The effect of ageing on presentation, management and outcomes in degenerative cervical myelopathy: a systematic review

2020 ◽  
Author(s):  
Ben Grodzinski ◽  
Rory Durham ◽  
Oliver Mowforth ◽  
Daniel Stubbs ◽  
Mark R N Kotter ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Status ◽  
Cervical Myelopathy ◽  
Older Patients ◽  
Meta Analysis ◽  
Current Evidence ◽  
Clinical Aspects ◽  
Similar Amount ◽  
Degenerative Cervical Myelopathy ◽  
The Impact

Abstract Objective Degenerative cervical myelopathy (DCM) is a disabling neurological condition. The underlying degenerative changes are known to be more common with age, but the impact of age on clinical aspects of DCM has never been synthesised. The objective of this study is to determine whether age is a significant predictor in three domains—clinical presentation, surgical management and post-operative outcomes of DCM. Methods a systematic review of the Medline and Embase databases (inception to 12 December 2019), registered with PROSPERO (CRD42019162077) and reported in accordance with preferred reporting items of systematic reviews and meta-analysis (PRISMA) guidelines, was conducted. The inclusion criteria were full text articles in English, evaluating the impact of age on clinical aspects of DCM. Results the initial search yielded 2,420 citations, of which 206 articles were eventually included. Age was found to be a significant predictor in a variety of measures. Within the presentation domain, older patients have a worse pre-operative functional status. Within the management domain, older patients are more likely to undergo posterior surgery, with more levels decompressed. Within the outcomes domain, older patients have a worse post-operative functional status, but a similar amount of improvement in functional status. Because of heterogenous data reporting, meta-analysis was not possible. Conclusion the current evidence demonstrates that age significantly influences the presentation, management and outcomes of DCM. Although older patients have worse health at all individual timepoints, they experience the same absolute benefit from surgery as younger patients. This finding is of particular relevance when considering the eligibility of older patients for surgery.

scholarly journals Does Spondylolisthesis Affect Severity and Outcome of Degenerative Cervical Myelopathy? A Systematic Review and Meta-analysis

2020 ◽  
pp. 219256822096045
Author(s):  
Renato Gondar ◽  
Aria Nouri ◽  
Gianpaolo Jannelli ◽  
Karl Schaller ◽  
Enrico Tessitore
Keyword(s):  
Systematic Review ◽  
Cervical Myelopathy ◽  
Meta Analysis ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Postoperative Outcome ◽  
Minor Role ◽  
Recovery Ratio ◽  
Degenerative Cervical Myelopathy ◽  
The Impact

Study Design: This was a systematic review and meta-analysis. Objectives: Degenerative cervical myelopathy (DCM) with spondylolisthesis remains not well defined, poorly studied, and underreported and plays a minor role in the therapeutic decision-making. Spondylolisthesis, however, is not uncommon and may result in dynamic injury to the spinal cord. We aim to describe the impact of spondylolisthesis in DCM severity and postoperative outcomes. Methods: Two independent reviewers conducted a Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA 2015)-based review between 1970 and May 2020 for articles reporting outcome of DCM in patients with degenerative cervical spondylolisthesis. Patient clinical and radiological data was recorded at baseline and during postoperative follow-up (FU). A meta-analysis comparing surgical outcome between DCM patients with and without spondylolisthesis assessed by the regular/modified Japanese Orthopaedic Association Assessment Scale (mJOA) recovery ratio was completed. Results: A total of 3 studies were included (1 ambispective and 2 retrospective cohorts); 607 patients with DCM were identified, 102 (16.8%) of whom also had spondylolisthesis. DCM patients with spondylolisthesis were significantly older ( P < .05), presented with worse baseline mJOA and Nurick grades ( P < .05 in 2 studies), and were more commonly operated via posterior approaches ( P < .05). All groups experienced a (m)JOA and/or Neck Disability Index score improvement during FU. In the pooled meta-analysis, spondylolisthesis patients showed a significantly lower functional recovery ratio at 2 years compared with other DCM patients ( P = .05). Conclusions: Spondylolisthesis is frequent in older DCM patients and may be a predictor of a more advanced degeneration and subsequent worse baseline conditions and postoperative outcome.

