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International Wound Journal Jun 2024To assess all published studies which describe what happens to the delivery of pressure ulcer/injury (PI/PU) care pathways as a result of detecting raised sub-epidermal... (Review)
Review
To assess all published studies which describe what happens to the delivery of pressure ulcer/injury (PI/PU) care pathways as a result of detecting raised sub-epidermal moisture (SEM) delta (∆ ≥ 0.6). We undertook a systematic review of the literature, and included original research studies using either a prospective or retrospective study design that report the impact that assessment using SEM assessments have on healthcare practitioners' delivery of PI/PU care pathways in adults at risk of developing PI/PUs. The review protocol was registered on PROSPERO (CRD42023416975). A literature search was conducted in May 2023, using PubMed, CINAHL, Scopus, Cochrane, EMBASE, Web of Science and Science Direct databases. Data were extracted using a data extraction tool including elements such as country, setting, sample size, intervention, control and quality appraisal was undertaken using the Evidence-based Librarianship. We identified nine papers published between 2017 and 2022. The majority of these studies were conducted in England (n = 6; 67%). The systematic review included studies conducted across multiple care settings including acute care, medical-surgical units, and palliative care, highlighting the importance of PI/PU prevention and management across diverse patient populations. The PI/PU care pathways implemented in the studies varied, but commonly included elements such as the application or increased use of pressure-redistributing mattresses/cushions, implementation of repositioning plans, management of incontinence and moisture, regular skin inspection, and assessment of patient mobility. Out of the nine studies identified, seven reported PI/PU incidence. A meta-analysis of seven studies (N = 18 451) demonstrated a statistically significant reduction in visual PI/PU development in favour of SEM-guided care pathways compared to usual care (the odds ratio = 0.36 [95% confidence interval: 0.24-0.53, p < 0.00001]). This systematic review provides evidence that implementing SEM assessments in patients at risk of developing PI/PUs prompts anatomy-specific clinical actions. The subsequent implementation of enhanced and targeted skin care interventions leads to consistent and sustained reductions in hospital-acquired PU incidence. The findings emphasise the importance of incorporating SEM assessments as part of comprehensive PI/PU prevention strategies in all care settings and patient populations. This systematic review is limited by the predominance of observational studies and variable study quality. Future research should focus on randomised trials in different care settings that monitor the efficacy of preventive interventions and their impact in reducing PI/PU incidence when implemented based on SEM assessments.
Topics: Pressure Ulcer; Humans; Male; Female; Middle Aged; Aged; Adult; Aged, 80 and over; Critical Pathways; Delivery of Health Care
PubMed: 38832363
DOI: 10.1111/iwj.14928 -
Accuracy of optical coherence tomography for diagnosing glaucoma: an overview of systematic reviews.The British Journal of Ophthalmology Apr 2021To assess the diagnostic accuracy (DTA) of optical coherence tomography (OCT) for detecting glaucoma by systematically searching and appraising systematic reviews (SRs)... (Meta-Analysis)
Meta-Analysis
AIMS
To assess the diagnostic accuracy (DTA) of optical coherence tomography (OCT) for detecting glaucoma by systematically searching and appraising systematic reviews (SRs) on this issue.
METHODS
We searched a database of SRs in eyes and vision maintained by the Cochrane Eyes and Vision United States on the DTA of OCT for detecting glaucoma. Two authors working independently screened the records, abstracted data and assessed the risk of bias using the Risk of Bias in Systematic Reviews checklist. We extracted quantitative DTA estimates as well as qualitative statements on their relevance to practice.
RESULTS
We included four SRs published between 2015 and 2018. These SRs included between 17 and 113 studies on OCT for glaucoma diagnosis. Two reviews were at low risk of bias and the other two had two to four domains at high or unclear risk of bias with concerns on applicability. The two reliable SRs reported the accuracy of average retinal nerve fibre layer (RNFL) thickness and found a sensitivity of 0.69 (0.63 to 0.73) and 0.78 (0.74 to 0.83) and a specificity of 0.94 (0.93 to 0.95) and 0.93 (0.92 to 0.95) in 57 and 50 studies, respectively. Only one review included a clear specification of the clinical pathway. Both reviews highlighted the limitations of primary DTA studies on this topic.
CONCLUSIONS
The quality of published DTA reviews on OCT for diagnosing glaucoma was mixed. Two reliable SRs found moderate sensitivity at high specificity for average RNFL thickness in diagnosing manifest glaucoma. Our overview suggests that the methodological quality of both primary and secondary DTA research on glaucoma is in need of improvement.
