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Journal of the American Geriatrics... Dec 2012To compare the effectiveness of acute geriatric unit care, based on all or part of the Acute Care for Elders (ACE) model and introduced in the acute phase of illness or... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To compare the effectiveness of acute geriatric unit care, based on all or part of the Acute Care for Elders (ACE) model and introduced in the acute phase of illness or injury, with that of usual care.
DESIGN
Systematic review and meta-analysis of 13 randomized controlled and quasi-experimental trials with parallel comparison groups retrieved from multiple sources.
SETTING
Acute care geriatric and nongeriatric hospital units.
PARTICIPANTS
Acutely ill or injured adults (N = 6,839) with an average age of 81.
INTERVENTIONS
Acute geriatric unit care characterized by one or more ACE components: patient-centered care, frequent medical review, early rehabilitation, early discharge planning, prepared environment.
MEASUREMENTS
Falls, pressure ulcers, delirium, functional decline at discharge from baseline 2-week prehospital and hospital admission statuses, length of hospital stay, discharge destination (home or nursing home), mortality, costs, and hospital readmissions.
RESULTS
Acute geriatric unit care was associated with fewer falls (risk ratio (RR) = 0.51, 95% confidence interval (CI) = 0.29-0.88), less delirium (RR = 0.73, 95% CI = 0.61-0.88), less functional decline at discharge from baseline 2-week prehospital admission status (RR = 0.87, 95% CI = 0.78-0.97), shorter length of hospital stay (weighted mean difference (WMD) = -0.61, 95% CI = -1.16 to -0.05), fewer discharges to a nursing home (RR = 0.82, 95% CI = 0.68-0.99), lower costs (WMD = -$245.80, 95% CI = -$446.23 to -$45.38), and more discharges to home (RR = 1.05, 95% CI = 1.01-1.10). A nonsignificant trend toward fewer pressure ulcers was observed. No differences were found in functional decline between baseline hospital admission status and discharge, mortality, or hospital readmissions.
CONCLUSION
Acute geriatric unit care, based on all or part of the ACE model and introduced during the acute phase of older adults' illness or injury, improves patient- and system-level outcomes.
Topics: Accidental Falls; Activities of Daily Living; Aged; Aged, 80 and over; Female; Geriatrics; Hospital Mortality; Hospital Units; Humans; Length of Stay; Male; Patient Discharge; Patient Readmission; Patient-Centered Care; Pressure Ulcer; Quality of Health Care
PubMed: 23176020
DOI: 10.1111/jgs.12028 -
Journal of Strength and Conditioning... Apr 2023Glänzel, MH, Rodrigues, DR, Petter, GN, Pozzobon, D, Vaz, MA, and Geremia, JM. Foam rolling acute effects on myofascial tissue stiffness and muscle strength: a... (Meta-Analysis)
Meta-Analysis
Glänzel, MH, Rodrigues, DR, Petter, GN, Pozzobon, D, Vaz, MA, and Geremia, JM. Foam rolling acute effects on myofascial tissue stiffness and muscle strength: a systematic review and meta-analysis. J Strength Cond Res 37(4): 951-968, 2023-Foam rolling (FR) is widely used in rehabilitation and physical training. However, the effects of FR on myofascial tissue stiffness and muscle strength remain unclear. This study aimed to perform a systematic review with meta-analysis of trials that tested the FR acute effects during warm-up on the myofascial tissue stiffness and muscle strength in healthy adults or athletes. This systematic review (CRD42021227048) was performed according to Cochrane's recommendations, with searches performed in PubMed, Web of Science, Embase, and PEDro databases. Syntheses of included studies' data were performed, and the PEDro scale was used to assess the methodological quality of the studies. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluations approach. Twenty included studies assessed trunk and thigh fascial tissue stiffness, and thigh and calf muscle stiffness, whereas muscle strength was assessed in the knee extensors and flexors, and plantar flexors muscles. Qualitative analysis showed decreases in fascial ( n = 2) and muscle ( n = 5) stiffness after FR. However, the meta-analysis showed no effects of FR on myofascial tissue stiffness. Both qualitative and quantitative analyses showed no effects of FR on isometric muscle strength, eccentric torque, and rate of force development. However, the knee extensor concentric torque increased after FR. Foam rolling increases the knee extensor concentric torque, but it does not acutely change the myofascial tissue stiffness and isometric muscle strength. However, evidence of these studies provides low certainty to state that FR does not change these parameters. Therefore, high methodological quality studies should be performed to better ascertain the effects of FR on the myofascial tissue stiffness and muscle strength.
