scholarly journals Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Management of Patients With Myelomeningocele: Whether Persistent Ventriculomegaly Adversely Impacts Neurocognitive Development

Neurosurgery ◽  
2019 ◽  
Vol 85 (3) ◽  
pp. E414-E416
Author(s):  
Jeffrey P Blount ◽  
Susan R Durham ◽  
Paul Klimo Jr ◽  
Nadege Assassi ◽  
David F Bauer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intellectual Development ◽  
Newborn Infants ◽  
Treatment Strategies ◽  
The United States ◽  
Ventricular Size ◽  
Class Iii ◽  
Neurocognitive Development ◽  
Strict Inclusion

Abstract BACKGROUND Myelomeningocele (MM) is the most common congenital anomaly to affect the nervous system and affects 1500-2000 newborn infants per year in the United States. It is accompanied by symptomatic hydrocephalus in approximately 70%-80% of patients. Different treatment strategies for hydrocephalus characteristically result in different effects on the size of the ventricles. OBJECTIVE The objective of this systematic review was to determine whether persistent ventricular enlargement adversely impacts neurocognitive development in patients with MM. METHODS The PubMed National Library of Medicine Medline database and Embase were queried using MeSH headings and keywords relevant to neurocognitive or intellectual development and ventricular size or morphology. Abstracts were reviewed by the authors to identify which studies met strict inclusion criteria. An evidence table was constructed that summarized the included studies and reflected the quality of evidence (Classes I–III) that each represented. A recommendation was made that is based on the quality of the evidence. RESULTS An initial abstract review utilizing strict inclusion/exclusion criteria yielded 48 studies, 9 of which underwent full-text review. There is limited and conflicting Class III evidence from 2 studies. CONCLUSION Currently, there is insufficient data to conclude that ventricular size and morphology impact neurocognitive development. The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-5.

Anosmia: Differential Diagnosis, Evaluation, and Management

2017 ◽  
Vol 31 (1) ◽  
pp. e3-e7 ◽  
Author(s):  
George A. Scangas ◽  
Benjamin S. Bleier
Keyword(s):  
Differential Diagnosis ◽  
Negative Impact ◽  
Treatment Strategies ◽  
Communication Disorders ◽  
The United States ◽  
Current Treatment ◽  
Olfactory Dysfunction ◽  
Olfactory Testing ◽  
Smell Disorders

The ability to scrutinize our surroundings remains heavily dependent on the sense of smell. From the ability to detect dangerous situations such as fires to the recollection of a fond memory triggered by an odor, the advantages of an intact olfactory system cannot be overstated. Outcomes studies have highlighted the profound negative impact of anosmia and parosmia on the overall quality of life. The National Institute on Deafness and Other Communication Disorders estimates that ∼1.4% of the United States population experiences chronic olfactory dysfunction and smell loss. Efforts have focused on improving both the diagnosis of olfactory dysfunction through olfactory testing and improved reporting of treatment outcomes of olfactory training. The purpose of this article was to review the differential diagnosis, workup, and current treatment strategies of anosmia and smell disorders.

scholarly journals 104. Plague Meningitis - A Systematic Review of Published Cases, Antimicrobial Treatment, and Outcomes

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S65-S65
Author(s):  
Katharine Cooley ◽  
Shannon Fleck-Derderian ◽  
Christina Nelson
Keyword(s):  
Systematic Review ◽  
Case Fatality Rate ◽  
Case Reports ◽  
Treatment Strategies ◽  
Case Fatality ◽  
The United States ◽  
Antimicrobial Treatment ◽  
Recent Analysis ◽  
Fatality Rate ◽  
Bubonic Plague

