A systematic review on diagnostics and surgical treatment of adult right-sided Bochdalek hernias and presentation of the current management pathway

Abstract Purpose Bochdalek hernia is a congenital diaphragmatic hernia. The incidence in adults is estimated around 0.17%. Right-sided hernias are much more seldom than left-sided ones because of faster closure of the right pleuroperitoneal canal and the protective effect of the liver. Due to its rarity, there have been no large prospective or retrospective studies following great need for evidence-based diagnostics and treatment strategies. In this systematic review, we evaluated the current evidence of diagnostics, treatment, and follow-up of adult right-sided Bochdalek hernias. Methods According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines a systematic literature review was conducted in PubMed and Cochrane library from 2004 to January 2021. The literature search included all studies with non-traumatic right-sided Bochdalek hernias. Literature on left- or both-sided, pregnancy-associated, pediatric, and other types of hernias were explicitly excluded. Quality assessment of the included studies was performed. Results Database search identified 401 records. After eligibility screening 41 studies describing 44 cases of right-sided non-traumatic Bochdalek hernias in adulthood were included for final analysis. Based upon the systematic literature review, the current diagnostic, therapeutic, and follow-up management pathway for this rare surgical emergency is presented. Conclusion This systematic review underlined that most studies investigating management of adult non-traumatic right-sided Bochdalek hernias are of moderate to low methodological quality. Hernias tend to occur more frequently in middle-aged and older women presenting with abdominal pain and dyspnea. A rapid and accurate diagnosis following surgical repair and regular follow-up is mandatory. High-quality studies focusing on the management of this rare entity are urgently needed.

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Effectiveness of e-cigarettes in smoking cessation: a systematic review and meta-analysis

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1226 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Oberndorfer ◽

I Grabovac ◽

S Haider ◽

T E Dorner

Keyword(s):

Systematic Review ◽

Smoking Cessation ◽

Meta Analysis ◽

Current Evidence ◽

Promising Alternative ◽

Quality Of Evidence ◽

Different Populations ◽

Meta Analyses

Abstract Background Reports of the effectiveness of e-cigarettes (ECs) for smoking cessation vary across different studies making implementation recommendations hard to attain. We performed a systematic review and meta-analysis to synthesise the current evidence regarding the effectiveness of ECs for smoking cessation. Methods PubMed, PsycInfo and Embase databases were searched for randomized controlled trials comparing nicotine ECs with non-nicotine ECs or with established smoking cessation interventions (nicotine replacement therapy (NRT) and or counselling) published between 01/01/2014 and 01/05/2019. Data from eligible studies were extracted and used for random-effects meta-analyses. Results Our literature review yielded 13190 publications with 10 studies being identified as eligible for systematic review, covering 8362 participants, and 8 for meta-analyses (n = 30 - 6006). Using the last follow-up of eligible studies, the proportion of smokers achieving abstinence was 1.67 [95CI:0.99 - 2.81] times higher in nicotine EC users compared to non-nicotine EC users. The proportion of abstinent smokers was 1.69 [95CI:1.25 - 2.27] times higher in EC users compared to participants receiving NRT. EC users showed a 2.70 [95CI:1.15 - 6.30] times higher proportion of abstinent smokers in comparison to participants solely receiving counselling. Conclusions Our analysis showed modest effects of nicotine-ECs compared to non-nicotine ECs. When compared to NRT or counselling, results suggest that nicotine EC may be more effective for smoking cessation. As ECs also help maintaining routinized behaviour and social aspects of smoking, we hypothesise that this may explain their advantage as a tool for smoking cessation. However, given the small number of included studies, different populations, heterogeneous designs, and the overall moderate to low quality of evidence, it is not possible to offer clear recommendations. More comparable data is needed to strengthen confidence in the quality of evidence. Key messages The number of previous studies assessing the effectiveness of ECs for smoking cessation is limited. Further, comparability of these studies is restricted, weakening the quality of evidence. Although current evidence on the effectiveness of ECs for smoking cessation is inconclusive, our meta-analyses suggest that ECs could be a promising alternative tool in attempts to achieve abstinence.