Topics: Adult; Humans; Muscle, Skeletal; Knee; Knee Joint; Lower Extremity; Muscle Strength; Range of Motion, Articular
PubMed: 36227232
DOI: 10.1519/JSC.0000000000004385 -
Dermatologic Therapy Sep 2021Acute localized exanthematous pustulosis (ALEP) is a rare disease characterized by the acute onset of multiple localized non-follicular, pinhead-sized pustules. ALEP is... (Review)
Review
Acute localized exanthematous pustulosis (ALEP) is a rare disease characterized by the acute onset of multiple localized non-follicular, pinhead-sized pustules. ALEP is considered a localized form of acute generalized exanthematous pustulosis but its pathogeny is not well identified. We performed a systematic review of the literature of all publications regarding ALEP cases using the term "acute localized exanthematous pustulosis," to provide an update on this disease and its management. Results and conclusion ALEP is an uncommon skin condition attributed primarily to a hypersensitivity reaction to a systemic drug (classical or herbal); though a contact mechanism has been reported. It may be misdiagnosed as infectious or inflammatory disease but the clinico-pathological correlation in addition to the rapid response to withdrawal of the culprit agent supports this diagnosis. The pathogenesis of ALEP is still unclear, and there are no standardized treatment guidelines to manage this disease. Both AGEP and ALEP have a good prognosis if an early diagnosis is made.
Topics: Acute Generalized Exanthematous Pustulosis; Humans
PubMed: 34351040
DOI: 10.1111/dth.15087 -
Sports Medicine - Open Nov 2023Although stretching can acutely increase joint range of motion (ROM), there are a variety of factors which could influence the extent of stretch-induced flexibility such...
BACKGROUND
Although stretching can acutely increase joint range of motion (ROM), there are a variety of factors which could influence the extent of stretch-induced flexibility such as participant characteristics, stretching intensities, durations, type (technique), and muscle or joint tested.
OBJECTIVE
The objective of this systematic review and meta-analysis was to investigate the acute effects of stretching on ROM including moderating variables such as muscles tested, stretch techniques, intensity, sex, and trained state.
METHODS
A random-effect meta-analysis was performed from 47 eligible studies (110 effect sizes). A mixed-effect meta-analysis subgroup analysis was also performed on the moderating variables. A meta-regression was also performed between age and stretch duration. GRADE analysis was used to assess the quality of evidence obtained from this meta-analysis.
RESULTS
The meta-analysis revealed a small ROM standard mean difference in favor of an acute bout of stretching compared to non-active control condition (ES = −0.555; Z = −8.939; CI (95%) −0.677 to −0.434; < 0.001; I = 33.32). While there were ROM increases with sit and reach ( = 0.038), hamstrings ( < 0.001), and triceps surae ( = 0.002) tests, there was no change with the hip adductor test ( = 0.403). Further subgroup analyses revealed no significant difference in stretch intensity ( = 0.76), trained state ( = 0.99), stretching techniques ( = 0.72), and sex ( = 0.89). Finally, meta-regression showed no relationship between the ROM standard mean differences to age (R = −0.03; = 0.56) and stretch duration ( = 0.00; = 0.39), respectively. GRADE analysis indicated that we can be moderately confident in the effect estimates.
CONCLUSION
A single bout of stretching can be considered effective for providing acute small magnitude ROM improvements for most ROM tests, which are not significantly affected by stretch intensity, participants’ trained state, stretching techniques, and sex.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1186/s40798-023-00652-x.
