1285 Reporting of Robotic Pancreaticoduodenectomy As A Surgical Innovation: Systematic Review and Narrative Synthesis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
D Scroggie ◽  
K S Lee ◽  
R Purves ◽  
E Sewart ◽  
S Van Laarhoven ◽  
...  
Keyword(s):  
Systematic Review ◽  
Synthesis Method ◽  
Surgical Techniques ◽  
Learning Curves ◽  
Narrative Synthesis ◽  
Minimal Access ◽  
Surgical Innovation ◽  
Research Reporting ◽  
Full Text Review ◽  
Robotic Pancreaticoduodenectomy

Abstract Aim Pancreaticoduodenectomy (PD) is most commonly performed using open surgical techniques. Minimal access approaches have reduced the morbidity of many types of surgery, however technical limitations have hindered the widespread adoption of laparoscopic methods for PD. There has been increasing use of surgical robots to facilitate a minimal access approach, motivated by improved visualisation, ergonomics and dexterity compared to standard laparoscopic methods. Methods for the safe introduction of novel techniques are lacking, and the way in which surgical innovations are reported may affect adoption into clinical practice. The aim of this study is to understand how robotic PD has been reported as a surgical innovation. Method A systematic review is being conducted by the trainee led RoboSurg Collaborative. A literature search was performed to identify primary research reporting outcomes of robotic PD. Articles are being screened in duplicate by title and abstract, then by full text review. The following data will be extracted: study methodology and rationale; centre, surgeons and patient details; governance and ethical considerations; learning curves; details of the intervention, including modifications; and how outcomes were reported, including use of core outcome sets. The data will be analysed using a narrative synthesis method. Results The search identified 1305 articles reporting on robotic pancreas surgery. An interim report of progress will be presented. Conclusions A rich narrative synthesis will enable innovators to understand how robotic PD has been reported. This will encourage transparent, methodical, and meaningful reporting of robotic PD, increasing the quality of clinical evidence.

scholarly journals Effectiveness and meaningful use of paediatric surgical safety checklists and their implementation strategies: a systematic review with narrative synthesis

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016298 ◽  
Author(s):  
Janaka Lagoo ◽  
Steven R Lopushinsky ◽  
Alex B Haynes ◽  
Paul Bain ◽  
Helene Flageole ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Implementation Strategy ◽  
Citation Index ◽  
Improve Patient Safety ◽  
Implementation Strategies ◽  
Meaningful Use ◽  
Narrative Synthesis ◽  
Surgical Safety ◽  
Full Text Review

ObjectiveTo examine the effectiveness and meaningful use of paediatric surgical safety checklists (SSCs) and their implementation strategies through a systematic review with narrative synthesis.Summary background dataSince the launch of the WHO SSC, checklists have been integrated into surgical systems worldwide. Information is sparse on how SSCs have been integrated into the paediatric surgical environment.MethodsA broad search strategy was created using Pubmed, Embase, CINAHL, Cochrane Central, Web of Science, Science Citation Index and Conference Proceedings Citation Index. Abstracts and full texts were screened independently, in duplicate for inclusion. Extracted study characteristic and outcomes generated themes explored through subgroup analyses and idea webbing.Results1826 of 1921 studies were excluded after title and abstract review (kappa 0.77) and 47 after full-text review (kappa 0.86). 20 studies were of sufficient quality for narrative synthesis. Clinical outcomes were not affected by SSC introduction in studies without implementation strategies. A comprehensive SSC implementation strategy in developing countries demonstrated improved outcomes in high-risk surgeries. Narrative synthesis suggests that meaningful compliance is inconsistently measured and rarely achieved. Strategies involving feedback improved compliance. Stakeholder-developed implementation strategies, including team-based education, achieved greater acceptance. Three studies suggest that parental involvement in the SSC is valued by parents, nurses and physicians and may improve patient safety.ConclusionsA SSC implementation strategy focused on paediatric patients and their families can achieve high acceptability and good compliance. SSCs’ role in improving measures of paediatric surgical outcome is not well established, but they may be effective when used within a comprehensive implementation strategy especially for high-risk patients in low-resource settings.

