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D'Souza S, Downs G, Hendrikx S, Fazelzad R, Boldt G, Burns K, Chapman D, Dawes D, Giannarakos A, Oja LA, Schorr R, Babb M, Hodgson A, McEwan J, Jacobs P, Stockley T, Tripp T, King I. Clinical reporting for personalized cancer genomics requires extensive access to subscription-only literature. J Med Libr Assoc 2023; 111:579-590. [PMID: 37312803 PMCID: PMC10259627 DOI: 10.5195/jmla.2023.1572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Objective Medical care for cancer is increasingly directed by genomic laboratory testing for alterations in the tumor genome that are significant for diagnosis, prognosis and therapy. Uniquely in medicine, providers must search the biomedical literature for each patient to determine the clinical significance of these alterations. Access to published scientific literature is frequently subject to high fees, with access limited to institutional subscriptions. We sought to investigate the degree to which the scientific literature is accessible to clinical cancer genomics providers, and the potential role of university and hospital system libraries in information access for cancer care. Methods We identified 265 journals that were accessed during the interpretation and reporting of clinical test results from 1,842 cancer patients at the University Health Network (Toronto, Canada). We determined the degree of open access for this set of clinically important literature, and for any journals not available through open access we surveyed subscription access at seven academic hospital systems and at their affiliated universities. Results This study found that nearly half (116/265) of journals have open access mandates that make articles freely available within one year of release. For the remaining subscription access journals, universities provided a uniformly high level of access, but access available through hospital system collections varied widely. Conclusion This study highlights the importance of different modes of access to the use of the scientific literature in clinical practice and points to challenges that must be overcome as genomic medicine grows in scale and complexity.
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Affiliation(s)
| | | | - Shawn Hendrikx
- , Collections and Content Strategies Librarian, Western University, London, ON, Canada
| | - Rouhi Fazelzad
- , Information Specialist, Library and Information Services, University Health Network, Toronto, ON, Canada
| | - Gabriel Boldt
- , Clinical Librarian, London Health Sciences Centre, London Regional Cancer Program, London, ON, Canada
| | - Karen Burns
- , University Health Network, Toronto, ON, Canada
| | - Darlene Chapman
- , Operations Manager, Library Services, IWK Health, Halifax, NS, Canada
| | | | - Antonia Giannarakos
- , Senior Librarian, Library & Knowledge Services Canada, Trillium Health Partners, Mississauga, ON, Canada
| | - Lori Anne Oja
- , Executive Director HSICT, Health Sciences Information Consortium of Toronto, Toronto, ON, Canada
| | | | - Maureen Babb
- , Science Liaison Librarian, University of Manitoba, Winnipeg, MB, Canada
| | | | - Jessica McEwan
- , User Experience Librarian, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Tim Tripp
- , Director, Library & Information Services, University Health Network, Toronto, ON, Canada
| | - Ian King
- , University Health Network, Toronto, ON, Canada
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Longstaffe R, Hendrikx S, Naudie D, Willits K, Degen RM. Iliopsoas Release: A Systematic Review of Clinical Efficacy and Associated Complications. Clin J Sport Med 2021; 31:522-529. [PMID: 32032164 DOI: 10.1097/jsm.0000000000000784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 05/10/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To perform a systematic review of the findings of iliopsoas release as it relates to resolution of snapping, improvement of groin pain, and associated complications. DESIGN Systematic review. DATA SOURCES Four electronic databases PubMed/MEDLINE, EMBASE, CINAHL, and Web of Science were searched, identifying all literature pertaining to surgical treatment of a snapping hip/coxa saltans, iliopsoas impingement, or iliopsoas tendinitis. A total of 818 studies were identified. Two reviewers independently screened the titles, abstracts, and full-text articles for eligibility. ELIGIBILITY CRITERIA All studies published in English that reported on iliopsoas release for snapping hip/coxa saltans, iliopsoas impingement, or iliopsoas tendinitis reporting outcomes or associated complications were eligible. RESULTS A total of 48 articles were included in this review. Three surgical indications were identified for iliopsoas release, internal snapping hip, labral tear secondary to iliopsoas impingement, and iliopsoas tendinopathy after total hip arthroplasty. Arthroscopic techniques seemed to be superior to open techniques with regards to reoccurrence of snapping (5.1% vs 21.7%) and groin pain relief (89.1% vs 85.6%) with fewer complications (4.2% vs 21.1%) overall. CONCLUSIONS Both open and arthroscopic iliopsoas releases have been shown to be successful treatment options regardless of the surgical indications identified in this review. Arthroscopic release demonstrated a decreased failure rate, fewer complications, and improved outcomes when compared with open procedures.
