scholarly journals Manipulative and Manual Therapies in the Management of Patients with Prior Lumbar Surgery: A Systematic Review

2020 ◽  
Author(s):  
Clinton J Daniels ◽  
Zachary A. Cupler ◽  
Jordan A Gliedt ◽  
Sheryl Walters ◽  
Alec L Schielke ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Clinical Decision Making ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Clinical Decision ◽  
Manual Therapies ◽  
Lumbar Surgery ◽  
Pilot Studies ◽  
Surgical Interventions

Abstract BackgroundThe purpose was to identify, summarize, and rate scholarly literature that describes manipulative and manual therapy following lumbar surgery.MethodsThe review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered with PROSPERO. PubMed, Cochrane Database of Systematic Reviews, ICL, CINAHL, and PEDro were searched through July 2019. Articles were screened independently by at least two reviewers for inclusion. Articles included described the practice, utilization, and/or clinical decision making to post surgical intervention with manipulative and/or manual therapies. Data extraction consisted of principal findings, pain and function/disability, patient satisfaction, opioid/medication consumption, and adverse events. Scottish Intercollegiate Guidelines Network critical appraisal checklists were utilized to assess study quality.ResultsLiterature search yielded 1916 articles, 348 duplicates were removed, 109 full-text articles were screened and 50 citations met inclusion criteria. There were 37 case reports/case series, 3 randomized controlled trials, 3 pilot studies, 5 systematic/scoping/narrative reviews, and 2 commentaries. ConclusionThe findings of this review may help inform practitioners who utilize manipulative and/or manual therapies regarding levels of evidence for patients with prior lumbar surgery. Following lumbar surgery, the evidence indicated inpatient neural mobilization does not improve outcomes. There is inconclusive evidence to recommend for or against most manual therapies after most surgical interventions.Trial registrationProspectively registered with PROSPERO (#CRD42020137314). Registered 24 January 2020.

scholarly journals Dantrolene in the treatment of MDMA-related hyperpyrexia: a systematic review

CJEM ◽  
2010 ◽  
Vol 12 (05) ◽  
pp. 435-442 ◽  
Author(s):  
Brian E. Grunau ◽  
Matthew O. Wiens ◽  
Jeffrey R. Brubacher
Keyword(s):  
Systematic Review ◽  
Clinical Decision Making ◽  
Case Reports ◽  
Data Extraction ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
Poison Control ◽  
Published Data ◽  
Published Evidence

ABSTRACTObjective:The use of dantrolene in the treatment of hyperpyrexia related to MDMA (3,4-methylenedioxymethamphetamine) is controversial, with little data available to guide clinical decision-making. Although the treatment is recommended by several poison control centres, published data are primarily in the form of case reports and animal and in vitro experiments. We conducted a systematic review to investigate the published evidence regarding the safety and benefits of dantrolene for MDMA-related hyperpyrexia in humans.Data sources:A systematic search of Embase and MEDLINE was conducted from the earliest possible date to November 2008.Study selection:All human trials and case reports of MDMA-related hyperpyrexia were considered.Data extraction:Data were abstracted systematically and characteristics including use of dantrolene, adverse reactions attributed to dantrolene, peak temperature, complications from MDMA-related hyperpyrexia and survival were recorded.Data synthesis:Our search yielded 668 articles of which 53, reporting 71 cases of MDMA-induced hyperpyrexia, met our inclusion criteria. No clinical trials, randomized controlled trials, observational studies or meta-analyses were identified. Dantrolene was used in 26 cases. Patient characteristics were similar in the dantrolene and no dantrolene groups. The proportion of survivors was higher in the dantrolene group (21/26) than in the no dantrolene group (25/45). This difference was especially pronounced in those with extreme (≥ 42°C) and severe (≥ 40°C) fever, with a survival rate of 8 of 13 and 10 of 10, respectively, in the dantrolene group compared with 0 of 4 and 15 of 27 in the no dantrolene group. There were no reports of adverse events attributable to dantrolene with the exception of a possible association with an episode of transient hypoglycemia.Conclusion:Our systematic review suggests that dantrolene is safe for patients with MDMA-related hyperpyrexia. Dantrolene may also be associated with improved survival and reduced complications, especially in patients with extreme (≥ 42°C) or severe (≥ 40°C) hyperpyrexia, although this conclusion must be interpreted with caution given the risk of reporting or publication bias.

