scholarly journals Conservative Treatment for Acute Ankle Sprain: A Systematic Review

2020 ◽  
Vol 9 (10) ◽  
pp. 3128
Author(s):  
Ana Belen Ortega-Avila ◽  
Pablo Cervera-Garvi ◽  
Ana Marchena-Rodriguez ◽  
Esther Chicharro-Luna ◽  
Christopher J. Nester ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pain Relief ◽  
Conservative Treatment ◽  
Ankle Sprain ◽  
Relevant Literature ◽  
Randomised Control Trial ◽  
Inclusion Criteria ◽  
Short Term ◽  
Study Designs

The aim was to identify conservative treatments available for acute ankle sprain and to evaluate their effectiveness with respect to pain relief and short-term recovery of functional capacity. A systematic review of the relevant literature was conducted via a data search of the PROSPERO, PubMed, Scopus, CINAHL, PyscINFO and SPORTDiscus databases, from inception until December 2019, focusing on randomised control trial studies. Two of the authors independently assessed the quality of each study located and extracted the relevant data. The quality of each paper was assessed using the Cochrane risk of bias tool included in RevMan 5. In all, 20 studies met the inclusion criteria. In terms of absence of bias, only nine papers were classed as “high quality”. Studies (75%) were of low quality in terms of the blinding of participants and personnel and uncertainty in blinding of outcome assessment and all presented one or more other forms of bias. Despite the generally low quality of the studies considered, it can be concluded that conservative treatment for acute ankle sprain normally achieves pain relief and rapidly improved functionality. Research based on higher-quality study designs and procedures would enable more definitive conclusions to be drawn.

scholarly journals Carpal Tunnel Release Surgery- A Systematic Review of Open and Endoscopic Approaches

2020 ◽  
Vol 10 (6) ◽  
Author(s):  
Vwaire Orhurhu ◽  
Sebastian Orman ◽  
Jacquelin Peck ◽  
Ivan Urits ◽  
Mariam Salisu Orhurhu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pain Relief ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Inclusion Criteria ◽  
Short Term ◽  
Pain Outcomes ◽  
Tunnel Syndrome ◽  
Open Carpal Tunnel Release

Context: Carpal tunnel syndrome (CTS) is the most frequent peripheral compression-induced neuropathy observed in patients worldwide. Surgery is necessary when conservative treatments fail and severe symptoms persist. Traditional Open carpal tunnel release (OCTR) with visualization of carpal tunnel is considered the gold standard for decompression. However, Endoscopic carpal tunnel release (ECTR), a less invasive technique than OCTR is emerging as a standard of care in recent years. Evidence Acquisition: Criteria for this systematic review were derived from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two review authors searched PubMed, MEDLINE, and the Cochrane Database in May 2018 using the following MeSH terms from 1993-2016: ‘carpal tunnel syndrome,’ ‘median nerve neuropathy,’ ‘endoscopic carpal tunnel release,’ ‘endoscopic surgery,’ ‘open carpal tunnel release,’ ‘open surgery,’ and ‘carpal tunnel surgery.’ Additional sources, including Google Scholar, were added. Also, based on bibliographies and consultation with experts, appropriate publications were identified. The primary outcome measure was pain relief. Results: For this analysis, 27 studies met inclusion criteria. Results indicate that ECTR produced superior post-operative pain outcomes during short-term follow-up. Of the studies meeting inclusion criteria for this analysis, 17 studies evaluated pain as a primary or secondary outcome, and 15 studies evaluated pain, pillar tenderness, or incision tenderness at short-term follow-up. Most studies employed a VAS for assessment, and the majority reported superior short-term pain outcomes following ECTR at intervals ranging from one hour up to 12 weeks. Several additional studies reported equivalent pain outcomes at short-term follow-up as early as one week. No study reported inferior short-term pain outcomes following ECTR. Conclusions: ECTR and OCTR produce satisfactory results in pain relief, symptom resolution, patient satisfaction, time to return to work, and adverse events. There is a growing body of evidence favoring the endoscopic technique for pain relief, functional outcomes, and satisfaction, at least in the early post-operative period, even if this difference disappears over time. Several studies have demonstrated a quicker return to work and activities of daily living with the endoscopic technique.

