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BMJ Surgery, Interventions, & Health... 2022Diabetic foot ulceration (DFU) has devastating complications and a lifetime occurrence of 15%-34%. Debridement of DFU is regarded as an intervention that accelerates...
BACKGROUND
Diabetic foot ulceration (DFU) has devastating complications and a lifetime occurrence of 15%-34%. Debridement of DFU is regarded as an intervention that accelerates ulcer healing and may reduce complications including amputations, infections, and poor quality of life (QoL), which have serious public health and clinical implications. A systematic review (SR) of SRs and of randomized controlled trials (RCTs) with meta-analyses (MAs) on debridement of DFU that synthesizes all human experimental evidence is warranted.
OBJECTIVES
Are debridement methods in DFU beneficial over other forms and standard gauze dressings (control condition) in these outcomes?
STUDY ELIGIBILITY CRITERIA
All SRs/MAs/RCTs comparing debridement methods for DFU with alternative methods of debridement and with control.
DATA SOURCES
Cochrane Wounds Group Specialized Register, Cochrane Central Register of Controlled Trials (Cochrane Library), Ovid MEDLINE, PubMed, EMBASE, EBSCO, CINAHL, and Web of Science.
PARTICIPANTS AND INTERVENTIONS
Adults with type 1/2 diabetes with DFU and any debridement method compared with alternative debridement methods or control.
MAIN OUTCOMES
Amputation rates, wound infections, QoL, proportion of ulcers healed, time to complete healing, ulcer recurrence, and treatment cost.
STUDY SELECTION AND ANALYSIS
Data extraction/synthesis by two independent reviewers pooled using a random-effects model with sensitivity analysis.
RESULTS
10 SRs were retrieved and reported qualitatively. Six SRs included MAs. This SR included 30 studies, with 2654 participants, using 19 debridement combinations. The debridement methods were compared with findings pooled into MAs. Meta-regression (MR) did not identify significant predictors/moderators of outcomes.
LIMITATIONS
The studies may have been under-powered. The inclusion/exclusion criteria varied and the increased risk of bias contributed to low-quality evidence.
DISCUSSION/CONCLUSION
Weak evidence exists that debridement methods are superior to other forms of debridement or control in DFU.
IMPLICATIONS
Researchers should follow standardized reporting guidelines (Consolidated Standards of Reporting Trials). Clinicians/investigators could use the findings from this SR/MA/MR in guiding patient-individualized decision making and designing future RCTs.
PubMed: 35721280
DOI: 10.1136/bmjsit-2021-000081 -
BMJ Clinical Evidence Aug 2011Fungal infections are reported to cause 23% of foot diseases and 50% of nail conditions in people seen by dermatologists, but are less common in the general population,... (Review)
Review
INTRODUCTION
Fungal infections are reported to cause 23% of foot diseases and 50% of nail conditions in people seen by dermatologists, but are less common in the general population, affecting 3% to 5% of people.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral treatments for fungal toenail infections? What are the effects of topical treatments for fungal toenail infections? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 12 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: amorolfine, butenafine, ciclopirox, fluconazole, griseofulvin, itraconazole, ketoconazole, mechanical debridement, terbinafine, and tioconazole.
Topics: Administration, Oral; Administration, Topical; Debridement; Humans; Itraconazole; Nails; Onychomycosis
PubMed: 21846413
DOI: No ID Found -
Journal of Clinical Periodontology 2002The purpose of this systematic review was to determine the efficacy of machine-driven compared with manual subgingival debridement in the treatment of periodontitis. (Comparative Study)
Comparative Study Review
OBJECTIVES
The purpose of this systematic review was to determine the efficacy of machine-driven compared with manual subgingival debridement in the treatment of periodontitis.
BACKGROUND
Mechanical debridement of the periodontal pocket plays a pivotal role in the treatment of periodontitis.
METHODS
A literature search for controlled clinical trials with at least 6 months' follow-up comparing machine-driven instruments with hand instruments for the treatment of chronic periodontitis was performed up to April 2001. Screening of titles and abstracts as well as data extraction was conducted independently by two reviewers (J.T. & T.F.F.). As primary outcome variable, the prevention of tooth loss was used; secondary outcome variables were the prevention of disease progression, the resolution of anatomical defects and the resolution of gingival inflammation. Efficiency was assessed by mean time needed to treat one tooth.
