Toxic Epidermal Necrolysis Spectrum Management at Sunnybrook Health Sciences Centre: Our Multidisciplinary Approach After Review of the Current Evidence

2017 ◽  
Vol 22 (2) ◽  
pp. 213-219 ◽  
Author(s):  
Alexandra Mereniuk ◽  
Alejandra Jaque ◽  
Marc G. Jeschke ◽  
Neil H. Shear
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Relevant Literature ◽  
Treatment Protocol ◽  
Health Sciences ◽  
Spectrum Management ◽  
Current Evidence ◽  
Team Approach ◽  
Sunnybrook Health ◽  
Reference Centre ◽  
Meta Analyses

Toxic epidermal necrolysis spectrum (TENS) is a rare yet severe adverse drug reaction associated with a high mortality rate. Beyond supportive care, there is still no established therapy for TENS, although recent meta-analyses and UK guideline recommendations have attempted to offer a review of relevant literature on this difficult topic. As most directed treatments lack clear consensual evidence, care centres often resort to establishing their own strategies. As Canada’s largest adult burn centre and the provincial reference centre for most burn patients in Ontario, our team at the Ross Tilley Burn Centre, in collaboration with the Department of Dermatology at Sunnybrook Health Sciences Centre, Toronto, Canada, has managed over 60 confirmed cases of TENS over the past 2 decades. We would like to share our management, experience, and present our treatment protocol that we recently established by a collaborative multidisciplinary team approach to help guide treatment of these complex patients not only in Canada but worldwide.

scholarly journals The Treatment of Locally Advanced Pancreatic Cancer: A Practice Guideline

2003 ◽  
Vol 17 (3) ◽  
pp. 161-167 ◽  
Author(s):  
Craig C Earle ◽  
Olusegun Agboola ◽  
Jean Maroun ◽  
Lisa Zuraw ◽  
Keyword(s):  
Pancreatic Cancer ◽  
Practice Guideline ◽  
Relevant Literature ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Current Evidence ◽  
Cochrane Library ◽  
American Society ◽  
Meta Analyses ◽  
Study Designs

BACKGROUND: Pancreatic adenocarcinoma is the fourth most common cause of adult cancer death. About 50% of patients present with metastatic disease, 20% with resectable disease and the remaining 30% of patients are diagnosed with incurable, locally advanced unresectable but nonmetastatic pancreatic cancer.OBJECTIVES: To evaluate the current evidence regarding treatment of incurable, locally advanced, unresectable but nonmetastatic pancreatic cancer and produce an evidence-based practice guideline.METHODS: A systematic review of the literature was performed. The MEDLINE, CANCERLIT, and Cochrane Library databases were searched using the following medical subject heading search terms: ‘pancreatic neoplasms’, ‘chemotherapy, adjuvant’, ‘radiotherapy’, ‘immunotherapy’, combined with the text words: ‘chemotherapy’, ‘radiotherapy’, ‘radiation’, ‘immunotherapy’, combined with terms for the following study designs or publication types: practice guidelines, meta-analyses and randomized controlled trials. The Physician Data Query clinical trials database and the proceedings of the annual meetings of the American Society of Clinical Oncology (1996 to 2001) and the American Society for Therapeutic Radiology and Oncology (1999 to 2001) were searched for reports of new or ongoing trials. Relevant literature was selected and reviewed independently, and the reference lists from these sources were searched for additional trials. Interpretation of evidence was resolved by consensus.RESULTS: Eight randomized trials were obtained that met the inclusion criteria.CONCLUSIONS: Recommendations are to offer combined chemotherapy and radiotherapy to suitable patients. The preferred chemotherapeutic agent to combine with radiotherapy is bolus or infusional 5-fluorouracil, but the optimal mode and duration of 5-fluorouracil delivery is unclear. Chemotherapy alone with gem-citabine is an acceptable alternative.

scholarly journals Evaluation of the effectiveness of behavioural economic incentive programmes for the promotion of a healthy diet and physical activity: a protocol for a systematic review and network meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e046035
Author(s):  
Suparee Boonmanunt ◽  
Oraluck Pattanaprateep ◽  
Boonsong Ongphiphadhanakul ◽  
Gareth McKay ◽  
John Attia ◽  
...  
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Financial Incentives ◽  
Meta Analysis ◽  
Economic Incentive ◽  
Healthy Diet ◽  
Current Evidence ◽  
Diet And Physical Activity ◽  
Behavioural Economic ◽  
Meta Analyses

