-
Drug and Alcohol Dependence Sep 2017It is unclear what effect parents' rules about their children's alcohol use have on drinking in adolescence. This review and meta-analysis investigated associations... (Review)
Review
BACKGROUND
It is unclear what effect parents' rules about their children's alcohol use have on drinking in adolescence. This review and meta-analysis investigated associations between prospectively measured parental alcohol rules and later adolescent risky drinking.
METHODS
Using the PRISMA guidelines, we searched eight electronic databases for a variety of terms up to 10 September 2016. We imposed no restrictions on publication year. We assessed the risk of bias and conducted a meta-analysis.
RESULTS
We identified 13 eligible studies in four groups of specific exposures for meta-analysis. The pooled overall estimate showed that when parents set rules concerning alcohol, their children were less likely to develop risky drinking and related problems (OR=0.64, 95% CI=0.48, 0.86). Pooled estimates illustrate that parental alcohol rules were significantly negatively associated with adolescent risky drinking and related problems (OR=0.73, 95% CI=0.53, 0.99), as was parental approval of alcohol use (inverse OR=0.41, 95% CI=0.34, 0.50). Neither parental permissiveness (inverse OR=0.83, 95% CI=0.59, 1.19) nor parental disapproval of alcohol use (OR=0.49, 95% CI=0.20, 1.20) was significantly associated with alcohol-related problems. However, the small number of studies and variability in the point estimates in these latter two groups of studies limits inferences.
CONCLUSIONS
Parents' restrictiveness of their children's drinking was associated with lower risky drinking, but the risk of bias in the existing literature precludes strong inferences about the association. Further longitudinal studies with prospective measurement of parent behaviour, low attrition, and control for likely confounders, are needed.
Topics: Alcohol Drinking; Child; Ethanol; Humans; Mental Disorders; Parent-Child Relations; Parents; Prospective Studies; Risk; Underage Drinking
PubMed: 28667942
DOI: 10.1016/j.drugalcdep.2017.05.011 -
Public Health Nutrition Aug 2012To identify family- and school-based correlates of specific energy balance-related behaviours (physical activity, sedentary behaviour, breakfast consumption, soft drink... (Review)
Review
Family- and school-based correlates of energy balance-related behaviours in 10-12-year-old children: a systematic review within the ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) project.
OBJECTIVE
To identify family- and school-based correlates of specific energy balance-related behaviours (physical activity, sedentary behaviour, breakfast consumption, soft drink consumption) among 10-12-year-olds, using the EnRG framework (Environmental Research framework for weight Gain prevention).
DESIGN
A literature review to identify observational studies exploring at least one family- or school-based correlate of the specific behaviours, resulting in seventy-six articles.
SETTING
Eighteen studies were conducted in Europe, forty-one studies in North America and seventeen studies in Australasia.
SUBJECTS
Healthy children aged 10-12 years.
RESULTS
Parental and maternal physical activity, doing physical activities with parents and parental logistic support were identified as the most important, positive correlates of physical activity. Parental rules was the most important correlate of sedentary behaviour and was inversely related to it. School socio-economic status was positively related to physical activity and inversely related to sedentary behaviour. The available studies suggested a positive relationship between soft drink availability at home and consumption. Soft drink availability and consumption at school were the most important school-based correlates of soft drink consumption. A permissive parenting style was related to more soft drink consumption and less breakfast consumption.
CONCLUSIONS
An important role has been awarded to parents, suggesting parents should be involved in obesity prevention programmes. Despite the opportunities a school can offer, little research has been done to identify school-environmental correlates of energy balance-related behaviours in this age group. Obesity prevention programmes can focus on the most important correlates to maximize the effectiveness of the programme. Future research should aim at longitudinal studies.