Topics: Glaucoma; Humans; Intraocular Pressure; Nerve Fibers; Optic Disk; Reproducibility of Results; Tomography, Optical Coherence; Visual Fields
PubMed: 32493760
DOI: 10.1136/bjophthalmol-2020-316152 -
Sensors (Basel, Switzerland) May 2024Shoulder pain represents the most frequently reported musculoskeletal disorder, often leading to significant functional impairment and pain, impacting quality of life.... (Review)
Review
Shoulder pain represents the most frequently reported musculoskeletal disorder, often leading to significant functional impairment and pain, impacting quality of life. Home-based rehabilitation programs offer a more accessible and convenient solution for an effective shoulder disorder treatment, addressing logistical and financial constraints associated with traditional physiotherapy. The aim of this systematic review is to report the monitoring devices currently proposed and tested for shoulder rehabilitation in home settings. The research question was formulated using the PICO approach, and the PRISMA guidelines were applied to ensure a transparent methodology for the systematic review process. A comprehensive search of PubMed and Scopus was conducted, and the results were included from 2014 up to 2023. Three different tools (i.e., the Rob 2 version of the Cochrane risk-of-bias tool, the Joanna Briggs Institute (JBI) Critical Appraisal tool, and the ROBINS-I tool) were used to assess the risk of bias. Fifteen studies were included as they fulfilled the inclusion criteria. The results showed that wearable systems represent a promising solution as remote monitoring technologies, offering quantitative and clinically meaningful insights into the progress of individuals within a rehabilitation pathway. Recent trends indicate a growing use of low-cost, non-intrusive visual tracking devices, such as camera-based monitoring systems, within the domain of tele-rehabilitation. The integration of home-based monitoring devices alongside traditional rehabilitation methods is acquiring significant attention, offering broader access to high-quality care, and potentially reducing healthcare costs associated with in-person therapy.
Topics: Humans; Shoulder Pain; Telerehabilitation; Wearable Electronic Devices; Quality of Life; Shoulder; Monitoring, Physiologic; Home Care Services; Physical Therapy Modalities
PubMed: 38733040
DOI: 10.3390/s24092936 -
Frontiers in Human Neuroscience 2022It is widely known that exercise improves inhibitory control; however, the mechanisms behind the cognitive improvement remain unclear. This study analyzes the extant...
It is widely known that exercise improves inhibitory control; however, the mechanisms behind the cognitive improvement remain unclear. This study analyzes the extant literature on the neuronal effects of exercise on inhibitory control functions. We searched four online databases (Pubmed, Scopus, PsycINFO, and Web of Science) for relevant peer-reviewed studies to identify eligible studies published before September 1, 2021. Among the 4,090 candidate studies identified, 14 meet the inclusion criteria, and the results of 397 participants in these 14 studies are subsequently analyzed. We quantify the neural effects on the entire brain by using GingerALE software and identify 10 clusters of exercise-induced neuronal with either increases/decreases in the superior temporal gyrus (BA 22), precuneus (BA 7), superior frontal gyrus (BA 10), cuneus (BA 19), precuneus (BA 19), caudate, posterior cingulate (BA 19), middle temporal gyrus (B 37), parahippocampal gyrus (BA 30), precentral gyrus (BA 6). Meta-analytic coactivation map (MACM) showed that multiple functional networks overlap with brain regions with activation likelihood estimation (ALE) results. We propose the effect of exercise on neural activity is related to inhibitory control in the extended frontoparietal, default mode network (DMN), visual network, and other pathways. These results provide preliminary evidence of the neural effects of exercise on inhibitory control.
PubMed: 35814955
DOI: 10.3389/fnhum.2022.891095 -
Eye (London, England) Apr 2020To estimate the incidence of acute cerebral ischaemia detected by magnetic resonance imaging (MRI) in acute central retinal artery occlusion (CRAO), branch retinal... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To estimate the incidence of acute cerebral ischaemia detected by magnetic resonance imaging (MRI) in acute central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO) and transient monocular vision loss (TMVL).
METHODS
Studies reporting the incidence of acute cerebral ischaemia, detected by MRI, within 7 days from diagnosis of acute CRAO, BRAO and TMVL up to January 2019 were systematically searched for on Pubmed, Medline and Cochrane Library. Meta-analysis was performed using random effects model. The primary outcome was the pooled estimate of incidence of acute cerebral ischaemia in CRAO, BRAO and TMVL cohorts including both neurologically symptomatic and asymptomatic patients, expressed as a proportion along with 95% confidence intervals (CIs). The pooled estimate of incidence of asymptomatic acute cerebral ischaemia represented a secondary outcome measure.
