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Systematic review of immunoglobulin use in paediatric neurological and neurodevelopmental disorders.Developmental Medicine and Child... Feb 2017A systematic literature review of intravenous immunoglobulin (IVIG) treatment of paediatric neurological conditions was performed to summarize the evidence, provide... (Review)
Review
AIM
A systematic literature review of intravenous immunoglobulin (IVIG) treatment of paediatric neurological conditions was performed to summarize the evidence, provide recommendations, and suggest future research.
METHOD
A MEDLINE search for articles reporting on IVIG treatment of paediatric neuroinflammatory, neurodevelopmental, and neurodegenerative conditions published before September 2015, excluding single case reports and those not in English. Owing to heterogeneous outcome measures, meta-analysis was not possible. Findings were combined and evidence graded.
RESULTS
Sixty-five studies were analysed. IVIG reduces recovery time in Guillain-Barré syndrome (grade B). IVIG is as effective as corticosteroids in chronic inflammatory demyelinating polyradiculoneuropathy (grade C), and as effective as tacrolimus in Rasmussen syndrome (grade C). IVIG improves recovery in acute disseminated encephalomyelitis (grade C), reduces mortality in acute encephalitis syndrome with myocarditis (grade C), and improves function and stabilizes disease in myasthenia gravis (grade C). IVIG improves outcome in N-methyl-d-aspartate receptor encephalitis (grade C) and opsoclonus-myoclonus syndrome (grade C), reduces cataplexy symptoms in narcolepsy (grade C), speeds recovery in Sydenham chorea (grade C), reduces tics in selected cases of Tourette syndrome (grade D), and improves symptoms in paediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (grade B).
INTERPRETATION
IVIG is a useful therapy in selected neurological conditions. Well-designed, prospective, multi-centre studies with standardized outcome measures are required to compare treatments.
Topics: Humans; Immunoglobulins; Immunologic Factors; MEDLINE; Nervous System Diseases; Neurodevelopmental Disorders; Pediatrics
PubMed: 27900773
DOI: 10.1111/dmcn.13349 -
Haematologica Aug 2015Hospital-associated venous thromboembolism, including deep vein thrombosis and pulmonary embolism, is increasing in pediatric centers. The objective of this work was to... (Meta-Analysis)
Meta-Analysis Review
Hospital-associated venous thromboembolism, including deep vein thrombosis and pulmonary embolism, is increasing in pediatric centers. The objective of this work was to systematically review literature on pediatric hospital-acquired venous thromboembolism risk factors and risk-assessment models, to inform future prevention research. We conducted a literature search on pediatric venous thromboembolism risk via PubMed (1946-2014) and Embase (1980-2014). Data on risk factors and risk-assessment models were extracted from case-control studies, while prevalence data on clinical characteristics were obtained from registries, large (n>40) retrospective case series, and cohort studies. Meta-analyses were conducted for risk factors or clinical characteristics reported in at least three studies. Heterogeneity among studies was assessed with the Cochran Q test and quantified by the I(2) statistic. From 394 initial articles, 60 met the final inclusion criteria (20 case-control studies and 40 registries/large case series/cohort studies). Significant risk factors among case-control studies were: intensive care unit stay (OR: 2.14, 95% CI: 1.97-2.32); central venous catheter (OR: 2.12, 95% CI: 2.00-2.25); mechanical ventilation (OR: 1.56, 95%CI: 1.42-1.72); and length of stay in hospital (per each additional day, OR: 1.03, 95% CI: 1.03-1.03). Three studies developed/applied risk-assessment models from a combination of these risk factors. Fourteen significant clinical characteristics were identified through non-case-control studies. This meta-analysis confirms central venous catheter, intensive care unit stay, mechanical ventilation, and length of stay as risk factors. A few pediatric hospital-acquired venous thromboembolism risk scores have emerged employing these factors. Prospective validation is necessary to inform risk-stratified prevention trials.
