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Journal of the Pediatric Infectious... Jun 2015Jewish ritual circumcision rarely but occasionally includes a procedure involving direct oral suction of the wound, which can expose an infant to infection with herpes... (Review)
Review
Jewish ritual circumcision rarely but occasionally includes a procedure involving direct oral suction of the wound, which can expose an infant to infection with herpes simplex virus type 1 (HSV-1). This practice has provoked international controversy in recent years, but no systematic review of the clinical literature has previously been published. We designed this review to identify and synthesize all published studies examining the association between circumcision with direct oral suction and HSV-1 infection. Our search strategy identified 6 published case series or case reports, documenting 30 cases between 1988 and 2012. Clinical findings were consistent with transmission of infection during circumcision, although the evidence base is limited by the small number of infections and incomplete case data. Published evidence suggests that circumcision with direct oral suction has resulted in severe neonatal illness and death from HSV-1 transmission, but further research is necessary to clarify the risk of infection.
Topics: Ceremonial Behavior; Circumcision, Male; Herpes Simplex; Herpesvirus 1, Human; Humans; Infant, Newborn; Jews; Judaism; Male; Risk Assessment; Suction
PubMed: 26407411
DOI: 10.1093/jpids/piu075 -
The Cochrane Database of Systematic... Jul 2020Non-tubal ectopic pregnancy is the implantation of an embryo at a site lying outside the uterine cavity or fallopian tubes. Sites include a caesarean scar, the cornua... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Non-tubal ectopic pregnancy is the implantation of an embryo at a site lying outside the uterine cavity or fallopian tubes. Sites include a caesarean scar, the cornua uteri, the ovary, the cervix, and the abdomen. There has been an increasing trend in the occurrence of these rare conditions, especially caesarean scar pregnancy (CSP).
OBJECTIVES
To evaluate the clinical effectiveness and safety of surgery, medical treatment, and expectant management of non-tubal ectopic pregnancy in terms of fertility outcomes and complications.
SEARCH METHODS
We searched the Cochrane Gynaecology and Fertility (CGF) Group Specialised Register of Controlled Trials, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, the World Health Organization (WHO) search portal and nine other databases to 12 December 2019. We handsearched reference lists of articles retrieved and contacted experts in the field to obtain additional data.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) published in all languages that examined the effects and safety of surgery, medical treatment, and expectant management of non-tubal ectopic pregnancy.
DATA COLLECTION AND ANALYSIS
We used Cochrane standard methodological procedures. Primary outcomes were treatment success and complications.
MAIN RESULTS
We included five RCTs with 303 women, all reporting Caesarean scar pregnancy. Two compared uterine arterial embolization (UAE) or uterine arterial chemoembolization (UACE) plus methotrexate (MTX) versus systemic MTX and subsequent dilation and suction curettage; one compared UACE plus MTX versus ultrasonography-guided local MTX injection; and two compared suction curettage under hysteroscopy versus suction curettage under ultrasonography after UAE/UACE. The quality of evidence ranged from moderate to very low. The main limitations were imprecision (small sample sizes and very wide confidence intervals (CI) for most analyses), multiple comparisons with a small number of trials, and insufficient data available to assess heterogeneity. UAE/UACE versus systemic MTX prior to suction curettage Two studies reported this comparison. One compared UAE with systemic MTX and one compared UACE plus MTX versus systemic MTX, in both cases followed by a suction curettage. We are uncertain whether UAE/UACE improved success rates after initial treatment (UAE: risk ratio (RR) 1.00, 95% CI 0.90 to 1.12; 1 RCT, 72 women; low-quality evidence; UACE: RR 0.87, 95% CI 0.54 to 1.38; 1 RCT, 28 women; low-quality evidence). We are uncertain whether UAE/UACE reduced rates of complications (UAE: RR 0.47, 95% CI 0.13 to 1.75; 1 RCT, 72 women; low-quality evidence; UACE: RR 0.62, 95% CI 0.26 to 1.48; 1 RCT, 28 women; low-quality evidence). We are uncertain whether UAE/UACE reduced adverse effects (UAE: RR 1.58, 95% CI 0.41 to 6.11; 1 RCT, 72 women; low-quality evidence; UACE: RR 1.16, 95% CI 0.32 to 4.24; 1 RCT, 28 women; low-quality evidence), and it was not obvious that the types of events had similar values to participants (e.g. fever versus vomiting). Blood loss was lower in UAE/UACE groups than systemic MTX groups (UAE: