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Journal of Audiology & Otology Jan 2022Although the digit-in-noise (DIN) test is simple and quick, little is known about its key factors. This study explored the considerable components of the DIN test...
BACKGROUND AND OBJECTIVES
Although the digit-in-noise (DIN) test is simple and quick, little is known about its key factors. This study explored the considerable components of the DIN test through a systematic review and meta-analysis.
MATERIALS AND METHODS
After six electronic journal databases were screened, 14 studies were selected. For the meta-analysis, standardized mean difference was used to calculate effect sizes and 95% confidence intervals.
RESULTS
The overall result of the meta-analysis showed an effect size of 2.224. In a subgroup analysis, the patient's hearing status was found to have the highest effect size, meaning that the DIN test was significantly sensitive to screen for hearing loss. In terms of the length of the presenting digits, triple digits had lower speech recognition thresholds (SRTs) than single or pairs of digits. Among the types of background noise, speech-spectrum noise provided lower SRTs than multi-talker babbling. Regarding language variance, the DIN test showed better performance in the patient's native language(s) than in other languages.
CONCLUSIONS
When uniformly developed and well validated, the DIN test can be a universal tool for hearing screening.
PubMed: 34775699
DOI: 10.7874/jao.2021.00416 -
The Journal of Hand Surgery Jan 2022Digit replantation is a high-stakes procedure that has been shown to be cost-effective, especially for multiple-digit replantation. However, it is associated with...
PURPOSE
Digit replantation is a high-stakes procedure that has been shown to be cost-effective, especially for multiple-digit replantation. However, it is associated with prolonged lengths of stay (LOS) for monitoring and attempts at salvage. The cost-effectiveness of prolonged inpatient stays presumes that this is necessary and inherent to the replantation. We hypothesized that prolonged monitoring of replanted digits, in the hope of possible salvage after primary failure, is cost-ineffective due to the low rates of vascular compromise and salvage after replantation.
METHODS
Using previously published data comparing quality adjusted life years lost after traumatic digit amputation versus digit replantation, we devised a cost utility model to evaluate the incremental cost-effectiveness ratio of inpatient monitoring. To determine rates of vascular compromise and salvage after digit replantation, we performed a systematic review of the literature through MEDLINE and SCOPUS database searches to identify relevant articles on digital replantation since 1990. Cost-effectiveness was stratified based on the number of digits replanted.
RESULTS
Fewer than 9% of replanted digits both experience vascular compromise and are successfully salvaged. Adjusting for this, inpatient monitoring for single-digit and thumb replantation becomes cost-ineffective after 1 day of admission and monitoring for multiple-digit replantation becomes cost-ineffective after 2 days of admission.
CONCLUSIONS
In the United States, prolonged admissions for inpatient monitoring quickly become cost-ineffective, especially with relatively low rates of salvage. Surgeons should avoid extended hospitalizations for replant monitoring and should pursue enhanced recovery protocols for replantation, especially considering burgeoning health care costs in the United States.
TYPE OF STUDY/LEVEL OF EVIDENCE
Economic/Decision Analysis III.
Topics: Amputation, Traumatic; Cost-Benefit Analysis; Finger Injuries; Fingers; Humans; Inpatients; Replantation; Retrospective Studies; United States
PubMed: 34548183
DOI: 10.1016/j.jhsa.2021.07.024 -
Journal of Clinical Medicine May 2023Perioperative disorders of neurocognitive function are a set of heterogeneous conditions, which include transient post-operative delirium (POD) and more prolonged... (Review)
Review
Perioperative disorders of neurocognitive function are a set of heterogeneous conditions, which include transient post-operative delirium (POD) and more prolonged post-operative cognitive dysfunction (POCD). Since the number of annually performed surgical procedures is growing, we should identify which type of anesthesia is safer for preserving neurocognitive function. The purpose of this study was to compare the effect of general anesthesia (GA) and regional anesthesia (RA) in patients undergoing surgical procedures under general anesthesia and regional anesthesia. We searched for randomized controlled studies, which studied post-operative cognitive outcomes after general and regional anesthesia in the adult patient population. Thirteen articles with 3633 patients: the RA group consisted of 1823 patients, and the GA group of 1810 patients, who were selected for meta-analysis. The overall effect of the model shows no difference between these two groups in terms of risk for post-operative delirium. The result is insensitive to the exclusion of any study. There was no difference between RA and GA in terms of post-operative cognitive dysfunction. There was no statistically significant difference between GA and RA in the incidence of POD. There was no statistically significant difference in the incidence of POCD per-protocol analysis, psychomotor/attention tests (preoperative/baseline, post-operative), memory tests (postoperatively, follow up), mini-mental state examination score 24 h postoperatively, post-operative reaction time three months postoperatively, controlled oral word association test, and digit copying test. There were no differences in the incidence of POCD in general and regional anesthesia at one week postoperatively, three months postoperatively, or total events (one week or three months). The incidence of post-operative mortality also did not differ between two groups.