RESULTS
For the primary outcome, the pooled proportion of acute cerebral ischaemia was 0.30 (CI 0.24-0.36) in the CRAO cohort, and 0.25 (CI 0.16-0.37) in the BRAO cohort, without statistical heterogeneity. The rate of acute cerebral ischaemia was 11.8% in the TMVL cohort. For the secondary outcome, the pooled proportion of asymptomatic acute cerebral ischaemia was 0.22 (CI 0.16-0.28) in the CRAO cohort, 0.29 (CI 0.20-0.41) in the BRAO cohort and 0.08 (CI 0.05-0.15) in the TMVL cohort, with no statistical heterogeneity.
CONCLUSIONS
30% of patients with acute CRAO and 25% of patients with acute BRAO presented an acute cerebral ischaemia on MRI. Such high rates support a care pathway of prompt referral of such patients for neurological evaluation and brain imaging.
Topics: Cohort Studies; Humans; Magnetic Resonance Imaging; Retinal Artery Occlusion; Stroke; Visual Acuity
PubMed: 31527762
DOI: 10.1038/s41433-019-0576-y -
Ontario Health Technology Assessment... 2024Glaucoma is the term for a group of eye disorders that causes progressive damage to the optic nerve, which can lead to visual impairment and, potentially, irreversible...
BACKGROUND
Glaucoma is the term for a group of eye disorders that causes progressive damage to the optic nerve, which can lead to visual impairment and, potentially, irreversible blindness. Minimally invasive bleb surgery (MIBS) reduces eye pressure through the implantation of a device that creates a new subconjunctival outflow pathway for eye fluid drainage. MIBS is a less invasive alternative to conventional/incisional glaucoma surgery (e.g., trabeculectomy). We conducted a health technology assessment of MIBS for people with glaucoma, which included an evaluation of effectiveness, safety, the budget impact of publicly funding MIBS, and patient preferences and values.
METHODS
We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of each included study using the Cochrane Risk of Bias 1.0 tool for randomized controlled trials (RCTs) and the Risk of Bias Assessment tool for Nonrandomized Studies (RoBANS) for comparative observational studies, and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We conducted an economic literature search and we estimated the budget impact of publicly funding MIBS in Ontario. We did not conduct a primary economic evaluation due to the limited long-term effectiveness data. We summarized the preferences and values evidence from previous health technology assessments to understand the perspectives and experiences of patients with glaucoma.
RESULTS
We included 41 studies (2 RCTs and 39 comparative observational studies) in the clinical evidence review. MIBS may reduce intraocular pressure and the number of medications used, but we are uncertain if MIBS results in outcomes similar to trabeculectomy (GRADE: Moderate to Very low). Compared with trabeculectomy, MIBS may result in fewer follow-up visits and interventions, and adverse events (GRADE: Moderate to Very Low). MIBS may also reduce intraocular pressure and the number of antiglaucoma medications used, compared with other glaucoma treatments, but the evidence is uncertain (GRADE: Very low). Our economic evidence review identified two directly applicable studies. The results of these studies indicate that the cost-effectiveness of MIBS is highly uncertain, and the cost of glaucoma interventions are likely to vary across provinces. The annual budget impact of publicly funding MIBS in Ontario ranged from $0.11 million in year 1 to $0.67 million in year 5, for a total 5-year budget impact estimate of $1.93 million. Preferences and values evidence suggests that fear of ultimate blindness and difficulty managing medication for glaucoma led patients to explore other treatment options such as MIBS. Glaucoma patients found minimally invasive glaucoma surgery (MIGS) procedure beneficial, with minimal side effects and recovery time.
CONCLUSIONS
Minimally invasive bleb surgery reduces intraocular eye pressure and the number of antiglaucoma medications needed, but we are uncertain if the outcomes are similar to trabeculectomy (GRADE: Moderate to Very low). However, MIBS may be safer than trabeculectomy (GRADE: Moderate to Very low) and result in fewer follow-ups (GRADE: Moderate to Very low). MIBS may also improve glaucoma symptoms compared with other glaucoma treatments, but the evidence is very uncertain (GRADE: Very low).We estimate that publicly funding MIBS would result in an additional cost of $1.93 million over 5 years. Patients who underwent MIGS procedures found them to be generally successful and beneficial, with minimal side effects and recovery time. We could not draw conclusions about specific MIBS procedures or long-term outcomes.
