scholarly journals Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review

2021 ◽  
Vol 2 ◽  
Author(s):  
Mahdis Hashemi ◽  
Nadine Sturbois-Nachef ◽  
Marry Ann Keenan ◽  
Paul Winston
Keyword(s):  
Systematic Reviews ◽  
Upper Limb ◽  
Surgical Techniques ◽  
Adult Patients ◽  
Surgical Approaches ◽  
Cochrane Central Register ◽  
Level Of Evidence ◽  
Cochrane Database ◽  
Limb Deformities ◽  
Almost All

Introduction: Spasticity is the main complication of many upper motor neuron disorders. Many studies describe neuro-orthopedic surgeries for the correction of joint and limb deformities due to spasticity, though less in the upper extremity. The bulk of care provided to patients with spasticity is provided by rehabilitation clinicians, however, few of the surgical outcomes have been summarized or appraised in the rehabilitation literature.Objective: To review the literature for neuro-orthopedic surgical techniques in the upper limb and evaluate the level of evidence for their efficacy in adult patients with spasticity.Method: Electronic databases of MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were searched for English, French as well as Farsi languages human studies from 1980 to July 2, 2020. After removing duplicated articles, 2,855 studies were screened and 80 were found to be included based on the criteria. The studies were then divided into two groups, with 40 in each trial and non-trial. The results of the 40 trial articles were summarized in three groups: shoulder, elbow and forearm, and wrist and finger, and each group was subdivided based on the types of intervention.Results: The level of evidence was evaluated by Sackett's approach. There were no randomized control trial studies found. About, 4 studies for shoulder, 8 studies for elbow and forearm, 26 studies for wrist and finger (including 4 for the thumb in palm deformity), and 2 systematic reviews were found. Around, two out of 40 trial articles were published in the rehabilitation journals, one systematic review in Cochrane, and the remaining 38 were published in the surgical journals.Conclusion: Most surgical procedures are complex, consisting of several techniques based on the problems and goals of the patient. This complexity interferes with the evaluation of every single procedure. Heterogenicity of the participants and the absence of clinical trial studies are other factors of not having a single conclusion. This review reveals that almost all the studies suggested good results after the surgery in carefully selected cases with goals of reducing spasticity and improvement in function, pain, hygiene, and appearance. A more unified approach and criteria are needed to facilitate a collaborative, evidence-based, patient referral, and surgical selection pathway.

Incidence of Intraoperative and Postoperative Complications After Posterolateral Corner Reconstruction or Repair: A Systematic Review of the Current Literature

2021 ◽  
pp. 036354652098169
Author(s):  
Bhargavi Maheshwer ◽  
Justin Drager ◽  
Nalin S. John ◽  
Brady T. Williams ◽  
Robert F. LaPrade ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Postoperative Complication ◽  
Systematic Reviews ◽  
Complication Rate ◽  
Common Peroneal Nerve ◽  
Posterolateral Corner ◽  
Cochrane Central Register ◽  
Level Of Evidence ◽  
Intraoperative Complication

Background: Posterolateral corner (PLC) injuries of the knee are being increasingly recognized and treated in current orthopaedic practice. While there are numerous systematic reviews evaluating the management and outcomes after PLC injuries, there are limited data investigating complications after PLC reconstruction or repair. Purpose: To systematically review the literature to determine the incidence of postoperative complications after the surgical treatment of PLC injury. Study Design: Systematic review; Level of evidence, 4. Methods: The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (2008-2019), Embase (2008-2019), and MEDLINE (2008-2019) were queried for literature reporting on PLC reconstruction or repair, with or without concomitant ligamentous or meniscal surgery. Data including type of surgery performed, concomitant procedures, and follow-up time were extracted. Complications recorded included intra- and postoperative complications. Results: After the intra- and postoperative complication data of 60 studies (1747 cases) were combined, surgical management of PLC injuries was associated with an intraoperative complication rate of 0.34% (range, 0%-2.8%) and a postoperative complication rate of 20% (range, 0%-51.2%). The most common postoperative complication was arthrofibrosis (range, 0%-20%). The overall infection rate was 1.3% (range, 0%-10%). Four cases of postoperative common peroneal nerve palsy were reported. Failure of reconstruction or repair was reported in 164 (9.4%) of all cases examined (range, 0%-37.1%). Conclusion: Although the intraoperative rate of complications during PLC reconstructions is low, postoperative complications rates of 20% can be expected, including arthrofibrosis, infection, and neurovascular injury. PLC structures repaired or reconstructed failed in 9.4% of the cases.

