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Journal of Clinical Nursing Dec 2022To synthesise the effects of music intervention on the physical and psychological problems of adults receiving haemodialysis. (Meta-Analysis)
Meta-Analysis Review
AIMS AND OBJECTIVES
To synthesise the effects of music intervention on the physical and psychological problems of adults receiving haemodialysis.
BACKGROUND
Adults receiving haemodialysis experience many physical and psychological problems. Music interventions may have beneficial effect on the management of these problems.
DESIGN
A systematic review and meta-analysis based on PRISMA 2020.
METHODS
This study followed the Cochrane 2021 guideline. Eleven electronic databases were searched from inception to July 2021. Randomised controlled trials that assessed music intervention on haemodialysis-related physical and psychological problems were included. Two authors independently assessed risk of bias with the Cochrane Collaboration tool. The Comprehensive Meta-Analysis software version 3 was used for meta-analysis.
RESULTS
Sixteen randomised controlled trials were included. This meta-analysis demonstrated that music intervention had significant and large effect on physical outcomes such as breath rate, oxygen saturation, arteriovenous fistula puncture-related pain, itching, sleep quality as well as psychological outcomes such as state anxiety and stress. The study also found that music intervention had significant and medium effect on physical outcomes such as systolic and diastolic blood pressure, heart rate and pain, and psychological outcomes such as anxiety. Music intervention had no effect on physical outcomes such as body temperature and cramps, and psychological outcomes such as trait anxiety and depression. Subgroup analyses indicated that sessions of 4-6 are more effective for improving the systolic and diastolic blood pressure and heart rate than three sessions or less. It also found that music duration of 20 min or less is more effective in reducing anxiety compared to music duration of 30 min or more.
CONCLUSIONS
This study demonstrated that music intervention may partially improve haemodialysis-related physical and psychological problems.
RELEVANCE TO CLINICAL PRACTICE
This study will contribute to perform of music intervention for haemodialysis-related physical and psychological problems for health professionals, particularly nurses.
STUDY REGISTRATION
This study has been registered at PROSPERO (Registration No. CRD42021267463).
Topics: Adult; Humans; Music; Music Therapy; Anxiety; Renal Dialysis; Pain
PubMed: 35118718
DOI: 10.1111/jocn.16199 -
Journal of Vascular Surgery Dec 2020The comparison between paclitaxel-coated balloon (PCB) angioplasty and plain balloon angioplasty (PBA) for hemodialysis (HD) access stenosis or occlusion has not been... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The comparison between paclitaxel-coated balloon (PCB) angioplasty and plain balloon angioplasty (PBA) for hemodialysis (HD) access stenosis or occlusion has not been well investigated. The objectives of this systematic review and meta-analysis were to compare all-cause mortality, HD access primary patency, and circuit primary patency after endovascular maintenance procedures using PCB angioplasty vs PBA.
METHODS
MEDLINE, Embase, and Cochrane Databases were systematically searched to identify all the relevant studies on paclitaxel-coated devices for stenosis or thrombosis of HD access. A random effects model was applied to pool the effect measures. Dichotomous data were presented using an odds ratio (OR). Effect data were presented using pooled hazard ratio (HR) with 95% confidence interval (CI).
