Low-value clinical practices in adult traumatic brain injury : an umbrella review

Despite numerous interventions and treatment options, the outcomes of traumatic brain injury (TBI) have improved little over the last 3 decades, which raises concern about the value of care in this patient population. We aimed to synthesize the evidence on 14 potentially low-value clinical practices in TBI care. Using umbrella review methodology, we identified systematic reviews evaluating the effectiveness of 14 potentially low-value practices in adults with acute TBI. We present data on methodological quality (Assessing the Methodological Quality of Systematic Reviews), reported effect sizes, and credibility of evidence (I to IV). The only clinical practice with evidence of benefit was therapeutic hypothermia (credibility of evidence II to IV). However, the most recent meta-analysis on hypothermia based on high-quality trials suggested harm (credibility of evidence IV). Meta-analyses on platelet transfusion for patients on antiplatelet therapy were all consistent with harm but were statistically non-significant. For the following practices, effect estimates were consistently close to the null: computed tomography (CT) in adults with mild TBI who are low-risk on a validated clinical decision rule; repeat CT in adults with mild TBI on anticoagulant therapy with no clinical deterioration; antibiotic prophylaxis for external ventricular drain placement; and decompressive craniectomy for refractory intracranial hypertension. We identified five clinical practices with evidence of lack of benefit or harm. However, evidence could not be considered to be strong for any clinical practice as effect measures were imprecise and heterogeneous, systematic reviews were often of low quality, and most included studies had a high risk of bias

Ansellone A, a seterterpenoid isolated from the nudibranch Cadlina luetomarginata and the sponge Phorbas sp. Activates the cAMP signalling pathway

Ansellone A (1) has been isolated from the dorid nudibranch Cadlina luteomarginata and the sponge Phorbas sp. It has the new “ansellane” sesterterpenoid carbon skeleton, and it activates the cAMP signaling pathway

Drinking Motives and Drinking Consequences across Days: Differences and Similarities between Moderate, Binge, and High‐Intensity Drinking

BackgroundThe current study examined the extent to which within- person variation in drinking motives differentiates moderate, binge, and high- intensity drinking; and independent associations of motives and drinking intensity with alcohol use consequences in a sample of young adult drinkers from across the United States.MethodsParticipants were past 30- day drinkers in the U.S. nationally representative Monitoring the Future 12th grade sample in 2018, who also reported alcohol use during a 14- day data collection burst 1 year later (N = 484 people, mean age 19.3 [SD 0.40], 43% female; N = 1042 drinking days) as part of the Young Adult Daily Life Study in 2019. Weighted multilevel modeling estimated within- and between- person associations of drinking motives, drinking intensity (i.e., moderate [women 1- 3, men 1- 4 drinks], binge [women 4- 7, men 5- 9 drinks], and high- intensity drinking [women 8+, men 10+ drinks]), and number of positive and negative alcohol consequences.ResultsOn days participants reported greater enhancement and social motives, they were more likely to engage in high- intensity (vs. binge) drinking and binge (vs. moderate) drinking and experience more positive alcohol consequences. On days participants reported greater enhancement and coping motives, they experienced more negative alcohol consequences. Binge (vs. moderate) drinking on a given day was associated with more positive and negative alcohol consequences; high- intensity (vs. binge) drinking on a given day was associated with more negative alcohol consequences that day. Moderation analyses indicated that social motives were associated with high- intensity (vs. binge) drinking only among college students.ConclusionsStronger drinking motives on a given day were associated with drinking intensity (enhancement and social motives) and negative consequences (enhancement and coping). High- intensity (vs. binge or moderate) drinking was associated with more negative consequences but not more positive consequences. These results underscore that high- intensity drinking and consequences vary across days and time- varying, occasion- specific risks such as current motivational context are appropriate targets for intervention.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167795/1/acer14591_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167795/2/acer14591.pd