scholarly journals Change in Functional Impairment, Disability, and Quality of Life Following Operative Treatment for Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 53S-69S ◽  
Author(s):  
Michael G. Fehlings ◽  
Lindsay A. Tetreault ◽  
Shekar Kurpad ◽  
Darrel S. Brodke ◽  
Jefferson R. Wilson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Operative Treatment ◽  
Functional Impairment ◽  
Cervical Myelopathy ◽  
Surgical Intervention ◽  
Japanese Orthopaedic Association ◽  
Duration Of Symptoms ◽  
Degenerative Cervical Myelopathy ◽  
The Impact

Study Design: Systematic review. Objectives: The primary objective of this systematic review was to define the change in impairment, disability, and pain following surgical intervention in patients with degenerative cervical myelopathy (DCM). Secondary objectives included to assess the impact of preoperative disease severity and duration of symptoms on outcomes and to summarize complications associated with surgery. Methods: A systematic literature search was conducted to identify prospective studies evaluating the effectiveness and safety of operative treatment in patients with DCM. Outcomes of interest were functional status, disability, pain, and complications. The quality of each study was evaluated using the Newcastle-Ottawa Scale, and the strength of the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. Results: Of the 385 retrieved citations, 32 met inclusion criteria and are summarized in this review. Based on our results, pooled standard mean differences showed a large effect for improvement in Japanese Orthopaedic Association or modified Japanese Orthopaedic Association score from baseline at short-, medium-, and long-term follow-up: 6 to 12 months (1.92; 95% confidence interval [CI] = 1.41 to 2.43), 13 to 36 months (1.40; 95% CI = 1.12 to 1.67), and ≥36 months (1.92; 95% CI = 1.14 to 2.69) (moderate evidence). Surgery also resulted in significant improvements in Nurick, Neck Disability Index, and Visual Analogue Scale scores (low to very low evidence). The cumulative incidence of complications was low (14.1%; 95% CI = 10.1% to 18.2%). Conclusion: Surgical intervention for DCM results in significant improvements in functional impairment, disability, and pain and is associated with an acceptably low rate of complications.

scholarly journals The Effect of Anakinra in Hospitalized Patients with COVID-19: An Updated Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (19) ◽  
pp. 4462
Author(s):  
Konstantinos G. Kyriakoulis ◽  
Anastasios Kollias ◽  
Garyphallia Poulakou ◽  
Ioannis G. Kyriakoulis ◽  
Ioannis P. Trontzas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Interleukin 1 ◽  
Severe Pneumonia ◽  
Hospitalized Patients ◽  
Current Evidence ◽  
Adjusted Risk ◽  
Risk Of Death ◽  
The Impact

The role of immunomodulatory agents in the treatment of hospitalized patients with COVID-19 has been of increasing interest. Anakinra, an interleukin-1 inhibitor, has been shown to offer significant clinical benefits in patients with COVID-19 and hyperinflammation. An updated systematic review and meta-analysis regarding the impact of anakinra on the outcomes of hospitalized patients with COVID-19 was conducted. Studies, randomized or non-randomized with adjustment for confounders, reporting on the adjusted risk of death in patients treated with anakinra versus those not treated with anakinra were deemed eligible. A search was performed in PubMed/EMBASE databases, as well as in relevant websites, until 1 August 2021. The meta-analysis of six studies that fulfilled the inclusion criteria (n = 1553 patients with moderate to severe pneumonia, weighted age 64 years, men 66%, treated with anakinra 50%, intubated 3%) showed a pooled hazard ratio for death in patients treated with anakinra at 0.47 (95% confidence intervals 0.34, 0.65). A meta-regression analysis did not reveal any significant associations between the mean age, percentage of males, mean baseline C-reactive protein levels, mean time of administration since symptoms onset among the included studies and the hazard ratios for death. All studies were considered as low risk of bias. The current evidence, although derived mainly from observational studies, supports a beneficial role of anakinra in the treatment of selected patients with COVID-19.