RESULTS
From a total of 419 abstracts, 27 articles were included for the review. The weighted kappa score for agreement between the two reviewers was 0.77, 95% CI: 0.65-0.89, indicating substantial agreement. No study reported on the selected primary outcome variables. Using clinical attachment gain, probing pocket depth reduction or bleeding on probing reduction as outcome variables, there appeared to be no differences between ultrasonic/sonic and manual debridement. No major differences in the frequency or severity of adverse effects were found. However no meta-analysis could be performed on any of the previously mentioned parameters. Ultrasonic/sonic debridement was found to take significantly less time, i.e. 36.6%, than debridement using hand instruments (P = 0.0002, 95% CI of the standardized effect estimate: 0.39-1.37, heterogeneity P = 0.77).
CONCLUSIONS
With respect to clinical outcome measures, the available data do not indicate a difference between ultrasonic/sonic and manual debridement in the treatment of chronic periodontitis for single-rooted teeth; however, the evidence for this is not very strong. In addition, ultrasonic/sonic subgingival debridement requires less time than hand instrumentation. Further research is needed to assess the efficacy of machine-driven debridement on multirooted teeth and clinical outcome variables having tangible benefit to the patients should be used.
Topics: Chronic Disease; Dental High-Speed Equipment; Dental Scaling; Disease Progression; Electricity; Humans; Periodontal Index; Periodontitis; Subgingival Curettage; Tooth Loss; Ultrasonics
PubMed: 12787208
DOI: 10.1034/j.1600-051x.29.s3.4.x -
BMJ Clinical Evidence Jul 2010Mammalian bites are usually caused by dogs, cats, or humans, and are more prevalent in children (especially boys) than in adults. Animal bites are usually caused by the... (Review)
Review
INTRODUCTION
Mammalian bites are usually caused by dogs, cats, or humans, and are more prevalent in children (especially boys) than in adults. Animal bites are usually caused by the person's pet and, in children, frequently involve the face. Human bites tend to occur in children as a result of playing or fighting, while in adults they are usually the result of physical or sexual abuse. Mixed aerobe and anaerobe infection is the most common type of infection, and can occur in up to half of human bites.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent complications of mammalian bites? What are the effects of treatments for infected mammalian bites? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found five systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotic prophylaxis (human bites, non-human bites), antibiotics, debridement, decontamination, irrigation, primary wound closure, and tetanus vaccination (after mammalian bites).
Topics: Animals; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bites and Stings; Bites, Human; Debridement; Evidence-Based Medicine; Humans; Incidence
PubMed: 21418668
DOI: No ID Found -
Pain Physician Jul 2019Percutaneous endoscopic debridement and drainage (PEDD) has played a vital role in the management of spinal infection; however, limited PEDD results are available to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Percutaneous endoscopic debridement and drainage (PEDD) has played a vital role in the management of spinal infection; however, limited PEDD results are available to date.
OBJECTIVES
The purpose of this systematic review is to examine the existing literature, to give an objective estimate of the outcomes of PEDD using a meta-analytical approach.
STUDY DESIGN
Meta-analysis and systematic review of retrospective single-arm studies.
METHODS
A comprehensive online review was performed in MEDLINE, EMBASE, PubMed, Web of Science, and Cochrane databases from 1980 to October 2018. Eligible studies included the single-arm studies that mentioned PEDD in the management of spinal infection. Pooled event rates for positive bacteria culture, pain control satisfaction, and reoperation were estimated. The complications of PEDD were also recorded.
RESULTS
Nine single-arm PEDD articles (158 patients) were included. The pooled event rate was 82% (95% CI: 75%-88%) for positive bacteria culture, 81% (95% CI: 73%-87%) for pain control satisfaction, and 21% (95% CI: 15%-29%) for reoperation. There are few complications reported in the literature that included transient paresthesia in the affected lumbar segment and local kyphosis.
