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BackgroundSystematic reviews (SRs) are considered the highest level of evidence to answer research questions; however, they are time and resource intensive. ObjectiveWhen comparing SR tasks done manually, using standard methods, versus those same SR tasks done using automated tools, (1) what is the difference in time to complete the SR task and (2) what is the impact on the error rate of the SR task? MethodsA case study compared specific tasks done during the conduct of an SR on prebiotic, probiotic, and synbiotic supplementation in chronic kidney disease. Two participants (manual team) conducted the SR using current methods, comprising a total of 16 tasks. Another two participants (automation team) conducted the tasks where a systematic review automation (SRA) tool was available, comprising of a total of six tasks. The time taken and error rate of the six tasks that were completed by both teams were compared. ResultsThe approximate time for the manual team to produce a draft of the background, methods, and results sections of the SR was 126 hours. For the six tasks in which times were compared, the manual team spent 2493 minutes (42 hours) on the tasks, compared to 708 minutes (12 hours) spent by the automation team. The manual team had a higher error rate in two of the six tasks—regarding Task 5: Run the systematic search, the manual team made eight errors versus three errors made by the automation team; regarding Task 12: Assess the risk of bias, 25 assessments differed from a reference standard for the manual team compared to 20 differences for the automation team. The manual team had a lower error rate in one of the six tasks—regarding Task 6: Deduplicate search results, the manual team removed one unique study and missed zero duplicates versus the automation team who removed two unique studies and missed seven duplicates. Error rates were similar for the two remaining compared tasks—regarding Task 7: Screen the titles and abstracts and Task 9: Screen the full text, zero relevant studies were excluded by both teams. One task could not be compared between groups—Task 8: Find the full text. ConclusionsFor the majority of SR tasks where an SRA tool was used, the time required to complete that task was reduced for novice researchers while methodological quality was maintained.

BACKGROUND: Antimicrobial resistance (AMR) is undermining modern medicine, a problem compounded by bacterial adaptation to antibiotic pressures. Phages are viruses that infect bacteria. Their diversity and evolvability offer the prospect of their use as a therapeutic solution. Reported are outcomes of customized phage therapy for patients with difficult-to-treat antimicrobial resistant infections. METHODS: We retrospectively assessed 12 cases of customized phage therapy from a phage production center. Phages were screened, purified, sequenced, characterized, and Food and Drug Administration-approved via the IND (investigational new drug) compassionate-care route. Outcomes were assessed as favorable or unfavorable by microbiologic and clinical standards. Infections were device-related or systemic. Other experiences such as time to treatment, antibiotic synergy, and immune responses were recorded. RESULTS: Fifty requests for phage therapy were received. Customized phages were generated for 12 patients. After treatment, 42% (5/12) of cases showed bacterial eradication and 58% (7/12) showed clinical improvement, with two-thirds of all cases (66%) showing favorable responses. No major adverse reactions were observed. Antibiotic-phage synergy in vitro was observed in most cases. Immunological neutralization of phages was reported in 5 cases. Several cases were complicated by secondary infections. Complete characterization of the phages (morphology, genomics, and activity) and their production (methods, sterility, and endotoxin tests) are reported. CONCLUSIONS: Customized phage production and therapy was safe and yielded favorable clinical or microbiological outcomes in two-thirds of cases. A center or pipeline dedicated to tailoring the phages against a patients specific AMR bacterial infection may be a viable option where standard treatment has failed.

