Routine Postoperative Management of Blepharoplasty: A Review of Current Evidence-Based Practice

2021 ◽  
Author(s):  
Mohsan Malik ◽  
Eamon Shamil ◽  
Alwyn Ray D'Souza
Keyword(s):  
Case Series ◽  
Evidence Base ◽  
Postoperative Management ◽  
Current Evidence ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Search Criterion ◽  
Current Evidence Base ◽  
Facial Plastic ◽  
Based Medicine

Abstract Introduction Advances in blepharoplasty have resulted in an improved understanding of preoperative risk factors, intraoperative hemostasis, and wound closure. This has reduced the risk of severe adverse events. The aim of this review is to determine the current evidence base for routine postblepharoplasty management. Method A literature review was performed using MEDLINE, PUBMED, and EMBASE databases. Expanded search criterion “bleph*” was combined with individual terms assessing postoperative management. Articles were assessed and qualified as per Oxford Centre of Evidence-Based Medicine levels 1 to 5 (1 = highest level of evidence). Results A total of 47 unique articles matched our search strategy. Most articles were a description of individual expert opinion, surveys of practice, or case series (level 4–5 evidence). Few randomized controlled trials were performed (level 2). Conclusion Many articles describe the clinical experience of senior facial plastic surgeons. Our review found some evidence for postoperative cooling and preincision antisepsis to be effective. This review highlights the need for higher-quality studies to improve the evidence base for routine postoperative management.

scholarly journals Disinfection of the Access Orifice in NOTES: Evaluation of the Evidence Base

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Mikael H. Sodergren ◽  
Philip Pucher ◽  
James Clark ◽  
David R. C. James ◽  
Jenny Sockett ◽  
...  
Keyword(s):  
Case Series ◽  
Evidence Base ◽  
Infectious Complications ◽  
Current Evidence ◽  
Natural Orifice ◽  
Current Evidence Base ◽  
Transgastric Approach ◽  
Randomised Controlled ◽  
Based Medicine ◽  
Antiseptic Irrigation

Introduction. Appropriate prevention of infection is a key area of research in natural orifice translumenal endoscopic surgery (NOTES), as identified by the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR). Methods. A review of the literature was conducted evaluating the evidence base for access orifice preparation/treatment in NOTES procedures in the context of infectious complications. Recommendations based on the Oxford Centre for Evidence-Based Medicine guidelines were made. Results. The most robust evidence includes several experimental randomised controlled trials assessing infectious complications in the transgastric approach to NOTES. Transvaginal procedures are long established for accessing the peritoneal cavity following disinfection with antiseptic. Only experimental case series for transcolonic and transvesical approaches are described. Conclusion. Grade C recommendation requiring no preoperative preparation can be made for the transgastric approach. Antiseptic irrigation is recommended for transvaginal (grade C) NOTES access, as is current practice. Further human trials need to be conducted to corroborate the current evidence base for transgastric closure. It is important that future trials are conducted in a methodologically robust fashion, with emphasis on clinical outcomes and standardisation of enterotomy closure and postoperative therapy.

Couple and Family Therapy

2017 ◽  
Author(s):  
Jessica ChenFeng ◽  
Diane Gehart
Keyword(s):  
Eating Disorders ◽  
Substance Use ◽  
Family Therapy ◽  
Couples Therapy ◽  
Evidence Base ◽  
Current Evidence ◽  
Evidence Based ◽  
Couple And Family Therapy ◽  
Current Evidence Base ◽  
Cord Injury

