Cerebral Bypass Surgery: Level of Evidence and Grade of Recommendation

To perform a systematic review of the literature on the control of oral biofilms and the incidence of nosocomial pneumonia, in addition to assessing and classifying studies as to the grade of recommendation and level of evidence. The review was based on PubMed, LILACS, and Scopus databases, from January 1st, 2000 until December 31st, 2012. Studies evaluating oral hygiene care related to nosocomial infections in patients hospitalized in intensive care units were selected according to the inclusion criteria. Full published articles available in English, Spanish, or Portuguese, which approached chemical or mechanical oral hygiene techniques in preventing pneumonia, interventions performed, and their results were included. After analysis, the articles were classified according to level of evidence and grade of recommendation according to the criteria of the Oxford Centre for Evidence-Based Medicine. A total of 297 abstracts were found, 14 of which were full articles that met our criteria. Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia. All articles were classified as B in the level of evidence, and 12 articles were classified as 2B and two articles as 2C in grade of recommendation. It was observed that the control of oral biofilm reduces the incidence of nosocomial pneumonia, but the fact that most articles had an intermediate grade of recommendation makes clear the need to conduct randomized controlled trials with minimal bias to establish future guidelines for oral hygiene in intensive care units.

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Consensus-based recommendations for the use of biosimilars to treat rheumatological diseases

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-211937 ◽

2017 ◽

Vol 77 (2) ◽

pp. 165-174 ◽

Cited By ~ 91

Author(s):

Jonathan Kay ◽

Monika M Schoels ◽

Thomas Dörner ◽

Paul Emery ◽

Tore K Kvien ◽

...

Keyword(s):

English Language ◽

Task Force ◽

Level Of Evidence ◽

Conference Abstract ◽

Consensus Recommendations ◽

American College Of Rheumatology ◽

Published Evidence ◽

Grade Of Recommendation ◽

Scientific Meetings ◽

Rheumatological Diseases

The study aimed to develop evidence-based recommendations regarding the evaluation and use of biosimilars to treat rheumatological diseases. The task force comprised an expert group of specialists in rheumatology, dermatology and gastroenterology, and pharmacologists, patients and a regulator from ten countries. Four key topics regarding biosimilars were identified through a process of discussion and consensus. Using a Delphi process, specific questions were then formulated to guide a systematic literature review. Relevant English-language publications through November 2016 were searched systematically for each topic using Medline; selected papers and pertinent reviews were examined for additional relevant references; and abstracts presented at the 2015 and 2016 American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) annual scientific meetings were searched for those about biosimilars. The experts used evidence obtained from these studies to develop a set of overarching principles and consensus recommendations. The level of evidence and grade of recommendation were determined for each. By the search strategy, 490 references were identified. Of these, 29 full-text papers were included in the systematic review. Additionally, 20 abstracts were retrieved from the ACR and EULAR conference abstract databases. Five overarching principles and eight consensus recommendations were generated, encompassing considerations regarding clinical trials, immunogenicity, extrapolation of indications, switching between bio-originators and biosimilars and among biosimilars, and cost. The level of evidence and grade of recommendation for each varied according to available published evidence. Five overarching principles and eight consensus recommendations regarding the evaluation and use of biosimilars to treat rheumatological diseases were developed using research-based evidence and expert opinion.

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Processed Electroencephalogram-Based Monitoring to Guide Sedation in Critically Ill Patients: A Systematic Review and International Expert Panel-Based Consensus Recommendations

10.21203/rs.3.rs-1014725/v1 ◽

2021 ◽

Author(s):

Frank A Rasulo ◽

Philip Hopkins ◽

Francisco Almeida Lobo ◽

Pierre Pandin ◽

Basil Matta ◽

...

Keyword(s):

Systematic Review ◽

Critically Ill ◽

Critically Ill Patients ◽

Level Of Evidence ◽

Assessment Development ◽

Modified Delphi ◽

Delphi Round ◽

Processed Eeg ◽

Grade Of Recommendation ◽

Excessive Sedation

Abstract BackgroundThe literature related to the use of processed EEG (pEEG) for depth of sedation (DOS) monitoring is increasing, however it is unclear how to use this type of monitoring for critical care patients within the intensive care unit (ICU).MethodsWe performed a systematic review of the literature according to the Grade of Recommendation assessment, Development, and Evaluation (GRADE) approach. The modified Delphi method was utilised by a team of experts to produce statements and recommendations derived from study questions. Three separate online rounds discussing 89 statements categorized into four domains were formulated. The panelists rated the appropriateness of each statement and were able to suggest modifications or addition of statements. An analysis of anonymised ratings of the statements by part of the panel followed each Delphi round and previously validated criteria were used to define appropriateness and consensus.ResultsLevel of evidence regarding the four domains was very low. Fourteen panelists participated in the Delphi rounds and consensus was reached for 28 out of 89 statements, from which the reccomendations were created. The main findings were that DOS monitoring should be performed in critically ill patients whenever clinical evaluation is not possible, it should be performed by continuous pEEG techniques and the resulting data depicted with graphical tools to facilitate detection of excessive sedation, a potential cause of burst-suppression, and finally, structured training is suggested to achieve a basic pEEG competency.ConclusionsAlthough evidence on using DOS monitors in ICU is scarce and further research is required in order to better define the benefits of using pEEG, the results of this consensus highlight the general agreement that critically-ill patients would benefit from this type of neuromonitoring.

