scholarly journals Metrics of OsteoChondral Allografts (MOCA) Group Consensus Statements on the Use of Viable Osteochondral Allograft

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098360
Author(s):  
Simon Görtz ◽  
Suzanne M. Tabbaa ◽  
Deryk G. Jones ◽  
John D. Polousky ◽  
Dennis C. Crawford ◽  
...  
Keyword(s):  
Scientific Evidence ◽  
The Body ◽  
Osteochondral Allograft ◽  
Osteochondral Defects ◽  
Level Of Evidence ◽  
Modified Delphi ◽  
Cartilage Restoration ◽  
Consensus Statements ◽  
Surgical Application ◽  
High Level

Background: Osteochondral allograft (OCA) transplantation has evolved into a first-line treatment for large chondral and osteochondral defects, aided by advancements in storage protocols and a growing body of clinical evidence supporting successful clinical outcomes and long-term survivorship. Despite the body of literature supporting OCAs, there still remains controversy and debate in the surgical application of OCA, especially where high-level evidence is lacking. Purpose: To develop consensus among an expert group with extensive clinical and scientific experience in OCA, addressing controversies in the treatment of chondral and osteochondral defects with OCA transplantation. Study Design: Consensus statement. Methods: A focus group of clinical experts on OCA cartilage restoration participated in a 3-round modified Delphi process to generate a list of statements and establish consensus. Questions and statements were initially developed on specific topics that lack scientific evidence and lead to debate and controversy in the clinical community. In-person discussion occurred where statements were not agreed on after 2 rounds of voting. After final voting, the percentage of agreement and level of consensus were characterized. A systematic literature review was performed, and the level of evidence and grade were established for each statement. Results: Seventeen statements spanning surgical technique, graft matching, indications, and rehabilitation reached consensus after the final round of voting. Of the 17 statements that reached consensus, 11 received unanimous (100%) agreement, and 6 received strong (80%-99%) agreement. Conclusion: The outcomes of this study led to the establishment of consensus statements that provide guidance on surgical and perioperative management of OCAs. The findings also provided insights on topics requiring more research or high-quality studies to further establish consensus and provide stronger evidence.

Patellar Instability Management: A Survey of the International Patellofemoral Study Group

2017 ◽  
Vol 46 (13) ◽  
pp. 3299-3306 ◽  
Author(s):  
Joseph N. Liu ◽  
Michael E. Steinhaus ◽  
Irene L. Kalbian ◽  
William R. Post ◽  
Daniel W. Green ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Online Survey ◽  
Patellofemoral Instability ◽  
Lateral Release ◽  
Study Group ◽  
Current Standard ◽  
Level Of Evidence ◽  
Consensus Statements ◽  
High Level ◽  
First Time

Background: Although patellofemoral instability is among the most prevalent knee disorders, the management of patients with this condition is complex and remains variable, given the lack of long-term, high-level clinical outcome studies to compare various operative and nonoperative modalities. Purpose: To discover a consensus within treatment controversies in patellofemoral instability among experienced knee surgeons with a specific interest in the patellofemoral joint. Study Design: Expert opinion; Level of evidence, 5. Methods: A 3-step modified Delphi technique was used to establish a consensus. A 34-question, case-based online survey regarding patellofemoral instability was distributed to all active members of the International Patellofemoral Study Group. Consensus statements were generated if at least 66% of the respondents agreed and then redistributed to the same panel. Modifications to the consensus statements were made based on the iterative feedback process until no discordance was encountered in the third stage. Results: Eight consensus statements were achieved. Nonoperative management is the current standard of care for a first-time dislocation in the absence of an osteochondral fragment or loose body requiring excision (100% agreement). In patients with a first-time dislocation with an operative osteochondral fracture requiring excision or repair, patellar instability should be addressed concurrently (89% agreement). Recurrent instability should be treated surgically, with most surgeons favoring medial reconstruction (77%-86% agreement). While there is general agreement that bony procedures should be performed to correct underlying bony deformities, there is no consensus regarding the most appropriate type of procedure performed. Lateral release should not be performed in isolation for the treatment of patellar instability (89% agreement). Conclusion: Despite the consensus generated in this study, our current understanding remains limited by a lack of high-level evidence as well as the numerous complex variables influencing treatment decision making. High-quality, multicenter randomized controlled trials, particularly those directly comparing specific surgical treatment methods while controlling for underlying risk factors, are needed to address these areas of uncertainty.