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Management of postoperative internal carotid artery intimal flap after carotid endarterectomy: a cohort study and systematic review

Journal of Neurosurgery ◽

10.3171/2021.2.jns2167 ◽

2021 ◽

pp. 1-8

Author(s):

Jonathan Rychen ◽

Adrian Madarasz ◽

Michael Murek ◽

Philippe Schucht ◽

Mirjam R. Heldner ◽

...

Keyword(s):

Systematic Review ◽

Carotid Artery ◽

Literature Review ◽

Internal Carotid Artery ◽

Carotid Endarterectomy ◽

Systematic Literature Review ◽

Internal Carotid ◽

Management Strategies ◽

Intimal Flap

OBJECTIVE Postoperative internal carotid artery (ICA) intimal flap (IF) is a potential complication after carotid endarterectomy (CEA) for carotid artery stenosis. There are no clear recommendations in the current literature on the management of this condition due to sparse evidence. Some authors advocate carotid stent placement or reoperation, while others suggest watchful waiting. The aim of this study was to analyze incidence and management strategies of postoperative ICA-IF, and moreover, to put these findings into context with a systematic literature review. METHODS The authors retrospectively reviewed all consecutive CEA cases performed at the University Hospital of Bern over a decade (January 2008 to December 2018). The incidence of postoperative ICA-IF, risk factors, management strategies, and outcomes were analyzed. These results were put into context with a systematic review following the PRISMA guidelines. RESULTS A total of 725 CEAs were performed between January 2008 and December 2018. Postoperative ICA-IF was detected by routine duplex neurovascular ultrasound (NVUS) in 13 patients, corresponding to an incidence rate of 1.8% (95% CI 1.0%–3.1%). There were no associated intraluminal thrombi on the detected IF. Intraoperative shunt placement was used in 5.6% and one or more intima tack sutures were performed in 42.5% of the 725 cases. There was no significant association between intraoperative shunt placement and the occurrence of an IF (p > 0.99). Two patients (15.4%) with IF experienced a transient postoperative neurological deficit (transient ischemic attack). In these cases, the symptoms resolved spontaneously without any interventions or change in the antiplatelet regimen. All other cases (84.6%) with IF were asymptomatic. In 1 patient (7.7%) with IF, the antiplatelet treatment was switched from a mono- to a dual-antiaggregating regimen because the IF led to a stenosis > 70%; this patient remained asymptomatic. All cases of IFs were managed conservatively with close radiological follow-up evaluations, without reoperation or stenting of the ICA. All 13 IFs vanished spontaneously after a mean duration of 6.9 months (median 1.5 months, range 0.5–48 months). A systematic literature review revealed a postoperative ICA-IF incidence of 3.0% (95% CI 2.1%–4.1%) with relatively heterogenous management strategies. CONCLUSIONS Postoperative ICA-IF is a rare finding after CEA. Conservative therapy with close NVUS follow-up evaluations appears to be an acceptable and safe management strategy for asymptomatic IFs without associated intraluminal thrombi.

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Relaxation therapy as a treatment for tics in patients with Tourette syndrome: a systematic literature review

Neurological Sciences ◽

10.1007/s10072-019-04207-5 ◽

2019 ◽

Vol 41 (5) ◽

pp. 1011-1017 ◽

Cited By ~ 1

Author(s):

Florence Tilling ◽

Andrea E. Cavanna

Keyword(s):