Association of Ventilation during Initial Trauma Resuscitation for Traumatic Brain Injury and Post-Traumatic Outcomes: A Systematic Review

2021 ◽  
pp. 1-6
Author(s):  
Mary Beth Howard ◽  
Nichole McCollum ◽  
Emily C. Alberto ◽  
Hannah Kotler ◽  
Mary E. Mottla ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Trauma Resuscitation ◽  
Cerebral Herniation ◽  
Full Text Review ◽  
Post Traumatic ◽  
Ventilation Strategies ◽  
End Tidal

Abstract Objectives: In the absence of evidence of acute cerebral herniation, normal ventilation is recommended for patients with traumatic brain injury (TBI). Despite this recommendation, ventilation strategies vary during the initial management of patients with TBI and may impact outcome. The goal of this systematic review was to define the best evidence-based practice of ventilation management during the initial resuscitation period. Methods: A literature search of PubMed, CINAHL, and SCOPUS identified studies from 2009 through 2019 addressing the effects of ventilation during the initial post-trauma resuscitation on patient outcomes. Results: The initial search yielded 899 articles, from which 13 were relevant and selected for full-text review. Six of the 13 articles met the inclusion criteria, all of which reported on patients with TBI. Either end-tidal carbon dioxide (ETCO2) or partial pressure carbon dioxide (PCO2) were the independent variables associated with mortality. Decreased rates of mortality were reported in patients with normal PCO2 or ETCO2. Conclusions: Normoventilation, as measured by ETCO2 or PCO2, is associated with decreased mortality in patients with TBI. Preventing hyperventilation or hypoventilation in patients with TBI during the early resuscitation phase could improve outcome after TBI.

scholarly journals Delivering and implementing child and adolescent mental health training for mental health and allied professionals: a systematic review and qualitative meta-aggregation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emily Banwell ◽  
Neil Humphrey ◽  
Pamela Qualter
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Qualitative Research ◽  
Mental Health Professionals ◽  
Synthesis Method ◽  
Barriers And Facilitators ◽  
Youth Workers ◽  
Mental Health Training ◽  
Health Training ◽  
Starting Point

Abstract Background The increasing prevalence of mental health difficulties among children and young people (CYP) suggests that early intervention is vital. A comprehensive system of care and support requires the involvement of mental health professionals, including psychologists and psychiatrists, and allied professionals, including teachers, police, and youth workers. A critical starting point is the provision of effective training, in order that these professionals can better support the mental health needs of the CYP that they encounter. Objectives Given the primacy of training in the CYP mental health support system, understanding the factors that maximise potential gains and facilitate uptake is pertinent. The current review therefore located and explored qualitative research evidence, to identify the barriers and facilitators underpinning successful delivery and implementation of training focussed on the mental health of CYP, for both mental health and allied professionals. Methods A systematic review and qualitative meta-aggregation were conducted. Systematic searches were carried out using ASSIA, EMBASE, MEDLINE, NICE Evidence, PsycINFO, and Scopus databases, for papers published between 2000 and 2020. Twelve thousand four hundred forty-eight records were identified, of which 39 were eligible for review. The records were appraised for quality using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research, and synthesised using the qualitative meta-aggregation method. Results One hundred eighty-two raw findings were extracted from the 39 papers, which were condensed into 47 sub-categories, 19 categories, and finally 5 synthesis statements. These synthesis statements reflected the barriers and facilitators influencing the training delivery process (“support”; “content, design, and planning”), and the implementation of training into the workplace (“context”; “perceived value”; “organisational factors”). Conclusions The synthesis statements and underlying categories provide practical recommendations for those designing, delivering, or implementing CYP mental health training. Recommendations ranged from facilitating peer support during training, to the idea that training will be better implemented when perceived need is high. The review provides a robust evidence-based foundation to “common-sense” principles, drawing them into a coherent and organised framework using a synthesis method grounded in pragmatism. Protocol registration number PROSPERO reference ID: CRD42020162876.

