Unilateral neglect is associated with poor proprioception after stroke – a systematic review

AbstractBackgroundProprioceptive impairment is a potential contributing factor to the clinical presentation of Unilateral Neglect (UN), a common and debilitating condition that can occur after stroke. To date there has not been a comprehensive review of studies examining the various aspects of proprioception in UN after stroke.AimTo determine if the presence of UN is associated with more severe proprioceptive deficit in stroke affected populations.MethodsThe MEDLINE, Embase, Scopus, CINAHL and Web of Science databases were searched from inception to January 2019 using an a priori search strategy. Two independent reviewers screened abstracts and full texts. Two reviewers then independently extracted data from each full text. A third reviewer resolved disagreements at each step. Risk of bias was assessed using the AXIS Quality Assessment tool. For full protocol see PROSPERO, registration number CRD42018086070. One-hundred and sixty-seven abstracts were identified, of which fifty-four were eligible for full text screening. A total of 18 papers were included in the review.ConclusionsMore severe proprioceptive deficit is associated with the presence of UN after stroke. However, the available evidence is limited by the large heterogeneity of assessment of both UN and proprioception, and level of study quality. UN and proprioception are seldom completely assessed in research, and it is likely this is true in everyday clinical practice.

Download Full-text

Proprioceptive impairment in unilateral neglect after stroke: A systematic review

SAGE Open Medicine ◽

10.1177/2050312120951073 ◽

2020 ◽

Vol 8 ◽

pp. 205031212095107

Author(s):

Georgia Fisher ◽

Camila Quel de Oliveira ◽

Arianne Verhagen ◽

Simon Gandevia ◽

David Kennedy

Keyword(s):

Search Strategy ◽

Assessment Tool ◽

A Priori ◽

Risk Of Bias ◽

Assessment Tools ◽

Proprioceptive Information ◽

Quality Assessment Tool ◽

Unilateral Neglect ◽

Large Heterogeneity ◽

Full Text Screening

Introduction: Unilateral neglect is a debilitating condition that can occur after stroke and can affect a variety of domains and modalities, including proprioception. Proprioception is a sensorimotor process essential to motor function and is thus important to consider in unilateral neglect. To date, there has not been a comprehensive review of studies examining the various aspects of proprioceptive impairment in unilateral neglect after stroke. This review aimed to determine if people with unilateral neglect have more severe proprioceptive impairments than those without unilateral neglect after stroke. Methods: The MEDLINE, Embase, Scopus, CINAHL and Web of Science databases were searched from inception to September 2019 using an a priori search strategy. Two independent reviewers screened abstracts and full texts, and extracted data from the included full texts. A third reviewer resolved disagreements at each step. Risk of bias was assessed using the AXIS Quality Assessment tool. Results: A total of 191 abstracts were identified, with 56 eligible for full-text screening. A total of 18 studies were included in the review and provided evidence that people with unilateral neglect have more severe proprioceptive impairment than people without unilateral neglect. This impairment is present in multiple subtypes of unilateral neglect and aspects of proprioception. Most studies had a moderate risk of bias. Conclusion: People with unilateral neglect after stroke are more likely to have impaired processing of multiple types of proprioceptive information than those without unilateral neglect. However, the available evidence is limited by the large heterogeneity of assessment tools used to identify unilateral neglect and proprioception. Unilateral neglect and proprioception were rarely assessed comprehensively. PROSPERO Registration: CRD42018086070.

Download Full-text

Overview of information retrieval in a hospital-based health technology assessment center in a Swedish region

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462321000106 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Ida Stadig ◽

Therese Svanberg

Keyword(s):

Information Retrieval ◽

Literature Review ◽

Health Technology Assessment ◽

Technology Assessment ◽

Full Text ◽

Health Technology ◽

University Hospital ◽

Literature Searching ◽

Medical Library ◽

Full Text Screening

Abstract Objectives This article aims to provide a brief review of information retrieval and hospital-based health technology assessment (HB-HTA) and describe library experiences and working methods at a regional HB-HTA center from the center's inception to the present day. Methods For this brief literature review, searches in PubMed and LISTA were conducted to identify studies reporting on HB-HTA and information retrieval. The description of the library's involvement in the HTA center and its working methods is based on the authors’ experience and internal and/or unpublished documents. Results Region Västra Götaland is the second largest healthcare region in Sweden and has had a regional HB-HTA center since 2007 (HTA-centrum). Assessments are performed by clinicians supported by HTA methodologists. The medical library at Sahlgrenska University Hospital works closely with HTA-centrum, with one HTA librarian responsible for coordinating the work. Conclusion In the literature on HB-HTA, we found limited descriptions of the role librarians and information specialists play in different units. The librarians at HTA-centrum play an important role, not only in literature searching but also in abstract and full-text screening.

