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Diabetes/metabolism Research and Reviews Mar 2020Prevention of foot ulcers in patients with diabetes is important to help reduce the substantial burden on both patient and health resources. A comprehensive analysis of...
Prevention of foot ulcers in patients with diabetes is important to help reduce the substantial burden on both patient and health resources. A comprehensive analysis of reported interventions is needed to better inform healthcare professionals about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to help prevent both first and recurrent foot ulcers in persons with diabetes who are at risk for this complication. We searched the available medical scientific literature in PubMed, EMBASE, CINAHL, and the Cochrane databases for original research studies on preventative interventions. We screened trial registries for additional studies not found in our search and unpublished trials. Two independent reviewers assessed data from controlled studies for methodological quality, and extracted and presented this in evidence and risk of bias tables. From the 13,490 records screened, 35 controlled studies and 46 non-controlled studies were included. Few controlled studies, which were of generally low to moderate quality, were identified on the prevention of a first foot ulcer. For the prevention of recurrent plantar foot ulcers, there is benefit for the use of daily foot skin temperature measurements, and for therapeutic footwear with demonstrated plantar pressure relief, provided it is consistently worn by the patient. For prevention of ulcer recurrence, there is some evidence for providing integrated foot care, and no evidence for a single session of education.Surgical interventions have been shown effective in selected patients, but the evidence base is small. Foot-related exercises do not appear to prevent a first foot ulcer. A small increase in the level of weight-bearing daily activities does not seem to increase the risk for foot ulceration. The evidence base to support the use of specific self-management and footwear interventions for the prevention of recurrent plantar foot ulcers is quite strong. The evidence is weak for the use of other, sometimes widely applied, interventions, and is practically non-existent for the prevention of a first foot ulcer and non-plantar foot ulcer.
Topics: Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Foot; Disease Management; Humans; Patient Compliance; Patient Education as Topic; Practice Guidelines as Topic; Practice Patterns, Physicians'
PubMed: 31957213
DOI: 10.1002/dmrr.3270 -
JAMA Jun 2022Cardiovascular disease and cancer are the 2 leading causes of death in the US, and vitamin and mineral supplementation has been proposed to help prevent these conditions.
Vitamin and Mineral Supplements for the Primary Prevention of Cardiovascular Disease and Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.
IMPORTANCE
Cardiovascular disease and cancer are the 2 leading causes of death in the US, and vitamin and mineral supplementation has been proposed to help prevent these conditions.
OBJECTIVE
To review the benefits and harms of vitamin and mineral supplementation in healthy adults to prevent cardiovascular disease and cancer to inform the US Preventive Services Task Force.
DATA SOURCES
MEDLINE, PubMed (publisher-supplied records only), Cochrane Library, and Embase (January 2013 to February 1, 2022); prior reviews.
STUDY SELECTION
English-language randomized clinical trials (RCTs) of vitamin or mineral use among adults without cardiovascular disease or cancer and with no known vitamin or mineral deficiencies; observational cohort studies examining serious harms.
DATA EXTRACTION AND SYNTHESIS
Single extraction, verified by a second reviewer. Quantitative pooling methods appropriate for rare events were used for most analyses.
MAIN OUTCOMES AND MEASURES
Mortality, cardiovascular disease events, cancer incidence, serious harms.
RESULTS
Eighty-four studies (N=739 803) were included. In pooled analyses, multivitamin use was significantly associated with a lower incidence of any cancer (odds ratio [OR], 0.93 [95% CI, 0.87-0.99]; 4 RCTs [n=48 859]; absolute risk difference [ARD] range among adequately powered trials, -0.2% to -1.2%) and lung cancer (OR, 0.75 [95% CI, 0.58-0.95]; 2 RCTs [n=36 052]; ARD, 0.2%). However, the evidence for multivitamins had important limitations. Beta carotene (with or without vitamin A) was significantly associated with an increased risk of lung cancer (OR, 1.20 [95% CI, 1.01-1.42]; 4 RCTs [n=94 830]; ARD range, -0.1% to 0.6%) and cardiovascular mortality (OR, 1.10 [95% CI, 1.02-1.19]; 5 RCTs [n=94 506] ARD range, -0.8% to 0.8%). Vitamin D use was not significantly associated with all-cause mortality (OR, 0.96 [95% CI, 0.91-1.02]; 27 RCTs [n=117 082]), cardiovascular disease (eg, composite cardiovascular disease event outcome: OR, 1.00 [95% CI, 0.95-1.05]; 7 RCTs [n=74 925]), or cancer outcomes (eg, any cancer incidence: OR, 0.98 [95% CI, 0.92-1.03]; 19 RCTs [n=86 899]). Vitamin E was not significantly associated with all-cause mortality (OR, 1.02 [95% CI, 0.97-1.07]; 9 RCTs [n=107 772]), cardiovascular disease events (OR, 0.96 [95% CI, 0.90-1.04]; 4 RCTs [n=62 136]), or cancer incidence (OR, 1.02 [95% CI, 0.98-1.08]; 5 RCTs [n=76 777]). Evidence for benefit of other supplements was equivocal, minimal, or absent. Limited evidence suggested some supplements may be associated with higher risk of serious harms (hip fracture [vitamin A], hemorrhagic stroke [vitamin E], and kidney stones [vitamin C, calcium]).