IntroductionObesity and being overweight are major risk factors for metabolic syndrome and non-communicable diseases. Despite the recommendation that a healthy diet and physical activity can reduce the severity of these diseases, many fail to adhere to these measures. From a behavioural economic perspective, adherence to such measures can be encouraged through financial incentives. However, additional related behavioural economic approaches may improve the effectiveness of an incentive programme. As such, we have developed a protocol for a systematic review and network meta-analysis to summarise the current evidence from financial incentive programmes with and without behavioural economic insights for promoting healthy diet and physical activity.Methods and analysisPrevious systematic reviews, meta-analyses and individual studies were identified from Medline and Scopus in June 2020 and will be updated until December 2020. Individual studies will be selected and data extracted by two reviewers. Disagreement will be resolved by consensus or adjudicated by a third reviewer. A descriptive analysis will summarise the effectiveness of behavioural economic incentive programmes for promoting healthy diet and physical activity. Moreover, individual studies will be pooled using network meta-analyses where possible. I2 statistics and Cochran’s Q test will be used to assess heterogeneity. Risk of bias and publication bias, if appropriate, will be evaluated, as well as the overall strength of the evidence.Ethics and disseminationEthics approval for a systematic review and meta-analysis is not required. The findings will be published in a peer-reviewed journal.PROSPERO registration numberCRD42020198024.

scholarly journals Effectiveness of e-cigarettes in smoking cessation: a systematic review and meta-analysis

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Oberndorfer ◽  
I Grabovac ◽  
S Haider ◽  
T E Dorner
Keyword(s):  
Systematic Review ◽  
Smoking Cessation ◽  
Meta Analysis ◽  
Current Evidence ◽  
Promising Alternative ◽  
Quality Of Evidence ◽  
Different Populations ◽  
Meta Analyses

Abstract Background Reports of the effectiveness of e-cigarettes (ECs) for smoking cessation vary across different studies making implementation recommendations hard to attain. We performed a systematic review and meta-analysis to synthesise the current evidence regarding the effectiveness of ECs for smoking cessation. Methods PubMed, PsycInfo and Embase databases were searched for randomized controlled trials comparing nicotine ECs with non-nicotine ECs or with established smoking cessation interventions (nicotine replacement therapy (NRT) and or counselling) published between 01/01/2014 and 01/05/2019. Data from eligible studies were extracted and used for random-effects meta-analyses. Results Our literature review yielded 13190 publications with 10 studies being identified as eligible for systematic review, covering 8362 participants, and 8 for meta-analyses (n = 30 - 6006). Using the last follow-up of eligible studies, the proportion of smokers achieving abstinence was 1.67 [95CI:0.99 - 2.81] times higher in nicotine EC users compared to non-nicotine EC users. The proportion of abstinent smokers was 1.69 [95CI:1.25 - 2.27] times higher in EC users compared to participants receiving NRT. EC users showed a 2.70 [95CI:1.15 - 6.30] times higher proportion of abstinent smokers in comparison to participants solely receiving counselling. Conclusions Our analysis showed modest effects of nicotine-ECs compared to non-nicotine ECs. When compared to NRT or counselling, results suggest that nicotine EC may be more effective for smoking cessation. As ECs also help maintaining routinized behaviour and social aspects of smoking, we hypothesise that this may explain their advantage as a tool for smoking cessation. However, given the small number of included studies, different populations, heterogeneous designs, and the overall moderate to low quality of evidence, it is not possible to offer clear recommendations. More comparable data is needed to strengthen confidence in the quality of evidence. Key messages The number of previous studies assessing the effectiveness of ECs for smoking cessation is limited. Further, comparability of these studies is restricted, weakening the quality of evidence. Although current evidence on the effectiveness of ECs for smoking cessation is inconclusive, our meta-analyses suggest that ECs could be a promising alternative tool in attempts to achieve abstinence.

scholarly journals Consequences of the COVID-19 Syndemic for Nutritional Health: A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1168
Author(s):  
Cristian Neira ◽  
Rejane Godinho ◽  
Fabio Rincón ◽  
Rodrigo Mardones ◽  
Janari Pedroso
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Preventive Measures ◽  
Physical Contact ◽  
Current Evidence ◽  
Study Objective ◽  
Eating Style ◽  
Healthy Nutrition ◽  
Meta Analyses ◽  
The Impact

Confinement at home, quarantine, and social distancing are some measures adopted worldwide to prevent the spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2), which has been generating an important alteration in the routines and qualities of life of people. The impact on health is still being evaluated, and consequences in the nutritional field are not entirely clear. The study objective was to evaluate the current evidence about the impact that preventive measures of physical contact restriction causes in healthy nutrition. A systematic review was carried out according to the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” PRISMA Group and Cochrane method for rapid systematic reviews. Searching was performed in six electronic databases and evaluated articles published between 2010 and 2020, including among their participants adult subjects who had been exposed to the preventive measures of physical contact restriction. Seven studies met the selection criteria and reported an overall increase in food consumption, weight, Body Mass Index (BMI), and a change in eating style. Findings suggest that healthy nutrition is affected by preventive measures to restrict physical contact as a result of the COVID-19 syndemic.

