scholarly journals Disinfection of the Access Orifice in NOTES: Evaluation of the Evidence Base

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Mikael H. Sodergren ◽  
Philip Pucher ◽  
James Clark ◽  
David R. C. James ◽  
Jenny Sockett ◽  
...  
Keyword(s):  
Case Series ◽  
Evidence Base ◽  
Infectious Complications ◽  
Current Evidence ◽  
Natural Orifice ◽  
Current Evidence Base ◽  
Transgastric Approach ◽  
Randomised Controlled ◽  
Based Medicine ◽  
Antiseptic Irrigation

Introduction. Appropriate prevention of infection is a key area of research in natural orifice translumenal endoscopic surgery (NOTES), as identified by the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR). Methods. A review of the literature was conducted evaluating the evidence base for access orifice preparation/treatment in NOTES procedures in the context of infectious complications. Recommendations based on the Oxford Centre for Evidence-Based Medicine guidelines were made. Results. The most robust evidence includes several experimental randomised controlled trials assessing infectious complications in the transgastric approach to NOTES. Transvaginal procedures are long established for accessing the peritoneal cavity following disinfection with antiseptic. Only experimental case series for transcolonic and transvesical approaches are described. Conclusion. Grade C recommendation requiring no preoperative preparation can be made for the transgastric approach. Antiseptic irrigation is recommended for transvaginal (grade C) NOTES access, as is current practice. Further human trials need to be conducted to corroborate the current evidence base for transgastric closure. It is important that future trials are conducted in a methodologically robust fashion, with emphasis on clinical outcomes and standardisation of enterotomy closure and postoperative therapy.

Routine Postoperative Management of Blepharoplasty: A Review of Current Evidence-Based Practice

2021 ◽  
Author(s):  
Mohsan Malik ◽  
Eamon Shamil ◽  
Alwyn Ray D'Souza
Keyword(s):  
Case Series ◽  
Evidence Base ◽  
Postoperative Management ◽  
Current Evidence ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Search Criterion ◽  
Current Evidence Base ◽  
Facial Plastic ◽  
Based Medicine

Abstract Introduction Advances in blepharoplasty have resulted in an improved understanding of preoperative risk factors, intraoperative hemostasis, and wound closure. This has reduced the risk of severe adverse events. The aim of this review is to determine the current evidence base for routine postblepharoplasty management. Method A literature review was performed using MEDLINE, PUBMED, and EMBASE databases. Expanded search criterion “bleph*” was combined with individual terms assessing postoperative management. Articles were assessed and qualified as per Oxford Centre of Evidence-Based Medicine levels 1 to 5 (1 = highest level of evidence). Results A total of 47 unique articles matched our search strategy. Most articles were a description of individual expert opinion, surveys of practice, or case series (level 4–5 evidence). Few randomized controlled trials were performed (level 2). Conclusion Many articles describe the clinical experience of senior facial plastic surgeons. Our review found some evidence for postoperative cooling and preincision antisepsis to be effective. This review highlights the need for higher-quality studies to improve the evidence base for routine postoperative management.

Management of feline carpal injuries: What are the options and when is arthrodesis indicated?

2019 ◽  
Vol 21 (9) ◽  
pp. 809-823 ◽  
Author(s):  
Rachel M Basa ◽  
Kenneth A Johnson
Keyword(s):  
Treatment Options ◽  
Case Series ◽  
Evidence Base ◽  
Careful Examination ◽  
Current Evidence ◽  
Collateral Ligament ◽  
Retrospective Case ◽  
Radial Collateral Ligament ◽  
Current Evidence Base ◽  
Direct Extrapolation