CONCLUSIONS AND RELEVANCE
Vitamin and mineral supplementation was associated with little or no benefit in preventing cancer, cardiovascular disease, and death, with the exception of a small benefit for cancer incidence with multivitamin use. Beta carotene was associated with an increased risk of lung cancer and other harmful outcomes in persons at high risk of lung cancer.
Topics: Adult; Advisory Committees; Cardiovascular Diseases; Dietary Supplements; Humans; Lung Neoplasms; Minerals; Neoplasms; Primary Prevention; United States; Vitamin A; Vitamins; beta Carotene
PubMed: 35727272
DOI: 10.1001/jama.2021.15650 -
British Journal of Sports Medicine Nov 2022To evaluate the effectiveness of interventions to prevent and manage knee injuries in runners. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the effectiveness of interventions to prevent and manage knee injuries in runners.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
MEDLINE, EMBASE, CINAHL, Web of Science and SPORTDiscus up to May 2022.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Randomised controlled trials (RCTs) with a primary aim of evaluating the effectiveness of intervention(s) to prevent or manage running-related knee injury.
RESULTS
Thirty RCTs (18 prevention, 12 management) analysed multiple interventions in novice and recreational running populations. Low-certainty evidence (one trial, 320 participants) indicated that running technique retraining (to land softer) reduced the risk of knee injury compared with control treadmill running (risk ratio (RR) 0.32, 95% CI 0.16 to 0.63). Very low-certainty to low-certainty evidence from 17 other prevention trials (participant range: 24 -3287) indicated that various footwear options, multicomponent exercise therapy, graduated running programmes and online and in person injury prevention education programmes did not influence knee injury risk (RR range: 0.55-1.06). In runners with patellofemoral pain, very low-certainty to low-certainty evidence indicated that running technique retraining strategies, medial-wedged foot orthoses, multicomponent exercise therapy and osteopathic manipulation can reduce knee pain in the short-term (standardised mean difference range: -4.96 to -0.90).
CONCLUSION
There is low-certainty evidence that running technique retraining to land softer may reduce knee injury risk by two-thirds. Very low-certainty to low-certainty evidence suggests that running-related patellofemoral pain may be effectively managed through a variety of active (eg, running technique retraining, multicomponent exercise therapy) and passive interventions (eg, foot orthoses, osteopathic manipulation).
PROSPERO REGISTRATION NUMBER
CRD42020150630.
Topics: Humans; Exercise Therapy; Knee Injuries; Knee Joint; Patellofemoral Pain Syndrome; Running; Randomized Controlled Trials as Topic
PubMed: 36150753
DOI: 10.1136/bjsports-2022-105553 -
Revista Da Escola de Enfermagem Da U S P 2020To investigate whether the adoption of upright positions by women during childbirth prevents perineal lacerations compared to the lithotomy position. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate whether the adoption of upright positions by women during childbirth prevents perineal lacerations compared to the lithotomy position.
METHOD
A systematic review with meta-analysis. The searches were carried out in the databases: LILACS, Medline/PubMed, CINAHL, Cochrane Library, Web of Science, Science Direct and Scopus. Searches in the gray literature were conducted on Google Scholar and OpenGrey databases. Reference lists of included articles were also considered. The Cochrane collaboration tool and ACROBAT-NRSI were used to analyze the methodological quality of the articles.
RESULTS
There were 26 studies listed and 8 were selected for the meta-analysis. The level of scientific evidence was classified by the GRADE System and considered high. There was no statistically significant difference between upright positions in relation to horizontal positions. Despite this finding, the upright positions showed reduced rates of severe perineal lacerations.
CONCLUSION
Adopting upright positions in normal delivery can be encouraged by professionals as it can prevent severe perineal lacerations; however, it is not possible to accurately affirm their effectiveness to the detriment of horizontal positions for an intact perineum outcome.
