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The Cochrane Database of Systematic... May 2024Peripheral arterial catheters (ACs) are used in anaesthesia and intensive care settings for blood sampling and monitoring. Despite their importance, ACs often fail,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Peripheral arterial catheters (ACs) are used in anaesthesia and intensive care settings for blood sampling and monitoring. Despite their importance, ACs often fail, requiring reinsertion. Dressings and securement devices maintain AC function and prevent complications such as infection.
OBJECTIVES
To evaluate the effectiveness of peripheral AC dressing and securement devices to prevent failure and complications in hospitalised people.
SEARCH METHODS
We searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL Plus up to 16 May 2023. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform up to 16 May 2023.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) comparing different dressing and securement devices for the stabilisation of ACs in hospitalised people.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected trials for inclusion, extracted data, and assessed risk of bias using Cochrane's RoB 1 tool. We resolved disagreements by discussion, or by consulting a third review author when necessary. We assessed the certainty of evidence using GRADE.
MAIN RESULTS
We included five RCTs with 1228 participants and 1228 ACs. All included studies had high risk of bias in one or more domains. We present the following four comparisons, with the remaining comparisons reported in the main review. Standard polyurethane (SPU) plus tissue adhesive (TA) compared with SPU: we are very uncertain whether use of SPU plus TA impacts rates of AC failure (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.20 to 0.98; I² = 0%; 2 studies, 165 participants; very low-certainty evidence). Neither study (165 participants) reported catheter-related bloodstream infections (CRBSI), thus we are very uncertain whether SPU plus TA impacts on the incidence of CRBSI (very low-certainty evidence). It is very uncertain whether use of SPU plus TA impacts AC dislodgement risk (RR 0.54, 95% CI 0.03 to 9.62; I² = 44%; 2 studies, 165 participants; very low-certainty evidence). We are very uncertain whether use of SPU plus TA impacts AC occlusion rates (RR 1.20, 95% CI 0.37 to 3.91; I² = 3%; 2 studies, 165 participants; very low-certainty evidence). We are very uncertain whether use of SPU plus TA impacts rates of adverse events with few reported events across groups (RR 0.89, 95% CI 0.09 to 8.33; I² = 0%; 2 studies, 165 participants; very low-certainty evidence). Bordered polyurethane (BPU) compared to SPU: we are very uncertain whether use of BPU impacts rates of AC failure (RR 0.67, 95% CI 0.21 to 2.13; 1 study, 60 participants; very low-certainty evidence). BPU may make little or no difference to CRBSI compared to SPU (RR 3.05, 95% CI 0.12 to 74.45; I² = not applicable as 1 study (60 participants) reported 0 events; 2 studies, 572 participants; low-certainty evidence). BPU may make little or no difference to the risk of AC dislodgement compared with SPU (RR 0.75, 95% CI 0.17 to 3.22; I² = 0%; 2 studies, 572 participants; low-certainty evidence). BPU may make little or no difference to occlusion risk compared with SPU (RR 0.80, 95% CI 0.60 to 1.07; I² = 0%; 2 studies, 572 participants; low-certainty evidence). It is very uncertain whether BPU impacts on the risk of adverse events compared with SPU (RR 0.33, 95% CI 0.01 to 7.87; 1 study, 60 participants; very low-certainty evidence). SPU plus sutureless securement devices (SSD) compared to SPU: we are very uncertain whether SPU plus SSD impacts risk of AC failure compared with SPU (RR 0.78, 95% CI 0.40 to 1.52; I² = 0%; 2 studies, 157 participants; very low-certainty evidence). We are very uncertain if SPU plus SSD impacts CRBSI incidence rate with no events in both groups (2 studies, 157 participants; very low-certainty evidence). It is very uncertain whether SPU plus SSD impacts risk of dislodgement (RR 0.14, 95% CI 0.01 to 2.57; I² = not applicable as 1 study (96 participants) reported 0 events; 2 studies, 157 participants; very low-certainty evidence). It is very uncertain whether SPU plus SSD impacts risk of AC occlusion (RR 1.94, 95% CI 0.50 to 7.48; I² = 38%; 2 studies, 157 participants; very low-certainty evidence). We are very uncertain whether SPU plus SSD impacts on the risk of adverse events (RR 1.94, 95% CI 0.19 to 20.24; I² = not applicable as 1 study (96 participants) reported 0 events; 2 studies, 157 participants; very low-certainty evidence). Integrated securement dressings compared to SPU: integrated securement dressings may result in little or no difference in risk of AC failure compared with SPU (RR 1.96, 95% CI 0.80 to 4.84; 1 study, 105 participants; low-certainty evidence); may result in little or no difference in CRBSI incidence with no events reported (1 study, 105 participants; low-certainty evidence); may result in little or no difference in the risk of dislodgement (RR 0.33, 95% CI 0.04 to 3.04; 1 study, 105 participants; low-certainty evidence), may result in little or no difference in occlusion rates with no events reported (1 study, 105 participants; low-certainty evidence), and may result in little or no difference in the risk of adverse events (RR 0.35, 95% CI 0.01 to 8.45; 1 study, 105 participants; low-certainty evidence).
