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Cardiovascular and Interventional... May 2016Subclavian artery occlusive disease (SAOD) is often associated with cerebrovascular symptoms such as subclavian steal syndrome and stroke. We conducted a systematic... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND AND PURPOSE
Subclavian artery occlusive disease (SAOD) is often associated with cerebrovascular symptoms such as subclavian steal syndrome and stroke. We conducted a systematic review and meta-analysis to compare percutaneous transluminal angioplasty (PTA) and stent placement for the treatment of SAOD.
MATERIALS AND METHODS
We searched Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through October 16, 2014. From each study, we abstracted baseline patient characteristics, study design variables, and outcome data including rates of technical success, primary patency (≤2 and >2 years follow-up), symptom resolution, and complications. Meta-analysis was performed using a random-effects model.
RESULTS
A total of 35 non-comparative studies with 1726 patients were included. Technical success rate was significantly higher in the stent group than the PTA group (92.8 vs 86.8%, p = 0.007). Long-term primary patency rates (76.9 vs 79.6%, p = 0.729) and symptom resolution rates (82.2 vs 73.0%, p = 0.327) were not statistically different. There was no statistically significant difference in the rates of stroke or death.
CONCLUSION
Stent placement for treatment of SAOD may be associated with higher rates of technical success but similar rates of symptom resolution and long-term outcomes. The confidence in the available estimates is low. Further comparative studies are needed to guide patients and clinicians in shared decision making.
Topics: Angioplasty; Arterial Occlusive Diseases; Blood Vessel Prosthesis Implantation; Humans; Stents; Stroke; Subclavian Artery; Subclavian Steal Syndrome
PubMed: 26630966
DOI: 10.1007/s00270-015-1250-9 -
Unexplained Absences and Risk of Death and Injury Among Nursing Home Residents: A Systematic Review.Journal of the American Medical... Apr 2017Unexplained absence of nursing home (NH) residents is one of the most challenging issues related to the care of older people. The aim of this review was to examine the... (Review)
Review
BACKGROUND
Unexplained absence of nursing home (NH) residents is one of the most challenging issues related to the care of older people. The aim of this review was to examine the death and injury outcomes of unexplained absence of NH residents.
METHOD
We searched MEDLINE, CINAHL, EMBASE, PsycINFO, AgeLine, and Cochrane Library to identify qualitative and quantitative studies published in the English language. Data on death and injury were collated, and aggregate proportions were calculated where possible.
RESULTS
Nine studies were identified; most (n = 6) were conducted in the United States. Persons with dementia formed the study population in all studies. There were 1440 individual unexplained absences reported across the 9 studies. We calculated a rate of 82 deaths and 61 injuries per 1000 incidents of unexplained absence. Extreme temperatures were the most common cause of death. Most individuals left by foot, and were found within a 1-mile radius of place last seen in green vegetation and waterways.
CONCLUSION
This review provides valuable insight into death and injury outcomes. Further studies are recommended to improve understanding and prevent adverse outcomes.
Topics: Aged; Aged, 80 and over; Death; Female; Humans; Male; Middle Aged; Nursing Homes; Wandering Behavior; Wounds and Injuries
PubMed: 28242190
DOI: 10.1016/j.jamda.2017.01.007 -
Life (Basel, Switzerland) Dec 2021Chondral and soft tissue injuries can be associated with first time patellar dislocation, but it is unclear how common they are, and which tissues are affected. A... (Review)
Review
INTRODUCTION
Chondral and soft tissue injuries can be associated with first time patellar dislocation, but it is unclear how common they are, and which tissues are affected. A systematic review of the literature was performed to investigate the frequency, location, and extent of chondral and medial patellofemoral ligament (MPFL) injuries in patients following first time patellar dislocation.
METHODS
This systematic review was conducted according to the PRISMA guidelines. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in November 2021. All the published clinical studies reporting the frequency, location, and extent of soft tissue lesions following first time patellar dislocation were accessed. Studies reporting data on habitual, congenital, or recurrent patellofemoral instability were excluded.
