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Wolsing SK, Frølund JC, Dalgård C, Hilberg O, Gantzhorn E. Telephone follow-up as a substitute for standard out-clinic follow-up in CPAP therapy for obstructive sleep apnea patients: a randomized controlled trial. Sleep Breath 2024; 28:1651-1659. [PMID: 38720151 PMCID: PMC11303568 DOI: 10.1007/s11325-024-03045-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/29/2024] [Accepted: 04/26/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE This study assessed the feasibility of telephone follow-up consultations (TC) using an online data sharing and editing function (Airview™), as alternative to standard out-clinic follow-up consultations (SC) on adherence to continuous positive airway pressure (CPAP) in obstructive sleep apnea (OSA) patients. Furthermore, we investigated compliance to follow-up consultations and examined potential influencing factors, including baseline AHI (apnea-hypopnea-index), age, and distance from home to the hospital on consultation compliance. METHODS Two hundred OSA patients, with AHI ≥ 5 were randomly assigned (1:1) to receive TC or SC with follow-up after one month and 12 month of CPAP initiation. Adherence goal was defined as achieving ≥ 4 h of CPAP use daily in 70% of the days in a 365-days period. RESULTS The proportion of participants achieving CPAP adherence was non-significantly lower in the TC group compared to the SC group (TC: 30% versus SC: 36%, adjusted OR 0.84, p = 0.59). Of participants who completed the study, the TC group had a significant average of 107 min less use of CPAP compared to the SC group (p = 0.048). However, a higher proportion of participants was compliant to consultations in the TC group. The only influencing factor found was increasing baseline AHI, which might be a predictor for compliance to consultations and adherence to CPAP therapy. CONCLUSION TC might serve as substitute for SC in some part of the OSA population. If TC becomes a part of CPAP therapy management, it is important to consider patient characteristics and treatment-related issues to prevent decline in adherence.
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Affiliation(s)
- Sofie Krogh Wolsing
- Department of Medicine, Lillebaelt Hospital, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Jannie Christina Frølund
- Department of Medicine, Lillebaelt Hospital, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Christine Dalgård
- Research Unit of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Ole Hilberg
- Department of Medicine, Lillebaelt Hospital, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Eline Gantzhorn
- Department of Medicine, Lillebaelt Hospital, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
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Sebastián Infante J, Blackburn N, Felipe Vargas J. Radiofrequency of suprascapular nerve as an analgesic strategy for chronic pain management. Systematic review and meta-analysis. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024:S2341-1929(24)00124-0. [PMID: 38987019 DOI: 10.1016/j.redare.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/26/2023] [Accepted: 03/13/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Chronic shoulder pain is highly prevalent in the general population. Many different analgesic strategies have been described, including radiofrequency treatment to the suprascapular nerve (RFS); however, the effectiveness this approach remains unclear, and no strong recommendation can be made. The aim of this systematic review is to analyse the latest clinical trials evaluating the effectiveness of RFS techniques applied to the suprascapular nerve in terms of management of chronic shoulder pain, post-procedural functionality, and adverse effects. METHODS We performed a systematic review of clinical trials retrieved from Medline, Embase and the CENTRAL databases. We included trials comparing RFS with other strategies, including placebo, that had as their primary outcome measures pain rated on a visual analogue scale, functionality rated on a shoulder pain and disability index (SPADI), and the incidence of adverse events. Risk of bias was analysed using the Cochrane RoB2 tool. Evidence was analysed using a random effects model and heterogeneity was quantified using the I2 test. RESULTS We identified 3030 trials, of which 8 met the inclusion criteria (n = 408). Seven had a high risk of bias. Pain intensity at 1 and 3 months was lower in patients receiving RFS, with a standardised mean difference (SMD) of -0.9 (95% CI [-1.1, 0.33], p = 0.29; I2 88%, p < 0.001) and -1.17 (95% CI [-2.49, 0.14], p = 0.08; I2 97%, p < 0.001), respectively. Functional compromise at 1 and 3 months decreased in patients receiving RFS, with an SMD of -0.31 (95% CI [-0.91, 0.29], p = 0.31; I2 80%, p < 0.001) and -1.54 (95% CI [-3.26, 0.19], p = 0.08; I2 98%, p < 0.001), respectively. No RFS-related adverse events were described. CONCLUSION The evidence suggests that RFS reduces pain and improves functionality. However, the certainty of the evidence is low.
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Affiliation(s)
- J Sebastián Infante
- Departament of Anaesthesiology and Pain Management Hospital Pablo Tobón Uribe, Bogotá, Colombia
| | - N Blackburn
- Anaesthesiologist, Research Fellow at the Clinica de Dolor y Cuidados Paliativos, Universidad el Bosque, Bogotá, Colombia.
| | - J Felipe Vargas
- Departament of Anaesthesiology and Pain Management Hospital Pablo Tobón Uribe, Bogotá, Colombia
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Giess D, Erdos J, Wild C. An updated systematic review on spinal muscular atrophy patients treated with nusinersen, onasemnogene abeparvovec (at least 24 months), risdiplam (at least 12 months) or combination therapies. Eur J Paediatr Neurol 2024; 51:84-92. [PMID: 38905882 DOI: 10.1016/j.ejpn.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/14/2024] [Accepted: 06/14/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE This systematic review provides an update on outcomes for patients with spinal muscular atrophy (SMA) type 1 to 4 treated with approved therapeutics, including the most recent, risdiplam, for an observation period of up to 48 months. METHODS A systematic literature search was conducted in July 2023 in four databases. Selected publications were assessed for internal validity and risk of bias by two authors and relevant data were extracted into standardised tables. Results were summarised narratively as substantial heterogeneity of studies prevents meaningful quantitative analysis. RESULTS Twenty observational studies and one RCT were included in the analysis, fifteen studies on nusinersen, one on onasemnogene abeparvovec and two on risdiplam. Evidence supports the effectiveness of the therapies in motor function improvement for up to 48 months of follow-up in the SMA types specified in their respective indications. Better results were observed with earlier treatment initiation and higher baseline function. Whilst motor improvement was consistently observed, regardless of SMA type or treatment used, we noted no significant improvements in respiratory and nutritional outcomes. Quality of life endpoints were rarely investigated. Adverse events were common but seldom classified as treatment-related except for post-lumbar puncture syndrome, which was frequently reported across nusinersen studies. CONCLUSION The treatment of SMA with the new therapies changes the disease phenotype with changes in motor function far exceeding any improvement in respiratory and nutritional function. Questions persist on long-term efficacy, potential regressions, impact on quality of life and social functioning, therapy duration, and discontinuation indicators.
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Affiliation(s)
- Doris Giess
- Austrian Institute for Health Technology Assessment, 1090, Vienna, Garnisonsgasse 7/20, Austria.
| | - Judit Erdos
- Austrian Institute for Health Technology Assessment, 1090, Vienna, Garnisonsgasse 7/20, Austria
| | - Claudia Wild
- Austrian Institute for Health Technology Assessment, 1090, Vienna, Garnisonsgasse 7/20, Austria
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Thomsen AML, Tayyari N, Duvald I, Kirkegaard H, Obel B, Nielsen CP. Hospital at home for elderly acute patients: a study protocol for a randomised controlled trial. BMJ Open 2024; 14:e083372. [PMID: 38697766 PMCID: PMC11086463 DOI: 10.1136/bmjopen-2023-083372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/09/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION The increasing elderly population has led to a growing demand for healthcare services. A hospital at home treatment model offers an alternative to standard hospital admission, with the potential to reduce readmission and healthcare consumption while improving patients' quality of life. However, there is little evidence regarding hospital at home treatment in a Danish setting. This article describes the protocol for a randomised controlled trial (RCT) comparing standard hospital admission to hospital at home treatment. The main aim of the intervention is to reduce 30-day acute readmission after discharge and improve the quality of life of elderly acute patients. METHODS AND ANALYSIS A total of 849 elderly acute patients will be randomised in a 1:2 ratio to either the control or intervention group in the trial. The control group will receive standard hospital treatment in a hospital emergency department while the intervention group will receive treatment at home. The primary outcomes of the trial are the rate of 30-day acute readmission and quality of life, assessed using the European Quality of Life-5 Dimensions-5-Level instrument. Primary analyses are based on the intention-to-treat principle. Secondary outcomes are basic functional mobility, resource use in healthcare, primary and secondary healthcare cost, incremental cost-effectiveness ratio, and the mortality rate 3 months after discharge. ETHICS AND DISSEMINATION The RCT was approved by the Ethical Committee, Central Denmark Region (no. 1-10-72-67-20). Results will be presented at relevant national and international meetings and conferences and will be published in international peer-reviewed journals. Furthermore, we plan to communicate the results to relevant stakeholders in the Danish healthcare system. TRIAL REGISTRATION NUMBER NCT05360914.
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Affiliation(s)
- Anne Marie Ladehoff Thomsen
- Central Denmark Region, Defactum, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Nasrin Tayyari
- Central Denmark Region, Defactum, Aarhus, Denmark
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Gistrup, Denmark
| | - Iben Duvald
- Interdisciplinary Centre for Organizational Architecture, Department of Management, Aarhus University School of Business and Social Sciences, Aarhus, Denmark
- The Emergency Department, Viborg Regional Hospital, Regional Hospital Central Jutland, Central Denmark Region, Viborg, Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Emergency Department and Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Børge Obel
- Interdisciplinary Centre for Organizational Architecture, Department of Management, Aarhus BSS, Aarhus, Denmark
| | - Camilla Palmhøj Nielsen
- Central Denmark Region, Defactum, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Tauqeer S, Arooj A, Shakeel H. Effects of manual therapy in addition to stretching and strengthening exercises to improve scapular range of motion, functional capacity and pain in patients with shoulder impingement syndrome: a randomized controlled trial. BMC Musculoskelet Disord 2024; 25:192. [PMID: 38431547 PMCID: PMC10908164 DOI: 10.1186/s12891-024-07294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The current study aimed to measure the effectiveness of manual therapy in addition to stretching and strengthening exercises in patients with shoulder impingement syndrome to improve functional capacity, pain, and scapular range of motion. METHODS This is a single-blinded randomized controlled trial. Thirty-two participants with chronic shoulder impingement syndrome were randomly allocated into two groups. Both groups received stretching and strengthening exercises while the treatment group was given manual therapy additionally. Treatment was started after the patients signed an informed consent form. The data were collected from the University of Lahore Teaching Hospital between March 2022 and December 2022. The study aimed to measure pain using a numeric pain rating scale, functional capacity was assessed by the disability of the arm and shoulder, and goniometry was used for scapular ranges, i.e., scapular protraction and upward rotation. Each treatment session lasted 45 min for the treatment group and 30 min for the control group. The treatment comprised five days a week for four weeks, after which post-intervention measurements were taken. RESULTS Thirty-two participants were enrolled in the study, and 16 were divided into each group. The mean age of the participants in the treatment group was 38.19 ± 7.31 while the comparison group was 35.69 ± 7.98. An independent sample t-test was run on the data with a 95% confidence interval, statistically significant results were obtained, i.e., p-value < 0.05, post-intervention in the treatment group. Both groups have significantly improved functional capacity and scapular protraction (p < 0.005), however, pain and scapular upward rotation were not found statistically significant in the control group (p > 0.05). CONCLUSION The addition of manual therapy along with exercise therapy showed clinical and statistical significant results for pain, functional capacity, and scapular range of motion. It demonstrated superior effects than exercise therapy alone for the chronic condition of SIS. TRIAL REGISTRATION The trial was registered in the Iranian Registry of Clinical Trials ( https://www.irct.ir/ ) with the registration number: IRCT20230526058291N1, (Date: 12/08/2023).
