What is the level of evidence for the amnestic effects of sedatives in pediatric patients? A systematic review and meta-analyses

Abstract Background Entero-colovesical fistula is a rare complication of various benign and malignant diseases. The diagnosis is prominently based on clinical symptoms; imaging studies are necessary not only to confirm the presence of the fistula, but more importantly to demonstrate the extent and the nature of the fistula. There is still a lack of consensus regarding the if, when and how to repair the fistula. The aim of the study is to review the different surgical treatment options, focus on surgical indications, and explore cumulative recurrence, morbidity, and mortality rates of entero-vesical and colo-vesical fistula patients. Methods A systematic review of the literature was conducted according to PRISMA guidelines. Random effects meta-analyses of proportions were developed to assess primary and secondary endpoints. I2 statistic and Cochran’s Q test were computed to assess inter-studies’ heterogeneity. Results Twenty-two studies were included in the analysis with a total of 861 patients. Meta-analyses of proportions pointed out 5, 22.2, and 4.9% rates for recurrence, complications, and mortality respectively. A single-stage procedure was performed in 75.5% of the cases, whereas a multi-stage operation in 15.5% of patients. Palliative surgery was performed in 6.2% of the cases. In 2.3% of the cases, the surgical procedure was not specified. Simple and advanced repair of the bladder was performed in 84.3% and 15.6% of the cases respectively. Conclusions Although burdened by a non-negligible rate of complications, surgical repair of entero-colovesical fistula leads to excellent results in terms of primary healing. Our review offers opportunities for significant further research in this field. Level of Evidence Level III according to ELIS (SR/MA with up to two negative criteria).

Download Full-text

Union rates and functional outcome of double plating of the femur: systematic review of the literature

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03767-6 ◽

2021 ◽

Author(s):

M. F. Lodde ◽

M. J. Raschke ◽

J. Stolberg-Stolberg ◽

J. Everding ◽

S. Rosslenbroich ◽

...

Keyword(s):

Systematic Review ◽

Fracture Healing ◽

Functional Outcome ◽

Femoral Fractures ◽

Periprosthetic Fractures ◽

Level Of Evidence ◽

Distal Femoral Fractures ◽

Femur Fractures ◽

Meta Analyses ◽

Double Plating

Abstract Background The optimal treatment strategy for the surgical management of femur fractures and non-unions remains unknown. The aim of this study is to assess union rates, complications and outcome after femoral double plating. Treatment of shaft, distal, periprosthetic fractures and pathological proximal femur fractures as well as femoral non-unions with double plating were evaluated. Methods A systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was conducted. Published literature reporting on the treatment and clinical outcome of femoral fractures and non-unions with double plating was identified. In total, 24 studies with 436 cases of double plating, 64 cases of single plating, 84 cases of intramedullary nailing (IM), and 1 interfragmentary screw treatment met the inclusion criteria of this systematic review. The evaluated literature was published between 1991 and 2020. Results Double plating of femoral fractures achieved high healing rates and few complications were reported. It displayed significantly less intraoperative haemorrhage, shorter surgery time reduced risk of malunion in polytraumatised patients when compared to IM. Fracture healing rate of double-plating distal femoral fractures was 88.0%. However, there were no significant differences regarding fracture healing, complication or functional outcome when compared to single plating. Treatment of periprosthetic fractures with double plating displayed high healing rates (88.5%). Double plating of non-unions achieved excellent osseous union rates (98.5%). Conclusions The literature provides evidence for superior outcomes when using double plating in distal femoral fractures, periprosthetic fractures and femoral non-unions. Some evidence suggests that the use of double plating of femoral fractures in polytraumatised patients may be beneficial over other types of fracture fixation. Level of evidence IV.

Download Full-text

Factors associated with neck pain in fighter aircrew: a systematic review and meta-analysis

Occupational and Environmental Medicine ◽

10.1136/oemed-2020-107103 ◽

2021 ◽

pp. oemed-2020-107103

Author(s):

James B Wallace ◽

Phil M Newman ◽

Aoife McGarvey ◽

Peter G Osmotherly ◽

Wayne Spratford ◽

...