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Affiliation(s)
- Robert Longstaffe
- Fowler Kennedy Sport Medicine Clinic, Department of Surgery, Western University, London, ON, Canada
| | - Shawn Hendrikx
- Western Libraries, Western University, London, ON, Canada ; and
| | - Douglas Naudie
- University Hospital, London Health Sciences Centre, Department of Surgery, London, ON, Canada
| | - Kevin Willits
- Fowler Kennedy Sport Medicine Clinic, Department of Surgery, Western University, London, ON, Canada
| | - Ryan M Degen
- Fowler Kennedy Sport Medicine Clinic, Department of Surgery, Western University, London, ON, Canada
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Sukhera J, Bertram K, Hendrikx S, Chisolm MS, Perzhinsky J, Kennedy E, Lingard L, Goldszmidt M. Exploring implicit influences on interprofessional collaboration: a scoping review. J Interprof Care 2021; 36:716-724. [PMID: 34602007 DOI: 10.1080/13561820.2021.1979946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Interprofessional collaboration (IPC) is fraught with multiple tensions. This is partly due to implicit biases within teams, which can reflect larger social, physical, organizational, and historical contexts. Such biases may influence communication, trust, and how collaboration is enacted within larger contexts. Despite the impact it has on teams, the influence of bias on IPC is relatively under-explored. Therefore, the authors conducted a scoping review on the influence of implicit biases within interprofessional teams. Using scoping review methodology, the authors searched several online databases. From 2792 articles, two reviewers independently conducted title/abstract screening, selecting 159 articles for full-text eligibility. From these, reviewers extracted, coded, and iteratively analyzed key data using a framework derived from socio-material theories. Authors found that many studies demonstrated how biases regarding dominance and expertise were internalized by team members, influencing collaboration in predominantly negative ways. Articles also described how team members dynamically adapted to such biases. Overall, there was a paucity of research that described material influences, often focusing on a single material element instead of the dynamic ways that humans and materials are known to interact and influence each other. In conclusion, implicit biases are relatively under-explored within IPC. The lack of research on material influences and the relationship among racial, age-related, and gender biases are critical gaps in the literature. Future research should consider the longitudinal and reciprocal nature of both positive and negative influences of bias on collaboration in diverse settings.
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Affiliation(s)
- Javeed Sukhera
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kaitlyn Bertram
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Shawn Hendrikx
- Western University Libraries, Western University, London, Ontario, Canada
| | - Margaret S Chisolm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Erin Kennedy
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Abstract
Telepsychiatry, the use of televideo in psychiatric assessment and treatment, is utilized throughout Canada. Major depressive disorder (MDD) is common, with significant burdens of suffering and cost. This systematic review explores the literature on the use of televideo to diagnose and treat MDD, particularly acceptability and patient satisfaction, efficacy, and cost-effectiveness. A literature search was conducted for years 1946 to 2019. Study eligibility criteria included: MDD as the condition of interest, use of televideo technology, randomized controlled trials (RCTs), Adult (18 years or older) population, any clinical setting, and any healthcare professional providing care. The study must have included at least one of the following measures, satisfaction, efficacy, and cost-effectiveness. Fourteen studies were included. Satisfaction is equivalent to or significantly higher than face-to-face intervention. Both televideo and control groups found relief from depressive symptoms, with differences either statistically insignificant or in favour of televideo. Despite increased cost upfront for televideo due to the technology required, televideo would eventually be more cost-effective due to reducing travel expenses. Limitations include that there is little RCT data, and what exists often uses a collaborative treatment model. Many studies consisted solely of U.S. Veterans, and have limited generalizability. Further research needed to directly compare psychiatrist assessment over televideo versus in-person, and determine if particular patient subgroups benefit more from televideo or in-person intervention.Systematic review registration number: CRD42016048224.