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Affiliation(s)
- Sana Tauqeer
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
| | - Ayesha Arooj
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan.
| | - Hammad Shakeel
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
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Alivand Z, Nourizadeh R, Hakimi S, Esmaeilpour K, Mehrabi E. The effect of cognitive-behavioral therapy and haptonomy on fear of childbirth in primigravida women: a randomized clinical trial. BMC Psychiatry 2023; 23:929. [PMID: 38082410 PMCID: PMC10712131 DOI: 10.1186/s12888-023-05414-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Considering the role of fear of childbirth (FOC) in the enhancement of unnecessary cesarean sections (CS), the present study aimed at evaluating the effect of Cognitive-Behavioral Therapy (CBT) and haptonomy on the FOC (as primary outcome) and intended birth method and final birth method (as secondary outcomes) among primigravida women. METHODS This randomized clinical trial was conducted on 99 primigravida women in Tabriz, Iran 2022. Participants were assigned to three groups with a ratio of 1:1:1 using stratified block randomization based on the fear intensity. One of the intervention groups (n = 33) received eight group sessions of CBT from 24 to 28 weeks of gestation and the other intervention group (n = 33) received haptonomy during seven sessions once a week. The control group (n = 33) received routine prenatal care. The Wijma questionnaire was completed by the participants before the intervention, after the intervention at 35-37 weeks of gestation, and after birth. The intended birth method was investigated before and after the intervention at 35-37 weeks of gestation. The final birth method and the reasons for CS were recorded based on the mother's medical profile. The one-way ANOVA was used before the intervention and RMANOVA after the intervention to compare the mean scores of FOC among the three groups. Further, chi-square test was applied to compare the intended and final birth method. RESULTS The mean (standard deviation: SD) of FOC in the CBT group changed from 74.09 (11.35) at 24-28 weeks of gestation to 46.50 (18.28) at 35-37 weeks and 48.78 (20.64) after birth (P < 0.001). The means (SDs) of FOC in the haptonomy group were 76.81 (13.09), 46.59 (15.81), and 45.09 (20.11), respectively (P < 0.001). The mean (SD) of FOC in the control group decreased from 70.31 (6.71) to 66.56 (18.92) and then, increased to 71.00 (21.14) after birth (P = 0.878). After the intervention, there was no statistically significant difference among the three groups in terms of the intended birth method (P = 0.278), and final birth method (P = 0.107). CONCLUSION The findings of the present study revealed that both CBT and haptonomy interventions reduce FOC. Although the desire for vaginal birth and final vaginal birth in the haptonomy group was more than that in the other two groups, there was no statistically significant difference among the three groups. TRIAL REGISTRATION Iranian Registry of Clinical Trials: IRCT20170506033834N9. Date of registration: 02.01.2022. URL: http://en.irct.ir .
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Affiliation(s)
- Zahra Alivand
- Student Research Committee, Midwifery Department, Tabriz University of Medical sciences, Tabriz, Iran
| | - Roghaiyeh Nourizadeh
- Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical sciences, Tabriz, Iran.
| | - Sevil Hakimi
- Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical sciences, Tabriz, Iran
| | | | - Esmat Mehrabi
- Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical sciences, Tabriz, Iran
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Udenigwe O, Omonaiye O, Yaya S. Gender transformative approaches in mHealth for maternal healthcare in sub-Saharan Africa: a systematic review. Front Digit Health 2023; 5:1263488. [PMID: 38026837 PMCID: PMC10662097 DOI: 10.3389/fdgth.2023.1263488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background This review focuses on studies about digital health interventions in sub-Saharan Africa. Digital health interventions in sub-Saharan Africa are increasingly adopting gender-transformative approaches to address factors that derail women's access to maternal healthcare services. However, there remains a paucity of synthesized evidence on gender-transformative digital health programs for maternal healthcare and the corresponding research, program and policy implications. Therefore, this systematic review aims to synthesize evidence of approaches to transformative gender integration in digital health programs (specifically mHealth) for maternal health in sub-Saharan Africa. Method The following key terms "mobile health", "gender", "maternal health", "sub-Saharan Africa" were used to conduct electronic searches in the following databases: PsycInfo, EMBASE, Medline (OVID), CINAHL, and Global Health databases. The method and results are reported as consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Data synthesis followed a convergent approach for mixed-method systematic review recommended by the JBI (Joanna Briggs Institute). Results Of the 394 studies retrieved from the databases, 11 were included in the review. Out of these, six studies were qualitative in nature, three were randomized control trials, and two were mixed-method studies. Findings show that gender transformative programs addressed one or more of the following categories: (1) gender norms/roles/relations, (2) women's specific needs, (3) causes of gender-based health inequities, (4) ways to transform harmful gender norms, (5) promoting gender equality, (6) progressive changes in power relationships between women and men. The most common mHealth delivery system was text messages via short message service on mobile phones. The majority of mHealth programs for maternal healthcare were focused on reducing unintended pregnancies through the promotion of contraceptive use. The most employed gender transformative approach was a focus on women's specific needs. Conclusion Findings from gender transformative mHealth programs indicate positive results overall. Those reporting negative results indicated the need for a more explicit focus on gender in mHealth programs. Highlighting gender transformative approaches adds to discussions on how best to promote mHealth for maternal health through a gender transformative lens and provides evidence relevant to policy and research. Systematic review registration PROSPERO CRD42023346631.
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Affiliation(s)
- Ogochukwu Udenigwe
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Olumuyiwa Omonaiye
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
- Centre for Quality and Patient Safety Research—Eastern Health Partnership, Eastern Health, Box Hill, VIC, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Dardari D, Franc S, Charpentier G, Orlando L, Bobony E, Bouly M, Xhaard I, Amrous Z, Sall KL, Detournay B, Penfornis A. Hospital stays and costs of telemedical monitoring versus standard follow-up for diabetic foot ulcer: an open-label randomised controlled study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 32:100686. [PMID: 37520145 PMCID: PMC10384180 DOI: 10.1016/j.lanepe.2023.100686] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023]
Abstract
Background Two randomised controlled trials (RCTs) have previously shown that telemedical monitoring of diabetic foot ulcer (DFU) reduces the number of visits to the outpatient clinic, without losing treatment efficacy or increasing costs. Here we present the results of an open-label, randomised controlled trial designed to investigate whether telemonitoring, provided by an expert nurse (with extensive experience in DFU and trained in remote monitoring), reduces the hospital stay and the associated costs for a patient with DFU (TELEPIED trial). Methods Eligible patients (n = 180) were randomly allocated to: (i) a control group, in which they received standard care, and (ii) an intervention group, in which they received asynchronous telemedicine follow-up by the expert nurse. The primary outcome was the cumulative hospital days over 12 months. The main secondary outcomes were (i) direct healthcare costs (estimated in a collective perspective), (ii) wound healing and (iii) amputation rates. ITT (intention-to-treat) population was analysed. Findings In the ITT population, cumulative hospital days were significantly higher in the control group (13.4 days [95% CI 9.0-17.8]) than in the intervention group (7.1 days [2.8-11.5]) (p = 0.0458, ANCOVA model). Cumulative direct costs over 12 months were 7185 € (95% CI 5144-9226) in the control group and 3471 € (95% CI 1430-5512) in the intervention group (p = 0.0120). The percentage of wounds healed and amputation rate were not significantly different between groups. Similar results were found with the PP population. Interpretation The implementation of a telemedical intervention with an expert nurse could lead to a length of hospitalization and direct costs that were two times lower compared to conventional follow-up. This lower medical and economic burden was obtained without losing effectiveness on the rate of healing, nor increasing the amputation rate. Additional studies are required to confirm these findings. Funding This study was designed, funded and conducted by CERITD (Study and Research Centre for Intensification of Diabetes Treatment, Evry, France), Genopole GIP, 20 rue Henri Desbruères, 91030 EVRY Cedex and Laboratoires URGO, 15 Avenue d'Iéna, 75116 Paris Cedex, France. The findings and conclusions in this study are those of the authors and do not necessarily represent the views of the sponsor. The corresponding author (DD) certify that authors were not precluded from accessing data in the study, and they accept responsibility to submit for publication.
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Affiliation(s)
- Dured Dardari
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- LBEPS, Université d’Evry, IRBA, Université de Paris-Saclay, Evry, France
| | - Sylvia Franc
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Guillaume Charpentier
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Laurent Orlando
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Elise Bobony
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Marie Bouly
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
| | - Ilham Xhaard
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Zohra Amrous
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Khadijatou Ly Sall
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Bruno Detournay
- CEMKA, 43, Boulevard du Maréchal Joffre, Bourg-La-Reine 92340, France
| | - Alfred Penfornis
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- Paris-Sud Medical School, Paris-Saclay University, Saint-Aubin, France
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Patti A, Thornton JS, Giustino V, Drid P, Paoli A, Schulz JM, Palma A, Bianco A. Effectiveness of Pilates exercise on low back pain: a systematic review with meta-analysis. Disabil Rehabil 2023:1-14. [PMID: 37632387 DOI: 10.1080/09638288.2023.2251404] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE Low back pain is the most frequently reported musculoskeletal disorder and represents one of the highest patient burdens in healthcare. This systematic review and meta-analysis aimed to investigate the effectiveness of Pilates exercise on pain intensity and functional disability caused by low back pain (LBP). MATERIALS AND METHODS A Systematic review with meta-analysis was conducted. Data sources: MEDLINE-NLM and MEDLINE-EBSCO. We also searched on Scopus Elsevier, Cochrane, DOAJ, SciELO, PEDro, and PLOS ONE databases. Eligibility criteria: randomized controlled trials (RCTs) evaluating LBP in which the primary treatment was based on Pilates exercise compared with no exercise, or non-specific exercise. RESULTS The search returned 1566 records of which 36 articles were included in the systematic review and 19 in the meta-analysis. Twenty-two studies compared the effects of Pilates exercise vs no exercise and 13 studies examined the effects of Pilates exercise vs non-specific exercise. Analysis showed that Pilates had a positive effect on the perception of LBP vs no exercise. A similar trend occurred with non-specific exercise. CONCLUSIONS Pilates exercise can decrease LBP compared to no exercise and non-specific exercise. General practitioners should consider Pilates exercise as an effective strategy to manage LBP and counteract the growing health. TRIAL REGISTRATION PROSPERO registration number: CRD42022308387.IMPLICATIONS FOR REHABILITATIONPilates is a good strategy for improving low back pain and is more effective than other exercise programs or no exercise.Pilates is a safe tool to apply to most of the population with low back pain.Pilates is a non-pharmacological strategy useful for counteracting low back pain.
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Affiliation(s)
- Antonino Patti
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Jane S Thornton
- Western Centre for Public Health and Family Medicine, University of Western Ontario Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Valerio Giustino
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Antonio Paoli
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Jenna M Schulz
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Canada
- Bone and Joint Institute, University of Western Ontario, London, Canada
| | - Antonio Palma
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
- Regional Sports School of Italian National Olympic Committee (CONI) Sicilia, Palermo, Italy
| | - Antonino Bianco
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
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Ahmad MA, Moganan M, A Hamid MS, Sulaiman N, Moorthy U, Hasnan N, Yusof A. Comparison between Low-Level and High-Intensity Laser Therapy as an Adjunctive Treatment for Knee Osteoarthritis: A Randomized, Double-Blind Clinical Trial. Life (Basel) 2023; 13:1519. [PMID: 37511894 PMCID: PMC10381799 DOI: 10.3390/life13071519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Low-level (LLLT) and high-intensity laser therapy (HILT) can be beneficial additions to knee osteoarthritis (KOA) rehabilitation exercises; however, it is still being determined which electrophysical agent is more effective. AIM To compare the effects of LLLT and HILT as adjuncts to rehabilitation exercises (LL + EX and HL + EX) on clinical outcomes in KOA. METHODS Thirty-four adults with mild-to-moderate KOA were randomly allocated to either LL + EX or HL + EX (n = 17 each). Both groups underwent their respective intervention weekly for twelve weeks: LL + EX (400 mW, 830 nm, 10 to 12 J/cm2, and 400 J per session) or HL + EX (5 W, 1064 nm, 19 to 150 J/cm2, and 3190 J per session). The laser probe was placed vertically in contact with the knee and moved in a slow-scan manner on the antero-medial/lateral sides of the knee joint. Participants' Knee Injury and Osteoarthritis Outcome Score (KOOS), Numerical Pain Rating Scale (NPRS), active knee flexion, and Timed Up-and-Go test (TUG) were assessed. RESULTS Post intervention, both groups showed improvements in their KOOS, NPRS, active knee flexion, and TUG scores compared to baseline (p < 0.01). The mean difference of change in KOOS, NPRS, and active knee flexion scores for the HL + EX group surpassed the minimal clinically important difference threshold. In contrast, the LL + EX group only demonstrated clinical significance for the NPRS scores. CONCLUSIONS Incorporating HILT as an adjunct to usual KOA rehabilitation led to significantly higher improvements in pain, physical function, and knee-related disability compared to LLLT applied in scanning mode.