RESULTS
Data from 42 articles (2254 patients, mean age 21.6 ± 7.3 years) were retrieved. Ninety-eight percent of patients who experienced first time patellar dislocation demonstrated MPFL rupture at MRI. Forty-eight percent of MPFL ruptures were located at the patellar side, 34% at the femoral insertion site, and 18% in the midportion. Eighty-five percent of patients showed signs of patellar chondral damage at MRI, and trochlear chondral injuries were evidenced in 47% of patients. Intra-articular loose bodies were observed in 11.5% of patients. At arthroscopy, the medial facet and the crest of the patella more commonly exhibited chondral lesions than the lateral facet and femoral trochlea.
CONCLUSIONS
Most patients suffer chondral damage and MPFL tears following after a first time patellar dislocation.
PubMed: 34947891
DOI: 10.3390/life11121360 -
Preventive Medicine Apr 2018Indigenous populations experience health disparities including increased obesity, diabetes and cardiovascular disease rates. Cardiorespiratory fitness is beneficial for... (Meta-Analysis)
Meta-Analysis
Indigenous populations experience health disparities including increased obesity, diabetes and cardiovascular disease rates. Cardiorespiratory fitness is beneficial for maintaining positive health outcomes. The objective of this systematic review is to evaluate cardiorespiratory fitness among Indigenous populations including comparisons across genders, Indigenous identities, age groups, decades, socio-demographic variables and in comparison to non-Indigenous groups. Included articles reported various cardiorespiratory fitness measures using maximal treadmill or cycle ergometer tests, 20 m shuttle run, 1 mile run/walk test and 6 min walk test. From 14 databases searched in March 2017, including MEDLINE, EMBASE and Scopus, 1069 citations were evaluated and 39 articles included, representing 32 investigations and 10,579 individuals. First Nations/American Indian (FN/AI) adults have greater cardiorespiratory fitness than Inuit. Inuit and FN/AI men and boys have higher cardiorespiratory fitness than women and girls. Lower cardiorespiratory fitness is associated with obesity, metabolic syndrome and a western lifestyle. Cardiorespiratory fitness has declined among Inuit adults, averaging 51.7 ± 7.9 mL·kg·min in 1970 to 37.7 ± 6.9 mL·kg·min in 2000. Among men, FN/AI have greater cardiorespiratory fitness compared to European-descents, and European-descents have greater cardiorespiratory fitness compared to Inuit. The 1 mile run/walk time showed that FN/AI boys, girls, and youth had faster times compared to European-descendants, but 20 m shuttle run showed that European-descent boys and youth advanced to further stages compared to FN/AI populations. Cardiorespiratory fitness is declining, and among some Indigenous populations to lower levels than European-descent populations. Improving cardiorespiratory fitness for Indigenous populations should be considered a primary health strategy.
Topics: Age Factors; Cardiorespiratory Fitness; Exercise; Exercise Test; Health Status Disparities; Humans; Indians, North American; Inuit; Sex Factors
PubMed: 29339114
DOI: 10.1016/j.ypmed.2018.01.007 -
World Journal of Microbiology &... Aug 2022With the advent of green chemistry, the use of enzymes in industrial processes serves as an alternative to the conventional chemical catalysts. A high demand for... (Review)
Review
With the advent of green chemistry, the use of enzymes in industrial processes serves as an alternative to the conventional chemical catalysts. A high demand for sustainable processes for catalysis has brought a significant attention to hunt for novel enzymes. Among various hydrolases, the α-amylase has a gamut of biotechnological applications owing to its pivotal role in starch-hydrolysis. Industrial demand requires enzymes with thermostability and to ameliorate this crucial property, various methods such as protein engineering, directed evolution and enzyme immobilisation strategies are devised. Besides the traditional culture-dependent approach, metagenome from uncultured bacteria serves as a bountiful resource for novel genes/biocatalysts. Exploring the extreme-niches metagenome, advancements in protein engineering and biotechnology tools encourage the mining of novel α-amylase and its stable variants to tap its robust biotechnological and industrial potential. This review outlines α-amylase and its genetics, its catalytic domain architecture and mechanism of action, and various molecular methods to ameliorate its production. It aims to impart understanding on mechanisms involved in thermostability of α-amylase, cover strategies to screen novel genes from futile habitats and some molecular methods to ameliorate its properties.