RESULTS
A total of 16 studies were included in this meta-analysis, 12 randomized controlled trials and 4 cohort studies involving 1086 patients who underwent endovascular treatment for HD access stenosis or occlusion. All-cause mortality rates at 6, 12, and 24 months after intervention were similar between the PCB and PBA groups (6 months: OR, 1.06 [95% CI, 0.38-2.96; P = .907; I = 19.2%]; 12 months: OR, 1.20 [95% CI, 0.66-2.16; P = .554; I = 0%]; 24 months: OR, 1.43 [95% CI, 0.83-2.45; P = .195; I = 0%]). There was a significant improvement of primary patency in the PCB group compared with the PBA group (HR, 0.47; 95% CI, 0.33-0.69; P < .001; I = 67.3%). This benefit was consistent with the analysis of randomized controlled trials, whereas cohort studies were excluded. Further subgroup analysis of target lesions demonstrated that primary patency was significantly higher in the PCB group than in the PBA group, not only for arteriovenous fistula (HR, 0.54; 95% CI, 0.30-0.98; P = .041; I = 76.8%) but also for central venous stenosis (HR, 0.39; 95% CI, 0.22-0.71; P = .002; I = 0%). The PCB group was associated with higher 6-month (OR, 0.40; 95% CI, 0.27-0.59; P < .001) and 24-month lesion primary patency (OR, 0.28; 95% CI, 0.11-0.72; P = .009) than PBA and was marginally associated with 12-month lesion primary patency (OR, 0.52; 95% CI, 0.26-1.03; P = .06). Circuit primary patency analysis showed a marginal trend toward better outcome in the PCB group (HR, 0.63; 95% CI, 0.40-1.00) but no statistical significance (P = .052).
CONCLUSIONS
This systematic review and meta-analysis demonstrated that PCB angioplasty is associated with significantly improved primary patency of arteriovenous fistula and central venous stenosis for HD access maintenance, with no evidence of increasing all-cause mortality based on short-term and midterm follow-up. Further large cohort study is needed to investigate long-term mortality.
Topics: Aged; Aged, 80 and over; Angioplasty, Balloon; Arteriovenous Shunt, Surgical; Blood Vessel Prosthesis Implantation; Cardiovascular Agents; Coated Materials, Biocompatible; Equipment Design; Female; Graft Occlusion, Vascular; Humans; Male; Middle Aged; Paclitaxel; Recurrence; Renal Dialysis; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Vascular Access Devices; Vascular Patency
PubMed: 32540324
DOI: 10.1016/j.jvs.2020.04.525 -
Journal of Neurointerventional Surgery Sep 2020Despite the recent increase in the number of publications on diagnostic cerebral angiograms using transradial access (TRA), there have been relatively few regarding TRA...
BACKGROUND
Despite the recent increase in the number of publications on diagnostic cerebral angiograms using transradial access (TRA), there have been relatively few regarding TRA for neurointerventional cases. Questions of feasibility and safety may still exist among physicians considering TRA for neurointerventional procedures.
METHODS
A systematic literature review was performed following PRISMA guidelines. Three online databases (MedLine via PubMed, Scopus and Embase) were searched for articles published between January 2000 and December 2019. Search terms included "Transradial access", "Radial Access", "Radial artery" AND "Neurointerventions". The reference lists of selected articles and pertinent available non-systematic analysis were reviewed for other potential citations. Primary outcomes measured were access site complications and crossover rates.
RESULTS
Twenty-one studies (n=1342 patients) were included in this review. Two of the studies were prospective while the remaining 19 were retrospective. Six studies (n=616 patients) included TRA carotid stenting only. The rest of the studies included treatment for cerebral aneurysms (n=423), mechanical thrombectomy (n=127), tumor embolization (n=22), and other indications (n=154) such as angioplasty and stenting for vertebrobasilar stenosis, balloon test occlusion, embolization of dural arteriovenous fistula and arteriovenous malformation, chemotherapeutic drug delivery, intra-arterial thrombolysis, and arterial access during a venous stenting procedure. Two (0.15%) major complications and 37 (2.75%) minor complications were reported. Sixty-four (4.77%) patients crossed over to transfemoral access for completion of the procedure. Seven (0.52%) patients crossed over due to access failure and 57 (4.24%) patients crossed over to TFA due to inability to cannulate the target vessel.
CONCLUSION
This systematic review demonstrates that TRA has a relatively low rate of access site complications and crossovers. With increasing familiarity, development of TRA-specific neuroendovascular devices, and the continued reports of its success in the literature, TRA is expected to become more widely used by neurointerventionalists.
