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Minerva Anestesiologica Jun 2016Postoperative delirium (POD) is defined as an acute neurologic insult characterized by changes in consciousness and cognition, altered perception and a fluctuating... (Review)
Review
INTRODUCTION
Postoperative delirium (POD) is defined as an acute neurologic insult characterized by changes in consciousness and cognition, altered perception and a fluctuating course. It leads to poor outcome and increased health care system costs. Considering its high incidence, up to 60%, and the lack of a first-choice treatment, prevention has become a priority. Our aim was to systematically review literature on POD prevention and to identify the role of anesthesia in this context.
EVIDENCE ACQUISITION
MEDLINE and EMBASE were searched for studies considering any anesthetic intervention intended to prevent POD. Risk of bias was assessed with the Quality Assessment Tool for Quantitative Studies for original articles and with the R-AMSTAR checklist for systematic reviews.
EVIDENCE SYNTHESIS
A total of 27 studies were included. Interventions included pre-, intra-/peri- and postoperative strategies to prevent POD. Only 9 out of 27 studies had high methodological quality. Use of a depth of anesthesia monitor and lighter sedation had the strongest evidence in reduction of POD. Perioperative dexmedetomidine, ketamine, dexamethasone, and antipsychotic administration may reduce the risk of POD.
CONCLUSIONS
Methodologically robust studies supporting strategies for preventing POD are still lacking. Based on our analysis, anesthesiologists should consider the intraoperative use of a depth of anesthesia monitor and the choice for a lighter sedation when possible. The administration of preventive medications should be considered very carefully. Considering the multifactorial nature of POD, however, the integration of effective preventive strategies into multidisciplinary programs is advisable and should be the target for future research.
Topics: Analgesics, Non-Narcotic; Anesthesia; Anesthetics; Antipsychotic Agents; Checklist; Delirium; Dexamethasone; Dexmedetomidine; Humans; Ketamine; Postoperative Complications
PubMed: 26822815
DOI: No ID Found -
World Neurosurgery Feb 2016The three-dimensional (3D) endoscope is a novel tool that provides stereoscopic vision and may allow for improved dexterity and safety during surgical resection of... (Review)
Review
OBJECTIVE
The three-dimensional (3D) endoscope is a novel tool that provides stereoscopic vision and may allow for improved dexterity and safety during surgical resection of ventral skull base lesions. We describe here the cumulative experience available in the neurosurgical literature.
METHODS
A PubMed literature review was performed to identify and analyze all studies pertaining to 3D endoscopic endonasal skull base surgery.
RESULTS
We identified 26 articles: 14 clinical articles, 5 simulated environment studies, 5 human cadaveric studies, and 2 expert opinions. In all the clinical studies, 262 patients were treated for the following 257 pathologies listed in the articles: 190 suprasellar/parasellar lesions (73.9%), 41 ventral skull base lesions (16.0%), 19 sinonasal pathologies (7.4%), and 7 cerebrospinal fluid leak repairs (2.7%). Complication rates, operative time, length of hospital stay, and extent of tumor resection were equivalent between two-dimensional (2D) and 3D endoscopy. However, all studies reported that subjective depth perception and spatial orientation were markedly improved with 3D technology. In 3 studies (11.5%), it was concluded that there was no clinically significant surgical benefit in switching from 2D to 3D endoscopy. All cadaveric studies and expert opinions concluded that 3D endoscopy improved the identification of key anatomical structures and was superior to 2D endoscopy. Simulated environment studies demonstrated that 3D endoscopy improved speed and accuracy of endonasal tasks, more so in novice surgeons.
CONCLUSIONS
Our findings suggest that 3D endoscopy provides improved surgical dexterity by affording the surgeon with depth perception when manipulating tissue and maneuvering the endoscope in the endonasal corridor.
Topics: Endoscopy; Humans; Imaging, Three-Dimensional; Skull Base; Treatment Outcome
PubMed: 26463398
DOI: 10.1016/j.wneu.2015.10.004 -
Asian Pacific Journal of Cancer... 2015Breast cancer is the most common cancer and the leading cause of cancer mortality among women of all ethnic and age groups in Malaysia. Delay in seeking help for breast... (Review)
Review
BACKGROUND
Breast cancer is the most common cancer and the leading cause of cancer mortality among women of all ethnic and age groups in Malaysia. Delay in seeking help for breast cancer symptoms is preventable and by identifying possible factors for delayed diagnosis, patient prognosis and survival rates could be improved.
