Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Incidence of Shunt-Dependent Hydrocephalus in Infants With Myelomeningocele After Prenatal Versus Postnatal Repair

Abstract BACKGROUND Myelomeningocele (MM) is a condition that is responsible for considerable morbidity in the pediatric population. A significant proportion of the morbidity related to MM is attributable to hydrocephalus and the surgical management thereof. Postnatal repair remains the most common form of treatment; however, increased rates of prenatal diagnosis, advances in fetal surgery, and a hypothesis that neural injury continues in utero until the MM defect is repaired have led to the development and evaluation of prenatal surgery as a means to improve outcomes in afflicted infants. OBJECTIVE The objective of this guideline is to systematically evaluate the literature to determine whether there is a difference in the proportion of patients who develop shunt-dependent hydrocephalus in infants who underwent prenatal MM repair compared to infants who had postnatal repair. METHODS The Guidelines Task Force developed search terms and strategies used to search PubMed and Embase for relevant literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used to screen abstracts and to develop a list of relevant articles for full-text review. Full-text articles were then reviewed, and when appropriate, included as evidence. RESULTS A total of 87 abstracts were identified and reviewed by 3 independent reviewers. Thirty-nine full-text articles were selected for analysis. Three studies met selection criteria and were included in the evidence table. CONCLUSION Class I evidence from 1 study and class III evidence from 2 studies suggest that, in comparison to postnatal repair, prenatal surgery for MM reduces the risk of developing shunt-dependent hydrocephalus. Therefore, prenatal repair of MM is recommended for those fetuses who meet specific criteria for prenatal surgery to reduce the risk of developing shunt-dependent hydrocephalus (level I). Differences between prenatal and postnatal repair with respect to the requirement for permanent cerebrospinal fluid diversion should be considered alongside other relevant maternal and fetal factors when deciding upon a preferred method of MM closure. The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-2.

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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Closure of Myelomeningocele Within 48 Hours to Decrease Infection Risk

Neurosurgery ◽

10.1093/neuros/nyz264 ◽

2019 ◽

Vol 85 (3) ◽

pp. E412-E413

Author(s):

Alexandra D Beier ◽

Dimitrios C Nikas ◽

Nadege Assassi ◽

David F Bauer ◽

Jeffrey P Blount ◽

...

Keyword(s):

Wound Infection ◽

Full Text ◽

Task Force ◽

Relevant Literature ◽

Complication Rates ◽

Class Iii ◽

Inclusion Criteria ◽

Full Text Review ◽

Infection Complication ◽

Global Increase

Abstract BACKGROUND Appropriate timing for closure of myelomeningocele (MM) varies in the literature. Older studies present 48 h as the timeframe after which infection complication rates rise. OBJECTIVE The objective of this guideline is to determine if closing the MM within 48 h decreases the risk of wound infection or ventriculitis. METHODS The Guidelines Task Force developed search terms and strategies used to search PubMed and Embase for relevant literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used to screen abstracts and to develop a list of relevant articles for full-text review. Full text articles were then reviewed and when appropriate, included in the evidentiary table. The class of evidence was evaluated, discussed, and assigned to each study that met inclusion criteria. RESULTS A total of 148 abstracts were identified and reviewed. A total of 31 articles were selected for full text analysis. Only 4 of these studies met inclusion criteria. CONCLUSION There is insufficient evidence that operating within 48 h decreases risk of wound infection or ventriculitis in 1 Class III study. There is 1 Class III study that provides evidence of global increase in postoperative infection after 48 h, but is not specific to wound infection or ventriculitis. There is 1 Class III study that provides evidence if surgery is going to be delayed greater than 48 h, antibiotics should be given. The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-4.

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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Incidence of Tethered Cord Syndrome in Infants With Myelomeningocele With Prenatal Versus Postnatal Repair

Neurosurgery ◽

10.1093/neuros/nyz266 ◽

2019 ◽

Vol 85 (3) ◽

pp. E417-E419 ◽

Cited By ~ 1

Author(s):

Catherine A Mazzola ◽

Rachana Tyagi ◽

Nadege Assassi ◽

David F Bauer ◽

Alexandra D Beier ◽

...

