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PubMedDate not supplied

Bacterial vaginosis in pregnancy and preterm birth: evidence from the literature.

We review below the evidence from the literature about the relationships between bacterial vaginosis, its treatment and pregnancy outcome. The literature indicates that there is a well-defined association between the presence of bacterial vaginosis during pregnancy and the risk of premature membrane rupture and preterm birth. Less definite is the role of the treatment of such pathology in reducing the frequency of preterm birth and/or premature rupture of membranes. The results of the controlled clinical trials are not entirely consistent. Of the most studied therapies, clindamycin seems to have shown favourable results most consistently but the published data are limited to trials including just a few hundred subjects. Only the availability of further data from controlled clinical trials will clarify the role of such treatment for bacterial vaginosis in pregnancy.

Anti-Bacterial Agents↗
PubMed2026

Impact of Physical Environment of Pediatric Inpatient Wards on Children: A Systematic Literature Review.

ObjectiveThe study aimed to examine empirical studies published between 2003 and 2025 to identify elements of physical environments influencing health outcomes and experiences of children and families.BackgroundIn the past 40 years, research has shown that the physical environment influences the health and well-being of patients in the healthcare environment. However, similar research in the context of "pediatric inpatient wards" remains underexplored.MethodsPubMed, Embase, Scopus, and Web of Science were used to identify relevant articles. All extracted articles underwent a three-step screening process using PRISMA. A total of 30 eligible articles were used for the analysis. The protocol is registered at PROSPERO (CRD42023408997).ResultsKey findings reveal positive and negative impacts of identified elements. Positive-effect elements include play spaces, space for parents, natural light, connections with nature, and so on, which promote comfort, healing, and emotional resilience. Conversely, negative-effect elements, such as noise, artificial lighting, uncomfortable temperature, and so on, contribute to stress and disrupted sleep. Mixed effects were observed for elements like art and television, which underscore the complexity of designing environments that address the diverse needs of different age groups and genders.ConclusionsThe review findings highlight significant knowledge gaps. The study also tries to bridge existing gaps between research and practice by systematically identifying environmental elements, offering actionable insights to architects, designers, healthcare providers, and policymakers. Future research must adopt rigorous, culturally inclusive approaches to advance the field of pediatric healthcare design and ensure equitable care across diverse sociocultural contexts.

Humans↗
PubMed2025

A Digital Tool for Clinical Evidence-Driven Guideline Development by Studying Properties of Trial Eligible and Ineligible Populations: Development and Usability Study.

BACKGROUND: Clinical guideline development preferentially relies on evidence from randomized controlled trials (RCTs). RCTs are gold-standard methods to evaluate the efficacy of treatments with the highest internal validity but limited external validity, in the sense that their findings may not always be applicable to or generalizable to clinical populations or population characteristics. The external validity of RCTs for the clinical population is constrained by the lack of tailored epidemiological data analysis designed for this purpose due to data governance, consistency of disease or condition definitions, and reduplicated effort in analysis code. OBJECTIVE: This study aims to develop a digital tool that characterizes the overall population and differences between clinical trial eligible and ineligible populations from the clinical populations of a disease or condition regarding demography (eg, age, gender, ethnicity), comorbidity, coprescription, hospitalization, and mortality. Currently, the process is complex, onerous, and time-consuming, whereas a real-time tool may be used to rapidly inform a guideline developer's judgment about the applicability of evidence. METHODS: The National Institute for Health and Care Excellence-particularly the gout guideline development group-and the Scottish Intercollegiate Guidelines Network guideline developers were consulted to gather their requirements and evidential data needs when developing guidelines. An R Shiny (R Foundation for Statistical Computing) tool was designed and developed using electronic primary health care data linked with hospitalization and mortality data built upon an optimized data architecture. Disclosure control mechanisms were built into the tool to ensure data confidentiality. The tool was deployed within a Trusted Research Environment, allowing only trusted preapproved researchers to conduct analysis. RESULTS: The tool supports 128 chronic health conditions as index conditions and 161 conditions as comorbidities (33 in addition to the 128 index conditions). It enables 2 types of analyses via the graphic interface: overall population and stratified by user-defined eligibility criteria. The analyses produce an overview of statistical tables (eg, age, gender) of the index condition population and, within the overview groupings, produce details on, for example, electronic frailty index, comorbidities, and coprescriptions. The disclosure control mechanism is integral to the tool, limiting tabular counts to meet local governance needs. An exemplary result for gout as an index condition is presented to demonstrate the tool's functionality. Guideline developers from the National Institute for Health and Care Excellence and the Scottish Intercollegiate Guidelines Network provided positive feedback on the tool. CONCLUSIONS: The tool is a proof-of-concept, and the user feedback has demonstrated that this is a step toward computer-interpretable guideline development. Using the digital tool can potentially improve evidence-driven guideline development through the availability of real-world data in real time.

Humans↗
PubMed2026

Hyperbaric oxygen for the treatment of traumatic incomplete spinal cord injury: a systematic review and meta-analysis of randomized controlled trials.

