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Graefe's Archive For Clinical and... Dec 2022Ophthalmic surgery involves the manipulation of micron-level sized structures such as the internal limiting membrane where tactile sensation is practically absent. All... (Review)
Review
PURPOSE
Ophthalmic surgery involves the manipulation of micron-level sized structures such as the internal limiting membrane where tactile sensation is practically absent. All humans have physiologic tremors that are of low amplitude and not discernible to the naked eye; they do not adversely affect the majority of the population's daily functioning. However, during microsurgery, such tremors can be problematic. In this review, we focus on the impact of physiological tremors on ophthalmic microsurgery and offer a comparative discussion on the impact of such tremors on other surgical specialties.
METHODS
A single investigator used the MEDLINE database (via PubMed) to search for and identify articles for inclusion in this systematic review. Ten key factors were identified as potentially having an impact on tremor amplitude: beta-blockers, muscle fatigue, robotic systems, handheld tools/micromanipulators, armrests/wrist supports, caffeine, diet, sleep deprivation, consuming alcohol, and workouts (exercise). These key terms were then searched using the advanced Boolean search tool and operators (i.e., AND, OR) available on PubMed: (*keyword*) AND (surgeon tremor OR microsurgery tremor OR hand steadiness OR simulator score).
RESULTS
Ten studies attempted to quantify the baseline severity of operator physiologic tremor. Approximately 89% of studies accessing the impact of tremors on performance in regards to surgical metrics reported an improvement in performance compared to 57% of studies concluding that tremor elimination was of benefit when considering procedural outcomes.
CONCLUSIONS
Robotic technology, new instruments, exoskeletons, technique modifications, and lifestyle factors have all demonstrated the potential to assist in overcoming tremors in ophthalmology.
Topics: Humans; Tremor; Ophthalmology; Microsurgery; Robotics; Caffeine
PubMed: 35788893
DOI: 10.1007/s00417-022-05718-2 -
Sports Medicine (Auckland, N.Z.) Feb 2017Lower body positive pressure treadmills (LBPPTs) aim to reduce musculoskeletal loading during running. As LBPPTs have become more commercially available, they have... (Review)
Review
BACKGROUND
Lower body positive pressure treadmills (LBPPTs) aim to reduce musculoskeletal loading during running. As LBPPTs have become more commercially available, they have become integrated into athletic performance and clinical rehabilitation settings. Consequentially, published research examining the biomechanical and physiological responses to unweighted running has increased.
OBJECTIVE
The purpose of this systematic review was to synthesize the literature in an attempt to provide researchers and clinicians with a comprehensive review of physiologic and biomechanical responses to LBPPT running.
METHODS
Through a generic search of PubMed, CINAHL, MEDLINE, and SPORTDiscus using a comprehensive list of search terms related to LBPPT, unweighting, and body weight support during running, we identified all peer-reviewed publications that included LBPPT running. Two reviewers independently evaluated the quality of studies using a modified Downs and Black checklist for non-randomized studies.
RESULTS
A total of 15 articles met the inclusion criteria for this review. Peak and active vertical ground-reaction forces were consistently reduced with unweighting, but regional loading within the foot was also altered towards a forefoot strike. LBPPTs also provide some horizontal assistance. Neuromuscular activation is generally reduced with LBPPTs, but the stabilizer muscle groups may respond differently than the propulsive muscle groups. Submaximal heart rate and volume oxygen consumption are reduced with unweighting, but physiologic response remains generally unchanged at maximal intensities.
CONCLUSIONS
The current literature suggests that LBPPTs are effective in allowing individuals to achieve a given metabolic stimulus with reduced musculoskeletal loading. However, LBPPTs not only reduce impact but also change neuromuscular activation and biomechanics in a complex manner. Thus, clinicians must account for the specific biomechanical and physiological alterations induced by LBPPTs when designing training programs and rehabilitation protocols.