OBJECTIVES
This narrative review aimed to understand and evaluate the level of in-depth breast cancer knowledge in terms of clinical breast examination and breast self-examination, and other important aspects such as side-effects and risk factors in Malaysian females. Since Malaysia is multicultural, this review assessed social perceptions, cultural beliefs and help-seeking behaviour in respect to breast cancer among different ethnic groups, since these may impinge on efforts to 'avoid' the disease.
MATERIALS AND METHODS
A comprehensive literature search of seven databases was performed from December 2015 to January 2015. Screening of relevant published journals was also undertaken to identify available information related to the knowledge, perception and help-seeking behaviour of Malaysian women in relation to breast cancer.
RESULTS
A total of 42 articles were appraised and included in this review. Generally, women in Malaysia had good awareness of breast cancer and its screening tools, particularly breast self-examination, but only superficial in-depth knowledge about the disease. Women in rural areas had lower levels of knowledge than those in urban areas. It was also shown that books, magazines, brochures and television were among the most common sources of breast cancer information. Delay in presentation was attributed mainly to a negative social perception of the disease, poverty, cultural and religion practices, and a strong influence of complementary and alternative medicine, rather than a lack of knowledge.
CONCLUSIONS
This review highlighted the need for an intensive and in-depth breast cancer education campaigns using media and community health programmes, even with the existing good awareness of breast cancer. This is essential in order to avoid misconceptions and to frame the correct mind-set about breast cancer among women in Malaysia. Socio-cultural differences and religious practices should be taken into account by health care professionals when advising on breast cancer. Women need to be aware of the risk factors and symptoms of breast cancer so that early diagnosis can take place and the chances of survival improved.
Topics: Breast Neoplasms; Breast Self-Examination; Delayed Diagnosis; Female; Health Behavior; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Patient Acceptance of Health Care; Perception; Prognosis; Risk Factors
PubMed: 26225677
DOI: 10.7314/apjcp.2015.16.13.5349 -
Revista Medica de Chile Jan 2015There is growing interest in the treatment and return-to-work of workers with labor related mental illnesses. (Review)
Review
BACKGROUND
There is growing interest in the treatment and return-to-work of workers with labor related mental illnesses.
AIM
To perform a systematic review of practices and interventions that improve return to work.
MATERIAL AND METHODS
Systematic literature review. Thirty articles were selected for in- depth analysis.
RESULTS
Self efficacy perception, work motivation, a lower age and a better socioeconomic status were identified as worker-related return to work facilitators. Among work environment facilitators, good communication practices, supervisor support, a good assessment and modification of work load, adjustment of expectations, a good relationship between employers and employees and positive work experiences were identified. Treatment may improve return to work using a multidisciplinary approach, reducing stress and identifying psychosocial determinants of mental problems rather than symptoms and providing a timely health care.
CONCLUSIONS
Return to work of workers with labor related mental illnesses requires a constant sharing of information between health care workers, employers and employees to identify common therapeutic objectives.
Topics: Age Factors; Female; Humans; Male; Mental Disorders; Middle Aged; Occupational Diseases; Return to Work; Work Capacity Evaluation
PubMed: 25860273
DOI: 10.4067/S0034-98872015000100011 -
Surgical Endoscopy Jan 2016Laparoscopic surgery is widely used, and results in accelerated patient recovery time and hospital stay were compared with laparotomy. However, laparoscopic surgery is... (Comparative Study)
Comparative Study Review
BACKGROUND
Laparoscopic surgery is widely used, and results in accelerated patient recovery time and hospital stay were compared with laparotomy. However, laparoscopic surgery is more challenging compared with open surgery, in part because surgeons must operate in a three-dimensional (3D) space through a two-dimensional (2D) projection on a monitor, which results in loss of depth perception. To counter this problem, 3D imaging for laparoscopy was developed. A systematic review of the literature was performed to assess the effect of 3D laparoscopy.
METHODS
A systematic search of the literature was conducted to identify randomized controlled trials that compared 3D with 2D laparoscopy. The search was accomplished in accordance with the PRISMA guidelines using the PubMed, EMBASE, and The Cochrane Library electronic databases. No language or year of publication restrictions was applied. Data extracted were cohort size and characteristics, skill trained or operation performed, instrument used, outcome measures, and conclusions. Two independent authors performed the search and data extraction.
RESULTS
Three hundred and forty articles were screened for eligibility, and 31 RCTs were included in the review. Three trials were carried out in a clinical setting, and 28 trials used a simulated setting. Time was used as an outcome measure in all of the trials, and number of errors was used in 19 out of 31 trials. Twenty-two out of 31 trials (71%) showed a reduction in performance time, and 12 out of 19 (63%) showed a significant reduction in error when using 3D compared to 2D.
