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The Journal of Laryngology and Otology Jun 2012Vocal fold paralysis can be an early warning sign of serious extra-laryngeal pathology. Even if imaging investigations show no pathology, there is always concern about... (Review)
Review
INTRODUCTION
Vocal fold paralysis can be an early warning sign of serious extra-laryngeal pathology. Even if imaging investigations show no pathology, there is always concern about the emergence of new pathology in the future. There is currently no consensus on the best follow-up protocol for vocal fold paralysis patients with no abnormalities on investigation.
METHODS
Systematic review, using an Ovid and Medline database search of papers written in the English language and published in the last 20 years.
RESULTS
Eight relevant studies were identified. Not all of them were directly comparable. A narrative review of the studies is presented and conclusions are drawn.
CONCLUSION
Current diagnostic modalities are sufficiently reliable and sensitive to diagnose any significant existing extra-laryngeal pathology. Thus, once initial investigation (including computed tomography) has concluded, no further follow up is necessary.
Topics: Databases, Bibliographic; Duty to Recontact; Early Detection of Cancer; Evidence-Based Practice; Follow-Up Studies; Humans; Neoplasms; Radiography; Vocal Cord Paralysis
PubMed: 22643202
DOI: 10.1017/S0022215112000576 -
Pain Physician 2017Failed back surgery syndrome (FBSS) is a frequently encountered disease entity following lumbar spinal surgery. Although many plausible reasons have been investigated,... (Review)
Review
BACKGROUND
Failed back surgery syndrome (FBSS) is a frequently encountered disease entity following lumbar spinal surgery. Although many plausible reasons have been investigated, the exact pathophysiology remains unknown. Various medications, reoperations, interventions such as spinal cord stimulation, epidural adhesiolysis or epidural injection, exercise therapy, and psychotherapy have been suggested treatment options. However, the evidence of the clinical outcome for each treatment has not been clearly determined.
OBJECTIVES
To evaluate the outcomes of each treatment modality and to present treatment guidelines for patients with FBSS.
STUDY DESIGN
A systematic review of each treatment regimen in patients with FBSS.
METHODS
The available literature regarding each modality for the treatment of refractory back pain or radiating pain for FBSS was reviewed. The quality assessment and the level of evidence were analyzed using the "Methodology Checklist" of SIGN (Scottish Intercollegiate Guidelines Network). Data sources included relevant English language literature identified through searches of Pubmed, EMBASE, and Cochrane library from 1980 to Feb 2016. The primary outcome measure was pain relief of back pain or radiating pain for at least 3 months. Secondary outcome measures were improvement of the patient's functional status, health-related quality of life, return to work, and reduction of opioid use.
RESULTS
Twenty-three articles were finally identified and reviewed. Based on our analysis, epidural adhesiolysis showed a short-term (6 to 24 months) effect (grade A) and spinal cord stimulation showed a mid-term (2 or 3 years) effect (grade B). Epidural injections showed a short-term (up to 2 years) effect (grade C). However, other treatments were recommended as grade D or inconclusive.
LIMITATIONS
The limitations of this systematic review included the rarity of relevant literature.
CONCLUSIONS
Epidural adhesiolysis or spinal cord stimulation can be effective in order to control chronic back pain or leg pain due to FBSS, and its recommendation grades are A and B, respectively. Other treatments showed poor or inconclusive evidence.Key words: Failed back surgery syndrome, post spinal surgery syndrome, chronic low back pain, post lumbar surgery syndrome, epidural adhesiolysis, spinal cord stimulation, epidural injection, revision.
Topics: Failed Back Surgery Syndrome; Humans; Injections, Epidural; Low Back Pain; Quality of Life; Spinal Cord Stimulation; Treatment Outcome
PubMed: 28072795
DOI: No ID Found -
Thorax Jul 2022To determine the diagnostic accuracy of point-of-care ultrasound in suspected pulmonary embolism. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine the diagnostic accuracy of point-of-care ultrasound in suspected pulmonary embolism.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
MEDLINE, Embase, CINAHL and Cochrane library were searched on 2 July 2020 with no restrictions on the date of publication. Subject headings or subheadings combined with text words for the concepts of pulmonary embolism, ultrasound and diagnosis were used.