Topics: Case-Control Studies; Child; Hospital Mortality; Humans; Iatrogenic Disease; Incidence; Odds Ratio; Pediatrics; Prevalence; Risk Assessment; Risk Factors; Venous Thromboembolism
PubMed: 26001789
DOI: 10.3324/haematol.2015.123455 -
Neurosurgical Review Feb 2022Endoscopic third ventriculostomy (ETV) is a well-established surgical procedure for hydrocephalus treatment, but there is sparse evidence on the optimal choice between... (Meta-Analysis)
Meta-Analysis Review
Endoscopic third ventriculostomy (ETV) is a well-established surgical procedure for hydrocephalus treatment, but there is sparse evidence on the optimal choice between flexible and rigid approaches. A meta-analysis was conducted to compare efficacy and safety profiles of both techniques in pediatrics and adults. A comprehensive search was conducted on PubMED, EMBASE, and Cochrane until 11/10/2019. Efficacy was evaluated comparing incidence of ETV failure, while safety was defined by the incidence of perioperative complications, intraoperative bleedings, and deaths. Random-effects models were used to pool the incidence. Out of 1365 studies, 46 case series were meta-analyzed, yielding 821 patients who underwent flexible ETV and 2918 who underwent rigid ETV, with an age range of [5 days-87 years]. Although flexible ETV had a higher incidence of failure in adults (flexible: 54%, 95%CI: 22-82% vs rigid: 20%, 95%CI: 22-82%) possibly due to confounding due to etiology in adults treated with flexible, a smaller difference was seen in pediatrics (flexible: 36%, pediatric: 32%). Safety profiles were acceptable for both techniques, with a certain degree of variability for complications (flexible 2%, rigid 18%) and death (flexible 1%, rigid 3%) in pediatrics as well as complications (rigid 9%, flexible 13%), death (flexible 4%, rigid 6%) and intra-operative bleeding events (rigid 6%, flexible 8%) in adults. No clear superiority in efficacy could be depicted between flexible and rigid ETV for hydrocephalus treatment. Safety profiles varied by age but were acceptable for both techniques. Well-designed comparative studies are needed to assess the optimal endoscopic treatment option for hydrocephalus.
Topics: Adult; Child; Child, Preschool; Humans; Hydrocephalus; Infant; Neuroendoscopy; Pediatrics; Retrospective Studies; Third Ventricle; Treatment Outcome; Ventriculostomy
PubMed: 34173114
DOI: 10.1007/s10143-021-01590-6 -
Medical Decision Making : An... Jan 2014Measuring utilities and health-related quality of life (HRQL) in children is challenging due to their cognitive abilities and changing developmental stages. (Review)
Review
BACKGROUND
Measuring utilities and health-related quality of life (HRQL) in children is challenging due to their cognitive abilities and changing developmental stages.
PURPOSE
. To identify methodological issues on utility measurements in children, we performed a systematic review on utilities measured with a single instrument, the Health Utilities Index (HUI), in pediatric acute lymphoblastic leukemia (ALL). The secondary goal was to facilitate future cost-utility analyses without the need for time-consuming assessments. Data Sources. PubMed, Embase, Cochrane Library, CINAHL, and PsycINFO were searched from inception to June 2012. Studies had to report on utility scores in pediatric ALL, either on or after treatment, to be included.
RESULTS
. Fifteen studies were included. Most studies had methodological shortcomings, which mainly concerned
STUDY DESIGN
and definition and representativeness of the study group. Utility scores were dependent on treatment variables, and there generally was an improvement in HRQL as treatment or survivorship advanced. In general, proxy-respondents were less reliable for subjective phenomena than for observable conditions. HUI2 and HUI3 scores were not interchangeable. Limitations. Studies may have been missed because no validated search method for utility studies exists, due to language bias or the exclusion of non-peer-reviewed papers.
CONCLUSIONS
. Most studies in this review were methodologically suboptimal. Future developments should focus on including developmentally appropriate items for the whole pediatric age group. Adding disease-specific domains may enhance the sensitivity and responsiveness of instruments. Efforts should be undertaken to elicit valuation of health states from older children and teenagers as much as possible. For now, it remains difficult to make valid and informed decisions on the financing of interventions until health state valuation in children has become more methodologically robust.
Topics: Child; Child, Preschool; Health Status; Humans; Pediatrics; Quality-Adjusted Life Years
PubMed: 23886678
DOI: 10.1177/0272989X13497263 -
Headache Mar 2017Migraine headaches are common in children and adolescents. Current pharmacologic treatment options are limited despite the prevalence and debilitating effects of... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Migraine headaches are common in children and adolescents. Current pharmacologic treatment options are limited despite the prevalence and debilitating effects of pediatric migraine. Cognitive behavioral therapy (CBT) is an evidence-based practice that focuses on the development of coping strategies and cognitive restructuring to alter the pain experience. Till date, no meta-analysis has been done to examine the use of CBT in pediatric migraine.
METHODS
Using the keywords (cognitive behavioral therapy OR cognitive behavior therapy OR cognitive behavioral therapy OR cognitive behavior therapy OR CBT) AND (headache OR migraine), a preliminary search on the PubMed and Ovid database yielded 3841 articles published in English between 1 Jan 1980 and 1 May 2016. Full articles were also reviewed for references of interest. After data extraction, 14 studies were included in the meta-analysis.