Drug-Induced Restless Legs Syndrome

2018 ◽  
Vol 52 (7) ◽  
pp. 662-672 ◽  
Author(s):  
Edna Patatanian ◽  
Melanie K. Claborn
Keyword(s):  
Restless Legs Syndrome ◽  
English Language ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Predisposing Factors ◽  
Drug Induced ◽  
Restless Legs ◽  
Drug Classes ◽  
Study Selection

Objective: To review the literature on drug-induced restless legs syndrome (DI-RLS). Data Sources: The review included a search for English-language literature from 1966 to December 2017 in the MEDLINE, PubMed, and Ovid databases using the following search terms: restless legs syndrome (RLS), periodic limb movement, adverse effects, and drug-induced. In addition, background articles on the pathophysiology, etiology, and epidemiology of RLS were retrieved. Bibliographies of relevant articles were reviewed for additional citations. Study Selection and Data Extraction: All case reports, case series, and review articles of DI-RLS were identified and analyzed. There were only a small number of controlled clinical trials, and most data were from case reports and case series. Results: Several drugs and drug classes have been implicated in DI-RLS, with antidepressants, antipsychotics, and antiepileptics having the most evidence. In addition, RLS may be linked with a number of disorders or underlying predisposing factors as well. Conclusions: The prevalence of RLS is variable and ranges from 3% to 19% in the general population. There are many predisposing factors to RLS, but an emerging body of evidence suggests that there is an association between numerous drugs and RLS.

Transducer-based comparisons of the prosthetic feet used by transtibial amputees for different walking activities: a pilot study

2012 ◽  
Vol 36 (2) ◽  
pp. 203-216 ◽  
Author(s):  
Edward Schreiber Neumann ◽  
Kartheek Yalamanchili ◽  
Justin Brink ◽  
Joon S Lee
Keyword(s):  
Clinical Decision Making ◽  
Research Question ◽  
Case Series ◽  
Clinical Decision ◽  
Residual Limb ◽  
Convenience Sample ◽  
Loading Patterns ◽  
Prosthetic Feet ◽  
Transtibial Amputees ◽  
Resultant Forces

Background: Knowledge of transtibial residual limb force and moment loading during gait can be clinically useful. The research question was whether a transducer attached between the socket and pylon can be used to detect differences in loading patterns created by prosthetic feet of different design and different walking activities in real-world environments outside the gait lab. Objectives: To develop methods for obtaining, processing, analyzing and interpreting transducer measurements and examining their clinical usefulness. Study Design: Case series design. Methods: A convenience sample of four K3-K4 transtibial amputees and a wireless tri-axial transducer mounted distal to the socket. Activities included self-selected comfortable speed walking, and ascending and descending ramps and steps. Measurements taken about three orthogonal axes were processed to produce plots of normalized resultant force versus normalized resultant moment. Within-subject differences in peak resultant forces and moments were tested. Results: Loading patterns between feet and subjects and among the activities were distinctly different. Optimal loading of peak resultant forces tentatively might occur around 25% and 69% to73% of stance during self-selected comfortable walking. Ascending and descending ramps is useful for examining heel and forefoot response. Conclusions: Force-moment plots obtained from transducer data may assist clinical decision making. Clinical relevance A pylon-mounted transducer distal to the socket reveals the moments and forces transmitted to the residual limb and can be used to evaluate the loading patterns on the residual limb associated with different foot designs and different everyday activities outside the gait lab.

Prognostic Factors for Persistent Symptoms in Adults With Mild Traumatic Brain Injury: an Overview of Systematic Reviews

2021 ◽  
Author(s):  
Julien Déry ◽  
Béatrice Ouellet ◽  
Élaine de Guise ◽  
Ève-Line Bussières ◽  
Marie-Eve Lamontagne
Keyword(s):  
Traumatic Brain Injury ◽  
Prognostic Factors ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Systematic Reviews ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Persistent Symptoms ◽  
Wide Range ◽  
Overview Of Systematic Reviews