AUTHORS' CONCLUSIONS
There is currently limited rigorous RCT evidence available about the relative clinical effectiveness of AC dressing and securement products. Limitations of current evidence include small sample size, infrequent events, and heterogeneous outcome measurements. We found no clear difference in the incidence of AC failure, CRBSI, or adverse events across AC dressing or securement products including SPU, BPU, SSD, TA, and integrated securement products. The limitations of current evidence means further rigorous RCTs are needed to reduce uncertainty around the use of dressing and securement devices for ACs.
Topics: Humans; Randomized Controlled Trials as Topic; Catheterization, Peripheral; Bandages; Catheter-Related Infections; Polyurethanes; Bias; Equipment Failure
PubMed: 38780138
DOI: 10.1002/14651858.CD013023.pub2 -
Journal of Burn Care & Research :... May 2024Biodegradable Temporizing Matrix (BTM) is a synthetic dermal template recently developed to reconstruct complex wounds. Current literature describes BTM outcomes in the...
Biodegradable Temporizing Matrix (BTM) is a synthetic dermal template recently developed to reconstruct complex wounds. Current literature describes BTM outcomes in the presence of infection and other comorbidities but are limited by small sample sizes. The purpose of this systemic review and meta-analysis was to determine current breadth and success of BTM use for complex wound closure. Databases were searched to identify previously published studies describing BTM use in human wounds. Studies were excluded if conducted in vitro, using non-human animals, or for procedures irrelevant to wound care. Twenty-four studies met inclusion criteria, representing 202 patients. The most common injury treated with BTM was burns (68 cases, 33.7%) followed by acute surgical wounds (59 cases, 29.2%). The large majority of patients did not experience any post-operative infections (76.6%). Infected wounds were associated with a 7.5-day delay from BTM to grafting. Univariate regression analyses showed a negative association between time to BTM implantation and age, exposed muscle, and exposed tendon (p < 0.001). Ninety-two percent of patients received BTM implantation less than 2 weeks from admission. Eighty-four percent of patients had a greater than 95% BTM take. The median time to STSG was 34 days, and 92% of patients experienced a greater than 95% STSG survival. To our knowledge, this is the first reported systemic review on the application of BTM for wound reconstruction. According to the published data, BTM is versatile dermal template for complex wounds coverage with low risk of infection, high template take rate, and excellent autograft survival.
PubMed: 38733573
DOI: 10.1093/jbcr/irae081 -
Journal of Pharmacy & Bioallied Sciences Feb 2024This systematic review examines the efficacy and biocompatibility of orthodontic clear aligner tooth aligners constructed from polyethylene terephthalate glycol (PeT-G),...
Effectiveness and Biocompatibility of Tooth Aligners Made from Polyethylene Terephthalate Glycol (PeT-G), Polypropylene (PP), Polycarbonate (PC), Thermoplastic Polyurethanes (TPUs), and Ethylene-Vinyl Acetate (EVA): A Systematic Review.
