What is the effect of larval therapy on the debridement of venous leg ulcers? A systematic review

AimTo determine the impact of larval therapy on the debridement of venous leg ulcers, in comparison to other debridement methods or no debridement.MethodUsing systematic review methodology, published quantitative studies focusing on the effect of larval therapy on the debridement of venous leg ulcers were included. The search was conducted in January 2020 and updated in May 2021 using CINAHL, PubMed, Embase, and the Cochrane library, and returned 357 records, of which six studies met the inclusion criteria. Data were extracted using a predesigned extraction tool and all studies were quality appraised using the RevMan risk of bias assessment tool.ResultsLarval therapy was found to debride at a faster rate than hydrogel (p = 0.011, p < 0.001, p = 0.0039), have a similar effect to sharp debridement (p = 0.12, p = 0.62), and was a resource-effective method of debridement (p < 0.05, p < 0.001, p < 0.001). When larval therapy in combination with compression therapy was compared to compression alone, larvae had a greater effect on debridement (p < 0.05), however, it did not improve overall wound healing rates (p = 0.54, p = 0.664, p = 0.02). Pain levels increased during larval therapy and reduced after treatment, when compared to other standard debridement techniques.ConclusionLarval therapy promotes rapid debridement of venous leg ulcers. However, further high quality randomised controlled trials, comparing larval therapy to other debridement methods for venous leg ulcers, incorporating the use of compression is required to determine the long term effects of larval therapy.     

What causes worsening of eczema? A systematic review

BACKGROUND: Flares of eczema are attributed to many factors, often with minimal scientific evidence. OBJECTIVES: Systematically to search, summarize and critically appraise the scientific evidence to support the roles of individual 'flare factors' in eczema. METHODS: We searched Medline from 1966 until 20 April 2005 to identify relevant articles for inclusion in this review. No language restrictions were imposed. All study designs were included and were ranked according to the strength of evidence. Experimental and provocation studies were restricted to those using a double-blind design. We included randomized controlled trials if they were provocation studies. Meta-analysis was not possible due to differences in study populations and methodology. The studies are therefore described qualitatively. RESULTS: The roles of foodstuffs (13 studies), house dust mite (three), other aeroallergens (two), seasonality (two), bacterial infections (one), textiles (three), detergents (one), sunlight (one) and stress (two) were assessed in different study populations, using a variety of study designs. All studies were performed on selected groups and only four were longitudinal in design. Collectively, these studies provide some evidence that certain foods, house dust mite, stress and seasonal factors are relevant causes of disease worsening in certain subgroups with eczema. No good evidence could be found to support the role of detergents, textiles and irritants in causing worsening of eczema. CONCLUSIONS: Despite anecdotal lists in textbooks and review articles, very little good evidence exists for 'flare factors' in eczema. The focus of all of the included studies was on disease worsening rather than clinically relevant flares. Studies of longitudinal design are required to clarify the roles of these and other putative flare factors in eczema.     

Does palliative care improve outcomes for patients with HIV/AIDS? A systematic review of the evidence

BACKGROUND: The need for palliative care in HIV management is underlined by the high prevalence of pain and symptoms, the toxicity, side effects, and virological failure associated with antiretroviral therapy, emergence of co-morbidities, continued high incidence of malignancies, late presentation of people with HIV disease, and the comparatively higher death rates among the infected individuals. METHODS: A systematic review was undertaken to appraise the effect of models of palliative care on patient outcomes. A detailed search strategy was devised and biomedical databases searched using specific terms relevant to models of palliative care. Data from papers that met the inclusion criteria were extracted into common tables, and evidence independently graded using well described hierarchy of evidence. RESULTS: 34 services met the inclusion criteria. Of these, 22 had been evaluated, and the evidence was graded as follows: grade 1 (n = 1); grade 2 (n = 2); grade 3 (n = 7); grade 4 (n = 1); qualitative (n = 6). Services were grouped as: home based care (n = 15); home palliative care/hospice at home (n = 7); hospice inpatient (n = 4); hospital inpatient palliative care (n = 4); specialist AIDS inpatient unit (n = 2); and hospital inpatient and outpatient care (n = 2). The evidence largely demonstrated that home palliative care and inpatient hospice care significantly improved patient outcomes in the domains of pain and symptom control, anxiety, insight, and spiritual wellbeing. CONCLUSIONS: Although the appraisal of evidence found improvements across domains, the current body of evidence suffers from a lack of (quasi) experimental methods and standardised measures. The specialism of palliative care is responding to the clinical evidence that integration into earlier disease stages is necessary. Further studies are needed to both identify feasible methods and evaluate the apparent beneficial effect of palliative care on patient outcomes in the post-HAART era.     