PubMed: 37962709
DOI: 10.1186/s40798-023-00652-x -
European Journal of Preventive... Feb 2020Minimising risk factors through secondary prevention behaviour is challenging for patients following an acute coronary syndrome. Cognitive impairment can potentially...
BACKGROUND
Minimising risk factors through secondary prevention behaviour is challenging for patients following an acute coronary syndrome. Cognitive impairment can potentially make these changes more difficult. However, cognitive impairment prevalence in acute coronary syndrome patients is poorly understood.
DESIGN
This study was based on a systematic review.
METHODS
A systematic review was conducted of PubMed, Medline, PsycINFO and Cochrane databases up to March 2019, to identify studies reporting the prevalence of cognitive impairment in acute coronary syndrome patients. Predefined inclusion criteria were specified, including use of a validated cognitive impairment screening tool. Studies were excluded if patients had diagnosed dementia or coronary artery bypass graft surgery. Strengthening The Reporting of Observational Studies in Epidemiology and Cochrane Risk of Bias tools were used to assess quality.
RESULTS
From 747 potential studies, nine were included. The total sample size was 6457 (range 53-2174), mean age range was 51.3-77.4 years, and range of proportions of males was 57-100%. Reported cognitive impairment prevalence rates varied substantially (9-85%) with no clear pattern over time. From the two studies which examined domains, verbal fluency, memory and language were affected the most. Meta-analysis could not be undertaken due to diverse screening tools ( = 9), cut-off scores and screening timepoints.
CONCLUSIONS
Cognitive impairment in acute coronary syndrome patients is currently poorly described, and likely affects a substantial number of acute coronary syndrome patients who remain undetected and have the potential to develop to dementia in the future. As domains are most affected, this could impact understanding and retention of health education. Research is needed to accurately determine the prevalence of cognitive impairment in acute coronary syndrome patients and create suitable standardised measures and thresholds.
Topics: Acute Coronary Syndrome; Aged; Cognition; Cognitive Dysfunction; Female; Humans; Male; Middle Aged; Prevalence; Prognosis; Risk Factors
PubMed: 31645116
DOI: 10.1177/2047487319878945 -
PloS One 2013Active video games (AVGs) have gained interest as a way to increase physical activity in children and youth. The effect of AVGs on acute energy expenditure (EE) has... (Review)
Review
BACKGROUND
Active video games (AVGs) have gained interest as a way to increase physical activity in children and youth. The effect of AVGs on acute energy expenditure (EE) has previously been reported; however, the influence of AVGs on other health-related lifestyle indicators remains unclear.
OBJECTIVE
This systematic review aimed to explain the relationship between AVGs and nine health and behavioural indicators in the pediatric population (aged 0-17 years).
DATA SOURCES
Online databases (MEDLINE, EMBASE, psycINFO, SPORTDiscus and Cochrane Central Database) and personal libraries were searched and content experts were consulted for additional material.
DATA SELECTION
Included articles were required to have a measure of AVG and at least one relevant health or behaviour indicator: EE (both habitual and acute), adherence and appeal (i.e., participation and enjoyment), opportunity cost (both time and financial considerations, and adverse events), adiposity, cardiometabolic health, energy intake, adaptation (effects of continued play), learning and rehabilitation, and video game evolution (i.e., sustainability of AVG technology).
RESULTS
51 unique studies, represented in 52 articles were included in the review. Data were available from 1992 participants, aged 3-17 years, from 8 countries, and published from 2006-2012. Overall, AVGs are associated with acute increases in EE, but effects on habitual physical activity are not clear. Further, AVGs show promise when used for learning and rehabilitation within special populations. Evidence related to other indicators was limited and inconclusive.
CONCLUSIONS
Controlled studies show that AVGs acutely increase light- to moderate-intensity physical activity; however, the findings about if or how AVG lead to increases in habitual physical activity or decreases in sedentary behaviour are less clear. Although AVGs may elicit some health benefits in special populations, there is not sufficient evidence to recommend AVGs as a means of increasing daily physical activity.