Practical relevance: Feline carpal injuries are usually caused by falls from a height that result in hyperextension injury or antebrachiocarpal luxation or subluxation. Isolated ligamentous damage or fracture of the carpus is unusual; it is more common to have a combination of both in the cat. These injuries can be debilitating since cats climb and jump from great heights, and have a greater range of antebrachial pronation and supination than dogs. Anatomy: There are differences in the anatomy of the feline and canine carpus. In particular, cats only have a single short radial collateral ligament, also known as the medial collateral ligament. This means that, in the cat, antebrachiocarpal subluxation is possible with rupture of the dorsal joint capsule and short radial collateral ligament alone. Clinical challenges: Many feline carpal injuries can be treated without performing pancarpal arthrodesis. However, determining which ligaments and joint levels are affected requires careful examination and often stress radiography. When pancarpal arthrodesis is performed in the cat, it has been reported to reduce the height of jumping and to increase reluctance to climb. This is speculated to be due to reduced pronation and supination movement of the carpus. Evidence base: The current evidence base for management of feline carpal injuries is grade III or IV, with most of the studies being retrospective case series involving cadaveric dissection or direct extrapolation from published information about the dog. There are few guidelines regarding the optimal treatment options for carpal injuries in the cat.

Active warming after caesarean section to prevent neonatal hypothermia: a systematic review

2020 ◽  
Vol 28 (12) ◽  
pp. 829-837
Author(s):  
Aliona Vilinsky-Redmond ◽  
Maria Brenner ◽  
Linda Nugent ◽  
Margaret McCann
Keyword(s):  
Systematic Review ◽  
Caesarean Section ◽  
Elective Caesarean Section ◽  
Evidence Base ◽  
Current Evidence ◽  
Skin Contact ◽  
Current Evidence Base ◽  
Randomised Controlled ◽  
Skin To Skin ◽  
Neonatal Hypothermia

There is a lack of evidence on the effects of perioperative warming on maternal and neonatal outcomes in women undergoing elective caesarean section who are performing at-birth skin-to-skin contact. This study aimed to provide a systematic review of the current evidence base on the effects of perioperative warming versus no warming. Inclusion criteria included randomised controlled trials involving pregnant women ≥18 years old undergoing an elective caesarean section at term under regional anaesthesia and who initiated at-birth neonatal skin-to-skin contact. Studies investigated active warming versus no active warming interventions. Three studies were included, with a total of 286 participants. Active warming of women resulted in significantly less occurrence of neonatal hypothermia, with no difference in maternal hypothermia. Perioperative active warming of mothers and newborns who had skin-to-skin contact may be beneficial. The quality of the included studies was low, so the review findings should be interpreted with caution. High quality studies with larger sample sizes need to be undertaken.

Pelvic ureteric junction obstruction: Natural history, nephrological considerations and current evidence base for surgical management in poorer functioning kidneys

2019 ◽  
Vol 13 (2) ◽  
pp. 116-121 ◽  
Author(s):  
Dora Moon ◽  
Timothy Napier-Hemy
Keyword(s):  
Natural History ◽  
Systemic Disease ◽  
Case Series ◽  
Evidence Base ◽  
Poor Quality ◽  
Quality Data ◽  
Current Evidence ◽  
Current Evidence Base ◽  
History Of ◽  
Split Function

Pelvic ureteric junction obstruction (PUJO) can pose a management challenge to urologists. The natural history of the disease, particularly in adults is poorly understood and management decisions are largely based on historical, poor quality data. Additionally, many older patients may already have a degree of renal impairment secondary to systemic disease, further compounding the situation. The purpose of this paper is to detail the pathophysiology and natural history of PUJO, discuss the implications of chronic kidney disease in this population detailing the current evidence base for poorer functioning kidneys and describe the nephrological advantages of accurate renal function testing. There exists accurate methods to assess both glomerular filtration rate (GFR) and split function which could potentially provide both the urologist and patient with more relevant data on which to base their decisions when contemplating surgical intervention. The existing, low patient number case series currently published fail to address the relevance of overall GFR on the outcomes after pyeloplasty, no studies use single unit GFR and there is no clear consensus on what constitutes surgical success. PUJO is an area of benign upper tract disease that is in need of high-quality scientific studies to identify when intervention is necessary, long-term success of both surgery and conservative management in poorer functioning kidneys and clear guidelines for urologists.

scholarly journals Psychological treatments in intellectual disability: the challenges of building a good evidence base

