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Review Articles

Pharmacotherapies for muscle wasting in older ICU patients: A narrative review of the current literature

Dr. Finn Dolan Cogswell, MD BSc

ABSTRACT

Background: The predominantly geriatric syndrome of frailty can result from the gradual reduction of function in multiple physiologic systems that occurs with increasing age. Critical illness accelerates the age-related loss of muscle that often accompanies frailty, and the combination of these two conditions creates a distinctly morbid state of vulnerability. Muscle wasting while in the intensive care unit (ICU) results in greater patient morbidity, making the preservation of muscle mass an important therapeutic target. This article narratively reviews the drug therapies that have been trialed for mitigating muscle wasting in older critically ill patients.

Materials and Methods: MEDLINE, PubMed, Web of Science and EMBASE were searched. Inclusion criteria were drug trials with muscle-related outcome measures in critically ill populations aged 50 or older. Exclusion criteria were non-pharmacological interventions, a lack of muscle related outcomes, review articles, case studies, case series and non-English articles. 

Results: From 4586 identified articles, 27 articles were included in the final review. While burn populations benefitted from oxandrolone, the only pharmacotherapy that demonstrated an improvement of muscle outcomes in older general ICU patients was intensive insulin therapy. However, due to the risk of hypoglycaemia, the use of intensive insulin therapy remains largely unfavourable.

Discussion: The requirement for an effective drug therapy targeting the preservation of muscle mass in older ICU populations remains unfulfilled. Several novel drug therapies targeting myostatin and activin receptors have recently been studied in frail, non-critically ill populations. Future research should focus on studying novel pharmacotherapies in the frail and critically ill. 

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Review Articles

Effectiveness of baclofen for the treatment of alcohol use disorder in patients with alcoholic liver disease: a narrative literature review

Available online: 24th February 2023

Luisa Wigg

James Cook University

Background: Alcohol use disorder (AUD) is linked to alcoholic liver disease (ALD), which contributes greatly to the global burden of disease. Baclofen has been studied in patients with these concurrent disorders. However, due to limited research, baclofen is only used off-label.

Aim: To determine the effectiveness of baclofen for the treatment of AUD and ALD.

Methods: MEDLINE, Scopus and The Cochrane Library were searched using the terms [((“alcohol use disorder” OR “alcohol dependence”) AND (“alcoholic liver disease” OR “cirrhosis”)) AND (“baclofen”)]. Additional papers were retrieved from the reference lists of relevant studies.

Results: We identified seventy-one studies and retrieved two from reference searching. Ten studies meeting inclusion and exclusion criteria were retained for review, four of which were randomised controlled trials (RCTs). Retrospective and prospective cohort studies were also included, along with one Markov model. The literature defined baclofen’s effectiveness in terms of abstinence, alcohol consumption, hospitalisations, cost-effectiveness, mortality rates, and side effects. While controlled evidence is limited, baclofen was found to promote abstinence, whilst also reducing drinking levels, long-term mortality, and days spent in hospital. Additionally, the drug had a favourable cost-effectiveness profile. However, acute confusion and overdoses have been reported, particularly with high dosages.

Conclusion: Our findings support the efficacy and use of baclofen to treat AUD and ALD. The risk of serious adverse events remains a concern, requiring vigilant prescribing and reporting from healthcare professionals. RCTs and studies with larger sample sizes are required to support these initial findings and confirm the viability of baclofen.

Keywords: Alcohol use disorder; alcoholic liver disease; baclofen; effectiveness; abstinence

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Uncategorized Review Articles

COVID-19: Adaptations to Primary Care in Australia

Abstract

Introduction

The Australian Government has implemented its National Primary Care Response action plan to combat the growing threat of the COVID-19 pandemic across the country. The plan recognises the integral role of primary care services in protecting the most vulnerable citizens of our nation and recommends a number of interventions aimed at reducing transmission, including expanding telehealth services, physical distancing measures, and the use of personal protective equipment. The efficacy of these suggested measures needs to be evaluated to ensure everything is being done to maximise the safety of Australia’s primary care system while maintaining the highest level of care possible.

Summary

This review article delves into the benefits and limitations of the interventions suggested in the National Primary Care Response action plan and formulates recommendations on each intervention based on the currently available literature. Based on the literature findings, recommendations have been made to implement telehealth, physical distancing, and face masks in primary care settings across Australia to curb the transmission of COVID-19 across the country.

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Review Articles

Simulation training in laparoscopic surgery

This article summarises the role of simulation-based training in laparoscopic surgery, exploring elements for curriculum development, implementation, and current practice.

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Review Articles

Do medical students practice what they preach? A review of their dietary patterns over the last decade.

Abstract

Background

While many studies have been performed to evaluate different indicators of psychological distress among medical students, the amount of published data evaluating their dietary habits is limited. Therefore, the purpose of this scoping review was to provide an overview of medical students’ dietary behavior. This is the first review paper to summarise the information available about dietary practices among medical students.

Materials and Methods

A scoping review was performed in 2018 using the PRISMA-ScR framework and the MEDLINE database was searched by combining the terms ‘eat’, ‘diet’, ‘meals’, ‘nutrition’ with the word ‘medical student’ by using the ‘AND’ function. Some additional papers were also selected from the citations of relevant publications. Data was independently extracted by two authors using pretested forms.

