Immobilization Regime Following Lateral Patellar Dislocation: A Systematic Review and Meta-Analysis of the Current Evidence Base

2010 ◽  
Vol 36 (4) ◽  
pp. 353-360 ◽  
Author(s):  
Toby O. Smith ◽  
Leigh Davies ◽  
Simon T. Donell
Keyword(s):  
Systematic Review ◽  
Patellar Dislocation ◽  
Meta Analysis ◽  
Evidence Base ◽  
Current Evidence ◽  
Lateral Patellar Dislocation ◽  
Current Evidence Base

scholarly journals Effectiveness of universal programmes for the prevention of suicidal ideation, behaviour and mental ill health in medical students: a systematic review and meta-analysis

2019 ◽  
Vol 22 (2) ◽  
pp. 84-90 ◽  
Author(s):  
Katrina Witt ◽  
Alexandra Boland ◽  
Michelle Lamblin ◽  
Patrick D McGorry ◽  
Benjamin Veness ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medical Students ◽  
Suicidal Ideation ◽  
Meta Analysis ◽  
Evidence Base ◽  
Current Evidence ◽  
Study Selection ◽  
Medical Education And Training ◽  
Current Evidence Base ◽  
Anxiety Depression

QuestionA growing body of work suggests that medical students may be particularly at risk of mental ill health, suicidal ideation and behaviour, resulting in recent calls to develop interventions to prevent these outcomes. However, few reviews have synthesised the current evidence base regarding the effectiveness of these interventions and provided guidance to improve future intervention efforts.Study selection and analysisThe authors conducted a systematic review to identify studies of any design reporting the effectiveness of any universal intervention to address these outcomes in medical students. Embase, MEDLINE and PsycINFO databases were searched from their respective start dates until 1 December 2017.FindingsData from 39 studies were included. Most investigated the effectiveness of relatively brief interventions designed to reduce stress; most commonly using mindfulness-based or guided meditation approaches. Only one implemented an intervention specifically designed to address suicidal ideation; none investigated the effectiveness of an intervention specifically designed to address suicidal behaviour. Five investigated the effects of curriculum-level changes. Overall, there was limited evidence of an effect for these programmes at both the postintervention and longest follow-up assessment on depression, anxiety and stress.ConclusionsRelatively brief, individually focused, mindfulness-based interventions may be effective in reducing levels of anxiety, depression and stress in medical students in the short term. Effects on suicidal ideation and behaviour, however, remain to be determined. There has been a significant lack of attention on organisational-level stressors associated with medical education and training.

Exercise therapy for whiplash-associated disorders: a systematic review and meta-analysis

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Bruno Chrcanovic ◽  
Johan Larsson ◽  
Eva-Maj Malmström ◽  
Hans Westergren ◽  
Birgitta Häggman-Henrikson
Keyword(s):  
Systematic Review ◽  
Neck Pain ◽  
Exercise Therapy ◽  
Full Text ◽  
Meta Analysis ◽  
Current Evidence ◽  
Positive Effects ◽  
Current Evidence Base ◽  
Whiplash Associated Disorders ◽  
Neck Disability

Abstract Objectives Acute as well as chronic pain syndromes are common after whiplash trauma and exercise therapy is proposed as one possible intervention strategy. The aim of the present systematic review was to evaluate the effect of exercise therapy in patients with Whiplash-Associated Disorders for the improvement of neck pain and neck disability, compared with other therapeutic interventions, placebo interventions, no treatment, or waiting list. Content The review was registered in Prospero (CRD42017060356) and conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search in PubMed, Scopus and Cochrane from inception until January 13, 2020 was combined with a hand search to identify eligible randomized controlled studies. Abstract screening, full text assessment and risk of bias assessment (Cochrane RoB 2.0) were conducted by two independent reviewers. Summary The search identified 4,103 articles. After removal of duplicates, screening of 2,921 abstracts and full text assessment of 100 articles, 27 articles that reported data for 2,127 patients were included. The included articles evaluated the effect of exercise therapy on neck pain, neck disability or other outcome measures and indicated some positive effects from exercise, but many studies lacked control groups not receiving active treatment. Studies on exercise that could be included in the random-effect meta-analysis showed significant short-term effects on neck pain and medium-term effects on neck disability. Outlook Despite a large number of articles published in the area of exercise therapy and Whiplash-Associated Disorders, the current evidence base is weak. The results from the present review with meta-analysis suggests that exercise therapy may provide additional effect for improvement of neck pain and disability in patients with Whiplash-Associated Disorders.

scholarly journals Investigation of antihypertensive class, dementia, and cognitive decline

Neurology ◽  
2019 ◽  
Vol 94 (3) ◽  
pp. e267-e281 ◽  
Author(s):  
Ruth Peters ◽  
Sevil Yasar ◽  
Craig S. Anderson ◽  
Shea Andrews ◽  
Riitta Antikainen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cognitive Decline ◽  
Meta Analysis ◽  
Evidence Base ◽  
Reliable Change Index ◽  
Current Evidence ◽  
Index Method ◽  
Current Evidence Base ◽  
Registration Number ◽  
Prospective Longitudinal

