scholarly journals 1300 Version Abnormalities of the Femur and Acetabulum in Patients with Femoroacetabular Impingement: A Systematic Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
Z Arshad ◽  
H D Maughan ◽  
M H Pettit ◽  
K H S Kumar ◽  
A Arora ◽  
...  
Keyword(s):  
Systematic Review ◽  
Femoroacetabular Impingement ◽  
Clinical Decision Making ◽  
Slipped Capital Femoral Epiphysis ◽  
Clinical Decision ◽  
Open Science ◽  
Distribution Analysis ◽  
Inclusion Criteria ◽  
Acetabular Version ◽  
Femoral Version

Abstract Aim This systematic review aims to understand the relationship between version abnormalities of the femur and acetabulum in patients with primary and secondary femoroacetabular impingement (FAI). Method A systematic review was conducted according to PRISMA guidelines. A computer-based search was performed using the EMBASE, MEDLINE, PubMed and Cochrane databases for articles relating to version and torsional abnormalities in FAI, Legg-Calve-Perthes disease (LCPD) and slipped capital femoral epiphysis (SCFE). The study was registered in the Open Science Framework. Two authors independently performed title/abstract and full text screening according to predetermined inclusion criteria. Results A total of 1206 articles were identified 55 articles, involving 10, 091 hips, met the inclusion criteria. All studies evaluating femoral/acetabular version in FAI reported ‘normal’ mean version values (10o to 25o). However, distribution analysis revealed that an estimated 31.4% and 51.3% of patients with FAI displayed abnormal acetabular and femoral version, respectively. Abnormal femoral version was reported in an estimated 74.5% of hips with LCPD, and abnormal acetabular version in an estimated 20%. Acetabular version was significantly lower in hips with SCFE compared to controls (Z=-3.26, P < 0.01). Conclusions Patients presenting with hip pain attributed to FAI are likely to display an abnormality in femoral or acetabular version. This highlights the importance of evaluating these parameters during assessment of these patients, in order to guide clinical decision making.

scholarly journals Over one third of patients with symptomatic femoroacetabular impingement display femoral or acetabular version abnormalities

2021 ◽  
Author(s):  
Zaki Arshad ◽  
Henry David Maughan ◽  
Karadi Hari Sunil Kumar ◽  
Matthew Pettit ◽  
Arvind Arora ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Original Research ◽  
Distribution Analysis ◽  
Inclusion Criteria ◽  
Acetabular Version ◽  
Level Of Evidence ◽  
Femoral Version ◽  
Normal Mean ◽  
The Relationship

Abstract Purpose The aim of this study was investigate the relationship between version and torsional abnormalities of the acetabulum, femur and tibia in patients with symptomatic FAI. Methods A systematic review was performed according to PRISMA guidelines using the EMBASE, MEDLINE, PubMed and Cochrane databases. Original research articles evaluating the described version and torsional parameters in FAI were included. The MINORS criteria were used to appraise study quality and risk of bias. Mean version and torsion values were displayed using forest plots and the estimated proportion of hips displaying abnormalities in version/torsion were calculated. Results A total of 1206 articles were identified from the initial search, with 43 articles, involving 8861 hips, meeting the inclusion criteria. All studies evaluating femoral or acetabular version in FAI reported ‘normal’ mean version values (10–25 °). However, distribution analysis revealed that an estimated 31% and 51% of patients with FAI displayed abnormal central acetabular and femoral version, respectively. Conclusion Up to 51% of patients presenting with symptomatic FAI show an abnormal femoral version, whilst up to 31% demonstrate abnormal acetabular version. This high percentage of version abnormalities highlights the importance of evaluating these parameters routinely during assessment of patients with FAI, to guide clinical decision-making. Level of evidence IV.

scholarly journals Influence of Femoral Version on the Outcomes of Hip Arthroscopic Surgery for Femoroacetabular Impingement or Labral Tears: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110091
Author(s):  
Chenghui Wang ◽  
Yaying Sun ◽  
Zheci Ding ◽  
Jinrong Lin ◽  
Zhiwen Luo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Femoroacetabular Impingement ◽  
Arthroscopic Surgery ◽  
Harris Hip Score ◽  
Cochrane Library ◽  
Femoral Version ◽  
Labral Tears ◽  
Significant Difference ◽  
Secondary Outcomes