Abstract Background: Mild traumatic brain injury (mTBI) is an increasing public health problem, because of its persistent symptoms and several functional consequences. Understanding the prognosis of a condition is an important component of clinical decision-making and can help to guide prevention of persistent symptoms following mTBI. Prognosis of mTBI has stimulated several empirical primary research papers and many systematic reviews leading to the identification of a wide range of factors. We aim to synthesize these factors to get a better understanding of their breadth and scope.Methods: We conducted an overview of systematic reviews. We searched in databases systematic reviews synthesizing evidence about prognosis of persistent symptoms after mTBI in the adult population. Two reviewers independently screened all references and selected eligible reviews based on eligibility criteria. They extracted relevant information using an extraction grid. They also rated independently the risk of bias using the ROBIS tool. We synthesized evidence into a comprehensive conceptual map to facilitate the understanding of prognostic factors that have an impact on persistent post-concussion symptoms.Results: From the 3857 references retrieved in database search, we included 25 systematic reviews integrating the results of 312 primary articles published between 1957 and 2019. We examined 35 prognostic factors from the systematics reviews. No single prognostic factor demonstrated convincing and conclusive results. However, age, sex and multiple concussions showed an affirmatory association with persistent post-concussion outcomes in systematic reviews.Conclusion: We highlighted the need of a comprehensive picture of prognostic factors related to persistent post-concussion symptoms. We believe that these prognostic factors would guide clinical decision and research related to prevention and intervention regarding persistent post-concussion symptoms.Systematic review registration: PROSPERO CRD42020176676

scholarly journals Axillary Web Syndrome in Breast Cancer: A Prevalent But Under-Recognized Postoperative Complication

Breast Care ◽  
2018 ◽  
Vol 13 (2) ◽  
pp. 129-132 ◽  
Author(s):  
Susan R. Harris
Keyword(s):  
Breast Cancer ◽  
Cohort Studies ◽  
Systematic Reviews ◽  
Nurse Practitioners ◽  
Case Reports ◽  
Case Series ◽  
Diagnosis And Management ◽  
Oncology Nurse ◽  
Management Interventions ◽  
Axillary Web Syndrome

The purpose of this review is to define axillary web syndrome (AWS) and describe its diagnosis and management. The following databases were searched through July 2017: PubMed, EMBASE (OvidSP), Cumulative Index for Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Cochrane Database of Systematic Reviews. Search terms included ‘axillary web syndrome', ‘axillary cording', and ‘lymphatic cording'. 49 articles were identified; 8 did not relate to breast cancer, and 3 were not in English. Of the remaining articles, the majority were case reports, case series, or descriptive reviews. 2 systematic reviews were located as well as 1 randomized trial, 6 prospective cohort studies, and 2 retrospective cohort studies. Although a common sequela after axillary surgery for breast cancer staging, AWS has been poorly described in the medical literature as to the underlying pathophysiology, diagnosis, and management. Interventions range from patient education and simple reassurance that the syndrome will resolve spontaneously to active physical or manual therapies to maintain upper extremity range-of-motion, especially adequate motion for undergoing radiation therapy. Oncologists, breast surgeons, family physicians, and oncology nurse practitioners that work with patients with breast cancer should educate them about this prevalent complication and inform them preoperatively about what to anticipate.

A Review and Assessment of Drug-Induced Thrombocytosis

2018 ◽  
Vol 53 (5) ◽  
pp. 523-536 ◽  
Author(s):  
Quyen T. Vo ◽  
Dennis F. Thompson
Keyword(s):  
English Language ◽  
Web Of Science ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Search Term ◽  
Drug Induced ◽  
Reactive Thrombocytosis ◽  
All Trans Retinoic Acid ◽  
Mesh Terms