Topics: Adolescent; Child; Child, Preschool; Energy Metabolism; Exercise; Health; Health Status Indicators; Humans; Learning; Video Games
PubMed: 23799008
DOI: 10.1371/journal.pone.0065351 -
PloS One 2023The importance of leptin in controlling body mass has recently gained more attention. Its levels are directly associated with the amount of fat mass, but not necessarily... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The importance of leptin in controlling body mass has recently gained more attention. Its levels are directly associated with the amount of fat mass, but not necessarily dependent on it. Exercise has great potential in reducing leptin levels, however the response of exercise to this cytokine is still not well understood.
OBJECTIVE
The objective of the review was to analyze the effects of physical exercise on plasma leptin concentration, either acutely (post-exercise/training session) and/or after a training period (short- or long-term), as well as to investigate the existence of possible moderating variables.
METHODS
The studies included in this systematic review were published between 2005 and May 2023. Only peer-reviewed studies, available in English, performed with humans that evaluated the effects of any form of exercise on leptin levels were included. The search was conducted on May 03, 2023, in Embase (Elsevier), MEDLINE via PubMed®, and Web of Science (Core collection). The risk of bias in the included trials was assessed by the Physiotherapy Evidence Database tool, considering 11 questions regarding the methodology of each study with 10 questions being scored. The data (n, mean, and standard deviation) were extracted from included studies to perform random effects meta-analyses using standardized mean difference between the pre- and post-intervention effects.
RESULTS
Twenty-five studies (acute effect: 262 subjects; short- and long-term effect: 377 subjects) were included in this systematic review and meta-analysis. Short- and long-term physical exercise and caloric restriction plus exercise reduce plasma leptin levels, presenting statistically significant differences (p<0.001); as well as acute effect (p = 0.035), however the latter result was influenced by the pre-exercise meal as shown in the subgroup analysis. In this meta-analysis the effect of moderating factors on leptin reduction, not addressed by past reviews, is verified, such as the relationship with caloric restriction, exercise intensity and pre-exercise meal on acute responses.
CONCLUSION
Both acute and chronic exercise reduce leptin levels, yet the acute effect is dependent on the pre-exercise meal. In addition to having a long-term reduction in leptin levels, the minimum amount of weekly exercise to have a significant reduction in plasma leptin is 180 minutes of moderate-intensity exercise and 120 minutes of high-intensity exercise.
Topics: Humans; Caloric Restriction; Leptin; Exercise; Fasting
PubMed: 38015889
DOI: 10.1371/journal.pone.0288730 -
The British Journal of General Practice... Feb 2008Prompt diagnosis of acute myocardial infarction or acute coronary syndrome is very important. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Prompt diagnosis of acute myocardial infarction or acute coronary syndrome is very important.
AIM
A systematic review was conducted to determine the accuracy of 10 important signs and symptoms in selected and non-selected patients.
DESIGN OF STUDY
Diagnostic meta-analysis.
METHOD
Using MEDLINE, CINAHL, EMBASE, tracing references, and by contacting experts, studies were sought out that described one of the 10 signs and symptoms on one or both conditions. Studies were excluded if they were not based on original data. Validity was assessed using QUADAS and all data were pooled using a random effects model.
RESULTS
Sixteen of the 28 included studies were about patients who were non-selected. In this group, absence of chest-wall tenderness on palpation had a pooled sensitivity of 92% (95% confidence interval [CI] = 86 to 96) for acute myocardial infarction and 94% (95% CI = 91 to 96) for acute coronary syndrome. Oppressive pain followed with a pooled sensitivity of 60% (95% CI = 55 to 66) for acute myocardial infarction. Sweating had the highest pooled positive likelihood ratio (LR+), namely 2.92 (95% CI = 1.97 to 4.23) for acute myocardial infarction. The other pooled LR+ fluctuated between 1.05 and 1.49. Negative LRs (LR-) varied between 0.98 and 0.23. Absence of chest-wall tenderness on palpation had a LR- of 0.23 (95% CI = 0.18 to 0.29).