2011 ◽  
Vol 198 (6) ◽  
pp. 428-430 ◽  
Author(s):  
Sabyasachi Bhaumik ◽  
Satheesh Gangadharan ◽  
Avinash Hiremath ◽  
Paul Swamidhas Sudhakar Russell
Keyword(s):  
Randomised Controlled Trials ◽  
Evidence Base ◽  
Good Evidence ◽  
Current Evidence ◽  
Controlled Trials ◽  
Psychological Treatments ◽  
Current Evidence Base ◽  
People With Intellectual Disabilities ◽  
Randomised Controlled ◽  
The Cost

SummaryPsychological treatments are widely used for the management of mental health and behavioural problems in people with intellectual disabilities. The evidence base, including the cost-effectiveness of such interventions, is limited. This editorial explores the current evidence base and analyses its strengths and limitations. The editorial also highlights current problems in conducting randomised controlled trials in this area and suggests a way forward.

scholarly journals Effectiveness of powered exoskeleton use on gait in individuals with cerebral palsy: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252193
Author(s):  
Lucinda Rose Bunge ◽  
Ashleigh Jade Davidson ◽  
Benita Roslyn Helmore ◽  
Aleksandra Daniella Mavrandonis ◽  
Thomas David Page ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cerebral Palsy ◽  
Case Series ◽  
Gait Training ◽  
Evidence Base ◽  
The Body ◽  
Current Evidence ◽  
Childhood Disability ◽  
Ongoing Research ◽  
Current Evidence Base

Background Cerebral palsy (CP) is a leading cause of childhood disability. The motor impairments of individuals with CP significantly affect the kinematics of an efficient gait pattern. Robotic therapies have become increasingly popular as an intervention to address this. Powered lower limb exoskeletons (PoLLE) are a novel form of robotic therapy that allow the individual to perform over-ground gait training and yet its effectiveness for CP is unknown. Purpose To determine the effectiveness of PoLLE use on gait in individuals with CP. Method A systematic search of eight electronic databases was conducted in March 2020. Studies included children (0–18 years) and or adults (18+ years) diagnosed with CP who used a PoLLE for gait training. This review was conducted and reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement, with the methodology registered with PROSPERO (CRD42020177160). A modified version of the McMaster critical review form for quantitative studies was used to assess the methodological quality. Due to the heterogeneity of the included studies, a descriptive synthesis using the National Health & Medical Research Council (NHMRC) FORM framework was undertaken. Results Of the 2089 studies screened, ten case series and three case studies met the inclusion criteria highlighting the current evidence base is emerging and low level. A range of PoLLEs were investigated with effectiveness measured by using a number of outcome measures. Collectively, the body of evidence indicates there is some consistent positive evidence on the effectiveness of PoLLE in improving gait in individuals with CP, with minimal adverse effects. While this is a positive and encouraging finding for an emerging technology, methodological concerns also need to be acknowledged. Conclusion With rapidly evolving technology, PoLLEs could play a transformative role in the lives of people impacted by CP. Ongoing research is required to further strengthen the evidence base and address current methodological concerns.

Body-worn video: A systematic review of literature

2016 ◽  
Vol 50 (3) ◽  
pp. 379-396 ◽  
Author(s):  
Timothy IC Cubitt ◽  
Rebecca Lesic ◽  
Gemma L Myers ◽  
Robert Corry
Keyword(s):  
Systematic Review ◽  
Law Enforcement ◽  
Grey Literature ◽  
Evidence Base ◽  
Current Evidence ◽  
Current Case ◽  
Public Response ◽  
Current Evidence Base ◽  
Crime Types ◽  
Randomised Controlled

Law enforcement use of video-based technology has substantially increased over the past decade. This systematic review examines the current evidence base for efficacy of body-worn video and the current case for implementation. Five articles were identified as pertinent to this review from a search of five electronic databases, with a further six articles of grey literature included. Inter-rater reliability was high amongst three independent screeners of literature. Articles were short listed for review if they explicitly identified police and recording devices as topic areas. Articles were then excluded if they did not involve an operational trial of body-worn video. Eleven articles were included for review; of the five peer-reviewed studies, two were randomised controlled trials. An abundance of evidence was provided; however, the majority of articles were methodologically weak. Body-worn video was shown to reduce use of force incidents, crime rates for certain crime types and court costs. Public response to body-worn video was varied, as was police officer and public opinion. Due to methodological limitations evident in most studies and the general lack of peer-reviewed material, further research is required; however, there are some considerable benefits reported in the current literature.