PubMed: 37240655
DOI: 10.3390/jcm12103549 -
Assessment Mar 2012Reliable Digit Span (RDS) is a heavily researched symptom validity test with a recent literature review yielding more than 20 studies ranging in dates from 1994 to 2011.... (Review)
Review
Reliable Digit Span (RDS) is a heavily researched symptom validity test with a recent literature review yielding more than 20 studies ranging in dates from 1994 to 2011. Unfortunately, limitations within some of the research minimize clinical generalizability. This systematic review and cross-validation study was conducted to address these limitations, thus increasing the measure's clinical utility. Sensitivity and specificity rates were calculated for the ≤6 and ≤7 cutoffs when data were globally combined and divided by clinical groups. The cross-validation of specific diagnostic groups was consistent with the data reported in the literature. Overall, caution should be used when utilizing the ≤7 cutoff in all clinical groups and when utilizing the ≤6 cutoff in the following groups: cerebrovascular accident, severe memory disorders, mental retardation, borderline intellectual functioning, and English as a second language. Additional limitations and cautions are provided.
Topics: Bayes Theorem; Brain Injuries; Cognition Disorders; Confidence Intervals; Humans; Malingering; Nervous System Diseases; Neuropsychological Tests; Reproducibility of Results; Sensitivity and Specificity
PubMed: 22156721
DOI: 10.1177/1073191111428764 -
Journal of Toxicology and Environmental... 2016Attention Restoration Theory (ART) suggests the ability to concentrate may be restored by exposure to natural environments. Although widely cited, it is unclear as to... (Meta-Analysis)
Meta-Analysis Review
Attention Restoration Theory (ART) suggests the ability to concentrate may be restored by exposure to natural environments. Although widely cited, it is unclear as to the quantity of empirical evidence that supports this. A systematic review regarding the impact of exposure to natural environments on attention was conducted. Seven electronic databases were searched. Studies were included if (1) they were natural experiments, randomized investigations, or recorded "before and after" measurements; (2) compared natural and nonnatural/other settings; and (3) used objective measures of attention. Screening of articles for inclusion, data extraction, and quality appraisal were performed by one reviewer and checked by another. Where possible, random effects meta-analysis was used to pool effect sizes. Thirty-one studies were included. Meta-analyses provided some support for ART, with significant positive effects of exposure to natural environments for three measures (Digit Span Forward, Digit Span Backward, and Trail Making Test B). The remaining 10 meta-analyses did not show marked beneficial effects. Meta-analysis was limited by small numbers of investigations, small samples, heterogeneity in reporting of study quality indicators, and heterogeneity of outcomes. This review highlights the diversity of evidence around ART in terms of populations, study design, and outcomes. There is uncertainty regarding which aspects of attention may be affected by exposure to natural environments.
Topics: Attention; Environment; Environmental Health; Humans; Public Health
PubMed: 27668460
DOI: 10.1080/10937404.2016.1196155 -
Hormones and Behavior Nov 2020The ratio of length between the second and fourth fingers (2D:4D) is commonly used as an indicator of prenatal sex hormone exposure. Several approaches have been used to... (Meta-Analysis)
Meta-Analysis
The ratio of length between the second and fourth fingers (2D:4D) is commonly used as an indicator of prenatal sex hormone exposure. Several approaches have been used to try to validate the measure, including examining 2D:4D in people with congenital adrenal hyperplasia (CAH), a suite of conditions characterised by elevated adrenal androgen production secondary to defective steroidogenesis. We present a systematic review and meta-analysis that examines the relationship between these two variables. Twelve articles relating to nine CAH cohorts were identified, and 2D:4D comparisons have been made between cases and controls in eight of these cohorts. Altogether, at least one 2D:4D variable has been compared between n = 251 females with CAH and n = 358 unaffected females, and between n = 108 males with CAH and n = 204 unaffected males. A previous meta-analysis (Hönekopp and Watson, 2010) reported lower right hand (R2D:4D) and left hand (L2D:4D) digit ratios in patients with CAH relative to sex-matched controls. Our meta-analysis showed the same pattern, with medium effect sizes for R2D:4D and small effect sizes for L2D:4D. Differences of small magnitude were also observed for M2D:4D, and no significant effects were observed for D. Notably, the only effects that remained statistically significant when stratified by sex were R2D:4D in males and L2D:4D in females, and the average effect size had reduced by 46.70% since the meta-analysis of Hönekopp and Watson (2010). We also found that individual comparisons in this literature were considerably underpowered, and that patterns of sexual dimorphism in 2D:4D were similar in CAH samples as in typically developing populations. Findings are discussed in relation to the prenatal androgen hypothesis as well as alternative explanations.