Topics: Biomechanical Phenomena; Exercise Test; Foot; Healthy Volunteers; Humans; Pressure; Running
PubMed: 27380101
DOI: 10.1007/s40279-016-0581-2 -
Neurosurgical Review Jun 2022Elevated intracranial pressure (ICP) with reduced cerebral perfusion pressure is a well-known cause of secondary brain injury. Previously, there have been some reports... (Meta-Analysis)
Meta-Analysis Review
Elevated intracranial pressure (ICP) with reduced cerebral perfusion pressure is a well-known cause of secondary brain injury. Previously, there have been some reports describing different supra- and infratentorial ICP measurements depending on the location of the mass effect. Therefore, we aimed to perform a systematic review and meta-analysis to clarify the issue of optimal ICP monitoring in the infratentorial mass lesion. A literature search of electronic databases (PUBMED, EMBASE) was performed from January 1969 until February 2021 according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Two assessors are independently screened for eligible studies reporting the use of simultaneous ICP monitoring in the supra- and infratentorial compartments. For quality assessment of those studies, the New Castle Ottawa Scale was used. The primary outcome was to evaluate the value of supra- and infratentorial ICP measurement, and the secondary outcome was to determine the time threshold until equalization of both values. Current evidence surrounding infratentorial ICP measurement was found to be low to very low quality according to New Castle Ottawa Scale. Eight studies were included in the systematic review, four of them containing human subjects encompassing 27 patients with infratentorial pathology. The pooled data demonstrated significantly higher infratentorial ICP values than supratentorial ICP values 12 h after onset (p < 0.05, 95% CI 3.82-5.38) up to 24 h after onset (p < 0.05; CI 1.14-3.98). After 48-72 h, both ICP measurements equilibrated showing no significant difference. Further, four studies containing 26 pigs and eight dogs showed a simultaneous increase of supra- and infratentorial ICP value according to the increase of supratentorial mass volume; however, there was a significant difference towards lower ICP in the infratentorial compartment compared to the supratentorial compartment. The transtentorial gradient leads to a significant discrepancy between supra- and infratentorial ICP monitoring. Therefore, infratentorial ICP monitoring is warranted in case of posterior fossa lesions for at least 48 h.
Topics: Animals; Cerebrovascular Circulation; Dogs; Humans; Intracranial Hypertension; Intracranial Pressure; Monitoring, Physiologic; Skull; Swine
PubMed: 35118578
DOI: 10.1007/s10143-022-01746-y -
International Journal of Surgery... Sep 2016The marked improvements in medical technology and healthcare, lead an increasing number of elderly patients to take advantage of even complex surgical. Recently,... (Review)
Review
OBJECTIVE
The marked improvements in medical technology and healthcare, lead an increasing number of elderly patients to take advantage of even complex surgical. Recently, laparoscopic surgery has been accepted as a minimally invasive treatment to reduce the morbidity after conventional surgery, and a number of studies have demonstrated the feasibility of laparoscopy with significant advantages also in the elderly. On the other side, the laparoscopic procedure has some drawbacks, including prolonged operation time and impact of carbon dioxide pneumoperitoneum on circulatory and respiratory dynamics. This paper will review the physiopathological implications of laparoscopy, as well as the current literature concerning the most common laparoscopic procedures that are increasingly performed in elderly patients.
MATERIALS AND METHODS
A systematic review of the current literature was performed using the search engines EMBASE and PubMed to identify all studies reporting the physiopathological implications of laparoscopy in the elderly. The MeSH search terms used were "laparoscopy in the elderly", "physiopathology of laparoscopy", and "pneumoperitoneum". Multiple combinations of the keywords and MeSH terms were used with particular reference to elderly patients.
RESULTS
Although laparoscopy is minimally invasive in its dissection techniques, the increased physiologic demands present particular challenges among elderly patients.
CONCLUSIONS
Laparoscopy and its safety in the elderly patients remains a challenge and the evaluation of this approach is therefore mandatory. Although many studies have demonstrated the applicability and advantages of the laparoscopy also in the geriatric population, with low rates of morbidity and mortality, in elderly patients undergoing general surgical procedures the physiologic demands of laparoscopy should be carefully considered.