Topics: Enzymes, Immobilized; Metagenome; Protein Engineering; Starch; alpha-Amylases
PubMed: 35999473
DOI: 10.1007/s11274-022-03396-0 -
Arthroscopy : the Journal of... May 2016To evaluate clinical outcomes, rate of recurrence, and complications following distal realignment procedures (Elmslie-Trillat, Maquet, Fulkerson, Roux Goldthwait, and... (Review)
Review
Elmslie-Trillat, Maquet, Fulkerson, Roux Goldthwait, and Other Distal Realignment Procedures for the Management of Patellar Dislocation: Systematic Review and Quantitative Synthesis of the Literature.
PURPOSE
To evaluate clinical outcomes, rate of recurrence, and complications following distal realignment procedures (Elmslie-Trillat, Maquet, Fulkerson, Roux Goldthwait, and other distal realignment procedures) performed alone or in combination with proximal procedures for the management of patellar dislocation.
METHODS
A systematic literature review was performed following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A search in PubMed, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, and Google Scholar databases using various combinations of the keywords "patellar," "dislocation," "tibial transfer," "Elmslie-Trillat," "Roux Goldthwait," "tibial tubercle osteotomy," "Fulkerson," "Maquet," "procedure," "clinical," and "outcome."
RESULTS
Thirty-eight articles were included in the systematic review. A total of 1,182 knees belonging to 1,023 patients were grouped according to the duration of the follow-up period. The overall rate of recurrence was 7% (83 of 1,182 knees). Approximately 5.3% (28 of 520 knees) of the redislocation occurred in the short-medium term, and 8.3% (55 of 662 knees) occurred in the long-term.
CONCLUSIONS
Distal realignment procedures performed alone or in combination with proximal procedures for the management of patellar dislocation have shown good clinical outcomes and a low rate of recurrence highlighting the efficacy of these procedures. To date no randomized controlled clinical trials are available on the topic.
LEVEL OF EVIDENCE
Level IV, systematic review of Level III and IV studies.
Topics: Arthrodesis; Humans; Joint Instability; Knee Joint; Osteotomy; Patellar Dislocation; Recurrence; Tibia
PubMed: 26921127
DOI: 10.1016/j.arthro.2015.10.019 -
Sports Medicine and Arthroscopy Review Mar 2023One of the most frequent concerns of the increasing number of patients undergoing shoulder arthroplasty is the possibility to resume sport after surgery. This systematic...
PURPOSE
One of the most frequent concerns of the increasing number of patients undergoing shoulder arthroplasty is the possibility to resume sport after surgery. This systematic review determined the rate of return to sport after total shoulder arthroplasty (TSA) and hemiarthroplasty (HA).
MATERIALS AND METHODS
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review. A systematic electronic search was performed using the PubMed (MEDLINE), EMBASE, and Cochrane Library databases. All the studies analyzing the rates of reverse shoulder arthroplasties were pooled; data were extracted and statistically analyzed. Only studies with at least 10 adult patients recruited were considered. All studies had to relate return to sport after TSA or HA.
RESULTS
A total of 76 studies were included for a total of 694 patients. The mean age and average follow-up were, respectively, 64.5 years (range: 24 to 92 y) and 4.5 years (range: 0.5 to 12 y). The mean rate of return to sport ranged from 49.3% to 96.4%. The mean time to resume sports was 8.1 months. The overall rate of return to sport after the procedures, according to a random effect model, was 83%. The mean level of sports at the time of the survey was worsened in 9.4% (±2.82%), improved or reported from good to excellent in 55.6% (±13.6%), and did not change in 40% (±1.4) of patients.