Keyword(s):

Systematic Review ◽

Neck Pain ◽

Data Availability ◽

Computer Work ◽

Current Evidence ◽

Level Of Evidence ◽

Operational Capability ◽

Factors Associated ◽

Common Complaint ◽

Meta Analyses

Neck pain is a common complaint among fighter aircrew, impacting workforce health and operational capability. This systematic review aimed to identify, evaluate and synthesise the current evidence for factors associated with the occurrence of neck pain among fighter aircrew. Six electronic databases were searched in June 2019 and updated in June 2020 utilising the maximum date ranges. Included studies were appraised for methodological quality, ranked according to level of evidence and relevant data extracted. Where methods were homogeneous and data availability allowed, meta-analyses were performed. A total of 20 studies (16 cross sectional, one case–control, one retrospective cohort and two prospective cohort) were eligible for inclusion. Of the 44 factors investigated, consistent evidence was reported for greater occurrence of neck pain among aircrew operating more advanced aircraft and those exposed to more desk/computer work, while another 12 factors reported consistent evidence for no association. Of the 20 factors where meta-analyses could be performed, greater occurrence of neck pain was indicated for aircrew: flying more advanced aircraft, undertaking warm-up stretching and not placing their head against the seat under greater +Gz. Despite many studies investigating factors associated with neck pain among fighter aircrew, methodological limitations limited the ability to identify those factors that are most important to future preventive programmes. High-quality prospective studies with consistent use of definitions are required before we can implement efficient and effective programmes to reduce the prevalence and impact of neck pain in fighter aircrew. PROSPERO registration number: CRD42019128952.Neck pain is a common complaint among fighter aircrew, impacting workforce health and operational capability. This systematic review aimed to identify, evaluate and synthesise the current evidence for factors associated with the occurrence of neck pain among fighter aircrew.

Download Full-text

Can nurses improve self-management among pediatric patients? A systematic review and meta-analysis

European Journal of Public Health ◽

10.1093/eurpub/ckz185.604 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

A Mele ◽

A Nardi ◽

G P Prencipe ◽

G Migliara ◽

A Massimi ◽

...

Keyword(s):

Systematic Review ◽

Educational Intervention ◽

Pediatric Patients ◽

Meta Analysis ◽

Educational Interventions ◽

Risk Of Bias ◽

Ed Visits ◽

Meta Analyses ◽

Almost All

Abstract Background Few studies report educational interventions for pediatric patients with asthma or diabetes type 1 as a fundamental instrument to engage them and improve their health. The aim of this systematic review and meta-analysis was to synthesize evidence about behavioral changes in life style, disease management and clinical outcome in pediatric patients after a structured educational intervention delivered by nurses. Methods A systematic review of the literature was carried out in MEDLINE, Scopus and CINHAL including only RCTs. Methodological quality of the studies was assessed using Cochrane tool. Meta-analyses on HbA1c reduction for diabetes and hospitalization, emergency department (ED) visits and medication for asthma were carried-out. Results Of the 3559 papers initially retrieved, 5 regarding diabetes and 19 asthma met the inclusion criteria for the systematic review and 14 for the meta-analyses. Included studies were highly heterogeneous in terms of type of intervention and follow-up duration. Almost all the studies showed an improvement but only few were statistically significant. All studies regarding diabetes showed a low risk of bias (only one RCTs had a high risk of bias in one domain), while almost all RCTs on asthma showed a high risk of bias. The pooled mean differences in favor of the experimental groups were: HBA1c -0.02 (IC95%: -0.26 - 0.22), Hospitalization 0.58 (IC95%: 0.19 - 1.78), Medication -0.10 (IC95%: -0.43 - 0.23), ED Visits 0.82 (IC95%: 0.44 - 1.54). Conclusions There is a general agreement about the central role of educational intervention delivered by nurses to pediatric patients and the assessment of the behavioral changes after educational interventions is strongly recommended in pediatric population. However, more efforts are requested in designing studies on patients with asthma and to program more appropriate follow-up and periodic recall in order to engage pediatric patients in the management of their own chronic disease. Key messages educational intervention delivered by nurses to pediatric patients with asthma or diabetes type 1 as a fundamental instrument to engage them. more efforts are requested in designing studies on patients with asthma and to program more appropriate follow-up and periodic recall in order to engage pediatric patients.