Objectives: The purpose of this article is to review the current literature on drug-induced thrombocytosis with the goal of critically assessing causality and providing a comprehensive review of the topic. Thrombopoietic growth factors, such as thrombopoietin-receptor agonists (romiplostim and eltrombopag) and erythropoietin are not included in our review. Data Sources: The literature search included published articles limited to the English language and humans in MEDLINE, EMBASE, and Web of Science databases. MEDLINE/PubMed (1966 to September 2018) was searched using the MeSH terms thrombocytosis/chemically-induced and thrombocytosis/etiology. EMBASE (1980 to September 2018) was searched using the EMTAGS thrombocytosis/side effect. Web of Science (1970 to September 2018) was searched using the search term thrombocytosis. References of all relevant articles were reviewed for additional citations and information. Study Selection and Data Extraction: Review articles, clinical trials, background data, case series, and case reports of drug-induced thrombocytosis were collected, and case reports were assessed for causality using a modified Naranjo nomogram. Data Synthesis: Drug-induced thrombocytosis, a form of reactive thrombocytosis cannot be easily differentiated from more common etiologies of reactive thrombocytosis. In all, 43 case reports of drug-induced thrombocytosis from a wide variety of drugs and drug classes were reviewed using a modified Naranjo probability scale that included criteria specific for thrombocytosis. Conclusions: Drug-induced thrombocytosis is a relatively rare adverse drug reaction. The strongest evidence of causality supports low-molecular-weight heparins and neonatal drug withdrawal. Weaker evidence exists for all-trans retinoic acid, antibiotics, clozapine, epinephrine, gemcitabine, and vinca alkaloids.

scholarly journals P071: Artificial intelligence in emergency medicine: A scoping review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S90-S90
Author(s):  
A. Kirubarajan ◽  
A. Taher ◽  
S. Khan ◽  
S. Masood
Keyword(s):  
Artificial Intelligence ◽  
Emergency Medicine ◽  
Language Processing ◽  
Scoping Review ◽  
Clinical Decision Making ◽  
Data Extraction ◽  
A Priori ◽  
Clinical Decision ◽  
Hospital Environment ◽  
Clinical Implementation

Introduction: The study of artificial intelligence (AI) in medicine has become increasingly popular over the last decade. The emergency department (ED) is uniquely situated to benefit from AI due to its power of diagnostic prediction, and its ability to continuously improve with time. However, there is a lack of understanding of the breadth and scope of AI applications in emergency medicine, and evidence supporting its use. Methods: Our scoping review was completed according to PRISMA-ScR guidelines and was published a priori on Open Science Forum. We systematically searched databases (Medline-OVID, EMBASE, CINAHL, and IEEE) for AI interventions relevant to the ED. Study selection and data extraction was performed independently by two investigators. We categorized studies based on type of AI model used, location of intervention, clinical focus, intervention sub-type, and type of comparator. Results: Of the 1483 original database citations, a total of 181 studies were included in the scoping review. Inter-rater reliability for study screening for titles and abstracts was 89.1%, and for full-text review was 77.8%. Overall, we found that 44 (24.3%) studies utilized supervised learning, 63 (34.8%) studies evaluated unsupervised learning, and 13 (7.2%) studies utilized natural language processing. 17 (9.4%) studies were conducted in the pre-hospital environment, with the remainder occurring either in the ED or the trauma bay. The majority of interventions centered around prediction (n = 73, 40.3%). 48 studies (25.5%) analyzed AI interventions for diagnosis. 23 (12.7%) interventions focused on diagnostic imaging. 89 (49.2%) studies did not have a comparator to their AI intervention. 63 (34.8%) studies used statistical models as a comparator, 19 (10.5%) of which were clinical decision making tools. 15 (8.3%) studies used humans as comparators, with 12 of the 15 (80%) studies showing superiority in favour of the AI intervention when compared to a human. Conclusion: AI-related research is rapidly increasing in emergency medicine. AI interventions are heterogeneous in both purpose and design, but primarily focus on predictive modeling. Most studies do not involve a human comparator and lack information on patient-oriented outcomes. While some studies show promising results for AI-based interventions, there remains uncertainty regarding their superiority over standard practice, and further research is needed prior to clinical implementation.

P1858Meta-analysis of performance of risks scores for predicting outcomes after percutaneous Mitraclip implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T K M Wang ◽  
M T M Wang
Keyword(s):  
Confidence Interval ◽  
Risk Stratification ◽  
Clinical Decision Making ◽  
Operative Mortality ◽  
Data Extraction ◽  
Meta Analysis ◽  
Critical Role ◽  
Clinical Decision ◽  
Risk Scores ◽  
Sts Score