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Affiliation(s)
- Mohd Azzuan Ahmad
- Physiotherapy Programme, Centre for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
- Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Mageswari Moganan
- Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Mohamad Shariff A Hamid
- Sports Medicine Unit, Faculty of Medicine, Universiti Malaya Medical Centre, Kuala Lumpur 59100, Malaysia
| | - Norhuda Sulaiman
- Sports Medicine Unit, Faculty of Medicine, Universiti Malaya Medical Centre, Kuala Lumpur 59100, Malaysia
| | - Ushantini Moorthy
- Sports Medicine Unit, Faculty of Medicine, Universiti Malaya Medical Centre, Kuala Lumpur 59100, Malaysia
| | - Nazirah Hasnan
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 59100, Malaysia
| | - Ashril Yusof
- Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur 50603, Malaysia
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11
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Junqueira DR, Zorzela L, Golder S, Loke Y, Gagnier JJ, Julious SA, Li T, Mayo-Wilson E, Pham B, Phillips R, Santaguida P, Scherer RW, Gøtzsche PC, Moher D, Ioannidis JPA, Vohra S. CONSORT Harms 2022 statement, explanation, and elaboration: updated guideline for the reporting of harms in randomized trials. J Clin Epidemiol 2023; 158:149-165. [PMID: 37100738 DOI: 10.1016/j.jclinepi.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/28/2023]
Abstract
Randomized controlled trials remain the reference standard for healthcare research on effects of interventions, and the need to report both benefits and harms is essential. The Consolidated Standards of Reporting Trials (the main CONSORT) statement includes one item on reporting harms (i.e., all important harms or unintended effects in each group). In 2004, the CONSORT group developed the CONSORT Harms extension; however, it has not been consistently applied and needs to be updated. Here, we describe CONSORT Harms 2022, which replaces the CONSORT Harms 2004 checklist, and shows how CONSORT Harms 2022 items could be incorporated into the main CONSORT checklist. Thirteen items from the main CONSORT were modified to improve harms reporting. Three new items were added. In this article, we describe CONSORT Harms 2022 and how it was integrated into the main CONSORT checklist and elaborate on each item relevant to complete reporting of harms in randomized controlled trials. Until future work from the CONSORT group produces an updated checklist, authors, journal reviewers, and editors of randomized controlled trials should use the integrated checklist presented in this paper.
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Affiliation(s)
- Daniela R Junqueira
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Liliane Zorzela
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Golder
- Department of Health Sciences, University of York, York, UK
| | - Yoon Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Joel J Gagnier
- Department of Epidemiology and Biostatistics, Department of Surgery, Western University, London, Ontario, Canada
| | - Steven A Julious
- Design, Trials and Statistics, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Evan Mayo-Wilson
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Ba Pham
- Knowledge Translation Programme, Unity Health Toronto, Toronto, Ontario, Canada
| | - Rachel Phillips
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Pasqualina Santaguida
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | | | | | - David Moher
- Centre for Journalology, Clinical Epidemiology Programme, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, Stanford University, Stanford, CA, USA
| | - Sunita Vohra
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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12
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Junqueira DR, Zorzela L, Golder S, Loke Y, Gagnier JJ, Julious SA, Li T, Mayo-Wilson E, Pham B, Phillips R, Santaguida P, Scherer RW, Gøtzsche PC, Moher D, Ioannidis JPA, Vohra S. CONSORT Harms 2022 statement, explanation, and elaboration: updated guideline for the reporting of harms in randomised trials. BMJ 2023; 381:e073725. [PMID: 37094878 DOI: 10.1136/bmj-2022-073725] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Affiliation(s)
- Daniela R Junqueira
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Liliane Zorzela
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Susan Golder
- Department of Health Sciences, University of York, York, UK
| | - Yoon Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Joel J Gagnier
- Department of Epidemiology and Biostatistics, Department of Surgery, Western University, London, ON, Canada
| | - Steven A Julious
- Design, Trials and Statistics, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Evan Mayo-Wilson
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Ba Pham
- Knowledge Translation Programme, Unity Health Toronto, Toronto, ON, Canada
| | - Rachel Phillips
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Pasqualina Santaguida
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | | | | | - David Moher
- Centre for Journalology, Clinical Epidemiology Programme, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, Stanford University, Stanford, CA, USA
| | - Sunita Vohra
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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13
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Madigand J, Rio M, Vandevelde A. Equine assisted services impact on social skills in autism spectrum disorder: A meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2023; 125:110765. [PMID: 37031948 DOI: 10.1016/j.pnpbp.2023.110765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/19/2023] [Accepted: 04/06/2023] [Indexed: 04/11/2023]
Abstract
Many studies focus on the impact of equine assisted services (EAS) on social skills in autism spectrum disorder (ASD) but existing data are not consensual and the only available meta-analysis included only three studies and did not consider the social responsiveness scale (SRS). This meta-analysis aims to measure the impact of EAS on social skills in ASD. Using Pubmed, Embase, Web of Science and the Cochrane Library, the means and standard deviations of every available SRS post-intervention scores in each participant group were collected from the five selected randomised controlled trials with 240 participants. An EAS significant beneficial impact was found for the total SRS score, social communication and social cognition. A tendency to a significant impact was found for social awareness and social motivation. No significant difference was shown for autistic mannerisms. This meta-analysis shows a significant beneficial impact of EAS for several social skills in ASD. Further randomised controlled trials are required to complement these results and expand the knowledge on the field of possibilities of this care in ASD.
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Affiliation(s)
- Jérémy Madigand
- Psychiatry Department, Fondation du Bon Sauveur de la Manche, Saint-Lô F-50000, France.
| | - Marine Rio
- SAMSAH TSA, LADAPT Manche, Saint-Lô F-50000, France
| | - Anaïs Vandevelde
- Psychiatry Department, CHU de Tours, Tours F-37000, France; UNICAEN, Inserm UMR-S 1237, GIP Cyceron, Caen F-14000, France
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14
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Mallur P, Ikeda A, Patel A, Raol N, Ahanotu A, Suarez-Goris D, Randolph GW, Shin JJ. Evidence-Based Medicine in Otolaryngology Part 14: Falsehood and Bias. Otolaryngol Head Neck Surg 2023; 168:1584-1595. [PMID: 36808631 DOI: 10.1002/ohn.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/30/2022] [Accepted: 11/16/2022] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Falsehood and bias can have tangible effects, whether related to the "hoax" of Corona virus disease/COVID-19 or the impact of personal protective equipment in city-wide news. The spread of false information requires the diversion of time and resources into rebolstering the truth. Our objective is thus to elucidate types of bias that may influence our daily work, along with ways to mitigate them. DATA SOURCES Publications are included which delineate specific aspects of bias or address how to preempt, mitigate, or correct bias, whether conscious or unconscious. REVIEW METHODS We discuss: (1) the background and rationale for proactively considering potential sources of bias, (2) relevant definitions and concepts, (3) potential means to limit effects of inaccurate data sources, and (4) evolving frontiers in the management of bias. In doing so, we review epidemiological concepts and susceptibility to bias within study designs, including database studies, observational studies, randomized controlled trials (RCTs), systematic reviews, and meta-analyses. We additionally discuss concepts such as the difference between disinformation and misinformation, differential or nondifferential misclassification, bias toward a null result, and unconscious bias, among others. CONCLUSION We have the means to mitigate sources of potential bias in database studies, observational studies, RCTs, and systematic reviews, beginning with education and awareness. IMPLICATIONS FOR PRACTICE False information may spread faster than true information, so it is beneficial to understand potential sources of falsehood we face, in order to safeguard our daily impressions and decisions. Awareness of potential sources of falsehood and bias forms the foundation for accuracy in our everyday work.
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Affiliation(s)
- Pavan Mallur
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Allison Ikeda
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Anju Patel
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Nikhila Raol
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Adaobi Ahanotu
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Dany Suarez-Goris
- Division of Thoracic Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
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15
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Knowlson CN, Brealey S, Keding A, Torgerson D, Rangan A. Examination of early treatment effects and related biases during the conduct of two UK-wide pragmatic orthopaedic surgical trials: ProFHER and UK FROST. Bone Jt Open 2023; 4:96-103. [PMID: 37051861 PMCID: PMC9999120 DOI: 10.1302/2633-1462.42.bjo-2022-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Early large treatment effects can arise in small studies, which lessen as more data accumulate. This study aimed to retrospectively examine whether early treatment effects occurred for two multicentre orthopaedic randomized controlled trials (RCTs) and explore biases related to this. Included RCTs were ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation), a two-arm study of surgery versus non-surgical treatment for proximal humerus fractures, and UK FROST (United Kingdom Frozen Shoulder Trial), a three-arm study of two surgical and one non-surgical treatment for frozen shoulder. To determine whether early treatment effects were present, the primary outcome of Oxford Shoulder Score (OSS) was compared on forest plots for: the chief investigator's (CI) site to the remaining sites, the first five sites opened to the other sites, and patients grouped in quintiles by randomization date. Potential for bias was assessed by comparing mean age and proportion of patients with indicators of poor outcome between included and excluded/non-consenting participants. No bias in treatment effect was observed overall for the CI site, or the first five sites, compared with the remaining sites in either trial. An early treatment effect on the OSS was observed for the first quintile of participants recruited to ProFHER only (clinically relevant difference of seven points). Selection bias for age was observed in the ProFHER trial only, with slightly younger patients being recruited into the study. Both trials showed some selection bias for markers of poor prognosis, although these did not appear to change over time. No bias in treatment effects overall were found at the CI or early sites set-up. An early treatment effect was found in one of the two trials, which was likely a chance effect as this did not continue during the study. Selection bias was observed in both RCTs, however this was minimal and did not impact on outcome.
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Affiliation(s)
| | - Stephen Brealey
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Ada Keding
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Amar Rangan
- James Cook University Hospital, Middlesbrough, UK
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16
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Rahman B, Al-Marzooq F, Saad H, Benzina D, Al Kawas S. Dysbiosis of the Subgingival Microbiome and Relation to Periodontal Disease in Association with Obesity and Overweight. Nutrients 2023; 15:nu15040826. [PMID: 36839184 PMCID: PMC9965236 DOI: 10.3390/nu15040826] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Obesity causes gut dysbiosis; nevertheless, little is known about the oral microbiome. We aimed to identify differences in the subgingival microbiota influenced by body weight and periodontal status. Patients (n = 75) recruited at the University Dental Hospital Sharjah, United Arab Emirates, were distributed into three equal groups (healthy weight, overweight, and obese) sub-divided into having either no-mild (NM) or moderate-severe (MS) periodontitis. Subgingival plaques were collected. Microbiota were identified by 16S rRNA sequencing using nanopore technology. Linear discriminant analysis demonstrated significant bacterial biomarkers for body weight and periodontal health. Unique microbiota signatures were identified, with enrichment of periopathogens in patients with MS periodontitis (Aggregatibacter actinomycetemcomitans in obese, Tannerella forsythia and Treponema denticola in overweight, Porphyromonas gingivalis and Fusobacterium nucleatum in healthy weight), thus reflecting differences in the microbiota affected by body weight. Other pathogenic bacteria, such as Salmonella enterica and Klebsiella pneumoniae, were enriched in overweight subjects with NM periodontitis, suggesting an increase in the relative abundance of pathogens even in patients with good periodontal health if they were overweight. Alpha and beta diversities were significantly different among the groups. Dysbiosis of the subgingival microbiota in obese and overweight individuals was associated with increased prevalence and severity of periodontal disease, which was correlated with the body mass index. This study highlights the immense importance of the oral microbiome and the need for lifestyle and dental interventions to resolve oral dysbiosis and restore normal homeostasis.
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Affiliation(s)
- Betul Rahman
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Farah Al-Marzooq
- Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, UAE University, Al Ain 15551, United Arab Emirates
- Correspondence:
| | - Hiba Saad
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Dalenda Benzina
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Sausan Al Kawas
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
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17
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Rodovanski GP, Réus BAB, Neves Dos Santos A. The effects of multisensory stimulation on the length of hospital stay and weight gain in hospitalized preterm infants: A systematic review with meta-analysis. Braz J Phys Ther 2023; 27:100468. [PMID: 36689887 PMCID: PMC9876839 DOI: 10.1016/j.bjpt.2022.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 09/14/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Multisensory interventions, such as auditory-tactile-visual-vestibular intervention (ATVV), tactile-kinesthesic stimulation (TKS), and the kangaroo mother care (KMC), have been commonly applied in hospitalized preterm infants. OBJECTIVE To investigate the effectiveness of the ATVV, the TKS, and the KMC combined to standard care compared to standard care in the length of hospital stay and weight gain of hospitalized preterm infants. METHODS PubMed, Scopus, Web of Science, Embase, SciELO Citation Index, CINAHL, Cochrane, and LILACS databases were searched from the inception to May 06, 2022 without language restrictions. We included randomized controlled trials. Two independent reviewers selected studies and extracted information about participants, interventions, outcomes, and the risk of bias. The body of evidence was synthesized through GRADE. Data were pooled using a random-effects model. RESULTS Sixty-three randomized clinical trials included a range of 20-488 preterm infants (gestational age=25 to <37 weeks). Evidence was low to very low due to risk of bias, inconsistency, and imprecision. Most studies presented some concerns about methodological quality. The ATVV and the KMC increased weight gain. The TKS reduced the number of days at the hospital and increased the daily weight gain and the total weight gain. CONCLUSIONS Adding ATVV, TKS, or KMC to standard care was more effective than standard care alone to improve weight gain. Only the TKS combined with standard care was more effective than standard care alone to reduce the length of hospital stay.