RESULTS
The results of the meta-analysis well-support the clinical role of CBT in the management of pediatric migraine. The pooled odds ratios of clinically significant improvement, that is, 50% or greater headache activity reduction post-treatment and at follow-up (3 months or later) were OR 9.11 (95% CI: 5.01 to 16.58, P < .001) and OR 9.18 (95% CI: 5.69 to 14.81, P < .001) respectively, demonstrating significant clinical improvement with CBT as compared with wait-list control, placebo, or standard medication. Furthermore, the clinical improvement was stable, even at a 1-year follow-up as evident in some of the studies.
CONCLUSION
There is good evidence that CBT is beneficial to children suffering from migraine, and may also augment the efficacy of standard medications such as amitriptyline.
Topics: Adolescent; Child; Cognitive Behavioral Therapy; Humans; Longitudinal Studies; Migraine Disorders; Pediatrics; Retrospective Studies
PubMed: 28028812
DOI: 10.1111/head.13016 -
International Journal of Cardiology Nov 2016The treatment of native coarctation of aorta (CoA) has evolved since surgery performed in 1944, followed by transcatheter balloon angioplasty and recently, widely... (Review)
Review
BACKGROUND/OBJECTIVES
The treatment of native coarctation of aorta (CoA) has evolved since surgery performed in 1944, followed by transcatheter balloon angioplasty and recently, widely adopted stent implantation. Despite good results demonstrated with stent implantation, a systematic review and meta-analysis (SRMA) looking at the efficacy and safety of the intervention, particularly in younger population is yet to be done. We aimed to obtain pooled estimates of the success and complication rates after transcatheter stent implantation in the treatment of native CoA based on SRMA.
METHODS
We searched literature published until 31 Dec. 2015, reporting outcomes of transcatheter stent implantation in the treatment of native CoA. The pooled estimates were obtained using the random effect model.
RESULTS
Seventeen reports comprising 561 patients were included. Fourteen studies reported 100% success rate, the lowest was 77%, the largest study reported 81% using a definition of systolic pressure difference of less than 15mmHg. The pooled estimate of overall success rate was 98% (95% CI: 94.5-100.0; I=65%, heterogeneity test p<0.001). Six out of 17 studies reported zero complication. Two studies, however, reported complications in almost half of the cohort. The pooled estimate of rate of complications was 10% (95% CI: 5.1-15.5; I=72%, heterogeneity test p<0.001). Three studies comprising only children, 62, with mean age of 11.1 (4-19) years reported high mean success rate at 98% with only 1 failure.
CONCLUSIONS
There is a high success rate with a small complication rate with stent implantations for native CoA even as the treatment is brought to younger age group.
Topics: Aortic Coarctation; Cardiac Catheterization; Child; Heart Valve Prosthesis Implantation; Humans; Pediatrics; Treatment Outcome
PubMed: 27592045
DOI: 10.1016/j.ijcard.2016.08.295 -
Child's Nervous System : ChNS :... Jan 2016In an era of residency duty-hour restrictions, there has been a recent effort to implement simulation-based training methods in neurosurgery teaching institutions.... (Review)
Review
PURPOSE
In an era of residency duty-hour restrictions, there has been a recent effort to implement simulation-based training methods in neurosurgery teaching institutions. Several surgical simulators have been developed, ranging from physical models to sophisticated virtual reality systems. To date, there is a paucity of information describing the clinical benefits of existing simulators and the assessment strategies to help implement them into neurosurgical curricula. Here, we present a systematic review of the current models of simulation and discuss the state-of-the-art and future directions for simulation in neurosurgery.
METHODS
Retrospective literature review.
RESULTS
Multiple simulators have been developed for neurosurgical training, including those for minimally invasive procedures, vascular, skull base, pediatric, tumor resection, functional neurosurgery, and spine surgery. The pros and cons of existing systems are reviewed.
CONCLUSION
Advances in imaging and computer technology have led to the development of different simulation models to complement traditional surgical training. Sophisticated virtual reality (VR) simulators with haptic feedback and impressive imaging technology have provided novel options for training in neurosurgery. Breakthrough training simulation using 3D printing technology holds promise for future simulation practice, proving high-fidelity patient-specific models to complement residency surgical learning.