Literature Review ◽

Tourette Syndrome ◽

Systematic Literature Review ◽

Treatment Strategies ◽

Small Sample ◽

Relaxation Therapy ◽

Behavioural Treatment ◽

Study Protocols ◽

Small Sample Sizes ◽

Meta Analyses

Abstract Background Tourette syndrome (TS) is a neurodevelopmental condition characterized by the presence of multiple motor and phonic tics, often associated with co-morbid behavioural problems. Tics can be modulated by environmental factors and are characteristically exacerbated by psychological stress, among other factors. This observation has led to the development of specific behavioural treatment strategies, including relaxation therapy. Objective This review aimed to assess the efficacy of relaxation therapy to control or reduce tic symptoms in patients with TS. Methods We conducted a systematic literature review of original studies on the major scientific databases, including Medline, EMBASE, and PsycInfo, according to the standards outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcomes measures included both tic severity and tic frequency. Results Our literature search identified three controlled trials, with a total number of 40 participants (range: 6–18 participants). In all three studies, relaxation therapy decreased the severity and/or the frequency of tic symptoms. However, the only trial comparing relaxation therapy to two other behavioural techniques found relaxation therapy to be the least effective intervention, as it reduced the number of tics by 32% compared to 44% with self-monitoring and 55% with habit reversal. Discussion The results of this systematic literature review provide initial evidence for the use of relaxation therapy as a behavioural treatment intervention for tics in patients with TS. Caution is needed in the interpretation of these findings, because the reviewed trials had small sample sizes and there was high heterogeneity across the study protocols.

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Current evidence for a strategic approach to the management of rheumatoid arthritis with disease-modifying antirheumatic drugs: a systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis

Annals of the Rheumatic Diseases ◽

10.1136/ard.2009.126748 ◽

2010 ◽

Vol 69 (6) ◽

pp. 987-994 ◽

Cited By ~ 96

Author(s):

R Knevel ◽

M Schoels ◽

T W J Huizinga ◽

D Aletaha ◽

G R Burmester ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Literature Review ◽

Clinical Outcome ◽

Physical Function ◽

Systematic Literature Review ◽

Structural Damage ◽

Task Force ◽

Treatment Strategies ◽

Current Evidence ◽

Eular Recommendations

ObjectivesTo perform a systematic literature review of effective strategies for the treatment of rheumatoid arthritis (RA).MethodsAs part of a European League Against Rheumatism (EULAR) Task Force investigation, a literature search was carried out from January 1962 until February 2009 in PubMed/Ovid Embase/Cochrane and EULAR/American College of Rheumatism (ACR)) abstracts (2007/2008) for studies with a treatment strategy adjusted to target a predefined outcome. Articles were systematically reviewed and clinical outcome, physical function and structural damage were compared between intensive and less intensive strategies. The results were evaluated by an expert panel to consolidate evidence on treatment strategies in RA.ResultsThe search identified two different kinds of treatment strategies: strategies in which the reason for treatment adjustment differed between the study arms (‘steering strategies’, n=13) and strategies in which all trial arms used the same clinical outcome to adjust treatment with different pharmacological treatments (‘medication strategies’, n=7). Both intensive steering strategies and intensive medication strategies resulted in better outcome than less intensive strategies in patients with early active RA.ConclusionIntensive steering strategies and intensive medication strategies produce a better clinical outcome, improved physical function and less structural damage than conventional steering or treatment. Proof in favour of any steering method is lacking and the best medication sequence is still not known.

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Gastric Electrical Stimulation with the Enterra System: A Systematic Review

Gastroenterology Research and Practice ◽

10.1155/2015/762972 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 24

Author(s):

Nikhil Lal ◽

Sam Livemore ◽

Declan Dunne ◽

Iftikhar Khan

Keyword(s):

