Efficacy of Oral Cryotherapy in the Prevention of Oral Mucositis Associated with Cancer Chemotherapy: Systematic Review with Meta-Analysis and Trial Sequential Analysis.

BACKGROUND: This review aimed to evaluate the efficacy of oral cryotherapy in the prevention of chemotherapy-induced oral mucositis using meta-analysis and trial sequential analysis, as well as to assess the quality of the results by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. METHODS: A comprehensive search of three databases including Medline, Embase and Central was performed to identify randomized controlled trials that used oral cryotherapy for the prevention of chemotherapy-induced oral mucositis. The primary outcome was the incidence of oral mucositis for trials employing oral cryotherapy as the intervention for the prevention of oral mucositis. The meta-analysis was performed using the random-effects model and random errors of the meta-analyses were detected by trial sequential analysis. RESULTS: A total of 14 RCTs with 1577 participants were included in the present meta-analysis. Patients treated with oral cryotherapy were associated with a significantly lower risk of developing oral mucositis of any grade (risk ratio (RR), 0.67 (95% CI: 0.56-0.81, p < 0.05)). Findings from the subgroup analyses showed that oral cryotherapy significantly reduced the risk of oral mucositis in patients undergoing bone marrow transplantation (RR 0.69, CI: 0.54-0.89, p < 0.05) as well as chemotherapy (RR 0.66, CI: 0.58-0.75, p < 0.05). Findings from the trial sequential analysis suggested that the evidence on oral cryotherapy as a preventive intervention for oral mucositis in patients with solid malignancies receiving conventional chemotherapy was conclusive. CONCLUSION: Oral cryotherapy is effective in preventing oral mucositis in patients undergoing chemotherapy for the management of solid malignancies. The use of oral cryotherapy in preventing oral mucositis in bone marrow transplantation settings showed promising efficacy, but the evidence is not conclusive and requires more high-quality randomized controlled trials.

Efficacy and safety of posaconazole for the prevention of invasive fungal infections in immunocompromised patients: a systematic review with meta-analysis and trial sequential analysis.

Invasive fungal infections are a potentially life-threatening complication in immunocompromised patients. The aim of this study was to assess the efficacy and safety of posaconazole as compared with other antifungal agents for preventing invasive fungal infections in immunocompromised patients. Embase, CENTRAL, and MEDLINE were searched for randomized conweekmonthtrolled trials (RCTs) up to June 2020. A systematic review with meta-analysis of RCTs was performed using random-effects model. Trial sequential analysis (TSA) was conducted for the primary outcome to assess random errors. A total of five RCTs with 1,617 participants were included. Posaconazole prophylaxis was associated with a significantly lower risk of IFIs (RR, 0.43 [95% CI 0.28 to 0.66, p = 0.0001]) as compared to other antifungal agents. No heterogeneity was identified between studies (I2 = 0%). No significant associations were observed for the secondary outcomes measured, including risk reduction of invasive aspergillosis and candidiasis, clinical failure, all-cause mortality, and treatment-related adverse events, except for infection-related mortality (RR, 0.31 [95% CI 0.15 to 0.64, p = 0.0001]). Subgroup analysis favoured posaconazole over fluconazole for the prevention of IFIs (RR, 0.44 [95% CI 0.28 to 0.70, p = 0.0004]). TSA confirmed the prophylactic benefit of posaconazole against IFIs. Posaconazole is effective in preventing IFIs among immunocompromised patients, particularly those with hematologic malignancies and recipients of allogenic hematopoietic stem cell transplantation.

A cross-sectional study on knowledge and attitude toward Traditional Chinese Medicine (TCM) among adults in selected regions of Malaysia.

