Intranasal cautery for the management of adult epistaxis: systematic review

2017 ◽  
Vol 131 (12) ◽  
pp. 1056-1064 ◽  
Author(s):  
R W J Mcleod ◽  
A Price ◽  
R J Williams ◽  
M E Smith ◽  
M Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Search Strategy ◽  
Controlled Trial ◽  
Economic Assessment ◽  
Success Rates ◽  
Review Of The Literature ◽  
Limited Evidence ◽  
Patient Tolerance ◽  
Randomised Controlled ◽  
Chemical Cautery

AbstractBackground:Cauterisation techniques are commonly used and widely accepted for the management of epistaxis. This review assesses which methods of intranasal cautery should be endorsed as optimum treatment on the basis of benefits, risks, patient tolerance and economic assessment.Method:A systematic review of the literature was performed using a standardised methodology and search strategy.Results:Eight studies were identified: seven prospective controlled trials and one randomised controlled trial. Pooling of data was possible from 3 studies, yielding a total of 830 patients. Significantly lower re-bleed rates were identified (p < 0.01) using electrocautery (14.5 per cent) when compared to chemical cautery (35.1 per cent). No evidence suggested that electrocautery was associated with more adverse events or discomfort. Limited evidence supported the use of a vasoconstrictor agent and operating microscope during the procedure. The included studies had considerable heterogeneity in terms of design and outcome measures.Conclusion:Consistent evidence suggests that electrocautery has higher success rates than chemical cautery, and is not associated with increased complications or patient discomfort. Lower quality evidence suggests that electrocautery reduces costs and duration of hospital stay.

Surgical and interventional radiological management of adult epistaxis: systematic review

2017 ◽  
Vol 131 (12) ◽  
pp. 1108-1130 ◽  
Author(s):  
C Swords ◽  
A Patel ◽  
M E Smith ◽  
R J Williams ◽  
I Kuhn ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Effect ◽  
Interventional Radiology ◽  
Search Strategy ◽  
Database Search ◽  
Economic Effects ◽  
Success Rates ◽  
Review Of The Literature ◽  
Artery Ligation ◽  
Sphenopalatine Artery

AbstractBackground:There is variation regarding the use of surgery and interventional radiological techniques in the management of epistaxis. This review evaluates the effectiveness of surgical artery ligation compared to direct treatments (nasal packing, cautery), and that of embolisation compared to direct treatments and surgery.Method:A systematic review of the literature was performed using a standardised published methodology and custom database search strategy.Results:Thirty-seven studies were identified relating to surgery, and 34 articles relating to interventional radiology. For patients with refractory epistaxis, endoscopic sphenopalatine artery ligation had the most favourable adverse effect profile and success rate compared to other forms of surgical artery ligation. Endoscopic sphenopalatine artery ligation and embolisation had similar success rates (73–100 per cent and 75–92 per cent, respectively), although embolisation was associated with more serious adverse effects (risk of stroke, 1.1–1.5 per cent). No articles directly compared the two techniques.Conclusion:Trials comparing endoscopic sphenopalatine artery ligation to embolisation are required to better evaluate the clinical and economic effects of intervention in epistaxis.

scholarly journals Is End-Stage Ankle Arthrosis Best Managed with Total Ankle Replacement or Arthrodesis? A Systematic Review

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Robert W. Jordan ◽  
Gurdip S. Chahal ◽  
Anna Chapman
Keyword(s):  
Systematic Review ◽  
Functional Outcome ◽  
Controlled Trial ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Online Databases ◽  
Ankle Replacement ◽  
Comparative Group ◽  
Randomised Controlled ◽  
End Stage

Introduction. End-stage ankle osteoarthritis is a debilitating condition. Traditionally, ankle arthrodesis (AA) has been the surgical intervention of choice but the emergence of total ankle replacement (TAR) has challenged this concept. This systematic review aims to address whether TAR or AA is optimal in terms of functional outcomes.Methods. We conducted a systematic review according to PRISMA checklist using the online databases Medline and EMBASE after January 1, 2005. Participants must be skeletally mature and suffering from ankle arthrosis of any cause. The intervention had to be an uncemented TAR comprising two or three modular components. The comparative group could include any type of ankle arthrodesis, either open or arthroscopic, using any implant for fixation. The study must have reported at least one functional outcome measure.Results. Of the four studies included, two reported some significant improvement in functional outcome in favour of TAR. The complication rate was higher in the TAR group. However, the quality of studies reviewed was poor and the methodological weaknesses limited any definitive conclusions being drawn.Conclusion. The available literature is insufficient to conclude which treatment is superior. Further research is indicated and should be in the form of an adequately powered randomised controlled trial.