Download Full-text

Analgesic Efficacy of Nerve Blocks After Abdominoplasty: A Systematic Review

Aesthetic Surgery Journal ◽

10.1093/asj/sjz313 ◽

2019 ◽

Vol 40 (11) ◽

pp. 1208-1215 ◽

Cited By ~ 1

Author(s):

Peter M Vonu ◽

Paul Campbell ◽

Noah Prince ◽

Bruce A Mast

Keyword(s):

Systematic Review ◽

Rectus Sheath ◽

Analgesic Efficacy ◽

Postoperative Pain Management ◽

Opioid Consumption ◽

Transversus Abdominis ◽

Level Of Evidence ◽

Nerve Blocks ◽

Quadratus Lumborum ◽

Meta Analyses

Abstract Background A variety of regional nerve blocks have been utilized in abdominoplasty procedures, including transversus abdominis plane (TAP), intercostal, rectus sheath (RS), pararectus + ilioinguinal/iliohypogastric, quadratus lumborum, and paravertebral blocks. No consensus exists regarding the most effective nerve block modality in optimizing postprocedural comfort levels. Objectives The purpose of this systematic review was to explore the efficacy of the various abdominal nerve blocks employed in abdominoplasty surgery and to draw attention to any modality that may be superior in regards to effectiveness and/or administration. Methods Utilizing Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was performed to identify studies that have employed regional nerve blocks in abdominoplasty procedures. Opioid consumption, pain scores, time to ambulation, time in the recovery room, and time to first analgesia request were extracted when available. Results A total of 191 articles were reviewed, of which 8 met inclusion criteria. The nerve blocks represented included TAP, RS, pararectus + ilioinguinal/iliohypogastric, intercostal, and quadratus lumborum. All modalities were effective in reducing opioid consumption except quadratus lumborum. Conclusions TAP, RS, pararectus + ilioinguinal/iliohypogastric, and intercostal regional nerve blocks have been shown to optimize postoperative pain management in abdominoplasty procedures. The existing literature suggests that when studied against one another, TAP is more efficacious than RS and pararectus + ilioinguinal/iliohypogastric. When ultrasound guidance is unavailable, consideration should be given to TAP employing the direct visualization approach. Level of Evidence: 2

Download Full-text

The experience of conducting a Cochrane systematic review of the impact of clinical pathways on professional practice, patient outcomes, length of stay and hospital costs

International Journal of Care Pathways ◽

10.1258/jicp.2009.009009 ◽

2009 ◽

Vol 13 (2) ◽

pp. 62-66 ◽

Cited By ~ 2

Author(s):

Thomas Rotter ◽

Leigh Kinsman ◽

Erica James ◽

Andreas Machotta ◽

Holger Gothe ◽

...

Keyword(s):

Systematic Review ◽

Clinical Pathways ◽

Hospital Costs ◽

Evidence Base ◽

Care Group ◽

Level Of Evidence ◽

Organisation Of Care ◽

High Level ◽

Meta Analyses ◽

The Impact

Despite the high prevalence of clinical pathways (CPWs), the results from published studies are inconsistent and contradictory. The plethora of study designs, settings and lack of an agreed definition of a CPW make the relevance of individual studies difficult to apply to clinical settings. It was timely to catalogue and analyse the existing evidence base for CPWs via a rigorous systematic review. Systematic reviews and meta-analyses provide a high level of evidence for the effectiveness of interventions and are commonly employed reviewing strategies for addressing scientific questions in health-related research. This method is especially useful when research results are known to be inconsistent. Instead of conducting another primary evaluation, a detailed review is needed that reflects a summation of available research. This paper reports and discusses methodological and technical issues of a systematic review of the effectiveness of CPWs in hospitals, based on our experience with the Cochrane Effective Practice and Organisation of Care Group.