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18
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Manoj P, Derwin R, George S. What is the impact of daily oral supplementation of vitamin D3 (cholecalciferol) plus calcium on the incidence of hip fracture in older people? A systematic review and meta-analysis. Int J Older People Nurs 2023; 18:e12492. [PMID: 35842938 PMCID: PMC10078370 DOI: 10.1111/opn.12492] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Hip fractures have a huge impact in reducing the quality of life and increasing mortality. This review aims to assess the impact of daily oral supplementation of vitamin D3 plus calcium on the incidence of hip fracture in people over 65 years. METHODS PRISMA guidelines were followed and RCTs that evaluated the effectiveness of daily oral supplementation of vitamin D3 plus calcium in preventing hip fracture in adults over 65 years were included in the study. The databases such as Cochrane Library, Embase, Medline, PubMed, CINAHL, Web of Science and Scopus were searched from October 2019- January 2020.The Cochrane risk of bias tool was used to check the quality of the included studies. A meta-analysis with fixed effect model using Review Manager (Revman 5.3) was used to analyse the data. RESULTS The meta-analysis of seven RCTs on vitamin D3 plus calcium supplementation and hip fracture (n = 12,620) identified odds ratio (OR) of 0.75; 95% Confidence interval (CI): 0.64, 0.87; p = .0003. Daily oral supplementation of 800 IU of Vitamin D3 plus 1200 mg of calcium was found more effective (n = 5676 participants; OR = 0.69; 95% CI: 0.58, 0.82; p < .0001) than daily oral supplementation of 800 IU of Vitamin D3 plus 1000 mg of calcium (n = 6555,OR = 1.08; 95% CI: 0.74, 1.56; p = .70) in reducing hip fracture. A meta-analysis of the seven RCTs to identify the incidence of non-vertebral fracture gave the OR of 0.80; 95% CI: 0.72, 0.89; p < .0001. A meta-analysis of three RCTs on femoral neck bone mineral density (BMD) (n = 483) gave a mean difference of 1.21; 95% CI: -0.79, 3.20; p = .24. CONCLUSION Daily oral supplementation 800 IU of vitamin D3 plus 1200 mg of calcium reduces hip fracture and non-vertebral fracture in older people. Administering vitamin D3 and calcium supplements had no effect in increasing the femoral neck BMD. IMPLICATIONS FOR PRACTICE Even though it is evident from the review that optimal daily intake of vitamin D3 plus calcium supplementation help in the prevention of fracture, it is only one essential element in fracture prevention. Also, people who are on dietary supplements should be compliant with same for better result. Efforts to prevent bone loss and osteoporosis should begin from an early age. It includes maintaining a healthy lifestyle, optimal intake of calcium and vitamin D3, proper nutrition, adequate exposure to sunlight, exercise etc. Proper education on healthy lifestyle, avoiding risk factors like smoking, caffeine, alcohol and awareness of bone health should continue throughout life with emphasis during menopause when increased bone loss is expected.
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Affiliation(s)
- Preethy Manoj
- School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin 2, Ireland.,Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Rosemarie Derwin
- School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Sherly George
- School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin 2, Ireland
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19
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Expectancy in placebo-controlled trials of psychedelics: if so, so what? Psychopharmacology (Berl) 2022; 239:3047-3055. [PMID: 36063208 PMCID: PMC9481484 DOI: 10.1007/s00213-022-06221-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/23/2022] [Indexed: 11/30/2022]
Abstract
Modern psychedelic research remains in an early phase, and the eventual introduction of psychedelics into clinical practice remains in doubt. In this piece, we discuss the role of blinding and expectancy in psychedelic trials, and place this in a broader historical and contemporary context of blinding in trials across the rest of healthcare. We suggest that premature and uncritical promotion ('hype') of psychedelics as medicines is not only misleading, but also directly influences participant expectancy in ongoing psychedelic trials. We argue that although psychedelic trials are likely to significantly overestimate treatment effects by design due to unblinding and expectancy effects, this is not a unique situation. Placebo-controlled RCTs are not a perfect fit for all therapeutics, and problems in blinding should not automatically disqualify medications from licencing decisions. We suggest that simple practical measures may be (and indeed already are) taken in psychedelic trials to partially mitigate the effects of expectancy and unblinding, such as independent raters and active placebos. We briefly suggest other alternative trial methodologies which could be used to bolster RCT results, such as naturalistic studies. We conclude that the results of contemporary placebo-controlled RCTs of psychedelics should neither be dismissed due to imperfections in design, nor should early data be taken as firm evidence of effectiveness.
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20
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Sparks KV, Ring C. A rowing-specific mindfulness intervention: Effects on mindfulness, flow, reinvestment, and performance. Front Psychol 2022; 13:871804. [PMID: 36160525 PMCID: PMC9491153 DOI: 10.3389/fpsyg.2022.871804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Mindfulness can benefit athletes’ mindset and performance. These benefits may be enhanced by sport-specific mindfulness interventions. Accordingly, our objectives were 2-fold: first, to develop a rowing-specific mindfulness intervention, and second, to investigate its effects on mindfulness, flow, reinvestment, and rowing performance. Rowers were randomly assigned to either a 6-week rowing-specific mindfulness intervention (n = 23), which included generic and rowing-specific practices, or a control group (n = 21). Rowers completed pre-test and post-test measures of performance, mindfulness, flow, and rowing-specific reinvestment. Lastly, rowers completed an evaluation form following the intervention. The results demonstrated that the intervention group increased flow, mindfulness, and improved performance, additionally conscious motor processing decreased from pre-test to post-test. However, the intervention did not preferentially change mindfulness or reinvestment compared to control. Participants provided favorable feedback and evaluated the intervention positively. Our 6-week rowing-specific mindfulness intervention promoted flow, encouraged mindfulness, and aided performance. Thus, we provide preliminary explorative evidence that a sport-specific mindfulness intervention can benefit athletes. We recommend that future research, with large sample sizes and improved home practice, should examine mediators and moderators of the mindfulness-performance relationship.
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Chen SC, Yu J, Wang HS, Wang DD, Sun Y, Cheng HL, Suen LKP, Yeung WF. Parent-administered pediatric Tuina for attention deficit/hyperactivity disorder symptoms in preschool children: A pilot randomized controlled trial embedded with a process evaluation. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 102:154191. [PMID: 35636174 DOI: 10.1016/j.phymed.2022.154191] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 05/04/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Beneficial effects of parent-administered pediatric tuina on ADHD in children have been reported in previous studies, but no rigorously designed randomized controlled trials (RCTs) have been conducted on it. OBJECTIVE To assess the feasibility and preliminary effects of parent-administered pediatric tuina for ADHD symptoms in preschoolers. METHODS This project was a two-arm, parallel, open-label, pilot RCT. Sixty-four participants were randomized into two groups at a 1:1 ratio. Parents in the parent-administered tuina group (n = 32) attended an online training program on pediatric tuina for ADHD and conduct this intervention on their children at home. Parents in the parent-child interaction group (n = 32) attended an online training about progressive muscle relaxation exercise and carried out parent-child interactive physical activities with their children at home. Both interventions were carried out every other day during a two-month intervention period, with each manipulation for at least 20 min. Feasibility outcomes included recruitment rate, consent rate, participants' adherence, retention rate, and adverse event. Outcomes were assessed at baseline, week 4, and week 8. The primary outcome measure was the Swanson, Nolan, and Pelham parent scale (SNAP); the secondary outcomes included preschool anxiety scale, children's sleep habits questionnaire, and parental stress scale. A mixed-method process evaluation embedded within the outcome evaluation was performed. RESULTS The recruitment rate was 12.8 per month. The consent rate was 98.5%. Good adherence was shown from the parent logbook. Four participants withdraw from the study. No severe adverse event was reported. For the SNAP total score, both groups showed improvement with moderate within-group effect size (Cohen's d > 0.5, all p < 0.001) and the between-group effect size was minimal (dppc2< 0.2, p > 0.05). Perceived improvements on children's appetite and sleep quality, and parent-child relationship was observed from the qualitative data. CONCLUSIONS The study design and the parent-administered pediatric tuina intervention were feasible. Parent-administered pediatric tuina provided beneficial effects on improving core hyperactivity/impulsivity symptoms in preschool children. Parents perceived improvements on children's appetite and sleep quality. Further large-scale are warranted.
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Affiliation(s)
- Shu-Cheng Chen
- School of Nursing, the Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, HKSAR, China
| | - Juan Yu
- Yantai Aviation Medical Room, Shandong airlines, China
| | | | - Dong-Dong Wang
- Children's Massage Center, Shandong University of Traditional Chinese Medicine Affiliated Hospital, China
| | - Yan Sun
- Yantai Aviation Medical Room, Shandong airlines, China
| | - Hui-Lin Cheng
- School of Nursing, the Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, HKSAR, China
| | | | - Wing-Fai Yeung
- School of Nursing, the Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, HKSAR, China.
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Leung LYL, Chan SMN, Tam HL, Wong ESW. Astaxanthin Influence on Health Outcomes of Adults at Risk of Metabolic Syndrome: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14102050. [PMID: 35631193 PMCID: PMC9148008 DOI: 10.3390/nu14102050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023] Open
Abstract
The use of medication is effective in managing metabolic syndrome (MetS), but side effects have led to increased attention on using nutraceuticals and supplements. Astaxanthin shows positive effects in reducing the risk of MetS, but results from individual studies are inconclusive. This systematic review summarizes the latest evidence of astaxanthin in adults with risk factors of MetS. A systematic search of English and Chinese randomized controlled trials in 14 electronic databases from inception to 30 June 2021 was performed. Two reviewers independently screened the titles and abstracts, and conducted full-text review, quality appraisal, and extraction of data. Risk of bias was assessed by PEDro. A total of 7 studies met the inclusion criteria with 321 participants. Six studies were rated to have excellent methodological quality, while the remaining one was rated at good. Results show marginal effects of astaxanthin on reduction in total cholesterol and systolic blood pressure, and a significant attenuating effect on low-density lipoprotein cholesterol. Further robust evidence is needed to examine the effects of astaxanthin in adults at risk of MetS.
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Affiliation(s)
- Leona Yuen-Ling Leung
- The Ronin Institute, Montclair, NJ 07043, USA;
- Hong Kong Food Science and Technology Association, Hong Kong, China
- Canadian Academy of Independent Scholars, Vancouver, BC V6B 5K3, Canada
| | - Sidney Man-Ngai Chan
- School of Science and Technology, Hong Kong Metropolitan University, Hong Kong, China;
| | - Hon-Lon Tam
- Education Department, Kiang Wu Nursing College of Macau, Macau 999078, China
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
- Correspondence: (H.-L.T.); (E.S.-W.W.)
| | - Emily Sze-Wan Wong
- School of Science and Technology, Hong Kong Metropolitan University, Hong Kong, China;
- Correspondence: (H.-L.T.); (E.S.-W.W.)
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Effectiveness of Interventions to Promote Medication Adherence in Schizophrenic Populations in Thailand: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052887. [PMID: 35270585 PMCID: PMC8910437 DOI: 10.3390/ijerph19052887] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 01/19/2023]
Abstract
Medication non-adherence is a leading cause of poor treatment outcomes among Thai patients with psychiatric disorders and creates challenges for psychiatric nurses. This systematic review synthesized research on intervention effectiveness for antipsychotic medication adherence in Thai schizophrenic populations. Following PRISMA guidelines, searches were completed in seven databases, including PubMed, PsycINFO, CINAHL, Web of Science, Scopus, ThaiJO, and Google Scholar. No restriction dates were used. Screening and extraction of data were performed systematically. Eligible studies consisted of nine quasi-experimental and two randomized control trial studies. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used to assess the studies’ methodological quality. This review revealed that individual counseling combined with cognitive-behavioral therapy (CBT) and motivational interviewing (MI) techniques improved and maintained medication adherence behavior over time. Post-testing after intervention completion and at 3- and 6-month follow-ups showed that treatment group participants were more adherent than control group participants (p < 0.01). These findings suggest that incorporating CBT and MI into clinical practice can enhance medication adherence behavior. Booster session efficacy for reinforcing and sustaining adherence should be investigated. Greater rigor is warranted in future intervention studies based on a quality appraisal of previous studies.