LIMITATIONS
First, all included studies were retrospective series with inherent methodological limitations. Second, the sample size and the number of studies that were found to be eligible was small. In addition, all included studies are single-arm, and further studies are necessary in large randomized controlled trials on comparing the efficacy of conservative therapy, PEDD, and open surgical intervention.
CONCLUSIONS
PEDD not only has a high rate of causative-pathogen identification, but also provides satisfactory clinical outcome. Early PEDD intervention in spinal infection is encouraging; however, further studies in large randomized controlled trials on comparing the efficacy of conservative therapy, PEDD, and open surgical intervention are necessary.
KEY WORDS
Percutaneous endoscopic debridement and drainage, spinal infection, meta-analysis.
Topics: Debridement; Drainage; Endoscopy; Humans; Myelitis; Retrospective Studies; Spondylitis
PubMed: 31337161
DOI: No ID Found -
Journal of Clinical Orthopaedics and... Apr 2021Non-tuberculous pyogenic spinal infection (PSI) incorporates a variety of different clinical conditions. Surgical interventions may be necessary for severe cases where... (Review)
Review
Posterior stabilisation without formal debridement for the treatment of non-tuberculous pyogenic spinal infection in frail and debilitated population - A systematic review and meta-analysis.
Non-tuberculous pyogenic spinal infection (PSI) incorporates a variety of different clinical conditions. Surgical interventions may be necessary for severe cases where there is evidence of spinal instability or neurological compromise. The primary surgical procedure, for late-stage PSI, focuses on the anterior approach with aggressive debridement of the infected tissue regions. An alternative treatment method that employs a posterior approach without any formal debridement, is seen as controversial. To the best of our knowledge, few case series and no systematic reviews are assessing the value of this posterior technique. We aim to evaluate the effectiveness of the posterior approach formal debridement and the associated clinical outcomes, for PSI cases requiring surgical intervention. Several databases including MEDLINE, NHS Evidence, and the Cochrane database were searched from the date of creation of each database to December 16, 2019. A selection of the keywords used includes: "posterior approach", "debridement" and "discitis". Studies were excluded if they involved the anterior approach, carried out formal debridement, or were tuberculous spinal infection cases. We accepted any study type which included adult patients, with spinal infection at any level of the vertebral column. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used to follow standard systematic review structure. The main clinical outcomes evaluated include pain, neurological recovery (Frankel Grading System, FGS) post-operative complications, and functional outcomes (Kirkaldy-Willis Criteria and Spine Tango Combined Outcome Measure Index, COMI). Post-surgical neurological improvement was demonstrated with a mean FGS improvement of 1.12 in 102 patients over the included four articles. Post-operative neurological function was found to be improved at a statistically significant level when a random-effects model was applied, with the effect size found to be at 0.68 (p < 0.001). Pain level was improved significantly postoperatively. There were also enhanced functional outcomes post-intervention when the Kirkaldy-Willis criteria and COMI scores were assessed in certain studies. Within the limit of the available literature, our results showed that the posterior approach with posterior stabilisation without formal debridement can result in successful infection resolution, improved pain scores and neurological outcomes. However, Larger series with longer follow-up duration is strongly recommended.
PubMed: 33717910
DOI: 10.1016/j.jcot.2020.11.009 -
The Journal of Hand Surgery Dec 2022Seymour fractures are injuries with a potentially high risk of infection and osteomyelitis. The optimal management of this pediatric open fracture is unknown. We... (Meta-Analysis)
Meta-Analysis
PURPOSE
Seymour fractures are injuries with a potentially high risk of infection and osteomyelitis. The optimal management of this pediatric open fracture is unknown. We performed a systematic review and meta-analysis to summarize the best evidence for these fractures and determine their optional management based on primary clinical studies.
METHODS
A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis was performed. A comprehensive search strategy was applied to the MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and gray literature databases (from May 1966 to April 15, 2020). Studies describing patients under the age of 18 years with Seymour fractures were included. Treatment was grouped based on debridement and antibiotic status as well as the timing of these interventions. The primary outcome was infection. The secondary outcomes included malunion, physeal disturbance, and nail dystrophy.