Topics: Angioplasty; Catheterization; Catheterization, Peripheral; Cerebral Angiography; Embolization, Therapeutic; Female; Humans; Intracranial Aneurysm; Male; Neurosurgical Procedures; Prospective Studies; Radial Artery; Randomized Controlled Trials as Topic; Retrospective Studies; Stents
PubMed: 32152185
DOI: 10.1136/neurintsurg-2019-015764 -
The Journal of Vascular Access Feb 2024This study aimed to compare basilic vein tunnel transposition (BVTT) to basilic vein elevation transposition (BVET) technique for superficialization of a basilic... (Review)
Review
This study aimed to compare basilic vein tunnel transposition (BVTT) to basilic vein elevation transposition (BVET) technique for superficialization of a basilic arteriovenous fistula. This is a systematic review and meta-analysis comparing outcomes between BVTT and BVET for brachiobasilic arteriovenous fistula (AVF) creation. Primary endpoints were primary patency at several time intervals during follow-up and postoperative local complications, whereas secondary endpoints included primary assisted patency and secondary patency. A random effects model meta-analysis was conducted, and the statistic was used to assess heterogeneity. Nine eligible studies were identified, including 543 patients (247 in the BVTT group and 296 in the BVET group). BVTT group was associated with inferior primary patency rate at 6 months compared to BVET group (three studies; OR: 0.43; 95% CI: 0.22-0.83; = 0%; = 0.012). However, primary patency rates were similar between the two study groups at 12 months (six studies; OR: 0.64; 95% CI: 0.33-1.22; = 40.7%; = 0.176), and at 24 months (six studies; OR: 0.86; 95% CI: 0.32-2.29; = 74.9%; = 0.764). No significant differences in terms of primary assisted patency, secondary patency, and postoperative complications were detected between the groups. More specifically, wound infection (BVTT: = 9/150; BVET: = 6/186; OR: 1.39; 95% CI: 0.48-4.06; = 0%; = 0.542) and healing of the scar, particularly regarding arm edema (BVTT: = 18/100; BVET: = 27/165; OR: 1.11; 95% CI: 0.57-2.18; = 0%; = 0.755) and hematoma formation (BVTT: = 14/173; BVET: = 42/209; OR: 0.40; 95% CI: 0.13-1.19; = 49%; = 0.101), did not differ significantly between the two study groups. BVET achieved superior primary patency at 6 months compared to BVTT, but this benefit seems to be lost during longer follow-up intervals. Therefore, both surgical techniques provide similar long-term outcomes.
PubMed: 38336667
DOI: 10.1177/11297298241226993 -
Oral Oncology Jan 2023Interventional strategies for dealing with microvascular free flap failure are varied among institutions and even individual surgeons. This systematic review aims to... (Review)
Review
Interventional strategies for dealing with microvascular free flap failure are varied among institutions and even individual surgeons. This systematic review aims to identify the published methods for salvaging a failing free flap and provide surgeons with a comprehensive toolset for successful intervention. A title and abstract search of the PubMed, Embase, and Web of Science databases was performed. 1694 abstracts were screened by three reviewers according to Prisma guidelines. 62 full text articles meeting inclusion criteria detailed techniques which were separated into the categories of thrombectomy, thrombolysis, leech therapy, vascular fistula, and an "other" category outlining techniques which did not fit into the prior framework. Assessment of the efficacy of individual salvage techniques is limited due to limited empirical data, however, the approach to successful salvage should be based on timely identification of flap compromise, followed by the implementation of one or several of the aforementioned techniques.
Topics: Humans; Free Tissue Flaps; Retrospective Studies; Postoperative Complications; Head; Neck; Salvage Therapy
PubMed: 36402054
DOI: 10.1016/j.oraloncology.2022.106246 -
The Journal of Vascular Access May 2020Arteriovenous fistula is the most preferred form of vascular access, but stenosis treated by balloon angioplasty is prone to restenosis. Multiple trials have been... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Arteriovenous fistula is the most preferred form of vascular access, but stenosis treated by balloon angioplasty is prone to restenosis. Multiple trials have been published with regard to the use of paclitaxel-coated balloon to prolong lesion patency compared to conventional balloon. Although paclitaxel-coated balloon has theoretical appeal, its use has not been widespread nationwide due to cost and lack of large-scale multicenter studies. We performed this meta-analysis to evaluate whether paclitaxel-coated balloon outperforms conventional balloon to prolong target lesion patency.