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White KM, Matcham F, Leightley D, Carr E, Conde P, Dawe-Lane E, Ranjan Y, Simblett S, Henderson C, Hotopf M. Exploring the Effects of In-App Components on Engagement With a Symptom-Tracking Platform Among Participants With Major Depressive Disorder (RADAR-Engage): Protocol for a 2-Armed Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e32653. [PMID: 34932005 PMCID: PMC8734922 DOI: 10.2196/32653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Multi-parametric remote measurement technologies (RMTs) comprise smartphone apps and wearable devices for both active and passive symptom tracking. They hold potential for understanding current depression status and predicting future depression status. However, the promise of using RMTs for relapse prediction is heavily dependent on user engagement, which is defined as both a behavioral and experiential construct. A better understanding of how to promote engagement in RMT research through various in-app components will aid in providing scalable solutions for future remote research, higher quality results, and applications for implementation in clinical practice. OBJECTIVE The aim of this study is to provide the rationale and protocol for a 2-armed randomized controlled trial to investigate the effect of insightful notifications, progress visualization, and researcher contact details on behavioral and experiential engagement with a multi-parametric mobile health data collection platform, Remote Assessment of Disease and Relapse (RADAR)-base. METHODS We aim to recruit 140 participants upon completion of their participation in the RADAR Major Depressive Disorder study in the London site. Data will be collected using 3 weekly tasks through an active smartphone app, a passive (background) data collection app, and a Fitbit device. Participants will be randomly allocated at a 1:1 ratio to receive either an adapted version of the active app that incorporates insightful notifications, progress visualization, and access to researcher contact details or the active app as usual. Statistical tests will be used to assess the hypotheses that participants using the adapted app will complete a higher percentage of weekly tasks (behavioral engagement: primary outcome) and score higher on self-awareness measures (experiential engagement). RESULTS Recruitment commenced in April 2021. Data collection was completed in September 2021. The results of this study will be communicated via publication in 2022. CONCLUSIONS This study aims to understand how best to promote engagement with RMTs in depression research. The findings will help determine the most effective techniques for implementation in both future rounds of the RADAR Major Depressive Disorder study and, in the long term, clinical practice. TRIAL REGISTRATION ClinicalTrials.gov NCT04972474; http://clinicaltrials.gov/ct2/show/NCT04972474. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/32653.
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Affiliation(s)
- Katie M White
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Faith Matcham
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Daniel Leightley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Ewan Carr
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Pauline Conde
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Erin Dawe-Lane
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Yatharth Ranjan
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sara Simblett
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Claire Henderson
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Yang Y, Conti J, McMaster CM, Hay P. Beyond Refeeding: The Effect of Including a Dietitian in Eating Disorder Treatment. A Systematic Review. Nutrients 2021; 13:nu13124490. [PMID: 34960041 PMCID: PMC8706437 DOI: 10.3390/nu13124490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Eating disorders are potentially life-threatening mental health disorders that require management by a multidisciplinary team including medical, psychological and dietetic specialties. This review systematically evaluated the available literature to determine the effect of including a dietitian in outpatient eating disorder (ED) treatment, and to contribute to the understanding of a dietitian’s role in ED treatment. Six databases and Google Scholar were searched for articles that compared treatment outcomes for individuals receiving specialist dietetic treatment with outcomes for those receiving any comparative treatment. Studies needed to be controlled trials where outcomes were measured by a validated instrument (PROSPERO CRD42021224126). The searches returned 16,327 articles, of which 11 articles reporting on 10 studies were included. Two studies found that dietetic intervention significantly improved ED psychopathology, and three found that it did not. Three studies reported that dietetic input improved other psychopathological markers, and three reported that it did not. One consistent finding was that dietetic input improved body mass index/weight and nutritional intake, although only two and three studies reported on each outcome, respectively. A variety of instruments were used to measure each outcome type, making direct comparisons between studies difficult. Furthermore, there was no consistent definition of the dietetic components included, with many containing psychological components. Most studies included were also published over 20 years ago and are now out of date. Further research is needed to develop consistent dietetic guidelines and outcome measures; this would help to clearly define the role of each member of the multidisciplinary team, and particularly the role of dietitians, in ED treatment.
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Affiliation(s)
- Yive Yang
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (Y.Y.); (J.C.)
| | - Janet Conti
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (Y.Y.); (J.C.)
- School of Psychology, Western Sydney University, Penrith, NSW 2750, Australia
| | - Caitlin M. McMaster
- University of Sydney Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, Westmead, NSW 2145, Australia;
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (Y.Y.); (J.C.)
- Camden and Campbelltown Hospitals, South Western Sydney Local Health District, Sydney, NSW 2560, Australia
- Correspondence:
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Bryce CJC. School Based Motor Skill Interventions for Developmentally Delayed and Non-Delayed Children. Glob Pediatr Health 2021; 8:2333794X211057707. [PMID: 34841010 PMCID: PMC8613880 DOI: 10.1177/2333794x211057707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/12/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: A mere 33% of all children meet the recommended minimum physical activity guidelines for adequate health maintenance. Available literature however suggests children are more likely to be active when they are competent with their own motor ability. This review aimed to evaluate how several regimented motor skills training courses and interventions improve motor skill competence among children compared with age matched control peers. Method: Electronic databases were searched and included Medline Complete and Psych INFO (both hosted by EBSCO Host). The search syntax examined titles and abstracts. The study aimed to create novelty by examining participants with and without developmental delays simultaneously from studies around the globe. Included interventions were aimed at the most crucial developmental years for children (between 3 and 11 years). Results: Results were found in favor of the motor skill intervention groups (from pre-to post-test). Included interventions involved weekly motor skills exposure of 60 to 120 minutes for periods of between 2 and 6 months. Over 50% of included interventions involved alterations to current school curriculums. The included studies were of moderate to high quality. Conclusion: The findings suggest that for those with and without developmental delays, several interventions can be effectively applied in once weekly 60-minute sessions (over eight or more weeks) to improve children’s motor skill abilities. Applying appropriate difficulty to interventions seems equally influential. Implications are discussed.
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Affiliation(s)
- Colby J C Bryce
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
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27
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Agarwal A, Selvam MKP, Baskaran S, Finelli R, Leisegang K, Barbăroșie C, Pushparaj PN, Robert KA, Ambar RF, Iovine C, Durairajanayagam D, Henkel R. Highly Cited Articles in the Field of Male Infertility and Antioxidants: A Scientometric Analysis. World J Mens Health 2021; 39:760-775. [PMID: 33663027 PMCID: PMC8443986 DOI: 10.5534/wjmh.200181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/14/2020] [Accepted: 01/02/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The objective of this scientometric analysis was to recognize the top 100 cited articles on 'Male infertility and Antioxidants' and analyze its publication characteristics. MATERIALS AND METHODS The Scopus database was used to retrieve related articles and the top 100 identified based on citation rate. RESULTS The articles were published in 56 journals between 1995 and 2019 with a median (interquartile range) citation score of 17 (5-62). Among the top 100 articles, 69 were clinical studies, which included controlled and blinded (33.33%), prospective (27.54%), randomized-controlled trials (26.09%), uncontrolled (11.59%), and retrospective (1.45%) studies. In addition to conventional semen parameters, advanced sperm function tests such as oxidative stress (51%) and sperm DNA damage (23%) were reported. Pregnancy rate (33%) was found to be the most reported reproductive outcome. Antioxidant therapy was mostly investigated in male cohorts with sperm abnormalities such as asthenozoospermia (28%) and clinical conditions such as idiopathic male infertility (20%), varicocele/varicocelectomy (17%) and general male infertility (16%). CONCLUSIONS The most influential publications on antioxidants and male infertility were identified for the first time in the literature. This will serve as a reliable source of information for researchers and clinicians alike.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | | | - Saradha Baskaran
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Kristian Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Cătălina Barbăroșie
- Department of Genetics, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | - Peter Natesan Pushparaj
- King Abdulaziz University, Center of Excellence in Genomic Medicine, Jeddah, Saudi Arabia
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kathy Amy Robert
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Rafael F Ambar
- Urology Department of Centro Universitario em Saude do ABC/Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
| | - Concetta Iovine
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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Nishizaki D, Ganeko R, Hoshino N, Hida K, Obama K, Furukawa TA, Sakai Y, Watanabe N. Roux-en-Y versus Billroth-I reconstruction after distal gastrectomy for gastric cancer. Cochrane Database Syst Rev 2021; 9:CD012998. [PMID: 34523717 PMCID: PMC8441595 DOI: 10.1002/14651858.cd012998.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gastric cancer is the fifth most common cancer diagnosed worldwide. Due to improved early detection rates of gastric cancer and technological advances in treatments, a significant improvement in survival rates has been achieved in people with cancer undergoing gastrectomy. Subsequently, there has been increasing emphasis on postgastrectomy syndrome (e.g. fullness, delayed emptying, and cold sweat, amongst others) and quality of life postsurgery. However, it is uncertain which types of reconstruction result in better outcomes postsurgery. OBJECTIVES To assess the evidence on health-related quality of life and safety outcomes of Roux-en-Y and Billroth-I reconstructions after distal gastrectomy for people with gastric cancer. SEARCH METHODS We searched the Cochrane Library and the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase on 4 May 2021. We checked the reference lists of the included studies and contacted manufacturers and professionals in the field. There were no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) allocating participants to Roux-en-Y reconstruction or Billroth-I reconstruction after distal gastrectomy for gastric cancer. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies identified by the search for eligibility and extracted data. The primary outcomes were health-related quality of life after surgery and incidence of anastomotic leakage. The secondary outcomes included body weight loss, incidence of bile reflux, length of hospital stay, and overall morbidity. We used a random-effects model to conduct meta-analyses. We assessed risk of bias of the included studies in accordance with the Cochrane Handbook for Systematic Reviews of Interventions, and the certainty of the evidence using the GRADE approach. MAIN RESULTS We included eight RCTs (942 participants) in the review. One study included both cancer patients and benign disease patients such as stomach ulcers. Two studies compared Roux-en-Y, Billroth-I, and Billroth-II reconstructions, whilst the other studies compared Roux-en-Y and Billroth-I directly. For the primary outcomes, the evidence suggests that there may be little to no difference in health-related quality of life between Roux-en-Y and Billroth-I reconstruction (standardised mean difference 0.04, 95% confidence interval (CI) -0.11 to 0.18; I² = 0%; 6 studies; 695 participants; low-certainty evidence due to study limitations and imprecision). The evidence for the effect of Roux-en-Y versus Billroth-I reconstruction on the incidence of anastomotic leakage is very uncertain (risk ratio (RR) 0.63, 95% CI 0.16 to 2.53; I² = 0%; 5 studies; 711 participants; very low-certainty evidence). The incidence of anastomotic leakage was 0.6% and 1.4% in the Roux-en-Y and Billroth-I groups, respectively. For the secondary outcomes, the evidence suggests that Billroth-I reconstruction may result in little to no difference in loss of body weight compared to Roux-en-Y reconstruction (mean difference (MD) 0.41, 95% CI -0.77 to 1.59; I² = 0%; 4 studies; 541 participants; low-certainty evidence). Roux-en-Y reconstruction probably reduces the incidence of bile reflux compared to Billroth-I reconstruction (RR 0.40, 95% CI 0.25 to 0.63; I² = 22%; 4 studies; 399 participants; moderate-certainty evidence). Billroth-I reconstruction may shorten postoperative hospital stay, but the evidence for this outcome is very uncertain (MD 0.96, 95% CI 0.16 to 1.76; I² = 56%; 7 studies; 894 participants; very low-certainty evidence). Billroth-I reconstruction may reduce postoperative overall morbidity compared to Roux-en-Y reconstruction (RR 1.47, 95% CI 1.02 to 2.11; I² = 0%; 7 studies; 891 participants; low-certainty evidence). AUTHORS' CONCLUSIONS The evidence suggests that there is little to no difference between Roux-en-Y and Billroth-I reconstruction for the outcome health-related quality of life. The evidence for the effect of Roux-en-Y versus Billroth-I reconstruction on the incidence of anastomotic leakage is very uncertain as the incidence of this outcome was low. Although the certainty of evidence was low, we found some possibly clinically meaningful differences between Roux-en-Y and Billroth-I reconstruction for short-term outcomes. Roux-en-Y reconstruction probably reduces the incidence of bile reflux into the remnant stomach compared to Billroth-I reconstruction. Billroth-I reconstruction may shorten postoperative hospital stay compared to Roux-en-Y reconstruction, but the evidence is very uncertain. Billroth-I reconstruction may reduce postoperative overall morbidity compared to Roux-en-Y reconstruction. Future trials should include long-term follow-up of health-related quality of life and body weight loss.