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.

scholarly journals Robotic colorectal surgery: more than a fantastic toy?

2018 ◽  
Vol 3 (1) ◽  
pp. 65-68 ◽  
Author(s):  
James W.T. Toh ◽  
Kevin Phan ◽  
Seon-Hahn Kim
Keyword(s):  
Rectal Cancer ◽  
Colorectal Surgery ◽  
Da Vinci Surgical System ◽  
Current Evidence ◽  
Rectal Cancer Surgery ◽  
Cancer Trial ◽  
Robotic Colorectal Surgery ◽  
Significant Difference ◽  
Meta Analyses ◽  
Laparoscopic Assisted

AbstractThere has been a rapid rise in the number of robotic colorectal procedures worldwide since the da Vinci Surgical System robotic technology was approved for surgical procedures in the year 2000. Several recent meta-analyses and systematic reviews have shown a significant difference in outcomes between robotic and laparoscopic rectal cancer surgery. However, these results from pooled data have not been supported by the initial results reported from the Robotic assisted versus laparoscopic assisted resection for rectal cancer trial. In this article, we examine the current evidence for robotic colorectal surgery, assess its features and functionality, evaluate its learning curve and provide our perspective on its future.

The anti-osteoporosis effects of Vitamin K in postmenopausal women

2021 ◽  
Vol 16 ◽  
Author(s):  
Yuan Liu ◽  
Yuan He ◽  
Baorong He ◽  
Lingbo Kong
Keyword(s):  
Postmenopausal Women ◽  
Vitamin K ◽  
Relevant Literature ◽  
Osteoporotic Fractures ◽  
Mortality And Morbidity ◽  
Standard Guideline ◽  
Set Up ◽  
Meta Analyses ◽  
Aging People ◽  
Analytical Approaches

Abstract: As a common systemically muscular-skeleton disorder in aging, osteoporosis is characterized by the uninterrupted deconstruction in osseous microarchitecture. Osteoporosis can consequently lead to a significantly high risk of osteoporotic fractures, such as osteoporotic vertebral compressive fractures [OVCF] in the spine and osteoporotic femoral neck fractures, which can significantly increase the numbers of mortality and morbidity in aging people, especially in postmenopausal women. In addition, vitamin K has been demonstrated to play a key role in inhibiting osteoporotic fractures among postmenopausal women, but its long-term benefits, potential harms, and effects of the combination between vitamin K and other anti-osteoporosis medicines such as bisphosphonates or teriparatide were just extensively studied. Therefore, the present review aimed to systematically reviewed published literature on the role of vitamin K in the treatment of osteoporosis. We currently, via multiple queries strategy, searched the relevant literature in Cochrane and PubMed from January 2010 to December 2019. Subsequently, we conducteda systematic review according to the standard guideline of Preferred Reporting Item for Systematic Reviews and Meta-Analyses [PRISMA]. Finally, ten relevant works of literature met our current criteria for inclusion, and then we followed the PRISMA guideline and systematically reviewed each study by the categorized data sources and analytical approaches in each study, meanwhile set up variables and defined each study outcomes.

SP1.1.16Endoscopic evaluation after acute colonic diverticulitis: Review of literature

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Hazim A. Eltyeb ◽  
Sriram Subramonia
Keyword(s):  
Colorectal Cancer ◽  
Confidence Interval ◽  
Acute Diverticulitis ◽  
Significant Risk ◽  
Acute Attack ◽  
Current Evidence ◽  
Colonic Diverticulitis ◽  
Endoscopic Evaluation ◽  
Medical Societies ◽  
Meta Analyses