METHODS
PubMed/Medline, Clinical Trials.gov, EMBASE, Scopus, Web of Science, and Cochrane Central were searched from inception through April 2019 for studies that investigated the use of paclitaxel-coated balloon in arteriovenous fistula.
RESULTS
Ten studies were included in the final meta-analysis: six studies were randomized controlled trials and four studies were cohort studies. There were 911 participants with a mean age of 64.78 (±5.96) years, and 61.89% were male. Outcome of interest was target lesion primary patency, recorded at 1, 3, 6, 7, 12, and 24 months. Meta-analysis of randomized controlled trials shows that paclitaxel-coated balloons did not statistically improve target lesion primary patency compared to conventional balloons at months 1 (odds ratio = 1.54, p = 0.6373), 3 (odds ratio = 0.57, p = 0.0575), 6 (odds ratio = 0.65, p = 0.3644), 7 (odds ratio = 0.63, p = 0.0582), 12 (odds ratio = 0.64, p = 0.0612), and 24 (odds ratio = 0.43, p = 0.3452). Effect of paclitaxel-coated balloons was statistically significant for cohort studies at months 6 (odds ratio = 0.26, p = 0.0007), 12 (odds ratio = 0.21, p = 0.0001), and 24 (odds ratio = 0.23, p = 0.01).
CONCLUSION
Paclitaxel-coated balloon showed no statistically significant improvement over conventional balloons in decreasing fistula stenosis in randomized controlled trial but were significant for cohort studies.
Topics: Aged; Angioplasty, Balloon; Arteriovenous Shunt, Surgical; Cardiovascular Agents; Coated Materials, Biocompatible; Equipment Design; Female; Graft Occlusion, Vascular; Humans; Male; Middle Aged; Observational Studies as Topic; Paclitaxel; Randomized Controlled Trials as Topic; Risk Factors; Time Factors; Treatment Outcome; Vascular Patency
PubMed: 31595799
DOI: 10.1177/1129729819878612 -
The Journal of Vascular Access Sep 2020To examine the feasibility of snuffbox arteriovenous fistula as a first option for haemodialysis.
PURPOSE
To examine the feasibility of snuffbox arteriovenous fistula as a first option for haemodialysis.
BACKGROUND
Snuffbox arteriovenous fistula is the most distal native anastomosis possible for haemodialysis access. It was described by Rassat et al. This systematic review evaluates all literature investigating the feasibility and efficiency of performing snuffbox arteriovenous fistula.
METHODS
PubMed, Cochrane Library and Google Scholar were systematically searched for all English articles related to snuffbox arteriovenous fistula. Included studies were appraised using relevant appraisal tools.
RESULTS
Eleven papers were included, one prospective trial and the remaining being retrospective. Two trials compared snuffbox arteriovenous fistula to the standard Cimino-Brescia wrist fistula. Factors predicting success included vessel diameter, diabetes, age <70 years, male gender, palpable radial artery, central venous system patency and surgical technique. Patency rates ranged from 61% to 87% at 1-year follow-up and decreased to 36.3%-87% on longer duration follow-up. Ipsilateral radiocephalic fistula was successfully formed in 45%-100% of snuffbox arteriovenous fistula that failed (average of 73.5%).
CONCLUSION
This is a systematic review investigating snuffbox arteriovenous fistula's efficacy. The current literature is scarce and of poor quality; however, it does reflect that, in the well-selected patient, snuffbox arteriovenous fistula is a good and valid option for first-line haemodialysis. It provides a long segment of vessel for needling and also spares the proximal vessels for future use. Ability to effectively convert to wrist fistula in the event of snuffbox arteriovenous fistula failure provides longevity to native haemodialysis access before prosthetic adjuncts are required. This review provides recommendation for well-constructed randomised controlled trials to help delineate snuffbox arteriovenous fistula efficacy and investigate factors that affect success of these fistulas.