Topics: Delivery, Obstetric; Female; Humans; Lacerations; Parturition; Patient Positioning; Perineum; Pregnancy
PubMed: 32935765
DOI: 10.1590/S1980-220X2018027503610 -
Intensive & Critical Care Nursing Feb 2023Intensive care unit-acquired weakness is a frequent problem that develops as a secondary disorder while patients are suffering from life-threatening conditions. This... (Review)
Review
Effectiveness of physical exercise and neuromuscular electrical stimulation interventions for preventing and treating intensive care unit-acquired weakness: A systematic review of randomized controlled trials.
OBJECTIVE
Intensive care unit-acquired weakness is a frequent problem that develops as a secondary disorder while patients are suffering from life-threatening conditions. This study aimed to evaluate the effectiveness of physical exercise or neuromuscular electrical stimulation interventions on (i) preventing loss of muscle mass and weakness in critically ill patients admitted to intensive care units; (ii) recovering patients discharged from the intensive care unit with acquired weakness.
METHODS
A systematic review of randomized controlled trials was carried out, with studies identified in PubMed, Scopus, and Web of Science. The studies included assessed muscle mass and muscle strength, and performed a time × group analysis of effects. The risk of bias assessment was performed using the Revised Cochrane risk-of-bias tool for randomized trials.
RESULTS
Six trials with low risk of bias examined muscle mass, muscle strength, and functionality in 182 adult patients. In critically ill patients admitted to intensive care units, both neuromuscular electrical stimulation and bed/chair cycling for five to ten days prevented significant muscle loss. neuromuscular electrical stimulation in lower and upper limbs resulted in a significant reduction in the length of the hospitalization. In addition, cycle ergometer increased muscle strength and functionality. In patients discharged from the intensive care unit with acquired weakness, both neuromuscular electrical stimulation and physical exercise interventions increased muscle strength, but only physical exercise increased functionality.
CONCLUSIONS
Physical exercise and neuromuscular electrical stimulation interventions prevent excessive muscle mass loss in critically ill patients admitted to the intensive care unit and increase muscle strength in patients discharged from the intensive care unit with acquired weakness. Physical exercise seems more adequate for improving functionality.
Topics: Adult; Humans; Muscle Weakness; Randomized Controlled Trials as Topic; Intensive Care Units; Critical Illness; Exercise; Electric Stimulation
PubMed: 36283894
DOI: 10.1016/j.iccn.2022.103333 -
JAMA Aug 2023Neural tube defects are among the most common birth defects in the US.
IMPORTANCE
Neural tube defects are among the most common birth defects in the US.
OBJECTIVE
To review new evidence on the benefits and harms of folic acid supplementation for the prevention of neural tube defects to inform the US Preventive Services Task Force.
EVIDENCE REVIEW
Sources included PubMed, Cochrane Library, Embase, and trial registries from July 1, 2015, through July 2, 2021; references; and experts, with surveillance through February 10, 2023. Two investigators independently reviewed English-language randomized studies and nonrandomized cohort studies in very highly developed countries that focused on the use of folic acid supplementation for the prevention of neural tube defect-affected pregnancies; methodological quality was dually and independently assessed.
FINDINGS
Twelve observational studies (reported in 13 publications) were eligible for this limited update (N = 1 244 072). Of these, 3 studies (n = 990 372) reported on the effect of folic acid supplementation on neural tube defects. For harms, 9 studies were eligible: 1 randomized clinical trial (n = 431) reported on variations in twin delivery, 7 observational studies (n = 761 125) reported on the incidence of autism spectrum disorder, and 1 observational study (n = 429 004) reported on maternal cancer. Two cohort studies and 1 case-control study newly identified in this update reported on the association between folic acid supplementation and neural tube defects (n = 990 372). One cohort study reported a statistically significant reduced risk of neural tube defects associated with folic acid supplementation taken before pregnancy (adjusted relative risk [aRR], 0.54 [95% CI, 0.31-0.91]), during pregnancy (aRR, 0.62 [95% CI, 0.39-0.97]), and before and during pregnancy (aRR, 0.49 [95% CI, 0.29-0.83]), but this association occurred for only the later of 2 periods studied (2006-2013 and not 1999-2005). No other statistically significant benefits were reported overall. No study reported statistically significant harms (multiple gestation, autism, and maternal cancer) associated with pregnancy-related folic acid exposure.