Healthcare professionals and students’ knowledge on termination of pregnancy legislation and clinical practice: A systematic review

BackgroundLegal and safe termination of pregnancy (TOP) has long been recognised as an important public health issue internationally. Healthcare professionals (HCPs) and students have a key role within TOP services, and it is crucial that they have sufficient understanding of laws, guidelines and clinical practice to facilitate safe and effective care. The current systematic review aims to study the level of knowledge of both HCPs and students on TOP legislation, methods and procedures and potential associated complications.MethodsPubMed, Embase, Scopus and EBSCOhost were searched for peer-reviewed studies published until July 2020. After initial selection, 239 articles were screened in full and 31 studies (qualitative and quantitative) were included. A narrative review and synthesis of the findings was completed.Main findingsPoor knowledge on TOP legislation and clinical practice was reported for HCPs and students. The main issues identified included limited awareness of specific circumstances for legal TOP and poor understanding of methods and medical regimens recommended. Overall, education/training, experience in provision of TOP and receiving reminders of legislation were the main factors associated with increased levels of knowledge.ConclusionHCPs must be fully aware of the clinical practice and circumstances in which TOP is legal in their country/region so adequate provision of this service is ensured. This study highlighted the importance of involving and promoting participation of HCPs and students in the provision of TOP services. A clear need and desire for staff education and training on TOP was shown. Adequate training allows preparation of current and future HCPs to provide respectful and compassionate care.     

Is atopic dermatitis associated with obesity? A systematic review of observational studies

Obesity has been associated with atopic dermatitis (AD); however, the results have been conflicting. Our aim was to provide an update on current knowledge from observational studies addressing the possible association between obesity and AD. Systematic literature review was performed by identifying studies addressing a possible link between AD and overweight/obesity from PubMed, EMBASE and the Cochrane Library in accordance with the Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines. The quality of the included studies was assessed using the Newcastle–Ottawa Scale. A total of 45 studies (comprising more than 90 000 individuals with AD) fulfilled the criteria and were included in the present review. The available studies revealed inconsistencies, but the majority indicated that obesity is associated with AD. Studies addressing obesity in infancy or early childhood (age < 2 years) and AD reported a positive association. From childhood into adulthood, there is a discrepancy in the observations, as the more recent prospective studies found a positive association, whereas this was not observed in older cross‐sectional studies. The inconsistency might be explained by the difference in study design, the diagnostic criteria of AD, regional differences, and by the varied definitions of overweight and obesity used in the studies. In Conclusion, overweight/obesity is associated with an increased risk of AD. Large prospective cohort studies are required to confirm the association between AD and obesity and the possibility that weight control in childhood may help to mitigate or reverse AD symptoms.     

Who uses sunbeds? A systematic literature review of risk groups in developed countries