scholarly journals Preemptive local analgesia at vaginal hysterectomy: a systematic review

2021 ◽  
Author(s):  
Nadja Taumberger ◽  
Anna-Maria Schütz ◽  
Klaus Jeitler ◽  
Andrea Siebenhofer ◽  
Holger Simonis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Systematic Reviews ◽  
Vaginal Hysterectomy ◽  
Preemptive Analgesia ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Local Analgesia ◽  
Cochrane Database ◽  
Full Text Review

Abstract Introduction and hypothesis We conducted a systematic review of the effectiveness of local preemptive analgesia for postoperative pain control in women undergoing vaginal hysterectomy. Methods MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews were searched systematically to identify eligible studies published through September 25, 2019. Only randomized controlled trials and systematic reviews addressing local preemptive analgesia compared to placebo at vaginal hysterectomy were considered. Data were extracted by two independent reviewers. Results were compared, and disagreement was resolved by discussion. Forty-seven studies met inclusion criteria for full-text review. Four RCTs, including a total of 197 patients, and two SRs were included in the review. Results Preemptive local analgesia reduced postoperative pain scores up to 6 h and postoperative opioid requirements in the first 24 h after surgery. Conclusion Preemptive local analgesia at vaginal hysterectomy results in less postoperative pain and less postoperative opioid consumption.

scholarly journals Surgical Results of Chronic Distal Biceps Ruptures: A Systematic Review

2022 ◽  
Vol 10 (1) ◽  
pp. 232596712110657
Author(s):  
Arpun Bajwa ◽  
Maciej J.K. Simon ◽  
Jordan M. Leith ◽  
Farhad O. Moola ◽  
Thomas J. Goetz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Management ◽  
Functional Outcomes ◽  
Biceps Tendon ◽  
Surgical Techniques ◽  
Elbow Flexion ◽  
Level Of Evidence ◽  
Arm Pain ◽  
Distal Biceps ◽  
Cochrane Database

Background: Distal biceps tendon tears can cause weakness and fatigue with activities requiring elbow flexion and supination. Surgical management of chronic tears (>21 days) is not well described in the literature. Purpose: To determine the clinical outcomes of chronic distal biceps repairs and reconstructions. Study Design: Systematic review; Level of evidence, 4. Methods: We performed a search of Medline (PubMed and Ovid), EMBASE, CINAHL physical therapy, Cochrane Database of Systematic Reviews and Central Register of Controlled Trials, and PubMed Central from inception until September 29, 2020, to identify articles on chronic distal biceps ruptures. The inclusion criteria were studies with at least 1 outcome measure and 10 patients with chronic distal biceps ruptures treated surgically. The quality of the included studies was assessed with the methodological index for nonrandomized studies (MINORS) score. Functional outcomes and complications were reviewed. Results: A total of 12 studies were included after systematic database screenings. The MINORS scores ranged from 5 to 19. There were a total of 1704 distal biceps ruptures, of which 1270 were acute and 434 were chronic. Average follow-up time was 12 months to 5.1 years. Single-incision (n = 3), 2-incision (n = 2), or both (n = 6) surgical techniques were used in these studies. Four studies described the use of autografts, and 4 articles used allografts in the chronic repair. Range of motion, function, and strength outcomes were similar when compared with the contralateral arm. Pain was reduced to minimal levels. Main postoperative complications were of paresthesia (specifically to the lateral antebrachial cutaneous nerve), which were temporary in 69.1% of cases. Conclusion: The results of this review indicate that surgical management of chronic distal biceps ruptures demonstrates improvement in outcomes including pain reduction and functional ability. Although there may be a slightly higher immediate complication rate, the functional outcomes remain comparable with those seen in the patient population with acute distal biceps.

scholarly journals Saúde Ocupacional aplicada à Dança

2020 ◽  
Vol 10 ◽  
pp. S172-S182
Author(s):  
Mónica Santos ◽  
Armando Almeida ◽  
Catarina Lopes
Keyword(s):  
Systematic Reviews ◽  
Full Text ◽  
Allied Health ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Cochrane Database ◽  
Central Register ◽  
Text Database