CONCLUSIONS
Overall, 3D laparoscopy appears to improve speed and reduce the number of performance errors when compared to 2D laparoscopy. Most studies to date assessed 3D laparoscopy in simulated settings, and the impact of 3D laparoscopy on clinical outcomes has yet to be examined.
Topics: Clinical Competence; Humans; Imaging, Three-Dimensional; Laparoscopy; Medical Errors; Operative Time; Outcome Assessment, Health Care
PubMed: 25840896
DOI: 10.1007/s00464-015-4189-7 -
Health Technology Assessment... Nov 2014Elective cataract surgery is the most commonly performed surgical procedure in the NHS. In bilateral cataracts, the eye with greatest vision impairment from cataract is... (Review)
Review
BACKGROUND
Elective cataract surgery is the most commonly performed surgical procedure in the NHS. In bilateral cataracts, the eye with greatest vision impairment from cataract is operated on first. First-eye surgery can improve vision and quality of life. However, it is unclear whether or not cataract surgery on the second eye provides enough incremental benefit to be considered clinically effective and cost-effective.
OBJECTIVE
To conduct a systematic review of clinical effectiveness and analysis of cost-effectiveness of second-eye cataract surgery in England and Wales, based on an economic model informed by systematic reviews of cost-effectiveness and quality of life.
DATA SOURCES
Twelve electronic bibliographic databases, including MEDLINE, EMBASE, Web of Science, The Cochrane Library and the Centre for Reviews and Dissemination databases were searched from database inception to April 2013, with searches updated in July 2013. Reference lists of relevant publications were also checked and experts consulted.
REVIEW METHODS
Two reviewers independently screened references, extracted and checked data from the included studies and appraised their risk of bias. Based on the review of cost-effectiveness, a de novo economic model was developed to estimate the cost-effectiveness of second-eye surgery in bilateral cataract patients. The model is based on changes in quality of life following second-eye surgery and includes post-surgical complications.
RESULTS
Three randomised controlled trials (RCTs) of clinical effectiveness, three studies of cost-effectiveness and 10 studies of health-related quality of life (HRQoL) met the inclusion criteria for the systematic reviews and, where possible, were used to inform the economic analysis. Heterogeneity of studies precluded meta-analyses, and instead data were synthesised narratively. The RCTs assessed visual acuity, contrast sensitivity, stereopsis and several measures of HRQoL. Improvements in binocular visual acuity and contrast sensitivity were small and unlikely to be of clinical significance, but stereopsis was improved to a clinically meaningful extent following second-eye surgery. Studies did not provide evidence that second-eye surgery significantly affected HRQoL, apart from an improvement in the mental health component of HRQoL in one RCT. In the model, second-eye surgery generated 0.68 incremental quality-adjusted life-years with an incremental cost-effectiveness ratio of £1964. Model results were most sensitive to changes in the utility gain associated with second-eye surgery, but otherwise robust to changes in parameter values. The probability that second-eye surgery is cost-effective at willingness-to-pay thresholds of £10,000 and £20,000 is 100%.
LIMITATIONS
Clinical effectiveness studies were all conducted more than 9 years ago. Patients had good vision pre surgery which may not represent all patients eligible for second-eye surgery. For some vision-related patient-reported outcomes and HRQoL measures, thresholds for determining important clinical effects are either unclear or have not been determined.
CONCLUSIONS
Second-eye cataract surgery is generally cost-effective based on the best available data and under most assumptions. However, more up-to-date data are needed. A well-conducted RCT that reflects current populations and enables the estimation of health state utility values would be appropriate. Guidance is required on which vision-related, patient-reported outcomes are suitable for assessing effects of cataract surgery in the NHS and how these measures should be interpreted clinically.
STUDY REGISTRATION
This project is registered as PROSPERO CRD42013004211.
FUNDING
This project was funded by the National Institute for Health Research Health Technology Assessment programme.
Topics: Accidental Falls; Activities of Daily Living; Aged; Aged, 80 and over; Cataract Extraction; Clinical Trials as Topic; Cost-Benefit Analysis; Depth Perception; Elective Surgical Procedures; England; Female; Humans; Male; Models, Econometric; Patient Satisfaction; Quality of Life; Quality-Adjusted Life Years; Risk Assessment; State Medicine; Vision Tests; Visually Impaired Persons
PubMed: 25405576
DOI: 10.3310/hta18680 -
Journal of Surgical Education 2015To systematically review literature pertaining to microsurgical skill assessment tools to determine those specific to, and validated for, microsurgery training. (Review)
Review
OBJECTIVES
To systematically review literature pertaining to microsurgical skill assessment tools to determine those specific to, and validated for, microsurgery training.