Topics: Australasia; Breakfast; Carbonated Beverages; Child; Choice Behavior; Energy Metabolism; Europe; Feeding Behavior; Health Promotion; Humans; Motor Activity; North America; Obesity; Parents; Sedentary Behavior; Social Environment; Weight Gain
PubMed: 22269173
DOI: 10.1017/S1368980011003168 -
Health Policy (Amsterdam, Netherlands) Mar 2023It is common for doctors to engage in clinical innovation-i.e. to use novel interventions that differ from standard practice, and that have not yet been shown to be safe... (Review)
Review
BACKGROUND
It is common for doctors to engage in clinical innovation-i.e. to use novel interventions that differ from standard practice, and that have not yet been shown to be safe or effective according to the usual standards of evidence-based medicine-in the belief that this will benefit their patients. Clinical innovation is currently poorly defined and lacks cohesive oversight mechanisms.
METHODS
A systematic narrative review, with the aim of identifying areas of similarity and divergence in innovation ethics frameworks developed across different medical specialties.
RESULTS
47 articles were included in the review. Few ethical issues raised by the ethics frameworks appear to be unique to distinct areas of practice. While variations exist in the oversight mechanisms suggested, these are again not specific to areas of practice, but rather reflect either cautious or more permissive attitudes towards clinical innovation.
CONCLUSIONS
There is considerable overlap amongst ethics frameworks developed for use in diverse areas of practice. This reflects a tendency to treat innovative interventions in each area of practice as "exceptional" and a failure to develop "higher order" frameworks such as those that have been developed for research. Those involved in the oversight of clinical innovation need to aim for a balance between exceptionalism and harmonisation.
Topics: Humans; Physicians; Creativity; Inventions; Evidence-Based Medicine
PubMed: 36639310
DOI: 10.1016/j.healthpol.2023.104706 -
The Cochrane Database of Systematic... Jun 2018An abdominal aortic aneurysm (AAA) is the pathological enlargement of the aorta and can develop in both men and women. Progressive aneurysm enlargement can lead to... (Review)
Review
BACKGROUND
An abdominal aortic aneurysm (AAA) is the pathological enlargement of the aorta and can develop in both men and women. Progressive aneurysm enlargement can lead to rupture. The rupture of an AAA is frequently fatal and accounts for the death from haemorrhagic shock of at least 45 people per 100,000 population. The outcome of people with ruptured AAA varies among countries and healthcare systems, with mortality ranging from 53% to 90%. Definitive treatment for ruptured AAA includes open surgery or endovascular repair. The management of haemorrhagic shock is crucial for the person's outcome and aims to restore organ perfusion and systolic blood pressure above 100 mmHg through immediate and aggressive fluid replacement. This rapid fluid replacement is known as the normotensive resuscitation strategy. However, evidence suggests that infusing large volumes of cold fluid causes dilutional and hypothermic coagulopathy. The association of these factors may exacerbate bleeding, resulting in a 'lethal triad' of hypothermia, acidaemia, and coagulopathy. An alternative to the normotensive resuscitation strategy is the controlled (permissive) hypotension resuscitation strategy, with a target systolic blood pressure of 50 mmHg to 100 mmHg. The principle of controlled or hypotensive resuscitation has been used in some management protocols for endovascular repair of ruptured AAA. It may be beneficial in preventing blood loss by avoiding the clot disruption caused by the rapid increase in systolic blood pressure; avoiding dilution of clotting factors, platelets and fibrinogen; and by avoiding the temperature decrease that inhibits enzyme activity involved in platelet and clotting factor function. This is an update of a review first published in 2016.
OBJECTIVES
To compare the effects of controlled (permissive) hypotension resuscitation and normotensive resuscitation strategies for people with ruptured AAA.
SEARCH METHODS
The Cochrane Vascular Information Specialist searched the Specialised Register (August 2017), the Cochrane Register of Studies (CENTRAL (2017, Issue 7)) and EMBASE (August 2017). The Cochrane Vascular Information Specialist also searched clinical trials databases (August 2017) for details of ongoing or unpublished studies.
SELECTION CRITERIA
We sought all published and unpublished randomised controlled trial (RCTs) that compared controlled hypotension and normotensive resuscitation strategies for the management of shock in patients with ruptured abdominal aortic aneurysms.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed identified studies for potential inclusion in the review. We used standard methodological procedures in accordance with the Cochrane Handbook for Systematic Review of Interventions.
MAIN RESULTS
We identified no RCTs that met the inclusion criteria.