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Affiliation(s)
- Giuseppe Guaiana
- Department of Psychiatry and Department of Epidemiology and Biostatistics, Western University, London, Canada.
| | | | - Shawn Hendrikx
- Collections & Content Strategies, Western Libraries, Western University, London, Canada
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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Poonai N, Spohn J, Vandermeer B, Ali S, Bhatt M, Hendrikx S, Trottier ED, Sabhaney V, Shah A, Joubert G, Hartling L. Intranasal Dexmedetomidine for Procedural Distress in Children: A Systematic Review. Pediatrics 2020; 145:peds.2019-1623. [PMID: 31862730 DOI: 10.1542/peds.2019-1623] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Intranasal dexmedetomidine (IND) is an emerging agent for procedural distress in children. OBJECTIVE To explore the effectiveness of IND for procedural distress in children. DATA SOURCES We performed electronic searches of Medline (1946-2019), Embase (1980-2019), Google Scholar (2019), Cumulative Index to Nursing and Allied Health Literature (1981-2019), and Cochrane Central Register. STUDY SELECTION We included randomized trials of IND for procedures in children. DATA EXTRACTION Methodologic quality of evidence was evaluated by using the Cochrane Collaboration's risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system, respectively. The primary outcome was the proportion of participants with adequate sedation. RESULTS Among 19 trials (N = 2137), IND was superior to oral chloral hydrate (3 trials), oral midazolam (1 trial), intranasal midazolam (1 trial), and oral dexmedetomidine (1 trial). IND was equivalent to oral chloral hydrate (2 trials), intranasal midazolam (2 trials), and intranasal ketamine (3 trials). IND was inferior to oral ketamine and a combination of IND plus oral ketamine (1 trial). Higher doses of IND were superior to lower doses (4 trials). Adverse effects were reported in 67 of 727 (9.2%) participants in the IND versus 98 of 591 (16.6%) in the comparator group. There were no reports of adverse events requiring resuscitative measures. LIMITATIONS The adequacy of sedation was subjective, which possibly led to biased outcome reporting. CONCLUSIONS Given the methodologic limitations of included trials, IND is likely more effective at sedating children compared to oral chloral hydrate and oral midazolam. However, this must be weighed against the potential for adverse cardiovascular effects.
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Affiliation(s)
- Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; .,Division of Emergency Medicine and.,Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | | | - Ben Vandermeer
- Department of Pediatrics and Alberta Research Centre for Health Evidence
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, and.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Maala Bhatt
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Shawn Hendrikx
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Evelyne D Trottier
- Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montréal, Québec, Canada; and
| | - Vikram Sabhaney
- BC Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Gary Joubert
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.,Division of Emergency Medicine and
| | - Lisa Hartling
- Department of Pediatrics and Alberta Research Centre for Health Evidence
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Poonai N, Spohn J, Hendrikx S, Doyon-Trottier E, Sabhaney V, Ali S, Shah A. 117 Intranasal dexmedetomidine for procedural distress in children: a systematic review and meta-analysis. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Poonai N, Canton K, Ali S, Hendrikx S, Shah A, Miller M, Joubert G, Hartling L. Intranasal ketamine for anesthetic premedication in children: a systematic review. Pain Manag 2018; 8:495-503. [PMID: 30394192 DOI: 10.2217/pmt-2018-0039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIM In children, intravenous anesthetic premedication can be distressing. Intranasal (IN) ketamine offers a less invasive approach. MATERIALS AND METHODS We included randomized trials of IN ketamine in anesthetic premedication in children 0-19 years. We performed electronic searches of MEDLINE, EMBASE, Google Scholar, CINAHL, Cochrane Library, Web of Science, Scopus, clinical trial registries and conference proceedings. RESULTS Among the 23 trials (n = 1680) included, IN ketamine adequately sedated 220/311 (70%) for face mask application, 217/308 (70%) for caregiver separation, 200/371 (54%) for iv. insertion and 19/30 (63%) for monitor application. Vomiting was the most common adverse effect (35/1579 [2.2%]). CONCLUSION There is a need for sufficiently powered, methodologically rigorous trials, using psychometrically evaluated, objective outcome measures to meaningfully inform practice.