OBJECTIVE
This systematic review examines the efficacy and biocompatibility of orthodontic clear aligner tooth aligners constructed from polyethylene terephthalate glycol (PeT-G), polypropylene (PP), polycarbonate (PC), thermoplastic polyurethanes (TPUs), and ethylene-vinyl acetate (EVA).
MATERIALS AND METHODS
To find relevant papers published through September 2021, PubMed was searched extensively. Randomized clinical trials (RCTs) and observational studies assessing the effectiveness and biocompatibility of the aligner materials were included. Data were extracted independently, and the quality of included research was appraised using relevant procedures. The research variability necessitated a narrative synthesis.
RESULTS
Five studies were included for comparison. All materials were biocompatible; however, PeT-G and EVA aligners caused the least tissue irritation. Patients preferred TPU aligners for initial comfort and PeT-G aligners for transparency and endurance.
CONCLUSION
Biocompatible PeT-G, PP, PC, TPU, and EVA tooth aligners fix malocclusions. Aligner materials should be chosen based on patient preferences, treatment goals, and material qualities. For stronger proof, a longer-term study is needed.
PubMed: 38595485
DOI: 10.4103/jpbs.jpbs_883_23 -
The Journal of Vascular Access Jan 2024Short peripheral catheters (SPCs) are used to provide intravenous therapies in hospitalized patients. Recently, the category of SPC has become more complex, with the...
BACKGROUND
Short peripheral catheters (SPCs) are used to provide intravenous therapies in hospitalized patients. Recently, the category of SPC has become more complex, with the introduction in clinical practice of "integrated" SPCs (ISPCs), renewed regarding the material (polyurethane rather than polytetrafluoroethylene) and design (large wing; pre-assembled extension; preassembled needle-free connector (NFC)).
METHODS
This systematic review and meta-analysis aimed to analyze randomized controlled trials (RCTs) and quasi-randomized studies in hospitalized patients, analyzing the risk of overall catheter failure as well as the risk of each type of complication (occlusion, infiltration, thrombophlebitis, and dislodgement) for ISPCs compared to non-integrated SPCs. These systematic review and meta-analysis were registered on PROSPERO (CRD42022322970).
DATA SOURCES
We searched PUBMED, EMBASE, and the Cochrane Controlled Clinical Trials register from April to November 2022.
RESULTS: INCLUDED STUDIES
The research identified 1260 articles. After the abstract review, 13 studies were included for full manuscript review and, after that, six papers (4727 patients) were included in the meta-analysis.
DESCRIPTION OF THE EFFECT
We found a significantly reduced risk of catheter failure (pooling all complications) for ISPCs compared to SPCs ( = 0.002 RR 0.65; 95% CI 0.63-0.9). A significant reduction in the risks of occlusion ( = 0.007 RR 0.72; 95% CI 0.56-0.92) was observed. As regards the risk of infiltration, thrombophlebitis, and dislodgement, the analysis showed a trend in favor of ISPCs, though not statistically significant (respectively = 0.2 RR 0.84; 95% CI 0.64-1.1; = 0.25 RR 0.91; 95% CI 0.78-1.07; = 0.06 RR 0.72; 95% CI 0.52-1.01).
CONCLUSIONS
ISPCs significantly reduce the risks of catheter failure (overall complications) and occlusion. More RCTs are needed to understand if the preassembled ISPC is better than the composted closed system (non-integrated SPC + extension line + NFC).
PubMed: 38166435
DOI: 10.1177/11297298231218468 -
Evidence-based Dentistry Mar 2024The clinical effectiveness of clear aligners depends on the material properties both physical and mechanical. The purpose of this systematic review is to evaluate the...
INTRODUCTION
The clinical effectiveness of clear aligners depends on the material properties both physical and mechanical. The purpose of this systematic review is to evaluate the physical and mechanical properties of different clear aligner materials and changes in the same during and after intra-oral use.
METHODS
Search was done in five electronic databases: Pubmed, Embase, Scopus, Web of Science and Ovid individually by two reviewers. In vivo, Ex vivo and In vitro studies that evaluated the physical and mechanical properties of clear aligner materials were selected. The risk of bias assessment was performed using a modified Cochrane risk of bias tool.
