Cochrane corner: ergonomic positioning or equipment for treating carpal tunnel syndrome

2013 ◽  
Vol 38 (5) ◽  
pp. 580-581 ◽  
Author(s):  
S. Buchan ◽  
R. Amirfeyz

Background: Non-surgical treatments, including ergonomic positioning or equipment, are sometimes offered to people experiencing mild to moderate symptoms from carpal tunnel syndrome. The effectiveness and duration from ergonomic positioning or equipment interventions for treating carpal tunnel syndrome are unknown. Objectives: To assess the effects of ergonomic positioning compared with no treatment, a placebo or another non-surgical intervention in people with carpal tunnel syndrome. Search methods: We searched the Cochrane Neuromuscular Disease Group Specialized Register (14 June 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (2011, Issue 2, in The Cochrane Library), MEDLINE (1966 to June 2011), EMBASE (1980 to June 2011), CINAHL Plus (1937 to June 2011), and AMED (1985 to June 2011). We also reviewed the reference lists of randomized or quasi-randomized trials identified from the electronic search. Selection criteria: Randomized or quasi-randomized controlled trials comparing ergonomic positioning or equipment with no treatment, placebo or another non-surgical intervention in people with carpal tunnel syndrome. Data collection and analysis: Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias of included studies. They calculated risk ratios and mean differences with 95% confidence intervals for the primary and secondary outcomes. Results of clinically and statistically homogeneous trials were pooled, where possible, to provide estimates of the effect of ergonomic positioning or equipment.

2012 ◽  
Vol 37 (4) ◽  
pp. 375-376 ◽  
Author(s):  
J. Henton ◽  
A. Jain

Background: Although various solutions have been recommended for cleansing wounds, normal saline is favoured as it is an isotonic solution and does not interfere with the normal healing process. Tap water is commonly used in the community for cleansing wounds because it is easily accessible, efficient and cost effective; however, there is an unresolved debate about its use. Objectives: The objective of this review was to assess the effects of water compared with other solutions for wound cleansing. Search strategy: For this update we searched the Cochrane Wounds Group Specialised Register (Searched 22 February 2010); The Cochrane Central Register of Controlled Trials (CENTRAL) ( The Cochrane Library, 2010 Issue 1); Ovid MEDLINE – 2007 to February Week 2 2010; Ovid MEDLINE – In-Process & Other Non-Indexed Citations (Searched19 February 2010); Ovid EMBASE – 2007 to 2010 Week 06; EBSCO CINAHL – 2007 to 22 February 2010. Selection criteria: Randomized and quasi-randomized controlled trials that compared the use of water with other solutions for wound cleansing were eligible for inclusion. Additional criteria were outcomes that included objective or subjective measures of wound infection or healing. Data collection and analysis: Two review authors independently carried out trial selection, data extraction and quality assessment. We settled differences in opinion by discussion. We pooled some data using a random-effects model.


2019 ◽  
Vol 37 (4) ◽  
pp. 294-299 ◽  
Author(s):  
Jun Kako ◽  
Masamitsu Kobayashi ◽  
Yasufumi Oosono ◽  
Kohei Kajiwara ◽  
Mika Miyashita

Background: Dyspnea is a common distressing symptom in patients with malignant and nonmalignant diseases. Fan therapy, which uses a fan to blow air toward the patient’s face, can alleviate dyspnea; however, its efficacy remains unclear. Aim: To examine the immediate efficacy of fan therapy for alleviation of dyspnea at rest. Design: Meta-analysis. Data sources: We searched the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE EBSCO, CINAHL EBSCO, and Scopus from January 1, 1987, to August 21, 2018 (PROSPERO-CRD42018108610). In addition, we hand-searched studies and used the similar articles feature on PubMed to search for articles. Randomized controlled trials comparing the effects of fan therapy with placebo or other interventions to alleviate dyspnea at rest, in which patients were aged ≥18 years, were eligible for inclusion in the review. We excluded articles on long-term intervention involving fan therapy and complex intervention (including fan therapy). The risk of bias assessment was conducted using the Cochrane tool, and the meta-analysis was performed using RevMan version 5.3. Results: We identified a total of 218 studies; 2 met our criteria for inclusion in the meta-analysis. Fan therapy significantly improved dyspnea at rest in terminally ill patients with cancer compared to control groups (mean difference: −1.31, 95% confidence interval: −1.79 to −0.83, P < .001). There were no studies that met the inclusion criteria regarding fan therapy for patients with nonmalignant disease. Conclusions: This meta-analysis demonstrated that fan therapy may be an effective intervention for dyspnea at rest in patients with terminal cancer.