Abstract Background Plague meningitis is a rare but serious manifestation of infection with the bacterium Yersinia pestis. The risk factors, clinical evolution, and optimal treatment strategies of plague meningitis are not well understood, and data is limited to sporadic case reports. To advance knowledge of this condition and support clinical practice recommendations, we conducted a systematic review of published cases of plague meningitis. Methods We reviewed PubMed Central, Medline, Embase, and other databases for publications on plague meningitis in any language. Articles that contained reports of patients with plague meningitis plus information on patient outcome were included. Results Among 1,090 articles identified in our search, we found 54 articles describing 83 cases eligible for inclusion. Cases occurred between 1898 and 2015; mean age of patients was 20.5 years (range 6 wks - 64 yrs) and 65% were male. Most patients lived in the United States (23%), Argentina (18%), Vietnam (12%), or China (12%). Four patients (5%) had primary plague meningitis. More than half (59%) of patients developed meningitis secondary to primary bubonic plague; the remainder developed meningitis secondary to other or unknown forms of plague. Of patients with a bubo, 51% had an axillary bubo. The most common symptoms were fever (66%), nuchal rigidity (43%), and headache (35%); 23 patients had focal neurologic deficits such as cranial nerve abnormality. Case fatality rate was 96% (n=23/24) for patients who did not receive antimicrobial treatment and 42% (n=25/59) for patients treated with antimicrobials. Case fatality rate by antimicrobial received, including patients who received multiple antimicrobial classes, was 50% for sulfonamides (n= 38), 50% for fluoroquinolones (n=2), 19% for aminoglycosides (n=21), 11% for chloramphenicol (n=19), and 0% for tetracyclines (n=14). Conclusion Plague meningitis has a high fatality rate, but antimicrobial treatment can improve patient outcomes. Having an axillary bubo may be a risk factor for developing plague meningitis – in contrast to our findings, a recent analysis found that only 24% of patients with bubonic plague had buboes in the axillary region. Additional research would be helpful to investigate this association further. Disclosures All Authors: No reported disclosures

Quality of life, intellectual development and behavioural characteristics of single children in China: evidence from a 1980 survey in Changsha, Hunan Province

1985 ◽  
Vol 17 (2) ◽  
pp. 127-136 ◽  
Author(s):  
Dudley L. Poston ◽  
Mei-Yu Yu
Keyword(s):  
Quality Of Life ◽  
Intellectual Development ◽  
Negative Impact ◽  
The United States ◽  
Hunan Province ◽  
Social Scientists ◽  
Behavioural Characteristics ◽  
Children’S Behaviour ◽  
The One

SummaryThis paper reports the results of a June 1980 survey of 1069 children in Changsha, Hunan Province. The data have been unavailable previously either in Chinese or in English. In general, they suggest that comparisons of single children with children from multiple-child families in China regarding quality of life, intellectual development, and behavioural traits are similar to comparisons conducted in the United States and other western countries. As in many western studies, single children in China appear to have a better quality of life than children with siblings. Regarding intellectual development, single children in China perform better than those with siblings, a finding which is consonant with the family intactness model of Falbo. Single children in Changsha are little different from ones from multiple-child families on various aspects of behaviour, and are more co-operative and less hostile. These findings are the opposite of those of the Shanghai study, the other major analysis of single children in China; the Shanghai survey indicated that single children were not as well-behaved as those with siblings, a finding that caused some concern among Chinese social scientists. To the extent that the findings of the Changsha study, and not those of the Shanghai study, reflect the situation of single children in China, this could mean that the one-child family planning campaign may not be having a negative impact on children's behaviour.

scholarly journals Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Diagnosis of Patients with Positional Plagiocephaly

Neurosurgery ◽  
2016 ◽  
Vol 79 (5) ◽  
pp. E625-E626 ◽  
Author(s):  
Catherine Mazzola ◽  
Lissa C. Baird ◽  
David F. Bauer ◽  
Alexandra Beier ◽  
Susan Durham ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Systematic Review ◽  
Clinical Examination ◽  
Full Text ◽  
Evidence Based ◽  
X Rays ◽  
Class Iii ◽  
Positional Plagiocephaly ◽  
Evidence Based Guideline

Abstract BACKGROUND: No evidence-based guidelines exist for the imaging of patients with positional plagiocephaly. OBJECTIVE: The objective of this systematic review and evidence-based guideline is to answer the question, Is imaging necessary for infants with positional plagiocephaly to make a diagnosis. METHODS: The National Library of Medicine Medline database and the Cochrane Library were queried with the use of MeSH headings and key words relevant to imaging as a means to diagnose plagiocephaly. Abstracts were reviewed, and an evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III). RESULTS: A total of 42 full-text articles were selected for review. Of these, 10 were eliminated; thus, 32 full-text were manuscripts selected. There was no Class I evidence, but 2 Class II and 30 Class III studies were included. Three-dimensional cranial topographical imaging, ultrasound, skull x-rays, computed tomography, and magnetic resonance imaging were investigated. CONCLUSION: Clinical examination is most often sufficient to diagnose plagiocephaly (quality, Class III; strength, Level III). Within the limits of this systematic review, the evidence suggests that imaging is rarely necessary and should be reserved for cases in which the clinical examination is equivocal. Many of the imaging studies were not designed to address the diagnostic utility of the imaging modality, and authors were actually assessing the utility of the imaging in longitudinal follow-up, not initial diagnosis. For this reason, some of the studies reviewed were downgraded in Level of Evidence. When needed, 3-dimensional cranial topographical photo, skull x-rays, or ultrasound imaging is almost always sufficient for definitive diagnosis. Computed tomography scanning should not be used to diagnose plagiocephaly, but it may be necessary to rule out craniosynostosis. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_2.