Download Full-text

Effect of oromotor exercises on feeding in children with cerebral palsy: systematic review

Bulletin of Faculty of Physical Therapy ◽

10.1186/s43161-021-00054-8 ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Rania El Nagar ◽

Alaa AL-Nemr ◽

Faten Abdelazeim

Keyword(s):

Systematic Review ◽

Cerebral Palsy ◽

Descriptive Analysis ◽

Sensory Stimulation ◽

Cochrane Library ◽

Feeding Problems ◽

Level Of Evidence ◽

Weak Evidence ◽

Children With Cerebral Palsy ◽

Meta Analyses

Abstract Background Feeding problems are prevalent in children with cerebral palsy (CP). Oromotor exercises (OME) should be started as soon as possible to enhance chewing and drooling. Oromotor exercises consist of active exercises, passive exercises, and sensory stimulation. The purpose of this review is to evaluate the effectiveness of oromotor exercises on feeding, chewing, and drooling in children with CP. Body The American Academy for Cerebral Palsy and Developmental Medicine and Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology were used to conduct a systematic review. Four databases (PubMed, Cochrane Library, PEDro, and Google Scholar) were searched; this review includes seven articles, participants were 173 participants ranging in age from 18 months to 18 years. Articles were assessed according to their level of evidence and quality assessment was done by AACPDM, PEDro scale, and JBI scale. Due to the heterogeneity across included studies, descriptive analysis was performed on all of them. Primary outcomes were chewing and drooling. Results showed the effectiveness of OME in improving drooling, but with weak evidence while not effective in improving chewing. Conclusion High-quality studies are required to develop a firm judgment on the influence of oromotor exercises on feeding. The current level of evidence to support the effectiveness of oromotor exercises in children with CP is currently insufficient.

Download Full-text

Wunder-women: Systematic review of causes, treatment and outcomes of Wunderlich syndrome during pregnancy

Journal of Clinical Urology ◽

10.1177/2051415818759367 ◽

2018 ◽

Vol 12 (2) ◽

pp. 134-144

Author(s):

Thomas Ahn ◽

Matthew J Roberts ◽

Anojan Navaratnam ◽

Eric Chung ◽

Simon T Wood

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Case Reports ◽

Contemporary Literature ◽

Case Series ◽

Artery Aneurysm ◽

Well Being ◽

Renal Neoplasm ◽

Level Of Evidence ◽

Meta Analyses

Objective: The objective of this article is to conduct a contemporary literature review on Wunderlich syndrome, or spontaneous renal haemorrhage (SRH), among pregnant women to describe contemporary aetiology, investigations and management patterns. Methods: A systematic review of MEDLINE and CENTRAL in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. All articles, including case reports and case series on SRH published from 2000 to 2016, were included. Full-text manuscripts describing SRH among pregnant women were reviewed for clinical parameters, which were collated and analysed. Results: Twenty cases of SRH in pregnant women were identified. The median age and gestation were 32.1 years and 26.5 weeks, respectively, with SRH most commonly occurring in the third trimester (nine patients; 45%) and due to renal neoplasm, specifically angiomyolipoma (AML; 12 patients; 60%), followed by renal artery aneurysm (RAA; five patients; 25%). Surgical intervention (55%) was most commonly used for acute SRH. Foetal demise was not uncommon (15%). Conclusions: SRH in pregnant women is an uncommon but complex urological and obstetric emergency with potentially catastrophic consequences. A multidisciplinary approach is key to timely diagnosis and appropriate management considering the well-being both of mother and foetus. Pre-emptive diagnosis and intervention may reduce complications. Level of evidence: 4

Download Full-text

Salvage of the Failed Total Wrist Arthroplasty: A Systematic Review

Journal of Wrist Surgery ◽

10.1055/s-0040-1713728 ◽

2020 ◽

Vol 09 (05) ◽

pp. 446-456

Author(s):

Onur Berber ◽

Sam Gidwani ◽

Lorenzo Garagnani ◽

Michelle Spiteri ◽

Nicholas Riley ◽

...

