BACKGROUND Hypertension or high blood pressure is considered as a significant contributor and risk factor to many serious conditions,approximately 1.13 billion people have hypertension globally.However,the integrated ...BACKGROUND Hypertension or high blood pressure is considered as a significant contributor and risk factor to many serious conditions,approximately 1.13 billion people have hypertension globally.However,the integrated technologies can upscale health provisions and improve the effectiveness of the healthcare system.WHO has recommended that the digital health interventions(DHIs)and the Health System Challenges should be used in tandem in addressing health.AIM To summarise the outcomes from a range of research which investigated the use of DHI to improve the medication-related quality of care(MRQOC)for hypertensive patients.METHODS An integrative literature review was undertaken in October 2019 using the Medline,Cumulative Index of Nursing and Allied Health Literature,and Scopus databases for publications in English with no date limit.RESULTS In total,18433 participants were included in this review from 28 studies meeting the eligibility criteria.There were 19 DHI identified within eight countries:Australia,Canada,India,South Korea,Lebanon,Pakistan,the United Kingdom,and the United States of America.The DHI were provided as community-based,clinical-based and home-based program through mobile phone,mobile health system,short message service,and telehealth,digital medicine,and online healthcare(web-based).The mean age of participants was 59 ranging from 42 to 81 years with an average mean systolic blood pressure of 143.3 mmHg at baseline,ranging from 129.0 mmHg to 159.0 mmHg.The proportion of male participants ranged from 13.9%to 92.0%.Eighteen interventions showed evidence of reduction in blood pressure and improvement of self-management in relation to medication adherence and blood pressure control.The reduction of systolic blood pressure ranged between 1.9 mmHg and 26.0 mmHg,with a mean of 10.8 mmHg.The digital health was found positively associated with the MRQOC for hypertensive patients such as improvement in medication adherence and medication management;better blood pressure control;maintaining followups appointment and self-management;increasing access to healthcare particularly among patients living in rural area;and reducing adverse events.However,some interventions found no significant effect on hypertensive care.The follow up duration varied between 2 mo and 18 mo with an average attrition rate of 10.1%,ranging from 0.0%to 17.4%.CONCLUSION Utilising digital health innovation for hypertensive care in different settings with tailored interventions positively impacted on MRQOC leading to an improvement of patient outcomes and their quality of life.Nevertheless,inconclusive findings were found in some interventions,and inconsistent outcomes between DHI were noted.A future research and evidence-based DHI for hypertension or chronic diseases should be developed through the evidenceto-decision framework and guidelines.展开更多
Medication-related osteonecrosis of the jaw(MRONJ)is primarily associated with administering antiresorptive or antiangiogenic drugs.Despite significant research on MRONJ,its pathogenesis and effective treatments are s...Medication-related osteonecrosis of the jaw(MRONJ)is primarily associated with administering antiresorptive or antiangiogenic drugs.Despite significant research on MRONJ,its pathogenesis and effective treatments are still not fully understood.Animal models can be used to simulate the pathophysiological features of MRONJ,serving as standardized in vivo experimental platforms to explore the pathogenesis and therapies of MRONJ.Rodent models exhibit excellent effectiveness and high reproducibility in mimicking human MRONJ,but classical methods cannot achieve a complete replica of the pathogenesis of MRONJ.Modified rodent models have been reported with improvements for better mimicking of MRONJ onset in clinic.This review summarizes representative classical and modified rodent models of MRONJ created through various combinations of systemic drug induction and local stimulation and discusses their effectiveness and efficiency.Currently,there is a lack of a unified assessment system for MRONJ models,which hinders a standard definition of MRONJ-like lesions in rodents.Therefore,this review comprehensively summarizes assessment systems based on published peer-review articles,including new approaches in gross observation,histological assessments,radiographic assessments,and serological assessments.This review can serve as a reference for model establishment and evaluation in future preclinical studies on MRONJ.展开更多
Introduction:Medication-related osteonecrosis of the temporal bone is rare and has been reported to be associated with the use of anti-resorptive and biologic agents.Here,we present the first case of tyrosine-kinase i...Introduction:Medication-related osteonecrosis of the temporal bone is rare and has been reported to be associated with the use of anti-resorptive and biologic agents.Here,we present the first case of tyrosine-kinase inhibitor-related external auditory canal(EAC)osteonecrosis as well as two cases related to anti-resorptive therapies.Methods:A retrospective case series.Results:Case one:an 84-year-old female presented with chronic otitis externa and osteonecrosis of EACs bilaterally.She had a history of osteoporosis treated with denosumab and risedronic acid.She successfully underwent left EAC reconstruction using an inferiorly-based pedicle periosteal flap while the right ear canal was managed conservatively.Case two:a 69-year-old male presented with osteonecrosis of the right EAC.He had a history of osteoporosis treated with alendronic acid and zoledronic acid.His osteonecrosis is conservatively managed with local debridement and antibiotic application.Case three:a 60-year-old male presented with osteonecrosis of the right inferior EAC.He had a history of chronic myelogenous leukemia treated with a tyrosine-kinase inhibitor,imatinib.After failing conservative therapy,he underwent right ear canal reconstruction using a periosteal vascular pedicle flap without complication and experienced complete resolution to his symptoms.Conclusion:Anti-resorptive agents and/or tyrosine kinase inhibitors may lead to dysregulation of bone remodeling and result in rare cases of temporal bone osteonecrosis.When a local debridement and antibiotic therapy fail,definitive surgical excision of necrotic bone with subsequent reconstruction of the EAC may offer patients a possible resolution in symptoms.展开更多