O setor da dança está pouco retratado em contexto de Saúde Ocupacional e a bibliografia é razoavelmente escassa. Neste setor o profissional pode apenas efetuar ensaios e atuações (a solo ou em equipa), pode dar aulas para eventuais futuros colegas e/ ou para leigos ou acumular ambas as vertentes. Trata-se de uma Revisão Bibliográfica, iniciada através de uma pesquisa realizada em agosto de 2020 nas bases de dados “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina e RCAAP”. A dança é uma arte complexa, cujo instrumento é o corpo. Conjuga movimento com a emoção, servindo também como forma de comunicação. Em alguns estilos de dança a rotina de treinos é muito exigente e competitiva, de forma a aperfeiçoar departamentos como força, resistência, velocidade, flexibilidade, equilíbrio e controlo. Aos treinos intensos, por vezes, associam-se algias e lesões concretas. Por exemplo, no Ballet clássico, a exigência técnica é muito elevada e desafiante e, na bibliografia selecionada, é certamente a dança mais estudada neste contexto. A escassa bibliografia encontrada incide sobretudo nas principais lesões associadas (quer acidentes de trabalho, quer doenças profissionais); sendo que alguns artigos também destacam o eventual consumo de substâncias psicoativas em algumas modalidades específicas. Os autores elaboraram uma descrição dos principais Fatores de Risco/ Riscos Laborais deste setor, no geral; bem como listaram as Medidas de Proteção (coletivas e individuais) que consideram ser mais adequadas. O setor da dança está muito pouco estudado pela Saúde Ocupacional, sendo pertinente a análise da realidade portuguesa, sobretudo em alguns estilos muito desenvolvidos no nosso país e sobre os quais não se encontrou qualquer bibliografia específica (mesmo em contexto internacional). PALAVRAS-CHAVE: dança, bailarino, saúde ocupacional e medicina do trabalho.

scholarly journals Multinational Association of Supportive Care in Cancer (MASCC) expert opinion/guidance on the use of clinically assisted nutrition in patients with advanced cancer

2021 ◽  
Author(s):  
Bryony Alderman ◽  
Lindsey Allan ◽  
Koji Amano ◽  
Carole Bouleuc ◽  
Mellar Davis ◽  
...  
Keyword(s):  
Supportive Care ◽  
Advanced Cancer ◽  
Search Strategy ◽  
Evidence Based ◽  
Cochrane Central Register ◽  
Patient Needs ◽  
Level Of Evidence ◽  
Cochrane Database ◽  
Central Register ◽  
Care Study

Abstract Purpose The pro vision of clinically assisted nutrition (CAN) in patients with advanced cancer is controversial, and there is a paucity of specific guidance, and so a diversity in clinical practice. Consequently, the Palliative Care Study Group of the Multinational Association of Supportive Care in Cancer (MASCC) formed a Subgroup to develop evidence-based guidance on the use CAN in patients with advanced cancer. Methods This guidance was developed in accordance with the MASCC Guidelines Policy. A search strategy for Medline was developed, and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were explored for relevant reviews/trials respectively. The outcomes of the review were categorised by the level of evidence, and a “category of guideline” based on the level of evidence (i.e. “recommendation”, “suggestion”, or “no guideline possible”). Results The Subgroup produced 11 suggestions, and 1 recommendation (due to the paucity of evidence). These outcomes relate to assessment of patients, indications for CAN, contraindications for CAN, procedures for initiating CAN, and re-assessment of patients. Conclusions This guidance provides a framework for the use of CAN in advanced cancer, although every patient needs individualised management.

The Role of Selective Peripheral Neurectomy in the Treatment of Upper Limb Spasticity

2018 ◽  
Vol 23 (02) ◽  
pp. 181-191 ◽  
Author(s):  
Li Yenn Yong ◽  
Charis H.L. Wong ◽  
Mark Gaston ◽  
Wee Leon Lam
Keyword(s):  
Systematic Review ◽  
Surgical Technique ◽  
Upper Limb ◽  
Surgical Techniques ◽  
Controlled Trials ◽  
Neurosurgical Procedures ◽  
Cochrane Central Register ◽  
Inclusion Criteria ◽  
Limb Spasticity ◽  
Peripheral Neurectomy