2021 ◽  
Vol 12 ◽  
Author(s):  
Wei Zhao ◽  
Chuantao Peng ◽  
Hafiz Arbab Sakandar ◽  
Lai-Yu Kwok ◽  
Wenyi Zhang

Lactobacillus (L.) plantarum strains, belong to lactic acid bacteria group, are considered indispensable probiotics. Here, we performed meta-analysis to evaluate the regulatory effects of L. plantarum on the immunity during clinical trials. This meta-analysis was conducted by searching across four most common literature databases, namely, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and PubMed. Clinical trial articles that met the inclusion and exclusion criteria were analyzed by Review Manager (version 5.3). p-value &lt; 0.05 of the total effect was considered statistically significant. Finally, total of 677 references were retrieved, among which six references and 18 randomized controlled trials were included in the meta-analysis. The mean differences observed at 95% confidence interval: interleukin (IL)-4, −0.48 pg/mL (−0.79 to −0.17; p &lt; 0.05); IL-10, 9.88 pg/mL (6.52 to 13.2; p &lt; 0.05); tumor necrosis factor (TNF)-α, −2.34 pg/mL (−3.5 to −1.19; p &lt; 0.05); interferon (IFN)-γ, −0.99 pg/mL (−1.56 to −0.41; p &lt; 0.05). Therefore, meta-analysis results suggested that L. plantarum could promote host immunity by regulating pro-inflammatory and anti-inflammatory cytokines.


2020 ◽  
Vol 9 ◽  
pp. 15-30
Author(s):  
Diana Costa

INTRODUCTION/ FRAMEWORK/ OBJECTIVES Carpal tunnel syndrome (CTS) is a progressively painful condition of the wrist and hands, caused by compression of the median nerve, at the level of the carpal tunnel, on the anterior side of the wrist. There are several known risk factors, such as repetitive movements, loads, vibrations, diabetes or pregnancy, but some authors consider that in 50% of cases the etiology is idiopathic. This review aims to visualize CTS in addition to repetitive movements, seeking to provide a different perspective when relating it to inappropriate lifestyles, such as metabolic syndrome or insulin resistance. METHODS It is an integrative bibliographic review in the EBSCO databases: CINAHL Plus, Nursing & Allied Health Collection, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), MedicLatina; MEDLINE, PUBMED and RCAAP, held in January 2020, considering what is described in the literature regarding carpal tunnel syndrome and insulin resistance or metabolic syndrome. RESULTS/DISCUSSION We found cross-sectional and case-control studies, in which CTS is associated with changes in glycemic metabolism (between 50 to 75% of cases), or manifestations at the insulin level, including changes in fasting insulin or HOMA-IR. CONCLUSIONS Approaching the link between idiopathic CTS as an indicator of an inadequate lifestyle (marked by metabolic syndrome or insulin resistance) represents a first step towards early approaches in individuals with tendinopathies. It is proposed that professionals study possible insulin resistance as a suspect of all workers with idiopathic tendinopathies, requiring an effort from the entire multidisciplinary team. More than stretching, massages, anti-inflammatory drugs and muscle relaxers, it is necessary not to look at CTS as just “a fist”, but as a system that acts (repetitively) in synergy with inappropriate lifestyles, resulting from exposure to more risk factors beyond the most obvious.


2020 ◽  
Vol 5 (2) ◽  
pp. 198-204
Author(s):  
Xiao Wang ◽  
Danhong Wu ◽  
Ping Zhong

Bilirubin, a product of heme metabolism, is the most potent endogenous antioxidant which increases in many oxidative stress conditions such as stroke. It has been widely known to exert neuroprotective effect on stroke through mechanisms involved in development, therefore, it can influence the occurrence and prognosis of ischaemic stroke (IS). In this review, studies were identified by a comprehensive search of Pubmed, Embase, the Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register) and Web of Science to examine the correlation between serum bilirubin levels and risks of developing IS as well as IS outcomes. Additional studies were identified by reviewing references and contacting authors.


2020 ◽  
Author(s):  
Fu-An Yang ◽  
Ya-Chu Shih ◽  
Jia-Pei Hong ◽  
Chin-Wen Wu ◽  
Chun-De Liao ◽  
...  