Topics: Adolescent; Adrenal Hyperplasia, Congenital; Adult; Androgens; Body Weights and Measures; Case-Control Studies; Child; Child, Preschool; Female; Fingers; Gonadal Steroid Hormones; Humans; Male; Pregnancy; Prenatal Exposure Delayed Effects; Sex Characteristics; Young Adult
PubMed: 32998030
DOI: 10.1016/j.yhbeh.2020.104867 -
The Cochrane Database of Systematic... Mar 2015Comforting behaviours, such as the use of pacifiers (dummies, soothers), blankets and finger or thumb sucking, are common in babies and young children. These comforting... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Comforting behaviours, such as the use of pacifiers (dummies, soothers), blankets and finger or thumb sucking, are common in babies and young children. These comforting habits, which can be referred to collectively as 'non-nutritive sucking habits' (NNSHs), tend to stop as children get older, under their own impetus or with support from parents and carers. However, if the habit continues whilst the permanent dentition is becoming established, it can contribute to, or cause, development of a malocclusion (abnormal bite). A diverse variety of approaches has been used to help children with stopping a NNSH. These include advice, removal of the comforting object, fitting an orthodontic appliance to interfere with the habit, application of an aversive taste to the digit or behaviour modification techniques. Some of these interventions are easier to apply than others and less disturbing for the child and their parent; some are more applicable to a particular type of habit.
OBJECTIVES
The primary objective of the review was to evaluate the effects of different interventions for cessation of NNSHs in children. The secondary objectives were to determine which interventions work most quickly and are the most effective in terms of child and parent- or carer-centred outcomes of least discomfort and psychological distress from the intervention, as well as the dental measures of malocclusion (reduction in anterior open bite, overjet and correction of posterior crossbite) and cost-effectiveness.
SEARCH METHODS
We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 8 October 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 9), MEDLINE via OVID (1946 to 8 October 2014), EMBASE via OVID (1980 to 8 October 2014), PsycINFO via OVID (1980 to 8 October 2014) and CINAHL via EBSCO (1937 to 8 October 2014), the US National Institutes of Health Trials Register (Clinical Trials.gov) (to 8 October 2014) and the WHO International Clinical Trials Registry Platform (to 8 October 2014). There were no restrictions regarding language or date of publication in the searches of the electronic databases. We screened reference lists from relevant articles and contacted authors of eligible studies for further information where necessary.
SELECTION CRITERIA
Randomised or quasi-randomised controlled trials in children with a non-nutritive sucking habit that compared one intervention with another intervention or a no-intervention control group. The primary outcome of interest was cessation of the habit.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by The Cochrane Collaboration. Three review authors were involved in screening the records identified; two undertook data extraction, two assessed risk of bias and two assessed overall quality of the evidence base. Most of the data could not be combined and only one meta-analysis could be carried out.