Objective To identify and summarize the evidence about the extent of overuse of medications in low- and middle- income countries, its drivers, consequences and potential solutions. Methods We conducted a scoping review by searching the databases PubMed[R], Embase[R], APA PsycINFO[R] and Global Index Medicus using a combination of MeSH terms and free text words around overuse of medications and overtreatment. We included studies in any language published before 25 October 2021 that reported on the extent of overuse, its drivers, consequences and solutions. Findings We screened 3489 unique records and included 367 studies reporting on over 5.1 million prescriptions across 80 low- and middle-income countries--with studies from 58.6% (17/29) of all low-, 62.0% (31/50) of all lower-middle- and 60.0% (33/55) of all upper-middle-income countries. Of the included studies, 307 (83.7%) reported on the extent of overuse of medications, with estimates ranging from 7.3% to 98.2% (interquartile range: 30.2-64.5). Commonly overused classes included antimicrobials, psychotropic drugs, proton pump inhibitors and antihypertensive drugs. Drivers included limited knowledge of harms of overuse, polypharmacy, poor regulation and financial influences. Consequences were patient harm and cost. Only 11.4% (42/367) of studies evaluated solutions, which included regulatory reforms, educational, deprescribing and audit-feedback initiatives. Conclusion Growing evidence suggests overuse of medications is widespread within low- and middle-income countries, across multiple drug classes, with few data of solutions from randomized trials. Opportunities exist to build collaborations to rigorously develop and evaluate potential solutions to reduce overuse of medications. Objectif Identifier et resumer les donnees demontrant l'ampleur de la surconsommation de medicaments dans les pays a revenu faible et intermediaire, mais aussi les causes de cette surconsommation, ses consequences et les pistes de solution. Methodes Nous avons mene une analyse exploratoire en effectuant une recherche dans les bases de donnees PubMed[R], Embase[R], APA PsycINFO[R] et l'Index Medicus mondial a l'aide d'une combinaison de termes MeSH et de mots en texte libre lies a la surconsommation de medicaments et aux surtraitements. Nous avons inclus des etudes redigees dans toutes les langues et publiees avant le 25 octobre 2021, qui mentionnaient l'ampleur de la surconsommation, ses causes, ses consequences et les pistes de solution. Resultats Nous avons passe en revue 3489 documents uniques et conserve 367 etudes faisant etat de plus de 5,1 millions d'ordonnances dans 80 pays a revenu faible et intermediaire--ces etudes concernaient 58,6% (17/29) des pays a revenu faible, 62,0 % (31/50) de ceux a revenu intermediaire de la tranche inferieure et 60,0% (33/55) de ceux a revenu intermediaire de la tranche superieure. Sur l'ensemble des etudes reprises, 307 (83,7%) signalaient l'ampleur de la surconsommation de medicaments, avec des estimations comprises entre 7,3% et 98,2% (ecart interquartile: 30,2-64,5). Cette surconsommation s'observait principalement dans des categories telles que les antimicrobiens, les substances psychotropes, les inhibiteurs de la pompe a protons et les antihypertenseurs. Plusieurs causes etaient evoquees: meconnaissance des degats lies a une surconsommation, polypharmacie, mauvaise reglementation et influences economiques. Les consequences etaient surtout nefastes pour la sante des patients et les couts engendres. A peine 11,4% (42/367) des etudes examinaient des solutions, parmi lesquelles des reformes reglementaires, ainsi que des initiatives de sensibilisation, de deprescription et d'audit-feedback. Conclusion Un faisceau croissant de preuves indique que la surconsommation de medicaments est largement repandue dans les pays a revenu faible et intermediaire, dans de nombreuses categories de substances, et peu d'informations circulent quant aux solutions issues des essais randomises. Il existe neanmoins des opportunites de collaboration qui permettraient de developper et d'evaluer rigoureusement des pistes de solution pour lutter contre la surconsommation de medicaments. Objetivo Identificar y resumir la evidencia sobre el grado del uso excesivo de medicamentos en los paises de ingresos bajos y medios, sus causas, consecuencias y posibles soluciones. Metodos Se realizo una revision exploratoria mediante busquedas en las bases de datos PubMed[R], Embase[R], APA PsycINFO[R] y Global Index Medicus a partir de una combinacion de terminos MeSH y palabras de texto libre sobre el uso excesivo de medicamentos y el sobretratamiento. Se incluyeron estudios en cualquier idioma publicados antes del 25 de octubre de 2021 y que informaran sobre el grado del uso excesivo, sus causas, consecuencias y soluciones. Resultados Se examinaron 3489 registros unicos y se incluyeron 367 estudios que informaron sobre mas de 5,1 millones de recetas en 80 paises de ingresos bajos y medios, con estudios del 58,6 % (17/29) de todos los paises de ingresos bajos, el 62,0 % (31/50) de todos los paises de ingresos medios bajos y el 60,0 % (33/55) de los paises de ingresos medios altos. De los estudios incluidos, 307 (83,7 %) informaron sobre el grado de uso excesivo de medicamentos, con estimaciones que oscilaban entre el 7,3 % y el 98,2 % (rango intercuartil: 30,2-64,5). Las clases mas usadas en exceso incluian los antimicrobianos, los psicofarmacos, los inhibidores de la bomba de protones y los antihipertensores. Los factores causantes incluyeron el conocimiento limitado de los danos del uso excesivo, la polifarmacia, la falta de regulacion y las influencias financieras. Las consecuencias incluian el dano a los pacientes y el coste. Solo el 11,4 % (42/367) de los estudios evaluaron las soluciones, entre las que se encontraban las reformas normativas, las iniciativas de educacion, de desprescripcion y de retroalimentacion de auditorias. Conclusion Cada vez hay mas evidencias de que el uso excesivo de medicamentos esta muy extendido en los paises de ingresos bajos y medios, en multiples clases de medicamentos, y se dispone de datos insuficientes sobre soluciones procedentes de ensayos aleatorizados. Hay oportunidades de crear colaboraciones para desarrollar y evaluar con rigor posibles soluciones para reducir el uso excesivo de los medicamentos., Introduction Overuse in health care is broadly defined as tests or treatments that are inappropriate, unnecessary or of low value and are likely to cause people more harm than benefit. [...]

