Medicinal Plant Extracts and Natural Compounds for the Treatment of Cutaneous Lupus Erythematosus: A Systematic Review

Cutaneous lupus erythematosus (CLE) is a group of autoimmune connective tissue disorders that significantly impact quality of life. Current treatment approaches typically use antimalarial medications, though patients may become recalcitrant. Other treatment options include general immunosuppressants, highlighting the need for more and more targeted treatment options. The purpose of this systematic review was to identify potential compounds that could be repurposed for CLE from natural products since many rheumatologic drugs are derived from natural products, including antimalarials. This study was registered with PROSPERO, the international prospective register of systematic reviews (registration number CRD42021251048). We comprehensively searched Ovid Medline, Cochrane Library, and Scopus databases from inception to April 27th, 2021. These terms included cutaneous lupus erythematosus; general plant, fungus, bacteria terminology; selected plants and plant-derived products; selected antimalarials; and JAK inhibitors. Our search yielded 13,970 studies, of which 1,362 were duplicates. We screened 12,608 abstracts, found 12,043 to be irrelevant, and assessed 565 full-text studies for eligibility. Of these, 506 were excluded, and 59 studies were included in the data extraction. The ROBINS-I risk of bias assessment tool was used to assess studies that met our inclusion criteria. According to our findings, several natural compounds do reduce inflammation in lupus and other autoimmune skin diseases in studies using in vitro methods, mouse models, and clinical observational studies, along with a few randomized clinical trials. Our study has cataloged evidence in support of potential natural compounds and plant extracts that could serve as novel sources of active ingredients for the treatment of CLE. It is imperative that further studies in mice and humans are conducted to validate these findings

Clinicopathologic features of endometrial cancer with mismatch repair deficiency

The inclusion of DNA mismatch repair (MMR) evaluation as a standard of care for endometrial cancer management will result in a growing population of patients with MMR deficiency and negative germline Lynch syndrome testing (MMR-deficient). In this systematic review and study, the clinicopathologic features of endometrial cancer in patients with MMR-intact, MLH1 methylation positive, MMR-deficient or Lynch syndrome are evaluated. A systematic search of online databases between 1990 and 2018 identified studies of endometrial cancer patients with tumour testing (MMR protein immunohistochemistry or microsatellite instability) and germline assessment for Lynch syndrome. Extracted data included tumour testing, germline genetic testing, age, body mass index (BMI), family history, tumour stage, grade and histologic type. Associations between MMR-intact, MLH1 methylation positive, MMR-deficient and Lynch syndrome groups were analysed using descriptive statistics. The comprehensive search produced 4,400 publications, 29 met inclusion criteria. A total of 7,057 endometrial cancer cases were identified, 1,612 with abnormal immunohistochemistry, 977 with microsatellite instability. Nine-hundred patients underwent germline genetic testing, identifying 212 patients with Lynch syndrome. Patients in the Lynch syndrome and MMR-deficient groups were significantly younger than patients in the MMR-intact and MLH1 methylation positive groups. Patients with MMR-intact tumours had the highest BMI, followed by MMR-deficient, then Lynch syndrome. MMR-intact tumours were more likely to be grade I at diagnosis than other groups. Patients with Lynch syndrome and MMR-deficient tumours were less likely to have stage I disease as compared to patients with MMR-intact tumours. Endometrial cancer patients with MMR-deficient tumours have similar features to those with germline Lynch syndrome mutations, including age, grade, histology and stage. Even in the absence of a germline mutation, tumour evaluation for MMR status may have important clinical implications

Systematic review of prospective studies focused on regionalization of care in surgical oncology