RESULTS
The searches helped identify 56 records, of which 10 nonrandomized studies met our inclusion criteria, comprising 352 patients and 355 fractures. Early (<48 hours) debridement was associated with significantly less risk of infection (risk ratio [RR] = 0.28 [95% CI, 0.12-0.64]) and malunion (RR = 0.25 [95% CI, 0.07-0.99]). Prophylactic (<24 hours) antibiotics significantly reduced the risk of infection (RR = 0.21 [95% CI, 0.10-0.43]). In addition, prophylactic antibiotics and debridement were associated with a 70% reduction in the risk of infection (RR = 0.30 [95% CI, 0.11-0.83]). Over one-third of patients with delayed presentation (median 8.5 days) were infected at presentation.
CONCLUSIONS
The high-risk nature of Seymour fractures may be mitigated by prompt recognition and early, basic interventions, which can usually be performed in any setting.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
Topics: Humans; Adolescent; Child; Fractures, Open; Osteomyelitis; Anti-Bacterial Agents
PubMed: 34810026
DOI: 10.1016/j.jhsa.2021.08.022 -
Orthopaedics & Traumatology, Surgery &... Jun 2023Hip dysplasia and femoroacetabular impingement are pathologies whose impact on the function and survival of the hip joint is no longer debated. Labral tears may be... (Review)
Review
INTRODUCTION
Hip dysplasia and femoroacetabular impingement are pathologies whose impact on the function and survival of the hip joint is no longer debated. Labral tears may be present and impact the prognosis of the causal pathology. Labral tear management lacks consensus and still raises several questions, thus we conducted a systematic analysis to clarify: 1) What is its prevalence in hip dysplasia and femoroacetabular impingement? 2) Does it modify the symptomatology of the causal pathology? 3) Is its repair better than resection or abstention?
MATERIAL AND METHOD
A systematic literature review was carried out following the PRISMA guidelines, using the Medline and Embase databases and including all articles in French or English, written until June 2022 referring to labral tears in hip dysplasia and femoroacetabular impingement. The articles were analyzed by 2 surgeons in order to select them according to a predefined algorithm. 1) Articles were selected by title from the search results. 2) A selection based on the abstract was then made. 3) A final selection was made upon complete reading. 4) In the event of a discrepancy during the selection, a third co-author was contacted for a final decision. 5) Data extraction was then carried out by the two readers using a preformatted sheet.
RESULTS
Of the 1177 articles identified, 43 articles were kept for the final analysis. The prevalence of labral tears was on average 78.80±4.7% [17 to 100%] in dysplasia and 93.8±16.8% [33% to 100%] in impingement. The review did not reveal any symptomatology specific to the labral tear. In dysplasia, 5 comparative studies were analyzed. A single study on shelf arthroplasties demonstrated the negative impact of a labral tear in the event of resection on survival compared to no tear (83% versus 15.2% (p=0.048)). Regarding impingements, 8 comparative studies were analyzed. At 7 years of follow-up, only one study found a significant and clinically relevant functional gain in terms of MCID (minimal clinically important difference) for labral repair compared to debridement on the mHHS score (p=0.008), SF-12 score (p=0.012), and pain scale (p=0.002). One study showed superiority of repair over labral debridement in terms of 10-year survival (78% 95% CI [64-92%] vs 46% 95% CI [26-66%] (p=0.009)).
DISCUSSION
The literature analysis was heterogeneous with a few comparative studies and predominantly short periods of follow-up. Understanding labral pathology and its impact requires differentiating between the different tear categories and proposing treatment to restore or preserve the biomechanical properties of the joint.
LEVEL OF EVIDENCE
IV, Systematic Review of Level 1-4 Evidence.
Topics: Humans; Femoracetabular Impingement; Hip Dislocation; Treatment Outcome; Hip Joint; Follow-Up Studies; Hip Dislocation, Congenital; Rupture; Arthroscopy; Retrospective Studies
PubMed: 36587762
DOI: 10.1016/j.otsr.2022.103539 -
Clinical Otolaryngology : Official... Feb 2015Chronic rhinosinusitis is a significant health problem, and the optimal postoperative treatment regime for patients post functional endoscopic sinus surgery has been a... (Review)
Review
BACKGROUND
Chronic rhinosinusitis is a significant health problem, and the optimal postoperative treatment regime for patients post functional endoscopic sinus surgery has been a topic debated for years.