PIK3CA Mutations and Their Impact on Survival Outcomes of Patients with Cervical Cancer: A Systematic Review

2020 ◽  
Vol 64 (6) ◽  
pp. 547-555
Author(s):  
Vasilios Pergialiotis ◽  
Christina Nikolaou ◽  
Dimitrios Haidopoulos ◽  
Maximos Frountzas ◽  
Nikolaos Thomakos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Cancer Progression ◽  
Meta Analysis ◽  
Current Evidence ◽  
Survival Outcomes ◽  
Cochrane Central Register ◽  
Wild Type ◽  
Pik3ca Mutations ◽  
The Impact

<b><i>Introduction:</i></b> Several studies have implicated the PIK3/AKT pathway in the pathophysiology of cancer progression as its activation seems to be aberrant in several forms of cancer. The purpose of the present systematic review is to evaluate the impact of PIK3CA mutations on survival outcomes of patients with cervical cancer. <b><i>Methods:</i></b> We used the Medline (1966–2020), Scopus (2004–2020), ClinicalTrials.gov (2008–2020), EMBASE (1980–2020), Cochrane Central Register of Controlled Trials (CENTRAL) (1999–2020), and Google Scholar (2004–2020) databases in our primary search along with the reference lists of electronically retrieved full-text papers. Statistical meta-analysis was performed with the RevMan 5.3 software. <b><i>Results:</i></b> Overall, 12 articles were included in the present study that comprised 2,196 women with cervical cancer. Of those, 3 studies did not report significant differences in survival outcomes among patients with mutated versus wild-type PIK3CA tumors, 5 studies reported decreased survival outcomes, and 3 studies revealed increased survival rates. The meta-analysis revealed that patients with the mutated PIK3CA genotypes had worse overall survival compared to patients with wild-type PIK3CA (HR 2.31; 95% CI: 1.51, 3.55; 95% PI: 0.54, 9.96; data from 3 studies) and the same was observed in the case of DFS rates (HR 1.82; 95% CI: 1.47, 2.25; 95% PI: 1.29, 2.56; data from 4 studies). <b><i>Conclusion:</i></b> Current evidence concerning the impact of PIK3CA mutations on survival outcomes of patients with cervical cancer is inconclusive, although the majority of included studies support a potential negative effect, primarily among those with squamous cell carcinoma tumors.

scholarly journals Long-Term Growth in Phenylketonuria: A Systematic Review and Meta-Analysis

Nutrients ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 2070 ◽  
Author(s):  
Fatma Ilgaz ◽  
Alex Pinto ◽  
Hülya Gökmen-Özel ◽  
Julio César Rocha ◽  
Esther van Dam ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Normal Growth ◽  
Optimal Growth ◽  
Current Evidence ◽  
Eligibility Criteria ◽  
Dietary Practices ◽  
Dietary Treatments ◽  
The Impact

There is an ongoing debate regarding the impact of phenylketonuria (PKU) and its treatment on growth. To date, evidence from studies is inconsistent, and data on the whole developmental period is limited. The primary aim of this systematic review was to investigate the effects of a phenylalanine (Phe)-restricted diet on long-term growth in patients with PKU. Four electronic databases were searched for articles published until September 2018. A total of 887 results were found, but only 13 articles met eligibility criteria. Only three studies had an adequate methodology for meta-analysis. Although the results indicate normal growth at birth and during infancy, children with PKU were significantly shorter and had lower weight for age than reference populations during the first four years of life. Impaired linear growth was observed until the end of adolescence in PKU. In contrast, growth impairment was not reported in patients with mild hyperphenylalaninemia, not requiring dietary restriction. Current evidence indicates that even with advances in dietary treatments, “optimal” growth outcomes are not attained in PKU. The majority of studies include children born before 1990s, so further research is needed to show the effects of recent dietary practices on growth in PKU.

scholarly journals Comorbidity and outcomes in traumatic brain injury: protocol for a systematic review on functional status and risk of death