Background: Management of upper limb spasticity remains challenging. Selective peripheral neurectomy (SPN) is a relatively recent intervention for cases refractory to medical therapy. The aim of this study was to conduct a systematic review looking at the efficacy and outcomes of SPN, in order to clarify the patient selection criteria and surgical technique. Methods: A search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, Open Grey and CINAHL was conducted. Inclusion criteria included studies comparing pre- and post-operative outcomes for SPN, neurectomy, fasciculotomy and upper limb spasticity. Results: Only case series were reported with no randomised controlled trials found. 7 studies met the inclusion criteria with a total of 174 patients. A meta-analysis was not possible due to the degree of baseline heterogeneity. All studies had no control arm for comparison of outcomes, with a high risk of bias due to poor internal and external validity, as well as design and performance bias. Surgical techniques differ vastly between studies, with percentage of fascicles ablated between 30–80% and length of neurectomy between 5–10 mm. Some advocated removing end branches while others performed fascicular SPN proximally. 13 patients underwent orthopaedic or neurosurgical procedures, which are both confounding factors. All studies reported an improvement in spasticity although functional outcomes were reported with non-standardized measures. Recurrence rates were reported to be 0–16.1% (mean 3.72%). Conclusions: From this systematic review, SPN appeared to be a useful technique in selected cases, but overall no firm conclusions can be drawn regarding the best surgical technique, or the extent of functional improvement.

Métodos para detetar o Risco de surgirem Lesões Músculo-Esqueléticas relacionadas com o Trabalho- sabemos o suficiente?

2020 ◽  
Vol 10 ◽  
pp. 1-66
Author(s):  
Mónica Santos
Keyword(s):  
Occupational Health ◽  
Full Text ◽  
Direct Methods ◽  
Practical Experience ◽  
Cochrane Central Register ◽  
Self Assessment ◽  
Work Related ◽  
Cochrane Database ◽  
Central Register ◽  
Almost All

Introduction / background / objectives Work-related Musculoskeletal Injuries are prevalent and relevant. There are several methods for detecting risk, depending on the tasks performed. However, not all professionals working in the Occupational Health teams have well-structured knowledge or practical experience in most of these methods. Methodology It is a Review, initiated through a survey conducted in April 2020, in the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina and RCAAP ”. Content There are several categories of methods for assessing the risk of Musculoskeletal Lesions Related to Work. For that we have, in a very synthetic way, the self-assessment questionnaires (completed by the workers), the observational methods (more or less complex) and the direct methods. This work describes in detail OWAS, RULA, REBA, NIOSH Equation and Strain Index. Conclusions Articles are easily found in indexed databases that mention that they used them, but due to the limitations imposed by most journals in view of the size of the document, almost all authors only mention the name of the method they used and, at most, make a description very synthetic of it. In turn, in some Master’s or Doctoral Theses (where this problem does not exist), a more detailed methodological description can be found, but even so, it is not always possible to understand in practice how to use all methods or we find discreetly different versions, result of adaptations or a mixture of methods, carried out over the decades. Any professional on an Occupational Health Team will have a reasonable sense of what are the most damaging tasks; however, presenting this evidence, attenuating subjectivity and making use of the hierarchy that mathematical scales can offer, makes evaluations more scientific, rigorous and easier to be accepted as valid by the Employer/ Representatives/ Workers and, consequently, increase the receptivity to proposed measures to mitigate/ correct the problem and reassess it after this phase. It would be desirable for all professionals in the field to have at least a generic idea of ​​the existing methods and to know where they can go to obtain more information, in order to execute these techniques, if necessary.

scholarly journals Evidence of pharmacological and non-pharmacological interventions for the management of dental fear in paediatric dentistry: a systematic review protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016043 ◽  
Author(s):  
Stefano Cianetti ◽  
Luigi Paglia ◽  
Roberto Gatto ◽  
Alessandro Montedori ◽  
Eleonora Lupatelli
Keyword(s):  
Systematic Review ◽  
Children And Adolescents ◽  
Systematic Reviews ◽  
Dental Anxiety ◽  
Dental Fear ◽  
Population Characteristics ◽  
Cochrane Central Register ◽  
Pharmacological Interventions ◽  
Cochrane Database

IntroductionSeveral techniques have been proposed to manage dental fear/dental anxiety (DFA) in children and adolescents undergoing dental procedures. To our knowledge, no widely available compendium of therapies to manage DFA exists. We propose a study protocol to assess the evidence regarding pharmacological and non-pharmacological interventions to relieve dental anxiety in children and adolescents.Methods and analysisIn our systematic review, we will include randomised trials, controlled clinical rials and systematic reviews (SRs) of trials that investigated the effects of pharmacological and non-pharmacological interventions to decrease dental anxiety in children and adolescents. We will search the Cochrane Database of Systematic Reviews, the Cochrane Database of Abstracts of Reviews of Effects=, the Cochrane Central Register of Controlled Trials, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature and the Web of Science for relevant studies. Pairs of review authors will independently review titles, abstracts and full texts identified by the specific literature search and extract data using a standardised data extraction form. For each study, information will be extracted on the study report (eg, author, year of publication), the study design (eg, the methodology and, for SRs, the types and number of studies included), the population characteristics, the intervention(s), the outcome measures and the results. The quality of SRs will be assessed using the A Measurement Tool to Assess Reviews instrument, while the quality of the retrieved trials will be evaluated using the Cochrane Handbook for Systematic Reviews of Interventions criteria.Ethics and disseminationApproval from an ethics committee is not required, as no participants will be included. Results will be disseminated through a peer-reviewed publications and conference presentations.