The therapeutic efficacy of hyperbaric oxygen therapy for traumatic incomplete spinal cord injury remains a subject of debate. To comprehensively evaluate the impact of hyperbaric oxygen on motor function, sensory function, and activities of daily living in patients with traumatic incomplete spinal cord injury, we conducted a systematic review and meta-analysis. We performed a comprehensive search across PubMed, Embase, the Cochrane Library, Web of Science, and major Chinese databases for randomized controlled trials published through June 2025. A total of 15 randomized controlled trials were included. The pooled results indicated that hyperbaric oxygen therapy significantly improved the American Spinal Injury Association motor score (mean difference = 10.30, 95% confidence interval: 7.70-12.90), the total American Spinal Injury Association sensory score (mean difference = 29.29, 95% confidence interval: 18.82-39.75), the American Spinal Injury Association light touch score (mean difference = 9.84, 95% confidence interval: 6.15-13.53), and the American Spinal Injury Association pinprick score (mean difference = 8.75, 95% confidence interval: 4.40-13.11). Furthermore, hyperbaric oxygen therapy was associated with significant enhancements in the Barthel Index (mean difference = 16.60, 95% confidence interval: 10.51-22.68) and the Functional Independence Measure (mean difference = 17.41, 95% confidence interval: 10.83-23.98). In conclusion, adjunctive hyperbaric oxygen therapy appears to improve motor function, sensory function, and activities of daily living in patients with traumatic incomplete spinal cord injury compared to conventional treatments alone. However, due to methodological limitations and potential publication bias in the included studies, these findings should be interpreted with caution, and further high-quality, multi-center randomized controlled trials are warranted.

Humans↗
PubMed1996

Multidisciplinary management controversies in laryngeal cancer.

While the primary goal of laryngeal cancer management is to save life, the preservation of structure and function also holds a very prominent position in the decision making for this disease. Although the therapeutic options to achieve these goals exist for most patients presenting with laryngeal carcinoma, they are not applied to a significant number of patients. In this paper we will summarise some of the disagreements which exist about optimal management and demonstrate that the opinions of experts trained to treat this disease have been shaped by non-evidence based approaches. In large part the specialty of practice and the geographic location of specialists have the greatest influence on the type of treatment recommended to an individual patient with a given stage of disease; medical knowledge, or more correctly the lack of it when comparing treatment options, seems to have a lesser influence on the decision process. We will consider the principal opportunities available to attempt to resolve controversies in laryngeal cancer. The discussion will include attention to randomised clinical trials, patient preferences, economic issues, and techniques to avoid the problems of selection bias when comparing outcomes for different treatments.

Carcinoma↗
PubMedDate not supplied

[Factual medicine].

It is well known that a number of medical interventions are still based on personal practitioner impression, non-systematic clinical experience or pathophysiologic rationale rather than solid scientific evidence, even when available. Evidence based medicine consists in systematically finding, appraising and using validated research results as a basis for clinical decision making. Access to evidence is essentially provided by randomized clinical trials. One can hope that medical practice supported by the best available evidence about diagnosis, prognosis and therapy will lead to some improvement in patient care. Nevertheless, the field of grey zones is still so large in clinical practice (where incertainty is mainly the rule) that evidence based medicine remains for the moment a positive mental attitude more than a pragmatic and generalizable approach.

Controlled Clinical Trials as Topic↗
PubMed1996

On the value of clinical information. Is there a bridge between quantum theory and medical diagnosis?

This paper discusses the problems in assigning a precise value to an item (or group of items) of clinical information. Historical viewpoints are reviewed; the paper illustrates how determinist descriptive thinking has been overtaken by concepts of uncertainty and probability. Four equations are proposed outlining the factors which affect the value of clinical information. The validation of these equations and their implications is discussed. Parallels are drawn between the situation in theoretical physics a century ago and medical diagnostics today; and the central theme of uncertainty in both is emphasised. Finally, the need for further radical thinking is stressed.

Clinical Medicine↗
PubMed1996

The use of dental radiographs to estimate the probability of cavitation of carious interproximal lesions. Part I: Evidence from the literature.

It is generally recommended that a cavitated, carious lesion be present before an interproximal tooth surface is restored. These lesions often are not clinically visible, however, and must be diagnosed using dental radiographs. Radiographic results can underestimate and overestimate the size of a carious lesion. The purpose of this study was to review and graphically summarize studies that have investigated the relationship between the radiographic image and the presence of a cavitated lesion on the interproximal surfaces of permanent teeth. A search of the literature identified 13 studies, eight of which were suitable for inclusion in our summary. Using the positive and negative likelihood ratios from each study, a graphical summary was developed showing the probability of cavitation based on the radiographic test result and the dentist's pre-radiograph estimate of the probability of cavitation. This graph should allow dentists to more accurately inform their patients of the probability of a cavitated interproximal lesion being present or absent. As a further observation, our findings suggest that to avoid frequent false positive diagnoses, dentists should estimate the probability of cavitation to be at least 30 per cent before they prescribe radiographs for patients who visit them on a regular basis.

Bibliographies as Topic↗