BACKGROUND: The objectives of this study were to determine the knowledge and attitude of adult Malaysians about Traditional Chinese Medicine (TCM), to understand the variation in the knowledge and attitude toward TCM among different demographic groups of adult Malaysian population and to determine the pattern of TCM use among adult Malaysians. METHODS: This study was a descriptive, cross-sectional survey using the convenience sampling method. A total of 400 adult Malaysians were recruited for this study. An interview-administered questionnaire was used. Descriptive statistics Mann-Whitney U Test and Kruskal-Wallis H test were used to analyze the data. The reliability of survey data in this study may affect since closed-ended questions are used. RESULTS: The more commonly utilized therapy was herbal medicine (n=192, 82.1%), acupuncture (n=79, 33.8%) and oriental massage (n=58, 24.8%). The mean knowledge score and mean attitude score for the respondents were 5.00±1.71 and 7.17±2.10 respectively. There was a significant difference in the mean knowledge score between genders, among TCM users and non-TCM users, people of different education levels and ethnicity. CONCLUSIONS: There were more TCM users than non-TCM users and the use of TCM was higher in females than males. The most popularly used TCM modalities were herbal medicines and acupuncture. Gender, education, ethnicity and use of TCM had a significant effect on adults' knowledge toward TCM.

Study of drug utilization pattern for acute exacerbation of chronic obstructive pulmonary disease in patients attending a government hospital in kerala, India.

OBJECTIVE: Drug utilization studies are powerful exploratory tools to ascertain the role of drugs in society. This study was conducted to establish the drug utilization pattern and the common adverse drug reactions for the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD) in one of the government hospitals in Kerala, India. METHODS: This was a prospective observational study aimed at recognizing the drug utilization pattern for the treatment of acute exacerbation of COPD for 7-day under nonexperimental settings. All information significant to the study was collected from the case records and discussions conducted with the inpatients and bystanders during ward rounds, with the support of a physician. Moreover, daily follow-ups were conducted to assemble data on amendment in therapy, add-on therapy, and clinical improvement until the patient was discharged from the hospital or to an upper limit of 7-day, whichever is earlier. RESULTS: All the patients in this study received combination therapy. Among the inhalational ß-agonists, salbutamol accounted for 74% use. Parenteral steroids were used in 78% of the patients and all of them received hydrocortisone. Steroid inhalers were used only in 25% of the patients. Anticholinergics were used in 77.5% of patients. Antibiotics were used in 86.7% patients. The main adverse effects noted were dry mouth (15%) and bad taste (10%) and these adverse effects were highly correlated with the use of anticholinergics (P < 0.05). CONCLUSIONS: Despite the use of drugs according to the availability and physician's preference, it was found in the analysis that majority were in accordance with Global Initiative for Chronic Obstructive Lung Disease criteria recommendations.

Standard setting in OSCEs: a borderline approach.

BACKGROUND: The evaluation of clinical skills and competencies is a high-stakes process carrying significant consequences for the candidate. Hence, it is mandatory to have a robust method to justify the pass score in order to maintain a valid and reliable objective structured clinical examination (OSCE). The aim was to trial the borderline approach using the two-domain global rating scale for standard setting in the OSCE. METHODS: For each domain, a set of six-point (from 5 to 0) scales were used to reflect high and low divisions within the 'pass', 'borderline' and 'fail' categories. Scores on the two individual global scales were summed to create a 'summed global rating'. Similarly task-based checklists for individual stations were summed to get a total score. It is mandatory to have a robust method to justify the pass score in order to maintain a valid and reliable OSCE RESULTS: The Pearson's correlation between task-based checklist scoring and the two-domain global rating scale were moderate and significant. The highest R(2) coefficient of 0.479 was obtained for station 7, and the lowest R(2) value was 0.241 for station 14. DISCUSSION: There was a significant positive correlation between the two scales; however, the R(2) value was not satisfactory except for station 7. The pass mark for the OSCE according to the borderline method was 64 per cent, which is higher than the arbitrarily set pass mark of 50 per cent. CONCLUSIONS: This study confirms that the two-domain global rating scale is appropriate to assess the abilities of students within the framework of an OSCE. The strong relationships between the two-domain global rating scale and task-based checklists provide evidence that the two-domain global rating scale can be used to genuinely assess students' proficiencies.