Topics: Aged; Arteriovenous Shunt, Surgical; Female; Graft Occlusion, Vascular; Humans; Male; Renal Dialysis; Risk Factors; Thumb; Treatment Outcome; Vascular Patency
PubMed: 31419923
DOI: 10.1177/1129729819867817 -
Annals of Translational Medicine Mar 2020Proximal femoral fracture (PFF), such as intertrochanteric femoral fracture or femur neck fracture, and its management are crucial issues to surgeons. PFF has been...
BACKGROUND
Proximal femoral fracture (PFF), such as intertrochanteric femoral fracture or femur neck fracture, and its management are crucial issues to surgeons. PFF has been dramatically is becoming exponentially prevalent, and it is at high risk of complication and mortality because it is frequently associated with serious trauma and advanced age, especially in patients treated with anticoagulants or antiplatelet agents. Surgical management is essential for the treatment of PFF. Unfortunately, current surgical procedures have been related to accompanied by vascular complications, including laceration, hemorrhage, thrombosis, embolism, intimal flap tear and pseudoaneurysm. Furthermore, these vascular injuries following surgical management of PFF are potentially limb- and life-threatening. Of the complications after operation of PFF, femoral arteriovenous fistula (AVF) is rare, but remains a challenging problem because it is frequently associated with significantly high mortality and morbidity and is very difficult to treat.
METHODS
A systematic literature review was conducted using the PRISMA guidelines with no language restriction. We searched scientific publications via PubMed, Embase, Cochrane central register of controlled trial, Google Scholar, the KoreaMed and the Research Information Sharing Service database. The goal of this study was to report on the incidence, clinical presentation, diagnosis, treatment, associated complications, morbidity and mortality of femoral AVF caused by PFF and to draw special attention to its prevention and management.
RESULTS
A total of 7 case reports on femoral AVF associated with operation of PFF were identified, and one our case was added to the systematic analysis. Of the 8 cases, 4 were male and 4 were female under the age of 67.87±18.44; 6 (75.0%) survived without any events, 1 (12.5%) survived with a sequela of peroneal nerve impairment, and 1 (12.5%) died of multi-organ failure and hypovolemia.
CONCLUSIONS
The incidence of femoral AVF associated with PFF is extremely low, though it appears to increase with the rising frequency of PFF. With a very few exceptions, complications following internal fixation are potentially limb- and life-threatening. There is still no definite consensus on the standardized diagnostic or therapeutic modalities. Therefore, surgeons should keep in mind that this serious complication requires early diagnosis and prompt treatment, which should not be underestimated. Femoral AVF following operation of PFF should be meticulously managed, because untreated fistulae result in serious unexpected complications including renin-mediated hypertension, high-output heart failure and venous and/or arterial insufficiency. Surgical treatment is still the gold standard for such cases, but in limited cases endovascular procedures using embolization and closure device can be a good treatment option.
PubMed: 32355735
DOI: 10.21037/atm.2020.03.08 -
Annals of Translational Medicine Mar 2023Balloon angioplasty could decrease restenosis of hemodialysis vascular access. The present study investigated the comparative effects and safety of commonly available...
Comparative efficacy and safety of four common balloon angioplasty techniques for an arteriovenous fistula or graft stenosis: a systematic review and network meta-analysis of randomized controlled trials.
BACKGROUND
Balloon angioplasty could decrease restenosis of hemodialysis vascular access. The present study investigated the comparative effects and safety of commonly available balloon angioplasty techniques for treating patients with failing autogenous arteriovenous fistulas (AVFs) and grafts (AVGs) stenosis.