scholarly journals Soccer Post-Match Recovery – a Review of the Evidence on Static Stretching

2018 ◽  
Author(s):  
Ryan Sciacchitano
Keyword(s):  
Muscle Soreness ◽  
Scientific Evidence ◽  
Technical Skills ◽  
The Body ◽  
Soccer Players ◽  
Static Stretching ◽  
Delayed Onset ◽  
Recovery Strategies ◽  
And Performance ◽  
High Level

Soccer is the most played sport worldwide, with over 265 million participants. It is an incredibly demanding sport, with many different technical skills and physical loads placed on the body. This makes post-match recovery strategies amongst high level soccer players of great importance. The aim of this review is to summarize the existing literature on stretching for post-match recovery, examining its relation to injury prevention, Delayed Onset Muscle Soreness (DOMS), and performance. Scientific evidence of the highest quality and relevance was extracted and reviewed. Despite its common practice, evidence does not support static stretching as a modality to improve recovery post-match amongst soccer players. Larger trials with important outcome measures are needed to determine if a post-match stretching regimen to facilitate recovery exists.

Level of scientific evidence underlying palliative care recommendations arising from the National Comprehensive Cancer Network (NCCN) clinical practice guidelines.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19537-e19537
Author(s):  
Felipe Melo Cruz ◽  
Fernando Mauro Lima Prearo ◽  
Daniel Iracema Cubero ◽  
Auro Del Giglio
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Supportive Care ◽  
Scientific Evidence ◽  
Relative Content ◽  
Level Of Evidence ◽  
Nccn Guidelines ◽  
Care Guidelines ◽  
High Level ◽  
Cancer Network

e19537 Background: The palliative care NCCN recommendations are classified according to the level of scientific evidence in four groups: category I, high level of evidence with uniform consensus; category IIA, lower level of evidence with uniform consensus; category IIB, lower level of evidence without a uniform consensus but with no major disagreement; and category III, any level of evidence but with major disagreement. Palliative care guidelines have not yet been judged as to the relative content of each of the aforementioned types of recommendations. Methods: We analyzed the distribution of categories of evidence cited in the 10 supportive care NCCN guidelines, version 2.2011. Results: Of the 2,537 recommendations found in the 10 guidelines, the proportion of category I, IIA and IIB recommendations were 2.9%, 95.7%, 1.4%, respectively. There wasn’t any category III recommendation (table 1). The fields with a higher rate of category I recommendations were fatigue (14.3%) and chemotherapy induced nausea and vomiting (12.7%). No category I recommendations were found on Senior Adult Oncology, Cancer and Chemotherapy induced Anemia and Adult Cancer Pain. Conclusions: : Palliative care NCCN recommendations are largely based on lower level of evidence, but with uniform expert opinion. This data show the urgent need to expand palliative care research in oncology. [Table: see text]

Nanotechnological Medical Devices and Nanopharmaceuticals: The European Regulatory Framework and Research Needs

2007 ◽  
Vol 7 (12) ◽  
pp. 4618-4625 ◽  
Author(s):  
D. G. Rickerby
Keyword(s):  
Medical Devices ◽  
Scientific Evidence ◽  
Regulatory Framework ◽  
The Body ◽  
Regulatory Regime ◽  
Response Data ◽  
Stage Of Development ◽  
European Regulatory ◽  
Living Organisms ◽  
High Level