Keyword(s):

Spina Bifida ◽

Full Text ◽

Task Force ◽

Relevant Literature ◽

Tethered Cord ◽

The United States ◽

Tethered Cord Syndrome ◽

Folic Acid Deficiency ◽

Increased Risk ◽

Postnatal Closure

Abstract BACKGROUND The incidence of spina bifida (SB) is higher in the developing world as compared to the United States because of folic acid deficiency during pregnancy. Advances in technology have made prenatal repair of myelomeningocele (MM) possible. OBJECTIVE The objective of this guideline was to determine if there is a difference in the rate of development of tethered cord syndrome (TCS) in infants who had prenatal closure compared to infants who had MM repair after birth. METHODS The Guidelines Task Force developed search terms and strategies to search PubMed and Embase for the relevant literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used. Full text articles were reviewed and, when appropriate, included as evidence. RESULTS A total of 261 abstracts were reviewed. Fifty-four full-text articles were selected for further analysis. Three studies met inclusion criteria. CONCLUSION There was Class II evidence from 1 study and Class III evidence from another 2 studies demonstrating that TCS develops in infants with prenatal MM closure at an equal or higher rate than with postnatal closure. There was an increased risk of development of inclusion cysts in infants who underwent in utero closure. Continued surveillance for TCS and/or the development of inclusion cysts in children with prenatal and postnatal closure of MM is indicated (Level II). Differences between prenatal and postnatal repair with respect to the development of TCS and/or inclusion cysts should be considered alongside other relevant maternal and fetal outcomes when deciding upon a preferred method for MM closure. The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-6.

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Effectiveness of Thermal Annular Procedures in Treating Discogenic Low Back Pain

January 2018 - Pain Physician ◽

10.36076/ppj/447 ◽

2017 ◽

Vol 6 (20;6) ◽

pp. 447-470 ◽

Cited By ~ 9

Author(s):

Standiford Helm

Keyword(s):

Systematic Review ◽

Task Force ◽

Relevant Literature ◽

Functional Improvement ◽

Low Back ◽

High Quality ◽

Discogenic Pain ◽

Term Efficacy ◽

Discogenic Low Back Pain ◽

Level I

Background: Discogenic low back is a distinct clinic entity characterized by pain arising from a damaged disc. The diagnosis is clouded by the controversy surrounding discography. The treatment options are limited, with unsatisfactory results from both conservative treatment and surgery. Multiple interventional therapies have been developed to treat discogenic pain, but most have not yet been validated by high quality studies. The best studied treatment for discogenic pain is the use of heat, which has been labeled as thermal intradiscal procedures (TIPs) by the Centers for Medicare and Medicaid Services (CMS). As the pathology is located in the annulus, we use the term thermal annular procedures (TAPs). Objectives: The aim of this study is to evaluate and update the efficacy of TAPs to treat chronic refractory discogenic pain. Study Design: The design of this study is a systematic review. Methods: The available literature on TAPs in treating chronic refractory discogenic pain was reviewed. The quality of each article used in this analysis was assessed. The level of evidence was classified on a 5-point scale from strong, based upon multiple randomized controlled trials (RCTs) to weak, based upon consensus, as developed by the US Preventive Services Task Force (USPSTF) and modified by the American Society of Interventional Pain Physicians (ASIPP). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2015 and manual searches of the bibliographies of known primary and review articles. The primary outcome measures were pain relief and functional improvement of at least 40%. Short-term efficacy was defined as improvement for less than 6 months; long-term efficacy was defined as improvement for 6 months or more. Results: For this systematic review, 49 studies were identified. Of these, there were 4 RCTs and no observational studies which met the inclusion criteria. Based upon 2 RCTs showing efficacy, with no negative trials, there is Level I, or strong, evidence of the efficacy of biacuplasty in the treatment of chronic, refractory discogenic pain. Based upon one high-quality RCT showing efficacy and one moderate-quality RCT interpreted as showing no benefit, there is Level III, or moderate, evidence supporting the use of intradiscal electrothermal therapy (IDET) in treating chronic, refractory discogenic pain. The evidence supporting the use of discTRODE is level V, or limited. Conclusion: The evidence is Level I, or strong, that percutaneous biacuplasty is efficacious in the treatment of chronic, refractory discogenic pain. Biacuplasty may be considered as a first-line treatment for chronic, refractory discogenic pain.The evidence is Level III, or moderate, that IDET is efficacious in the treatment of chronic, refractory discogenic pain. The evidence is Level V, or limited, that discTRODE is efficacious in the treatment of chronic, refractory discogenic pain.

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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Treatment of Pediatric Hydrocephalus: Update of the 2014 Guidelines

Neurosurgery ◽

10.1093/neuros/nyaa434 ◽

2020 ◽

Vol 87 (6) ◽

pp. 1071-1075

Author(s):

David F Bauer ◽

Lissa C Baird ◽

Paul Klimo ◽

Catherine A Mazzola ◽

Dimitrios C Nikas ◽

...