Topics: Humans; Antiglaucoma Agents; Blindness; Glaucoma; Technology Assessment, Biomedical; Trabeculectomy; Clinical Trials as Topic
PubMed: 38332948
DOI: No ID Found -
Circulation. Arrhythmia and... Apr 2020The optimal timing of catheter ablation for atrial fibrillation (AF) in reference to the time of diagnosis is unknown. We sought to assess the impact of the duration... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The optimal timing of catheter ablation for atrial fibrillation (AF) in reference to the time of diagnosis is unknown. We sought to assess the impact of the duration between first diagnosis of AF and ablation, or diagnosis-to-ablation time (DAT), on AF recurrence following catheter ablation.
METHODS
We conducted a systematic electronic search for observational studies reporting the outcomes associated with catheter ablation for atrial fibrillation stratified by diagnosis-to-ablation time. The primary meta-analysis using a random effects model assessed AF recurrence stratified by DAT ≤1 year versus >1 year. A secondary analysis assessed outcomes stratified by DAT ≤3 years versus >3 years.
RESULTS
Of the 632 screened studies, 6 studies met inclusion criteria for a total of 4950 participants undergoing AF ablation for symptomatic AF. A shorter DAT ≤1 year was associated with a lower relative risk of AF recurrence compared with DAT >1 year (relative risk, 0.73 [95% CI, 0.65-0.82]; <0.001). Heterogeneity was moderate (I=51%). When excluding the one study consisting of only patients with persistent AF, the heterogeneity improved substantially (I=0%, Cochran's Q =0.55) with a similar estimate of effect (relative risk, 0.78 [95% CI, 0.71-0.85]; <0.001).
CONCLUSIONS
Shorter duration between time of first AF diagnosis and AF ablation is associated with an increased likelihood of ablation procedural success. Additional study is required to confirm these results and to explore implementation of earlier catheter AF ablation and patient outcomes within the current AF care pathway. Visual Overview A visual overview is available for this article.
Topics: Action Potentials; Aged; Atrial Fibrillation; Catheter Ablation; Female; Heart Rate; Humans; Male; Middle Aged; Observational Studies as Topic; Recurrence; Risk Assessment; Risk Factors; Time Factors; Time-to-Treatment; Treatment Outcome
PubMed: 32191539
DOI: 10.1161/CIRCEP.119.008128 -
Frontiers in Neurology 2024Currently, the incidence of cerebral palsy is high in newborns. However, the current methods for diagnosing and treating patients with cerebral palsy are complex and...
BACKGROUND
Currently, the incidence of cerebral palsy is high in newborns. However, the current methods for diagnosing and treating patients with cerebral palsy are complex and poorly targeted. Moreover, these studies lack the support of bibliometric analysis results.
OBJECTIVE
Our study focused on a bibliometric analysis of published papers on the diagnosis and treatment of patients with cerebral palsy. This study identified the primary authors, institutions, and countries involved in analyzing the status and trends of research on the diagnosis and treatment of patients with cerebral palsy. Additionally, the study also involved screening pathways related to cerebral palsy.
METHODS
The PubMed database was searched for publications on the diagnosis and treatment of patients with cerebral palsy between 1990 and 2023. R v4.2.2 and VOSviewer v1.6.18 software tools were utilized to perform bibliometric analysis and visualization.
RESULTS
There were 1,965 publications on cerebral palsy diagnosis and 5,418 articles on the qualified treatment strategies, and the annual number of publications also increased. The United States dominated in this field of research. Gregory Y.H. Lip and Patrizio Lancellotti published the most number of papers. The Cleveland Clinic published the most number of papers in the field. According to the analysis of the co-occurrence of keywords, we found that the main research directions were age, sex, disease diagnosis, and treatment. Newly emerging research has focused mainly on heart failure, which is related to valvular heart disease.
CONCLUSION
The findings presented in this study offer valuable insights into ongoing research and potential future directions pertaining to cerebral palsy. These insights can assist researchers in identifying suitable collaborators and enhancing their investigations aimed at identifying the underlying molecular mechanisms associated with cerebral palsy, encompassing its etiology, preventive measures, and therapeutic interventions.
PubMed: 38694779
DOI: 10.3389/fneur.2024.1354311 -
BMC Ophthalmology Oct 2019Real-world data (RWD) has been a valuable addition to the scientific literature regarding treatment pathways, clinical outcomes and characteristics of patients with...
Real-world data in retinal diseases treated with anti-vascular endothelial growth factor (anti-VEGF) therapy - a systematic approach to identify and characterize data sources.