ObjectiveHigh blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimizing cognition. Our objective was to determine whether any particular antihypertensive class was associated with a reduced risk of cognitive decline or dementia using comprehensive meta-analysis including reanalysis of original participant data.MethodsTo identify suitable studies, MEDLINE, Embase, and PsycINFO and preexisting study consortia were searched from inception to December 2017. Authors of prospective longitudinal human studies or trials of antihypertensives were contacted for data sharing and collaboration. Outcome measures were incident dementia or incident cognitive decline (classified using the reliable change index method). Data were separated into mid and late-life (>65 years) and each antihypertensive class was compared to no treatment and to treatment with other antihypertensives. Meta-analysis was used to synthesize data.ResultsOver 50,000 participants from 27 studies were included. Among those aged >65 years, with the exception of diuretics, we found no relationship by class with incident cognitive decline or dementia. Diuretic use was suggestive of benefit in some analyses but results were not consistent across follow-up time, comparator group, and outcome. Limited data precluded meaningful analyses in those ≤65 years of age.ConclusionOur findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals.Clinical trials registrationThe review was registered with the international prospective register of systematic reviews (PROSPERO), registration number CRD42016045454.

Active warming after caesarean section to prevent neonatal hypothermia: a systematic review

2020 ◽  
Vol 28 (12) ◽  
pp. 829-837
Author(s):  
Aliona Vilinsky-Redmond ◽  
Maria Brenner ◽  
Linda Nugent ◽  
Margaret McCann
Keyword(s):  
Systematic Review ◽  
Caesarean Section ◽  
Elective Caesarean Section ◽  
Evidence Base ◽  
Current Evidence ◽  
Skin Contact ◽  
Current Evidence Base ◽  
Randomised Controlled ◽  
Skin To Skin ◽  
Neonatal Hypothermia

There is a lack of evidence on the effects of perioperative warming on maternal and neonatal outcomes in women undergoing elective caesarean section who are performing at-birth skin-to-skin contact. This study aimed to provide a systematic review of the current evidence base on the effects of perioperative warming versus no warming. Inclusion criteria included randomised controlled trials involving pregnant women ≥18 years old undergoing an elective caesarean section at term under regional anaesthesia and who initiated at-birth neonatal skin-to-skin contact. Studies investigated active warming versus no active warming interventions. Three studies were included, with a total of 286 participants. Active warming of women resulted in significantly less occurrence of neonatal hypothermia, with no difference in maternal hypothermia. Perioperative active warming of mothers and newborns who had skin-to-skin contact may be beneficial. The quality of the included studies was low, so the review findings should be interpreted with caution. High quality studies with larger sample sizes need to be undertaken.

scholarly journals Physical Activity in Rheumatoid Arthritis: A Systematic Review

2012 ◽  
Vol 9 (7) ◽  
pp. 1036-1048 ◽  
Author(s):  
Marie Tierney ◽  
Alexander Fraser ◽  
Norelee Kennedy
Keyword(s):  
Rheumatoid Arthritis ◽  
Physical Activity ◽  
Systematic Review ◽  
Population Group ◽  
Evidence Base ◽  
Current Evidence ◽  
Activity Levels ◽  
Current Evidence Base ◽  
Physical Activity Levels ◽  
Methodological Considerations

Background:Physical activity is associated with improved health outcomes in many populations. It is assumed that physical activity levels in the rheumatoid arthritis (RA) population may be reduced as a result of symptoms of the disease. The objective of this review is to establish the current evidence base for levels of physical activity in the RA population.Methods:A systematic review was performed of 7 databases (Ema-base, MEDLINE, AMED, Biomedical Reference Collection Expanded, CINAHL, Nursing and Allied Health Collection, and SportsDiscus) up to February 2011 to examine the evidence in the area.Results:One hundred and thirty-six studies were identified through electronic searching. One hundred and six were excluded based on title and/or abstract analysis and a further 14 were excluded based on full text analysis. Sixteen studies meeting the criteria were deemed suitable for inclusion. The results of the included studies indicate that the level of physical activity may be lower among individuals with RA when compared with healthy controls or normative data.Conclusions:There are a number of methodological considerations at play within the studies reviewed which prohibits definitive conclusion on the physical activity levels of this population group. Given the known health benefits of physical activity, further research in this area appears indicated.

Abstract 4450: Does the Evidence Support Guideline Recommendations for Clopidogrel Pretreatment?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Shervin Eshaghian ◽  
Stanley Chou ◽  
Jayanta Das ◽  
George A Diamond ◽  
Prediman K Shah ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Time Course ◽  
Meta Analysis ◽  
Bleeding Risk ◽  
Evidence Base ◽  
Current Evidence ◽  
Optimal Timing ◽  
Significant Heterogeneity ◽  
Current Evidence Base ◽  
The Impact

