-
Minerva Cardioangiologica Dec 2016Thoracic sympathectomy is performed in the management of a variety of disorders of the upper extremity. To evaluate the contemporary results of thoracic sympathectomy... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Thoracic sympathectomy is performed in the management of a variety of disorders of the upper extremity. To evaluate the contemporary results of thoracic sympathectomy for upper extremity ischemia a systematic review of the literature was conducted.
EVIDENCE AQUISITION
We performed a PubMed, EMBASE and Cochrane search of the literature written in the English language from January 1975 to December 2015. All articles presenting original patient data regarding the effect of treatment on symptoms or on the healing of ulcers were eligible for inclusion. Individual analyses for Primary Raynaud's Disease (PRD) and Secondary Raynaud's Phenomenon (SRP) were performed.
EVIDENCE SYNTHESIS
We included 6 prospective and 23 retrospective series with a total of 753 patients and 1026 affected limbs. Early beneficial effects of thoracic sympathectomy were noticed in 63-100% (median 94%) of all patients, in 73-100% (median 98%) of PRD patients and in 63-100% (median 94%) of SRP patients. The beneficial effect was noted to lessen over time. Long-term beneficial effects were reported in 13-100% (median 75%) of all patients, in 22-100% (median 58%) of PRD patients, and in 13-100% (median 79%) of SRD patients. Complete or improved ulcer healing was achieved in 33-100% and 25-67% respectively, of all patients.
CONCLUSIONS
Thoracic sympathectomy can be beneficial in the treatment of upper extremity ischemia in select patients. Although the effect in patients with PRD will lessen over time, it may still reduce the severity of symptoms. In SRD, effects are more often long-lasting. In addition, thoracic sympathectomy may maximize tissue preservation or prevent amputation in cases of digital ulceration.
Topics: Humans; Ischemia; Regional Blood Flow; Sympathectomy; Upper Extremity
PubMed: 27175977
DOI: No ID Found -
Annals of Internal Medicine Aug 2017Patients with essential thrombocythemia (ET) are at high risk for both thrombosis and hemorrhage. (Review)
Review
BACKGROUND
Patients with essential thrombocythemia (ET) are at high risk for both thrombosis and hemorrhage.
PURPOSE
To evaluate the risks and benefits of antithrombotic therapy in adults with ET.
DATA SOURCES
Multiple databases, including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials, through 4 March 2017.
STUDY SELECTION
Randomized and observational studies of antiplatelet or anticoagulant therapy, published in any language and reporting thrombotic or hemorrhagic events.
DATA EXTRACTION
Two reviewers independently extracted data, assessed risk of bias, and graded certainty of evidence.
DATA SYNTHESIS
No relevant randomized trials were identified. Twenty-four observational studies (18 comparative and 6 single-group) involving 6153 patients followed for 31 711 patient-years were reviewed; most were deemed to have high risk of bias. Most patients receiving antiplatelet therapy (3613 of 4527 [80%]) received low-dose aspirin (50 to 150 mg/d); 914 (20%) received high-dose aspirin (300 to 600 mg/d), dipyridamole, or other agents. Overall, findings were inconsistent and imprecise. The reported incidence rates of thrombosis, any bleeding, and major bleeding without antiplatelet therapy ranged from 5 to 110 (median, 20), from 3 to 39 (median, 8), and from 2 to 53 (median, 6) cases per 1000 patient-years, respectively. The reported relative risks for thrombosis, any bleeding, and major bleeding with antiplatelet therapy compared with none ranged from 0.26 to 3.48 (median, 0.74), from 0.48 to 11.04 (median, 1.95), and from 0.48 to 5.17 (median, 1.30), respectively. Certainty of evidence was rated low or very low for all outcomes.
LIMITATION
No randomized trials, no extractable data on anticoagulants, lack of uniform bleeding definitions, and systematic reporting of outcomes.
CONCLUSION
Available evidence about the risk-benefit ratio of antiplatelet therapy in adults with ET is highly uncertain.
PRIMARY FUNDING SOURCE
Regional Medical Associates. (PROSPERO: CRD42015027051).