To perform a systematic review of studies prospectively analyzing the impact of regionalization of complex surgical oncology care on patient outcomes. High volume care of complex surgical oncology patients has been repeatedly associated with improved outcomes. Most studies, however, are retrospective and have not prospectively accounted for confounders such as financial ability and social support. Four electronic databases (Ovid MEDLINE(R), Ovid EMBASE, Cochrane Library (Wiley), and EBSCHOHost) were searched from inception until August 25, 2018. Two authors independently reviewed 5887 references, with a third independent reviewer acting as arbitrator when needed. Data extracted from 11 articles that met inclusion criteria. Risk of bias assessments conducted using MINORS criteria for the non-randomized, observational studies, and the Cochrane tool for the randomized-controlled trial. Of the 11 studies selected, we found 7 historically-controlled trials, two retrospective cohort studies with prospective data collection, one prospective study, and one randomized-controlled trial. 73% of studies were from Northern Europe, 18% from Ontario, Canada, and 9% from England. Pancreatic surgery accounted for 36% of studies, followed by gynecologic oncology (27%), thoracic surgery (18%), and dermatologic surgery (9%). The studies reported varying outcome parameters, but all showed improvement post-regionalization. Included studies featured poor-to-fair risk of bias. 11 studies indicated improved outcomes following regionalization of surgical oncology, but most exhibit poor methodological rigor. Prospective evidence for the regionalization of surgical oncology is lacking. More research addressing patient access to care and specialist availability is needed to understand the shortcomings of centralization

Clinical Support During COVID-19

Background: The Lamar Soutter Library serves UMass Memorial Healthcare and the University of Massachusetts Medical School, which consists of the Schools of Nursing, Medicine, and Biomedical Sciences. In pursuit of our mission to help our community during the COVID-19 pandemic, we were called upon to provide clinical support in new ways as we also adapted to the “new normal” of working from home, social distancing, and remote interactions. Description: The Education and Clinical Services department (ECS) typically supports the clinical system by attending clinical rounds, staffing multiple library locations, providing education around information resources, and supporting literature searches. During COVID-19, many of our usual methods of support were not possible because we could not be there in person, and because educational pursuits were repurposed to answer the call for staffing and training during the pandemic. The need for immediate information and the desire to help meant demands for evidence-based information increased. To answer the call, ECS librarians had to learn new skills, come up with creative approaches, and stay up to date with an ever-changing information landscape. Conclusion: The COVID-19 pandemic was a force for change in the relationship between ECS and the clinical environment we support. Although it is wrong to say there is a silver lining to this tragedy, we have become more creative, more adaptive, and more flexible. We better understand the needs of our clinical community and are more proactive and confident in our approach to working with them. It was evident that our impact was felt by the response to our offers for new resident orientations. There was an almost 200% increase in the number of sessions (7 to 20) during March to September 2020 as compared to the same period in 2019. The skills we learned and the relationships we formed have changed the way we will approach clinical support going forward

Involvement of Information Professionals in Patient- and Family-Centered Care Initiatives: a Systematic Review

Poster presentation at the Medical Library Association Annual Meeting; 2019 May 3-8, Chicago, IL

Fertility preservation in reproductive-aged female patients with colorectal cancer: A scoping review

The objective of this scoping review is to describe and identify gaps in the existing literature on fertility preservation counseling received by young female patients with colorectal cancer

How Long Should We Keep Data? An Evidence-Based Recommendation for Data Retention Using Institutional Meta-Analyses

Objectives: The National Institutes of Health (NIH) is committed to ensuring results and data are made available to the public for research they fund, in whole or in part. Therefore, institutions and researchers must maintain accessible, sharable data for published studies. Using published meta-analyses (MAs) we sought to establish an evidence-based recommendation on how long data should be kept and shared. Methods: Using Web of Science (Core Collection – Clarivate Analytics) we identified all MAs with an affiliation of Weill Cornell Medicine (WCM) published through November 2019. The following search was used and identified 211 WCM affiliated meta-analyses: OO=(weill) AND TI=("meta-analysis") AND DT=(Article OR Review). The full text of each MA was reviewed. We then looked at all studies that met inclusion criteria for each MA and documented the publication date of the oldest included paper. For all 211 included MAs in this study, journal category (disciple) and impact factor was identified per Thomson Reuter's Journal Citation reports via Web of Science. All data and trends were analyzed using Power BI (Microsoft). Results: The average age of included studies is 17 years. The oldest data set utilized in a MA was 51 years old at the time of publishing, and the youngest was 2. WCM meta-analyses ranged in discipline, covering 37 out of 76 Web of Science medical-related journal categories. There appeared to be no strong association between data age and impact factor, but there is a possible correlation with data age and year of MA publication suggesting that newer publications include older studies relative to themselves. Conclusions: Based on our findings we recommend data be stored for sharing for a minimum of 17 years. This study lays groundwork for larger future studies