scholarly journals Students’ preparedness for disasters in schools: a systematic review protocol

2020 ◽  
Vol 4 (1) ◽  
pp. e000913
Author(s):  
Hamed Seddighi ◽  
Homeira Sajjadi ◽  
Sepideh Yousefzadeh ◽  
Mónica López López ◽  
Meroe Vameghi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Disaster Preparedness ◽  
Vulnerable Groups ◽  
Narrative Synthesis ◽  
Ethics Code ◽  
Study Characteristics ◽  
And Gender ◽  
Critical Appraisal Skills ◽  
Meta Analyses

IntroductionChildren are one of the most vulnerable groups in disasters. Improving students’ knowledge and skills to prepare for disasters can play a major role in children’s health. School as a place to teach children can make a significant contribution to provide the necessary skills. This study aims to identify the effects, strengths and weaknesses of interventions in schools to prepare children for disasters.Methods and analysisWe use Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to develop a protocol for this systematic review. The included studies will report on the results of interventions targeting ‘schoolchildren’ defined as individuals between 4 and under 18 years old studying in schools. Different electronic databases will be used for a comprehensive literature search, including MEDLINE, Web of Science, CINAHL, PsycINFO, Cochrane Register of Controlled Trials and EMBASE to identify the records that match the mentioned inclusion criteria published till December 2020. The main search terms are ‘disaster’, ‘preparedness’, ‘children’ and ‘school’. Four types of data will be extracted from the qualified studies including study characteristics (study design, year of publication and geographical region where the study was conducted), participant characteristics (sample size, age and gender), intervention characteristics (aim of intervention, intervention facilitators and barriers) and intervention outcomes. The quality appraisal of the selected papers will be conducted using Cochrane Collaboration’s Risk of Bias for quantitative studies and Critical Appraisal Skills Programme checklist for qualitative studies. We use a narrative synthesis for this systematic review. The narrative synthesis refers to an approach to systematic reviews which focuses mostly on applying words and texts to summarise and explain findings.Ethics and disseminationThis paper is a part of a Ph.D. thesis of Hamed Seddighi at University of Social welfare and Rehabilitation Sciences with ethics code IR.USWR.REC.1399.008 approved by the Ethics Committee of the above-mentioned university.PROSPERO registration numberCRD42020146536.

Systematic review and meta-analysis of surgical options for recurrent or persistent carpal tunnel syndrome: simple decompression versus coverage of the median nerve

2021 ◽  
pp. 175319342110017
Author(s):  
Saskia F. de Roo ◽  
Philippe N. Sprangers ◽  
Erik T. Walbeehm ◽  
Brigitte van der Heijden
Keyword(s):  
Systematic Review ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Open Release ◽  
Flap Coverage ◽  
Tunnel Syndrome

We performed a systematic review on the success of different surgical techniques for the management of recurrent and persistent carpal tunnel syndrome. Twenty studies met the inclusion criteria and were grouped by the type of revision carpal tunnel release, which were simple open release, open release with flap coverage or open release with implant coverage. Meta-analysis showed no difference, and pooled success proportions were 0.89, 0.89 and 0.85 for simple open carpal tunnel release, additional flap coverage and implant groups, respectively. No added value for coverage of the nerve was seen. Our review indicates that simple carpal tunnel release without additional coverage of the median nerve seems preferable as it is less invasive and without additional donor site morbidity. We found that the included studies were of low quality with moderate risk of bias and did not differentiate between persistent and recurrent carpal tunnel syndrome.

scholarly journals 105 Functional Recovery in Older Women Undergoing Surgery for Gynaecological Malignancies: A Systematic Review and Narrative Synthesis