scholarly journals Measures of Effectiveness, Efficiency, and Quality of Telemedicine in the Management of Alcohol Abuse, Addiction, and Rehabilitation: Systematic Review (Preprint)

2018 ◽  
Author(s):  
Clemens Scott Kruse ◽  
Kimberly Lee ◽  
Jeress B Watson ◽  
Lorraine G Lobo ◽  
Ashton G Stoppelmoor ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Health Care ◽  
Alcohol Consumption ◽  
Alcohol Use ◽  
Alcohol Abuse ◽  
The United States ◽  
The European Union ◽  
Measures Of Effectiveness

BACKGROUND More than 18 million Americans are currently suffering from alcohol use disorder (AUD): a compulsive behavior of alcohol use as a result of a chronic, relapsing brain disease. With alcohol-related injuries being one of the leading causes of preventable deaths, there is a dire need to find ways to assist those suffering from alcohol dependence. There still exists a gap in knowledge as to the potential of telemedicine in improving health outcomes for those patients suffering from AUD. OBJECTIVE The purpose of this systematic review was to evaluate the measures of effectiveness, efficiency, and quality that result from the utilization of telemedicine in the management of alcohol abuse, addiction, and rehabilitation. METHODS This review was conducted utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The articles used in this analysis were gathered using keywords inclusive of both <i>telemedicine</i> and <i>alcohol abuse</i>, which were then searched in the Cumulative Index to Nursing and Allied Health Literature, Cochrane, and MEDLINE (PubMed) databases. A total of 22 articles were chosen for analysis. RESULTS The results indicated that telemedicine reduced alcohol consumption. Other common outcomes included reduced depression (4/35, 11%), increased patient satisfaction (3/35, 9%), increase in accessibility (3/35, 9%), increased quality of life (2/35, 6%), and decreased cost (1/35, 3%). Interventions included mobile health (11/22, 50%), electronic health (6/22, 27%), telephone (3/33, 14%), and 2-way video (2/22, 9%). Studies were conducted in 3 regions: the United States (13/22, 59%), the European Union (8/22, 36%), and Australia (1/22, 5%). CONCLUSIONS Telemedicine was found to be an effective tool in reducing alcohol consumption and increasing patients’ accessibility to health care services or health providers. The group of articles for analysis suggested that telemedicine may be effective in reducing health care costs and improving the patient’s quality of life. Although telemedicine shows promise as an effective way to manage alcohol-related disorders, it should be further investigated before implementation.

Cost-Utility Analyses in US Orthopaedic Foot and Ankle Surgery: A Systematic Review

2018 ◽  
Vol 11 (6) ◽  
pp. 548-552 ◽  
Author(s):  
Aditya V. Karhade ◽  
John Y. Kwon
Keyword(s):  
Systematic Review ◽  
Health Economic ◽  
Cost Effective ◽  
The United States ◽  
Cost Utility ◽  
Ankle Fractures ◽  
Foot And Ankle ◽  
End Stage ◽  
Economic Studies

Background. While investigations have been performed examining the quality of US-based cost-utility analyses for other orthopaedic subspecialties and have provided important insights, a similar analysis has not been performed examining the foot and ankle literature. Methods. A systematic review of foot and ankle studies was conducted to identify cost-utility analyses published between 2000 and 2017. Of 687 studies screened by abstract, 4 cost-utility studies were identified and scored by the Quality of Health Economic Studies instrument. Results. Of these 4 studies, 3 examined end-stage arthritis and 1 examined unstable ankle fractures. Cost-effective interventions identified by these studies included the performance of total ankle arthroplasty over ankle arthrodesis or nonoperative treatment for end-stage arthritis and suture button fixation over syndesmotic screws for unstable supination–external rotation ankle fractures. The mean Quality of Health Economic Studies scores for these studies was 87.5. Conclusion. Despite the increasing focus on value-based care delivery in the United States, there are few foot and ankle cost-utility analyses. Nonetheless, the quality of existing analyses is high. Certain interventions have been identified as cost-effective as highlighted above and the findings of this review can be used to help design future analyses in order to best demonstrate the cost-effectiveness of foot and ankle interventions. Levels of Evidence: Level III: Systematic Review of level III studies

scholarly journals Arthrocentesis, arthroscopy or arthrotomy for septic knee arthritis in children: a systematic review