Topics: Fibrinolytic Agents; Hemorrhage; Humans; Platelet Aggregation Inhibitors; Risk Assessment; Thrombocythemia, Essential; Thrombosis
PubMed: 28632284
DOI: 10.7326/M17-0284 -
BMC Cancer Oct 2017Conduct a systematic review of previous systematic reviews with meta-analysis to determine the effects of exercise (aerobic, strength or both) on cancer-related-fatigue... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Conduct a systematic review of previous systematic reviews with meta-analysis to determine the effects of exercise (aerobic, strength or both) on cancer-related-fatigue (CRF) in adults with any type of cancer.
METHODS
Systematic reviews with meta-analyses of previous randomized controlled trials published through July of 2016 were included by searching six electronic databases and cross-referencing. Dual-selection and data abstraction were conducted. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Standardized mean differences (SMD) that were pooled using random-effects models were included as the effect size. In addition, 95% prediction intervals (PI), number needed-to-treat (NNT) and percentile improvements were calculated.
RESULTS
Sixteen studies representing 2 to 48 SMD effect sizes per analysis (mean ± SD, 7 ± 8, median = 5) and 37 to 3254 participants (mean ± SD, 633 ± 690, median = 400) were included. Length of training lasted from 3 to 52 weeks (mean ± SD, 14.6 ± 3.1, median = 14), frequency from 1 to 10 times per week (mean ± SD, 3.4 ± 0.8, median = 3), and duration from 10 to 120 min per session (mean ± SD, 44.3 ± 5.5, median = 45). Adjusted AMSTAR scores ranged from 44.4% to 80.0% (mean ± SD, 68.8% ± 12.0%, median = 72.5%). Overall, mean SMD improvements in CRF ranged from -1.05 to -0.01, with 22 of 55 meta-analytic results (52.7%) statistically significant (non-overlapping 95% CI). When PI were calculated for results with non-overlapping 95% CI, only 3 of 25 (12%) yielded non-overlapping 95% PI favoring reductions in CRF. Number needed-to-treat and percentile improvements ranged from 3 to 16 and 4.4 to 26.4, respectively.
CONCLUSIONS
A lack of certainty exists regarding the benefits of exercise on CRF in adults. However, exercise does not appear to increase CRF in adults.
TRIAL REGISTRATION
PROSPERO Registration # CRD42016045405 .
Topics: Adult; Aged; Exercise; Fatigue; Female; Humans; Male; Middle Aged; Models, Statistical; Neoplasms; Randomized Controlled Trials as Topic
PubMed: 29058631
DOI: 10.1186/s12885-017-3687-5 -
Heart, Lung & Circulation Oct 2019Despite no evidence to support weight limitations following median sternotomy, sternal precautions continue to be routinely prescribed. Moreover, international cardiac... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Despite no evidence to support weight limitations following median sternotomy, sternal precautions continue to be routinely prescribed. Moreover, international cardiac rehabilitation guidelines lack sufficient detail for the implementation of resistance training. This systematic review and meta-analysis aimed to determine what the literature defines as resistance training; how resistance training is applied, progressed and evaluated; and, whether resistance training improves physical and functional recovery postoperatively in the cardiac surgical population.
DATA SOURCES
Five (5) electronic databases were searched from inception to 28 September 2018 for studies published in English that investigated the effects of a resistance training intervention on physical and functional recovery following median sternotomy.
RESULTS
Eighteen (18) trials (n=3,462) met eligibility criteria and were included in the analysis. Seven (7) randomised controlled trials shared common outcome measures, allowing meta-analysis. The performance of resistance training appears to be safe and feasible, and resulted in similar improvements in both cardiopulmonary capacity and anthropometry, when compared to aerobic training alone. However, the definition and application of resistance training is frequently a lower intensity and volume than recommended by the American College of Sports Medicine. Furthermore, sternal precautions are not reflective of the kinematics and weights used when performing many activities of daily living. For this reason, resistance training needs to be task-specific, reflecting functional tasks to promote recovery.
CONCLUSION
Resistance training, in isolation or when combined with aerobic training, may lead to greater improvements in physical and functional recovery following cardiac surgery via median sternotomy; however, further research is required to inform clinical guidelines.