Results

A total of 739 articles were found by using the search terms. Thirty-three articles fulfilled the eligibility criteria and four further articles were found from the citations of relevant publications. Medical students showed an increasing tendency to exhibit conventionally unhealthy eating patterns, both as a whole and within different dietary categories. In particular, decreased fruit and vegetable intake, overindulgence of fast food, and a tendency to skip meals. Gender discrepancies were also noted in some categories.

Conclusion

Medical students, while for the most part displaying a full understanding of the nutritional science behind dietary recommendations, did not always meet the advised levels for most of the categories explored. Lapses in personal dietary choices may affect patient counselling, in addition to the many direct consequences of improper nutrition on the health and wellbeing of the student themselves.

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Uncategorized Review Articles

Musculoskeletal Disorders in Surgeons

Background

Musculoskeletal disorders (MSDs) are an occupational hazard amongst surgeons, causing detrimental effects in up to 20% of surgeons in their lifetime. However, there is a paucity of data examining solutions for the problem. There is also a lack of research comparing MSDs in surgeons who perform open surgery compared with those who perform newer methods of surgery such as laparoscopic and robotic surgery.

Aims

We aim to explore existing literature about the various risk factors and the consequences of MSDs. We believe that by raising awareness of such risk factors to medical students from early on in their medical careers, they can develop an appreciation of the potential long-term impacts and take an early approach to prevention. We discuss preventative strategies in the categories of individual, occupational, institutional, and intra-operative techniques.

Materials and Methods

Ovid Medline, Cochrane Library, and PubMed databases were used to identify articles. Studies reporting on work-related MSDs in surgeons were included. Articles relevant to medical fields with a high level of surgical involvement, such as gynaecology, were also included. This information was used to construct a narrative review of the literature (see Appendix 1 for full methodology). Within each database search, only a few articles relevant to this review were generated. Therefore, the citations were also screened to find additional articles that fit within the scope of this review.

Results

Multiple factors were found to contribute to the development of MSDs, including individual and occupational factors. MSDs have resulted in a high percentage of surgeons performing fewer surgeries or taking more time off work. Similar risk factors applied to laparoscopic and robotic surgery. Few studies examined strategies to combat MSDs, but techniques such as intraoperative exercise and ergonomic training have shown to be promising.

Conclusion

There is a need for ongoing research into strategies to prevent MSDs in surgeons. Currently there are no evidence-based guidelines for management of work-related MSDs. Medical students should be aware that this occupational hazard has deleterious effects on the body and should be encouraged to employ some of the currently available strategies to prevent MSDs. The authors of this review advocate for ergonomics education to be integrated into surgical training programs via collaboration between ergonomists and surgical program directors.

Main Learning Points

  1. MSDs in surgeons are under-researched but are still an important occupational hazard that can be potentially debilitating.
  2. There are no guidelines to manage MSDs – current best strategies involve having a well-balanced lifestyle, seeking help early, and being ergonomically aware of mechanisms of injury.
  3. Greater awareness of ergonomics among surgeons could possibly reduce the incidence of MSDs among high risk groups.

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Categories
Review Articles

Experimental pharmacotherapy approaches to prevention of alcohol dependency

Review of the experimental pharmacotherapy approaches available to reduce craving for alcohol, alcohol consumption, and/or relapse drinking as it pertains to alcohol dependency. 

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Review Articles

Intravenous Magnesium Therapy Treatment of Severe Asthma in Adults

This article systematically analyses the evidence behind the use of intravenous magnesium sulphate in adults with severe acute exacerbations of asthma.

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Review Articles

Efficacy and Safety of Allergen Immunotherapy to Treat House Dust Mite Allergic Asthma in Children

Allergic asthma is a significant disease of childhood, of which, house dust mite is the most common trigger. There have been many investigations into the role of allergen immunotherapy in preventing the development of allergic asthma, and potentially its treatment following formal diagnosis, as evidenced by studies demonstrating significant improvements in medication use, asthma symptoms, and respiratory function. However, there is a paucity of research into specific populations – significantly, paediatric populations. This article reviews the recent literature regarding the efficacy and safety of allergen immunotherapy in the treatment of house dust mite-allergic asthma, with a focus on paediatric populations.

This review suggests that immunotherapy effectively improves asthma symptoms and severity in paediatric populations. While adverse reactions may occur, serious or life-threatening reactions are rare. More research is required to investigate immunotherapy in populations who are polysensitised or who have severe or uncontrolled asthma – preliminary evidence suggests immunotherapy may have a role in the treatment of these patients.

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Review Articles

Paediatric simulation teaching for medical students: a review of current literature

The objective of this review article is to determine whether simulation-based education could enhance the teaching of paediatrics to Australian medical students.
A literature search of PubMed and Embase was performed and from 595 identified articles, 34 papers were included in this review. There are several benefits of simulation teaching in paediatrics, including skill acquisition, improvement, maintenance, enhanced confidence, better understanding of human factors, improved teamwork skills and an opportunity to debrief as well as the potential for downstream improvements in patient outcomes. However, several challenges of simulation teaching for paediatrics were acknowledged, such as resource availability. Approaches to overcoming these challenges were proposed by the use of low-fidelity manikins, alternatives to standardised patients, the judicious use of simulation education, optimisation of student preparation for simulation sessions, the use of registrars as simulation facilitators and the utilisation of remote facilitation. With further research regarding the impact of simulation teaching on real-life clinical performance as well as methods to optimise its delivery, efficiency and cost-effectiveness, paediatric simulation teaching has considerable potential to enhance education for medical students in Australia.

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