Systematic Review ◽

Electrical Stimulation ◽

Preoperative Assessment ◽

Gastric Electrical Stimulation ◽

Current Evidence ◽

Cochrane Library ◽

Symptom Improvement ◽

System A ◽

Gastric Emptying Time

Background. Gastric electrical stimulation (GES) is a surgically implanted treatment option for refractory gastroparesis.Aim. To systematically appraise the current evidence for the use of gastric electrical stimulation and suggest a method of standardisation of assessment and follow-up in these patients.Methods. A systematic review of PubMed, Web of Science, DISCOVER, and Cochrane Library was conducted using the keywords including gastric electrical stimulation, gastroparesis, nausea, and vomiting and neuromodulation, stomach, central nervous system, gastric pacing, electrical stimulation, and gastrointestinal.Results. 1139 potentially relevant articles were identified, of which 21 met the inclusion criteria and were included. The quality of studies was variable. There was a variation in outcome measures and follow-up methodology. Included studies suggested significant reductions in symptom severity reporting over the study period, but improvements in gastric emptying time were variable and rarely correlated with symptom improvement.Conclusion. The evidence in support of gastric electrical stimulation is limited and heterogeneous in quality. While current evidence has shown a degree of efficacy in these patients, high-quality, large clinical trials are needed to establish the efficacy of this therapy and to identify the patients for whom this therapy is inappropriate. A consensus view on essential preoperative assessment and postoperative measurement is needed.

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Prevalence of Exclusive Breastfeeding Practice and its Association with Maternal Employment in Ethiopia: A Systematic Review and Meta-Analysis, 2020

10.21203/rs.3.rs-33296/v2 ◽

2020 ◽

Author(s):

GETU ENGIDA WAKE ◽

YOHANNES MOGES MITTIKU

Keyword(s):

Systematic Review ◽

Exclusive Breastfeeding ◽

Maternal Employment ◽

Maternity Leave ◽

Meta Analysis ◽

Final Analysis ◽

Cochrane Library ◽

Pooled Prevalence ◽

Ethiopian Government ◽

Meta Analyses

Abstract Background: Exclusive breastfeeding is defined as the practice of providing only breast-milk for an infant for the first 6 months of life without addition of any other food or water, which recommends initiation of breastfeeding within one hour of life and continued breastfeeding for up to 2 years of age or more. There are highly variable findings regarding the prevalence of exclusive breastfeeding in Ethiopia. Maternal employment is the most important factor contributing to the low practice of exclusive breastfeeding. The purpose of this review was to estimate the pooled prevalence of exclusive breastfeeding and its association with maternal employment in the context of Ethiopia.Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used in this systematic review and meta-analysis. The databases such as; PubMed, Google Scholar, Science Direct, Cochrane library, Scopus, CINAHL, and Web of Science were systematically searched. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal. Results: Forty-five studies were included in the final analysis after reviewing 751 studies in this meta-analysis yielding the pooled prevalence of EBF 60.42% (95% CI: 55.81-65.02%) in Ethiopia. The subgroup analysis showed the highest prevalence reported in a study conducted in SNNP and Tigray( 87.84%), a study published during (2015-2016) (64.60 %), and among studies with a sample size of less than 500 (64.15%). Those employed mothers were 57% less likely to practice exclusive breastfeeding in comparison to unemployed mothers in Ethiopia [OR] 0.43; 95% CI (0.31, 0.61).Conclusions: Maternal employment was significantly associated with the practice of exclusive breastfeeding in comparison to their counterparts. The prevalence of exclusive breastfeeding in Ethiopia is low in comparison to the global recommendation. Based On our findings, we recommended that the Ethiopian government should increase legislated paid maternity leave after delivery beyond current paid maternity leave and implement policies that empower women and create a conducive environment for mothers to practice exclusive breastfeeding in the workplace.

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Prevalence of exclusive breastfeeding practice in Ethiopia and its association with maternal employment: a systematic review and meta-analysis, 2019.

10.21203/rs.3.rs-33572/v1 ◽

2020 ◽

Author(s):

Getu Engida Wake ◽

Yohannes Moges Mittiku

Keyword(s):