The European regulatory framework is examined in relation to nanotechnology based medical devices and medicinal products. Medical applications of nanotechnology will have to comply with the requirement for a high level of public health, safety, consumer, and environmental protection. An evaluation of the possible health or environmental risks of nanoparticles must therefore be carried out and it is important to ensure that particle size and chemistry are taken into account when investigating possible adverse effects. Further research is needed on the toxicological and ecotoxicological properties of nanoparticles, their uptake in the body, accumulation in tissues and organs, transport characteristics, exposure and dose-response data, and their distribution and persistence in the environment. The existing regulations appear adequate to manage the risks of nanotechnology at its current stage of development but continuous review of the regulatory regime will be needed to determine whether it is sufficient to protect human health and the environment. Modification of the legislation may prove necessary as new scientific evidence emerges regarding the effects of nanoparticles on living organisms and in the ecosystems.

scholarly journals A Delphi Study to Detect Deficiencies and Propose Actions in Real Life Treatment of Neovascular Age-Related Macular Degeneration

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Alfredo García-Layana ◽  
Luis Arias ◽  
Marta S. Figueroa ◽  
Javier Araiz ◽  
José María Ruiz-Moreno ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Delphi Study ◽  
Online Survey ◽  
Real Life ◽  
Age Related Macular Degeneration ◽  
Modified Delphi ◽  
Age Related ◽  
Consensus Statements ◽  
High Level ◽  
Level Of Agreement

Purpose. Spanish retina specialists were surveyed in order to propose actions to decrease deficiencies in real-life neovascular age macular degeneration treatment (nv-AMD).Methods. One hundred experts, members of the Spanish Vitreoretinal Society (SERV), were invited to complete an online survey of 52 statements about nv-AMD management with a modified Delphi methodology. Four rounds were performed using a 5-point Linkert scale. Recommendations were developed after analyzing the differences between the results and the SERV guidelines recommendations.Results. Eighty-seven specialists completed all the Delphi rounds. Once major potential deficiencies in real-life nv-AMD treatment were identified, 15 recommendations were developed with a high level of agreement. Consensus statements to reduce the burden of the disease included the use of treat and extend regimen and to reduce the amount of diagnostic tests during the loading phase and training technical staff to perform these tests and reduce the time between relapse detection and reinjection, as well as establishing patient referral protocols to outside general ophthalmology clinics.Conclusion. The level of agreement with the final recommendations for nv-AMD treatment among Spanish retinal specialist was high indicating that some actions could be applied in order to reduce the deficiencies in real-life nv-AMD treatment.

Algorithm for Treatment of Focal Cartilage Defects of the Knee: Classic and New Procedures

Cartilage ◽  
2021 ◽  
pp. 194760352199321
Author(s):  
Betina B. Hinckel ◽  
Dimitri Thomas ◽  
Evan E. Vellios ◽  
Kyle John Hancock ◽  
Jacob G. Calcei ◽  
...  
Keyword(s):  
Subchondral Bone ◽  
Treatment Algorithm ◽  
Treatment Strategies ◽  
Bone Involvement ◽  
Osteochondral Allograft ◽  
Cartilage Defects ◽  
Medium Size ◽  
Level Of Evidence ◽  
Cartilage Restoration ◽  
Restoration Techniques

Objective To create a treatment algorithm for focal grade 3 or 4 cartilage defects of the knee using both classic and novel cartilage restoration techniques. Design A comprehensive review of the literature was performed highlighting classic as well as novel cartilage restoration techniques supported by clinical and/or basic science research and currently being employed by orthopedic surgeons. Results There is a high level of evidence to support the treatment of small to medium size lesions (<2-4 cm2) without subchondral bone involvement with traditional techniques such as marrow stimulation, osteochondral autograft transplant (OAT), or osteochondral allograft transplant (OCA). Newer techniques such as autologous matrix-induced chondrogenesis and bone marrow aspirate concentrate implantation have also been shown to be effective in select studies. If subchondral bone loss is present OAT or OCA should be performed. For large lesions (>4 cm2), OCA or matrix autologous chondrocyte implantation (MACI) may be performed. OCA is preferred over MACI in the setting of subchondral bone involvement while cell-based modalities such as MACI or particulated juvenile allograft cartilage are preferred in the patellofemoral joint. Conclusions Numerous techniques exist for the orthopedic surgeon treating focal cartilage defects of the knee. Treatment strategies should be based on lesion size, lesion location, subchondral bone involvement, and the level of evidence supporting each technique in the literature.