Background: It remains controversial whether abnormal femoral version (FV) affects the outcomes of hip arthroscopic surgery for femoroacetabular impingement (FAI) or labral tears. Purpose: To review the outcomes of hip arthroscopic surgery for FAI or labral tears in patients with normal versus abnormal FV. Study Design: Systematic review; Level of evidence, 4. Methods: Embase, PubMed, and the Cochrane Library were searched in July 2020 for studies reporting the outcomes after primary hip arthroscopic surgery for FAI or labral tears in patients with femoral retroversion (<5°), femoral anteversion (>20°), or normal FV (5°-20°). The primary outcome was the modified Harris Hip Score (mHHS), and secondary outcomes were the visual analog scale (VAS) for pain, Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), Non-Arthritic Hip Score (NAHS), failure rate, and patient satisfaction. The difference in preoperative and postoperative scores (Δ) was also calculated when applicable. Results: Included in this review were 5 studies with 822 patients who underwent hip arthroscopic surgery for FAI or labral tears; there were 166 patients with retroversion, 512 patients with normal version, and 144 patients with anteversion. Patients with retroversion and normal version had similar postoperative mHHS scores (mean difference [MD], 2.42 [95% confidence interval (CI), –3.42 to 8.26]; P = .42) and ΔmHHS scores (MD, –0.70 [96% CI, –8.56 to 7.15]; P = .86). Likewise, the patients with anteversion and normal version had similar postoperative mHHS scores (MD, –3.09 [95% CI, –7.66 to 1.48]; P = .18) and ΔmHHS scores (MD, –1.92 [95% CI, –6.18 to 2.34]; P = .38). Regarding secondary outcomes, patients with retroversion and anteversion had similar ΔNAHS scores, ΔHOS-SSS scores, ΔVAS scores, patient satisfaction, and failure rates to those with normal version, although a significant difference was found between the patients with retroversion and normal version regarding postoperative NAHS scores (MD, 5.96 [95% CI, 1.66-10.26]; P = .007) and postoperative HOS-SSS scores (MD, 7.32 [95% CI, 0.19-14.44]; P = .04). Conclusion: The results of this review indicated that abnormal FV did not significantly influence outcomes after hip arthroscopic surgery for FAI or labral tears.

scholarly journals Diagnostic utility of the Active Compression Test for the superior labrum anterior posterior tear: A systematic review

2018 ◽  
Vol 11 (5) ◽  
pp. 321-331
Author(s):  
Cody Davis ◽  
Jenna Immormino ◽  
Brendan M Higgins ◽  
Kyle Clark ◽  
Samuel Engebose ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Compression Test ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Risk Of Bias ◽  
Pretest Probability ◽  
Positive Finding ◽  
Negative Finding ◽  
Superior Labrum

Background The Active Compression Test has been proposed to have high diagnostic accuracy for superior labrum anterior to posterior tears. The aim of this systematic review was to compile the available evidence for this test and evaluate its diagnostic accuracy. Methods The databases PubMed, Embase, Cochrane, CINAHL, and SCOPUS were searched for case control, diagnostic studies that evaluated the Active Compression Test between 1999 (date of test introduction) and February 2018. Two independent review authors screened the search results, assessed the risk of bias using QUADAS-2, and extracted the data. Results Eighteen studies (pooled sample = 3091) were included in this review. Twelve out of 18 studies either had high or unclear risk of bias (66.6%). Results from the pooled analysis of all 18 studies provided that the Active Compression Test is more sensitive (71.5: 95% CI = 68.8, 74.0) than specific (51.9: 95% CI = 50.7, 53.1) and only marginally influenced posttest probability from a pretest probability of 31.7–40.72% with a positive finding and a pretest probability of 31.7–20.33% with a negative finding. Discussion The Active Compression Test has both limited screening and confirmation ability; therefore, we do not advocate for its use in clinical decision making.

scholarly journals Validation of parsimonious prognostic models for patients infected with COVID-19