scholarly journals Medicines Related Problems (MRPs) Originating in Primary Care Settings in Older Adults - A Systematic Review

2021 ◽  
pp. 089719002110236
Author(s):  
Rosetta Chinyere Ude-Okeleke ◽  
Zoe Aslanpour ◽  
Soraya Dhillon ◽  
Nkiruka Umaru
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Library Science ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Data Bases ◽  
Primary Care Settings ◽  
Preventative Interventions ◽  
Use Of Health Services

Background: As people age, they become increasingly vulnerable to the untoward effects of medicines due to changes in body systems. These may result in medicines related problems (MRPs) and consequent decline or deterioration in health. Aim: To identify MRPs, indicators of deterioration associated with these MRPs, and preventative interventions from the literature. Design and Setting: Systematic review of primary studies on MRPs originating in Primary Care in older people. Methods: Relevant studies published between 2001 and April 2018 were obtained from Medline (via PubMed), CINAHL, Embase, Psych Info, PASCAL, Scopus, Cochrane Library, Science Direct, and Zetoc. Falls, delirium, pressure ulcer, hospitalization, use of health services and death were agreed indicators of deterioration. The methodological quality of included studies was assessed using the Down and Black tool. Results: There were 1858 articles retrieved from the data bases. Out of these, 21 full text articles met inclusion criteria for the review. MRPs identified were medication error, potentially inappropriate medicines, adverse drug reaction and non-adherence. These were associated with indicators of deterioration. Interventions that involved doctors, pharmacists and patients in planning and implementation yielded benefits in halting MRPs. Conclusion: This Systematic review summarizes MRPs and associated indicators of deterioration. Appropriate interventions appeared to be effective against certain MRPs and their consequences. Further studies to explore deterioration presented in this systematic review is imperative.

scholarly journals Short-term Efficacy of Upper-Extremity Exercise Training in Patients With Chronic Airway Obstruction: A Systematic Review

2009 ◽  
Vol 89 (5) ◽  
pp. 443-455 ◽  
Author(s):  
Stefania Costi ◽  
Mauro Di Bari ◽  
Paolo Pillastrini ◽  
Roberto D'Amico ◽  
Ernesto Crisafulli ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Exercise Training ◽  
Pulmonary Rehabilitation ◽  
Health Related Quality ◽  
Inclusion Criteria ◽  
Patient Centered ◽  
Related Quality ◽  
Health Related

Background, Objectives, and Measurements Patients with chronic airway obstruction (CAO) frequently experience dyspnea and fatigue during activities performed by accessory muscles of ventilation, which competitively participate in arm elevation. This systematic review of randomized controlled trials (RCTs) concerning patients with CAO addresses the effects of upper-extremity exercise training (UEET), added to lower-extremity training or comprehensive pulmonary rehabilitation, on the following patient-centered outcomes: exercise capacity, symptoms, ability to perform daily activities, and health-related quality of life. Methods Studies were retrieved using comprehensive database and hand-search strategies. Two independent reviewers determined study eligibility based on inclusion criteria. A detailed description of treatments was mandatory. Reviewers rated study quality and extracted information on study methods, design, intervention, and results. Results Forty publications were evaluated. Four RCTs met the inclusion criteria but had serious methodological limitations, which introduce possible biases that reduce their internal validity. The outcomes measured were heterogeneous, and the results were inconsistent regarding maximal exercise capacity, dyspnea, and health-related quality of life. No effect of UEET was demonstrated for measures of arm fatigue. Limitations and Conclusions The limited methodological quality of the studies retrieved prevented us from performing a meta-analysis, the results of which could be misleading. This systematic review shows that there is limited evidence examining UEET and that the evidence available is of poor quality. Therefore, a recommendation for the inclusion or exclusion of UEET in pulmonary rehabilitation programs for individuals with CAO is not possible. Further research is needed to definitively ascertain the effects of this training modality on patient-centered outcomes.