Management of Large Focal Chondral and Osteochondral Defects in the Knee

2020 ◽  
Vol 33 (12) ◽  
pp. 1187-1200
Author(s):  
Jacob G. Calcei ◽  
Taylor Ray ◽  
Seth L. Sherman ◽  
Jack Farr
Keyword(s):  
Articular Cartilage ◽  
Clinical Outcomes ◽  
Osteochondral Allograft ◽  
Cartilage Defects ◽  
Osteochondral Defects ◽  
Focal Lesions ◽  
Cartilage Restoration ◽  
Intervention Patient ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

AbstractLarge, focal articular cartilage defects of the knee (> 4 cm2) can be a source of significant morbidity and often require surgical intervention. Patient- and lesion-specific factors must be identified when evaluating a patient with an articular cartilage defect. In the management of large cartilage defects, the two classically utilized cartilage restoration procedures are osteochondral allograft (OCA) transplantation and cell therapy, or autologous chondrocyte implantation (ACI). Alternative techniques that are available or currently in clinical trials include a hyaluronan-based scaffold plus bone marrow aspirate concentrate, a third-generation autologous chondrocyte implant, and an aragonite-based scaffold. In this review, we will focus on OCA and ACI as the mainstay in management of large chondral and osteochondral defects of the knee. We will discuss the techniques and associated clinical outcomes for each, while including a brief mention of alternative treatments. Overall, cartilage restoration techniques have yielded favorable clinical outcomes and can be successfully employed to treat these challenging large focal lesions.

scholarly journals Symptomatic fever management in children: A systematic review of national and international guidelines

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0245815
Author(s):  
Cari Green ◽  
Hanno Krafft ◽  
Gordon Guyatt ◽  
David Martin
Keyword(s):  
The Body ◽  
Healthcare Organizations ◽  
Level Of Evidence ◽  
Low Level ◽  
Pediatric Society ◽  
Age Related ◽  
Symptomatic Management ◽  
Guideline Quality ◽  
High Level ◽  
Grade Assessment

Introduction Divergent attitudes towards fever have led to a high level of inconsistency in approaches to its management. In an attempt to overcome this, clinical practice guidelines (CPGs) for the symptomatic management of fever in children have been produced by several healthcare organizations. To date, a comprehensive assessment of the evidence level of the recommendations made in these CPGs has not been carried out. Methods Searches were conducted on Pubmed, google scholar, pediatric society websites and guideline databases to locate CPGs from each country (with date coverage from January 1995 to September 2020). Rather than assessing overall guideline quality, the level of evidence for each recommendation was evaluated according to criteria of the Oxford Centre for Evidence-Based Medicine (OCEBM). A GRADE assessment was undertaken to assess the body of evidence related to a single question: the threshold for initiating antipyresis. Methods and results are reported according to the PRISMA statement. Results 74 guidelines were retrieved. Recommendations for antipyretic threshold, type and dose; ambient temperature; dress/covering; activity; fluids; nutrition; proctoclysis; external applications; complementary/herbal recommendations; media; and age-related treatment differences all varied widely. OCEBM evidence levels for most recommendations were low (Level 3–4) or indeterminable. The GRADE assessment revealed a very low level of evidence for a threshold for antipyresis. Conclusion There is no recommendation on which all guidelines agree, and many are inconsistent with the evidence–this is true even for recent guidelines. The threshold question is of fundamental importance and has not yet been answered. Guidelines for the most frequent intervention (antipyresis) remain problematic.

scholarly journals Guidelines in Gastroenterology: Careful Interpretation Is Essential