AUTHORS' CONCLUSIONS
We found no RCTs that compared controlled hypotension and normotensive resuscitation strategies in the management of haemorrhagic shock in patients with ruptured abdominal aortic aneurysm that assessed mortality, presence of coagulopathy, intensive care unit length of stay, and the presence of myocardial infarct and renal failure. High quality studies that evaluate the best strategy for managing haemorrhagic shock in ruptured abdominal aortic aneurysms are required.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Blood Pressure; Humans; Hypotension, Controlled; Resuscitation; Shock, Hemorrhagic; Systole
PubMed: 29897100
DOI: 10.1002/14651858.CD011664.pub3 -
Journal of Pediatric Surgery Nov 2015Variable management practices complicate the identification of optimal strategies for infants with congenital diaphragmatic hernia (CDH). This review critically... (Review)
Review
OBJECTIVE
Variable management practices complicate the identification of optimal strategies for infants with congenital diaphragmatic hernia (CDH). This review critically appraises the available evidence to provide recommendations.
METHODS
Six questions regarding CDH management were generated. English language articles published between 1980 and 2014 were compiled after searching Medline, Cochrane, Embase and Web of Science. Given the paucity of literature on the subject, all studies irrespective of their rank in the levels of evidence hierarchy were included.
RESULTS
Gentle ventilation with permissive hypercapnia provides the best outcomes. Initial high frequency ventilation may be considered but its overall efficacy is unproven. Routine inhaled nitric oxide (iNO) or other medical adjuncts for acute, severe pulmonary hypertension demonstrate no benefit. Evidence does not support routine administration of pre- or postnatal glucocorticoids. Mode of extracorporeal membrane oxygenation (ECMO) has little bearing on outcomes. While the overall timing of repair does not impact outcomes, early repair on ECMO has benefits. Open repair leads to significantly fewer recurrences. Polytetrafluoroethylene (PTFE) is the most durable patch repair material.
CONCLUSIONS
Limited high-level evidence prevents the development of robust management guidelines for CDH. Prospective, multi-institutional studies are needed to identify best practices and optimize outcomes.
Topics: Evidence-Based Practice; Extracorporeal Membrane Oxygenation; Glucocorticoids; Hernias, Diaphragmatic, Congenital; High-Frequency Ventilation; Humans; Hypercapnia; Hypertension, Pulmonary; Infant, Newborn; Nitric Oxide; Prospective Studies; Respiration, Artificial
PubMed: 26463502
DOI: 10.1016/j.jpedsurg.2015.09.010 -
International Journal of Pediatric... Jun 2011Despite emerging efforts to investigate the influence parents have on their children's weight status and related dietary and activity behaviors, reviews regarding the... (Review)
Review
Despite emerging efforts to investigate the influence parents have on their children's weight status and related dietary and activity behaviors, reviews regarding the role of general parenting are lacking. We performed a systematic review regarding the relationship between general parenting and these weight-related outcomes to guide observational research. In total, 36 studies were included. Discrepancies across studies were found, which may be explained by differences in conceptualization of parenting constructs. Overall, however, results suggest that children raised in authoritative homes ate more healthy, were more physically active and had lower BMI levels, compared to children who were raised with other styles (authoritarian, permissive/indulgent, uninvolved/neglectful). Findings of some moderation studies indicate that general parenting has a differential impact on children's weight-related outcomes, depending on child and parental characteristics. These findings underline the importance of acknowledging interactions between general parenting and both child and parent characteristics, as well as behavior-specific parenting practices.