Keyword(s):

Systematic Review ◽

Revision Surgery ◽

Revision Arthroplasty ◽

Postoperative Outcome ◽

Secondary Outcome ◽

Level Of Evidence ◽

Total Wrist Arthroplasty ◽

High Level ◽

Meta Analyses ◽

Wrist Arthroplasty

Abstract Background Although the performance of total wrist arthroplasty systems has improved, failure is encountered and is a major challenge to manage. Questions Does physical function improve with surgical management of the failed wrist arthroplasty? Is there an improvement in secondary outcome measures including pain, grip strength, and range of motion? What are the reasons for failure in primary total wrist arthroplasty? What are the complications associated with revision of the failed total wrist arthroplasty? What are the survival profiles of the different revision strategies? Methods A systematic review of available literature was performed. Studies were systematically assessed, and data extracted from suitable studies for review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were adhered to. The study protocol was modified from a previous protocol published on the PROSPERO database. Results Fourteen studies were identified considering 218 patients/214 index operations with a follow-up duration following revision surgery of 2 months to 21 years (silicone wrist arthroplasty—42 cases; nonsilicone wrist arthroplasty—172 cases). The functional outcome of revision surgery was infrequently recorded and documented with only short-term assessments undertaken. Complications were seen in 1:2 revision procedures, with re-revision surgeries required in 21.6% of revised primary nonsilicone arthroplasties. Re-revision rate following a revision arthrodesis was 21.4% (15/70 cases) compared with revision arthroplasty of 34.8% (32/92 cases). Revision arthrodesis nonunion rate was 17.5% (22 cases). Conclusion This review has confirmed the high level of surgical complexity and the likelihood of a complicated postoperative outcome when salvaging a failed wrist replacement. Level of Evidence This is a Level 3, systematic review study.

Download Full-text

Injectable Ketorolac and Corticosteroid Use in Athletes: A Systematic Review

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738120946008 ◽

2020 ◽

Vol 12 (6) ◽

pp. 521-527

Author(s):

Timothy R. Jelsema ◽

Anthony C. Tam ◽

James L. Moeller

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Corticosteroid Injection ◽

Data Extraction ◽

Return To Sport ◽

Level Of Evidence ◽

Football Game ◽

Early Return ◽

Meta Analyses ◽

Intramuscular Ketorolac

Context: The use of injectable medications to help athletes quickly return to the field of play after injury is common. Understanding the effects and risks of these medications will help providers make informed decisions regarding their use in this patient population. Objective: To evaluate the utilization, efficacy, and adverse effects of injectable ketorolac and corticosteroids in athletes. Data Sources: This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A systematic search of the literature was performed using multiple databases (PubMed, Embase, Cochrane, Web of Science, and ClinicalTrials.gov). Secondary references were appraised for relevant articles. No randomized controlled trials or other prospective studies were identified. Articles included retrospective database reviews and physician survey studies. Study Selection: A total of 6 studies met the inclusion and exclusion criteria and were reviewed by 2 independent reviewers with a third consulted in the case of disagreement, which was not needed. Study Design: Systematic review. Level of Evidence: Level 5. Data Extraction: Two reviewers recorded rate of use, effectiveness of treatment, and reported side effect data. Results: Most studies centered around the football athlete, either professional or collegiate. Professional football game day use of intramuscular ketorolac declined from 93.3% (28/30) in 2002 to 48% in 2016. Collegiate football game day use of intramuscular ketorolac declined from 62% in 2008 to 26% in 2016. Game day corticosteroid injection was far lower than ketorolac usage. Both medications were reported to be effective with few adverse events. Conclusion: Use of injectable ketorolac is common but declining in professional and college football. Pain control efficacy is good, and risk of adverse events is low. The incidence of injectable corticosteroid use in athletes is unknown. Use of injectable corticosteroids in athletes allows for early return to sport activities with no reported complications.

Download Full-text