Topics: Activities of Daily Living; Cardiac Rehabilitation; Cardiac Surgical Procedures; Humans; Postoperative Care; Quality of Life; Recovery of Function; Resistance Training; Sternotomy
PubMed: 31208899
DOI: 10.1016/j.hlc.2019.05.097 -
British Journal of Sports Medicine Apr 2022To evaluate the provision of bystander interventions and rates of survival after exercise-related sudden cardiac arrest (SCA). (Review)
Review
OBJECTIVE
To evaluate the provision of bystander interventions and rates of survival after exercise-related sudden cardiac arrest (SCA).
DESIGN
Systematic review.
DATA SOURCES
MEDLINE, EMBASE, PubMed, CINAHL, SPORTDiscus, Cochrane Library and grey literature sources were searched from inception to November/December 2020.
STUDY ELIGIBILITY CRITERIA
Observational studies assessing a population of exercise-related SCA (out-of-hospital cardiac arrests that occurred during exercise or within 1 hour of cessation of activity), where bystander cardiopulmonary resuscitation (CPR) and/or automated external defibrillator (AED) use were reported, and survival outcomes were ascertained.
METHODS
Among all included studies, the median (IQR) proportions of bystander CPR and bystander AED use, as well as median (IQR) rate of survival to hospital discharge, were calculated.
RESULTS
A total of 29 studies were included in this review, with a median study duration of 78.7 months and a median sample size of 91. Most exercise-related SCA patients were male (median: 92%, IQR: 86%-96%), middle-aged (median: 51, IQR: 39-56 years), and presented with a shockable arrest rhythm (median: 78%, IQR: 62%-86%). Bystander CPR was initiated in a median of 71% (IQR: 59%-87%) of arrests, whereas bystander AED use occurred in a median of 31% (IQR: 19%-42%) of arrests. Among the 19 studies that reported survival to hospital discharge, the median rate of survival was 32% (IQR: 24%-49%). Studies which evaluated the relationship between bystander interventions and survival outcomes reported that both bystander CPR and AED use were associated with survival after exercise-related SCA.
CONCLUSION
Exercise-related SCA occurs predominantly in males and presents with a shockable ventricular arrhythmia in most cases, emphasising the importance of rapid access to defibrillation. Further efforts are needed to promote early recognition and a rapid bystander response to exercise-related SCA.
Topics: Cardiopulmonary Resuscitation; Death, Sudden, Cardiac; Defibrillators; Emergency Medical Services; Humans; Male; Middle Aged; Out-of-Hospital Cardiac Arrest
PubMed: 34853034
DOI: 10.1136/bjsports-2021-104623 -
Journal of Addiction MedicineCannabis use has been reported as a risk factor for stroke. We systematically review the prevalence and outcomes of stroke in people with cannabis use.
AIMS
Cannabis use has been reported as a risk factor for stroke. We systematically review the prevalence and outcomes of stroke in people with cannabis use.
METHODS
We searched MEDLINE and 6 other databases from inception to January 2020 for studies on the relationship between cannabis use and stroke. We followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) recommendations. Two independent reviewers extracted the data. Study quality was assessed by the Newcastle-Ottawa Scale for cohort and case-control studies.
RESULTS
Seventeen studies involving 3,185,560 people with cannabis use were included. Descriptive statistics demonstrated 18,676 (median 1.1%, interquartile range [IQR] 0.3%-1.3%) experienced stroke compared with 0.8% of those without use (Odds Ratio 1.17, 95% CI 1.10-1.25). Among people with cannabis use, median age was 26.2 years (IQR 25.2-34.3 years) and mostly male (median 57.8%). Of stroke subtypes, ischemic stroke was most prevalent (median 1.2%, IQR 0.4%-1.9%), followed by undefined stroke subtype (median 1.2%, IQR 1.1%-1.2%) and hemorrhagic stroke (median 0.3%, IQR 0.1%-0.6%). The majority of people with cannabis use who experienced stroke survived (median: 85.1%, IQR 83%-87.5%) and 64.0% of people experienced a good neurologic outcome, defined as modified Rankin Scale of 0 to 3. Few studies included outcomes of vasospasm or seizure.