scholarly journals Facilitated group work for people with long-term conditions: a systematic review of benefits from studies of group-work interventions

2019 ◽  
Vol 69 (682) ◽  
pp. e363-e372 ◽  
Author(s):  
Margaret Jackson ◽  
Daniel Jones ◽  
Judith Dyson ◽  
Una Macleod
Keyword(s):  
Systematic Review ◽  
Group Work ◽  
Evidence Base ◽  
Current Evidence ◽  
Control Group ◽  
Long Term Conditions ◽  
Health And Social Care ◽  
Current Evidence Base ◽  
Randomised Controlled

BackgroundAbout 15.4 million people in the UK live with a long-term condition. Of the health and social care spend, 70% is invested in caring for this population. Evidence suggests that group-work interventions offer patient support, improved outcomes, and reduce the costs of care.AimTo review the current evidence base examining the effectiveness of group work in long-term physical disease where such groups are facilitated by healthcare professionals.Design and settingSystematic review and narrative synthesis of studies of group-work interventions led by health professionals for adults with specified long-term illnesses.MethodMEDLINE, EMBASE, PsycINFO, and Cochrane databases were systematically searched using terms relating to group work and long-term conditions. Studies were included if they were randomised controlled trials (RCTs) with a control group that did not include group work.ResultsThe 14 included studies demonstrated a high degree of heterogeneity in terms of participant characteristics, interventions, and outcome measures and were of varying quality. The studies demonstrated some statistically significant improvements in pain, psychological outcomes, self-efficacy, self-care, and quality of life resulting from intervention.ConclusionThis review demonstrates significant benefits resulting from group participation, in adults with long-term disease. Results were mixed and some benefits were short-lived. Nevertheless, these results suggest that group work should be more widely used in the management and support of adults with long-term illness. There is a need for larger and better-quality studies to explore this potentially important area further.

scholarly journals Polyphenols and Cognition In Humans: An Overview of Current Evidence from Recent Systematic Reviews and Meta-Analyses

2020 ◽  
pp. 1-15
Author(s):  
Daniel Joseph Lamport ◽  
Claire Michelle Williams
Keyword(s):  
Systematic Reviews ◽  
Evidence Base ◽  
Epidemiological Studies ◽  
Cognitive Outcome ◽  
Current Evidence ◽  
Duration Of Treatment ◽  
Current Evidence Base ◽  
Cognitive Benefits ◽  
Meta Analyses ◽  
The Impact

There is increasing interest in the impact of dietary influences on the brain throughout the lifespan, ranging from improving cognitive development in children through to attenuating ageing related cognitive decline and reducing risk of neurodegenerative diseases. Polyphenols, phytochemicals naturally present in a host of fruits, vegetables, tea, cocoa and other foods, have received particular attention in this regard, and there is now a substantial body of evidence from experimental and epidemiological studies examining whether their consumption is associated with cognitive benefits. The purpose of this overview is to synthesise and evaluate the best available evidence from two sources, namely meta-analyses and systematic reviews, in order to give an accurate reflection of the current evidence base for an association between polyphenols and cognitive benefits. Four meta-analyses and thirteen systematic reviews published between 2017–2020 were included, and were categorised according to whether they reviewed specific polyphenol-rich foods and classes or all polyphenols. A requirement for inclusion was assessment of a behavioural cognitive outcome in humans. A clear and consistent theme emerged that whilst there is support for an association between polyphenol consumption and cognitive benefits, this conclusion is tentative, and by no means definitive. Considerable methodological heterogeneity was repeatedly highlighted as problematic such that the current evidence base does not support reliable conclusions relating to efficacy of specific doses, duration of treatment, or sensitivity in specific populations or certain cognitive domains. The complexity of multiple interactions between a range of direct and indirect mechanisms of action is discussed. Further research is required to strengthen the reliability of the evidence base.

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