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e018626 ◽  
Author(s):  
Tatyana Mollayeva ◽  
Chen Xiong ◽  
Sara Hanafy ◽  
Vincy Chan ◽  
Zheng Jing Hu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Functional Status ◽  
Medical Information ◽  
Longitudinal Design ◽  
Adverse Outcomes ◽  
Current Evidence ◽  
Risk Of Death ◽  
The Impact

IntroductionReports on the association between comorbidity and functional status and risk of death in patients with traumatic brain injury (TBI) have been inconsistent; it is currently unknown which additional clinical entities (comorbidities) have an adverse influence on the evolution of outcomes across the lifespan of men and women with TBI. The current protocol outlines a strategy for a systematic review of the current evidence examining the impact of comorbidity on functional status and early-term and late-term mortality, taking into account known risk factors of these adverse outcomes (ie, demographic (age and sex) and injury-related characteristics).Methods and analysisA comprehensive search strategy for TBI prognosis, functional (cognitive and physical) status and mortality studies has been developed in collaboration with a medical information specialist of the large rehabilitation teaching hospital. All peer-reviewed English language studies with longitudinal design in adults with TBI of any severity, published from May 1997 to April 2017, found through Medline, Central, Embase, Scopus, PsycINFO and bibliographies of identified articles, will be considered eligible. Study quality will be assessed using published guidelines.Ethics and disseminationThe authors will publish findings from this review in a peer-reviewed scientific journal(s) and present the results at national and international conferences. This work aims to understand how comorbidity may contribute to adverse outcomes in TBI, to inform risk stratification of patients and guide the management of brain injury acutely and at the chronic stages postinjury on a population level.PROSPERO registration numberCRD42017070033.

scholarly journals The Impact of Enhanced Recovery After Surgery on Total Joint Arthroplasty: Protocol for a Systematic Review and Meta-analysis

10.2196/25581 ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. e25581
Author(s):  
Siddharth Rele ◽  
Cade Shadbolt ◽  
Chris Schilling ◽  
Nicholas F Taylor ◽  
Michelle M Dowsey ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Service ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Recovery Of Function ◽  
Meta Analysis ◽  
Current Evidence ◽  
Cochrane Library ◽  
Economic Evaluations ◽  
The Impact

Background The number of total joint arthroplasties (TJAs) being performed is increasing worldwide. To match this increasing demand, there has been focus on hastening patients’ recovery of function. This effort has culminated in the formulation of enhanced recovery after surgery (ERAS) strategies. However, with evolving ERAS programs and new recommendations, a review of current evidence is required to provide clinicians with up-to-date information about its effect on outcomes for TJA. Objective The objective of this study is to assess the utility of ERAS programs on patient, health service, and economic outcomes for primary, elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods A systematic search will be conducted in Medline (Ovid), EMCARE (Ovid), EMBASE (Ovid), Web of Science, CINAHL, National Health Service Economic Evaluations Database, and the Cochrane Library. Analytical, observational, and experimental designs will be included in this systematic review. Only studies including patients undergoing primary TKA and THA comparing ERAS programs with conventional surgery and postoperative care will be included. Data related to patient outcomes, health service outcomes, safety, and economic evaluation will be extracted. Results The search terms and primary database searches have been finalized. Findings will be reported in narrative and tabular form. Where appropriate, random effects meta-analyses will be conducted for each outcome, and heterogeneity quantified with Cochran Q test and I2 statistic. Measures of effect or mean differences will be reported with 95% confidence intervals. The results of this systematic review will be disseminated in a peer-reviewed journal. Conclusions This protocol will guide a systematic review assessing outcomes associated with ERAS surgery in primary THA and TKA. Trial Registration Open Science Framework osf.io/y4bhs; https://osf.io/y4bhs International Registered Report Identifier (IRRID) PRR1-10.2196/25581

scholarly journals The Role of Nutrition in Degenerative Cervical Myelopathy: A Systematic Review

2021 ◽  
Vol 14 ◽  
pp. 117863882110546
Author(s):  
Celine I Partha Sarathi ◽  
Oliver D Mowforth ◽  
Amil Sinha ◽  
Faheem Bhatti ◽  
Aniqah Bhatti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Surgical Outcome ◽  
Assessment Tool ◽  
Hospital Readmissions ◽  
Functional Improvement ◽  
Current Evidence ◽  
Degenerative Cervical Myelopathy