CONCLUSIONS
In people with cannabis use, the prevalence of ischemic stroke and hemorrhagic stroke was 1.2% and 0.3%, respectively, higher than the prevalence of people without use (0.8% and 0.2%). There is insufficient information on timing, exposure, duration, and dose-responsive relationship.
Topics: Adult; Cannabis; Case-Control Studies; Cohort Studies; Female; Humans; Male; Risk Factors; Stroke
PubMed: 34001774
DOI: 10.1097/ADM.0000000000000870 -
Public Health Nov 2023The aim of this study was to systematically evaluate the current economic burden of coronary heart disease (CHD) in mainland China and provide a reference for the... (Review)
Review
OBJECTIVES
The aim of this study was to systematically evaluate the current economic burden of coronary heart disease (CHD) in mainland China and provide a reference for the formulation of policies to reduce the economic burden of CHD.
STUDY DESIGN
A systematic literature review was conducted of empirical studies on the economic burden of CHD over the past 20 years.
METHODS
PubMed, Web of Science, Embase, China Knowledge Resource Integrated Database and the WANFANG database were comprehensively searched for relevant articles published between 1 January 2000 and 22 December 2021. Content analysis was used to extract the data, and Stata 17.0 software was used for analysis. The median values were used to describe trends.
RESULTS
A total of 35 studies were included in this review. The annual median per-capita hospitalisation expense and the average expense per hospitalisation were $3544.40 ($891.64-$18,371.46) and $5407.34 ($1139.93-$8277.55), respectively. The median ratio on medical consumables expenses, drug expenses, medical examination expenses and treatment expenses were 41.59% (12.40%-63.73%), 26.90% (7.30%-60.00%), 9.45% (1.65%-33.40%) and 10.10% (2.36%-66.00%), respectively. The median per-capita hospitalisation expense in the eastern, central and western regions were $9374.45 ($2056.13-$18,371.46), $4751.5 ($2951.95-$8768.93) and $3251.25 ($891.64-$13,986.38), respectively. The median average expense per hospitalisation in the eastern and central regions were $6177.15 ($1679.15-$8277.55) and $1285.49 ($1239.93-$2197.36), respectively. The median average length of stay in the eastern, central and western regions were 9.3 days, 15.2 days and 16.1 days, respectively.
CONCLUSIONS
The economic burden of CHD is more severe in mainland China than in developed countries, especially in terms of the direct economic burden. In terms of the types of direct medical expenses, a proportion of medical examination expenses, treatment expenses and drug expenses were lowest in the eastern region, but medical consumables expenses were the highest in this region. This study provides guidance for the formulation of policies to reduce the economic burden of CHD in mainland China.
Topics: Humans; China; Coronary Disease; Cost of Illness; Hospitalization; Health Care Costs
PubMed: 37797560
DOI: 10.1016/j.puhe.2023.08.034 -
Drugs & Aging Jan 2015Infections frequently occur in patients with dementia and antibiotics are often prescribed, but may also be withheld. (Review)
Review
BACKGROUND
Infections frequently occur in patients with dementia and antibiotics are often prescribed, but may also be withheld.
OBJECTIVES
The aim of this systematic review is to provide a systematic overview of the prevalence of antibiotic use, and factors associated with prescribing antibiotics in patients with dementia.
DATA SOURCES
A systematic search of MEDLINE, EMBASE, PSYCINFO, CINAHL, and the Cochrane library databases until February 13, 2014 was performed, using both controlled terms and free-text terms.
RESULTS
Thirty-seven articles were included. The point prevalence of antibiotic use in patients with dementia ranged from 3.3 to 16.6%. The period prevalence ranged from 4.4 to 88% overall, and from 23.5 to 94% in variable time frames before death; the median use was 52% (median period 14 days) and 48% (median period 22 days), respectively. Most patients with lower respiratory tract infections or urinary tract infections (77-91%) received antibiotic treatment. Factors associated with antibiotic use related to patients, families, physicians, and the healthcare context. More severe dementia and a poor prognosis were associated with less antibiotic use in various countries. Associations with aspiration and illness severity differed by country.
CONCLUSIONS AND IMPLICATIONS
Antibiotic use in patients with dementia is substantial, and probably highly associated with the particular healthcare context. Future studies may report antibiotic use by infection type and stage of dementia, and compare cross-nationally.