We rationally designed a bacteriophage cocktail to treat a 56-year-old male liver transplant patient with complex, recurrent prostate and urinary tract infections caused by an extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) (UCS1). We screened our library for phages that killed UCS1, with four promising candidates chosen for their virulence, mucolytic properties, and ability to reduce bacterial resistance. The patient received 2 weeks of intravenous phage cocktail with concomitant ertapenem for 6 weeks. Weekly serum and urine samples were collected to track the patient's response. The patient tolerated the phage therapy without any adverse events with symptom resolution. The neutralization of the phage activity occurred with sera collected 1 to 4 weeks after the first phage treatment. This was consistent with immunoassays that detected the upregulation of immune stimulatory analytes. The patient developed asymptomatic recurrent bacteriuria 6 and 11 weeks following the end of phage therapy-a condition that did not require antibiotic treatment. The bacteriuria was caused by a sister strain of E. coli (UCS1.1) that remained susceptible to the original phage cocktail and possessed putative mutations in the proteins involved in adhesion and invasion compared to UCS1. This study highlights the utility of rationally designed phage cocktails with antibiotics at controlling E. coli infection and suggests that microbial succession, without complete eradication, may produce desirable clinical outcomes.

The eighth meeting of the International Collaboration for the Automation of Systematic Reviews (ICASR) was held on September 7 and 8, 2023, at the University College London, London, England. ICASR is an interdisciplinary group whose goal is to maximize the use of technology for conducting rapid, accurate, and efficient evidence synthesis, e.g., systematic reviews, evidence maps, and scoping reviews of scientific evidence. In 2023, the major themes discussed were understanding the benefits and harms of automation tools that have become available in recent years, the advantages and disadvantages of large language models in evidence synthesis, and approaches to ensuring the validity of tools for the proposed task. [ABSTRACT FROM AUTHOR]

PURPOSE Lower urinary tract symptoms are very common in older men. We conducted a systematic review and meta-analysis to evaluate the effects of self-management interventions on these symptoms. METHODS We included randomized controlled trials comparing the effect of self-management interventions (alone or combined with drug therapy) with usual care or drug therapy alone in men with lower urinary tract symptoms. Two independent reviewers screened retrieved articles, extracted data, and assessed the risk of bias of included studies. The primary outcome was lower urinary tract symptom severity. Where data were available, we calculated mean differences (MDs) between the interventions. RESULTS Analyses were based on 8 studies among 1,006 adult men. Seven of these studies were judged to be at high risk in 2 of the 7 domains of bias. The nature of the self-management interventions varied across studies. There was a clinically important reduction in the 35-point International Prostate Symptom Score at 6 months favoring self-management interventions compared with usual care (MD = -7.4; 95% CI, -8.8 to -6.1; 2 studies). The reduction in score with self-management was similar to that achieved with drug therapy at 6 to 12 weeks (MD = 0.0; 95% CI, -2.0 to 2.0; 3 studies). Self-management had a smaller, additional benefit at 6 weeks when added to drug therapy (MD = -2.3; 95% CI, -4.1 to -0.5; 1 study). CONCLUSIONS We found moderate-quality evidence (suggesting reasonable certainty in estimates) for the effectiveness of self-management for treating lower urinary tract symptoms in men. We therefore recommend the use of self-management interventions for this patient population. Key words: self-management; lower urinary tract symptoms; urinary incontinence; nocturia; overactive bladder; benign prostatic hyperplasia; non-pharmacological intervention, INTRODUCTION Lower urinary tract symptoms are a common problem among older men, (1) affecting 70% to 90% of those aged 80 years and older. (2,3) These symptoms can be divided [...]

PURPOSE Antibiotic use in acne treatment raises concerns about increased resistance, necessitating alternatives. We assessed the effectiveness of blue-light therapy for acne. METHODS We analyzed randomized controlled trials comparing blue light with nonlight interventions. Studies included people of any age, sex, and acne severity, in any setting, and reported on investigator-assessed change in acne severity, patients' assessment of improvement, change in inflammatory or noninflammatory lesions, and adverse events. Where data were sufficient, mean differences were calculated. RESULTS Eighteen references (14 trials) including 698 participants were included. Most of the trials were small and short ( CONCLUSION Methodological and reporting limitations of existing evidence limit conclusions about the effectiveness of blue light for acne. Clinicians and patients should therefore consider the balance between its benefits and adverse events, as well as costs. Key words: acne vulgaris; humans; light; phototherapy, INTRODUCTION Approximately 50 million Americans have acne vulgaris (1); it is the eighth most prevalent disease globally (2) and one of the most common reasons for clinical consultations, (3) including [...]