2021 ◽  
Vol 28 (1) ◽  
pp. e100267
Author(s):  
Keerthi Harish ◽  
Ben Zhang ◽  
Peter Stella ◽  
Kevin Hauck ◽  
Marwa M Moussa ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Validation Cohort ◽  
External Validation ◽  
Clinical Decision ◽  
Prognostic Models ◽  
Clinical Prediction ◽  
Inclusion Criteria ◽  
Local Data ◽  
External Data ◽  
Operator Curve

ObjectivesPredictive studies play important roles in the development of models informing care for patients with COVID-19. Our concern is that studies producing ill-performing models may lead to inappropriate clinical decision-making. Thus, our objective is to summarise and characterise performance of prognostic models for COVID-19 on external data.MethodsWe performed a validation of parsimonious prognostic models for patients with COVID-19 from a literature search for published and preprint articles. Ten models meeting inclusion criteria were either (a) externally validated with our data against the model variables and weights or (b) rebuilt using original features if no weights were provided. Nine studies had internally or externally validated models on cohorts of between 18 and 320 inpatients with COVID-19. One model used cross-validation. Our external validation cohort consisted of 4444 patients with COVID-19 hospitalised between 1 March and 27 May 2020.ResultsMost models failed validation when applied to our institution’s data. Included studies reported an average validation area under the receiver–operator curve (AUROC) of 0.828. Models applied with reported features averaged an AUROC of 0.66 when validated on our data. Models rebuilt with the same features averaged an AUROC of 0.755 when validated on our data. In both cases, models did not validate against their studies’ reported AUROC values.DiscussionPublished and preprint prognostic models for patients infected with COVID-19 performed substantially worse when applied to external data. Further inquiry is required to elucidate mechanisms underlying performance deviations.ConclusionsClinicians should employ caution when applying models for clinical prediction without careful validation on local data.

scholarly journals Quality of life of elderly patients with solid tumours undergoing adjuvant cancer therapy: a systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e018101 ◽  
Author(s):  
Karis Kin-Fong Cheng ◽  
Ethel Yee-Ting Lim ◽  
Ravindran Kanesvaran
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Elderly Patients ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Risk Of Bias ◽  
Solid Tumours

ObjectivesThe measurement of quality of life (QoL) in elderly cancer population is increasingly being recognised as an important element of clinical decision-making and the evaluation of treatment outcome. This systematic review aimed to summarise the evidence of QoL during and after adjuvant therapy in elderly patients with cancer.MethodsA systematic search was conducted of studies published in CINAHL plus, CENTRAL, PubMed, PsycINFO and Web of Science from the inception of these databases to December 2016. Eligible studies included RCTs and non-RCTs in which QoL was measured in elderly patients (aged 65 years or above) with stage I–III solid tumours who were undergoing adjuvant chemotherapy and/or radiotherapy. Because of the heterogeneity and the insufficient data among the included studies, the results were synthesised narratively.ResultsWe included 4 RCTs and 14 non-RCTs on 1785 participants. In all four RCTs, the risk of bias was low or unclear for most items but high for detection. Of the 14 non-RCTs, 5 studies were judged to have a low or moderate risk of bias for all domains, and the other 9 studies had a serious risk of bias in at least one domain. The bias was observed mainly in the confounding and in the selection of participants for the study. For most elderly patients with breast cancer, the non-significant negative change in the QoL was transient. A significant increase in the QoL during the course of temozolomide in elderly patients with glioblastoma but a decreasing trend in QoL after radiotherapy was shown. This review also shows a uniform trend of stable or improved QoL during adjuvant therapy and at follow-up evaluations across the studies with prostate, colon or cervical cancer population.ConclusionsThis review suggests that adjuvant chemotherapy and radiotherapy may not have detrimental effects on QoL in most elderly patients with solid tumours.

scholarly journals Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments to improve psychological outcome – a systematic review

2002 ◽  
Vol 32 (8) ◽  
pp. 1345-1356 ◽  
Author(s):  
S. M. GILBODY ◽  
A. O. HOUSE ◽  
T. SHELDON
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Assessment Instruments ◽  
Health Related Quality ◽  
Routine Administration ◽  
Related Quality ◽  
Health Related