文摘BACKGROUND Hypertension or high blood pressure is considered as a significant contributor and risk factor to many serious conditions,approximately 1.13 billion people have hypertension globally.However,the integrated technologies can upscale health provisions and improve the effectiveness of the healthcare system.WHO has recommended that the digital health interventions(DHIs)and the Health System Challenges should be used in tandem in addressing health.AIM To summarise the outcomes from a range of research which investigated the use of DHI to improve the medication-related quality of care(MRQOC)for hypertensive patients.METHODS An integrative literature review was undertaken in October 2019 using the Medline,Cumulative Index of Nursing and Allied Health Literature,and Scopus databases for publications in English with no date limit.RESULTS In total,18433 participants were included in this review from 28 studies meeting the eligibility criteria.There were 19 DHI identified within eight countries:Australia,Canada,India,South Korea,Lebanon,Pakistan,the United Kingdom,and the United States of America.The DHI were provided as community-based,clinical-based and home-based program through mobile phone,mobile health system,short message service,and telehealth,digital medicine,and online healthcare(web-based).The mean age of participants was 59 ranging from 42 to 81 years with an average mean systolic blood pressure of 143.3 mmHg at baseline,ranging from 129.0 mmHg to 159.0 mmHg.The proportion of male participants ranged from 13.9%to 92.0%.Eighteen interventions showed evidence of reduction in blood pressure and improvement of self-management in relation to medication adherence and blood pressure control.The reduction of systolic blood pressure ranged between 1.9 mmHg and 26.0 mmHg,with a mean of 10.8 mmHg.The digital health was found positively associated with the MRQOC for hypertensive patients such as improvement in medication adherence and medication management;better blood pressure control;maintaining followups appointment and self-management;increasing access to healthcare particularly among patients living in rural area;and reducing adverse events.However,some interventions found no significant effect on hypertensive care.The follow up duration varied between 2 mo and 18 mo with an average attrition rate of 10.1%,ranging from 0.0%to 17.4%.CONCLUSION Utilising digital health innovation for hypertensive care in different settings with tailored interventions positively impacted on MRQOC leading to an improvement of patient outcomes and their quality of life.Nevertheless,inconclusive findings were found in some interventions,and inconsistent outcomes between DHI were noted.A future research and evidence-based DHI for hypertension or chronic diseases should be developed through the evidenceto-decision framework and guidelines.
基金supported by the National Natural Science Foundation of China(No.81921002,No.81900970)Young Physician Innovation Team Project(No.QC202003)from Ninth People’s Hospital,Shanghai Jiao Tong University School of MedicineShanghai Sailing Program(19YF1426000)jointly。
文摘Medication-related osteonecrosis of the jaw(MRONJ)is primarily associated with administering antiresorptive or antiangiogenic drugs.Despite significant research on MRONJ,its pathogenesis and effective treatments are still not fully understood.Animal models can be used to simulate the pathophysiological features of MRONJ,serving as standardized in vivo experimental platforms to explore the pathogenesis and therapies of MRONJ.Rodent models exhibit excellent effectiveness and high reproducibility in mimicking human MRONJ,but classical methods cannot achieve a complete replica of the pathogenesis of MRONJ.Modified rodent models have been reported with improvements for better mimicking of MRONJ onset in clinic.This review summarizes representative classical and modified rodent models of MRONJ created through various combinations of systemic drug induction and local stimulation and discusses their effectiveness and efficiency.Currently,there is a lack of a unified assessment system for MRONJ models,which hinders a standard definition of MRONJ-like lesions in rodents.Therefore,this review comprehensively summarizes assessment systems based on published peer-review articles,including new approaches in gross observation,histological assessments,radiographic assessments,and serological assessments.This review can serve as a reference for model establishment and evaluation in future preclinical studies on MRONJ.
文摘Introduction:Medication-related osteonecrosis of the temporal bone is rare and has been reported to be associated with the use of anti-resorptive and biologic agents.Here,we present the first case of tyrosine-kinase inhibitor-related external auditory canal(EAC)osteonecrosis as well as two cases related to anti-resorptive therapies.Methods:A retrospective case series.Results:Case one:an 84-year-old female presented with chronic otitis externa and osteonecrosis of EACs bilaterally.She had a history of osteoporosis treated with denosumab and risedronic acid.She successfully underwent left EAC reconstruction using an inferiorly-based pedicle periosteal flap while the right ear canal was managed conservatively.Case two:a 69-year-old male presented with osteonecrosis of the right EAC.He had a history of osteoporosis treated with alendronic acid and zoledronic acid.His osteonecrosis is conservatively managed with local debridement and antibiotic application.Case three:a 60-year-old male presented with osteonecrosis of the right inferior EAC.He had a history of chronic myelogenous leukemia treated with a tyrosine-kinase inhibitor,imatinib.After failing conservative therapy,he underwent right ear canal reconstruction using a periosteal vascular pedicle flap without complication and experienced complete resolution to his symptoms.Conclusion:Anti-resorptive agents and/or tyrosine kinase inhibitors may lead to dysregulation of bone remodeling and result in rare cases of temporal bone osteonecrosis.When a local debridement and antibiotic therapy fail,definitive surgical excision of necrotic bone with subsequent reconstruction of the EAC may offer patients a possible resolution in symptoms.