CONCLUSIONS
On the basis of current available data, return to sports after TSA and HA is possible and is highly frequent. The subjective level of practice does not change or improve in most patients. More studies and better designed trials are needed to enrich the evidence on specific sport recovery after the procedure.
Topics: Adult; Humans; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Return to Sport; Hemiarthroplasty; Sports
PubMed: 36563123
DOI: 10.1097/JSA.0000000000000306 -
Journal of Functional Biomaterials Apr 2022The aim of this paper is to systematically analyse the effect of calcium silicate-based sealers in comparison to resin-based sealers on clinical and radiographic... (Review)
Review
Clinical and Radiographic Outcome of Non-Surgical Endodontic Treatment Using Calcium Silicate-Based Versus Resin-Based Sealers-A Systematic Review and Meta-Analysis of Clinical Studies.
The aim of this paper is to systematically analyse the effect of calcium silicate-based sealers in comparison to resin-based sealers on clinical and radiographic outcomes of non-surgical endodontic treatment in permanent teeth. Methods: The study was conducted according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. The literature search was performed using PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, DOAJ and OpenGrey with no language restrictions. Two reviewers critically assessed the studies for eligibility. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was carried out to assess the evidence. Meta-analysis of the pooled data with subgroups was carried out using the RevMan software (p < 0.05). Results: Results from the included studies showed that there were no significant differences between the groups in the 24 h post-obturation pain levels (mean difference (MD), −0.19, 95% CI = −0.43−0.06, p = 0.14, I2 = 0%), but at 48 h (MD, −0.35, 95% CI = −0.64−0.05, p = 0.02, I2 = 0%), a significant difference was observed in favour of calcium silicate sealers. Furthermore, there were no significant differences between the two sealers due to risk of onset or intensity of postoperative pain, need for analgesic and extrusion of the sealer. The heterogeneity assessed using Q test between the included studies was 97% (I2). Conclusions: Within the limitations of this review, the paper shows that calcium silicate-based sealers exhibited optimal performance with similar results to resin-based sealers in terms of average level of post-obturation pain, risk of onset and pain intensity at 24 and 48 h. The observations from the included studies are informative in the clinical evaluation of calcium silicate-based sealers and provide evidence for the conduction of well-designed, controlled randomised clinical trials for a period of at least four years in the future.
PubMed: 35466220
DOI: 10.3390/jfb13020038 -
Sports Medicine (Auckland, N.Z.) Dec 2016Sports-related groin pain (SRGP) is a common entity in rotational sports such as football, rugby and hockey, accounting for 12-18 % of injuries each year, with high... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Sports-related groin pain (SRGP) is a common entity in rotational sports such as football, rugby and hockey, accounting for 12-18 % of injuries each year, with high recurrence rates and often prolonged time away from sport.
OBJECTIVE
This systematic review synthesises movement and muscle function findings to better understand deficits and guide rehabilitation.
STUDY SELECTION
Prospective and retrospective cross-sectional studies investigating muscle strength, flexibility, cross-sectional area, electromyographic activation onset and magnitude in patients with SRGP were included.
SEARCH METHODS
Four databases (MEDLINE, Web of Knowledge, EBSCOhost and EMBASE) were searched in June 2014. Studies were critiqued using a modified version of the Downs and Black Quality Index, and a meta-analysis was performed.