DESIGN
Multiple databases were searched with preset terms. The search dates included all years up to May 2014. The eligibility criteria included the presence of statistical comparison with a control group and the presence of a measure of validation. The articles and their references were independently reviewed by 2 assessors. Each assessment tool was evaluated for content, construct, face, and criterion validities as well observation/expectant bias and interrater/intrarater reliability. For individual studies, we screened for expectant and selection bias.
RESULTS
Of the 261 articles reviewed, 10 articles and 1 abstract were included. Those excluded were predominantly assessment tools that did not evaluate microsurgical skill or articles where no assessment tool was described. The assessment tools identified in this review include a self-assessment tool where trainees rate their skill confidence from 1 to 5, stereoscopic visual acuity as a predictor for microsurgical performance, an objective motion-tracking electronic device--the Imperial College of Surgical Assessment Device, and 6 global rating scales. Content, construct, and face validities were consistently demonstrated in addition to observation/expectant bias and interrater reliability. Criterion validity was only demonstrated for half of the instruments and intrarater reliability for only 1.
CONCLUSIONS
Overall, 10 articles and 1 abstract described validated methods. Reliability and validity were demonstrated by 6 global rating scales (University of Western Ontario microsurgical skills acquisition, structured assessment of microsurgery skills, and video-based objective structured assessment of technical skill). Motion analysis using the Imperial College of Surgical Assessment Device is a valid objective measure of skill.
Topics: Clinical Competence; Depth Perception; Humans; Internship and Residency; Microsurgery; Reproducibility of Results; Task Performance and Analysis
PubMed: 25086464
DOI: 10.1016/j.jsurg.2014.06.009 -
The Cochrane Database of Systematic... Feb 2014Demographic data in North America, Europe, Asia, Australia and New Zealand suggest a rapid growth in the number of persons over the age of 65 years as the baby boomer... (Review)
Review
BACKGROUND
Demographic data in North America, Europe, Asia, Australia and New Zealand suggest a rapid growth in the number of persons over the age of 65 years as the baby boomer generation passes retirement age. As older adults make up an increasing proportion of the population, they are an important consideration when designing future evidence-based traffic safety policies, particularly those that lead to restrictions or cessation of driving. Research has shown that cessation of driving among older drivers can lead to negative emotional consequences such as depression and loss of independence. Older adults who continue to drive tend to do so less frequently than other demographic groups and are more likely to be involved in a road traffic crash, possibly due to what is termed the "low mileage bias". Available research suggests that older driver crash risk estimates based on traditional exposure measures are prone to bias. When annual driving distances are taken in to consideration, older drivers with low driving distances have an increased crash risk, while those with average or high driving distances tend to be safer drivers when compared to other age groups. In addition, older drivers with lower distance driving tend to drive in urban areas which, due to more complex and demanding traffic patterns, tend to be more accident-prone. Failure to control for actual annual driving distances and driving locations among older drivers is referred to as "low mileage bias" in older driver mobility research. It is also important to note that older drivers are more vulnerable to serious injury and death in the event of a traffic crash due to changes in physiology associated with normal ageing. Vision, cognition, and motor functions or skills (e.g., strength, co-ordination, and flexibility) are three key domains required for safe driving. To drive safely, an individual needs to be able to see road signs, road side objects, traffic lights, roadway markings, other vulnerable road users, and other vehicles on the road, among many other cues-all while moving, and under varying light and weather conditions. It is equally important that drivers must have appropriate peripheral vision to monitor objects and movement to identify possible threats in the driving environment. It is, therefore, not surprising that there is agreement among researchers that vision plays a significant role in driving performance. Several age-related processes/conditions impair vision, thus it follows that vision testing of older drivers is an important road safety issue. The components of visual function essential for driving are acuity, static acuity, dynamic acuity, visual fields, visual attention, depth perception, and contrast sensitivity. These indices are typically not fully assessed by licensing agencies. Also, current vision screening regulations and cut-off values required to pass a licensing test vary from country to country. Although there is a clear need to develop evidence-based and validated tools for vision screening for driving, the effectiveness of existing vision screening tools remains unclear. This represents an important and highly warranted initiative to increase road safety worldwide.