RESULTS
From the 24 articles selected, 19 evaluated a single physical property and 23 articles evaluated a single mechanical property of clear aligner materials. All domains in the risk of bias assessment showed low risk of bias except for 'blinding of outcome' which was unclear in almost all the selected studies. Properties such as hardness, optical properties, stiffness, and yield strength were found to be different for different clear aligner materials and were found to change with thermoforming, with intra-oral aging, and in simulated intraoral conditions. Due to heterogenicity in the parameters used to assess physical or mechanical properties a meta-analysis could not be done.
CONCLUSIONS
Properties like hardness, color, stiffness, stress relaxation and creep behavior were different for various clear aligner materials and were found to deteriorate with thermoforming and intra-oral aging. Polyurethane-based materials have a higher level of hardness and stiffness but exhibit increased creep and stress relaxation properties.
PROSPERO REGISTRATION NUMBER
CRD42021269597.
Topics: Humans; Tooth Movement Techniques; Polyurethanes; Treatment Outcome; Physical Examination; Orthodontic Appliances, Removable
PubMed: 38017152
DOI: 10.1038/s41432-023-00937-w -
International Journal of Nursing Studies Jan 2024Central venous catheters are commonly used in healthcare, but they come with a range of potential complications. Over the last 15 years, an influx of securement and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Central venous catheters are commonly used in healthcare, but they come with a range of potential complications. Over the last 15 years, an influx of securement and dressing products has been released, with unknown overall effectiveness to prevent these complications.
OBJECTIVE
To compare the effects of dressings and securement devices for central venous catheters on a range of common complications including catheter-related bloodstream infection, catheter tip colonisation, entry/exit-site infection, skin colonisation, skin irritation, failed catheter securement, dressing durability and mortality.
DESIGN
Systematic review with meta-analysis.
METHODS
Following standard Cochrane methods, a systematic search of Cochrane Wounds Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE Ovid, Embase Ovid, EBSCO CINAHL, and multiple clinical trial registries was completed in November 2022. Randomised controlled trials evaluating the effectiveness of dressing and securement devices for all CVC types were included. A random-effects model was used during the meta-analysis. Results were expressed using risk ratio (RR), rate ratio, or mean difference (MD), with 95 % confidence intervals (CIs). Methodological quality and bias were assessed.
RESULTS
We included 46 studies involving 10,054 participants. All studies had either an unclear or high-performance bias. The blinding of outcome assessment was unclear in most studies. Chlorhexidine gluconate-impregnated dressings, compared with standard polyurethane dressings, may reduce the incidence (7 studies; N = 5816; RR 0.60, 95 % CI 0.44-0.83; low certainty evidence) and rate (4 studies; N = 4447; RR 0.51, 95 % CI 0.32-0.79; moderate certainty evidence) of catheter-related bloodstream infection and catheter tip colonisation (8 studies; N = 4788; RR 0.70, 95 % CI 0.52-0.95; very low certainty evidence). Medication-impregnated dressings may reduce the incidence of catheter-related bloodstream infection (6 studies; N = 5687; RR 0.60, 95 % CI 0.39-0.93; low certainty evidence) and catheter-tip colonisation (7 studies; N = 4769; RR 0.60, 95 % CI 0.47-0.76; low certainty evidence) relative to non-impregnated dressing types. Tissue adhesive may increase the risk of skin irritation or damage compared with integrated securement dressings (3 studies; N = 166; RR 1.88, 95 % CI 1.09-3.24; low certainty evidence) or sutureless securement devices (4 studies; N = 241; RR 1.64, 95 % CI 1.10-2.44; moderate certainty evidence). Tissue adhesive increased dressing durability compared with integrated securement dressings (MD 43.03 h, 95 % CI 4.88-81.18; moderate certainty evidence) and sutureless securement devices (MD 42.90 h, 4.64-81.16; moderate certainty evidence). Tissue adhesive increased failed catheter securement rate compared with suture (2 studies; N = 103; RR 9.33, 95 % CI 1.10-79.21; moderate certainty evidence).
