Effectiveness of psychosocial interventions for pediatric patients with scoliosis:a systematic review

Background Pediatric patients affected by scoliosis have complex psychological and social care needs,and may benefit from psychosocial interventions.We therefore aimed to summarize evidence of the efficacy of psychosocial interventions for this patient population.Methods Literature was identified by searching Medline,PsycINFO,Embase,EBSCO Cumulated Index to Nursing and Allied Health Literature(CINAHL),and Cochrane Central Register of Controlled Trials(CENTRAL)from database inception to 20 March 2022.Articles that evaluated the effectiveness of psychosocial interventions for pediatric patients diagnosed with scoliosis and reported at least one quantitative outcome were included.Article eligibility,data extraction,and quality assessment(using the Cochrane Collaboration's Risk of Bias Tool and Methodological Index for Non-Randomized Studies)were performed by two independent researchers.Findings are presented using narrative synthesis.Results We identified ten studies,all of which focused on adolescent idiopathic scoliosis.Studies included a total of 1007 participants,most of whom were female.Three studies focused on patients undergoing bracing,six on patients undergoing spinal surgery,and one on patients broadly.Brace compliance monitoring and counseling were found to significantly improve brace compliance quality and quantity.Proactive mental healthcare delivery by nurses after spinal surgery was similarly found to improve outcomes.Several studies examined the efficacy of brief educational interventions;most did not report clear evidence of their efficacy.The methodological quality of studies was often unclear due to limitations in articles'reporting quality.Conclusions Research on the efficacy of psychosocial interventions for pediatric patients with scoliosis is limited,with interventions involving frequent patient-provider interactions showing the most promise.Future clinical and research efforts should focus on developing and testing psychosocial interventions for this patient population,with emphasis on multidisciplinary teams delivering holistic care.

Characteristics and outcomes of hepatocellular carcinoma patients with macrovascular invasion following surgical resection: a meta-analysis of 40 studies and 8,218 patients

Background:Guidelines recommend that hepatocellular carcinoma(HCC)patients with portal vein tumor thrombosis(PVTT)and/or hepatic vein tumor thrombosis(HVTT)should undergo systemic therapy.However,recent data suggest that surgical resection may be beneficial in selected cases,but outcomes are heterogenous.We aimed to estimate pooled overall survival(OS),recurrence free survival(RFS)and complication rates in HCC patients with macrovascular invasion(MVI)following surgical resection.Methods:In this systematic review and meta-analysis,two investigators independently searched PubMed,Embase,and Cochrane databases from inception to Nov 10,2020,without language restrictions,for studies reporting outcomes of adult HCC patients with MVI who underwent liver resection with curative intent.Results:We screened 8,598 articles and included 40 studies involving 8,218 patients.Among all patients with MVI,the pooled median OS was 14.39 months[95%confidence interval(CI):10.99-18.84],1-year OS was 54.47%(95%CI:46.12-62.58%)and 3-year OS was 23.20%(95%CI:16.61-31.42%).Overall,1-and 3-year RFS were 27.70%(95%CI:21.00-35.57%)and 10.06%(95%CI:6.62-15.01%),respectively.Among patients with PVTT,median OS was 20.41 months in those with segmental/2nd order involvement compared to 12.91 months if 1st order branch was involved and 6.41 months if the main trunk was involved.The pooled rate of major complications was 6.17%(95%CI:3.53-10.56%).Conclusions:Overall median survival was 14.39 months for HCC patients with MVI following resection.Median survival was higher in PVTT with segmental/2nd order involvement at 20.41 versus 6.41 months if the main trunk was involved.