MAIN RESULTS
We included six trials, which recruited 252 children (aged two and a half to 18 years), but presented follow-up data on only 246 children. Digit sucking was the only NNSH assessed in the studies. Five studies compared single or multiple interventions with a no-intervention or waiting list control group and one study made a head-to-head comparison. All the studies were at high risk of bias due to major limitations in methodology and reporting. There were small numbers of participants in the studies (20 to 38 participants per study) and follow-up times ranged from one to 36 months. Short-term outcomes were observed under one year post intervention and long-term outcomes were observed at one year or more post intervention. Orthodontics appliance (with or without psychological intervention) versus no treatmentTwo trials that assessed this comparison evaluated our primary outcome of cessation of habit. One of the trials evaluated palatal crib and one used a mix of palatal cribs and arches. Both trials were at high risk of bias. The orthodontic appliance was more likely to stop digit sucking than no treatment, whether it was used over the short term (risk ratio (RR) 6.53, 95% confidence interval (CI) 1.67 to 25.53; two trials, 70 participants) or long term (RR 5.81, 95% CI 1.49 to 22.66; one trial, 37 participants) or used in combination with a psychological intervention (RR 6.36, 95% CI 0.97 to 41.96; one trial, 32 participants). Psychological intervention versus no treatmentTwo trials (78 participants) at high risk of bias evaluated positive reinforcement (alone or in combination with gaining the child's co-operation) or negative reinforcement compared with no treatment. Pooling of data showed a statistically significant difference in favour of the psychological interventions in the short term (RR 6.16, 95% CI 1.18 to 32.10; I(2) = 0%). One study, with data from 57 participants, reported on the long-term effect of positive and negative reinforcement on sucking cessation and found a statistically significant difference in favour of the psychological interventions (RR 6.25, 95% CI 1.65 to 23.65). Head-to-head comparisonsOnly one trial demonstrated a clear difference in effectiveness between different active interventions. This trial, which had only 22 participants, found a higher likelihood of cessation of habit with palatal crib than palatal arch (RR 0.13, 95% CI 0.03 to 0.59).
AUTHORS' CONCLUSIONS
This review found low quality evidence that orthodontic appliances (palatal arch and palatal crib) and psychological interventions (including positive and negative reinforcement) are effective at improving sucking cessation in children. There is very low quality evidence that palatal crib is more effective than palatal arch. This review has highlighted the need for high quality trials evaluating interventions to stop non-nutritive sucking habits to be conducted and the need for a consolidated, standardised approach to reporting outcomes in these trials.
Topics: Adolescent; Bedding and Linens; Child; Child, Preschool; Fingersucking; Humans; Malocclusion; Orthodontic Appliances; Orthodontic Appliances, Functional; Pacifiers; Reinforcement, Psychology; Stress, Psychological; Sucking Behavior
PubMed: 25825863
DOI: 10.1002/14651858.CD008694.pub2 -
Journal of Hand Therapy : Official... 2019Systematic review INTRODUCTION: Trigger finger (TF) is a common condition in the hand. The primary purpose of this systematic review was to evaluate the current evidence...
STUDY DESIGN
Systematic review INTRODUCTION: Trigger finger (TF) is a common condition in the hand. The primary purpose of this systematic review was to evaluate the current evidence to determine the efficacy of orthotic management of TF. A secondary purpose was to identify the characteristics of the orthotic management. The tertiary purpose of this study was to ascertain if the studies used a patient-reported outcome to assess gains from the patient's perspective.
METHODS
All studies including randomized controlled trials, prospective, and retrospective cohort studies were included in this review due to limited high-level evidence.
RESULTS
Four authors demonstrated moderate to large effect sizes ranging from 0.49 to 1.99 for pain reduction after wearing an orthotic device. Two authors demonstrated a change in the stages of stenosing tenosynovitis scale scores showing a clinically important change with a large effect size ranging from 0.97 to 1.63. Seven authors immobilized a single joint of the affected digit using a variety of orthoses.
CONCLUSION
All authors reported similar results regardless of the joint immobilized; therefore for orthotic management of the TF, we recommend a sole joint be immobilized for 6-10 weeks. In assessing TF, most authors focused on body structures and functions including pain and triggering symptoms, 2 authors used a validated functional outcome measure. In the future therapists should use a validated patient report outcome to assess patient function that is sensitive to change in patients with TF. Furthermore, more randomized controlled trials are needed.
Topics: Conservative Treatment; Disability Evaluation; Humans; Orthotic Devices; Patient Reported Outcome Measures; Trigger Finger Disorder; Visual Analog Scale
PubMed: 29290504
DOI: 10.1016/j.jht.2017.10.016 -
Journal of Clinical Orthopaedics and... Jan 2021Recent spread of severe acute respiratory coronavirus syndrome-2 (SARS-CoV-2) has led to the coronavirus disease (COVID-19) pandemic, resulting in new challenges across... (Review)
Review
BACKGROUND
Recent spread of severe acute respiratory coronavirus syndrome-2 (SARS-CoV-2) has led to the coronavirus disease (COVID-19) pandemic, resulting in new challenges across all medical specialties. Limb and digit ischemia have been associated with COVID-19 infection. This systematic review includes primary studies of COVID-19 limb ischemia to identify risk factors, comorbidities, case characteristics, and treatment strategies to better understand the nature of this disease and its effects on the extremities.