Introduction: Degenerative cervical myelopathy (DCM) is the commonest cause of adult spinal cord impairment worldwide, encompassing chronic compression of the spinal cord, neurological disability and diminished quality of life. Evidence on the contribution of environmental factors is sparse; in particular, the role of nutrition in DCM is unknown. The objective of this review was to assess the effect of nutrition on DCM susceptibility, severity and surgical outcome. Methods: A systematic review in MEDLINE and Embase was conducted following PRISMA guidelines. Full-text papers in English papers, focussing on cervical myelopathy and nutrition, published before January 2020 were considered eligible. Quality assessments were performed using the GRADE assessment tool. Patient demographics, nutritional factor and DCM outcomes measures were recorded. Relationships between nutritional factors, interventions and disease prognosis were assessed. Results: In total, 5835 papers were identified of which 44 were included in the final analysis. DCM patients with pathological weight pre-operatively were more likely to see poorer improvements post-surgically. These patients experienced poorer physical and mental health improvements from surgery compared to normal weight patients and were more likely to suffer from post-operative complications such as infection, DVT, PE and hospital readmissions. Two trials reporting benefits of nutritional supplements were identified, with 1 suggesting Cerebrolysin to be significant in functional improvement. An unbalanced diet, history of alcohol abuse and malnourishment were associated with poorer post-operative outcome. Conclusion: Although the overall strength of recommendation is low, current evidence suggests nutrition may have a significant role in optimising surgical outcome in DCM patients. Although it may have a role in onset and severity of DCM, this is a preliminary suggestion. Further work needs to be done on how nutrition is defined and measured, however, the beneficial results from studies with nutritional interventions suggest nutrition could be a treatment target in DCM.

scholarly journals Recruitment and retention of fathers with young children in early childhood health intervention research: a systematic review and meta-analysis protocol

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Elizabeth M. Keys ◽  
Jill M. Norris ◽  
Emily E. Cameron ◽  
Katherine S. Bright ◽  
Lianne M. Tomfohr-Madsen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Early Childhood ◽  
Meta Analysis ◽  
Intervention Research ◽  
Current Evidence ◽  
Retention Strategies ◽  
Childhood Health ◽  
Recruitment And Retention ◽  
Early Childhood Health ◽  
The Impact

Abstract Background Fathers are under-represented in research and programs addressing early childhood health and development. Recruiting fathers into these interventions can be hampered for multiple reasons, including recruitment and retention strategies that are not tailored for fathers. The primary aim of this systematic review and meta-analysis is to determine the effectiveness of recruitment and retention strategies used to include fathers of children (from conception to age 36 months) in intervention studies. The secondary aim is to investigate study-level factors that may influence recruitment and retention. Methods We will conduct searches for scholarly peer-reviewed randomized controlled trials, quasi-experimental studies, and pre-post studies that recruited fathers using the following databases: MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), and CINAHL. English-language articles will be eligible if they recruited self-identified fathers of children from conception to age 36 months for health-promoting interventions that target healthy parents and children. Two reviewers will independently screen titles/abstracts and full texts for inclusion, as well as grading methodological quality. Recruitment and retention proportions will be calculated for each study. Where possible, we will calculate pooled proportional effects with 95% confidence intervals using random-effects models and conduct a meta-regression to examine the impact of potential modifiers of recruitment and retention. Discussion Findings from this review will help inform future intervention research with fathers to optimally recruit and retain participants. Identifying key factors should enable health researchers and program managers design and adapt interventions to increase the likelihood of increasing father engagement in early childhood health interventions. Researchers will be able to use this review to inform future research that addresses current evidence gaps for the recruitment and retention of fathers. This review will make recommendations for addressing key target areas to improve recruitment and retention of fathers in early childhood health research, ultimately leading to a body of evidence that captures the full potential of fathers for maximizing the health and wellbeing of their children. Systematic review registration PROSPERO CRD42018081332.

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