Topics: Abdominal Wall; Aged; Carbon Dioxide; Health Services for the Aged; Humans; Italy; Laparoscopy; Postoperative Complications
PubMed: 27255126
DOI: 10.1016/j.ijsu.2016.05.044 -
BMJ Open Aug 2021Our recent systematic review determined that remote patient monitoring (RPM) interventions can reduce acute care use. However, effectiveness varied within and between... (Review)
Review
OBJECTIVES
Our recent systematic review determined that remote patient monitoring (RPM) interventions can reduce acute care use. However, effectiveness varied within and between populations. Clinicians, researchers, and policymakers require more than evidence of effect; they need guidance on how best to design and implement RPM interventions. Therefore, this study aimed to explore these results further to (1) identify factors of RPM interventions that relate to increased and decreased acute care use and (2) develop recommendations for future RPM interventions.
DESIGN
Realist review-a qualitative systematic review method which aims to identify and explain why intervention results vary in different situations. We analysed secondarily 91 studies included in our previous systematic review that reported on RPM interventions and the impact on acute care use. Online databases PubMed, EMBASE and CINAHL were searched in October 2020. Included studies were published in English during 2015-2020 and used RPM to monitor an individual's biometric data (eg, heart rate, blood pressure) from a distance.
PRIMARY AND SECONDARY OUTCOME MEASURES
Contextual factors and potential mechanisms that led to variation in acute care use (hospitalisations, length of stay or emergency department presentations).
RESULTS
Across a range of RPM interventions 31 factors emerged that impact the effectiveness of RPM innovations on acute care use. These were synthesised into six theories of intervention success: (1) targeting populations at high risk; (2) accurately detecting a decline in health; (3) providing responsive and timely care; (4) personalising care; (5) enhancing self-management, and (6) ensuring collaborative and coordinated care.
CONCLUSION
While RPM interventions are complex, if they are designed with patients, providers and the implementation setting in mind and incorporate the key variables identified within this review, it is more likely that they will be effective at reducing acute hospital events.
PROSPERO REGISTRATION NUMBER
CRD42020142523.
Topics: Health Services; Health Services Needs and Demand; Hospitalization; Humans; Monitoring, Physiologic; Self-Management
PubMed: 34433611
DOI: 10.1136/bmjopen-2021-051844 -
International Journal of Nursing Studies Nov 2016Processed electroencephalogram-based depth of anaesthesia monitoring devices provide an additional method to monitor level of consciousness during procedural sedation... (Review)
Review
OBJECTIVES
Processed electroencephalogram-based depth of anaesthesia monitoring devices provide an additional method to monitor level of consciousness during procedural sedation and analgesia. The objective of this systematic review was to determine whether using a depth of anaesthesia monitoring device improves the safety and efficacy of sedation.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Electronic databases (CENTRAL; Medline; CINAHL) were searched up to May 2015.
REVIEW METHODS
Randomised controlled trials that compared use of a depth of anaesthesia monitoring device to a control group who received standard monitoring during procedural sedation and analgesia were included. Study selection, data extraction and risk of bias assessment (Cochrane risk of bias tool) were performed by two reviewers. Safety outcomes were hypoxaemia, hypotension and adverse events. Efficacy outcomes were amount of sedation used, duration of sedation recovery and rate of incomplete procedures.
RESULTS
A total of 16 trials (2138 participants) were included. Evidence ratings were downgraded to either low or moderate quality due to study limitations and imprecision. Meta-analysis of 8 trials (766 participants) found no difference in hypoxaemia (RR 0.87; 95% CI=0.67-1.12). No statistically significant difference in hypotension was observed in meta-analysis of 8 trials (RR 0.96; 95% CI=0.54-1.7; 942 participants). Mean dose of propofol was 51mg lower for participants randomised to depth of anaesthesia monitoring (95% CI=-88.7 to -13.3mg) in meta-analysis of results from four trials conducted with 434 participants who underwent interventional endoscopy procedures with propofol infusions to maintain sedation. The difference in recovery time between depth of anaesthesia and standard monitoring groups was not clinically significant (standardised mean difference -0.41; 95% CI=-0.8 to -0.02; I=86%; 8 trials; 809 participants).