Skin cancer is caused by ultraviolet radiation (UVR). Indoor tanning is a totally avoidable risk behaviour. This review addresses the specific characteristics of sunbed users and the differences in motivation and risk perception compared with non‐users. This review is based solely on empirical original articles. Based on literature searches with widely used reference databases (‘PubMed’, ‘OVID’, ‘Social Citation Index’, ‘ERIC – Educational Resources Information Center’, ‘Web of Science’ and the ‘International Bibliography of the Social Sciences’), we included studies from developed nations with a publication date between 1 January 2000 and 12 August 2008. All studies were selected, classified and coded simultaneously by both authors on a blinded basis. All searches were performed on 13 and 14 August 2008. In accordance with the QUOROM and the MOOSE Statements, we identified 16 original studies. The typical sunbed user is female, between 17 and 30 years old, and tends to live a comparatively unhealthy lifestyle: Users smoke cigarettes and drink alcohol more frequently and eat less healthy food than non‐users. Users are characterized by a lack of knowledge about health risks of UVR, and prompted by the frequent use of sunbeds by friends or family members and the experience of positive emotions and relaxation by indoor tanning. This review is the first systematic review on risk groups among sunbed users that has been published in a scientific journal. There is still a lack of information among users, particularly among young people regarding the safety of solariums.     

Does early life exposure to antibiotics increase the risk of eczema? A systematic review

A number of studies have suggested that early life exposure to antibiotics can lead to an increased risk of developing eczema. This systematic review and meta‐analysis of observational studies, involving children or young adults aged 0–25 years, assessed the impact of antibiotic exposure either in utero or during the first 12 months of life on subsequent eczema risk. Twenty studies examined the association between prenatal and/or postnatal exposure to antibiotics and development of eczema. The pooled odds ratio (OR) for the 17 studies examining postnatal antibiotic exposure was 1·41 [95% confidence interval (CI) 1·30–1·53]. The pooled OR for the 10 longitudinal studies was 1·40 (95% CI 1·19–1·64), compared with a pooled OR of 1·43 (95% CI 1·36–1·51) for the seven cross‐sectional studies. There was a significant dose–response association, suggesting a 7% increase in the risk of eczema for each additional antibiotic course received during the first year of life [pooled OR 1·07 (95% CI 1·02–1·11)]. Finally, the pooled OR for the four studies relating to antenatal exposure was 1·30 (95% CI 0·86–1·95). We conclude that exposure to antibiotics in the first year of life, but not prenatally, is more common in children with eczema.     

Is there a rural/urban gradient in the prevalence of eczema? A systematic review

Background Eczema affects approximately 10% of all schoolchildren in the western world and has shown an increase over the past decades in ‘developing’ countries. Numerous factors have been suggested that might contribute to the increasing prevalence of eczema. A plausible explanation is the role of environmental factors. As part of the ‘hygiene hypothesis’ it has been thought that eczema is more common in urban than in rural communities, but such a notion has never been assessed systematically. Objective Our aim was to assess whether there is a rural/urban gradient for the prevalence of eczema and, if so, to what extent. Methods All data sources were identified through a search in MEDLINE and EMBASE. All primary studies comparing the prevalence rate of eczema between urban and rural populations were assessed for eligibility. Included articles were reviewed for methodological quality and a relative risk was calculated to indicate the risk of eczema in urban over rural areas. Results Twenty‐six articles were included for analysis. Nineteen showed a higher risk for eczema in an urbanized area, of which 11 were significant. Six studies showed a lower risk of eczema in an urbanized area, of which one was statistically significant. One study had a relative risk of 1·00. Results were more homogeneous among studies of good methodological quality. A pooled relative risk could have been calculated but was not because of heterogeneity. Conclusion There is some evidence of a higher risk for eczema in urban compared with rural areas, suggesting that place of residence may have a role in the pathogenesis of eczema. Future reviews on environmental circumstances should be carried out to reveal the factors associated with a higher prevalence of eczema in urban areas and the association with other allergic diseases.     

Nurses’ attitude on pressure injury prevention: A systematic review and meta-analysis based on the pressure ulcer prevention instrument (APuP)