OBJECTIVES
To assess the effects of vision screening interventions for older drivers to prevent road traffic injuries and fatalities.
SEARCH METHODS
For the update of this review we searched the Cochrane Injuries Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP) and ISI Web of Science: (CPCI-S & SSCI). The searches were conducted up to 26 September 2013.
SELECTION CRITERIA
Randomised controlled trials (RCTs) and controlled before and after studies comparing vision screening to non-screening of drivers aged 55 years and older, and which assessed the effect on road traffic crashes, injuries, fatalities and any involvement in traffic law violations.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the reference lists for eligible articles and independently assessed the articles for inclusion against the criteria. If suitable trials had been available, two review authors would have independently extracted data using a standardised extraction form.
MAIN RESULTS
No studies were found that met the inclusion criteria for this review.
AUTHORS' CONCLUSIONS
Most countries require a vision screening test for the renewal of an individual's driver's licence. There is, however, lack of methodologically sound studies to assess the effects of vision screening tests on subsequent motor vehicle crash reduction. There is a need to develop valid and reliable tools of vision screening that can predict driving performance.
Topics: Accidents, Traffic; Aged; Automobile Driving; Humans; Vision Screening
PubMed: 24563119
DOI: 10.1002/14651858.CD006252.pub4 -
Journal of Cataract and Refractive... Oct 2013The aim of this systematic review was to synthesize and appraise the evidence of benefits of second-eye cataract extraction for visual function, patient-reported quality... (Review)
Review
UNLABELLED
The aim of this systematic review was to synthesize and appraise the evidence of benefits of second-eye cataract extraction for visual function, patient-reported quality of life, falls, and driving ability among the elderly. We conducted a comprehensive search in MEDLINE using "surgery," "cataract extraction," "second eye," and "bilateral." Ten studies met the inclusion and quality criteria. We found "moderate" evidence supporting improvement in stereopsis, stereoacuity, and anisometropia over and above the benefits of first-eye surgery. We also found "moderate" evidence supporting improvement in visual acuity, contrast sensitivity, and self-reported visual functioning. Studies included in the review do not provide definitive evidence of second-eye surgery benefits on health-related quality of life, visual fields, falls prevention, and driving performance. However, the heterogeneity of outcome measures and the limited number of studies likely contributed to our findings. The findings have implications for clinicians and policymakers in the health-care industry and emphasize the need for additional trials examining this important and widely performed clinical procedure.
FINANCIAL DISCLOSURE
No author has a financial or proprietary interest in any material or method mentioned.
Topics: Accidental Falls; Activities of Daily Living; Automobile Driving; Cataract; Cataract Extraction; Contrast Sensitivity; Depth Perception; Health Status; Humans; Outcome Assessment, Health Care; Quality of Life; Visual Acuity; Visual Fields
PubMed: 24075161
DOI: 10.1016/j.jcrs.2013.08.033 -
Chronic Respiratory Disease Aug 2013The aim of this study was to give an in-depth consideration of the chronic obstructive pulmonary disease (COPD) patients' subjective view of the impact of pulmonary... (Review)
Review
The aim of this study was to give an in-depth consideration of the chronic obstructive pulmonary disease (COPD) patients' subjective view of the impact of pulmonary rehabilitation (PR) on their lives. A systematic review in PubMed, Embase, CINAHL and PsychInfo databases yielded 3306 articles, of which 387 were duplicates, 263 remained after screening abstract and title; of them, 4 were excluded (editorial or due to lacking of full text) remaining a total of 259 for full text reading. Among these, eight studies met the inclusion criteria and were finally included. The meta-ethnography approach synthesized an understanding of the studies, which focused on constructing interpretations and developed a 'line-of-argument' synthesis. The psychosocial support of PR contributes to the patients' strength and desire for participation and the health education leads to illness-perception learning. Both psychosocial support and health education develop patients' empowerment, while PR promotes opportunities to health transitions. The empowerment experienced by the patients in taking advantage of these opportunities leads to positive impacts over time. If they do not exploit these occasions, negative impacts arise in their life, which make the treatment assistance or follow-up more difficult. The COPD patients' feedback revealed that PR promotes a better 'way of life', well-being and important behavioural changes towards health promotion.
Topics: Health Knowledge, Attitudes, Practice; Humans; Patient Acceptance of Health Care; Power, Psychological; Pulmonary Disease, Chronic Obstructive; Qualitative Research
PubMed: 23897930
DOI: 10.1177/1479972313493796