Brit J Hosp Med
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Aims/Background High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) and intermittent theta burst stimulation (iTBS) are emerging neuromodulation techniques for major depressive disorder (MDD). However, clinical trials directly comparing their efficacy are limited. This meta-analysis aimed to evaluate the antidepressant effects and safety profiles of iTBS versus HF-rTMS for MDD. ⋯ Conclusion iTBS and HF-rTMS have comparable efficacy and safety profiles in treating MDD based on current evidence. Both neuromodulation techniques are superior to sham stimulation. iTBS could be considered an alternative to HF-rTMS, with the advantage of shorter daily treatment duration. Further large RCTs with long-term follow-up are warranted to confirm these findings.
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Meta Analysis
Efficacy and Safety of Nerve Growth Factor in Treating Neurotrophic Keratitis Patients: A Meta-Analysis.
Aims/Background Nerve growth factor has been approved for treating neurotrophic keratitis in Europe and the United States. However, its clinical efficacy and safety profile in neurotrophic keratitis patients have not been systematically evaluated. Therefore, this study systematically assessed the efficacy and safety of nerve growth factor (NGF) in treating patients with neurotrophic keratitis. ⋯ However, the incidence of ailment progression (OR = 0.44, 95% CI: 0.17-1.13) and adverse events (OR = 0.88, 95% CI: 0.50-1.56) did not show significant differences between these two groups. Conclusion In summary, for patients with neuropathic keratitis, NGF treatment can promote corneal healing efficiency, effectively improve visual correction, and reduce disease progression and incidence of adverse events to a large extent. The clinical effect and safety are high, and it is worthy of clinical promotion and application.
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Review Meta Analysis
Can perioperative psychological interventions reduce chronic pain after surgery?
Chronic post-surgical pain is a relatively common adverse effect following surgery. Several prognostic factors for chronic post-surgical pain have been identified, including psychological states and traits. Psychological factors are modifiable, and perioperative psychological interventions may reduce the incidence of chronic post-surgical pain. ⋯ In addition, demonstration of cost-effectiveness may be a prerequisite for wider adoption of perioperative psychological interventions in regular healthcare. Offering psychological interventions selectively to patients at risk of chronic post-surgical pain could be a means to increase cost-effectiveness. Stepped-care approaches should also be considered, where the intensity of psychological support is adapted to the needs of the patient.
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Polypharmacy and multimorbidity are both currently rising. The number of medicines taken is the single biggest predictor of adverse drug events. ⋯ Multiple international evidence-based guidelines are emerging to promote discontinuation of high-risk medications, and use of alternative medical and non-pharmacological management. This review outlines the evidence base behind deprescribing, and suggests some pragmatic approaches to decision making around medication review.