RESULTS
Seventeen studies (14 high quality, 3 low quality; 8 prospective and 9 retrospective) were identified. Prospective findings: moderate evidence indicated decreased hip abduction flexibility as a risk factor for SRGP. Limited or very limited evidence suggested that decreased hip adduction strength during isokinetic testing at ~119°/s was a risk factor for SRGP, but no associations were found at ~30°/s or ~210°/s, or with peak torque angle. Decreased hip abductor strength in angular velocity in ~30°/s but not in ~119°/s and ~210°/s was found as a risk factor for SRGP. No relationships were found with hip internal or external rotation range of movement, nor isokinetic knee extension strength. Decreased isokinetic knee flexion strength also was a potential risk factor for SRGP, at a speed ~60°/s. Retrospective findings: there was strong evidence of decreased hip adductor muscle strength during a squeeze test at 45°, and decreased total hip external rotation range of movement (sum of both legs) being associated with SRGP. There was strong evidence of no relationship to abductor muscle strength nor unilateral hip internal and external rotation range of movement. Moderate evidence suggested that increased abduction flexibility and no change in total hip internal rotation range of movement (sum of both legs) were retrospectively associated with SRGP. Limited or very limited evidence (significant findings only) indicated decreased hip adductor muscle strength during 0° and 30° squeeze tests and during an eccentric hip adduction test, but a decrease in the isometric adductors-to-abductors strength ratio at speed 120°/s; decreased abductors-to-adductors activation ratio in the early phase in the moving leg as well as in all three phases in the weight-bearing leg during standing hip flexion; and increased hip flexors strength during isokinetic and decrease in transversus abdominis muscle resting thickness associated with SRGP.
CONCLUSIONS
There were a number of significant movement and muscle function associations observed in athletes both prior to and following the onset of SRGP. The strength of findings was hampered by the lack of consistent terminology and diagnostic criteria, with there being clear guides for future research. Nonetheless, these findings should be considered in rehabilitation and prevention planning.
Topics: Abdominal Pain; Arthralgia; Groin; Hip Joint; Humans; Muscle, Skeletal; Pain; Range of Motion, Articular
PubMed: 27142535
DOI: 10.1007/s40279-016-0523-z -
Human Resources For Health Jul 2022This paper explores the extent of community-level stock-out of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs) and...
Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences.
BACKGROUND
This paper explores the extent of community-level stock-out of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs) and identifies the reasons for and consequences of essential medicine stock-outs.
METHODS
A systematic review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five electronic databases were searched with a prespecified strategy and the grey literature examined, January 2006-March 2021. Papers containing information on (1) the percentage of CHWs stocked out or (2) reasons for stock-outs along the supply chain and consequences of stock-out were included and appraised for risk of bias. Outcomes were quantitative data on the extent of stock-out, summarized using descriptive statistics, and qualitative data regarding reasons for and consequences of stock-outs, analyzed using thematic content analysis and narrative synthesis.
RESULTS
Two reviewers screened 1083 records; 78 evaluations were included. Over the last 15 years, CHWs experienced stock-outs of essential medicines nearly one third of the time and at a significantly (p < 0.01) higher rate than the health centers to which they are affiliated (28.93% [CI 95%: 28.79-29.07] vs 9.17% [CI 95%: 8.64-9.70], respectively). A comparison of the period 2006-2015 and 2016-2021 showed a significant (p < 0.01) increase in CHW stock-out level from 26.36% [CI 95%: 26.22-26.50] to 48.65% [CI 95%: 48.02-49.28] while that of health centers increased from 7.79% [95% CI 7.16-8.42] to 14.28% [95% CI 11.22-17.34]. Distribution barriers were the most cited reasons for stock-outs. Ultimately, patients were the most affected: stock-outs resulted in out-of-pocket expenses to buy unavailable medicines, poor adherence to medicine regimes, dissatisfaction, and low service utilization.
CONCLUSIONS
Community-level stock-out of essential medicines constitutes a serious threat to achieving universal health coverage and equitable improvement of health outcomes. This paper suggests stock-outs are getting worse, and that there are particular barriers at the last mile. There is an urgent need to address the health and non-health system constraints that prevent the essential medicines procured for LMICs by international and national stakeholders from reaching the people who need them the most.
Topics: Community Health Workers; Delivery of Health Care; Developing Countries; Drugs, Essential; Humans
PubMed: 35840965
DOI: 10.1186/s12960-022-00755-8