CONCLUSIONS AND RELEVANCE
New evidence from observational studies provided additional evidence of the benefit of folic acid supplementation for preventing neural tube defects and no evidence of harms related to multiple gestation, autism, or maternal cancer. The new evidence was consistent with previously reviewed evidence on benefits and harms.
Topics: Female; Humans; Pregnancy; Autism Spectrum Disorder; Dietary Supplements; Folic Acid; Neural Tube Defects; Randomized Controlled Trials as Topic; Pregnancy Complications; Risk; Preconception Care; Prenatal Care
PubMed: 37526714
DOI: 10.1001/jama.2023.9864 -
International Journal of Nursing Studies Feb 2020Pressure injuries are potentially preventable but frequently occurring adverse events. Intensive care patients have major risk factors for pressure injury with a...
BACKGROUND
Pressure injuries are potentially preventable but frequently occurring adverse events. Intensive care patients have major risk factors for pressure injury with a reported pressure injury prevalence of 12-33%. Multi-faceted interventions, also known as programs or care bundles, are recommended to prevent pressure injuries.
AIM
This systematic review evaluated the effectiveness of pressure injury prevention programs in reducing pressure injury prevalence and incidence in the adult intensive care population. It also critically appraised the program components and strategies used to implement these programs.
METHOD
We searched PubMed, EMBASE (embase.com), Ovid MEDLINE, EBSCOhost CINAHL, and Cochrane Library databases separately for papers published in English and Chinese from the year of 2000 to May 2018. After removing duplicates, two authors independently screened the title and abstracts, then full-text against the inclusion and exclusion criteria. Data was extracted by one author and checked by a second author. Quality appraisal was conducted by two authors by using the Quality Improvement Minimum Quality Criteria Set, and the Mixed Methods Appraisal Tool. Content analysis was used to categorise program components. Implementation strategies were grouped into six classifications: dissemination strategies, implementation process strategies, integration strategies, capacity building strategies, sustainability strategies, and scale up strategies.
RESULTS
Twenty-one peer reviewed papers (12 quality improvement projects, and 9 research papers from 8 studies) were included. Pressure injury prevention programs with 2-11 components were commonly implemented. Common components of the programs included: clarification of staff roles, introducing new roles, repositioning, staff and patient education, support surfaces use, pressure injury risk assessment, skin assessment, nutrition needs assessment, documentation, multidisciplinary team involvement, and mobilisation. Implementation strategies commonly used were education, audit and feedback, and standardising documentation. Five of the eight research studies and one of the quality improvement projects reported significant decrease in pressure injury prevalence, and/or increase in compliance to pressure injury prevention protocols and strategies. Two quality improvement papers reported cost savings of $1 million and £2.6 million respectively after the implementation of the programs.
CONCLUSION
Much of the work on multicomponent pressure injury prevention programs has been undertaken as quality improvement projects and before and after research studies with limited rigour. However, positive outcomes and strong theoretical rationales for the components in the programs suggest that they are beneficial. This calls for future high-quality research such as randomised controlled trials to test the effectiveness of multicomponent interventions and their implementation strategies. Tweetable abstract: Some multicomponent pressure injury prevention programs were found to be effective; however, higher level of research evidence is needed.
Topics: Adult; Combined Modality Therapy; Critical Care; Guideline Adherence; Humans; Pressure Ulcer; Quality Improvement; Risk Factors
PubMed: 31835122
DOI: 10.1016/j.ijnurstu.2019.103483 -
Evidence-based Dentistry Sep 2023This study was a systematic review conducted in accordance with the Transparent Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature... (Meta-Analysis)
Meta-Analysis
DATA SOURCES
This study was a systematic review conducted in accordance with the Transparent Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was undertaken using eleven databases including PubMed, Embase, Web of Sciences, The Cochrane Library, Ovid, Scopus, Sinomed, Sciencedirect, China National Knowledge Infrastructure (CNKI), Wanfang and Technology Periodicals Database (VIP). Additional studies were identified by searching the references of these studies. The search time was from inception to April 2022.
STUDY SELECTION
The population, intervention, comparison and outcomes were considered. The level of evidence was limited to relevant randomised control trials (RCT) that answered the questions defined in this review.
DATA EXTRACTION AND SYNTHESIS
Screening of eligible studies was conducted by two independent reviewers. Data was extracted using a standardised form which included information about the type of research, population, sample size of experimental group and control group, outcome measurements and results. Bias risk and evidence quality assessment were also assessed. Where appropriate, standard meta-analysis techniques were used to pool study results. The statistical analysis was performed using the RevMan5.4 software and the Stata16. Sensitivity analysis was performed on the combined analysis results.