Download Full-text

A call to action for delirium research: Meta-analysis and regression of delirium associated mortality

BMC Geriatrics ◽

10.1186/s12877-020-01723-4 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

May Zin Aung Thein ◽

Jarett V. Pereira ◽

Anita Nitchingham ◽

Gideon A. Caplan

Keyword(s):

English Language ◽

Meta Analysis ◽

A Priori ◽

Group Analysis ◽

Hospital Setting ◽

Mortality Data ◽

Mixed Effect ◽

Elderly Inpatients ◽

Registration Number

Abstract Background Delirium is an extremely common hospital complication. No study to date has assessed whether a priori defined covariates; type of hospital setting and year of study publication, influence the relationship between delirium and mortality. This is also the first study to examine the longitudinal trend of delirium-associated mortality over recent decades, to analyse the trajectory of our efforts in combating this disease. Methods MEDLINE, EMBASE and PsycINFO, were searched from January 1981 to May 2018 for English-language primary articles. Rigorous title and abstract screen and full-text screen were conducted independently by two reviewers. This paper adhered to MOOSE guidelines. Data was extracted independently by one reviewer using standardised data-collection sheets, with a separate reviewer verifying for accuracy. The quality of included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Unadjusted effect sizes and event counts were analysed with a random effects model in primary meta-analysis and meta-regression, whereas a mixed effect model was used in secondary sub-group analysis. Mortality data at longest follow-up and cumulative mortality (hospital mortality combined with mortality at longest follow-up) data were analysed. Results As part of a larger project, 446 of 6790 articles were retrieved, including 71 studies that measured mortality. Our results demonstrate that elderly inpatients with delirium had significantly greater odds of mortality (OR 3.18 [95%CI: 2.73, 3.70]) compared to non-delirious controls. Patients with delirium in the ICU had the highest odds for mortality (OR: 7.09 [95%CI: 3.60, 14.0]); double the risk compared to the average. Curiously, despite advancements in delirium research, delirium associated in-hospital odds of mortality has not changed in 30 years. Conclusion This is the largest meta-analysis to confirm the association between delirium and mortality, in older (age ≥ 65) hospital inpatients. The current meta-analysis highlights the significant odds of mortality after an episode of delirium, and these odds are much higher for ICU patients. However, in contrast to other medical conditions that have seen a decrease in associated mortality over the past few decades, delirium associated mortality remains unchanged. These findings underscore the urgent need for better delirium treatments. PROSPERO Registration Number: CRD42018098627, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=98627

Download Full-text

The Effect of Socioeconomic Factors on Outcomes of Distal Radius Fractures: A Systematic Review

Hand ◽

10.1177/1558944717735945 ◽

2017 ◽

Vol 13 (5) ◽

pp. 509-515 ◽

Cited By ~ 4

Author(s):

Jessica L. Truong ◽

Chris Doherty ◽

Nina Suh

Keyword(s):