METHODS
A literature search for studies detailing COVID-19 infected patients with limb or digit ischemia was performed, identifying 157 articles, 12 of which met inclusion criteria, accounting for 47 patients. Inclusion criteria were (1) primary studies, (2) positive disease diagnosis (3) limb ischemia, (4) reported treatment. Demographic data, case characteristics, treatments, outcomes and mortality were collected and pooled.
RESULTS
The average patient age was 67.6 years, predominantly male (79.6%). Of the 44 cases discussing treatment, 13 (30%) patients underwent medical treatment alone, while 23 (52.3%) patients underwent medical plus surgical treatment. Four patients (9.1%) were treated with observation. In 10 of the 12 studies, lab findings, thrombosis, or conclusions supporting a hypercoagulable state as a cause of limb/digit ischemia were cited. Five patients (10.6%) were on vasopressors and 8 patients (17.0%) were on a ventilator. Of those treated with observation alone, there was 100% resolution of symptoms. Of those treated medically without surgical intervention (17 patients), 6 patients (35.3%) were reported to have revascularization, 6 patients (35.3%) died, and the remaining outcomes were not reported. Medical and surgical treatment resulted in one limb amputation (4.4%) and altogether 74% of patients achieved revascularization of the affected limb/digit. Mortality rate was 45%.
CONCLUSIONS
COVID-19 infection may be associated with increased risk of limb or digital ischemia, although the quality of evidence supporting this theory is limited. Evidence of inflammatory-mediated thrombosis and endothelial injury are possible explanations which would support the use of immunotherapy in addition to anticoagulation for treatment or prevention of thromboembolic events. Current outcomes and treatment strategies are variable.
LEVEL OF EVIDENCE
IV.
PubMed: 33281415
DOI: 10.1016/j.jcot.2020.11.018 -
American Journal of Human Biology : the... Mar 2022Digit ratio (2D:4D), a marker of prenatal testosterone exposure, is a weak negative correlate of sports/athletic/fitness performance. While numerous studies have... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Digit ratio (2D:4D), a marker of prenatal testosterone exposure, is a weak negative correlate of sports/athletic/fitness performance. While numerous studies have examined the relationship between 2D:4D and physical fitness, there has never been a comprehensive study that has synthesized studies examining relationships between 2D:4D and muscular fitness.
OBJECTIVES
To systematically review and meta-analyze the relationship between 2D:4D and muscular fitness measured as handgrip strength (HGS).
METHODS
We systematically searched five electronic databases, reference lists, topical systematic reviews/meta-analyses, and personal libraries in November 2020. Peer-reviewed, cross-sectional studies that reported Pearson's correlation coefficients between objectively measured 2D:4D and HGS were included. We used random-effects meta-analysis to estimate the pooled correlation and the 95% confidence interval (95%CI), and moderator analyses to estimate the influence of sex and age.
RESULTS
Data from 22 studies, representing 5271 individuals from 11 countries ranging in (mean) age from 10.4 to 58.0 years, were included. Overall, there was a weak negative correlation between 2D:4D and HGS (r = -0.15, 95%CI = -0.20 to -0.09), indicating that individuals with low 2D:4Ds had high HGS. We found substantial heterogeneity between studies (Q = 123.4, p < .0001; I = 74%), but neither sex (Q = 0.003, p = .96) nor age (Q = 0.46, p = .50) significantly moderated the pooled correlation.
CONCLUSIONS
We found a weak negative relationship between 2D:4D and HGS, which showed substantial heterogeneity between studies, but was neither moderated by sex nor age. Our finding probably reflects both the long-term (organizational) and short-term (activational) benefits of testosterone.
Topics: Adolescent; Adult; Athletic Performance; Child; Cross-Sectional Studies; Digit Ratios; Fingers; Hand Strength; Humans; Middle Aged; Testosterone; Young Adult
PubMed: 34331730
DOI: 10.1002/ajhb.23657