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Full Text ◽

Best Practice ◽

Medical Literature ◽

Task Force ◽

Relevant Literature ◽

Evidence Based ◽

Pediatric Hydrocephalus ◽

Evidence Based Guidelines

ABSTRACT BACKGROUND The Congress of Neurological Surgeons reviews its guidelines according to the Institute of Medicine's recommended best practice of reviewing guidelines every 5 yrs. The authors performed a planned 5-yr review of the medical literature used to develop the “Pediatric hydrocephalus: systematic literature review and evidence-based guidelines” and determined the need for an update to the original guideline based on new available evidence. OBJECTIVE To perform an update to include the current medical literature for the “Pediatric hydrocephalus: systematic literature review and evidence-based guidelines”, originally published in 2014. METHODS The Guidelines Task Force used the search terms and strategies consistent with the original guidelines to search PubMed and Cochrane Central for relevant literature published between March 2012 and November 2019. The same inclusion/exclusion criteria were also used to screen abstracts and to perform the full-text review. Full text articles were then reviewed and when appropriate, included as evidence and recommendations were added or changed accordingly. RESULTS A total of 41 studies yielded by the updated search met inclusion criteria and were included in this update. CONCLUSION New literature resulting from the update yielded a new recommendation in Part 2, which states that neuro-endoscopic lavage is a feasible and safe option for the removal of intraventricular clots and may lower the rate of shunt placement (Level III). Additionally a recommendation in part 7 of the guideline now states that antibiotic-impregnated shunt tubing reduces the risk of shunt infection compared with conventional silicone hardware and should be used for children who require placement of a shunt (Level I). <https://www.cns.org/guidelines/browse-guidelines-detail/pediatric-hydrocephalus-guideline>

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ELIGIBILITY FOR LOW-DOSE COMPUTED TOMOGRAPHY LUNG CANCER SCREENING IN OLDER ASIAN AMERICAN SMOKERS

Innovation in Aging ◽

10.1093/geroni/igz038.679 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S189-S189

Author(s):

Chien-Ching Li ◽

Kelsey Choi ◽

Alicia Matthews ◽

Raj Shah

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Asian American ◽

Low Dose ◽

Task Force ◽

Significant Proportion ◽

Lung Cancer Screening ◽

Lung Cancer Mortality ◽

Eligibility Criteria ◽

Low Dose Computed Tomography

Abstract Lung cancer is the leading cause of cancer-related deaths in Asian Americans. Low-dose computed tomography lung cancer (LDCT) screening is an effective way to decrease lung cancer mortality. This study aimed to examine the difference in LDCT screening eligibility among Asian American subgroups. The National Health Interview Survey data (2006-2016) was analyzed. The U.S. Preventive Services Task Force guideline was used to determine the LDCT eligibility. A higher and statistically significant proportion of current Filipino smokers (35.4%) met LDCT screening eligibility criteria compared to Chinese (26.5%) and other Asian smokers (22.7%) (p=0.02). Hierarchical logistic regression results further showed that Filipino were more likely to meet LDCT screening criteria than other Asian while adjusting demographics (OR=1.87; p=0.01). The differences in LDCT screening eligibility no longer existed after additionally adjusting socioeconomic factors as well as perceived health status. Future targeted outreach and intervention research is needed for Filipinos with lower socioeconomic status.

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Clinical profile of pediatric patients with tuberculosis in a tertiary care centre in India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20203653 ◽

2020 ◽

Vol 7 (9) ◽

pp. 1906

Author(s):

Ashna Kumar ◽

Javid Ahmad ◽

Pooja Bharti ◽

Vasundhara Bakshi

Keyword(s):