2020 ◽  
pp. 1-7
Author(s):  
Cornelia M. Donders ◽  
Anne J. Spaans ◽  
Johannes H. J. M. Bessems ◽  
Christiaan J. A. van Bergen
Keyword(s):  
Systematic Review ◽  
Septic Arthritis ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Needle Aspiration ◽  
Scientific Quality ◽  
Knee Arthritis ◽  
Level Of Evidence ◽  
Septic Knee Arthritis

Purpose Septic knee arthritis in children can be treated by arthrocentesis (articular needle aspiration) with or without irrigation, arthroscopy or arthrotomy followed by antibiotics. The objective of this systematic review was to identify the most effective drainage technique for septic arthritis of the knee in children. Methods The electronic PubMed, Embase and Cochrane databases were systematically searched for original articles that reported outcomes of arthrocentesis, arthroscopy or arthrotomy for septic arthritis of the knee. The quality of all included studies was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria. This systematic review was performed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO). Results Out of 2428 articles, 11 studies with a total of 279 knees were included in the systematic review. The quality of evidence was low (MINORS median 4 (2 to 7)). A meta-analysis could not be performed because of the diversity and low quality of the studies. In septic knee arthritis, additional drainage procedures were needed in 54 of 156 (35%) knees after arthrocentesis, in four of 96 (4%) after arthroscopy and in two of 12 (17%) after arthrotomy. Conclusion Included studies on treatment strategies for septic arthritis of the knee in children are diverse and the scientific quality is generally low. Knee arthroscopy might have a lower risk of additional drainage procedures as compared with arthrocentesis and arthrotomy, with acceptable clinical outcomes and no radiological sequelae. Level of evidence IV

scholarly journals The Impact of Community Health Coalitions On Preventative Health Outcomes: A Systematic Review

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Emily Shockley ◽  
Aliya Amin ◽  
Dennis Savaiano
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
Community Health ◽  
The United States ◽  
Randomized Control Trials ◽  
Preventative Care ◽  
Community Members ◽  
Preventative Health ◽  
Randomized Control

Background/Objective: Six out of ten deaths in the United States are caused by chronic diseases. There are multiple approaches to prevention and/or early detection of chronic diseases through screenings, nutrition, physical activity, and more. Unfortunately, a large portion of the US population have low rates of preventative care. Community health coalitions have the potential to improve preventative health outcomes by partnering with key members of communities to design programs that best fit community needs. In this systematic review, we examine evidence that community health coalitions can improve preventative health outcomes. Methods: PubMed, WebofScience, CINAHL, and PsycINFO were searched for (outcome OR health outcome) AND (prevention) AND (diabetes OR hypertension OR cancer OR prenatal) AND (community-based participatory research OR community coalition OR coalition OR health coalition). After screening 490 articles, 30 full-text, peer-reviewed, English articles meeting inclusion criteria of health coalition, prevention, health outcomes reported, and conducted in the United States were reviewed. Results: 27 of the 30 studies showed community health coalitions having a positive impact. Roughly half of the articles were randomized control trials. Community members and academia were represented in 80% and 77%, respectively, of the coalitions described, while other representations included faith-based organizations, health care, public health, industry, and education. Diabetes and cancer represented 74% of the targeted preventions addressed. 90% of the interventions focused on educating the community, and 33% focused on increasing health screening rates. 60% utilized trained community members to deliver interventions. 60% reported health measurements, 33% reported screening rates, and 30% reported knowledge and awareness. Conclusion, Impact, & Implications: While the evidence suggests community health coalitions are effective in improving preventative health outcomes, the quality of the studies remain low. There is a need for increased rigor of study design and assessment in order to determine the true efficacy of community health coalitions. The majority of the randomized-control trials in this review were rated as low-quality, highlighting the difficulty of designing a randomized, controlled study in a community. Inadequate funding, lack of rigorous design, or ethical challenges can limit the quality of the assessment. Further, although prenatal care was included as a search term, there were no coalitions found that addressed this type of preventative care. This points to a future need for the creation of or increased publications from prenatal health coalitions.  

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