RESULTS
A total of 17 RCTs were identified to meet the eligibility criteria. The trials lasted between 2 and 24 weeks and were published after 2000. The studies encompassed 3781 preschool children divided into an experimental group (n = 2047) and a control group (n = 1734). The meta-analysis highlighted that incidence of dental caries could be prevented by probiotics. Caries incidence in preschool children was reduced in the Lactobacillus rhamnosus group. Streptococcus Mutans (S.mutans) count in saliva could be reduced however, probiotics could not reduce the number of S.mutans in dental plaque.
CONCLUSIONS
The authors conclude that probiotics could prevent dental caries. Lactobacillus rhamnosus was identified as the more effective than other probiotics to reduce dental caries in preschool children.
Topics: Child, Preschool; Humans; China; Control Groups; Databases, Factual; Dental Caries; Lacticaseibacillus rhamnosus; Probiotics
PubMed: 37670134
DOI: 10.1038/s41432-023-00918-z -
The American Journal of Tropical... Jul 2020The common cold had resulted in significant economic and social burden worldwide. The effect of vitamin C on preventing common cold in healthy adults has been...
The common cold had resulted in significant economic and social burden worldwide. The effect of vitamin C on preventing common cold in healthy adults has been investigated extensively, but not that of other micronutrients. Thus, we aim to assess the effects of providing micronutrients singly through oral means, on cold incidence, and/or management (in terms of cold duration and symptom severity) in healthy adults from systematically searched randomized controlled trials. From four electronic databases, 660 identified studies were screened and data were extracted from 20 studies (zinc, 10; vitamin D, 8; and vitamins A and E, 2). The quality of selected studies was assessed using the Cochrane risk of bias tool and certainty in the outcomes was assessed with the Grading of Recommendations Assessment, Development and Evaluation approach. The review found that micronutrients supplementation, except vitamin C, may not prevent cold incidence or reduce symptom severity among healthy adults. However, zinc supplementation was observed to potentially reduce cold duration by 2.25 days (when zinc is provided singly, 95% CI: -3.39, -1.12). This suggests that zinc supplementation may reduce the overall burden due to common cold among healthy adults.
Topics: Adolescent; Adult; Aged; Ascorbic Acid; Common Cold; Dietary Supplements; Humans; Incidence; Micronutrients; Middle Aged; Odds Ratio; Randomized Controlled Trials as Topic; Severity of Illness Index; Vitamin A; Vitamin D; Vitamin E; Zinc
PubMed: 32342851
DOI: 10.4269/ajtmh.19-0718 -
Oral Oncology Mar 2022There is a wide range of commercial and custom-made devices available for the treatment of trismus (restricted jaw opening). They are used often in conjunction with a... (Review)
Review
BACKGROUND
There is a wide range of commercial and custom-made devices available for the treatment of trismus (restricted jaw opening). They are used often in conjunction with a prescribed exercise program with the aim of improving maximal inter-incisal opening (MIO). This study compared the efficacy (MIO and patient reported outcome results), adverse events, consumer experience and cost of the different types of devices available.
METHODS
Four databases were searched between the years 2001-2021 using the terms 'trismus' and 'device'. Two independent authors assessed each paper for inclusion, then conducted a quality analysis.
RESULTS
Thirty-two studies met the criterion required for inclusion. The majority (n = 27) were in the context of established trismus, where the remaining five used the device preventatively. The trismus device improved MIO in 23 of the rehabilitation programs (pooled mean MIO increased by 9.5 mm in the intervention arm compared to 2.4 mm for controls; p = 0.0001). Improved MIO was not observed in the prevention studies. The Therabite ® was the most common trismus device investigated and with a mean increase in MIO of 10.0 mm and cost of $499AUD. Forces applied by trismus devices were regulated by the perception of pain experienced by the patient, rather than a prescribed force by the treating health professional. Despite this guidance, several adverse events occurred (n = 8), including mandibular and molar fractures. Barriers experienced by consumers included pain, ill-fitting mouthpiece, adverse events, exercise adherence and cost.
CONCLUSION
Trismus devices which use the application of force to the jaw can improve the MIO of patients with established trismus. However, their role is unproven in the setting of trismus prevention during radiotherapy and several significant barriers such as cost, exercise adherence and safety concerns have been demonstrated for the intervention setting.
Topics: Exercise Therapy; Head and Neck Neoplasms; Humans; Pain; Prospective Studies; Quality of Life; Trismus
PubMed: 35104753
DOI: 10.1016/j.oraloncology.2022.105728