CONCLUSIONS
Based on this meta-analysis it was not possible to define an important role for signs and symptoms in the diagnosis of acute myocardial infarction or acute coronary syndrome. Only chest-wall tenderness on palpation largely ruled out acute myocardial infarction or acute coronary syndrome in low-prevalence settings.
Topics: Acute Coronary Syndrome; Adult; Aged; Female; Humans; Male; Middle Aged; Myocardial Infarction; Predictive Value of Tests; Sensitivity and Specificity
PubMed: 18307844
DOI: 10.3399/bjgp08X277014 -
Journal of Wrist Surgery Apr 2022Perilunate injuries are uncommon yet challenging and often missed injuries, representing 7% of all carpal traumas. Two types of injuries can be identified as...
Perilunate injuries are uncommon yet challenging and often missed injuries, representing 7% of all carpal traumas. Two types of injuries can be identified as follows: perilunate dislocations (PLD) and perilunate fracture-dislocations (PLFD). The purpose of this study was to conduct a systematic review and meta-analysis to establish which surgical treatment is superior for patients with perilunate injuries and the significance of delayed treatment. A total of 2056 articles were screened, and 16 articles were included. Risk of bias for case-control series and case series were assessed through the National Institute of Health study quality assessment tool. Qualitative outcomes of clinical scores for hand function were compared between different time points (acute, < 7 days; delayed 7-45 days; chronic > 45 days), open and closed reduction, and PLD and PLFD. Overall, the clinical outcome scores of patients treated within 7 days are good. The results suggest that closed reduction and internal fixation (CRIF) offers slightly better outcomes than open reduction and internal fixation (ORIF) for PLFD. Patients treated 6 weeks or more after the initial injury seem to have the worst overall outcomes than patients in the acute or delayed setting. The results suggest that patients with chronic PLD have even worse outcomes than patients with chronic PLFD. Timing of surgery is essential for an optimal outcome. When there is a delay of treatment, the outcomes are inferior to those treated acutely. Early referral to centralized treatment units for perilunate injuries would allow for targeted treatment and facilitate research on this difficult wrist injury.
PubMed: 35478950
DOI: 10.1055/s-0041-1735841 -
Journal of Strength and Conditioning... Mar 2017Tufano, JJ, Brown, LE, and Haff, GG. Theoretical and practical aspects of different cluster set structures: a systematic review. J Strength Cond Res 31(3): 848-867,... (Review)
Review
Tufano, JJ, Brown, LE, and Haff, GG. Theoretical and practical aspects of different cluster set structures: a systematic review. J Strength Cond Res 31(3): 848-867, 2017-When performing a set of successive repetitions, fatigue ensues and the quality of performance during subsequent repetitions contained in the set decreases. Oftentimes, this response may be beneficial because fatigue may stimulate the neuromuscular system to adapt, resulting in a super-compensatory response. However, there are instances in which accumulated fatigue may be detrimental to training or performance adaptations (i.e., power development). In these instances, the ability to recover and maintain repetition performance would be considered essential. By providing intermittent rest between individual repetitions or groups of repetitions within a set, an athlete is able to acutely alleviate fatigue, allowing performance to remain relatively constant throughout an exercise session. Within the scientific literature, a set that includes intermittent rest between individual repetitions or groups of repetitions within a set is defined as a cluster set. Recently, cluster sets (CS) have received more attention as researchers have begun to examine the acute and chronic responses to this relatively novel set structure. However, much of the rest period terminology within the literature lacks uniformity and many authors attempt to compare largely different protocols with the same terminology. Additionally, the present body of scientific literature has mainly focused on the effects of CS on power output, leaving the effects of CS on strength and hypertrophy relatively unexplored. Therefore, the purpose of this review was to further delineate cluster set terminology, describe the acute and chronic responses of CS, and explain the need for further investigation of the effects of CS.
Topics: Adaptation, Physiological; Adult; Athletes; Exercise; Fatigue; Humans; Male; Muscle Strength; Resistance Training; Rest
PubMed: 27465625
DOI: 10.1519/JSC.0000000000001581