CONCLUSIONS
The findings of the review provide insights and guidance for clinicians in selecting the appropriate dressings and securements for catheters. Findings should be interpreted with caution due to heterogeneity in catheters and patient types.
REGISTRATION
#CD010367.
TWEETABLE ABSTRACT
Time to implement chlorhexidine gluconate-impregnated dressings to prevent catheter-related bloodstream infections; a meta-analysis by @GraceNP and team.
Topics: Humans; Central Venous Catheters; Tissue Adhesives; Bandages; Sepsis
PubMed: 37879273
DOI: 10.1016/j.ijnurstu.2023.104620 -
Strahlentherapie Und Onkologie : Organ... Feb 2024Radiation-induced skin reactions remain one of the most frequent side effects of adjuvant radiotherapy for breast cancer, which is the most common global malignancy. In... (Review)
Review
PURPOSE
Radiation-induced skin reactions remain one of the most frequent side effects of adjuvant radiotherapy for breast cancer, which is the most common global malignancy. In individual cases, we observed a decrease in radiation dermatitis under film dressings used for skin marking purposes. Therefore, we decided to revise the available evidence regarding the prophylactic use of film dressings to reduce radiation dermatitis in breast cancer patients.
METHODS
On 20 March 2023, we conducted a systematic review of literature for randomized controlled trials published in the English, German, French, or Spanish language, available in the PubMed database.
RESULTS
Of 82 publications, 9 full texts were assessed and 6 randomized controlled trials were included in the final synthesis. Two trials analyzed the application of polyurethane film (Hydrofilm, Paul Hartmann AG, Heidenheim, Germany), the other four of silicone-based polyurethane film (Mepitel film, Molnlycke Health Care Limited, Milton Keynes, United Kingdom). The evaluation scales Common Terminology Criteria for Adverse Events (CTCAE), Radiation Therapy Oncology Group (RTOG), and the Radiation-Induced Skin Reaction Assessment Scale (RISRAS) were used for assessment. All six trials, with a total of 788 patients yielding data for analysis, demonstrate a significant decrease in radiation-induced skin reactions by use of the film (mainly p < 0.001).
CONCLUSION
Our analysis demonstrates a significant decrease in radiation-induced skin reactions by prophylactically applied film dressings in breast cancer patients. Consequent preventive use of film dressings might systematically reduce acute radiation-induced skin reactions in these patients.
Topics: Female; Humans; Bandages; Breast; Breast Neoplasms; Polyurethanes; Radiodermatitis
PubMed: 37755486
DOI: 10.1007/s00066-023-02151-0 -
Handchirurgie, Mikrochirurgie,... Aug 2023Breast implant-associated squamous cell carcinoma (BIA-SCC) is being discussed as a distinct malignant tumour entity originating from the implant capsule. The FDA and...
BACKGROUND
Breast implant-associated squamous cell carcinoma (BIA-SCC) is being discussed as a distinct malignant tumour entity originating from the implant capsule. The FDA and the ASPS published a safety communication on BIA-SCC in 2022, with a first case report of BIA-SCC having been published in the 1990s. This manuscript summarises the current scientific data on this rare tumour entity.
MATERIAL AND METHODS
This systematic literature review from two independent databases includes all publications of cases with histopathologically confirmed BIA-SCC. Data extraction included study design, demographic data, implant information and details regarding diagnosis and treatment.
RESULTS
Nineteen cases of BIA-SCC with a mean age of 57±10 years were reported in 16 publications. In most cases, the indication was aesthetic augmentation (n=13). Both silicone (n=11) and saline (n=7) implants with different surfaces (smooth n=3, textured n=3, polyurethane n=1) were used. Symptoms such as unilateral swelling (n=18), pain (n=14) and erythema (n=5) occurred on an average of 23±9 years after implantation. Imaging showed fluid collection (n=8) or a tumour mass (n=4) around the breast implant. The most common surgical treatment was explantation with capsulectomy. Metastasis was described in 6 cases.