Background. Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments has been advocated as part of clinical care to aid the recognition of psychosocial problems, to inform clinical decision making, to monitor therapeutic response and to facilitate patient–doctor communication. However, their adoption is not without cost and the benefit of their use is unclear.Method. A systematic review was conducted. We sought experimental studies that examined the addition of routinely administered measures of HRQoL to care in both psychiatric and non-psychiatric settings. We searched the following databases: MEDLINE, EMBASE, CINAHL, PsycLIT and Cochrane Controlled Trials Register (to 2000). Data were extracted independently and a narrative synthesis of results was presented.Results. Nine randomized and quasi-randomized studies conducted in non-psychiatric settings were found. All the instruments used included an assessment of mental well-being, with specific questions relating to depression and anxiety. The routine feedback of these instruments had little impact on the recognition of mental disorders or on longer term psychosocial functioning. While clinicians welcomed the information these instruments imparted, their results were rarely incorporated into routine clinical decision making. No studies were found that examined the value of routine assessment and feedback of HRQoL or patient needs in specialist psychiatric care settings.Conclusions. Routine HRQoL measurement is a costly exercise and there is no robust evidence to suggest that it is of benefit in improving psychosocial outcomes of patients managed in non-psychiatric settings. Major policy initiatives to increase the routine collection and use of outcome measures in psychiatric settings are unevaluated.

scholarly journals The experiences of family members witnessing the diminishing drinking of a dying relative: An adapted meta-narrative literature review

2019 ◽  
Vol 33 (9) ◽  
pp. 1146-1157 ◽  
Author(s):  
Annie Pettifer ◽  
Katherine Froggatt ◽  
Sean Hughes
Keyword(s):  
Oral Fluid ◽  
Cancer Cachexia ◽  
Clinical Decision Making ◽  
Family Members ◽  
Clinical Decision ◽  
Future Research ◽  
Inclusion Criteria ◽  
Relevant Research ◽  
Narrative Literature ◽  
Narrative Literature Review

Background:Addressing the concerns of family members is an important aspect of palliative and end-of-life care. One aspect that commonly causes family caregivers concern is the decline of patients’ oral fluid intake in the last few days of life.Aim:To map the narratives in which family members’ experiences of witnessing the diminishing drinking of a dying relative have been researched, review the findings within each narrative and consider directions for future research.Design:An adapted meta-narrative review approach.Data Sources:The Cumulative Index of Nursing and Applied Health Literature, Medline, PsycINFO, Psycharticles and Scopus databases were searched for relevant research published between January 1982 and December 2017. Quality was assessed using the Quality Assessment and Review Instrument.Results:A total of 22 papers met the inclusion criteria. No study focused specifically on the experiences of family members when witnessing the diminishing drinking of dying relatives. However, research about diminishing drinking was identified within studies broadly focusing on cancer cachexia, clinical decision-making about hydration and/or nutrition and support in a hospice context. The research indicates that family members’ experiences of diminishing drinking vary with their views about the significance of drinking, dying well and their expectations of themselves and healthcare professionals.Conclusion:While some understanding of the topic can be inferred from research in related areas, there is a paucity of information specifically about family members’ experiences when witnessing the diminishing drinking of a dying relative.

scholarly journals Host Inflammatory Biomarkers of Disease Severity in Pediatric Community-Acquired Pneumonia: A Systematic Review and Meta-analysis

2019 ◽  
Vol 6 (12) ◽  
Author(s):  
Catarina D Fernandes ◽  
María B Arriaga ◽  
Maria Carolina M Costa ◽  
Maria Clara M Costa ◽  
Maria Heloina M Costa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Disease Severity ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Serum Levels ◽  
Community Acquired Pneumonia ◽  
Inflammatory Biomarkers ◽  
Cross Sectional ◽  
Cell Counts