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Affiliation(s)
| | - Riki Ganeko
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Nobuaki Hoshino
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Koya Hida
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Kazutaka Obama
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Norio Watanabe
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
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Pascoali Rodovanski G, Bêz Reus BA, Cechinel Damiani AV, Franco Mattos K, Moreira RS, Neves Dos Santos A. Home-based early stimulation program targeting visual and motor functions for preterm infants with delayed tracking: Feasibility of a Randomized Clinical Trial. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 116:104037. [PMID: 34293634 DOI: 10.1016/j.ridd.2021.104037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/17/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
AIMS To verify the feasibility of a home-based early stimulation program targeting visual and motor functions in preterm infants with delayed visual tracking. METHOD We applied a randomized controlled trial. We included thirty low-risk preterm infants, from both genders, with delayed visual tracking, gestational between 28-37 weeks, and age at entrance between 1-2 months of corrected age, and absence of visual impairments. Infants were divided into two groups as follows: a) standard care group (SC) that received general orientation about sensory and motor development (16 infants); b) experimental group, that received a four-week home-based early stimulation program targeting visual and motor functions (ESPVM) applied by the caregivers (14 infants). The feasibility outcomes were retention and loss rates, adherence, adverse events, and stress signals. We obtained preliminary data by comparing visual tracking, motor development, and sensory behavior between groups at the end of the intervention. RESULTS Retention rate was high, 90 % of the caregivers provided ESPVM at least 22 days, and 70 % provided SC at least 17 days. No adverse events were reported. At the end of intervention, the ESPVM group presented higher frequencies of complete visual tracking for cards 7 (ESPVM = 57.3 %, SC = 6.3 %, p = 0.006) and 8 (ESPVM = 64.3 %, SC = 12.2 %, p = 0.013), and lower scores for total sensory profile (ESPVM: median = 58, range = 46-69; SC: median = 71, range = 54-90; p = 0.016). The groups were similar for motor development. CONCLUSIONS The protocol was feasible, and the results encourage a larger randomized controlled trial.
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Affiliation(s)
| | | | | | - Karina Franco Mattos
- Department of Health Science, Federal University of Santa Catarina, Araranguá, SC, Brazil
| | - Rafaela Silva Moreira
- Department of Health Science, Federal University of Santa Catarina, Araranguá, SC, Brazil
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Pang K, Sun P, Li J, Zeng N, Yang X, Jin L, Yang Y, Jin L, Yao H, Zhang Z. Prophylactic subcutaneous drainage reduces post-operative incisional infections in colorectal surgeries: a meta-analysis of randomized controlled trials. Int J Colorectal Dis 2021; 36:1633-1642. [PMID: 33723634 DOI: 10.1007/s00384-021-03908-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Due to lack of high-level evidences, prophylactic subcutaneous drainage has so far not been recommended in relevant guidelines as a countermeasure against incisional infections. This meta-analysis aims to clarify the efficacy of subcutaneous drainage in reducing incisional infections in colorectal surgeries. METHODS Cochrane Library, Embase, and PubMed were searched for randomized controlled trials comparing the incidence rate of incisional infections between patients receiving prophylactic subcutaneous drainage (interventions) and those not receiving (controls) after digestive surgeries. Results from included RCTs were pooled multiple times according to different surgical types. Heterogeneity, publication bias, and certainty of evidences were estimated. RESULTS Eight randomized controlled trials were included. Three RCTs each included patients receiving all sorts of digestive surgeries (gastrointestinal, hepatobiliary, and pancreatic); pooled incisional infection rates between the drainage group and the control group were not significantly different (RR = 0.76, 95%CI: 0.48-1.21, p = 0.25). Four RCTs included patients receiving colorectal surgeries; pooled incisional infection rate in the drainage group was significantly lower than that in the control group (RR = 0.34, 95%CI: 0.19-0.61, p = 0.0004). Four RCTs included patients receiving upper GI and/or HBP surgeries; pooled incisional infection rates in the drainage group and the non-drainage group were not significantly different (RR = 0.85, 95%CI: 0.54-1.34, p = 0.49). CONCLUSIONS Prophylactic subcutaneous drainage significantly reduces post-operative incisional infections in colorectal surgeries but was not efficacious in digestive surgeries in general.
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Affiliation(s)
- Kai Pang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Peilin Sun
- Peking Union Medical College, PUMC, Beijing, 100730, China
| | - Jun Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Na Zeng
- Department of Methodology and Statistics, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, Beijing, 100050, China
| | - Xiaobao Yang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Lei Jin
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Yingchi Yang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.
| | - Lan Jin
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.
| | - Hongwei Yao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.
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Kuipers S, Boonstra N, Kronenberg L, Keuning-Plantinga A, Castelein S. Oral Health Interventions in Patients with a Mental Health Disorder: A Scoping Review with Critical Appraisal of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158113. [PMID: 34360406 PMCID: PMC8346069 DOI: 10.3390/ijerph18158113] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 12/21/2022]
Abstract
Poor oral health affects quality of life and daily functioning in the general population and especially in patients with mental health disorders. Due to the high burden of oral health-related quality of life in patients with a mental health disorder, it is important for nurses to know how they can intervene in an early phase. The aim of this systematic scoping review was to identify and appraise oral health interventions in patients with a mental health disorder. A systematic scoping review with a critical appraisal of the literature was conducted using the Joanna Briggs Institute (JBI) methodology for scoping reviews and their checklists. MEDLINE, CINAHL, PsycINFO and reference lists were searched from their inception until December 2020. Results: Eleven quantitative studies were included in the review: four randomized controlled trials, six quasi-experimental studies and one cohort study. Studies focused on interventions for patients (n = 8) or focused on patients together with their professionals (n = 3). Four types of oral health interventions in mental health were found: (I) educational interventions; (II) physical interventions; (III) interventions combining behavioural and educational elements and (IV) interventions combining educational and physical elements. All studies (n = 11) had an evaluation period ≤12 months. Nine studies showed an effect on the short term (≤12 months) with regard to oral health knowledge, oral health behaviour, or physical oral health outcomes (e.g., plaque index). Two studies showed no effects on any outcome. Overall, the methodological insufficient to good. Conclusion: Four types of interventions with positive effects (≤12 months) on oral health knowledge, oral health behaviour, and physical oral health outcomes in different diagnostic patient groups were found. Due to the heterogeneity in both interventions, diagnostic groups and outcomes, one golden standard oral health intervention cannot be advised yet, although the methodological quality of studies seems sufficient. Developing an integrated oral health toolkit might be of great importance in mental health considering its potential effect on oral health-related quality of life.
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Affiliation(s)
- Sonja Kuipers
- Research Group Healthcare & Innovation in Psychiatry, Department of Healthcare, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, 8900 CG Leeuwarden, The Netherlands; (N.B.); (A.K.-P.)
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands;
- Correspondence: ; Tel.: +31-652-690-627
| | - Nynke Boonstra
- Research Group Healthcare & Innovation in Psychiatry, Department of Healthcare, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, 8900 CG Leeuwarden, The Netherlands; (N.B.); (A.K.-P.)
- KieN VIP, Oosterkade 72, 8911 KJ Leeuwarden, The Netherlands
| | - Linda Kronenberg
- Dimence Mental Health Care, Burgemeester Roelenweg 9, 8021 EV Zwolle, The Netherlands;
| | - Annette Keuning-Plantinga
- Research Group Healthcare & Innovation in Psychiatry, Department of Healthcare, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, 8900 CG Leeuwarden, The Netherlands; (N.B.); (A.K.-P.)
- Health Sciences-Nursing Science & Education, University Medical Centre Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Stynke Castelein
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands;
- Lentis Research, Lentis Psychiatric Institute, Hereweg 80, 9725 AG Groningen, The Netherlands
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32
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Patil S, Alkahtani A, Bhandi S, Mashyakhy M, Alvarez M, Alroomy R, Hendi A, Varadarajan S, Reda R, Raj AT, Testarelli L. Ultrasound Imaging versus Radiographs in Differentiating Periapical Lesions: A Systematic Review. Diagnostics (Basel) 2021; 11:1208. [PMID: 34359291 PMCID: PMC8303698 DOI: 10.3390/diagnostics11071208] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Ultrasonography is a non-invasive method of diagnosing periapical lesions while radiologic methods are more common. Periapical lesions due to endodontic infection are one of the most common causes of periapical radiolucency that need to be distinguished to help determine the course of treatment. This review aimed to examine the accuracy of ultrasound and compare it to radiographs in distinguishing these lesions in vivo. METHODS This review process followed the PRISMA guidelines. A literature search of databases (PubMed, Scopus, Embase, and Web of Science) was conducted without any restrictions on time. Articles available in English were included. The selection was done according to the inclusion and exclusion criteria. The QUADAS-2 tool was used to assess the quality of the studies. RESULTS The search provided a total of 87 articles, out of which, five were selected for the final review. In all the studies, ultrasound had higher accuracy in distinguishing periapical lesions. All the studies indicated a risk of bias, especially in patient selection. CONCLUSION Within limitations, the study indicates that ultrasound is a better diagnostic tool to distinguish periapical lesions compared to radiographs but further studies with well-designed, rigorous protocols and low risk of bias are needed to provide stronger evidence.
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Affiliation(s)
- Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia;
| | - Ahmed Alkahtani
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Shilpa Bhandi
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (S.B.); (M.M.)
| | - Mohammed Mashyakhy
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (S.B.); (M.M.)
| | - Mario Alvarez
- Division of Endodontics and Orthodontics, University of Southern California, Los Angeles, CA 90007, USA;
| | - Riyadh Alroomy
- Department of Restorative Dental Sciences, College of Dentistry, Majmaah University, AlMajmaah 11952, Saudi Arabia;
| | - Ali Hendi
- Department of Radiology, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia;
| | - Saranya Varadarajan
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai 600130, India; (S.V.); (A.T.R.)
| | - Rodolfo Reda
- Department of Oral and Maxillofacial Sciences, Sapienza University, University of Rome, 00161 Rome, Italy;
| | - A. Thirumal Raj
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai 600130, India; (S.V.); (A.T.R.)
| | - Luca Testarelli
- Department of Oral and Maxillofacial Sciences, Sapienza University, University of Rome, 00161 Rome, Italy;
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Kalkum E, Klotz R, Seide S, Hüttner FJ, Kowalewski KF, Nickel F, Khajeh E, Knebel P, Diener MK, Probst P. Systematic reviews in surgery-recommendations from the Study Center of the German Society of Surgery. Langenbecks Arch Surg 2021; 406:1723-1731. [PMID: 34129108 PMCID: PMC8481197 DOI: 10.1007/s00423-021-02204-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/16/2021] [Indexed: 01/08/2023]
Abstract
Background Systematic reviews are an important tool of evidence-based surgery. Surgical systematic reviews and trials, however, require a special methodological approach. Purpose This article provides recommendations for conducting state-of-the-art systematic reviews in surgery with or without meta-analysis. Conclusions For systematic reviews in surgery, MEDLINE (via PubMed), Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) should be searched. Critical appraisal is at the core of every surgical systematic review, with information on blinding, industry involvement, surgical experience, and standardisation of surgical technique holding special importance. Due to clinical heterogeneity among surgical trials, the random-effects model should be used as a default. In the experience of the Study Center of the German Society of Surgery, adherence to these recommendations yields high-quality surgical systematic reviews.
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Affiliation(s)
- Eva Kalkum
- Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Rosa Klotz
- Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.,Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Svenja Seide
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Felix J Hüttner
- Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Karl-Friedrich Kowalewski
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Felix Nickel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Elias Khajeh
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Phillip Knebel
- Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.,Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Markus K Diener
- Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Pascal Probst
- Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany. .,Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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34
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What is the effect of larval therapy on the debridement of venous leg ulcers? A systematic review. J Tissue Viability 2021; 30:301-309. [PMID: 34172356 DOI: 10.1016/j.jtv.2021.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 11/22/2022]
Abstract
AIM To determine the impact of larval therapy on the debridement of venous leg ulcers, in comparison to other debridement methods or no debridement. METHOD Using systematic review methodology, published quantitative studies focusing on the effect of larval therapy on the debridement of venous leg ulcers were included. The search was conducted in January 2020 and updated in May 2021 using CINAHL, PubMed, Embase, and the Cochrane library, and returned 357 records, of which six studies met the inclusion criteria. Data were extracted using a predesigned extraction tool and all studies were quality appraised using the RevMan risk of bias assessment tool. RESULTS Larval therapy was found to debride at a faster rate than hydrogel (p = 0.011, p < 0.001, p = 0.0039), have a similar effect to sharp debridement (p = 0.12, p = 0.62), and was a resource-effective method of debridement (p < 0.05, p < 0.001, p < 0.001). When larval therapy in combination with compression therapy was compared to compression alone, larvae had a greater effect on debridement (p < 0.05), however, it did not improve overall wound healing rates (p = 0.54, p = 0.664, p = 0.02). Pain levels increased during larval therapy and reduced after treatment, when compared to other standard debridement techniques. CONCLUSION Larval therapy promotes rapid debridement of venous leg ulcers. However, further high quality randomised controlled trials, comparing larval therapy to other debridement methods for venous leg ulcers, incorporating the use of compression is required to determine the long term effects of larval therapy.