CONCLUSIONS
BIA-SCC is a malignant tumour entity associated with breast implant capsules. Based on current low-quality data (level of evidence class V), no definitive conclusion regarding correlation and causality of SCC in patients with breast implants can be drawn. There is an urgent need for national and international breast implant and breast cancer registries to obtain valid data on the incidence, pathogenesis and clinical presentation of rare tumour entities.
Topics: Humans; Middle Aged; Aged; Female; Breast Implants; Breast Neoplasms; Breast Implantation; Device Removal; Carcinoma, Squamous Cell
PubMed: 37473774
DOI: 10.1055/a-2108-9111 -
Breast (Edinburgh, Scotland) Oct 2023Radiation dermatitis (RD) is the most common side effect of adjuvant whole-breast or chest wall irradiation, majorly impacting quality of life in numerous patients. The... (Meta-Analysis)
Meta-Analysis
PURPOSE
Radiation dermatitis (RD) is the most common side effect of adjuvant whole-breast or chest wall irradiation, majorly impacting quality of life in numerous patients. The use of barrier films (polyurethane dressings such as Hydrofilm® and Mepitel® film remaining on the skin for the duration of the radiation treatment) has been investigated as a prophylactic measure in several prospective trials. Here, we critically appraise the available evidence behind preventive barrier film application in the context of breast cancer treatment.
METHODS
International literature was reviewed and high-quality randomised controlled trials (RCTs) were included in this meta-analysis.
RESULTS
The results of 5 RCTs (663 patients; >90% Caucasian) were analysed. Overall, barrier films lead to improved clinician- and patient-reported outcomes: fewer grade ≥2 RD (11% vs. 42%; OR = 0.16; p < 0.001) and moist desquamation (2% vs. 16%; OR = 0.12; p = 0.006), as well as less patient-reported pain (standardised mean difference [SMD] -0.51; p < 0.001), itching (SMD -0.52; p = 0.001), burning (SMD -0.41; p = 0.011), and limitations in daily activities (SMD -0.20; p = 0.007). Furthermore, barrier films have a high acceptance rate among patients, as well as a favourable cost-benefit ratio. Possible side effects due to its application are mild and mostly self-limiting. Overall, there was a lack of information on the radiation treatment techniques used.
CONCLUSION
The evidence presented in this meta-analysis suggests that barrier films are an excellent tool in the prevention of RD among Caucasian patients receiving whole-breast or chest wall irradiation. Its use should therefore be considered routinely in these patients.
Topics: Humans; Female; Breast Neoplasms; Radiodermatitis; Skin; Randomized Controlled Trials as Topic
PubMed: 37473629
DOI: 10.1016/j.breast.2023.07.001 -
EFORT Open Reviews Apr 2023The biomechanical characteristics of different techniques to perform the modified Lapidus procedure are controversial, discussing the issue of stability, rigidity, and... (Review)
Review
PURPOSE
The biomechanical characteristics of different techniques to perform the modified Lapidus procedure are controversial, discussing the issue of stability, rigidity, and compression forces from a biomechanical point of view. The aim of this systematic review was to investigate the available options to identify whether there is a procedure providing superior biomechanical results.
METHODS
A comprehensive literature search was performed by screening PubMed, Embase, and Cochrane databases until September 2021. There was a wide heterogeneity of the available data in the different studies. Load to failure, stiffness, and compression forces were summarized and evaluated.
RESULTS
Seventeen biomechanical studies were retrieved - ten cadaveric and seven polyurethane foam (artificial bone) studies. Fixation methods ranged from the classic crossed screw approach (n = 5) to plates (dorsomedial and plantar) with or without compression screws (n = 11). Newer implants such as intramedullary stabilization screws (n = 1) and memory alloy staples (n = 2) were investigated.
CONCLUSION
The two crossed screws construct is still a biomechanical option; however, according to this systematic review, there is strong evidence that a plate-screw construct provides superior stability especially in combination with a compression screw. There is also evidence about plate position and low evidence about compression screw position. Plantar plates seem to be advantageous from a biomechanical point of view, whereas compression screws could be better when positioned outside the plate. Overall, this review suggests the biomechanical advantages of using a combination of locking plates with a compression screw.
PubMed: 37097047
DOI: 10.1530/EOR-22-0069