Pediatric Population ◽

Tertiary Care ◽

Significant Proportion ◽

Abdominal Tuberculosis ◽

Childhood Tuberculosis ◽

Diagnostic Methods ◽

North India ◽

Tuberculous Lymphadenitis ◽

Tertiary Care Centre ◽

Cross Sectional

Background: India has one of the highest TB burden globally. Children contribute a significant proportion of TB burden, in whom the diagnosis can be challenging because many childhood diseases mimic TB. Therefore, a high index of suspicion is required for early diagnosis of childhood tuberculosis to prevent poor outcome. Objectives was to evaluate the prevalence and profile of childhood tuberculosis cases and to determine the risk factorsMethods: An observational cross-sectional study was conducted over a period of 6 months at a hospital in north India and the prevalence and profile of the children admitted with the clinical suspicion of tuberculosis was studied. Case specific diagnostic approach was used for diagnosis and the appropriate treatment was instituted.Results: The prevalence of childhood TB was 2.3% among hospitalized children. Of these, 66.5% were males and 33.49% were females. The majority of cases were more than 8 years. The history of contact was present only in 31.1%. Tuberculin skin test was positive in 53.11%. Pulmonary tuberculosis was the most common type of childhood tuberculosis (45.45%) followed by neurological tuberculosis (42.8%), abdominal tuberculosis (6.45%), tuberculous lymphadenitis (2.63%), others (2.61%). Malnutrition was a potent contributing factor present in 91.86%. The mortality rate observed in the study was 9.56%.Conclusions: Owing to the high burden of tuberculosis among pediatric population in India, there is an alarming need to develop more economical and advanced diagnostic methods for better patient management and above all there is urgent need of the hour to educate the masses about the transmission and risk factors for this disease.

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Analysis and Assessment of Hazards Caused by Chemicals Contaminating Selected Items of Firefighter Personal Protective Equipment – a Literature Review

Safety & Fire Technology ◽

10.12845/sft.56.2.2020.6 ◽

2020 ◽

Vol 56 (2) ◽

pp. 92-109

Author(s):

Sylwia Krzemińska ◽

Małgorzata Szewczyńska

Keyword(s):

Volatile Organic Compounds ◽

Organic Compounds ◽

Personal Protective Equipment ◽

Relevant Literature ◽

Significant Proportion ◽

Aliphatic Hydrocarbons ◽

Protective Equipment ◽

Urine Metabolites ◽

Chemical Substances ◽

Volatile Organic

Aim: The aim of the presented paper is to review the literature concerning the risks related to possible contamination with chemical substances of firefighter’s personal protective equipment (i.e. special clothing, special gloves, firefighter boots and balaclavas) during rescue operations. The authors focused on contamination resulting from the interaction of aromatic and aliphatic hydrocarbons, volatile organic compounds and phthalates. Introduction: During rescue operations, firefighters are exposed to chemicals which are inherent in fires in buildings and open spaces. The health hazards caused by chemicals accumulating on the surface of personal protective equipment, which can enter the firefighter’s body through the skin, posing a lethal threat, is becoming an increasingly recognized issue. Scientific research shows that chemicals generated during fires are harmful – a significant proportion of them has a confirmed carcinogenic and mutagenic effect. Methodology: The presented analysis of the issue of chemical contamination of personal protective equipment and the associated risks to the firefighter was prepared on the basis of a review of selected Polish and foreign literature. The main types of chemical pollutants with chemical substances and the determined levels of pollution were addressed in the paper, indicating the conditions under which they were obtained. Additionally, the properties of the most common groups of chemicals that contaminate personal protective equipment are described. The characteristics of firefighter’s personal protective equipment, with the particular focus on the materials used for special firefighter suit, are also presented. Conclusions: A review of relevant literature indicates that contamination of firefighter’s personal protective equipment were investigated mainly with respect to the presence of aromatic and aliphatic hydrocarbons, volatile organic compounds with a proven carcinogenic effect. Phthalates as substances posing a very high risk to fertility were less commonly studied. The high content of harmful chemicals in dirt present on the surface of the material of special clothing and on other personal protective equipment, as well as in the urine metabolites, indicates unequivocally the need for decontamination of personal protective equipment after every fire.

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Economic Burden of Diabetes in Urban Indians

The Open Ophthalmology Journal ◽

10.2174/1874364101408010091 ◽

2014 ◽

Vol 8 (1) ◽

pp. 91-94 ◽

Cited By ~ 10

Author(s):

Pablo Chandra ◽

Bageshri Gogate ◽

Parikshit Gogate ◽

Nilesh Thite ◽

Abhay Mutha ◽

...

Keyword(s):