scholarly journals Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies

2017 ◽  
Vol 76 (11) ◽  
pp. 1870-1882 ◽  
Author(s):  
Sabrina M Nielsen ◽  
Else M Bartels ◽  
Marius Henriksen ◽  
Eva E Wæhrens ◽  
Henrik Gudbergsen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Longitudinal Studies ◽  
Randomised Trial ◽  
Risk Of Bias ◽  
Current Evidence ◽  
Short Term ◽  
Quality Of Evidence

ObjectivesWeight loss is commonly recommended for gout, but the magnitude of the effect has not been evaluated in a systematic review. The aim of this systematic review was to determine benefits and harms associated with weight loss in overweight and obese patients with gout.MethodsWe searched six databases for longitudinal studies, reporting the effect of weight loss in overweight/obese gout patients. Risk of bias was assessed using the tool Risk of Bias in Non-Randomised Studies of Interventions. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation.ResultsFrom 3991 potentially eligible studies, 10 were included (including one randomised trial). Interventions included diet with/without physical activity, bariatric surgery, diuretics, metformin or no intervention. Mean weight losses ranged from 3 kg to 34 kg. Clinical heterogeneity in study characteristics precluded meta-analysis. The effect on serum uric acid (sUA) ranged from −168 to 30 μmol/L, and 0%–60% patients achieving sUA target (<360 μmol/L). Six out of eight studies (75%) showed beneficial effects on gout attacks. Two studies indicated dose–response relationship for sUA, achieving sUA target and gout attacks. At short term, temporary increased sUA and gout attacks tended to occur after bariatric surgery.ConclusionsThe available evidence is in favour of weight loss for overweight/obese gout patients, with low, moderate and low quality of evidence for effects on sUA, achieving sUA target and gout attacks, respectively. At short term, unfavourable effects may occur. Since the current evidence consists of a few studies (mostly observational) of low methodological quality, there is an urgent need to initiate rigorous prospective studies (preferably randomised controlled trials).Systematic review registrationPROSPERO, CRD42016037937.

scholarly journals Barriers to Implementing the ACGME Outcome Project: A Systematic Review of Program Director Surveys

2012 ◽  
Vol 4 (4) ◽  
pp. 425-433 ◽  
Author(s):  
Mohammad U. Malik ◽  
David A. Diaz Voss Varela ◽  
Charles M. Stewart ◽  
Kulsoom Laeeq ◽  
Gayane Yenokyan ◽  
...  
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Medical Knowledge ◽  
Program Directors ◽  
Faculty Support ◽  
Inclusion Criteria ◽  
Competency Based Education ◽  
Inadequate Knowledge ◽  
Competency Based

Abstract Introduction The Accreditation Council for Graduate Medical Education (ACGME) introduced the Outcome Project in July 2001 to improve the quality of resident education through competency-based learning. The purpose of this systematic review is to determine and explore the perceptions of program directors regarding challenges to implementing the ACGME Outcome Project. Methods We used the PubMed and Web of Science databases and bibliographies for English-language articles published between January 1, 2001, and February 17, 2012. Studies were included if they described program directors' opinions on (1) barriers encountered when attempting to implement ACGME competency-based education, and (2) assessment methods that each residency program was using to implement competency-based education. Articles meeting the inclusion criteria were screened by 2 researchers. The grading criterion was created by the authors and used to assess the quality of each study. Results The survey-based data reported the opinions of 1076 program directors. Barriers that were encountered include: (1) lack of time; (2) lack of faculty support; (3) resistance of residents to the Outcome Project; (4) insufficient funding; (5) perceived low priority for the Outcome Project; (6) inadequate salary incentive; and (7) inadequate knowledge of the competencies. Of the 6 competencies, those pertaining to patient care and medical knowledge received the most responses from program directors and were given highest priority. Conclusions The reviewed literature revealed that time and financial constraints were the most important barriers encountered when implementing the ACGME Outcome Project.