scholarly journals What works to promote walking at the population level? A systematic review

2018 ◽  
Vol 52 (12) ◽  
pp. 807-812 ◽  
Author(s):  
Charlie Foster ◽  
Paul Kelly ◽  
Hamish A B Reid ◽  
Nia Roberts ◽  
Elaine M Murtagh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mass Media ◽  
English Language ◽  
Environmental Changes ◽  
Controlled Trial ◽  
Population Level ◽  
Eligibility Criteria ◽  
Community Initiatives ◽  
School Based ◽  
Randomised Controlled

ObjectiveInterventions to promote walking have focused on individual or group-based approaches, often via the randomised controlled trial design. Walking can also be promoted using population health approaches. We systematically reviewed the effectiveness of population approaches to promote walking among individuals and populations.DesignA systematic review.Data sources10 electronic databases searched from January 1990 to March 2017.Eligibility criteriaEligibility criteria include pre-experimental and postexperimental studies of the effects of population interventions to change walking, and the effects must have been compared with a ‘no intervention’, or comparison group/area/population, or variation in exposure; duration of ≥12 months of follow up; participants in free-living populations; and English-language articles.Results12 studies were identified from mostly urban high-income countries (one focusing on using tax, incentivising the loss of parking spaces; and one using policy only, permitting off-leash dogs in city parks). Five studies used mass media with either environment (n=2) or community (n=3) approaches. Four studies used environmental changes that were combined with policies. One study had scaled up school-based approaches to promote safe routes to schools. We found mass media, community initiatives and environmental change approaches increased walking (range from 9 to 75 min/week).

The impact of acupuncture on IVF success rates: A randomised controlled trial

2018 ◽  
Vol 5 (2) ◽  
pp. 48
Author(s):  
Roy Homburg ◽  
K. Gillerman ◽  
A. Kulkarni ◽  
A. Shah ◽  
A. Gudi
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Success Rates ◽  
Randomised Controlled ◽  
The Impact

Non-technical skills and otolaryngology: systematic review

2020 ◽  
Vol 134 (5) ◽  
pp. 415-418 ◽  
Author(s):  
R Bannon ◽  
K E Stewart ◽  
M Bannister
Keyword(s):  
Systematic Review ◽  
Assessment Tool ◽  
Controlled Trial ◽  
Technical Skills ◽  
Neck Surgery ◽  
Future Research ◽  
Skill Levels ◽  
Simulated Environments ◽  
Simulation Based ◽  
Randomised Controlled

AbstractObjectivesThis study aimed to assess the published literature on non-technical skills in otolaryngology surgery and examine the applicability of any research to others’ practice, and to explore how the published literature can identify areas for further development and guide future research.MethodsA systematic review was conducted using the following key words: ‘otolaryngology’, ‘otorhinolaryngology’, ‘ENT’, ‘ENT surgery’, ‘ear, nose and throat surgery’, ‘head and neck surgery’, ‘thyroid surgery’, ‘parathyroid surgery’, ‘otology’, ‘rhinology’, ‘laryngology’ ‘skull base surgery’, ‘airway surgery’, ‘non-technical skills’, ‘non technical skills for surgeons’, ‘NOTSS’, ‘behavioural markers’ and ‘behavioural assessment tool’.ResultsThree publications were included in the review – 1 randomised, controlled trial and 2 cohort studies – involving 78 participants. All were simulation-based studies involving training otolaryngology surgeons.ConclusionLittle research has been undertaken on non-technical skills in otolaryngology. Training surgeons’ non-technical skill levels are similar across every tested aspect. The research already performed can guide further studies, particularly amongst non-training otolaryngology surgeons and in both emergency and elective non-simulated environments.

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