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Affiliation(s)
- Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada.,Division of Emergency Medicine, Western University, London, Canada.,Children's Health Research Institute, London Health Sciences Centre, London, Canada
| | - Kyle Canton
- Division of Emergency Medicine, Western University, London, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.,Women & Children's Health Research Institute, University of Alberta, Edmonton, Canada
| | - Shawn Hendrikx
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada
| | - Amit Shah
- Division of Emergency Medicine, Western University, London, Canada
| | - Michael Miller
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada.,Children's Health Research Institute, London Health Sciences Centre, London, Canada
| | - Gary Joubert
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada.,Division of Emergency Medicine, Western University, London, Canada.,Children's Health Research Institute, London Health Sciences Centre, London, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Canada
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McCormick L, Godfrey CM, Muscedere J, Hendrikx S. Integrated knowledge translation strategies in the acute care of older people: a scoping review protocol. ACTA ACUST UNITED AC 2018; 14:103-107. [PMID: 27755322 DOI: 10.11124/jbisrir-2016-003084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this review is to identify the evidence on the use of integrated knowledge translation (iKT) strategies in acute care. This information will assist in the identification of the strategies used to engage stakeholders, such as patients and decision makers, in the research process and how their involvement has influenced the implementation or integration of research into practice. The extent to which these iKT activities have occurred in the context of care of the elderly, intensively ill patient will be examined. The question that will guide this review is: What iKT strategies have been used within the acute care environment for the care of an older person, specifically: (a) where have these strategies been used, and (b) how have iKT strategies been implemented?
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Affiliation(s)
- Loretta McCormick
- 1Western University, London, Ontario, Canada 2The Queen's Collaboration for Healthcare Quality: a Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Ontario, Canada 3Critical Care Program Kingston General Hospital, Department of Medicine Queen's University, Kingston, Ontario, Canada 4Allyn and Betty Taylor Library Western University, London, Ontario, Canada
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Marx R, Tanner‐Smith EE, Davison CM, Ufholz L, Freeman J, Shankar R, Newton L, Brown RS, Parpia AS, Cozma I, Hendrikx S. Later school start times for supporting the education, health, and well-being of high school students. Cochrane Database Syst Rev 2017; 7:CD009467. [PMID: 28670711 PMCID: PMC6483483 DOI: 10.1002/14651858.cd009467.pub2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND A number of school systems worldwide have proposed and implemented later school start times as a means of avoiding the potentially negative impacts that early morning schedules can have on adolescent students. Even mild sleep deprivation has been associated with significant health and educational concerns: increased risk for accidents and injuries, impaired learning, aggression, memory loss, poor self-esteem, and changes in metabolism. Although researchers have begun to explore the effects of delayed school start time, no one has conducted a rigorous review of evidence to determine whether later school start times support adolescent health, education, and well-being. OBJECTIVES We aimed to assess the effects of a later school start time for supporting health, education, and well-being in high school students.Secondary objectives were to explore possible differential effects of later school start times in student subgroups and in different types of schools; to identify implementation practices, contextual factors, and delivery modes associated with positive and negative effects of later start times; and to assess the effects of later school start times on the broader community (high school faculty and staff, neighborhood, and families). SEARCH METHODS We conducted the main search for this review on 28 October 2014 and updated it on 8 February 2016. We searched CENTRAL as well as 17 key electronic databases (including MEDLINE, Embase, ERIC, PsycINFO, and Sociological Abstracts), current editions of relevant journals and organizational websites, trial registries, and Google Scholar. SELECTION CRITERIA We included any randomized controlled trials, controlled before-and-after studies, and interrupted time series studies with sufficient data points that pertained to students aged 13 to 19 years and that compared different school start times. Studies that reported either primary outcomes of interest (academic outcomes, amount or quality of sleep, mental health indicators, attendance, or alertness) or secondary outcomes (health behaviors, health and safety indicators, social outcomes, family outcomes, school outcomes, or community outcomes) were eligible. DATA COLLECTION AND ANALYSIS At least two review authors independently determined inclusion and exclusion decisions through screening titles, abstracts, and full-text reports. Two review authors independently extracted data for all eligible studies. We presented findings through a narrative synthesis across all studies. When two or more study samples provided sufficient information to permit effect size calculations, we conducted random-effects meta-analyses to synthesize effects across studies. MAIN RESULTS Our search located 17 eligible records reporting on 11 unique studies with 297,994 participants; the studies examined academic outcomes, amount and quality of sleep, mental health