Should Levetiracetam or Phenytoin Be Used for Posttraumatic Seizure Prophylaxis? A Systematic Review of the Literature and Meta-analysis

Neurosurgery ◽  
2016 ◽  
Vol 79 (6) ◽  
pp. 775-782 ◽  
Author(s):  
Nickalus R. Khan ◽  
Matthew A. VanLandingham ◽  
Tamara M. Fierst ◽  
Caroline Hymel ◽  
Kathryn Hoes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antiepileptic Drug ◽  
Random Effects ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Seizure Prophylaxis ◽  
Number Of Patients ◽  
Severe Tbi ◽  
Antiepileptic Drug Therapy

Abstract BACKGROUND: Posttraumatic seizure (PTS) is a significant complication of traumatic brain injury (TBI). OBJECTIVE: To perform a systematic review and meta-analysis to compare levetiracetam with phenytoin for seizure prophylaxis in patients diagnosed with severe TBI. METHODS: An inclusive search of several electronic databases and bibliographies was conducted to identify scientific studies that compared the effect of levetiracetam and phenytoin on PTS. Independent reviewers obtained data and classified the quality of each article that met inclusion criteria. A random effects meta-analysis was then completed. RESULTS: During June and July 2015, a systematic literature search was performed that identified 6097 articles. Of these, 7 met inclusion criteria. A random-effects meta-analysis was performed. A total of 1186 patients were included. The rate of seizure was 35 of 654 (5.4%) in the levetiracetam cohort and 18 of 532 (3.4%) in the phenytoin cohort. Our meta-analysis revealed no change in the rate of early PTS with levetiracetam compared with phenytoin (relative risk, 1.02; 95% confidence interval, 0.53-1.95; P = .96). CONCLUSION: The lack of evidence on which antiepileptic drug to use in PTS is surprising given the number of patients prescribed an antiepileptic drug therapy for TBI. On the basis of currently available Level III evidence, patients treated with either levetiracetam or phenytoin have similar incidences of early seizures after TBI.

A Systematic Review of Randomized Trials on the Effectiveness of Opioids for Cancer Pain

2012 ◽  
Vol 3S;15 (3S;7) ◽  
pp. ES39-ES58 ◽  
Author(s):  
Lakshmi Koyyalagunta
Keyword(s):  
United States ◽  
Systematic Review ◽  
Side Effects ◽  
Pain Relief ◽  
Cancer Pain ◽  
Outcome Measures ◽  
Randomized Trials ◽  
Transdermal Fentanyl

Background: In all recommended guidelines put forth for the treatment of cancer pain, opioids continue to be an important part of a physician’s armamentarium. Though opioids are used regularly for cancer pain, there is a paucity of literature proving efficacy for long-term use. Cancer is no longer considered a “terminal disease”; 50% to 65% of patients survive for at least 2 years, and there are about 12 million cancer survivors in the United States. There is a concern about side effects, tolerance, abuse and addiction with long-term opioid use and a need to evaluate the effectiveness of opioids for cancer pain. Objective: The objective of this systematic review was to look at the effectiveness of opioids for cancer pain. Study Design: A systematic review of randomized trials of opioids for cancer pain. Methods: A comprehensive review of the current literature for randomized controlled trials (RCTs) of opioids for cancer pain was done. The literature search was done using PubMed, EMBASE, Cochrane library, clinical trials, national clearing house, Web of Science, previous narrative systematic reviews, and cross references. The studies were assessed using the modified Cochrane and Jadad criteria. Analysis of evidence was done utilizing the modified quality of evidence developed by United States Preventive Services Task Force (USPSTF). Outcome Measures: Pain relief was the primary outcome measure. Secondary outcome measures are quality of life (QoL) and side effects including tolerance and addiction. Results: The level of evidence for pain relief based on the USPSTF criteria was fair for transdermal fentanyl and poor for morphine, tramadol, oxycodone, methadone, and codeine. Limitations: Randomized trials in a cancer setting are difficult to perform and justify. There is a paucity of long-term trials and this review included a follow-up period of only 4 weeks. Conclusion: This systematic review of RCTs of opioids for cancer pain showed fair evidence for the efficacy of transdermal fentanyl and poor evidence for morphine, tramadol, oxycodone, methadone, and codeine. Key words: Opioids, pain relief, cancer pain, morphine, hydromorphone, methadone, fentanyl, oxymorphone, hydrocodone, oxycodone, buprenorphine.