BackgroundPrevention of pressure ulcers (PU) is one of the most important indicators of the quality of patient care that may be influenced by the attitude of nurses. Nurses are responsible for maintaining the integrity of the skin and preventing its complications. The aim of this study was to assess the overall attitude of nurses on PU prevention based on their scores on the Attitude towards Pressure ulcer Prevention instrument (APuP).MethodsIn this systematic review and meta-analysis, databases including Web of Science, Science Direct, PubMed, and Scopus were searched, using the following keywords: Pressure Ulcer, Pressure injury, Bedsore, Pressure Sore, Decubitus Ulcer, Attitude, and their possible combinations. Heterogeneity of studies was assessed with I² index and Cochrane-Q test. Based on heterogeneity between the studies, the data were analyzed using a random effects model. All the analyses were performed using STATA v.16 software.ResultsTwelve studies with a sample size of 7824 people were analyzed. The overall score of attitude towards pressure ulcer prevention was 70.84% (95% CI: 66.34–75.35) and the highest and lowest scores were related to the dimensions of individual priority (78.83%, 95% CI: 74.69–82.97) and competence (70.11%, 95% CI: 67.24–72.94), respectively. The percentage of the total score of attitude towards pressure ulcer prevention in nurses was higher than nursing students (72.15%, 95% CI: 67.10–77.20 vs. 67%, 95% CI: 53.80–80.20). Sensitivity analysis confirmed the stability of the results. Publication bias was significant (p = 0.036).ConclusionThe attitude of nurses and nursing students towards the prevention of pressure ulcers was moderate, and providing the necessary training to these groups was essential.     

Efficacy and safety of topical agents in the treatment of melasma: What's evidence? A systematic review and meta-analysis

Background

Various topical agents have been used to treat melasma; however, a large-scale evaluation among the currently available treatment is lacking.

Objectives

The aim of this study was to evaluate the efficacy and safety of topical agents for melasma.

Methods

The MEDLINE, Embase, Web of Science, Cochrane, and Alt-Healthwatch databases were searched in November 2021. Original studies that reported pre- and post-treatment Melasma Area Severity Index (MASI)/modified Melasma Area Severity Index (mMASI) scores and/or adverse effects (AEs) were eligible for inclusion. The main outcome was the efficacy analyzed by the changes in the pre- and post-treatment with standardized mean difference (SMD) of MASI/mMASI scores; the AEs were calculated with incidence proportion by the reported percentage of skin irritations.

Results

A total of 45 studies (2359 patients) and 55 studies (4539 patients) met the inclusion criteria for efficacy and AEs, respectively. Hydroquinone (HQ) monotherapy (SMD -1.3, 95% CI [−1.6 to −1.0]), HQ-containing combination therapy (−1.4, [−1.7 to −1.1]), cysteamine (−1.6, [−2.0 to −1.2]), tranexamic acid (−1.5, [−2.0 to −1.1]), azelaic acid (−1.3, [−1.7 to −1.0]), and kojic acid (−0.9, [−1.3 to −0.5]) demonstrated comparable efficacy, while zinc sulfate did not exhibit statistically significant improvement (−1.2, [−2.7 to 0.4]). HQ-containing combination therapy (50.9%) and cysteamine (42.2%) demonstrated the highest incidence of irritation, while azelaic acid (18.7%), kojic acid (5.3%), and tranexamic acid (0.8%) revealed a lower risk.

Conclusions

In this meta-analysis, non-HQ agents except zinc sulfate may be considered as an alternative to HQ-containing agents. However, treatment should be guided by patient's tolerance, availability, and physicians' experience.     

Peptides stimulating synthesis of extracellular matrix used in anti-ageing cosmetics: Are they clinically tested? A systematic review of the literature

Peptides stimulating synthesis of extracellular matrix are now commonly used in the production of anti-ageing cosmetics. However, much uncertainty still exists about the methodology of their clinical assessment. The aim of the study was to review the literature for clinical study designs assessing the efficacy of these peptides. The authors searched systematically publications indexed in PubMed, Scope and Web of Science, according to the PRISMA protocol. Altogether 12 scientific papers, reporting results of 15 independent studies were identified. Out of these 15 studies, only six used a placebo control. Double-blinding was applied in five out of 15 studies. Nine studies were based on female-only populations. For the product performance evaluation, most of the studies (10 out of the 15) used image-based methods. The literature on the topic is sparse. The studies carried out so far have many methodological limitations. Most of the clinical experiments hitherto conducted were non-double-blind and used no placebo control. There is a need for better planned and controlled clinical trials in this area.