Abstract Aim To compare the current evidence for routine endoscopic evaluation of the colon after an episode of acute diverticulitis against existing guidelines in the United Kingdom. Methodology A systematic literature search of Medline, Embase and Cochrane databases was performed using keywords “Diverticular disease”, “Diverticulitis”, “acute”, “Colorectal Cancer” and “endoscopy”. Recommendations from guidelines of specialist medical societies were reviewed. Available literature was explored to assess the risk of colorectal cancer in patients presenting with acute diverticulitis. Results The most recent UK guideline (Royal College of Surgeons Commissioning guide 2014 supported by ACPGBI) recommends the routine evaluation of colonic lumen after resolution of an acute attack of diverticulitis. More recent guidelines from specialist medical societies (European Society of Coloproctology 2020, World Society of Emergency Surgery 2020, European Association for Endoscopic Surgery and Society of American Gastrointestinal and Endoscopic Surgeons 2018) do not recommend routine endoscopic evaluation after recovery from uncomplicated colonic diverticulitis. Two meta-analyses as well as three large cohort studies showed no significant risk of colorectal cancer ((1.22% (95% confidence interval 0.63-1.97) and (0.7%; confidence interval 0.3%−1.4%)) following uncomplicated acute diverticulitis. Conclusion Existing UK guidance on routine colonic luminal evaluation after resolution of acute diverticulitis should be revised based on current evidence.

Abstract P060: Major Dietary Risk Factors for Chronic Diseases: A Systematic Review of the Current Evidence for Causal Effects and Effect Sizes

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Shahab Khatibzadeh ◽  
Renata Micha ◽  
Ashkan Afshin ◽  
Mayuree Rao ◽  
Mohammad Y Yakoob ◽  
...  
Keyword(s):  
Risk Factors ◽  
Dose Response ◽  
Convincing Evidence ◽  
Dietary Factors ◽  
Causal Effects ◽  
Effect Sizes ◽  
Current Evidence ◽  
Dietary Risk Factors ◽  
Dietary Risk ◽  
Meta Analyses

Background: Diet habits contribute to development of CVD and diabetes. Estimating the impact of diet on these diseases requires identification and quantification of causal effects of dietary factors. Objectives: To assess major dietary risk factors for CVD and diabetes, evaluate current evidence for causal effects, and identify the best unbiased effect estimates on risk. Methods: For multiple dietary risk factors, we evaluated WHO and similar criteria as part of the Global Burden of Diseases (GBD) study to assess probable or convincing evidence for causal effects, including consistency, dose-response, plausibility, and temporality. We performed systematic searches of online databases from 2008 to 2011, including hand-searches of references and author contacts, to identify systematic reviews and meta-analyses of well-designed observational or interventional studies. Meta-analyses were evaluated based on number of studies, design, definition of diet factors and outcomes, sample size, number of events, length of follow-up, statistical methods, evidence of bias, and control for confounders. Meta-analyses with largest numbers of studies and events and least evidence for bias were identified. Effect sizes and uncertainty were quantified per defined units of exposure, including pooling of categorical dose-response estimates using fixed-effects generalized least squares for trend estimation (GLST). Results: We identified 15 dietary risk factors having probable or convincing evidence of causal effects on CVD or diabetes. For 13, data were identified to provide the best pooled unbiased effect size on disease (Table). Conclusions: This systematic evaluation provides the best evidence-based quantitative estimates of the effects of major dietary factors on CVD and diabetes. These findings enable estimation of quantitative impacts on diseases burdens of suboptimal intakes of these factors in specific populations, and also highlight gaps in knowledge related to causality or effect sizes of other dietary factors.

Evaluation and treatment of the infected foot in a community teaching hospital

1996 ◽  
Vol 86 (9) ◽  
pp. 421-426 ◽  
Author(s):  
WF Todd ◽  
DG Armstrong ◽  
PJ Liswood
Keyword(s):  
Diabetic Foot ◽  
Average Length ◽  
Treatment Protocol ◽  
Cost Effective ◽  
Primary Diagnosis ◽  
Care Team ◽  
Team Approach ◽  
Foot Care ◽  
Hospital Days ◽  
Community Teaching

More inpatient hospital days are used for the care of diabetic foot infection than for any other diabetic sequela. Both the number of lower extremity amputations and the overall treatment cost of treating diabetic infections may be reduced by using a team approach in the care of the infected diabetic pedal wound. The authors propose an evaluation and treatment protocol of infected pedal ulcerations in an urban, community teaching institution when admitted to an established, multidisciplinary diabetic foot care team. The hospital course of 111 patients admitted with a primary diagnosis of infected pedal ulceration are retrospectively reviewed. Results revealed an average-length hospital stay of 7.4 days with a 96% limb-salvage rate. The authors suggest that in the treatment of the infected pedal wound, a diabetic foot care team with a well developed treatment protocol may yield a consistently favorable outcome and a cost-effective hospital course.

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