Systematic Review ◽

Socioeconomic Factors ◽

Clinical Outcomes ◽

Distal Radius ◽

Full Text ◽

Distal Radius Fractures ◽

Quality Analysis ◽

Current Evidence ◽

Radius Fractures ◽

Full Text Screening

Background: Socioeconomic factors are known to affect outcomes for both medical and surgical conditions. The purpose of this systematic review was to assess the current evidence regarding the effect of socioeconomic factors such as income, geographic location, educational level, and occupation on clinical outcomes after distal radius fractures. Methods: A systematic search strategy was performed to identify studies commenting on the effect of socioeconomic factors on clinical outcomes following open or closed distal radius fracture repair. Abstract and full-text screening was performed by 2 independent reviewers, and articles were evaluated by Structured Effectiveness Quality Evaluation Scale (SEQES). Treatment outcomes of interest included, but were not limited to, pain, function, range of motion, and grip strength. Results: There were 1745 studies that met our inclusion and exclusion criteria for abstract screening. Of these, 48 studies met our inclusion criteria for full-text screening and 20 studies met our criteria for quality analysis with the SEQES score. There were 3 studies of high quality, 16 of moderate quality, and 1 of low quality. Meta-analyses were not possible due to the variability in outcomes of interest across papers. Conclusions: Patient factors indicative of socioeconomic status are relevant predictors of functional outcome after distal radius fractures. There is currently limited evidence in this area of research, and further examination should be considered to improve outcomes from a patient and system standpoint.

Download Full-text

Hering’s Law Assessment Tool Revisited

Journal of Evidence-Based Complementary & Alternative Medicine ◽

10.1177/2156587214543142 ◽

2014 ◽

Vol 19 (4) ◽

pp. 260-266 ◽

Cited By ~ 2

Author(s):

Subhranil Saha ◽

Munmun Koley ◽

Jogendra Singh Arya ◽

Gurudev Choubey ◽

Shubhamoy Ghosh ◽

...

Keyword(s):

Assessment Tool ◽

A Priori ◽

Response Assessment ◽

Pain Visual Analogue Scale ◽

Patient Response ◽

Homeopathic Treatment ◽

Promising Tool ◽

Hering’S Law ◽

Further Development

Hering’s Law Assessment Tool emerged as a systematic outcome assessment tool following homeopathic intervention. The authors intend to modify it and develop a new tool—Patient Response Assessment Tool after Homeopathic Treatment (PRATHoT)—in chronic cases through Delphi technique for systematic categorization of probable outcomes following individualized homeopathic treatment in chronic cases. The PRATHoT was drafted after literature review and iterative Delphi rounds with multidisciplinary expert panel, setting Fleiss κ of 0.41 to 1.00 a priori as the desired level of multirater agreement. Following pilot testing, the tool was implemented on 37 patients suffering from knee osteoarthritis over 6 months. Logistic regression analysis confirmed that higher PRATHoT score was significantly associated with achieving pain visual analogue scale responses from the second follow-up visit onwards ( B = 0.037-0.066; SE = 0.021-0.036; P = .003-.048). The tool appeared to have acceptable psychometric properties; hence, it may be considered as a promising tool, amendable for further development.

Download Full-text

Safety and efficiency of gasless laparoscopy: a systematic review protocol

Systematic Reviews ◽

10.1186/s13643-020-01365-y ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Haitham Shoman ◽

Simone Sandler ◽

Alexander Peters ◽

Ameer Farooq ◽

Magdalen Gruendl ◽

...

Keyword(s):

Systematic Review ◽

Assessment Tool ◽

Data Extraction ◽

Meta Analysis ◽

A Priori ◽

Risk Of Bias ◽

Conventional Laparoscopy ◽

Eligibility Criteria ◽

Gasless Laparoscopy ◽

Resource Setting

Abstract Background Gasless laparoscopy, developed in the early 1990s, was a means to minimize the clinical and financial challenges of pneumoperitoneum and general anaesthesia. It has been used in a variety of procedures such as in general surgery and gynecology procedures including diagnostic laparoscopy. There has been increasing evidence of the utility of gasless laparoscopy in resource limited settings where diagnostic imaging is not available. In addition, it may help save costs for hospitals. The aim of this study is to conduct a systematic review of the available evidence surrounding the safety and efficiency of gasless laparoscopy compared to conventional laparoscopy and open techniques and to analyze the benefits that gasless laparoscopy has for low resource setting hospitals. Methods This protocol is developed by following the Preferred Reporting Items for Systematic review and Meta-Analysis–Protocols (PRISMA-P). The PRISMA statement guidelines and flowchart will be used to conduct the study itself. MEDLINE (Ovid), Embase, Web of Science, Cochrane Central, and Global Index Medicus (WHO) will be searched and the National Institutes of Health Clinical Trials database. The articles that will be found will be pooled into Covidence article manager software where all the records will be screened for eligibility and duplicates removed. A data extraction spreadsheet will be developed based on variables of interest set a priori. Reviewers will then screen all included studies based on the eligibility criteria. The GRADE tool will be used to assess the quality of the studies and the risk of bias in all the studies will be assessed using the Cochrane Risk assessment tool. The RoB II tool will assed the risk of bias in randomized control studies and the ROBINS I will be used for the non-randomized studies. Discussion This study will be a comprehensive review on all published articles found using this search strategy on the safety and efficiency of the use of gasless laparoscopy. The systematic review outcomes will include safety and efficiency of gasless laparoscopy compared to the use of conventional laparoscopy or laparotomy. Trial registration The study has been registered in PROSPERO under registration number: CRD42017078338