Abstract Carpal tunnel syndrome (CTS) refers to the symptoms and signs caused by the compression of the median nerve in the carpal tunnel. It can be treated by corticosteroid injection into the carpal tunnel. Two methods for injection have been employed, namely ultrasound-guided and landmark-guided injection. This systematic review and meta-analysis was conducted to compare these methods in terms of several outcomes. Randomized controlled trials (RCTs) were identified, and data collection was completed on 7 October 7, 2020. Results for continuous variables are expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Analyses were performed using RevMan 5.3 software. The analysis included eight RCTs published between 2013 and 2019 with a total of 448 patients. Ultrasound-guided injection yielded more favorable results for the Boston Carpal Tunnel Syndrome Questionnaire, Symptom Severity Scale [SMD = −0.49, 95% CI (−0.74, −0.25), P < 0.0001], Boston Carpal Tunnel Syndrome Questionnaire, Functional Status Scale [SMD = −0.24, 95% CI (−0.42, −0.06), P = 0.01], distal motor latency [SMD = −0.36, 95% CI (−0.70, −0.02), P = 0.04], and compound muscle action potential [SMD = 0.38, 95% CI (0.16, 0.61), P = 0.0008] . Ultrasound-guided corticosteroid injection is recommended for patients with CTS.


2020 ◽  
Vol 161 (16) ◽  
pp. 611-622
Author(s):  
Viktor L. Nagy ◽  
Zoltán Herold

Absztrakt: Bevezetés: A trimetazidin olyan metabolikus hatású anyag, amelynek hatékonysága igazolást nyert a stabil koszorúér-szindróma kezelésében. Az ajánlás szerint a trimetazidin második vonalbeli kezelésként megfontolandó az angina gyakoriságának csökkentésére és a terhelési tolerancia javítására azokban a betegekben, akiknek a tünetei nem kontrollálhatók megfelelően béta-blokkolók, kalciumcsatorna-blokkolók és tartós nitrátok adása mellett. Célkitűzés: Jelen vizsgálatunkban a különböző adagolású (3 × 20 mg, 2 × 35 mg, 1 × 80 mg) trimetazidinkészítmények hatékonyságát kívántuk tisztázni stabil angina pectorisban. Az elsődleges klinikai célváltozók a következők voltak: heti anginaszám, valamint a heti rövid hatástartamú sublingualis nitrátfogyasztás. Módszer: Mindketten adatgyűjtést végeztünk a PubMed, a Cochrane Library és a Cochrane Central Register of Controlled Trials adatbázisokban az 1967-től 2019. szeptember 30-ig terjedő időszakra vonatkozóan. A statisztikai elemzést standard metaanalízis-módszerekkel hajtottuk végre. Eredmények: Összesen 31 randomizált, kontrollált, illetve obszervációs tanulmány került bevonásra. 9856 beteg (átlagéletkor: 59,6 év, férfi: 61,6%) kezelését értékeltük. A trimetazidin a randomizált tanulmányokban a placebóval összehasonlítva csökkentette a heti anginaszámot (átlagos különbség: –1,84, 95% CI: –2,39; –1,30; p<0,0001) és a heti nitroglicerin-fogyasztást (–1,65, 95% CI: –2,17; –1,14; p<0,0001). A trimetazidin a kiinduláshoz képest a kombinációs és az obszervációs vizsgálatokban csökkentette a heti anginaszámot (átlagos különbség: –3,73, 95% CI: –4,53; –2,92; p<0,0001) és a heti nitroglicerin-fogyasztást (–3,23, 95% CI: –4,23; –2,24; p<0,0001). A három kezelési dózis között az anginaszám csökkenésében és a nitroglicerin-fogyasztásban nem lehetett különbséget kimutatni (p = 0,57, illetve p = 0,48). További eredményeink: a két primer változó vizitről vizitre csökkent; nagyobb beválasztási anginaszám a rövidebb időtartamú tanulmányokban és a kisebb adagú trimetazidint kapók között fordult elő gyakrabban, és ezek a betegek a többieknél fiatalabbak voltak. A rövidebb időtartamú tanulmányokban a kezdeti nitroglicerin-igény, illetve a -csökkenés nagyobb volt a hosszabb időtartamúakhoz képest. Következtetések: A trimetazidin kedvező klinikai hatású stabil angina pectorisban, az alkalmazott adagtól függetlenül. Új megállapításunk az, hogy a súlyosabb állapotú, fiatalabb betegek kezelésének klinikai haszna a legnagyobb. Orv Hetil. 2020; 161(16): 611–622.


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