Topics: Adolescent; Adolescent Behavior; Body Weight; Child; Child Behavior; Child, Preschool; Diet; Exercise; Female; Health Behavior; Humans; Infant; Male; Obesity; Overweight; Parent-Child Relations; Parenting; Parents; Risk Assessment; Risk Factors; Risk Reduction Behavior
PubMed: 21657834
DOI: 10.3109/17477166.2011.566339 -
The Cochrane Database of Systematic... May 2016An abdominal aortic aneurysm (AAA) is the pathological enlargement of the aorta and can develop in both men and women. Progressive aneurysm enlargement can lead to... (Review)
Review
BACKGROUND
An abdominal aortic aneurysm (AAA) is the pathological enlargement of the aorta and can develop in both men and women. Progressive aneurysm enlargement can lead to rupture. The rupture of an AAA is frequently fatal and accounts for the death from haemorrhagic shock of at least 45 people per 100,000 population. The outcome of people with ruptured AAA varies among countries and healthcare systems, with mortality ranging from 53% to 90%. Definitive treatment for ruptured AAA includes open surgery or endovascular repair. The management of haemorrhagic shock is crucial for the person's outcome and aims to restore organ perfusion and systolic blood pressure above 100 mm Hg through immediate and aggressive fluid replacement. This rapid fluid replacement is known as the normotensive resuscitation strategy. However, evidence suggests that infusing large volumes of cold fluid causes dilutional and hypothermic coagulopathy. The association of these factors may exacerbate bleeding, resulting in a 'lethal triad' of hypothermia, acidaemia, and coagulopathy. An alternative to the normotensive resuscitation strategy is the controlled (permissive) hypotension resuscitation strategy, with a target systolic blood pressure of 50 to 100 mm Hg. The principle of controlled or hypotensive resuscitation has been used in some management protocols for endovascular repair of ruptured AAA. It may be beneficial in preventing blood loss by avoiding the clot disruption caused by the rapid increase in systolic blood pressure; avoiding dilution of clotting factors, platelets and fibrinogen; and by avoiding the temperature decrease that inhibits enzyme activity involved in platelet and clotting factor function.
OBJECTIVES
To compare the effects of controlled (permissive) hypotension resuscitation and normotensive resuscitation strategies for people with ruptured AAA.
SEARCH METHODS
The Cochrane Vascular Information Specialist searched the Specialised Register (April 2016) and the Cochrane Register of Studies (CENTRAL (2016, Issue 3)). Clinical trials databases were searched (April 2016) for details of ongoing or unpublished studies.
SELECTION CRITERIA
We sought all published and unpublished randomised controlled trial (RCTs) that compared controlled hypotension and normotensive resuscitation strategies for the management of shock in patients with ruptured abdominal aortic aneurysms.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed identified studies for potential inclusion in the review. We used standard methodological procedures in accordance with the Cochrane Handbook for Systematic Review of Interventions.
MAIN RESULTS
We identified no RCTs that met the inclusion criteria.
AUTHORS' CONCLUSIONS
We found no RCTs that compared controlled hypotension and normotensive resuscitation strategies in the management of haemorrhagic shock in patients with ruptured abdominal aortic aneurysm that assessed mortality, presence of coagulopathy, intensive care unit length of stay, and the presence of myocardial infarct and renal failure. High quality studies that evaluate the best strategy for managing haemorrhagic shock in ruptured abdominal aortic aneurysms are required.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Blood Pressure; Humans; Hypotension, Controlled; Resuscitation; Shock, Hemorrhagic
PubMed: 27176127
DOI: 10.1002/14651858.CD011664.pub2 -
Expert Review of Respiratory Medicine Oct 2016Neurocritical care (NCC) patients often require prolonged mechanical ventilation, and they are at high risk of respiratory complications. Therefore, the potential... (Review)
Review
INTRODUCTION
Neurocritical care (NCC) patients often require prolonged mechanical ventilation, and they are at high risk of respiratory complications. Therefore, the potential benefit role of protective lung ventilation (PLV), which demonstrated to reduce postoperative complications in patients with acute distress respiratory syndrome, has been suggested even on NCC patients. However, PLV can increase intracranial pressure as result of permissive hypercapnia and of high airway pressures during recruitment maneuvers. The aim of this review (PROSPERO registration number: CRD42015027011) is to describe the ventilatory strategies, and in particular PLV, commonly used in NCC patients.
AREAS COVERED
We selected a total of 16 clinical studies, searching on PubMed and EMBASE databases, reporting original information on the MV on patients receiving NCC after acute brain injury, published in the last 10 years, in English language. Some of the included studies report data on a limited sample size. Expert commentary: The use of PLV techniques (PEEP, recruitment maneuvers, etc) in NCC patients is controversial. There is a wide variability among different centers in the treatment strategies and respiratory management of NCC patients, and there is the need for shared diagnostics and therapeutic studies, in order to improve the patients' outcome.