Systematic Review ◽

Exclusive Breastfeeding ◽

Maternal Employment ◽

Maternity Leave ◽

Meta Analysis ◽

Final Analysis ◽

Cochrane Library ◽

Pooled Prevalence ◽

Ethiopian Government ◽

Meta Analyses

Abstract Background: Exclusive breastfeeding defined as the practice of providing only breast-milk for an infant for the first 6 months of life without the addition of any other food or water, which recommends initiation of breastfeeding within one hour of life and continued breastfeeding for up to 2 years of age or more. Maternal employment is the most important factor contributing to the low practice of exclusive breastfeeding. However; the effect of maternal employment on exclusive breastfeeding is not investigated in Ethiopia. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used in this systematic review and meta-analysis. The databases used were; PubMed, Google Scholar, Science Direct, and Cochrane library were systematically searched. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. Results: thirty-six studies were included in the final analysis after reviewing 541 studies in this meta-analysis yielding the pooled prevalence of EBF 59.76% (95% CI: 54.84, 64.68) in Ethiopia.Those employed mothers were 57% less likely to practice exclusive breastfeeding in comparison to unemployed mothers in Ethiopia [OR] 0.43; 95% CI (0.3, 0.62).Conclusions: The overall prevalence of exclusive breastfeeding in this meta-analysis is low in comparison to the global recommendation of the practice of exclusive breastfeeding. Maternal employment was significantly associated with the practice of exclusive breastfeeding in comparison to their counterparts. Based On our review findings, we recommended that the Ethiopian government should increase legislated paid maternity leave after delivery beyond current paid maternity leave and implement policies that empower women and create a conducive environment for mothers to practice exclusive breastfeeding at the workplace.

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Physical Exercise vs. Metformin to Improve Delivery- and Newborn-Related Outcomes Among Pregnant Women With Overweight: A Network Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2021.796009 ◽

2021 ◽

Vol 8 ◽

Author(s):

Carlos Pascual-Morena ◽

Iván Cavero-Redondo ◽

Celia Álvarez-Bueno ◽

José Alberto Martínez-Hortelano ◽

Sara Reina-Gutiérrez ◽

...

Keyword(s):

Systematic Review ◽

Birth Weight ◽

Physical Exercise ◽

Cesarean Section ◽

Pregnant Women ◽

Current Evidence ◽

Cochrane Library ◽

Exercise Interventions ◽

Combined Exercise ◽

Meta Analyses

Background: Overweight/obesity is associated with the risk of delivery- and newborn-related complications in pregnancy. Interventions such as exercise or metformin could reduce the risk of these complications.Objective: To estimate and compare the effects of different types of exercise interventions (i.e., aerobic, resistance, combined exercise) and metformin on delivery- and newborn-related outcomes among pregnant women with overweight/obesity.Methods: MEDLINE, Scopus, Web of Science, Cochrane Library databases and the gray literature were searched from inception to September 2021. This systematic review was registered in PROSPERO (CDR: 42019121715). Randomized controlled trials (RCTs) of metformin or an exercise intervention aimed at preventing cesarean section, preterm birth, macrosomia, or birth weight among pregnant women with overweight/obesity were included. Random effects meta-analyses and frequentist network meta-analyses (NMA) were conducted for each outcome.Results: Fifteen RCTs were included. In the NMA, metformin reduced the risk of cesarean section (RR = 0.66, 95% CI: 0.46, 0.95), combined exercise reduced the risk of macrosomia (RR = 0.37, 95% CI: 0.14, 0.95), and aerobic exercise reduced birth weight (mean difference = −96.66 g, 95% CI: −192.45, −0.88). In the subgroup among pregnant women with obesity, metformin reduced the risk of cesarean section (RR = 0.66, 95% CI: 0.45, 0.97).Conclusions: Combined exercise could reduce the risk of macrosomia in pregnant women with overweight, whereas metformin could reduce the risk of cesarean section in pregnant women with obesity. However, previous evidence suggests a larger effect of physical exercise in other outcomes for this population group. Therefore, the medicalization of healthy pregnant women with obesity is not justified by the current evidence.Systematic Review Registration: PROSPERO: CRD42019121715; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019121715

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Knee ultrasound from research to real practice: a systematic literature review of adult knee ultrasound assessment feasibility studies.

