODS: A search for full-text articles where using an exoscope was compared with a traditional operating microscope was conducted on the databases PubMed, Scopus, Web of Science, and Embase. The following terms were used to guide our search: Microscope AND exoscope AND plastic surgery; Microscope AND exoscope AND microvascular surgery. RESULTS: Our search yielded 69 studies, of which 12 were included. Five exoscope systems were used by the authors. All studies reported the exoscope as a valid alternative to the standard operating microscope. The exoscope was reported as non-inferior to the operating microscope. Although some studies reported lower quality of image, this did not seem to influence the outcome of surgeries. Newer models may have bridged the gap between the operating microscope's image quality and the exoscope. Superior ergonomics was always reported among the included studies. CONCLUSION: Based on our search, we conclude that the exoscope is a safe and valid alternative to the operating microscope in plastic surgery. As newer models are now commercially available, these have overcome difficulties in image quality and zoom capabilities, responsible for the main drawbacks of the first exoscope systems.

The Upscale Manufacture of Chondrocytes for Allogeneic Cartilage Therapies.

Allogeneic chondrocyte therapies need to be developed to allow more individuals to be treated with a cell therapy for cartilage repair and to reduce the burden and cost of the current two-stage autologous procedures. Upscale manufacture of chondrocytes using a bioreactor could help provide an off-the-shelf allogeneic chondrocyte therapy with many doses being produced in a single manufacturing run. In this study, we assess a good manufacturing practice-compliant hollow-fiber bioreactor (Quantum®) for adult chondrocyte manufacture. Chondrocytes were isolated from knee arthroplasty-derived cartilage (n = 5) and expanded in media supplemented with 10% fetal bovine serum (FBS) or 5% human platelet lysate (hPL) on tissue culture plastic (TCP) for a single passage. hPL-supplemented cultures were then expanded in the Quantum bioreactor for a further passage. Matched, parallel cultures in hPL or FBS were maintained on TCP. Chondrocytes from all culture conditions were characterized in terms of growth kinetics, morphology, immunoprofile, chondrogenic potential (chondrocyte pellet assays), and single telomere length analysis. Quantum expansion of chondrocytes resulted in 86.4 ± 38.5 × 106 cells in 8.4 ± 1.5 days, following seeding of 10.2 ± 3.6 × 106 cells. This related to 3.0 ± 1.0 population doublings in the Quantum bioreactor, compared with 2.1 ± 0.6 and 1.3 ± 1.0 on TCP in hPL- and FBS-supplemented media, respectively. Quantum- and TCP-expanded cultures retained equivalent chondropotency and mesenchymal stromal cell marker immunoprofiles, with only the integrin marker, CD49a, decreasing following Quantum expansion. Quantum-expanded chondrocytes demonstrated equivalent chondrogenic potential (as assessed by ability to form and maintain chondrogenic pellets) with matched hPL TCP populations. hPL manufacture, however, led to reduced chondrogenic potential and increased cell surface positivity of integrins CD49b, CD49c, and CD51/61 compared with FBS cultures. Quantum expansion of chondrocytes did not result in shortened 17p telomere length when compared with matched TCP cultures. This study demonstrates that large numbers of adult chondrocytes can be manufactured in the Quantum hollow-fiber bioreactor. This rapid, upscale expansion does not alter chondrocyte phenotype when compared with matched TCP expansion. Therefore, the Quantum provides an attractive method of manufacturing chondrocytes for clinical use. Media supplementation with hPL for chondrocyte expansion may, however, be unfavorable in terms of retaining chondrogenic capacity.

Efficacy of topical versus oral analgesic medication compared to a placebo in injured athletes: A systematic review with meta-analysis.

BACKGROUND: Athletes are injured frequently and often take analgesic medication. Moreover, athletes commonly use non-prescription topical and oral medications with little guidance. Despite wide use, relatively few studies exist on the efficacy of pain medication in injured athletes compared to a placebo. OBJECTIVE: To determine efficacy of topical or oral medications in pain reduction compared to a placebo in injured athletes. STUDY DESIGN: A systematic review and meta-analysis. METHODS: We conducted an electronic search using Medline/Pubmed, Web of Science, Ovid, and SportDiscus for all literature relating to topical or oral medications in athletes for pain management post-injury. Two reviewers screened the studies and measured their quality. To determine efficacy, we calculated the Hedges' g value. We created forest plots with 95% CI to graphically summarize the meta-analyses. RESULTS: There was a significant pooled effect size reflecting a reduction in pain outcomes for the topical treatment versus placebo (g = -0.64; 95% CI [-0.89, -0.39]; p < 0.001). There was not a significant reduction in pain outcomes for the oral treatment versus placebo (g = -0.26; 95% CI [-0.60, 0.17]; p = 0.272). CONCLUSION: Topical medications were significantly better at reducing pain compared to oral medications versus a placebo in injured athletes. These results are different when compared to other studies that used experimentally induced pain versus musculoskeletal injuries. The results from our study suggest that athletes should use topical medications for pain reduction, as it is more effective, and there are less reported adverse effects compared to oral medication.