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Cerebral bypass surgery for skull base lesions: technical notes incorporating lessons learned over two decades

Neurosurgical FOCUS ◽

10.3171/foc/2008/24/2/e11 ◽

2008 ◽

Vol 24 (2) ◽

pp. E11 ◽

Cited By ~ 14

Author(s):

Ketan R. Bulsara ◽

Toral Patel ◽

Takanori Fukushima

Keyword(s):

Skull Base ◽

Bypass Surgery ◽

Case Series ◽

Senior Author ◽

Lessons Learned ◽

Morbidity Rate ◽

Skull Base Lesions ◽

Cavernous Carotid Artery ◽

Skull Base Meningiomas ◽

Cerebral Bypass

Object Despite advancements in endovascular neurosurgery, there remains an important role for cerebral bypass surgery in the treatment of skull base lesions. The authors describe their replacement cerebral bypass surgery techniques incorporating lessons learned over 2 decades. Methods The authors performed a retrospective review of cerebral bypass surgery performed by the senior author for skull base lesions between 1986 and 2006. One hundred patients had adjunct bypass surgery for skull base lesions. Results The bypass surgeries performed are conceptually divided into Skull Base Bypass I, II, and III. The majority of lesions requiring bypass surgery were giant cavernous carotid artery aneurysms or skull base meningiomas. There were no deaths in this case series. There was a 7% morbidity rate. Conclusions The ability to perform this surgery is an important adjunct in the armamentarium of skull base/cerebrovascular neurosurgeons.

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What Is the Role of Cerebral Bypass Surgery Today?

World Neurosurgery ◽

10.1016/j.wneu.2015.01.025 ◽

2015 ◽

Vol 83 (6) ◽

pp. 1048-1049 ◽

Cited By ~ 1

Author(s):

Mohamed Samy Elhammady ◽

Sudheer Ambekar ◽

Roberto C. Heros

Keyword(s):

Bypass Surgery ◽

Cerebral Bypass

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LEVEL OF EVIDENCE IN THE PLACEMENT OF TRANSPEDICULAR SCREWS IN SUBAXIAL CERVICAL SPINE

Coluna/Columna ◽

10.1590/s1808-185120161502155441 ◽

2016 ◽

Vol 15 (2) ◽

pp. 145-150 ◽

Cited By ~ 2

Author(s):

Cristóbal Herrera Palacios ◽

Armando Fabio Ramos Guerrero ◽

Gustavo Casas Martínez ◽

Alfredo Javier Moheno Gallardo ◽

Silvestre Fuentes Figueroa

Keyword(s):

Cervical Spine ◽

Health Care Professionals ◽

Pedicle Screws ◽

High Energy ◽

Cervical Region ◽

Level Of Evidence ◽

Safety And Efficacy ◽

Subaxial Cervical Spine ◽

Freehand Technique ◽

Grade Of Recommendation

ABSTRACT The high-energy trauma mainly involves vertebral lesions and 6% occur in the cervical region. This poses a challenge to spine surgeons in surgical decision-making, both in terms of approach as the instrumentation. International recommendations establish that the procedures performed are reproducible, safe, and effective. The techniques for placement of pedicle screws are complicated and have been based on intraoperative navigation (limited by cost) and fluoroscopy (greater exposure of health care professionals and patients to radiation). Therefore, the freehand technique is an option. The goal was to identify the level of evidence and grade of recommendation in the medical literature regarding the safety and efficacy of pedicle screw instrumentation with freehand technique in subaxial cervical spine. To this end, we carried out a systematic review with the following MeSH terms: safety, efficacy, vertebral artery. Articles were evaluated twice in a standardized and blind way by two observers skilled in systematic analysis, after CLEIS 3401 authorization in November 2014. Due to the nature of the study and the variables, articles with a high level of evidence and grade of recommendation were not found. Level of Evidence obtained on safety and efficacy in the placement of pedicle screws in subaxial column with freehand technique: 2b. Degree of Recommendation obtained on safety and efficacy in the placement of pedicle screws in subaxial column with freehand technique: B, favorable recommendation.

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The evolution of cerebral revascularization surgery

Neurosurgical FOCUS ◽

10.3171/2009.3.focus0931 ◽

2009 ◽

Vol 26 (5) ◽

pp. E17 ◽

Cited By ~ 10

Author(s):

Melanie G. Hayden ◽

Marco Lee ◽

Raphael Guzman ◽

Gary K. Steinberg

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

20Th Century ◽

Nobel Prize ◽

Bypass Surgery ◽

Cerebral Revascularization ◽

Cerebral Bypass ◽

Revascularization Surgery ◽

French Surgeon

Among the relatively few surgeons to be awarded the Nobel Prize was Alexis Carrel, a French surgeon and pioneer in revascularization surgery at the turn of the 20th century. The authors trace the humble beginnings of cerebral revascularization surgery through to the major developments that helped shape the modern practice of cerebral bypass surgery. They discuss the cornerstone studies in the development of this technique, including the Extracranial/Intracranial Bypass Study initiated in 1977. Recent innovations, including modern techniques to monitor cerebral blood flow, microanastomosis techniques, and ongoing trials that play an important role in the evolution of this field are also evaluated.

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