Evidence-based couple and family therapies have a robust and well-established evidence base as a cost-effective treatment for numerous conditions and are the treatment of choice for several childhood and adult mental health issues. This review provides a brief overview of systemic couple and family therapy principles and then reviews the evidence base for using these methods with specific disorders. Family therapy treatments have been identified as a primary intervention for several childhood and adolescent disorders, including conduct, alcohol and substance use, attention-deficit, autism, psychotic, mood, anxiety, and eating disorders, as well as certain physical disorders, including diabetes, enuresis, and asthma. For adults, the current evidence base supports couples therapy for major depressive disorder with couple distress, alcohol and substance use disorders, anxiety disorders, distressed couples, and interpersonal violence with certain batterers. In addition, couple and family therapy is indicated for certain adult chronic health conditions, including stroke, traumatic brain injury, spinal cord injury, cardiovascular diseases, cancer, dementia, and diabetes. The review concludes with a discussion of effective referral for and training in evidence-based family therapy approaches. This review contains 6 figures, 5 tables, and 53 references. Key words: ADD/ADHD, adolescent, childhood trauma, conduct disorder, couples therapy, depression, eating disorders, family therapy,  marital therapy, mood disorder

Management of feline carpal injuries: What are the options and when is arthrodesis indicated?

2019 ◽  
Vol 21 (9) ◽  
pp. 809-823 ◽  
Author(s):  
Rachel M Basa ◽  
Kenneth A Johnson
Keyword(s):  
Treatment Options ◽  
Case Series ◽  
Evidence Base ◽  
Careful Examination ◽  
Current Evidence ◽  
Collateral Ligament ◽  
Retrospective Case ◽  
Radial Collateral Ligament ◽  
Current Evidence Base ◽  
Direct Extrapolation

Practical relevance: Feline carpal injuries are usually caused by falls from a height that result in hyperextension injury or antebrachiocarpal luxation or subluxation. Isolated ligamentous damage or fracture of the carpus is unusual; it is more common to have a combination of both in the cat. These injuries can be debilitating since cats climb and jump from great heights, and have a greater range of antebrachial pronation and supination than dogs. Anatomy: There are differences in the anatomy of the feline and canine carpus. In particular, cats only have a single short radial collateral ligament, also known as the medial collateral ligament. This means that, in the cat, antebrachiocarpal subluxation is possible with rupture of the dorsal joint capsule and short radial collateral ligament alone. Clinical challenges: Many feline carpal injuries can be treated without performing pancarpal arthrodesis. However, determining which ligaments and joint levels are affected requires careful examination and often stress radiography. When pancarpal arthrodesis is performed in the cat, it has been reported to reduce the height of jumping and to increase reluctance to climb. This is speculated to be due to reduced pronation and supination movement of the carpus. Evidence base: The current evidence base for management of feline carpal injuries is grade III or IV, with most of the studies being retrospective case series involving cadaveric dissection or direct extrapolation from published information about the dog. There are few guidelines regarding the optimal treatment options for carpal injuries in the cat.

Pelvic ureteric junction obstruction: Natural history, nephrological considerations and current evidence base for surgical management in poorer functioning kidneys

2019 ◽  
Vol 13 (2) ◽  
pp. 116-121 ◽  
Author(s):  
Dora Moon ◽  
Timothy Napier-Hemy
Keyword(s):  
Natural History ◽  
Systemic Disease ◽  
Case Series ◽  
Evidence Base ◽  
Poor Quality ◽  
Quality Data ◽  
Current Evidence ◽  
Current Evidence Base ◽  
History Of ◽  
Split Function

Pelvic ureteric junction obstruction (PUJO) can pose a management challenge to urologists. The natural history of the disease, particularly in adults is poorly understood and management decisions are largely based on historical, poor quality data. Additionally, many older patients may already have a degree of renal impairment secondary to systemic disease, further compounding the situation. The purpose of this paper is to detail the pathophysiology and natural history of PUJO, discuss the implications of chronic kidney disease in this population detailing the current evidence base for poorer functioning kidneys and describe the nephrological advantages of accurate renal function testing. There exists accurate methods to assess both glomerular filtration rate (GFR) and split function which could potentially provide both the urologist and patient with more relevant data on which to base their decisions when contemplating surgical intervention. The existing, low patient number case series currently published fail to address the relevance of overall GFR on the outcomes after pyeloplasty, no studies use single unit GFR and there is no clear consensus on what constitutes surgical success. PUJO is an area of benign upper tract disease that is in need of high-quality scientific studies to identify when intervention is necessary, long-term success of both surgery and conservative management in poorer functioning kidneys and clear guidelines for urologists.