Topics: Brain Diseases; Computer Simulation; Humans; Image Processing, Computer-Assisted; Neuroimaging; Neurosurgery; Neurosurgical Procedures; Pediatrics
PubMed: 26438547
DOI: 10.1007/s00381-015-2923-z -
Acta Paediatrica (Oslo, Norway : 1992) Jun 1996The objective of this paper is to introduce the reader to clinical research methodologies and to illustrate how randomized controlled trials (RCTs) and systematic... (Review)
Review
The objective of this paper is to introduce the reader to clinical research methodologies and to illustrate how randomized controlled trials (RCTs) and systematic reviews provide a solid foundation for evidence-based perinatal practice. Relevant references were critically appraised for validity and usefulness. Random allocation is of utmost importance to avoid bias. There are thousands of reported perinatal RCTs. Systematic review techniques allow clinicians to assess the effectiveness of perinatal interventions. The application of the results of systematic reviews to perinatal practice is increasing. RCTs and systematic reviews provide the most valid results on which to build an evidence-based perinatal practice. A major challenge for perinatal researchers is the development of innovative means of communication. This assures that the evidence for an effective intervention is timely implemented. Consumers of care should be encouraged to actively participate in the design, execution and dissemination of perinatal research.
Topics: Bias; Data Interpretation, Statistical; Diffusion of Innovation; Evidence-Based Medicine; Humans; Meta-Analysis as Topic; Perinatology; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Reproducibility of Results; Research Design
PubMed: 8816197
DOI: 10.1111/j.1651-2227.1996.tb14116.x -
Clinical and Experimental Rheumatology 2016To develop recommendations for investigation and monitoring of children with Raynaud's syndrome, based on paediatric evidence collated by a systematic review. (Review)
Review
OBJECTIVES
To develop recommendations for investigation and monitoring of children with Raynaud's syndrome, based on paediatric evidence collated by a systematic review.
METHODS
A systematic review was undertaken to establish the paediatric evidence for assessment and monitoring of Raynaud's syndrome. An expert panel including members of the Paediatric Rheumatology European Society (PRES) Scleroderma Working Group, were invited to a consensus meeting where recommendations were developed based on evidence graded by the systematic review and where evidence was lacking, consensus opinion. A nominal technique was used where 75% consensus was taken as agreement.
RESULTS
The expert panel recommended testing anti-nuclear antibody (ANA), more specific antibodies associated with connective tissue disease and nail-fold capillaroscopy in all children presenting with Raynaud's syndrome as data suggests these can be risk factors for evolution into a connective tissue disease. The frequency of follow-up recommended depends on presence of these risk factors with the aim to detect evolving connective tissue disease early in high risk individuals. Those with no abnormalities on capillaroscopy and negative autoantibodies were deemed low risk of progression, whereas those with ANA positivity, specific autoantibodies and/or nailfold capillary changes were deemed high risk and more frequent follow-up was recommended.
CONCLUSIONS
Recommendations, primarily based on consensus opinion, were agreed regarding investigation and monitoring of children who present with Raynaud's syndrome. Further prospective studies are needed to better define the risk factors for progression to connective tissue disease.
Topics: Adolescent; Age Factors; Antibodies, Antinuclear; Biomarkers; Child; Consensus; Disease Progression; Female; Humans; Male; Microscopic Angioscopy; Pediatrics; Predictive Value of Tests; Prognosis; Raynaud Disease; Rheumatology; Risk Factors; Serologic Tests
PubMed: 27494080
DOI: No ID Found -
African Journal of Paediatric Surgery :... 2010Childhood trauma has become a major cause of mortality and morbidity, disability and socio-economic burden and it is expected by the World Health Organization (WHO) that... (Review)
Review
BACKGROUND
Childhood trauma has become a major cause of mortality and morbidity, disability and socio-economic burden and it is expected by the World Health Organization (WHO) that by 2020 it will be the number 1 disease globally. The WHO and UNICEF have published their third World Report on Child Injury Prevention in December 2008.
MATERIALS AND METHODS
A systematic review was performed on the history and magnitude of paediatric trauma worldwide. Additionally exciting developments and new trends were assessed and summarized.
RESULTS
Paediatric trauma is a growing field of clinical expertise. New developments include total body digital imaging of children presenting with polytrauma; targeted management of head injuries; conservative management of abdominal injuries in children and diagnostic laparoscopy, including the laparoscopic management of complications following the conservative management of solid organ injuries.
CONCLUSION
Paediatric trauma has long been neglected by the medical profession. In order to deal with it appropriately, it makes sense to adopt the public health approach, requiring that we view child injuries similarly to any other disease or health problem. The greatest gain in our clinical practice with dealing with child injuries will result from a strong focus on primary (preventing the injury), secondary (dealing with the injury in the most efficient manner) as well as tertiary prevention (making sure that children treated for trauma will be appropriately reintegrated within our society). By actively promoting child safety we will not only achieve a most welcome reduction in medical cost and disability, but also the ever-so-much desired decline of avoidable childhood misery and suffering.
Topics: Child; Humans; Pediatrics; Wounds and Injuries
PubMed: 20859013
DOI: 10.4103/0189-6725.70409