Topics: Anti-Bacterial Agents; Dementia; Humans; Practice Patterns, Physicians'; Respiratory Tract Infections; Urinary Tract Infections
PubMed: 25385686
DOI: 10.1007/s40266-014-0223-z -
European Journal of Radiology Jul 2017To assess the effectiveness of yttrium-90 (Y) radioembolization in the treatment of unresectable liver metastases of melanoma. (Review)
Review
PURPOSE
To assess the effectiveness of yttrium-90 (Y) radioembolization in the treatment of unresectable liver metastases of melanoma.
METHODS
PubMed and EMBASE were systemically searched for all English language studies related to Y radioembolization for unresectable liver metastases of melanoma, including clinical trials, observational studies, and abstracts from conferences, published between January 1991 and March 2016.
RESULTS
A total of 12 reports (7 observational studies and 5 abstracts from conferences) involving 255 patients were included in the analysis. The primary sites of melanoma were cutaneous (n=22; 8.6%), ocular (n=197; 77.3%), rectal (n=3; 1.2%), and unknown (n=33; 12.9%). The median disease control rate at 3 months was 73.6% (range, 58.3%-88.9%). Among the 207 patients for whom tumor response at 3 months was reported, complete response was seen in 1.0% (2/207), partial response was seen in 19.3% (40/207), stable disease was seen in 46.9% (97/207), and progressive disease was seen in 32.9% (68/207). The median survival was 10 months (range, 7-13.4 months), and the median 1-year survival rate was 34.6% (range, 23%-80%). Complications of Y radioembolization were reported in 13 cases. The most common side effects were fatigue (median, 36.1%), abdominal pain (median, 17.8%), and nausea (median, 15.0%).
CONCLUSIONS
Y radioembolization is a promising alternative therapy for the treatment of unresectable liver metastases of melanoma, with encouraging effects on disease control and survival. Some complications can occur, and side effects are frequent but mild.
Topics: Abdominal Pain; Aged; Brachytherapy; Embolization, Therapeutic; Female; Humans; Liver Neoplasms; Male; Melanoma; Middle Aged; Nausea; Radiopharmaceuticals; Skin Neoplasms; Survival Rate; Treatment Outcome; Yttrium Radioisotopes
PubMed: 28624008
DOI: 10.1016/j.ejrad.2017.05.005 -
Infection Aug 2022To estimate the central tendency and dispersion for incubation period of COVID-19 and, in turn, assess the effect of a certain length of quarantine for close contacts in... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To estimate the central tendency and dispersion for incubation period of COVID-19 and, in turn, assess the effect of a certain length of quarantine for close contacts in active monitoring.
METHODS
Literature related to SARS-CoV-2 and COVID-19 was searched through April 26, 2020. Quality was assessed according to Agency for Healthcare Research and Quality guidelines. Log-normal distribution for the incubation period was assumed to estimate the parameters for each study. Incubation period median and dispersion were estimated, and distribution was simulated.
RESULTS
Fifty-six studies encompassing 4095 cases were included in this meta-analysis. The estimated median incubation period for general transmissions was 5.8 days [95% confidence interval (95% CI): 5.3, 6.2]. Incubation period was significantly longer for asymptomatic transmissions (median: 7.7 days; 95% CI 6.3, 9.4) than for general transmissions (P = 0.0408). Median and dispersion were higher for SARS-CoV-2 incubation compared to other viral respiratory infections. Furthermore, about 12 in 10,000 contacts in active monitoring would develop symptoms after 14 days, or below 1 in 10,000 for asymptomatic transmissions. Meta-regression suggested that each 10-year increase in age resulted in an average 16% increment in length of median incubation (incubation period ratio, 1.16, 95% CI 1.01, 1.32; P = 0.0250).
CONCLUSION
This study estimated the median and dispersion of the SARS-CoV-2 incubation period more precisely. A 14-day quarantine period is sufficient to trace and identify symptomatic infections.
Topics: COVID-19; Humans; Quarantine; SARS-CoV-2; United States
PubMed: 34409563
DOI: 10.1007/s15010-021-01682-x