Level of scientific evidence supporting NCCN guidelines: Is there evidence of progress?

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 14-14
Author(s):  
Aakash Desai ◽  
Ronald S. Go ◽  
Thejaswi Poonacha
Keyword(s):  
Scientific Evidence ◽  
Clinical Care ◽  
Uterine Cancer ◽  
Evidence Base ◽  
Current Evidence ◽  
Level Of Evidence ◽  
Nccn Guidelines ◽  
Current Evidence Base ◽  
The Us ◽  
Therapeutic Recommendations

14 Background: National Comprehensive Cancer Network (NCCN) guidelines are the most comprehensive and widely used standard for clinical care in oncology by clinicians and payors in the US. The level of scientific evidence in NCCN guidelines has not been studied since it’s last review in 2010. We describe the categories of evidence and consensus (EC) among the 10 most common cancers in the US as of 2019 and compare them with 2010 guidelines. Methods: We obtained the 2019 version of NCCN guidelines. The definitions for various categories of EC used were: Category 1 (high level evidence such as randomized controlled trials with uniform consensus), 2A (lower level of evidence with uniform consensus), 2B (lower level of evidence without a uniform consensus but with no major disagreement) and 3 (any level of evidence but with major disagreement). We compared our results with previously published results from 2010 guidelines. Results: Total recommendations increased by 77% from 1023 (2010) to 1818 (2019). Of the 1818 recommendations, Category 1, 2A, 2B and 3 EC were 7%, 87%, 6% and 0% while in 2010 they were 5%, 85%, 9% and 1% respectively. Recommendations with category 1 EC were found in lung (13%), prostate (11%), melanoma (8%), breast (7%), NHL (5%), kidney (2%), bladder (2%) and colorectal (2%) guidelines. Pancreatic and uterine cancer guidelines had no recommendations with category 1 EC. 19% of therapeutic recommendations were category 1 EC with the majority (65%) pertaining to initial therapy. Guidelines with highest proportions of therapeutic recommendations with category 1 EC were breast (30%), lung (10%), and kidney (10%) cancers. No category 1 EC recommendations existed in screening or surveillance. Although we found an increase in the total number of recommendations, the distribution of different types of categories of EC are largely similar to 2010. Conclusions: Recommendations in 2019 NCCN guidelines are largely derived from lower levels of evidence with uniform expert opinion. Despite the major advances in oncology in the past decade, this is largely unchanged. Our study underscores the urgent need and available opportunities to expand the current evidence base in oncology which forms the platform for clinical practice guidelines.

Use of Statins in COVID-19 Treatment: Multiple Pathways but Minimal Evidence

2020 ◽  
Author(s):  
Adeleye JO
Keyword(s):  
Retrospective Study ◽  
Severe Acute Respiratory Syndrome ◽  
Evidence Base ◽  
Evidence Based ◽  
Specific Therapy ◽  
Level Of Evidence ◽  
New Era ◽  
Antiviral Effects ◽  
Based Medicine ◽  
Minimal Evidence

Coronavirus disease-2019(COVID-19) is an emerging viral infection of public importance and it is caused by a beta coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). So far, it has affected about 15 million individuals and over 600 000 patients have died from it. The virus is novel and there is no approved specific therapy for the infection. This has led to the trial of different drugs to reduce the morbidity and mortality of the infection. Statins are primarily used to lower cholesterol. They also have other pleiotropic effects such as anti-inflammatory, anti-thrombotic, immunomodulatory and antiviral effects. Coincidentally, the processes that statins antagonize are the mechanisms underlying the pathogenesis of COVID-19. Therefore, it has been suggested that statins should be considered as an adjunct in the treatment of COVID-19. In the new era of evidence-based medicine, there is a need to examine the level of evidence available to support the clinically beneficial effect of statins in COVID-19 treatment. This literature review explores the strength and volume of evidence for the usage of statins in COVID-19. However, as at the time of writing this review, the evidence base is very scanty. The most quoted evidence available is a retrospective study which is a low level of evidence. Therefore, it can be concluded that there are various mechanisms identified by which statins could be useful in the treatment of COVID-19. However, the evidence for their recommendation as adjuncts for COVID-19 treatment is very weak.

scholarly journals (A118) Evidence-Based Disaster Medicine: What Can We Learn from a “Science” Spread across 900 Journals?