Indirect Cost ◽

Direct Cost ◽

Economic Burden ◽

Significant Proportion ◽

Class Iii ◽

Lower Middle Class ◽

Average Percentage ◽

Diet Control ◽

The Cost ◽

Class Iv

Purpose : To find out the average economic burden of medical care on a patient with diabetes in Pune, India Methods : A semi-open ended questionnaire followed by interview was conducted with patients attending diabetes and ophthalmic out-patient departments. They were asked regarding the duration of diabetes, methods undertaken for blood sugar control and the amount they spend on consultations, laboratory tests, medicines and procedures if any within past year. Expenditure was classified as direct cost (cost of medicines, doctor’s fees, investigations, lasers and surgery) and indirect cost (travel, diet control, health classes and loss of wages). Data was collected regarding the socioeconomic status according to Kuppaswamy classification. Results : 219 patients participated of whom 129 were males (58.9%). Average annual direct cost of diabetes treatment was Rs 8,822 of which 52.1% was spend on medicines, 3.2% was spend on lasers, 12.6% was spend on surgical procedures, 11.6% spent on investigations and 10.4% was spend on clinician fees. Average annual indirect cost was Rs. 3949 of which 3.4% was spend on travelling purpose, 0.4% was spent on health classes, 4.9% was spent on diet control and 91.3% was loss of wages. Average expenditure done by lower middle class was 23.7% of their income. Average percentage of income for direct and indirect cost was 3.6% and 1.4% respectively. The cost of the treatment formed1.3% of the annual income for those in Socio-economic class I, 1.7% in class II, 3.7% in class III and 23.7% in class IV. Conclusion : The cost of managing diabetes was a significant proportion of the patients’ income, especially for those on lower socio-economic scale (class IV).

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Mapping evidence on access to healthcare information by women of reproductive age in low-and-middle-income countries: scoping review protocol

Systematic Reviews ◽

10.1186/s13643-019-1203-5 ◽

2019 ◽

Vol 8 (1) ◽

Author(s):

Joyce T. Shatilwe ◽

Tivani P. Mashamba-Thompson

Keyword(s):

Scoping Review ◽

Full Text ◽

Grey Literature ◽

Relevant Literature ◽

Access To Healthcare ◽

Reproductive Age ◽

Future Research ◽

Reference List ◽

Women Of Reproductive Age ◽

Healthcare Information

Abstract Background Research shows that there are inadequate interventions in resource-limited settings that could enable women of reproductive age to access and use health services in those settings. The main objective of this scoping review is to map the evidence on access to healthcare information by women of reproductive age in LMICs. Method and analysis The primary search will include Google Scholar, Science Direct, PubMed, EBSCOhost (Academic search complete, CINAHL with full text, MEDLINE with full text, MEDLINE), Emerald, Embase, CDSR, PsycINFO, published and peer review journals, organisational projects, conference papers, reference list, grey literature sources, as well as reports related to this objective will be included in the study. Identified keywords will be used to search articles from the studies. The articles and abstracts will be screened by two independent reviewers (JS and TPMT). Inclusion and exclusion criteria will be considered to guide the screening. A thematic content analysis will be used to present the narrative account of the reviews, using NVivo computer software (version 11). Discussions The scoping review will focus on women of reproductive age in LMICs. We anticipate finding relevant literature on the interventions aimed at accessing health care services in LMICs. The study findings will help reveal research gaps to guide future research. Scoping review registration Not registered with PROSPERO (not needed). Protocol and registration This scoping review was not registered.

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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Pediatric Myelomeningocele: Executive Summary

Neurosurgery ◽

10.1093/neuros/nyz261 ◽

2019 ◽

Vol 85 (3) ◽

pp. 299-301 ◽

Cited By ~ 4

Author(s):

Catherine A Mazzola ◽

Nadege Assassi ◽

Lissa C Baird ◽

David F Bauer ◽

Alexandra D Beier ◽

...

Keyword(s):

Systematic Review ◽

Spina Bifida ◽

Task Force ◽

The United States ◽

Folic Acid Deficiency ◽

Evidence Based ◽

Executive Summary ◽

Full Text Review ◽

Level I ◽

The Impact

Abstract BACKGROUND The incidence of spina bifida (SB) in the developing world is higher than in the United States because of malnutrition and folic acid deficiency during pregnancy. Advances in technology have made prenatal repair of myelomeningocele (MM) possible. OBJECTIVE The objective of the guidelines are, (1) To create clinical recommendations for best practices, based on a systematic review and analysis of available literature, (2) to obtain multi-disciplinary endorsement of these guidelines from relevant organizations, and (3) to disseminate the educational content to physicians to improve the care of infants with MM. METHODS The Guidelines Task Force developed search terms and strategies used to search PubMed and Embase for literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used to screen abstracts and to develop a list of relevant articles for full-text review. RESULTS Guidelines authors aimed to systematically review the literature and make evidence based recommendations about the timing of closure after birth, hydrocephalus, the impact of prenatal closure, and the effect of prenatal closure on ambulation ability and tethered spinal cord. Evidence concerning persistent ventriculomegaly and cognitive impairment was also evaluated. Hundreds of abstracts were identified and reviewed for each of the 5 topics. A total of 14 studies met stringent inclusion criteria. CONCLUSION Based on a comprehensive systematic review, a total of 5 clinical practice recommendations were developed, with 1 Level I, 2 Level II and 2 Level III recommendations. The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-1.

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