Psychosocial interventions to improve HIV treatment adherence: A systematic review

2021 ◽  
Author(s):  
Stefanella Costa-Cordella ◽  
Alejandra Rossi ◽  
Aitana Grasso-Cladera ◽  
Javiera Duarte ◽  
Claudia P. Cortes
Keyword(s):  
Systematic Review ◽  
Treatment Adherence ◽  
Peer Support ◽  
Psychosocial Interventions ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Individual Counselling ◽  
Suboptimal Adherence ◽  
Study Designs

Introduction: The problem of suboptimal adherence to antiretroviral treatment (ART) can be overcome through multidisciplinary management that includes evidence-based psychosocial interventions. Existing reviews focus only on randomized controlled trials, overlooking valuable interventions whose evidence comes from different study designs. This review aimed to synthesize the current state of the art in psychological interventions for ART adherence, integrating studies with a variety of research designs.Methods: We conducted a systematic review following PRISMA guidelines. We searched five databases for articles reporting a psychosocial intervention to improve treatment adherence for people living with HIV. The quality of each study was analyzed, and the data summarized using a narrative synthesis method.Results and discussion: Twenty-six articles were identified for inclusion. Individual counselling was the most common intervention, followed by peer-support based interventions delivered virtually or in person. Most interventions mixed different strategies, combining technology with individual counselling and peer support. It is important to note that the quality of evidence was not dependent on the study design.Conclusion: While the evidence requires further advancement, the review provides insight into which psychosocial interventions are helpful in improving ART treatment adherence.

Therapeutic dilemmas regarding giant aneurysms of the intracranial vertebral artery causing medulla oblongata compression

2021 ◽  
pp. 197140092110428
Author(s):  
Kun Hou ◽  
Lai Qu ◽  
Jinlu Yu
Keyword(s):  
Systematic Review ◽  
Conservative Treatment ◽  
Vertebral Artery ◽  
English Literature ◽  
Aggressive Treatment ◽  
Inclusion Criteria ◽  
Cerebrovascular Lesions ◽  
Giant Aneurysms ◽  
Pubmed Database ◽  
Removal Group

Background Giant aneurysms of the intracranial vertebral artery are very rare cerebrovascular lesions. Due to the rarity of these aneurysms, we know little about them. Methods We performed a systematic review of the English literature by searching the PubMed database. The inclusion criteria were as follows: (a) the full text was available and (b) complete clinical data were available. Results A total of 45 articles were identified, containing 53 patients (53 aneurysms). The patients were aged from 5 to 77 years (48.8 ± 20.8 years). Four patients receiving conservative treatment died. The remaining 49 patients were divided into the aneurysm removal group ( n = 17) and the aneurysm reserve group ( n = 32). The outcomes of the 49 treated cases could be obtained in 45 cases, 31 of which (68.9%, 31/45) had a Glasgow outcome scale score of 4–5. Conclusions It is still difficult to treat intracranial giant vertebral artery aneurysms, regardless of the treatment selected. Because of the malignant natural history, aggressive treatment is still advocated.

A Systematic Review of the Relationships Between Physical Activity and Sleep in Early Childhood

2021 ◽  
pp. 1-17
Author(s):  
Christine W. St. Laurent ◽  
Katrina Rodheim ◽  
Rebecca M.C. Spencer
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Evaluation Framework ◽  
Outcome Studies ◽  
Study Quality ◽  
Assessment Development ◽  
High Prevalence ◽  
Study Characteristics ◽  
Study Designs

The aim of this systematic review was to examine the associations between physical activity and sleep in children aged less than 6 years. Articles were included if participants were primarily aged less than 6 years and study designs were observational or experimental. Study characteristics were extracted, and the Grading Recommendations Assessment, Development and Evaluation framework was used to assess study quality. Thirty-six studies (16 sleep, 16 physical activity, and three fitness outcomes) from 18 countries reported in 29 articles were included. The majority of sleep and physical activity outcome studies reported mixed effects with very low to low quality of evidence. Fitness outcome studies were limited, and therefore, evidence was insufficient. The high prevalence of mixed and null results could be related to study limitations. Importantly, this review points to the critical need for higher quality studies of sleep and physical activity in young children, which would support health recommendations and intervention strategies for healthier child development.

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