ELIGIBILITY CRITERIA AND DATA ANALYSIS
Eligible studies reported sensitivity and specificity of deep venous, lung, cardiac or multiorgan ultrasound in patients with suspected pulmonary embolism, using an adequate reference-test. Prospective, cross-sectional and retrospective studies were considered for eligibility. No restrictions were made on language. Studies were excluded if a control group consisted of healthy volunteers or if transesophageal or endobronchial ultrasound was used. Risk of bias was assessed using quality assessment of diagnostic accuracy studies-2. Meta-analysis of sensitivity and specificity was performed by construction of hierarchical summary receiver operator curves. I was used to assess the study heterogeneity.
MAIN OUTCOME MEASURES
The primary outcome was overall sensitivity and specificity of reported ultrasound signs, stratified by organ approach (deep venous, lung, cardiac and multiorgan). Secondary outcomes were stratum-specific sensitivity and specificity within subgroups defined by pretest probability of pulmonary embolism.
RESULTS
6378 references were identified, and 70 studies included. The study population comprised 9664 patients with a prevalence of pulmonary embolism of 39.9% (3852/9664). Risk of bias in at least one domain was found in 98.6% (69/70) of included studies. Most frequently, 72.8% (51/70) of studies reported >24 hours between ultrasound examination and reference test or did not disclose time interval at all. Level of heterogeneity ranged from 0% to 100%. Most notable ultrasound signs were bilateral compression of femoral and popliteal veins (22 studies; 4708 patients; sensitivity 43.7% (36.3% to 51.4%); specificity 96.7% (95.4% to 97.6%)), presence of at least one hypoechoic pleural-based lesion (19 studies; 2134 patients; sensitivity 81.4% (73.2% to 87.5%); specificity 87.4% (80.9% to 91.9%)), D-sign (13 studies; 1579 patients; sensitivity 29.7% (24.6% to 35.4%); specificity 96.2% (93.1% to 98.0%)), visible right ventricular thrombus (5 studies; 995 patients; sensitivity 4.7% (2.7% to 8.1%); specificity 100% (99.0% to 100%)) and McConnell's sign (11 studies; 1480 patients; sensitivity 29.1% (20.0% to 40.1%); specificity 98.6% (96.7% to 99.4%)).
CONCLUSION
Several ultrasound signs exhibit a high specificity for pulmonary embolism, suggesting that implementation of ultrasound in the initial assessment of patients with suspected pulmonary embolism may improve the selection of patients for radiation imaging.
PROSPERO REGISTRATION NUMBER
CRD42020184313.
Topics: Cross-Sectional Studies; Humans; Lung; Prospective Studies; Pulmonary Embolism; Retrospective Studies; Sensitivity and Specificity
PubMed: 34497138
DOI: 10.1136/thoraxjnl-2021-216838 -
Alimentary Pharmacology & Therapeutics Jan 2015In the treatment of Crohn's disease (CD), mucosal healing has become a major goal, with the hope of avoiding intestinal damage from chronic inflammation. Magnetic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In the treatment of Crohn's disease (CD), mucosal healing has become a major goal, with the hope of avoiding intestinal damage from chronic inflammation. Magnetic resonance enterography (MRE) has emerged as a non-invasive means of monitoring inflammation and damage.
AIMS
As part of the development of MRE-based multi-item measures of inflammation and damage for paediatric studies, we carried out a systematic review and meta-analysis to identify MRE variables used to describe these two distinct concepts.
METHODS
2501 studies of MRI and CD were identified. Studies written in any language reporting individual MRE signs for patients diagnosed with CD were included. Two-hundred-and-forty-four studies were fully reviewed and 62 were included (inflammation, n = 51; damage, n = 24). Sensitivity, specificity and associated confidence intervals were calculated, and hierarchical summary ROC curves were constructed for each MRE sign.