Late-onset multiple venous malformations confined to the upper limb: link to somatic MAP3K3 mutations

2020 ◽  
Vol 45 (10) ◽  
pp. 1023-1027
Author(s):  
Mohammed M. Al-Qattan ◽  
Mohammed A. Al-Balwi ◽  
Ebtehal M. Al-Zayed ◽  
Mohammed Al-Sohaibani ◽  
Adnan G. Gelidan ◽  
...  
Keyword(s):  
Upper Limb ◽  
Cellular Proliferation ◽  
Mutational Analysis ◽  
Late Onset ◽  
Rare Condition ◽  
Surgical Excision ◽  
Venous Malformations ◽  
Level Of Evidence ◽  
Cavernous Malformations ◽  
Almost All

Venous (cavernous) malformations are commonly seen in the upper limb. Almost all venous malformations are congenital. They may be sporadic, familial, or syndromic. Late-onset, multiple venous malformations confined to the upper limb are rare. Lesions present after puberty. All previously reported cases were located subcutaneously and were small in size. The condition is non-hereditary and non-syndromic. We present a unique series of eight patients with this rare condition. Unique features included the presence of large malformations (up to 20 cm in diameter) and the presence of subfascial lesions causing nerve compression. Surgical excision was curative. Mutational analysis in one patient identified a novel somatic MAP3K3 gene mutation (c.1723T > C, p.Tyr 575 His) in the affected veins. The encoded MAP3K3 protein is known to accelerate the RAS pathway of cellular proliferation. Level of evidence: IV

Management of Ascending Aorta and Aortic Arch: Similarities and Differences Among Cardiovascular Guidelines

2021 ◽  
pp. 152660282110612
Author(s):  
Konstantinos Spanos ◽  
Petroula Nana ◽  
Yskert von Kodolitsch ◽  
Christian-Alexander Behrendt ◽  
George Kouvelos ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Open Surgery ◽  
Surgical Techniques ◽  
Ascending Aorta ◽  
Cochrane Central Register ◽  
Endovascular Techniques ◽  
Level Of Evidence ◽  
Indications For Treatment ◽  
Evidence Level

Background: Ascending aorta and aortic arch diseases have an increasing interest among cardiovascular specialists regarding diagnosis and management. Innovations in endovascular surgery and evolution of open surgery have extended the indications for treatment in patients previously considered unfit for surgery. The aim of this systematic review of the literature was to present and analyze current cardiovascular guidelines for overlap and differences in their recommendations regarding ascending aorta and aortic arch diseases and the assessment of evidence. Methods: The English medical literature was searched using the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases from January 2009 to December 2020. Recommendations on selected topics were analyzed, including issues from definitions and diagnosis (imaging and biomarkers) and indications for treatment to management, including surgical techniques, of the most important ascending aorta and aortic arch diseases. Results: The initial search identified 2414 articles. After exclusion of duplicate or inappropriate articles, the final analysis included 5 articles from multidisciplinary, cardiovascular societies published between 2010 and 2019. The definition of non-A-non-B aortic dissection is lacking from most of the guidelines. There is a disagreement regarding the class of recommendation and level of evidence for the diameter of ascending aorta as an indication. The indication for treatment of aortic disease may be individualized in specific cases while the growth rate may also affect the decision making. The role of endovascular techniques has not been established in current guidelines except by 1 society. Supportive evidence level in the management of aortic arch diseases remains limited. Conclusion: In current recommendations of cardiovascular societies, the ascending aorta and aortic arch remain a domain of open surgery despite the introduction of endovascular techniques. Recommendations of the included societies are mostly based on expert opinion, and the role of endovascular techniques has been highlighted only from 1 society. The chronological heterogeneity apparent among guidelines and the inconsistency in evidence level should be also acknowledged. More data are needed to develop more solid recommendations for the ascending aorta and aortic arch diseases.

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