Download Full-text

Can the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score Be Reliably Administered Over the Phone? A Randomized Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118791510 ◽

2018 ◽

Vol 6 (8) ◽

pp. 232596711879151 ◽

Cited By ~ 3

Author(s):

Brandon J. Erickson ◽

Peter N. Chalmers ◽

Jon Newgren ◽

Marissa Malaret ◽

Michael O’Brien ◽

...

Keyword(s):

Functional Assessment ◽

Power Analysis ◽

Assessment Tool ◽

A Priori ◽

Randomized Study ◽

Intraclass Correlation ◽

Level Of Evidence ◽

Orthopaedic Clinic ◽

Significant Difference ◽

A Priori Power Analysis

Background: The Kerlan-Jobe Orthopaedic Clinic (KJOC) shoulder and elbow outcome score is a functional assessment tool for the upper extremity of the overhead athlete, which is currently validated for administration in person. Purpose/Hypothesis: The purpose of this study was to validate the KJOC score for administration over the phone. The hypothesis was that no difference will exist in KJOC scores for the same patient between administration in person versus over the phone. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Fifty patients were randomized to fill out the KJOC questionnaire either over the phone first (25 patients) or in person first (25 patients) based on an a priori power analysis. One week after the patients completed the initial KJOC on the phone or in person, they then filled out the score via the opposite method. Results were compared per question and for overall score. Results: There was a mean ± SD of 8 ± 5 days between when patients completed the first and second questionnaires. There were no significant differences in the overall KJOC score between the phone and paper groups ( P = .139). The intraclass correlation coefficient comparing paper and phone scores was 0.802 (95% CI, 0.767-0.883; P < .001), with a Cronbach alpha of 0.89. On comparison of individual questions, there were significant differences for questions 1, 3, and 8 ( P = .013, .023, and .042, respectively). Conclusion: The KJOC questionnaire can be administered over the phone with no significant difference in overall score as compared with that from in-person administration.

Download Full-text

Lateral vs. Supine Positioning for Femoral Intramedullary Nailing: A Systematic Review of Comparative Studies

McMaster University Medical Journal ◽

10.15173/mumj.v17i1.2283 ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Mohamed Sarraj ◽

Daniel E Axelrod ◽

Sarah Zhu ◽

Herman Johal

Keyword(s):

Systematic Review ◽

Intramedullary Nailing ◽

Full Text ◽

Comparative Studies ◽

Femoral Shaft ◽

Definitive Treatment ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Lateral Positioning ◽

Full Text Screening

Femoral shaft fractures are devastating injuries that usually result from high-energy mechanisms in victims of poly-trauma. Reamed and statically locked intramedullary nailing (IMN) is the definitive treatment modality for femoral shaft fractures. Patients are most commonly positioned either supine or lateral decubitus. There remains considerable concern regarding the safety of lateral positioning in the traumatized patient, particularly in the management of a potentially difficult airway or concomitant C-spine injuries. We therefore undertook a systematic review of intraoperative positioning among patients with femoral shaft fractures following PRISMA guidelines. Title and abstract screening, full text screening, and data abstraction were all completed in duplicate. Methodological Index for Nonrandomized Studies (MINORS) scores were used to evaluate methodological quality. Results: 3018 studies were included in initial screening, with three studies ultimately meeting all inclusion criteria. A total of 1,949 patients were analyzed, with 684 patients treated in lateral positioning and 1,215 patients in supine positioning. Level of agreement was strong across title (κ = 0.872; 95% CI 0.794 to 0.951), abstract (κ = 0.801; 95% CI 0.585 to 1.000), and full-text screening (κ = 1.000). The consensus mean MINORS score of included studies was 17.67 ± 0.58, indicating good to high quality of evidence. Neither patient positioning offered obvious benefits such as fewer complications or shorter operative time. Furthermore, length of admission, days in ICU or on ventilator, and overall morbidity were not found to be significantly different between positions. Lateral positioning for intramedullary nailing of mid-shaft femur fractures appears to be a safe alternative to the standard supine positioning. There is a lack of both prospective and retrospective comparative studies investigating functional clinical outcomes in the literature.