RESULTS
A total of 22 MRE signs were used to reflect inflammation, and 9 to reflect damage. Diagnostic accuracy of MRE signs of inflammation and damage was heterogeneous; however, wall enhancement, mucosal lesions and wall T2 hyperintensity were the most consistently useful for inflammation (most sensitivities >80% and specificities >90%), and detection of abscess and fistula were most consistently useful for damage (most sensitivities >90%, specificities >95%).
CONCLUSIONS
Identifying the best MRE variables to reflect inflammation and damage will maximise the utility of this rapidly emerging technique and is the first stage of constructing MRE-based indices for evaluating inflammation and intestinal damage.
Topics: Abdominal Abscess; Child; Crohn Disease; Humans; Inflammation; Intestinal Fistula; Magnetic Resonance Imaging; ROC Curve; Sensitivity and Specificity; Symptom Assessment
PubMed: 25403954
DOI: 10.1111/apt.13024 -
Journal of Alternative and... Jun 2007(1) To evaluate the evidence on the effect of chiropractic care, rather than spinal manipulation only, on patients with nonmusculoskeletal conditions; and (2) to... (Review)
Review
OBJECTIVES
(1) To evaluate the evidence on the effect of chiropractic care, rather than spinal manipulation only, on patients with nonmusculoskeletal conditions; and (2) to identify shortcomings in the evidence base on this topic, from a Whole Systems Research perspective.
DESIGN
Systematic review.
METHODS
Databases included were PubMed, Ovid, Mantis, Index to Chiropractic Literature, and CINAHL. Search restrictions were human subjects, peer-reviewed journal, English language, and publication before May 2005. All randomized controlled trials (RCTs) were evaluated using the Scottish Intercollegiate Guidelines Network (SIGN) and Jadad checklists; a checklist developed from the CONSORT (Consolidated Standards of Reporting Trials) guidelines; and one developed by the authors to evaluate studies in terms of Whole Systems Research (WSR) considerations.
RESULTS
The search yielded 179 papers addressing 50 different nonmusculoskeletal conditions. There were 122 case reports or case series, 47 experimental designs, including 14 RCTs, 9 systematic reviews, and 1 a large cohort study. The 14 RCTs addressed 10 conditions. Six RCTs were rated "high" on the 3 conventional checklists; one of these 6 was rated "high" in terms of WSR considerations.
CONCLUSIONS
(1) Adverse effects should be routinely reported. For the few studies that did report, adverse effects of spinal manipulation for all ages and conditions were rare, transient, and not severe. (2) Evidence from controlled studies and usual practice supports chiropractic care (the entire clinical encounter) as providing benefit to patients with asthma, cervicogenic vertigo, and infantile colic. Evidence was promising for potential benefit of manual procedures for children with otitis media and elderly patients with pneumonia. (3) The RCT design is not necessarily incompatible with WSR. RCTs could improve generalizability by basing protocols on usual practice. (4) Case reports could contribute more to WSR by increasing their emphasis on patient characteristics and patient-based outcomes. (5) Chiropractic investigators, practitioners, and funding agencies should increase their attention to observational designs.
Topics: Acute Disease; Chiropractic; Chronic Disease; Controlled Clinical Trials as Topic; Evidence-Based Medicine; Follow-Up Studies; Humans; Manipulation, Chiropractic; Physical Examination; Research Design
PubMed: 17604553
DOI: 10.1089/acm.2007.7088 -
Vaccine Oct 2015Wheeze is an important sign indicating a potentially severe adverse event in vaccine and drug trials, particularly in children. However, there are currently no consensus... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Wheeze is an important sign indicating a potentially severe adverse event in vaccine and drug trials, particularly in children. However, there are currently no consensus definitions of wheeze or associated respiratory compromise in randomized controlled trials (RCTs).
OBJECTIVE
To identify definitions and severity grading scales of wheeze as an adverse event in vaccine and drug RCTs enrolling children <5 years and to determine their diagnostic performance based on sensitivity, specificity and inter-observer agreement.
METHODS
We performed a systematic review of electronic databases and reference lists with restrictions for trial settings, English language and publication date ≥1970. Wheeze definitions and severity grading were abstracted and ranked by a diagnostic certainty score based on sensitivity, specificity and inter-observer agreement.