CONCLUSIONS
Depth of anaesthesia monitoring did impact sedation titration during interventional procedures with propofol infusions. For this reason, it seems reasonable for anaesthetists to utilise a depth of anaesthesia monitoring device for select populations of patients if it is decided that limiting the amount of sedation would be beneficial for the individual patient. However, there is no need to invest in purchasing extra equipment or training staff who are not familiar with this technology (e.g. nurses who do not routinely use a depth of anaesthesia monitoring device during general anaesthesia) because there is no high quality evidence suggestive of clear clinical benefits for patient safety or sedation efficacy.
Topics: Adult; Analgesia; Anesthesia; Child; Conscious Sedation; Consciousness Monitors; Electroencephalography; Humans; Hypnotics and Sedatives; Hypotension; Hypoxia; Monitoring, Physiologic
PubMed: 27236824
DOI: 10.1016/j.ijnurstu.2016.05.004 -
IEEE Reviews in Biomedical Engineering 2016Human pulse rate (PR) can be estimated in several ways, including measurement instruments that directly count the PR through contact- and noncontact-based approaches.... (Review)
Review
Human pulse rate (PR) can be estimated in several ways, including measurement instruments that directly count the PR through contact- and noncontact-based approaches. Over the last decade, computer-vision-assisted noncontact-based PR estimation has evolved significantly. Such techniques can be adopted for clinical purposes to mitigate some of the limitations of contact-based techniques. However, existing vision-guided noncontact-based techniques have not been benchmarked with respect to a challenging dataset. In view of this, we present a systematic review of such techniques implemented over a uniform computing platform. We have simultaneously recorded the PR and video of 14 volunteers. Five sets of data have been recorded for every volunteer using five different experimental conditions by varying the distance from the camera and illumination condition. Pros and cons of the existing noncontact image- and video-based PR techniques have been discussed with respect to our dataset. Experimental evaluation suggests that image- or video-based PR estimation can be highly effective for nonclinical purposes, and some of these approaches are very promising toward developing clinical applications. The present review is the first in this field of contactless vision-guided PR estimation research.
Topics: Heart Rate; Humans; Monitoring, Physiologic; Signal Processing, Computer-Assisted
PubMed: 27071193
DOI: 10.1109/RBME.2016.2551778 -
Journal of Clinical Monitoring and... Oct 2016Several minimally-invasive technologies are available for cardiac output (CO) measurement in children, but the accuracy and precision of these devices have not yet been... (Meta-Analysis)
Meta-Analysis Review
Several minimally-invasive technologies are available for cardiac output (CO) measurement in children, but the accuracy and precision of these devices have not yet been evaluated in a systematic review and meta-analysis. We conducted a comprehensive search of the medical literature in PubMed, Cochrane Library of Clinical Trials, Scopus, and Web of Science from its inception to June 2014 assessing the accuracy and precision of all minimally-invasive CO monitoring systems used in children when compared with CO monitoring reference methods. Pooled mean bias, standard deviation, and mean percentage error of included studies were calculated using a random-effects model. The inter-study heterogeneity was also assessed using an I(2) statistic. A total of 20 studies (624 patients) were included. The overall random-effects pooled bias, and mean percentage error were 0.13 ± 0.44 l min(-1) and 29.1 %, respectively. Significant inter-study heterogeneity was detected (P < 0.0001, I(2) = 98.3 %). In the sub-analysis regarding the device, electrical cardiometry showed the smallest bias (-0.03 l min(-1)) and lowest percentage error (23.6 %). Significant residual heterogeneity remained after conducting sensitivity and subgroup analyses based on the various study characteristics. By meta-regression analysis, we found no independent effects of study characteristics on weighted mean difference between reference and tested methods. Although the pooled bias was small, the mean pooled percentage error was in the gray zone of clinical applicability. In the sub-group analysis, electrical cardiometry was the device that provided the most accurate measurement. However, a high heterogeneity between studies was found, likely due to a wide range of study characteristics.