BACKGROUND
Real-world data (RWD) has been a valuable addition to the scientific literature regarding treatment pathways, clinical outcomes and characteristics of patients with retinal diseases in recent years. Registries, observational studies and patient databases are often used for real-world research. However, there is limited information for each data source on the design, consistency, data captured, limitations and usability for assessing research questions. Using a systematic approach, we identified RWD sources for patients with retinal diseases and assessed them for completeness of data relating to different outcomes.
METHODS
A systematic literature review was carried out to identify RWD sources for patients with retinal disease. Potentially relevant articles published between 2006 and 2016 were screened following electronic searches in Embase and MEDLINE. Congress and supplementary searches were undertaken to identify RWD sources that may not be referenced in full publications. For each data source, availability and quantity of data on baseline status, clinical outcomes, treatment and management, safety, and patient-reported and economic burden were assessed using a bespoke completeness assessment tool based on International Consortium for Health Outcomes Measurement guidelines for macular degeneration. Completeness of data for each area of interest in each data source was assessed and rated using a 'good-moderate-poor' rating system based on availability and quantity of available data. Each data source was then given an overall score based on its score for each of the 7 areas of interest.
RESULTS
A total of 128 RWD sources from 32 countries were identified. Of the identified sources, 64 sources from 16 countries of interest were analyzed. Most of these sources provided information on baseline status and clinical outcomes and treatment, but few collected data on economic and patient-reported burden. Of the RWD sources analyzed, 10 scored highly in the overall completeness assessment, collecting data on most or all of the areas of interest; these sources are considered to be robust data sources for performing ophthalmology real-world studies.
CONCLUSIONS
The study provides a comprehensive list of RWD sources for patients with retinal disease, many of which will be useful for conducting real-world studies in the field of ophthalmology.
Topics: Angiogenesis Inhibitors; Humans; Information Storage and Retrieval; Intravitreal Injections; Retinal Diseases; Vascular Endothelial Growth Factor A; Visual Acuity
PubMed: 31619195
DOI: 10.1186/s12886-019-1208-9 -
EBioMedicine Jan 2024Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction globally. Associated neurological symptoms and signs have historically...
BACKGROUND
Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction globally. Associated neurological symptoms and signs have historically been explained by pathobiology within the cervical spine. However, recent advances in imaging have shed light on numerous brain changes in patients with DCM, and it is hypothesised that these changes contribute to DCM pathogenesis. The aetiology, significance, and distribution of these supraspinal changes is currently unknown. The objective was therefore to synthesise all current evidence on brain changes in DCM.
METHODS
A systematic review was performed. Cross-sectional and longitudinal studies with magnetic resonance imaging on a cohort of patients with DCM were eligible. PRISMA guidelines were followed. MEDLINE and Embase were searched to 28th August 2023. Duplicate title/abstract screening, data extraction and risk of bias assessments were conducted. A qualitative synthesis of the literature is presented as per the Synthesis Without Meta-Analysis (SWiM) reporting guideline. The review was registered with PROSPERO (ID: CRD42022298538).
FINDINGS
Of the 2014 studies that were screened, 47 studies were identified that used MRI to investigate brain changes in DCM. In total, 1500 patients with DCM were included in the synthesis, with a mean age of 53 years. Brain alterations on MRI were associated with DCM both before and after surgery, particularly within the sensorimotor network, visual network, default mode network, thalamus and cerebellum. Associations were commonly reported between brain MRI alterations and clinical measures, particularly the Japanese orthopaedic association (JOA) score. Risk of bias of included studies was low to moderate.
INTERPRETATION
The rapidly expanding literature provides mounting evidence for brain changes in DCM. We have identified key structures and pathways that are altered, although there remains uncertainty regarding the directionality and clinical significance of these changes. Future studies with greater sample sizes, more detailed phenotyping and longer follow-up are now needed.
FUNDING
ODM is supported by an Academic Clinical Fellowship at the University of Cambridge. BMD is supported by an NIHR Clinical Doctoral Fellowship at the University of Cambridge (NIHR300696). VFJN is supported by an NIHR Rosetrees Trust Advanced Fellowship (NIHR302544). This project was supported by an award from the Rosetrees Foundation with the Storygate Trust (A2844).
Topics: Humans; Middle Aged; Brain; Cross-Sectional Studies; Magnetic Resonance Imaging; Spinal Cord Diseases
PubMed: 38113760
DOI: 10.1016/j.ebiom.2023.104915