RESULTS
Of 1205 articles identified using our broad search terms, we identified 58 eligible trials conducted in 38 countries, mainly in high-income settings. Vaccines made up the majority (90%) of interventions, particularly influenza vaccines (65%). Only 15 trials provided explicit definitions of wheeze. Of 24 studies that described severity, 11 described wheeze severity in the context of an explicit wheeze definition. The remaining 13 studies described wheeze severity where wheeze was defined as part of a respiratory illness or a wheeze equivalent. Wheeze descriptions were elicited from caregiver reports (14%), physical examination by a health worker (45%) or a combination (41%). There were 21/58 studies in which wheeze definitions included combined caregiver report and healthcare worker assessment. The use of these two methods appeared to have the highest combined sensitivity and specificity.
CONCLUSION
Standardized wheeze definitions and severity grading scales for use in pediatric vaccine or drug trials are lacking. Standardized definitions of wheeze are needed for assessment of possible adverse events as new vaccines and drugs are evaluated.
Topics: Age Factors; Child; Child, Preschool; Drug-Related Side Effects and Adverse Reactions; Humans; Infant; Infant, Newborn; Randomized Controlled Trials as Topic; Reproducibility of Results; Respiratory Sounds; Sensitivity and Specificity; Severity of Illness Index; Vaccines
PubMed: 26319071
DOI: 10.1016/j.vaccine.2015.08.060 -
Annals of Surgical Oncology Jan 2019The laparoscopic approach to liver resection has experienced exponential growth in recent years; however, its application is still under debate and objective,... (Meta-Analysis)
Meta-Analysis
A Systematic Review and Meta-Analysis Comparing the Short- and Long-Term Outcomes for Laparoscopic and Open Liver Resections for Hepatocellular Carcinoma: Updated Results from the European Guidelines Meeting on Laparoscopic Liver Surgery, Southampton, UK, 2017.
BACKGROUND
The laparoscopic approach to liver resection has experienced exponential growth in recent years; however, its application is still under debate and objective, evidence-based guidelines for its safe future progression are needed.
OBJECTIVE
The aim of this study was to perform a systematic review and meta-analysis comparing the short- and long-term outcomes of laparoscopic and open liver resections for hepatocellular carcinoma (HCC).
METHODS
To identify all the comparative manuscripts reporting on laparoscopic and open liver resection for HCC, all published English-language studies with more than 10 cases were screened. In addition to the primary meta-analysis, four specific subgroup analyses were performed on patients with Child-Pugh A cirrhosis, resections for solitary tumors, and those undergoing minor and major resections. The quality of the studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology and the Newcastle-Ottawa Scale.
RESULTS
From the initial 361 manuscripts, 28 were included in the meta-analysis. Five of these 28 manuscripts were specific to patients with Child-Pugh A cirrhosis (321 cases), 11 focused on solitary tumors (1003 cases), 16 focused on minor resections (1286 cases), and 3 focused on major resections (164 cases). Three manuscripts compared 1079 cases but could not be assigned to any of the above subanalyses. In general terms, short-term outcomes were favorable when using a laparoscopic approach, especially in minor resections. The only advantage seen with an open approach was reduced operative time during major liver resections. No differences in long-term outcomes were observed between the approaches.
CONCLUSIONS
Laparoscopic liver resection for HCC is feasible and offers improved short-term outcomes, with comparable long-term outcomes as the open approach.
Topics: Carcinoma, Hepatocellular; Hepatectomy; Humans; Laparoscopy; Length of Stay; Liver Neoplasms; Postoperative Complications; Practice Guidelines as Topic; Prognosis; Survival Rate
PubMed: 30390167
DOI: 10.1245/s10434-018-6926-3 -
Patient Education and Counseling Sep 2023This study aims to systematically review health education interventions targeting individuals with hearing impairment. (Review)
Review
OBJECTIVES
This study aims to systematically review health education interventions targeting individuals with hearing impairment.
METHODS
A total of 18 studies were selected based on search results from five databases, and quality appraisal was conducted using an appropriate tool based on the study design. The extracted results were described using qualitative analysis.
