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Kuriakose Kuzhiyanjal, Anish J; Limdi, Jimmy K
doi: 10.1093/bmb/ldae006pmid: 38823040
BackgroundAcute severe ulcerative colitis (ASUC) is a potentially life-threatening medical emergency that occurs in up to 25% of patients with ulcerative colitis. Although intravenous corticosteroids remain the cornerstone of therapy, 30–40% of patients will not respond and need timely consideration of rescue therapy with (currently) either infliximab or ciclosporin or indeed colectomy, underscoring the importance of multidisciplinary care to ensure favourable outcomes for patients. We discuss the current evidence and present an approach to the management of ASUC for general and specialist clinicians caring for patients with ASUC.Sources of dataThe information in this review is derived from data published in peer- reviewed academic journals and registered clinical trials.Areas of agreementManagement of acute severe colitis requires a multidisciplinary approach with early initiation with steroids and timely escalation of treatment to either medical rescue therapy or surgery.Areas of controversyBalancing the risks of delayed surgery vs. optimizing medical therapy, including accelerated dosing schedules for biologics, remains ambiguous.Growing pointsThe position on newer molecules like Janus Kinase inhibitors, such as tofacitinib, is a growing area with early real-world data showing promise for steroid refractory ASUC.Areas timely for developing researchDeveloping predictive biomarkers and clinical risk scores for personalized rescue therapy selection is an evolving area of research.
Dempsey, Brendan; Madan, Ira; Stevelink, Sharon A M; Lamb, Danielle
doi: 10.1093/bmb/ldae008pmid: 39183058
IntroductionLong COVID (LC) occurs when people experience symptoms for weeks, months or even years after a COVID-19 infection. This review looks at research exploring the LC definitions, prevalence, symptoms, risk factors, and associated impacts in research on healthcare workers (HCWs).Data sourcesWe systematically searched five electronic databases (CINAHL, EMBASE, Medline, PsycInfo and PubMed) and compiled a narrative literature review based on 56 relevant studies.Areas of agreementLC is prevalent among HCWs who become infected by COVID-19. Many of the most frequent symptoms associated with LC in the general population are also reported among HCWs. Some risk factors for LC are also similar to those in the general population, such as female sex, older age, and having a pre-existing respiratory illness.Areas of controversyThe mechanism(s) responsible for LC remains unknown. A variety of terms, timeframes and symptoms are used to define LC, creating difficulties in comparing results across studies. Much of the research is cross-sectional and fails to explore the impacts that prolonged symptoms have on HCWs’ personal and professional lives.Growing pointsThe need to support HCWs with LC is clear. Identifying the mechanism(s) responsible for LC is a key priority, as this will inform treatments.Areas for developing researchFuture research should move towards a standard definition for LC. Greater attention should be paid to longitudinal and qualitative studies, which could give insights into prognosis, lived experience and work participation. Finally, studies evaluating treatments suitable for people with LC are timely.
Blake, Holly; Chaplin, Wendy J; Gupta, Alisha
doi: 10.1093/bmb/ldae007pmid: 38972661
IntroductionChronic pain affects over a quarter of the workforce with high economic burden for individuals, employers and healthcare services. Access to work-related advice for people with chronic pain is variable. This systematic review aims to explore the effectiveness of workplace-delivered digital interventions for the self-management of chronic pain.Source of dataMEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library, JBI, Open Science Framework, Epistemonikos and Google Scholar. Articles published between January 2001 and December 2023 were included. Searches were conducted between October 2023 and December 2023.Areas of agreementWorkplace-delivered digital interventions to support self-management of chronic pain at work may improve pain and health-related quality of life in vocationally active adults. Delivering interventions outside of clinical services, through the workplace setting, may help to reduce inequity in access to work-related advice for people with chronic pain, and ultimately reduce the burden on individuals, employers and healthcare services. Interventions include mobile apps and web-based programmes.Areas of controversyStudies were moderate-to-low quality. Most studies focused on exercise, few considered other aspects of pain self-management. Given the limited evidence in the current literature, consensus on best intervention format and delivery is lacking.Growing pointsMore high-quality studies are needed given the heterogeneity in study design, interventions and outcome measures.Areas timely for developing researchNo interventions included advice on work-related adjustments or support. Few studies included work-related outcomes, despite the known impact of pain on work and work on health.
Migliorini, Filippo; Cocconi, Federico; Schäfer, Luise; Simeone, Francesco; Jeyaraman, Madhan; Maffulli, Nicola
doi: 10.1093/bmb/ldae009pmid: 39222962
IntroductionSpinal cord injury (SCI) may bring lifelong consequences for affected patients and a high financial burden to the health care system.Source of dataPublished peer-reviewed scientific articles identified from EMBASE, Google Scholar, PubMed and Scopus.Areas of agreementSurgery and blood pressure management are the main targets in acute SCI to avoid secondary damage.Areas of controversyThe management of secondary chronic SCI is challenging, with unpredictable outcomes.Growing pointsGiven the lack of consensus on pharmacological therapy for acute and secondary chronic SCI, the present study analyses the currently available drugs and treatment options to manage secondary chronic SCI.Areas timely for developing researchDifferent approaches exist for the pharmacological management of secondary chronic SCI. One of the most investigated drugs, 4-aminopyridine, improves central motor conduction and shows improvement in neurological signs. Positive results in different areas have been observed in patients receiving the anti-spastic drugs tizanidine and baclofen or Granulocyte colony-stimulating factor. Growth hormone showed only minimal or no significant effects, and the therapy of secondary chronic SCI with riluzole has been poorly researched to date.
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