indicators, attendance, and student alertness. Overall, the quality of the body of evidence was very low, as we rated most studies as being at high or unclear risk of bias with respect to allocation, attrition, absence of randomization, and the collection of baseline data. Therefore, we cannot be confident about the effects of later school start times.Preliminary evidence from the included studies indicated a potential association between later school start times and academic and psychosocial outcomes, but quality and comparability of these data were low and often precluded quantitative synthesis. Four studies examined the association between later school start times and academic outcomes, reporting mixed results. Six studies examined effects on total amount of sleep and reported significant, positive relationships between later school start times and amount of sleep. One study provided information concerning mental health outcomes, reporting an association between decreased depressive symptoms and later school start times. There were mixed results for the association between later school start times and absenteeism. Three studies reported mixed results concerning the association between later school start times and student alertness. There was limited indication of potential adverse effects on logistics, as the qualitative portions of one study reported less interaction between parents and children, and another reported staffing and scheduling difficulties. Because of the insufficient evidence, we cannot draw firm conclusions concerning adverse effects at this time.It is important to note the limitations of this evidence, especially as randomized controlled trials and high-quality primary studies are difficult to conduct; school systems are often unwilling or unable to allow researchers the necessary control over scheduling and data collection. Moreover, this evidence does not speak to the process of implementing later school starts, as the included studies focused on reporting the effects rather than exploring the process. AUTHORS' CONCLUSIONS This systematic review on later school start times suggests several potential benefits for this intervention and points to the need for higher quality primary studies. However, as a result of the limited evidence base, we could not determine the effects of later school start times with any confidence.
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Affiliation(s)
- Robert Marx
- Vanderbilt UniversityDepartment of Human and Organizational Development, Peabody College of Education and Human DevelopmentNashvilleTNUSA
| | - Emily E Tanner‐Smith
- Vanderbilt UniversityPeabody Research InstituteBox 0181 GPC230 Appleton PlaceNashvilleTNUSA37215
| | - Colleen M Davison
- Queen's UniversityDepartment of Public Health Sciences, Kingston General Hospital Research CentreCarruthers Hall62 Fifth Field Company LaneKingstonONCanada
| | - Lee‐Anne Ufholz
- University of OttawaHealth Sciences Library451 Smyth RoadOttawaONCanadaK1H 8M5
| | - John Freeman
- Queen's UniversitySocial Program and Evaluation GroupDuncan McArthur Hall‐ Room B164KingstonONCanadaK7L 3N6
| | - Ravi Shankar
- Manipal UniversityDepartment of StatisticsManipalKarnatakaIndia576104
| | - Lisa Newton
- Toronto District School BoardResearch and Information Services1 Civic Centre Court, Lower LevelEtobicokeONCanadaM9C 2B3
| | - Robert S Brown
- Toronto District School BoardResearch and Information Services1 Civic Centre Court, Lower LevelEtobicokeONCanadaM9C 2B3
| | - Alyssa S Parpia
- Queen's UniversityDepartment of Public Health Sciences, Kingston General Hospital Research CentreCarruthers Hall62 Fifth Field Company LaneKingstonONCanada
| | - Ioana Cozma
- Queen's UniversityDepartment of Public Health Sciences, Kingston General Hospital Research CentreCarruthers Hall62 Fifth Field Company LaneKingstonONCanada
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Poonai N, Canton K, Ali S, Hendrikx S, Shah A, Miller M, Joubert G, Rieder M, Hartling L. Intranasal ketamine for procedural sedation and analgesia in children: A systematic review. PLoS One 2017; 12:e0173253. [PMID: 28319161 PMCID: PMC5358746 DOI: 10.1371/journal.pone.0173253] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 02/04/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Ketamine is commonly used for procedural sedation and analgesia (PSA) in children. Evidence suggests it can be administered intranasally (IN). We sought to review the evidence for IN ketamine for PSA in children. METHODS We performed a systematic review of randomized trials of IN ketamine in PSA that reported any sedation-related outcome in children 0 to 19 years. Trials were identified through electronic searches of MEDLINE (1946-2016), EMBASE (1947-2016), Google Scholar (2016), CINAHL (1981-2016), The Cochrane Library (2016), Web of Science (2016), Scopus (2016), clinical trial registries, and conference proceedings (2000-2016) without language restrictions. The methodological qualities of studies and the overall quality of evidence were evaluated using the Cochrane Collaboration's Risk of Bias tool, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, respectively. RESULTS The review included 7 studies (n = 264) of children ranging from 0 to 14 years. Heterogeneity in study design precluded meta-analysis. Most studies were associated with a low or unclear risk of bias and outcome-specific ratings for quality of evidence were low or very low. In four of seven studies, IN ketamine provided superior sedation to comparators and resulted in adequate sedation for 148/175 (85%) of participants. Vomiting was the most common adverse effect; reported by 9/91 (10%) of participants. CONCLUSIONS IN ketamine administration is well tolerated and without serious adverse effects. Although most participants were deemed adequately sedated with IN ketamine, effectiveness of sedation with respect to superiority over comparators was inconsistent, precluding a recommendation for PSA in children.