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35
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“Who am I to disagree?” A qualitative study of how patients interpret the consent process prior to manual therapy of the cervical spine. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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36
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Kler A, Sekhon N, Antoniou GA, Satyadas T. Totally extra-peritoneal repair versus trans-abdominal pre-peritoneal repair for the laparoscopic surgical management of sportsman's hernia: A systematic review and meta-analysis. Surg Endosc 2021; 35:5399-5413. [PMID: 34008111 DOI: 10.1007/s00464-021-08554-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Open and laparoscopic modalities are employed for treatment of sportsman's hernia with totally extra-peritoneal (TEP) and trans-abdominal pre-peritoneal (TAPP) laparoscopic approaches both currently being utilised. At present, neither subtype has demonstrated a beneficial superiority for sportsman's hernia repair, as concluded in the most recent systematic review comparing the outcomes of each technique. The aim of this review was to evaluate current evidence to ascertain whether there was a difference in laparoscopic techniques following sportsman's hernia repair. METHODS A systematic literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. Databases searched included PubMed, Scopus and Web of Science to identify all randomised controlled trials (RCTs) and observational studies Risk of bias was assessed using the Cochrane risk of bias tool and Newcastle-Ottawa scale for RCTs and observational studies, respectively.The assessed outcomes included median time to return to sporting activity, complications and the degree of postoperative pain reduction within three months. Random effects model was used to calculate pooled proportion data where feasible. Subgroup analyses were also performed. RESULTS 28 studies were identified including 2 RCTs and 26 observational studies. No significant differences were observed between techniques in the primary or secondary outcomes. Significant heterogeneity was observed in all outcomes. This was more pronounced for return to sporting activity meaning that meta-analysis was not feasible in this domain. Median time to return to sporting activity was 28 days for both techniques. CONCLUSIONS There is no observed difference in the primary and secondary outcomes in either technique. An RCT comparing TEP and TAPP repair is needed to provide definitive data on this matter.
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Affiliation(s)
- Aaron Kler
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Northern Care Alliance NHS Group, Manchester, UK. .,, Flat 2, 8 Moorfield Road, Manchester, M20 2UY, UK.
| | - Nisa Sekhon
- Department of General Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Northern Care Alliance NHS Group, Manchester, UK
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Northern Care Alliance NHS Group, Manchester, UK.,Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Thomas Satyadas
- Regional Hepato-Pancreato-Biliary Surgery Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
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Albaghdadi MS, Young MN, Chowdhury MM, Assmann S, Hamza T, Siami S, Villarreal M, Strong M, Menard M, Farber A, Rosenfield K. Clinical practice patterns and ascertainment bias for cardiovascular events in a randomized trial: A survey of investigators in the BEST-CLI trial. Vasc Med 2021; 26:180-186. [PMID: 33825577 DOI: 10.1177/1358863x21995897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ascertainment bias is a well-recognized source of bias in research, but few studies have systematically analyzed sources of ascertainment bias in randomized trials in which blinding is not possible and endpoint assessment is not protocolized. In the current study, we sought to evaluate differences in the clinical practice patterns of trial investigators with respect to bias in the ascertainment of pre-revascularization patient risk and the incidence of secondary endpoints post-revascularization. We conducted a cross-sectional survey of active investigators (n = 936) from the Best Endovascular Versus Best Surgical Therapy for Patients with Critical Limb Ischemia (BEST-CLI) trial. The total survey response rate was 19.6% (183/936). Vascular surgeons were more likely than nonsurgical interventionalists to order tests for cardiac complications after both surgical bypass (p < 0.001) and endovascular revascularization (p = 0.038). Post-procedure, investigators were more likely to order additional testing for cardiac complications in open surgery versus endovascular cases (7% vs 16% never, 41% vs 65% rarely, 43% vs 17% sometimes, 9% vs 2% always, respectively; p < 0.0001). Significant variation in practice patterns exist in the pre- and post-procedure assessment of cardiac risk and events for patients with CLI undergoing revascularization. Variation in the ascertainment of risk and outcomes according to the type of revascularization procedure and physician specialty should be considered when interpreting the results of clinical studies, such as the BEST-CLI trial. ClinicalTrials.gov Identifier: NCT02060630.
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Affiliation(s)
- Mazen S Albaghdadi
- Division of Cardiology and Section of Vascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Michael N Young
- Cardiology Division, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Mohammed M Chowdhury
- Department of Vascular and Endovascular Surgery, Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Susan Assmann
- HealthCore-New England Research Institutes, Inc., Watertown, MA, USA
| | - Taye Hamza
- HealthCore-New England Research Institutes, Inc., Watertown, MA, USA
| | - Sandra Siami
- HealthCore-New England Research Institutes, Inc., Watertown, MA, USA
| | - Maria Villarreal
- Department of Vascular Surgery, Boston Medical Center, Boston University, Boston, MA, USA
| | - Michael Strong
- Department of Vascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew Menard
- Department of Vascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alik Farber
- Department of Vascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kenneth Rosenfield
- Division of Cardiology and Section of Vascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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38
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McKeever L. Overview of Study Designs: A Deep Dive Into Research Quality Assessment. Nutr Clin Pract 2021; 36:569-585. [DOI: 10.1002/ncp.10647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Liam McKeever
- Department of Biostatistics, Epidemiology, and Informatics University of Pennsylvania Philadelphia Pennsylvania USA
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Ahmad MA, A Hamid MS, Yusof A. Effects of low-level and high-intensity laser therapy as adjunctive to rehabilitation exercise on pain, stiffness and function in knee osteoarthritis: a systematic review and meta-analysis. Physiotherapy 2021; 114:85-95. [PMID: 34654554 DOI: 10.1016/j.physio.2021.03.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND When treating knee osteoarthritis (KOA), rehabilitation exercise is often combined with low-level (LLLT) or high-intensity laser therapy (HILT). However, the effectiveness of these combinations is still uncertain. OBJECTIVE To examine the effects of LLLT or HILT combined with rehabilitation exercise (LLLT+E or HILT+E) on pain, stiffness and function in KOA. DATA SOURCES Five databases (PubMed, Web of Science, CINAHL, PEDro and SPORTDiscus) were searched for relevant studies published up to 31 December 2019. STUDY SELECTION KOA randomised controlled trials, LLLT+E or HILT+E against exercise alone with or without placebo laser, reported clinical outcomes, human studies and English language. DATA SYNTHESIS Methodological quality was assessed by the PEDro and Cochrane risk-of-bias scales, and the meta-analysis was undertaken using RevMan 5.3. RESULTS Of the 10 retrieved studies, six investigated LLLT+E, three on HILT+E, and one evaluated both. All the studies had high PEDro scores. However, as most of the studies employed a single type of laser therapy, only indirect comparison of LLLT+E and HILT+E was possible. This study found all treatment modalities were effective in reducing KOA symptoms. Interestingly, relative to control, the meta-analysis showed significant improvements in knee pain, stiffness and function for the HILT+E. CONCLUSION Both LLLT and HILT are beneficial as adjuncts to rehabilitation exercise in the management of KOA. Based on an indirect comparison, the HILT+E seems to have higher efficacy in reducing knee pain and stiffness, and in increasing function. To confirm this finding, a direct comparative investigation of the two types of laser therapy may be necessary. Systematic review registration PROSPERO ID CRD42020206228.
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Affiliation(s)
- Mohd Azzuan Ahmad
- Centre for Sport and Exercise Sciences, University of Malaya, 50603, Kuala Lumpur, Malaysia; Physiotherapy Programme, Centre for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia.
| | - Mohamad Shariff A Hamid
- Sports Medicine Unit, Faculty of Medicine, University of Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia.
| | - Ashril Yusof
- Centre for Sport and Exercise Sciences, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Kumah E, Abuosi AA, Ankomah SE, Anaba C. Self-management Education Program: The Case of Glycemic Control of Type 2 Diabetes. Oman Med J 2021; 36:e225. [PMID: 33585046 PMCID: PMC7868594 DOI: 10.5001/omj.2021.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 05/28/2019] [Indexed: 01/05/2023] Open
Abstract
Objectives Self-management education (SME) is recognized globally as a tool that enables patients to achieve optimal glucose control. While factors influencing the effectiveness of self-management interventions have been studied extensively, the impact of program length on clinical endpoints of patients diagnosed with diabetes is underdeveloped. This paper synthesized information from the existing literature to understand the effect of program length on glycated hemoglobin (HbA1C) in adults with type 2 diabetes mellitus. Methods We searched Web of Science, PubMed, Scopus, MEDLINE, EMBASE, PsychINFO, and the Cochrane Central Register of Controlled Trials to identify relevant English language publications on diabetes self-management education published between January 2000 and April 2019. Results The review included 25 randomized controlled trials, with 64.0% reporting significant changes in HbA1C. The studies classified as long-term (lasting one year and above) were associated with the greatest number of interventions achieving statistically significant (87.5% significant vs. 12.5% non-significant) differences in changes in HbA1C between the intervention and the control subjects, recording an overall between-group HbA1C mean difference of 0.6±0.3% (range = 0.2–1.2). Conclusions Our findings suggest that program length may change the effectiveness of educational interventions. Achieving sustained improvements in patients’ HbA1C levels will require long-term, ongoing SME, and support.
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Affiliation(s)
- Emmanuel Kumah
- Policy, Planning, Monitoring, and Evaluation Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
| | | | - Cynthia Anaba
- Department of Administration, St. Dominic Hospital, Akwatia, Eastern Region, Ghana
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Evidence-based Plastic Surgery: Assessing Progress over Two 5-year Periods from 2009 to 2019. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3337. [PMID: 33564577 PMCID: PMC7859015 DOI: 10.1097/gox.0000000000003337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/30/2020] [Indexed: 02/01/2023]
Abstract
Publications on evidence-based medicine have increased. Previous articles have examined evidence-based plastic surgery, but the latest was published in 2013. The aim of this study was to examine the trend in the number of high-evidence publications over two 5-year periods across 3 main plastic surgery journals. Further, this study aimed to quality-assess randomized controlled trials (RCTs) published in the latter period. Methods All articles were identified using PubMed Search Tools and Single Citation Matcher. Three journals were manually screened from May 15, 2009, to May 15, 2014, and from May 16, 2014, to May 16, 2019. The reporting of RCTs was assessed using a modified Consolidated Standards of Reporting Trials (CONSORT) checklist. Results Of a total of 17,334 publications, 6 were meta-analyses of RCTs, 120 were other meta-analyses, and 247 were initially identified as RCTs. Although a significant increase in the number of higher-evidence publications is observed, these represent 2.09% (n = 363) of the total. An estimated 86 RCTs were eligible for quality-assessment, with the most popular sub-specialty being breast surgery (n = 30). The most highly reported criteria were inclusion/exclusion criteria and blinding (both n = 67; 77.91%), and the least reported criterion was allocation concealment (n = 21; 24.42%). Conclusions This study observes a positive trend in high-evidence publications. The number of RCTs published has increased significantly over a breadth of sub-specialties. The reporting of several CONSORT criteria in RCTs remains poor. Observation to standard reporting guidelines is advocated to improve the quality of reporting.
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Comparison of new versus reused Harmonic scalpel performance in laparoscopic appendectomy in patients with acute appendicitis-a randomized clinical trial. Langenbecks Arch Surg 2020; 406:153-162. [PMID: 33241426 DOI: 10.1007/s00423-020-02039-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim of this study was to compare lateral thermal damage of the appendix and clinical outcomes after laparoscopic appendectomy using new versus reused Harmonic scalpels. METHODS A total of 100 consecutive patients with acute appendicitis who underwent laparoscopic appendectomy were enrolled in the two-center, randomized clinical trial. Using a computer random number generator, patients were allocated to new or reused group. Histopathological measurement of lateral thermal damage of the appendiceal base and mesoappendix, speed of transection of the appendiceal base, duration of surgery, subjective rating of device functionality, length of hospital stay, and complications were compared within groups. RESULTS The median lateral thermal damage on the appendiceal base in the new group (N = 49) was 0.2 mm (IQR 0.1-0.2) and 0.1 mm (IQR 0.1-0.3) in the reused group (N = 51) (P = 0.644), while on the mesoappendix for both groups, thermal damage was 0.1 mm (IQR 0.1-0.2) (P = 0.418). The median time required for base transection in both groups was 8 s (IQR 7-9) (P = 0.776). The median duration of surgery was also comparable between the groups (22 min, IQR 20-30 vs 25 min, IQR 21-35; P = 0.233). Two postoperative complications in the new group and one in the reused group were recorded (4% vs 2%; P = 0.536). Surgeons' subjective assessment of the instrument did not reveal significant difference between the groups in all of the investigated categories. CONCLUSIONS The results of our study support the reuse of Harmonic scalpels especially in the settings where economic constraints might hamper access to minimally invasive surgery to a larger number of patients. The results obtained on laparoscopic appendectomy might not be reproducible to other more demanding surgical procedures. TRIAL REGISTRATION ClinicalTrials.gov registry under identifier NCT04226482.