RESULTS
Among the selected studies, most interventions focused on specific cancers, and video materials were the most common delivery method. Various strategies were applied depending on the type of materials provided, in addition to sign language interpretation and the involvement of hearing-impaired related personnel. The interventions primarily resulted in a significant increase in knowledge.
CONCLUSION
This study suggests several recommendations, including expanding the scope of interventions to cover various chronic diseases, actively utilizing the features of video materials, considering health literacy, using peer support groups, and measuring behavior-related factors alongside knowledge levels.
PRACTICE IMPLICATIONS
This study makes a significant contribution to understanding the unique characteristics of the population with hearing impairment. Furthermore, it has the potential to facilitate the development of high-quality health education interventions for individuals with hearing impairment by providing insights into future research directions based on existing health education interventions.
Topics: Humans; Hearing Loss; Health Literacy
PubMed: 37301012
DOI: 10.1016/j.pec.2023.107830 -
Surgical Endoscopy Jan 2020The laparoscopic approach to liver resection has experienced exponential growth in recent years. However, evidence-based guidelines are needed for its safe future... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
The laparoscopic approach to liver resection has experienced exponential growth in recent years. However, evidence-based guidelines are needed for its safe future progression. The main aim of our study was to perform a systematic review and meta-analysis comparing the short- and long-term outcomes of laparoscopic and open liver resections for colorectal liver metastases (CRLM).
METHODS
To identify all the comparative manuscripts between laparoscopic and open liver resections for CRLM, all published English language studies with more than ten cases were screened. In addition to the primary meta-analysis, 3 specific subgroup analyses were performed on patients undergoing minor-only, major-only and synchronous resections. The quality of the studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology and Newcastle-Ottawa Score.
RESULTS
From the initial 194 manuscripts identified, 21 were meta-analysed, including results from the first randomized trial comparing open and laparoscopic resections of CRLM. Five of these were specific to patients undergoing a synchronous resection (399 cases), while six focused on minor (3 series including 226 cases) and major (3 series including 135 cases) resections, respectively. Thirteen manuscripts compared 2543 cases but could not be assigned to any of the above sub-analyses, so were analysed independently. The majority of short-term outcomes were favourable to the laparoscopic approach with equivalent rates of negative resection margins. No differences were observed between the approaches in overall or disease-free survival at 1, 3 or 5 years.
CONCLUSION
Laparoscopic liver resection for CRLM offers improved short-term outcomes with comparable long-term outcomes when compared to open approach.
Topics: Colorectal Neoplasms; Hepatectomy; Humans; Laparoscopy; Liver Neoplasms; Treatment Outcome
PubMed: 30989374
DOI: 10.1007/s00464-019-06774-2 -
American Journal of Health-system... Jun 2024We aimed to systematically review and meta-analyze published evidence on modes of communication between healthcare professionals and patients with hearing loss. (Meta-Analysis)
Meta-Analysis
PURPOSE
We aimed to systematically review and meta-analyze published evidence on modes of communication between healthcare professionals and patients with hearing loss.
METHODS
MEDLINE/PubMed, Scopus, CINAHL, ScienceDirect, and Thai Journals Online Complete databases were searched. A meta-analysis was performed using a random-effects model. Data on the prevalence and types of communication between healthcare professionals and patients with any extent of hearing loss were extracted.
RESULTS
Twenty studies were included. Using a hearing aid (pooled prevalence, 57.4%; 95% CI, 11.4%-103.4%, N = 3, I2 = 99.33) and gestures (pooled prevalence = 54.8%, 95%CI: 17.4% to 92.1%, N = 7, I2 = 99.68) were the most commonly reported modes of communication. Few healthcare professionals could use sign language, and limited access to qualified interpreters was common.
CONCLUSION
Communication barriers exist. Qualified sign language interpreters and assistive technology should be used to improve communication.
Topics: Humans; Hearing Loss; Health Personnel; Communication; Professional-Patient Relations; Communication Barriers; Hearing Aids; Sign Language
PubMed: 38430534
DOI: 10.1093/ajhp/zxae045