Abstract Background The Mitraclip is the most established percutaneous mitral valve intervention indicated for severe mitral regurgitation at high or prohibitive surgical risk. Risk stratification plays a critical role in selecting the appropriate treatment modality in high risk valve disease patients but have been rarely studied in this setting. We compared the performance of risk scores at predicting mortality after Mitraclip in this meta-analysis. Methods MEDLINE, Embase and Cochrane databases from 1 January 1980 to 31 December 2018 were searched. Two authors reviewed studies which reported c-statistics of risk models to predict mortality after Mitraclip for inclusion, followed by data extraction and pooled analyses. Results Amongst 494 articles searched, 47 full-text articles were evaluated, and 4 studies totalling 879 Mitraclip cases were included for analyses. Operative mortality was reported at 3.3–7.4% in three studies, and 1-year mortality 11.2%-13.5% in two studies. C-statistics (95% confidence interval) for operative mortality were EuroSCORE 0.66 (0.57–0.75), EuroSCORE II 0.72 (0.60–0.85) and STS Score 0.64 (0.56–0.73). Respective Peto's odds ratios (95% confidence interval) to assess calibration were EuroSCORE 0.21 (0.14–0.31), EuroSCORE II 0.43 (0.24–0.76) and STS Score 0.36 (0.21–0.61). C-statistics (95% confidence interval) for 1-year mortality were EuroSCORE II 0.64 (0.57–0.70) and STS Score (0.58–0.64). Conclusion All scores over-estimated operative mortality, and EuroSCORE II had the best moderate discrimination while the other two scores were only modestly prognostic. Development of Mitraclip-specific scores may improve accuracy of risk stratification for this procedure to guide clinical decision-making.

Clinical Toxicology of Yew Poisoning

2018 ◽  
Vol 52 (6) ◽  
pp. 591-599 ◽  
Author(s):  
Alexander W. Labossiere ◽  
Dennis F. Thompson
Keyword(s):  
English Language ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Therapeutic Interventions ◽  
Plant Materials ◽  
Search Terms ◽  
Life Threatening

Objectives: Yew plant materials contain highly toxic taxine alkaloids. Serious ingestions can result in life-threatening toxicity. The purpose of this article is to summarize the literature on the treatment of acute yew poisoning. Data Sources: PubMed (January 1946 to November 2017) was searched using the search terms “taxus/po”. EMBASE (1980 to November 2017) was searched using the search terms “taxus/to” and “yew.mp.” Web of Science (1945 to November 2017) was searched using the text words taxus, taxine, and yew. Study Selection and Data Extraction: Available English language articles involving case reports, epidemiology, treatment, and outcomes were included. Data Synthesis: Although not uncommon, unintentional yew poisoning rarely results in significant morbidity or mortality. A total of 26 case reports of yew poisoning were evaluated along with 4 case series articles (totaling 22 additional cases). Only 4 of the 48 total cases (8%) were accidental poisonings, the rest being deliberate ingestions. In 20 patients (42%), it resulted in fatalities. Severe, acute yew poisoning results in symptomatology largely resistant to pharmacotherapy intervention. Conclusions: Most nonintentional ingestions of yew plant constituents are asymptomatic and require little intervention. Severe poisoning can result in life-threatening cardiac toxicity and require aggressive supportive care. Therapeutic interventions, such as sodium bicarbonate, digoxin immune fab, and hemodialysis that have been utilized in case studies and case series in the literature have little proven benefit. Extracorporeal life support should be considered in severe yew poisoning.

scholarly journals Multiple Injuries to the Lower Urinary Tract: Two Cases and Comparison with the EAU Guidelines

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
N. Lumen ◽  
D. Sharma ◽  
Y. Abu-Ghanem ◽  
N. Djakovic ◽  
F. Kuehhas ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Clinical Decision Making ◽  
Case Reports ◽  
Clinical Decision ◽  
Pelvic Fractures ◽  
Urethral Injury ◽  
Concomitant Injuries ◽  
Strict Adherence ◽  
Lower Urinary

Blunt trauma to the lower urinary tract is usually associated with pelvic fractures. The European Association of Urology (EAU) provides guidelines to diagnose and treat these injuries. The guidelines summarise the available evidence and provide recommendations on diagnosis and treatment of these patients. Therefore, these guidelines are important adjuncts to the urologist and emergency physician in the clinical decision-making. However, strict adherence to the guidelines is not always easy or possible because of concomitant injuries obscuring the clinical picture. This is illustrated by two case reports of concomitant injuries of the lower urinary tract (bladder with urethral injury). The clinical decisions will be discussed point by point and should serve as a practical teaching moment for the reader.

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