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Affiliation(s)
- Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Division of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada
- Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Kyle Canton
- Division of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Shawn Hendrikx
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Amit Shah
- Division of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Michael Miller
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Gary Joubert
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Division of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada
- Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Michael Rieder
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta
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Wernerman J, Kirketeig T, Andersson B, Berthelson H, Ersson A, Friberg H, Guttormsen AB, Hendrikx S, Pettilä V, Rossi P, Sjöberg F, Winsö O. Scandinavian glutamine trial: a pragmatic multi-centre randomised clinical trial of intensive care unit patients. Acta Anaesthesiol Scand 2011; 55:812-8. [PMID: 21658010 DOI: 10.1111/j.1399-6576.2011.02453.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Low plasma glutamine concentration is an independent prognostic factor for an unfavourable outcome in the intensive care unit (ICU). Intravenous (i.v.) supplementation with glutamine is reported to improve outcome. In a multi-centric, double-blinded, controlled, randomised, pragmatic clinical trial of i.v. glutamine supplementation for ICU patients, we investigated outcomes regarding sequential organ failure assessment (SOFA) scores and mortality. The hypothesis was that the change in the SOFA score would be improved by glutamine supplementation. METHODS Patients (n=413) given nutrition by an enteral and/or a parenteral route with the aim of providing full nutrition were included within 72 h after ICU admission. Glutamine was supplemented as i.v. l-alanyl-l-glutamine, 0.283 g glutamine/kg body weight/24 h for the entire ICU stay. Placebo was saline in identical bottles. All included patients were considered as intention-to-treat patients. Patients given supplementation for >3 days were considered as predetermined per protocol (PP) patients. RESULTS There was a lower ICU mortality in the treatment arm as compared with the controls in the PP group, but not at 6 months. For change in the SOFA scores, no differences were seen, 1 (0,3) vs. 2 (0.4), P=0.792, for the glutamine group and the controls, respectively. CONCLUSION In summary, a reduced ICU mortality was observed during i.v. glutamine supplementation in the PP group. The pragmatic design of the study makes the results representative for a broad range of ICU patients.
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Affiliation(s)
- Jan Wernerman
- Department of Anesthesia and Intensive Care Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden.
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Hendrikx S, Heyligers IC, Koehler PJ. [Two patients with syringomyelia and Charcot's arthropathy]. Ned Tijdschr Geneeskd 2007; 151:1737-42. [PMID: 17784699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Two patients, a man aged 45 years and a woman aged 61 years, were diagnosed with syringomyelia. They later developed Charcot's arthropathy of the elbow and shoulder, respectively. The second patient was misdiagnosed with multiple sclerosis during the pre-MRI era. The 3 hallmarks of syringomyelia are impairment of vital or non-vital sensory perception, muscle weakness with atrophy and areflexia of the arms. Syringomyelia often occurs in association with other disorders, such as Chiari's malformation type I or tumours of the spinal column. Diagnosis should include scanning of the entire spinal column and the region surrounding the foramen magnum. Various treatment options exist: watchful waiting is possible or surgery, including decompression of the foramen magnum or placement of a syringosubarachnoidal or syringoperitoneal shunt. In the first patient, the elbow became infected, necessitating surgery. The joint later became non-functional. In the second patient, a conservative approach was followed.
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Affiliation(s)
- S Hendrikx
- Atrium Medisch Centrum, afd. Neurologie, Heerlen
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