2011 ◽  
Vol 26 (S1) ◽  
pp. s33-s33 ◽  
Author(s):  
E. Smith ◽  
F.M. Burkle ◽  
P. Aitken ◽  
F. Archer
Keyword(s):  
Hurricane Katrina ◽  
Large Scale ◽  
Search Strategy ◽  
Evidence Base ◽  
Disaster Medicine ◽  
Indian Ocean Tsunami ◽  
Current Evidence ◽  
Evidence Based ◽  
Current Evidence Base ◽  
Qualitative Methodologies

IntroductionDisasters and large-scale crises continue to increase in frequency. To mitigate the potential catastrophes that confront humanity in the new millennium, an evidence-based approach to disaster medicine is required urgently. This paper moves towards such an approach by identifying the current evidence-base for disaster medicine.MethodsUsing a search strategy developed by the Cochrane Prehospital and Emergency Health Field, three independent reviewers searched the electronically indexed database MEDLINE (January 2000 – August 2010) to identify peer-reviewed literature relevant to disaster medicine. Reviewers screened the titles and abstracts identified by the search strategy and applied predetermined criteria to classify the reported publications for date, source and study type and topic.ResultsA total of 8149 publications were identified. Of these, 8% focused on mitigation, 22% on preparedness, 19% on response and 51% on recovery. The publications were overwhelmingly anecdotal or descriptive (89%) while 5% were quantitative studies and 6% used qualitative methodologies. Only 66 of these publications were classified as being high level evidence. The publications were published in 928 journals, of which 34% were mental health related journals and 28% were public health journals. The journal “Prehospital and Disaster Medicine” had the greatest number of publications (5%) of all journals publishing on issues within the scope of disaster medicine. The events with the greatest numbers of publications were the 9/11 terrorist attacks, Hurricane Katrina, the Indian Ocean Tsunami, and the conflict in Iraq. Of note, this search highlights the lack of publications reporting on the application of evaluation tools or frameworks.ConclusionGiven that the “science” of disaster medicine is spread across over 900 different journals, keeping on top of the evolving evidence-base of this emerging discipline will continue to be a challenge. Furthermore, the overall low quality of the evidence is an ongoing concern.

scholarly journals Effectiveness of powered exoskeleton use on gait in individuals with cerebral palsy: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252193
Author(s):  
Lucinda Rose Bunge ◽  
Ashleigh Jade Davidson ◽  
Benita Roslyn Helmore ◽  
Aleksandra Daniella Mavrandonis ◽  
Thomas David Page ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cerebral Palsy ◽  
Case Series ◽  
Gait Training ◽  
Evidence Base ◽  
The Body ◽  
Current Evidence ◽  
Childhood Disability ◽  
Ongoing Research ◽  
Current Evidence Base

Background Cerebral palsy (CP) is a leading cause of childhood disability. The motor impairments of individuals with CP significantly affect the kinematics of an efficient gait pattern. Robotic therapies have become increasingly popular as an intervention to address this. Powered lower limb exoskeletons (PoLLE) are a novel form of robotic therapy that allow the individual to perform over-ground gait training and yet its effectiveness for CP is unknown. Purpose To determine the effectiveness of PoLLE use on gait in individuals with CP. Method A systematic search of eight electronic databases was conducted in March 2020. Studies included children (0–18 years) and or adults (18+ years) diagnosed with CP who used a PoLLE for gait training. This review was conducted and reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement, with the methodology registered with PROSPERO (CRD42020177160). A modified version of the McMaster critical review form for quantitative studies was used to assess the methodological quality. Due to the heterogeneity of the included studies, a descriptive synthesis using the National Health & Medical Research Council (NHMRC) FORM framework was undertaken. Results Of the 2089 studies screened, ten case series and three case studies met the inclusion criteria highlighting the current evidence base is emerging and low level. A range of PoLLEs were investigated with effectiveness measured by using a number of outcome measures. Collectively, the body of evidence indicates there is some consistent positive evidence on the effectiveness of PoLLE in improving gait in individuals with CP, with minimal adverse effects. While this is a positive and encouraging finding for an emerging technology, methodological concerns also need to be acknowledged. Conclusion With rapidly evolving technology, PoLLEs could play a transformative role in the lives of people impacted by CP. Ongoing research is required to further strengthen the evidence base and address current methodological concerns.