OBJECTIVE OF REVIEW
To systematically review and critically evaluate the evidence relating to postoperative debridement of the nasal cavity following functional endoscopic sinus surgery to guide best practice.
SEARCH STRATEGY
A search of the following databases was performed: Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, and Cochrane Central Register of Control Trials. Ovid Medline, EMBASE, Pubmed. The following key words were used: Postoperative, functional endoscopic sinus surgery, sinus surgery, debridement, follow-up, from 1970 to 2013.
EVALUATION METHOD
Two independent reviewers assessed the relevant articles using the consort guidance on systematic reviews Moher et al. BMJ 2010; 340: c869.
RESULTS
The best evidence available was 1B, with six Randomsied control trial (RCTs) identified. Four studies compared debridement against no debridement, and two looked at the frequency of the debridement. Cumulatively, results for 337 patients were included. Visual analogue scores were used in all studies. None of the results at the long-term follow-up showed any difference in sino-nasal outcome test scores or objective endoscopic scores. Four of the six studies demonstrated some benefit in symptom scores but only one in the long term. Two papers demonstrated the debridement group suffered more pain in the postoperative period.
CONCLUSIONS
Currently, there is no clear evidence for frequent postoperative debridement. Further well-designed RCTs are required to establish clear benefit, optimal frequency, extent and timing of debridement.
Topics: Debridement; Endoscopy; Humans; Rhinitis; Sinusitis; Treatment Outcome
PubMed: 25314101
DOI: 10.1111/coa.12330 -
Arthroscopy : the Journal of... Feb 2021To systematically review the available data with regard to clinical and functional outcomes of arthroscopic and open debridement for elbow arthritis to determine the... (Comparative Study)
Comparative Study
PURPOSE
To systematically review the available data with regard to clinical and functional outcomes of arthroscopic and open debridement for elbow arthritis to determine the complication rate with transition to arthroscopic surgery.
METHODS
Using the Preferred Reporting Items for Systematic Reviews and Meta Analyses protocol, a systematic review was performed including studies reporting clinical and functional outcomes following open or arthroscopic debridement of elbow arthritis. The primary outcome measures analyzed were functional outcome (Mayo Elbow Performance Score), range of motion, and complication rate. Data were extracted for the whole group and then compared between the techniques using ranges and forest plots.
RESULTS
In total, 39 level IV and 3 level III studies with 1097 elbows were eligible for inclusion; 684 elbows were treated using an open technique and 413 using an arthroscopic technique. Regarding functional outcome scores, mean Mayo Elbow Performance Score improved significantly with comparable magnitude of improvement in both groups (arthroscopic group: range 28-34, open group: range 25-31). Regarding range of motion, mean flexion-extension arc improved significantly in both groups (arthroscopic group: range 8-26°, open group: range 13-49°). The open group had a lower preoperative flexion-extension arc (range 63-96) in comparison with the arthroscopic group (range 84-119). The overall incidence of complications was 5.7% (range 0%-19%) in the arthroscopic group and 6.1% (range 0%-25%) in the open group. The most common complication type was neurologic, with an incidence of 2.1% (range 0%-8%) in the arthroscopic group and 1.9% (range 0%-12%) in the open group. The deep infection rate was 0.7% (range 0%-10%) in the open group with no reported incidence in the arthroscopic group.
CONCLUSIONS
This systematic review demonstrated good mid-term functional outcomes following debridement arthroplasty of the arthritic elbow. There was no increase in complications with an arthroscopic technique confirming its safety and efficacy.
LEVEL OF EVIDENCE
IV, Systematic Review of Level III and IV articles.
Topics: Arthroscopy; Debridement; Elbow Joint; Female; Humans; Male; Middle Aged; Osteoarthritis; Pain, Postoperative; Patient Reported Outcome Measures; Patient Satisfaction; Range of Motion, Articular; Treatment Outcome
PubMed: 32949630
DOI: 10.1016/j.arthro.2020.09.005