METHODS
A comprehensive literature search, including an updated search of PubMed and Embase (via Ovid) and screening of published meta-analyses, was conducted. Primary patency at 6 and 12 months was the primary outcome, and the incidence of complications was the secondary outcome. The random-effects model was used to conduct all statistical analyses, which were performed using RevMan 5.3 and ADDIS 1.16.8.
RESULTS
A total of 20 eligible studies involving four balloon angioplasty techniques were entered into the final analysis. Although the direct meta-analysis indicated that cutting balloon angioplasty (CtBA) significantly improved primary patency at 6 [odds ratio (OR), 1.91; 95% confidence interval (CI): 1.27 to 2.86] and 12 (OR, 1.56; 95% CI: 1.13 to 2.15) months compared with conventional balloon angioplasty (CBA), this was not supported by network meta-analysis, which suggested that CtBA was associated with a higher risk of complications compared with drug-coated balloon angioplasty (DcBA) [OR, 0.05; 95% credible interval (CrI): 0.00 to 0.83], high-pressure balloon angioplasty (HBA) (OR, 0.04; 95% CrI: 0.00 to 0.69), and CBA (OR, 0.11; 95% CrI: 0.02 to 0.59). Subgroup analysis of AVFs did not detect any significant differences.
CONCLUSIONS
In failing AVF and AVG stenosis, HBA might be a preferential option as it is related to a lower risk of complications and has numerically higher primary patency than DcBA and CBA. Further studies are needed to confirm these findings.
PubMed: 37082662
DOI: 10.21037/atm-22-381 -
Annals of Vascular Surgery Nov 2022For arteriovenous fistula (AVF) presence of a venous segment with adequate diameter is essential which is lacking in many patients. To find the optimal augmentation... (Meta-Analysis)
Meta-Analysis Review
Primary Balloon Angioplasty Versus Hydrostatic Dilation for Arteriovenous Fistula Creation in Patients with Small-Caliber Cephalic Veins: A Systematic Review and Meta-Analysis.
BACKGROUND
For arteriovenous fistula (AVF) presence of a venous segment with adequate diameter is essential which is lacking in many patients. To find the optimal augmentation technique in patients with small-caliber cephalic vein (i.e., cephalic vein diameter <3 mm), studies compared primary balloon angioplasty (PBA) versus hydrostatic dilation (HD); however, it remained debatable. This systematic review seeks to determine which technique is preferable.
METHODS
We searched MEDLINE, PubMed, Embase, and Google Scholar. Primary outcomes were 6-month primary patency, reintervention, and working AVF. Secondary outcomes were immediate success, the AVF's maturation time (day), and surgical site infection.
RESULTS
Three randomized controlled trials yielding 180 patients were included, of which 89 patients were in the PBA group. The odds ratio (OR) of primary patency was significantly higher in the PBA group (OR 6.09, 95% confidence interval [CI], 2.36-15.76, P = 0.0002), the OR of reintervention was significantly lower in the PBA group (OR 0.16, 95% CI, 0.06-0.42, P = 0.0002), and the OR of working AVF was greater in PBA group (OR 4.22, 95% CI, 1.31-13.59, P = 0.02). The OR of immediate success was significantly greater in the PBA group (OR 11.42, 95% CI, 2.54-51.42, P = 0.002), and the AVF maturation time was significantly shorter in patients who underwent PBA (mean difference -20.32 days, 95% CI, -30.12 to -10.52, P = 0.0001). The certainty of the evidence was high.
CONCLUSIONS
PBA of small cephalic veins with diameter ≤2.5 cm is a safe, feasible, and efficacious augmentation method for AVF creation. This technique achieves favorable maturation outcomes, and PBA is superior to the standard hydrostatic dilatation technique.
Topics: Humans; Arteriovenous Shunt, Surgical; Dilatation; Renal Dialysis; Treatment Outcome; Angioplasty, Balloon; Arteriovenous Fistula; Dilatation, Pathologic; Vascular Patency; Randomized Controlled Trials as Topic
PubMed: 36029949
DOI: 10.1016/j.avsg.2022.07.025