Although few concrete data exist about the optimal timing and dose of clopidogrel pretreatment, the ACC/AHA & ESC guidelines endorse pretreatment with 300 – 600 mg of clopidogrel at least 2– 6 hours before PCI as Class IA (ACS) and Class IC (elective PCI) recommendation. To evaluate the current evidence base in support for clopidogrel pretreat-ment. Five trials examining the impact of clopidogrel pretreatment in stable and unstable CAD were evaluated: PCI-CURE, PCI-CLARITY, CREDO, PRAGUE-8, ARMYDA-5. Because of substantial clinical heterogeneity in trial design and population, concomitant therapies (glycoprotein 2b/3a inhibitors, thrombolysis, etc), loading dose, pretreatment duration and analysis plan between PCI-CURE, PCI-CLARITY and the rest, a formal meta-analysis was confined only to CREDO, PRAGUE-8, ARMYDA-5. The key data are summarized in the Table . Clopidogrel pretreatment was associated with significant reduction in ischemic outcomes without a significant increase in major bleeding in two out of the 5 trials (PCI-CURE and PCI-CLARITY). Both these trials utilized nonrandomized subgroup comparisons with pretreatment duration longer than that typically encountered in clinical practice (<48h). A meta-analysis of the 3 trials demonstrated a nonsignificant 23% odds reduction in efficacy (P=0.1) and a nonsignificant 29% odds increase in major bleeding (P=0.24). No significant heterogeneity was observed for pooled efficacy (P=0.79) or bleeding (P=0.77) outcomes. Pretreatment hypothesis is currently not validated in rigorous prospective assessments, thereby calling into question the Class I recommendation (benefit >>>risk) endorsed by the guidelines. Clearly, further clinical data regarding dose, time course of pretreatment and associated benefit are warranted to provide unequivocal support. Until then, it is prudent to rule out surgical CAD before pretreatment to avoid bleeding risk. Trials Assessing Clopidogrel Pretreatment

A Systematic Review of the Qualitative Evidence for the Use of Lifestyle Planning in People with Learning Disabilities

1999 ◽  
Vol 3 (3) ◽  
pp. 148-158 ◽  
Author(s):  
D. Rowe ◽  
A. Rudkin
Keyword(s):  
Systematic Review ◽  
Learning Disabilities ◽  
Planning Process ◽  
Evidence Base ◽  
Outcome Data ◽  
Current Evidence ◽  
Future Research ◽  
Eligibility Criteria ◽  
Qualitative Evidence ◽  
Current Evidence Base

Lifestyle planning (LP) for people with learning disabilities is largely supported by qualitative rather than quantitative research. LP is a time-consuming and potentially resource-intensive area of practice which is becoming more prevalent in the UK. We present the first systematic review of the qualitative evidence base for the use of LP in people with learning disabilities. Such evidence concerns the special characteristics of LP and its outcomes in descriptive rather than quantitative terms. Qualitative research is usually aimed at enhancing validity by grounding theory in data collected. Twenty-one studies passed eligibility criteria for inclusion in this review, but only ten provided any outcome data, the others being concerned with process only. A replicable search strategy was employed and the resulting original data sources were critically reviewed with respect to major concepts and categories in the areas of: planning process, choices and preferences, ethics and outcomes. Explicitly person-centred approaches such as essential lifestyle planning are contrasted with more service-led methods such as individual programme planning. There are major methodological limitations in much of the available literature and suggestions for future research to clarify matters are made. The current evidence base suggests that no form of LP has significantly better outcomes than any other form and that it is not clear if LP in general enhances outcomes. Ongoing use of person centred planning in particular is informed by ethical considerations and is evolving in its structure and function.

scholarly journals What Are the Peer Interaction Strengths and Difficulties in Children with Developmental Language Disorder? A Systematic Review

2020 ◽  
Vol 17 (9) ◽  
pp. 3140
Author(s):  
Vanessa Lloyd-Esenkaya ◽  
Ailsa J. Russell ◽  
Michelle C. St Clair
Keyword(s):  
Systematic Review ◽  
Peer Interaction ◽  
Language Disorder ◽  
Peer Interactions ◽  
Pretend Play ◽  
Evidence Base ◽  
Current Evidence ◽  
Developmental Language Disorder ◽  
Current Evidence Base ◽  
Strengths And Difficulties

The current review gathers together research investigating peer interaction skills in children with Developmental Language Disorder (DLD) to give an overview of the strengths and challenges experienced by these children when interacting with other children. A systematic review was conducted to summarise the literature on peer interaction strengths and difficulties in children with DLD. No restrictions on time-period were made and the selection criteria accounted for many of the diagnostic labels previously used to refer to DLD. Studies included in this review involve English-speaking children of UK primary school age (4–11 years). A systematic search of databases identified 28 papers that met the inclusion criteria. Children with DLD are found to experience many challenges when interacting with peers. Difficulties have been found in studies exploring discourse characteristics such as turn-taking and in behaviours during play, such as access behaviours. Heterogeneity was however notable and peer interaction strengths are found in terms of the children’s abilities to make friends, use verbal and non-verbal behaviour to make joint decisions with peers, and abilities to engage with peers in social pretend play. While it is encouraging to find research exploring many different areas of peer interaction competence in children with DLD, the research is highly disparate and there are many research findings awaiting replication. The current evidence base is unable to comprehensively define the characteristics of peer interactions of children with DLD.

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