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i34-i36
Author(s):  
F E Martin ◽  
T Kalsi ◽  
J K Dhesi ◽  
J S L Partridge
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Older Women ◽  
Functional Recovery ◽  
Narrative Synthesis ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Gynaecological Malignancies

Abstract Introduction Older women are increasingly undergoing surgery for gynaecological malignancies. Although survival data is available other outcomes such as functional recovery are less well described. However older people are both more vulnerable to changes in function and often prioritise function over survival. There is limited published research examining function outside of context of sexual or urodynamic function following gynaeoncology surgery but a large body or research exists examining health-related quality of life (HrQOL) both as a pre-operative risk factor for survival and as a post-treatment outcome measure in its own right. HRQOL tools may report on physical function as a subcomponent within composite tools. This systematic review and narrative synthesis describes functional recovery after gynae-oncology surgery with respect to baseline characteristics which - if identified – could enable pre- or post-operative risk reduction. Methods Systematic search of MEDLINE and EMBASE databases and Cochrane Library between 1974-2018. Two reviewers independently reviewed abstracts/papers for inclusion against the following criteria:Mean/median age >60Gynaeoncological treatment includes surgery (RCTs, observational or mixed methods studies).Any measure of functional ability as defined by WHO ICF classification section D1–D7 inclusive, D855, D860-79 and D9 using validated tool.Minimum pre-operative and one post-operative measure. Results analysed and presented using narrative synthesis. Results Sixteen studies identified (7 Endometrial, 2 Ovarian, 2 Vulval, 6 mixed cancer types). 1/16 used a standalone functional assessment tool, 15/16 used Health-Related Quality of Life tools (EORTC QLQ C30 (10), FACT-G (3), SF-36 (3)) comprising items describing function. More studies showed full recovery to baseline (n=11) than incomplete recovery (n=5 including 2 reporting age as a negative association). Recovery was more likely and occurred faster in minimally-invasive surgery. 1 study demonstrated failure to recover baseline functional independence by 12 months.

A Systematic Review of Sleep and Circadian Rhythms in Children with Attention Deficit Hyperactivity Disorder

2021 ◽  
pp. 108705472097855
Author(s):  
Upasana Bondopadhyay ◽  
Unai Diaz-Orueta ◽  
Andrew N. Coogan
Keyword(s):  
Systematic Review ◽  
Circadian Rhythms ◽  
Sleep Disturbances ◽  
Behavioral Outcomes ◽  
Future Research ◽  
Narrative Synthesis ◽  
Adhd Symptoms ◽  
Children With Adhd ◽  
Hyperactivity Disorder ◽  
Form Part

Objective: Children and adults with ADHD often report sleep disturbances that may form part of the etiology and/or symptomatology of ADHD. We review the evidence for sleep changes in children with ADHD. Methods: Systematic review with narrative synthesis assessing sleep and circadian function in children aged 5 to 13 years old with a diagnosis of ADHD. Results: 148 studies were included for review, incorporating data from 42,353 children. We found that sleep disturbances in ADHD are common and that they may worsen behavioral outcomes; moreover, sleep interventions may improve ADHD symptoms, and pharmacotherapy for ADHD may impact sleep. Conclusion: Sleep disturbance may represent a clinically important feature of ADHD in children, which might be therapeutically targeted in a useful way. There are a number of important gaps in the literature. We set out a manifesto for future research in the area of sleep, circadian rhythms, and ADHD.

scholarly journals Professionals’, patients’ and families’ views on the use of opioids for chronic breathlessness: A systematic review using the framework method and pillar process

2021 ◽  
pp. 026921632110321
Author(s):  
Florence Reedy ◽  
Mark Pearson ◽  
Sarah Greenley ◽  
Joseph Clark ◽  
David C Currow ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
A Priori ◽  
Synthesis Method ◽  
Patient Characteristics ◽  
Severe Illness ◽  
Pharmacological Interventions ◽  
Eligibility Criteria ◽  
Treatment Regimens ◽  
Appraisal Tool