2021 ◽  
pp. 1-7
Author(s):  
Catarina Correia ◽  
Nuno Almeida ◽  
Pedro Narra Figueiredo
Keyword(s):  
Clinical Practice ◽  
Expert Opinion ◽  
North American ◽  
Clinical Judgment ◽  
Scientific Evidence ◽  
Improve Patient Care ◽  
Level Of Evidence ◽  
Low Level ◽  
High Level ◽  
Improve Patient

<b><i>Introduction:</i></b> Clinical practice guidelines (CPG) contain recommendations that aim to guide physicians in the diagnosis of and therapeutic approach toward patients affected by gastrointestinal (GI) pathologies. These CPG systematically combine scientific evidence and clinical judgment, culminating in recommendations that have been shown to improve patient care. <b><i>Material and Methods:</i></b> European and North American guidelines published in the area of gastroenterology in 2018 and 2019 were considered for inclusion. To standardize the results, only guidelines that used GRADE as an evidence system were included. Thus, in the end, 1,233 recommendations from 29 guidelines published between 2018 and 2019 were analyzed. <b><i>Results:</i></b> Of the 1,233 recommendations collected, 324 (26.3%) had a low level of evidence and 127 (10.3%) had a very low level of evidence, indicating little evidence or expert opinion. Of the 29 publications analyzed, 14 (48.3%) did not present any recommendation with a high level of evidence. Regarding the 1,233 individual recommendations expressed in these 29 publications, only 336 (27.25%) assumed a high level of evidence, with 277 (82.44%) referring to liver pathology. Of the recommendations evaluated, 77 were from North American societies and the remaining 1,156 were European recommendations. In relation to the first group, only 3 (3.9%) had a high level of evidence belonging to the Guidelines for Sedation and Anesthesia in GI Endoscopy. <b><i>Conclusions:</i></b> More than 25% of all recommendations currently accepted to guide patients with gastroenterological disorders are based on low-quality evidence or expert opinion. Thus, these documents should guide our performance, but clinical sense and multidisciplinarity must not be overlooked in dubious cases and with weak scientific evidence. Research should focus on the development of randomized controlled trials and systematic reviews to improve the evidence supporting the guidelines that guide clinical practice.

scholarly journals Alternate nostril breathing: a systematic review of clinical trials

2017 ◽  
Vol 5 (8) ◽  
pp. 3273 ◽  
Author(s):  
Shreya Ghiya
Keyword(s):  
Clinical Trials ◽  
Cognitive Functioning ◽  
Scientific Evidence ◽  
Systemic Review ◽  
Memory Retention ◽  
Level Of Evidence ◽  
Safety Issues ◽  
Autonomic Nervous ◽  
High Level ◽  
Clinical Populations

Anulom-vilom Pranayama/ alternate nostril breathing (ANB)/Nadi-suddhi pranayama is one of the common yogic breathing techniques and involves breathing through one nostril at a time while closing the other nostril manually. This study aimed to summarize effects of independent ANB on various physiological parameters, to evaluate safety issues in clinical populations and collect published primary scientific evidence on the benefits of ANB. PubMed/Medline, Cinahl, Web of Science and Google Scholar were searched using the following terms: Alternate nostril breathing, Anulom-vilom/ anuloma-viloma pranayama, Nadi-shodhan/Nadi-shodhana pranayama. Forty-four randomized controlled trials were included in this review paper. These studies evaluated the effects of alternate nostril breathing on parameters of the autonomic nervous system, cardiopulmonary system, cognitive functioning, problem solving and motor memory retention. Of the studies, ten showed a high level of bias; twenty-nine showed a low level of bias and five showed an unknown level of bias as per Cochrane systemic review guidelines. Most of the studies included healthy subjects and age range was eight to seventy years. Alternate nostril breathing has few variations and standardization of the technique is yet to be established. This technique provides high level evidence for positive outcomes for the autonomic nervous and cardiopulmonary systems. There is also high level of evidence regarding improvement in cognitive functioning with regular practice of alternate nostril breathing. More clinical trials are required to evaluate the effects of alternate nostril breathing in clinical populations and to synthesize effective frequency and duration parameters.

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