scholarly journals The evolution of an evidence based intervention designed to improve prescribing and reduce polypharmacy in older people with multimorbidity and significant polypharmacy in primary care (SPPiRE)

2020 ◽  
Vol 10 ◽  
pp. 2235042X2094624
Author(s):  
Caroline McCarthy ◽  
Frank Moriarty ◽  
Emma Wallace ◽  
Susan M Smith ◽  
Keyword(s):  
Older People ◽  
Medication Review ◽  
Patient Reported Outcome Measures ◽  
Evidence Base ◽  
Public Health Research ◽  
Primary Outcome Measure ◽  
Current Evidence ◽  
Evidence Based ◽  
Current Evidence Base ◽  
Patient Reported

Introduction: By the time an intervention is ready for evaluation in a definitive RCT the context of the evidence base may have evolved. To avoid research waste, it is imperative that intervention design and evaluation is an adaptive process incorporating emerging evidence and novel concepts. The aim of this study is to describe changes that were made to an evidence based intervention at the protocol stage of the definitive RCT to incorporate emerging evidence. Methods: The original evidence based intervention, a GP delivered web guided medication review, was modified in a five step process: Identification of core components of the original intervention. Literature review. Modification of the intervention. Pilot study. Final refinements. A framework, developed in public health research, was utilised to describe the modification process. Results: The population under investigation changed from older people with a potentially inappropriate prescription (PIP) to older people with significant polypharmacy, a proxy marker for complex multimorbidity. An assessment of treatment priorities and brown bag medication review, with a focus on deprescribing were incorporated into the original intervention. The number of repeat medicines was added as a primary outcome measure as were additional secondary patient reported outcome measures to assess treatment burden and attitudes towards deprescribing. Conclusions: A framework was used to systematically describe how and why the original intervention was modified, allowing the new intervention to build upon an effective and robustly developed intervention but also to be relevant in the context of the current evidence base.

The Oxford Handbook of Autism and Co-Occurring Psychiatric Conditions

2020 ◽  
Keyword(s):  
Sleep Problems ◽  
Evidence Base ◽  
Autism Spectrum ◽  
Current Evidence ◽  
Future Research ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Current Evidence Base ◽  
Psychiatric Conditions ◽  
Adults With Asd

People with autism spectrum disorder (ASD) are often diagnosed, and treated for, co-occurring mental health disorders. Co-occurring problems are, in fact, a primary reason for referral and treatment-seeking. Research on comorbidity and its management in youth and adults with ASD has expanded at a rapid rate over the last decade. This is the first comprehensive volume on the topic of co-occurring psychiatric conditions and symptoms in ASD. In this Handbook, internationally recognized clinical scientists synthesize the research on assessment and evidence-based treatment for a broad range of conditions as they present in ASD, from childhood through adulthood. In addition to coverage of formal diagnoses that frequently present in ASD (e.g., mood and anxiety disorders), common behavioural concerns (e.g., psychosexual and sleep problems) are also addressed. Each chapter summarizes the condition or disorder as it presents in ASD, and presents the extant research on its prevalence, developmental course, etiology, and assessment and diagnosis in the context of ASD. Each chapter also includes a summary of evidence-based treatment approaches or current best practices for intervention, as well as a case example to demonstrate application. Chapters are also included to synthesize broader issues related to co-occurring psychiatric conditions in ASD, including a historical overview and conceptual framework for co-occurring conditions in ASD, crisis management, and psychopharmacology. In sum, this handbook is comprehensive compilation of the current evidence-base and recommendations for future research to inform clinical practice related to co-occurring psychiatric conditions and symptoms in ASD.

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