Topics: Adolescent; Algorithms; Bias; Cardiac Output; Cardiology; Child; Child, Preschool; Electrophysiology; Female; Humans; Infant; Infant, Newborn; Male; Models, Statistical; Monitoring, Physiologic; Regression Analysis; Reproducibility of Results; Risk
PubMed: 26315477
DOI: 10.1007/s10877-015-9757-9 -
Personality and Social Psychology... May 2017Interpersonal autonomic physiology is defined as the relationship between people's physiological dynamics, as indexed by continuous measures of the autonomic nervous... (Review)
Review
Interpersonal autonomic physiology is defined as the relationship between people's physiological dynamics, as indexed by continuous measures of the autonomic nervous system. Findings from this field of study indicate that physiological activity between two or more people can become associated or interdependent, often referred to as physiological synchrony. Physiological synchrony has been found in both new and established relationships across a range of contexts, and it correlates with a number of psychosocial constructs. Given these findings, interpersonal physiological interactions are theorized to be ubiquitous social processes that co-occur with observable behavior. However, this scientific literature is fragmented, making it difficult to evaluate consistency across reports. In an effort to facilitate more standardized scholarly approaches, this systematic review provides a description of existing work in the area and highlights theoretical, methodological, and statistical issues to be addressed in future interpersonal autonomic physiology research.
Topics: Autonomic Nervous System; Humans; Interpersonal Relations
PubMed: 26921410
DOI: 10.1177/1088868316628405 -
British Journal of Health Psychology Sep 2014This article reviews evidence regarding effects of psychotherapy on overall cancer survival time. Special emphasis is given to research on adverse effects of depression... (Review)
Review
OBJECTIVES
This article reviews evidence regarding effects of psychotherapy on overall cancer survival time. Special emphasis is given to research on adverse effects of depression on cancer survival, breast cancer, and mediating psychophysiological pathways linking psychosocial support to longer survival.
DESIGN
It reviews all published clinical trials addressing effects of psychotherapy on cancer survival, emphasizing depression, breast cancer, and psychophysiological evidence linking stress, depression, and support to cancer survival.
METHODS
Systematic literature review and synthesis.
RESULTS
Eight of 15 published trials indicate that psychotherapy enhances cancer survival time. No studies show an adverse effect of psychotherapy on cancer survival. Potential psychophysiological mechanisms linking stress to shorter survival include dysregulation of diurnal cortisol, increased pro-inflammatory cytokines, reduced natural killer cell activity, shorter telomeres and lower telomerase activity, glucocorticoid-mediated suppression of p53 and BrCA1 gene expression, and sympathetic nervous system activation of vascular endothelial growth factor.
CONCLUSIONS
Stress and support affect the course of cancer progression.
STATEMENT OF CONTRIBUTION
What is known? Stress and support have been thought to be related to cancer risk and progression, but evidence has been mixed. Depression is a natural co-morbid condition with cancer. It has not been clear how stress and support could physiologically affect the rate of cancer progression. Immune function was not thought to have much relevance to cancer progression. Few other physiological mechanisms linking stress to cancer progression were known. What does this paper add? There is evidence from 15 RCTs indicating that effective psychosocial support improves quantity as well as quality of life with cancer. There is evidence that chronic depression predicts poorer prognosis with cancer. Dysregulated circadian cortisol patterns predict more rapid cancer progression. Inflammatory processes affect cancer growth and progression. Sympathetic nervous system activity, telomere length, telomerase activity, and oncogene expression are affected by stress and can affect cancer growth.
Topics: Breast Neoplasms; Female; Humans; Neoplasms; Psychotherapy; Social Support; Survivors
PubMed: 23980690
DOI: 10.1111/bjhp.12061