Abstract Background Community-acquired pneumonia (CAP) is the leading cause of death in children. Identification of reliable biomarkers offers the potential to develop a severity quantitative score to assist in clinical decision-making and improve outcomes. Methods A systematic review and meta-analysis was performed in PubMed and EMBASE on November 13, 2018, to examine the association between host inflammatory biomarkers and CAP severity in children. The inclusion criteria were case–control, cross-sectional, and cohort studies that examined candidate serum biomarkers. We extracted outcomes of interest, means, and standardized mean differences (SMDs) of plasma and serum levels of biomarkers together with information on disease severity. Meta-analysis was performed. This review was registered in the PROSPERO international registry (CRD42019123351). Results Two hundred seventy-two abstracts were identified, and 17 studies were included. Among the biomarkers evaluated, levels of C-reactive protein (CRP; SMD, 0.63; 95% confidence interval [CI], 0.35 to 0.91), interleukin (IL)-6 (SMD, 0.46; 95% CI, 0.25 to 0.66), IL-8 (SMD, 0.72; 95% CI, 0.15 to 1.29), neutrophil count (SMD, 0.27; 95% CI, 0.07 to 0.47), and procalcitonin (SMD, 0.68; 95% CI, 0.20 to 1.15) were substantially increased in severe CAP. In contrast, IL-2 concentrations (SMD, –0.24; 95% CI, –0.45 to –0.03) were higher in nonsevere CAP. Study heterogeneity was reported to be high (I2 &gt; 75%), except for IL-2, IL-5, IL-6, and IL-12p70, which were classified as moderate (I2 = 50%–74%). Only neutrophil and white blood cell counts were described by studies exhibiting a low level of heterogeneity. Conclusions Our results suggest that host biomarkers, and especially CRP, IL-6, IL-8, and procalcitonin levels, have the potential to predict severe CAP in pediatric populations.

scholarly journals Dantrolene in the treatment of MDMA-related hyperpyrexia: a systematic review

CJEM ◽  
2010 ◽  
Vol 12 (05) ◽  
pp. 435-442 ◽  
Author(s):  
Brian E. Grunau ◽  
Matthew O. Wiens ◽  
Jeffrey R. Brubacher
Keyword(s):  
Systematic Review ◽  
Clinical Decision Making ◽  
Case Reports ◽  
Data Extraction ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
Poison Control ◽  
Published Data ◽  
Published Evidence

ABSTRACTObjective:The use of dantrolene in the treatment of hyperpyrexia related to MDMA (3,4-methylenedioxymethamphetamine) is controversial, with little data available to guide clinical decision-making. Although the treatment is recommended by several poison control centres, published data are primarily in the form of case reports and animal and in vitro experiments. We conducted a systematic review to investigate the published evidence regarding the safety and benefits of dantrolene for MDMA-related hyperpyrexia in humans.Data sources:A systematic search of Embase and MEDLINE was conducted from the earliest possible date to November 2008.Study selection:All human trials and case reports of MDMA-related hyperpyrexia were considered.Data extraction:Data were abstracted systematically and characteristics including use of dantrolene, adverse reactions attributed to dantrolene, peak temperature, complications from MDMA-related hyperpyrexia and survival were recorded.Data synthesis:Our search yielded 668 articles of which 53, reporting 71 cases of MDMA-induced hyperpyrexia, met our inclusion criteria. No clinical trials, randomized controlled trials, observational studies or meta-analyses were identified. Dantrolene was used in 26 cases. Patient characteristics were similar in the dantrolene and no dantrolene groups. The proportion of survivors was higher in the dantrolene group (21/26) than in the no dantrolene group (25/45). This difference was especially pronounced in those with extreme (≥ 42°C) and severe (≥ 40°C) fever, with a survival rate of 8 of 13 and 10 of 10, respectively, in the dantrolene group compared with 0 of 4 and 15 of 27 in the no dantrolene group. There were no reports of adverse events attributable to dantrolene with the exception of a possible association with an episode of transient hypoglycemia.Conclusion:Our systematic review suggests that dantrolene is safe for patients with MDMA-related hyperpyrexia. Dantrolene may also be associated with improved survival and reduced complications, especially in patients with extreme (≥ 42°C) or severe (≥ 40°C) hyperpyrexia, although this conclusion must be interpreted with caution given the risk of reporting or publication bias.

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