Shivani M. Reddy

Objectives: Chondral defects of the knee can impair function, reduce quality of life and accelerate progression to osteoarthritis. Treatment aims to delay further cartilage damage and reduce the risk of early-onset osteoarthritis and knee replacement. This systematic review evaluated the effectiveness and safety of chondral defect repair procedures on the knee. Design: Systematic review. Data sources: PubMed and Cochrane Library. Eligibility criteria for selecting studies: Interventions were matrix-induced autologous chondrocyte implantation (MACI), osteochondral autologous transplantation (OATS) and cell-free implants. Comparators included microfracture (MF). Eligible study designs were randomised controlled trials (RCTs) and comparative non-randomised studies of interventions (NRSIs). Eligible outcomes included patient-reported outcomes (PROs), clinical response, treatment failure, reoperation and harms. Risk-of-bias assessments (RoB) on all included studies were assessed using the Cochrane Risk of Bias (RoB 2) for the RCTs and Risk Of Bias In Nonrandomized Studies of Interventions tool for the NRSIs. Results: 13 studies reported effectiveness and 8 studies reported harms. MACI was more effective than MF, measured by PROs and response to treatment ( moderate certainty of evidence (COE) from RCTs, very low to low COE from NRSIs). Evidence comparing OATS with MF suggested no difference in effectiveness, as measured by PROs ( low COE from RCTs and very low COE from NRSIs). MACI and OATS had similar harms to MF (COE low and very low ). Evidence for cell-free implants suggested greater effectiveness ( moderate COE) and fewer harms ( low COE) compared with MF. No studies compared these procedures to sham surgery or conservative management. Conclusion: MACI and OATS showed greater or comparable effectiveness compared with MF. Harms were comparable between procedures, though reporting was sparse. Rigorous study design, standardised effectiveness outcomes and consistent reporting of harms would strengthen the evidence base. These findings can inform clinical decision-making and identify future research needs.

The evidence base addressing transcranial magnetic stimulation (TMS) for behavioral health conditions other than treatment-resistant depression is not well

Background: There is a lack of consensus on the effectiveness of audio-based care to manage chronic conditions. This knowledge gap has implications for health policy decisions and for health equity, as underserved populations are more likely to access care by telephone. Objectives: We compared the effectiveness of audio-based care to usual care for managing chronic conditions (except diabetes). Design: We used systematic review methods to synthesize available evidence. Studies: We searched for English-language articles reporting on randomized controlled trials (RCTs) of adults diagnosed with a chronic condition published since 2012. Outcomes: We abstracted data on clinical outcomes, patient-reported health and quality of life, health care access and utilization, care quality and experience, and patient safety. Results: We included 40 RCTs evaluating audio-based care for a variety of chronic conditions, including cancer, heart failure, neurological disease, respiratory disease, musculoskeletal conditions, kidney disease, and others. There was significant heterogeneity across conditions and interventions. We generally found low to very low certainty of evidence of comparable effectiveness in the use of audio-based care to replace other care. Audio care as a supplement exhibited greater effectiveness in some outcomes, with generally low to very low certainty of evidence for most outcomes but moderate certainty for 2 groups of study outcomes. Conclusions: More research is needed to identify the conditions, populations, and intervention design combinations that improve outcomes and to determine when audio-based care can effectively replace other synchronous care.

Objectives: We compared the effectiveness of audio-based care, as a replacement or a supplement to usual care, for managing diabetes. Background: Diabetes is a chronic condition afflicting many in the United States. The impact of audio-based care on the health of individuals with diabetes is unclear, particularly for those at risk for disparities—many of whom may only be able to access telehealth services through telephone. Methods: We used systematic review methods to synthesize available evidence. We systematically searched for English-language articles from 2012 reporting randomized controlled trials of adults diagnosed with diabetes. We abstracted data on clinical outcomes (including A1c), patient-reported health and quality-of-life, health care access and utilization, care quality and experience, and patient safety. Results: Evidence for replacing in-person care with audio care was limited (n = 2), with low certainty of evidence for greater and comparable effectiveness for A1c and harms, respectively. Supplemental audio care (n = 23) had a positive effect on A1c (pooled mean difference A1c −0.20%; n = 8763; 95% CI: −0.36% to −0.04%), with moderate certainty of evidence. Stratified results indicated that audio interventions supplementing usual care performed more favorably in individuals with A1c ≤ 9%; populations not at risk of disparities; interventions with at least monthly contact; and interventions using remote monitoring tools. Conclusions: This evidence base reveals some promise for managing diabetes with audio-based care as a supplement to in-person care. Future studies could further investigate the effectiveness of audio-based care as a replacement and modify interventions to better serve individuals with poor glucose control and those at risk for disparities.

Objective Approximately one-third of women in the U.S. experience an adverse pregnancy outcome (APO), which are recognized as sex-specific cardiovascular disease (CVD) risk factors. We examine if APOs confer additional CVD risk beyond that of traditional CVD risk factors. Methods Women, age 40–79, with a pregnancy history and no pre-existing CVD were identified in the electronic health record of one health system (n = 2306). APOs included any APO, hypertensive disease of pregnancy (HDP), and gestational diabetes (GDM). Hazard ratios of time to CVD event were estimated from survival models using Cox proportional hazard regression. Discrimination, calibration, and net reclassification of re-estimated CVD risk prediction models including APOs were examined. Results There was no significant association between any APO, HDP, or GDM and time to CVD outcome in survival models (95% confidence intervals all include 1). Including any APO, HDP, GDM in the CVD risk prediction model did not significantly improve discrimination and there were no clinically relevant changes in net reclassification of cases and non-cases. The strongest predictor of time to CVD event in the survival models was Black race, with hazard ratios ranging from 1.59 to 1.62, statistically significant for all three models. Conclusion Women with APOs did not have an additional risk of CVD, controlling for traditional risk factors in the PCE and this sex-specific factor did not improve risk prediction. Black race was consistently a strong predictor of CVD even with data limitations. Further study of APOs can help determine how to best use this information for CVD prevention in women.

We compared the effectiveness of audio care, as a replacement or a supplement to usual care, for managing diabetes.

We compared the effectiveness of audio care, as a replacement or a supplement to usual care, for managing diabetes.