Medical Ultrasonography ◽

10.11152/mu-873 ◽

2016 ◽

Vol 18 (4) ◽

pp. 457

Author(s):

Alexandra Peltea ◽

Florian Berghea ◽

Tania Gudu ◽

Ruxandra Ionescu

Keyword(s):

Clinical Practice ◽

Literature Review ◽

Systematic Literature Review ◽

Feasibility Studies ◽

Final Analysis ◽

Information Gap ◽

Ultrasound Assessment ◽

Time Required ◽

The Right ◽

Real Practice

Objective: To identify and analyse existing data regarding knee ultrasound (US) feasibility in clinical practice. Material and methods: A systematic literature review was performed using the terms: (“knee”) AND (“ultrasound” OR “ultrasonography”) AND (“feasibility” OR “pilot” OR “proof of concept”). Feasibility studies regarding knee US or US aided maneuver involving knee joint, published during 2005-2015, were selected and evaluated against a complex framework constructed around mandatory key areas for feasibility studies: acceptability, demand, implementation, practicality, adaptation, integration and expansion. Results: One hundred and fifty-nine publications were identified, of which 9 were included in the final analysis: 6 dealt with the development and implementation of novel US scores, while the rest focused on implementing MSUS in clinical practice, evaluating the usefulness of articular cartilage US assessment and the feasibility of sonography for intra-articular knee injections, respectively. Six studies quantified feasibility as time spent for the evaluation, with only two addressing areassuch as acceptability, implementation and practicality, although none of these systematically assessed all feasibility domains. Conclusion: Knee US feasibility is still poorly addressed; the time required for US assessment is the main area addressed. This information gap should be properly addressed in future works, in order to ensure the right place for this technique.

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Augmentation of Meniscal Repair With Platelet-Rich Plasma: A Systematic Review of Comparative Studies

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120926145 ◽

2020 ◽

Vol 8 (6) ◽

pp. 232596712092614

Author(s):

John W. Belk ◽

Matthew J. Kraeutler ◽

Stephen G. Thon ◽

Connor P. Littlefield ◽

John H. Smith ◽

...

Keyword(s):

Systematic Review ◽

Platelet Rich Plasma ◽

Meniscal Repair ◽

International Knee Documentation Committee ◽

Current Evidence ◽

Cochrane Library ◽

Level Of Evidence ◽

Level 3 ◽

The Cochrane Library

Background: The effect of platelet-rich plasma (PRP) augmentation for meniscal repair (MR) is unclear, as current evidence is limited to small, mostly nonrandomized studies. Purpose: To systematically review the literature to evaluate the efficacy and safety of MR with PRP augmentation. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify studies (level of evidence 1-3) that compared the clinical efficacy of MR performed with versus without PRP. The search phrase used was platelet-rich plasma meniscus. Patients were assessed based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the visual analog scale (VAS) for pain, the Lysholm score, the Knee injury and Osteoarthritis Outcome Score (KOOS), the subjective International Knee Documentation Committee (IKDC) score, and treatment failure. Results: We identified 6 studies (2 studies with level 1 evidence; 4 studies with level 3 evidence) that met inclusion criteria, for a total of 309 patients undergoing MR with PRP (mean age, 31.9 years) and 445 patients without PRP augmentation (mean age, 29.6 years). The mean follow-up was 32.8 months (range, 12-72 months). Overall, 17.0% of PRP patients experienced MR failure compared with 22.1% of non-PRP patients. No differences in VAS, Lysholm, or subjective IKDC scores were found between groups except in 1 study, in which postoperative subjective IKDC scores were significantly better in the PRP group ( P < .01). Another study found significantly better postoperative WOMAC scores among PRP patients, and 2 studies found significantly better KOOS subscores among PRP patients. Conclusion: There are a limited number of high-quality studies comparing outcomes and healing rates between patients undergoing MR with versus without PRP augmentation. Based on the available evidence, patients undergoing MR with PRP augmentation experience similar clinical outcomes at midterm follow-up when compared with conventional MR, and additional studies are needed to determine the efficacy of MR augmented with PRP.

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