Download Full-text

Development of a Validated Exam to Assess Pathologist Knowledge of Genomic Oncology

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2020-0038-oa ◽

2020 ◽

Author(s):

Richard L. Haspel ◽

J. Louise Jones ◽

Hasan Rizvi ◽

Martin Young

Keyword(s):

Rasch Analysis ◽

Assessment Tool ◽

A Priori ◽

Critical Role ◽

Genomic Medicine ◽

High Stakes Testing ◽

Educational Interventions ◽

Cancer Diagnostics ◽

Significant Difference ◽

Genomics Tools

Context.— There is a clear need to educate health professionals in genomic medicine. Pathologists, given their critical role in cancer diagnostics, must understand core concepts in genomic oncology. Although high-quality evaluation is a cornerstone of medical education, to our knowledge a rigorously validated genomic oncology assessment tool has not been published. Objective.— To develop and validate a genomic oncology exam. Design.— A previously developed exam was updated and validated using 3 approaches: pretesting/posttesting in relation to a live genomic pathology workshop; comparison of scores of individuals at a priori defined knowledge levels; and use of Rasch analysis. This last approach is used in high-stakes testing, such as licensing exams. The exam included both knowledge-based as well as skills-based questions related to the use of online genomics tools. Results.— There was a significant difference in exam scores preworkshop and postworkshop (37.5% to 75%; P < .001). Individuals at a priori defined beginner, intermediate, and expert levels scored 35%, 58%, and 89%, respectively (P < .001). Rasch analysis demonstrated excellent fit and reliability and led to further exam refinement with the removal of 2 questions deemed unnecessary for assessment. Conclusions.— A rigorously validated exam has now been created to assess pathologist genomic oncology knowledge and skills. The exam can be used to assess both individual learners as well as educational interventions. The exam may also be applicable to other specialties involved in genomic-based cancer care.

Download Full-text

Olfactory recovery following infection with COVID-19: A systematic review

PLoS ONE ◽

10.1371/journal.pone.0259321 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259321

Author(s):

Ali Jafar ◽

Andrea Lasso ◽

Risa Shorr ◽

Brian Hutton ◽

Shaun Kilty

Keyword(s):

Systematic Review ◽

A Priori ◽

Olfactory Loss ◽

Olfactory Test ◽

Study Selection ◽

Registration Number ◽

The Common ◽

Polymerase Chain ◽

Reported Data

Olfactory loss has been identified as one of the common symptoms related to COVID-19 infection. Although olfactory loss is recognized, our understanding of both the extent of loss and time to olfactory recovery following infection is less well known. Similarly, knowledge of potential impactful patient factors and therapies that influence olfactory recovery is desirable but is not overtly clear in the literature. Our systematic review sought to fill this knowledge gap. We included studies that: involved either an observational or an interventional design that reported data on patients with olfactory dysfunction due to Reverse Transcription Polymerase Chain Reaction (RT-PCR) diagnosed COVID-19 infection; and reported data regarding olfactory recovery measured by an objective olfactory test, Likert scale and/or visual analog scale (VAS). The study methods were determined a priori and registered in PROSPERO (Registration Number CRD42020204354). An information specialist searched Medline, Embase, LitCovid and the Cochrane Register of Controlled Trials up to March 2021, and two reviewers were involved in all aspects of study selection and data collection. After screening 2788 citations, a total of 44 studies of assorted observational designs were included. Patients had undergone objective COVID-19 testing, and most were adult patients with mild to moderate COVID-19. Olfactory recovery was found to occur as early as 7 days, with most patients recovering olfaction within 30 days. Few studies included prolonged follow-up to 6 months or longer duration. Poor olfaction at initial presentation was associated with poor recovery rates. Only a small number of studies assessed olfactory retraining and steroid therapy. Additional trials are underway.

Download Full-text