Background: In combination with non-pharmacological interventions, opioids may safely reduce chronic breathlessness in patients with severe illness. However, implementation in clinical practice varies. Aim: To synthesise the published literature regarding health professionals’, patients’ and families’ views on the use of opioids for chronic breathlessness, identifying issues which influence implementation in clinical practice. Design: Systematic review and synthesis using the five-stage framework synthesis method. Data sources: Three electronic databases (MEDLINE, Embase via OVID, ASSIA via Proquest) were searched (March 2020) using a predefined search strategy. Studies were also citation chained from key papers. Papers were screened against a priori eligibility criteria. Data were extracted from included studies using the framework synthesis method. Qualitative and quantitative data were synthesised using the pillar process. Included studies were critically appraised using the Mixed-Methods Appraisal Tool. Results: After de-duplication, 843 papers were identified. Following screening, 22 studies were included. Five themes were developed: (i) clinician/patient characteristics, (ii) education/knowledge/experience, (iii) relationship between clinician/family, (iv) clinician/patient fear of opioids and (v) regulatory issues. Conclusions: There are significant barriers and enablers to the use of opioids for the symptomatic reduction of chronic breathlessness based on the knowledge, views and attitudes of clinicians, patients and families. Clinicians’ interactions with patients and their families strongly influences adherence with opioid treatment regimens for chronic breathlessness. Clinicians’, patients’ and families’ knowledge about the delicate balance between benefits and risks is generally poor. Education for all, but particularly clinicians, is likely to be a necessary (but insufficient) factor for improving implementation in practice.

scholarly journals Mini-Implant-Retained Overdentures for the Rehabilitation of Completely Edentulous Maxillae: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (8) ◽  
pp. 4377
Author(s):  
Serena Vi ◽  
Damon Pham ◽  
Yu Yian Marina Du ◽  
Himanshu Arora ◽  
Santosh Kumar Tadakamadla
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Survival Rate ◽  
Data Extraction ◽  
Meta Analysis ◽  
Empirical Studies ◽  
Implant Survival ◽  
Patient Reported ◽  
Full Text Review

Purpose: Mini-dental implants (MDIs) have been used to support and retain overdentures, providing patients with a less invasive placement procedure. Although lucrative, the use of MDIs to retain a maxillary overdenture is still not an established treatment modality. This systematic review aims to answer the question: Do mini-implant-retained maxillary overdentures provide a satisfactory treatment outcome for complete edentulism? Methods: A systematic search for relevant articles was conducted to include articles published until April 2021 in the following electronic databases: CINAHL, Cochrane, EMBASE, PubMed, and Web of Science. All empirical studies evaluating the biological, survival, or patient-reported outcomes after placing mini-implant-retained overdentures in maxilla were considered for inclusion. The risk of bias was assessed by utilizing the Joanna Briggs Institute critical appraisal checklist. Study screening and data extraction were conducted by three reviewers independently. Results: The electronic search retrieved 1276 titles after omitting duplicates. Twenty articles were considered for full-text review, of which six studies were included in this systematic review. The included studies evaluated a total of 173 participants with a mean age of 66.3 years. The overall mini-implant survival rate was 77.1% (95% CI: 64.7–89.5%) with a mean follow-up time of 1.79 years (range: 6 months to 3 years). Implant survival differed significantly when comparing complete and partial palatal coverage overdentures. Those with complete palatal coverage exhibited less bone loss overall compared to partial coverage overdentures. Participants of all studies reported an increase in the quality of life and in satisfaction after rehabilitation treatment with MDIs. Conclusions: The survival rate of mini-implants retaining an overdenture in the maxilla was observed to be lower than the values reported for traditional implants in the literature. Improvements were observed in all aspects in terms of patient satisfaction, quality of life, oromyofunction, and articulation after the treatment.

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