Topics: Critical Care; Humans; Nervous System Diseases; Respiration, Artificial; Respiratory Distress Syndrome
PubMed: 27635737
DOI: 10.1080/17476348.2017.1235976 -
BMJ Open Nov 2017Current guidelines suggest limiting the use of vasopressors following traumatic injury; however, wide variations in practice exist. Although excessive vasoconstriction... (Review)
Review
OBJECTIVES
Current guidelines suggest limiting the use of vasopressors following traumatic injury; however, wide variations in practice exist. Although excessive vasoconstriction may be harmful, these agents may help reduce administration of potentially harmful resuscitation fluids. This systematic review aims to compare early vasopressor use to standard resuscitation in adults with trauma-induced shock.
DESIGN
Systematic review.
DATA SOURCES
We searched MEDLINE, EMBASE, ClinicalTrials.gov and the Central Register of Controlled Trials from inception until October 2016, as well as the proceedings of 10 relevant international conferences from 2005 to 2016.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Randomised controlled trials and controlled observational studies that compared the early vasopressor use with standard resuscitation in adults with acute traumatic injury.
RESULTS
Of 8001 citations, we retrieved 18 full-text articles and included 6 studies (1 randomised controlled trial and 5 observational studies), including 2 published exclusively in abstract form. Across observational studies, vasopressor use was associated with increased short-term mortality, with unadjusted risk ratios ranging from 2.31 to 7.39. However, the risk of bias was considered high in these observational studies because patients who received vasopressors were systematically sicker than patients treated without vasopressors. One clinical trial (n=78) was too imprecise to yield meaningful results. Two clinical trials are currently ongoing. No study measured long-term quality of life or cognitive function.
CONCLUSIONS
Existing data on the effects of vasopressors following traumatic injury are of very low quality according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. With emerging evidence of harm associated with aggressive fluid resuscitation and, in selected subgroups of patients, with permissive hypotension, the alternatives to vasopressor therapy are limited. Observational data showing that vasopressors are part of usual care would provide a strong justification for high-quality clinical trials of early vasopressor use during trauma resuscitation.
TRIAL REGISTRATION NUMBER
CRD42016033437.
Topics: Fluid Therapy; Humans; Observational Studies as Topic; Randomized Controlled Trials as Topic; Resuscitation; Shock, Traumatic; Vasoconstrictor Agents
PubMed: 29151048
DOI: 10.1136/bmjopen-2017-017559 -
The British Journal of Surgery Aug 1998For most solid tumours, surgery remains the most effective primary treatment. Despite apparently curative resection, significant numbers of patients develop secondary... (Review)
Review
BACKGROUND
For most solid tumours, surgery remains the most effective primary treatment. Despite apparently curative resection, significant numbers of patients develop secondary disease due to growth of undetected micrometastases. The ability of a tumour to metastasize is related to the degree of angiogenesis it induces. In addition, micrometastases rely on new vessel formation to provide the nutrients necessary for growth. A better understanding of how tumours acquire their blood supply may lead to more effective adjuvant therapies and improve survival following surgery.
METHODS
A systematic review of the literature on angiogenesis between 1971 and 1997 was performed using the Medline database to ascertain current thinking on angiogenesis and its relevance in oncological surgery.
RESULTS
Angiogenesis is a physiological process subject to autocrine and paracrine regulation which has the potential to become abnormal and play a part in a number of pathological states, including cancer. Increased angiogenic stimuli in the perioperative period, associated with concomitant reduction in tumour-derived antiangiogenic factors following resection of a primary tumour, result in a permissive environment which allows micrometastases to grow.
CONCLUSION
Recognition of the role of angiogenesis in metastatic tumour growth represents a significant development in our understanding of tumour biology. The development of antiangiogenic agents offers new promise in the treatment of malignancy. Such agents may prevent or control the development and growth of primary and metastatic tumours.
Topics: Growth Substances; Humans; Neoplasms; Neovascularization, Pathologic
PubMed: 9717994
DOI: 10.1046/j.1365-2168.1998.00816.x