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A Systematic Review and Meta-analysis of Physical Exercise Prehabilitation in Major Abdominal Surgery (PROSPERO 2017 CRD42017080366). J Gastrointest Surg 2020; 24:1375-1385. [PMID: 31228083 DOI: 10.1007/s11605-019-04287-w] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/26/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Physical exercise prehabilitation has been proposed to improve postoperative outcomes in patients undergoing major abdominal surgery. The aim of this systematic review was to investigate the effect of preoperative exercise training compared with standard care on postoperative outcomes in major abdominal surgery. METHODS Randomized controlled trials (RCT) comparing prehabilitation with standard care were identified by a systematic literature search of MEDLINE and CENTRAL. Qualitative and quantitative analyses of perioperative outcome data were conducted. Meta-analyses were performed wherever possible and meaningful. RESULTS A total of eight trials including 442 patients met the inclusion criteria. These trials investigated the effect of prehabilitation in patient cohorts undergoing major liver, colorectal, gastroesophageal, and general abdominal surgery. Quantitative analyses of all included trials showed a significant reduction in postoperative pulmonary complications (OR 0.37; 0.20 to 0.67; p = 0.001) as well as in postoperative overall morbidity (OR 0.52; 0.30 to 0.88; p = 0.01) in the prehabilitation group compared with standard care. The length of hospital stay showed no significant differences between the groups (MD - 0.58; - 1.28 to 0.13; p = 0.11). Risk of bias and methodological quality varied substantially among the trials, most of which were small single-center studies. CONCLUSION Prehabilitation including a physical exercise intervention may lead to a reduction of postoperative pulmonary complications as well as less overall morbidity compared with standard care in patients undergoing major abdominal surgery. Further, well-designed RCT are needed to evaluate these potential positive effects in more detail and to identify suitable target populations. PROTOCOL REGISTRATION PROSPERO 2017 CRD42017080366.
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Laparoscopic Versus Open Pancreaticoduodenectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Ann Surg 2020; 271:54-66. [PMID: 30973388 DOI: 10.1097/sla.0000000000003309] [Citation(s) in RCA: 179] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare perioperative outcomes of laparoscopic pancreaticoduodenectomy (LPD) to open pancreaticoduodenectomy (OPD) using evidence from randomized controlled trials (RCTs). BACKGROUND LPD is used more commonly, but this surge is mostly based on observational data. METHODS We searched CENTRAL, Medline and Web of Science for RCTs comparing minimally invasive to OPD for adults with benign or malignant disease requiring elective pancreaticoduodenectomy. Main outcomes were 90-day mortality, Clavien-Dindo ≥3 complications, and length of hospital stay (LOS). Secondary outcomes were postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), bile leak, blood loss, reoperation, readmission, oncologic outcomes (R0-resection, lymph nodes harvested), and operative times. Data were pooled as odds ratio (OR) or mean difference (MD) with a random-effects model. Risk of bias was assessed using the Cochrane Tool and the GRADE approach (Prospero registration ID: CRD42019120363). RESULTS Three RCTs with a total of 224 patients were included. Meta-analysis showed there were no significant differences regarding 90-day mortality, Clavien-Dindo ≥3 complications, LOS, POPF, DGE, PPH, bile leak, reoperation, readmission, or oncologic outcomes between LPD and OPD. Operative times were significantly longer for LPD {MD [95% confidence interval (CI)] 95.44 minutes (24.06-166.81 minutes)}, whereas blood loss was lower for LPD [MD (CI) -150.99 mL (-168.54 to -133.44 mL)]. Certainty of evidence was moderate to very low. CONCLUSIONS At current level of evidence, LPD shows no advantage over OPD. Limitations include high risk of bias and moderate to very low certainty of evidence. Further studies should focus on patient safety during LPD learning curves and the potential role of robotic surgery.
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Abstract
Randomized controlled clinical trials (RCTs) are at the heart of "evidence-based" medicine. However, in surgical practice, RCTs remain uncommon. Conducting well-designed RCTs for surgical procedures is often challenged by inadequate recruitment accrual, blinding, or standardization of the surgical procedure, as well as lack of funding and evolution of the treatment strategy during the many years over which such trials are conducted. In addition, most clinical trials are performed in academic high-volume centers in highly selected patients, which may not necessarily reflect a "real-world" practice setting. Over the past decades, surgical outcomes research using nationwide administrative and registry databases has become increasingly common. Large databases provide easy and inexpensive access to data on a large and diverse patient population at a variety of treatment centers. Furthermore, large database studies provide the opportunity to answer questions that would be impossible or very arduous to answer using RCTs, including questions regarding health policy efficacy, trends in surgical practice, access to health care, impact of hospital volume, and adherence to practice guidelines, as well as research questions regarding rare disease, infrequent surgical outcomes, and specific subpopulation. Prospective data registries may also allow for quality benchmarking and auditing. This review outlines the role, advantages, and limitations of RCTs and large database studies in answering important research questions in surgery.
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Klotz R, Seide SE, Knebel P, Probst P, Bruckner T, Motsch J, Hyhlik-Dürr A, Böckler D, Larmann J, Diener MK, Weigand MA, Büchler MW, Mihaljevic AL. Continuous wound infiltration versus epidural analgesia for midline abdominal incisions - a randomized-controlled pilot trial (Painless-Pilot trial; DRKS Number: DRKS00008023). PLoS One 2020; 15:e0229898. [PMID: 32142529 PMCID: PMC7059935 DOI: 10.1371/journal.pone.0229898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/14/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To test the feasibility of a randomized controlled study design comparing epidural analgesia (EDA) with continuous wound infiltration (CWI) in respect to postoperative complications and mobility to design a future multicentre randomized controlled trial. DESIGN, SETTING, PARTICIPANTS CWI has been developed to address drawbacks of EDA. Previous studies have established the equivalent analgesic potential of CWI compared to EDA. This is a single centre, non-blinded pilot randomized controlled trial at a tertiary surgical centre. Patients undergoing elective non-colorectal surgery via a midline laparotomy were randomized to EDA or CWI. Endpoints included recruitment, feasibility of assessing postoperative mobility with a pedometer and morbidity. No primary endpoint was defined and all analyses were explorative. INTERVENTIONS CWI with local anaesthetics (experimental group) vs. thoracic EDA (control). RESULTS Of 846 patients screened within 14 months, 71 were randomized and 62 (31 per group) included in the intention-to-treat analysis. Mobility was assessed in 44 of 62 patients and revealed no differences within the first 3 postoperative days. Overall morbidity did not differ between the two groups (measured via the comprehensive complication index). Median pain scores at rest were comparable between the two groups, while EDA was superior in pain treatment during movement on the first, but not on the second and third postoperative day. Duration of preoperative induction of anaesthesia was shorter with CWI than with EDA. Of 17 serious adverse events, 3 were potentially related to EDA, while none was related to CWI. CONCLUSION This trial confirmed the feasibility of a randomized trial design to compare CWI and EDA regarding morbidity. Improvements in the education and training of team members are necessary to improve recruitment. TRIAL REGISTRATION DRKS00008023.
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Affiliation(s)
- Rosa Klotz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Svenja E. Seide
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Phillip Knebel
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Pascal Probst
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Johann Motsch
- Department of Anaesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Hyhlik-Dürr
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jan Larmann
- Department of Anaesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus K. Diener
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus A. Weigand
- Department of Anaesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus W. Büchler
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Andre L. Mihaljevic
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Writing an Evidence-based Article in Plastic Surgery: Translating Research into High-quality Care. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2544. [PMID: 32042541 PMCID: PMC6964924 DOI: 10.1097/gox.0000000000002544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/04/2019] [Indexed: 11/25/2022]
Abstract
Evidence-based medicine (EBM) is a triad that integrates the physician's medical expertise and the patient's individual characteristics with the best available scientific evidence. As patients become more active in the clinical decision-making process, the application of evidence-based practice in the field of plastic surgery is more critical now than ever. As a field that is recognized by its innovation, plastic surgeons must understand the various aspects of EBM to enhance and keep the field at the top of medical discovery. Many initiatives have been implemented to guide researchers in the collection, analysis, and distribution of high-quality evidence. In particular, Plastic and Reconstructive Surgery introduced a new EBM series to provide plastic surgeons with the appropriate resources to generate and integrate high-quality evidence into their practices. As a part of this initiative, this article will assist researchers in producing an evidence-based article that is well-written, relevant, and impactful to incorporate evidence-based practice into the specialty.
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Edmond SN, Turk DC, Williams DA, Kerns RD. Considerations of trial design and conduct in behavioral interventions for the management of chronic pain in adults. Pain Rep 2019; 4:e655. [PMID: 31583335 PMCID: PMC6749925 DOI: 10.1097/pr9.0000000000000655] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/17/2018] [Accepted: 03/21/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION A growing number and type of nonpharmacological approaches for the management of chronic pain have demonstrated at least modest evidence of efficacy, and for some, there is emerging evidence of their effectiveness in relatively large scale trials. Behavioral approaches are those that generally seek to promote adaptive behavioral change in the service of reducing pain and improving physical and emotional functioning and quality of life. Despite a substantial empirical literature supporting the clinical utility of these approaches, a large number of unanswered questions remain and clinical trials to answer some of these questions are needed. Although considerations for development and enactment of data-analytic plans are generally similar to those in pharmacological trials (eg, intent-to-treat, prespecifying outcomes and time points, and handling of missing data), there may be some important differences to consider when planning and conducting clinical trials examining these behavioral approaches. OBJECTIVES The primary objective of this article is to describe some aspects of clinical trials for behavioral approaches for the management of chronic pain that requires special consideration. METHODS Important topics discussed include: (1) intervention development, (2) research design considerations (adequate and appropriate control and comparison conditions), (3) appropriate outcomes, (4) recruitment and sampling biases and blinding, (5) intervention fidelity and adherence, and (6) demographic and cultural considerations. RESULTS AND CONCLUSIONS A number of methodological recommendations are made in the service of encouraging the conduct of high-quality research comparable with that performed for pharmacological and other medical interventions.
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Affiliation(s)
- Sara N. Edmond
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Dennis C. Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - David A. Williams
- Departments of Anesthesiology
- Internal Medicine
- Psychiatry, and
- Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Robert D. Kerns
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Departments of Neurology and
- Psychology, Yale University, New Haven, CT, USA
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Evidence-based recommendations for blinding in surgical trials. Langenbecks Arch Surg 2019; 404:273-284. [DOI: 10.1007/s00423-019-01761-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/05/2019] [Indexed: 12/15/2022]
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Low-Dose Landiolol Reduces Heart Rate and Cardiac Oxygen Consumption Without Compromising Initial Hemodynamic Resuscitation in a Canine Model of Endotoxin Shock. Shock 2018; 52:102-110. [PMID: 30052577 DOI: 10.1097/shk.0000000000001224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In septic shock, it is not known whether β-blocker can be used to reduce heart rate (HR) safely during the initial phase of hemodynamic resuscitation. The purpose of this study was to experimentally investigate the effects of low-dose landiolol, a β-blocker, on initial hemodynamic resuscitation in dogs with endotoxin shock. In 13 anesthetized dogs [n = 7 in control (CT) group, n = 6 in β-blockade (BB) group], after endotoxin shock was induced by intravenous infusion of lipopolysaccharide (4 mg kg), we started hemodynamic resuscitation to restore mean arterial pressure (AP) and cardiac output (CO) by infusing noradrenaline (NA) and Ringer acetate solution (RiA). During 4 h of hemodynamic resuscitation, dose of NA and RiA were automatically titrated with use of a computer-controlled drug infusion system that we developed previously. In BB group, landiolol was administered at a low-dose range (1-10 μg kg min) to lower HR to lower than 140 bpm. Hemodynamic resuscitation using the system restored AP to 70 mmHg and CO to greater than 90% of baseline level similarly in both groups. Throughout resuscitation, HR and indices of cardiac contractility were significantly lower in BB group than in CT group. However, there were no significant intergroup differences in the dose of NA and RiA. During First 2 h of resuscitation, cardiac oxygen consumption was significantly lower in BB group than in CT group. In conclusion, low-dose landiolol may reduce HR without compromising initial hemodynamic resuscitation in septic shock. To clearly establish this, large-size randomized study using animal models more relevant to septic shock is needed.
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