mean difference (MD) -378.70 mL, 95% CI -401.43 to -355.97; 1 RCT, 72 women; moderate-quality evidence; UACE: MD -879.00 mL, 95% CI -1135.23 to -622.77; 1 RCT, 28 women; moderate-quality evidence). Data were not available on time to normalize β-human chorionic gonadotropin (β-hCG). UACE plus MTX versus ultrasonography-guided local MTX injection We are uncertain whether UACE improved success rates after initial treatment (RR 0.95, 95% CI 0.56 to 1.60; 1 RCT, 45 women; very low-quality evidence). Adverse effects: the study reported the same number of failed treatments in each arm (RR 0.88, 95% CI 0.40 to 1.92; 1 RCT, 45 women). We are uncertain whether UACE shortened the time to normalize β-hCG (MD 1.50 days, 95% CI -3.16 to 6.16; 1 RCT, 45 women; very low-quality evidence). Data were not available for complications. Suction curettage under hysteroscopy versus under ultrasonography after UAE/UACE. Two studies reported this comparison. One compared suction curettage under hysteroscopy versus under ultrasonography after UAE, and one compared these interventions after UACE. We are uncertain whether suction curettage under hysteroscopy improved success rates after initial treatment (UAE: RR 0.91, 95% CI 0.81 to 1.03; 1 RCT, 66 women; very low-quality evidence; UACE: RR 1.02, 95% CI 0.96 to 1.09; 1 RCT, 92 women; low-quality evidence). We are uncertain whether suction curettage under hysteroscopy reduced rates of complications (UAE: RR 4.00, 95% CI 0.47 to 33.91; 1 RCT, 66 women; very low-quality evidence; UACE: RR 0.18, 95% CI 0.01 to 3.72; 1 RCT, 92 women; low-quality evidence). We are uncertain whether suction curettage under hysteroscopy reduced adverse effects (UAE: RR 3.09, 95% CI 0.12 to 78.70; 1 RCT, 66 women; very low-quality evidence; UACE: not estimable; 1 RCT, 92 women; very low-quality evidence). We are uncertain whether suction curettage under hysteroscopy shortened the time to normalize β-hCG (UAE: MD 4.03 days, 95% CI -1.79 to 9.85; 1 RCT, 66 women; very low-quality evidence; UACE: MD 0.84 days, 95% CI -1.90 to 3.58; 1 RCT, 92 women; low-quality evidence). Non-tubal ectopic pregnancy other than CSP No studies reported on non-tubal ectopic pregnancies in locations other than on a caesarean scar.
AUTHORS' CONCLUSIONS
For Caesarean scar pregnancies (CSP) it is uncertain whether there is a difference in success rates, complications, or adverse events between UAE/UACE and administration of systemic MTX before suction curettage (low-quality evidence). Blood loss was lower if suction curettage is conducted after UAE/UACE than after administration of systemic MTX (moderate-quality evidence). It is uncertain whether there is a difference in treatment success rates, complications, adverse effects or time to normalize β-hCG between suction curettage under hysteroscopy and under ultrasonography (very low-quality evidence). There are no studies of non-tubal ectopic pregnancy other than CSP and RCTs for these types of pregnancy are unlikely.
Topics: Abortifacient Agents, Nonsteroidal; Bias; Cesarean Section; Chemoembolization, Therapeutic; Cicatrix; Confidence Intervals; Dilatation and Curettage; Female; Humans; Hysteroscopy; Methotrexate; Pregnancy; Pregnancy, Ectopic; Randomized Controlled Trials as Topic; Sample Size; Ultrasonography, Interventional; Uterine Artery; Uterine Artery Embolization; Vacuum Curettage
PubMed: 32609376
DOI: 10.1002/14651858.CD011174.pub2 -
The Cochrane Database of Systematic... Dec 2014A burn wound is a complex and evolving injury, with both local and systemic consequences. Burn treatments include a variety of dressings, as well as newer strategies,... (Review)
Review
BACKGROUND
A burn wound is a complex and evolving injury, with both local and systemic consequences. Burn treatments include a variety of dressings, as well as newer strategies, such as negative pressure wound therapy (NPWT), which, by means of a suction force that drains excess fluids from the burn, tries to promote the wound healing process and minimise progression of the burn wound.
OBJECTIVES
To assess the effectiveness of NPWT for people with partial-thickness burns.
SEARCH METHODS
We searched the Cochrane Wounds Group Specialised Register (searched 04 September 2014); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 8).
SELECTION CRITERIA
All randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that evaluated the safety and effectiveness of NPWT for partial-thickness burns.
DATA COLLECTION AND ANALYSIS
Two review authors used standardised forms, and extracted the data independently. We assessed each trial for risk of bias, and resolved differences by discussion.
MAIN RESULTS
One RCT, that was an interim report, satisfied the inclusion criteria. We undertook a narrative synthesis of results, as the absence of data and poor reporting precluded us from carrying out any formal statistical analysis. The trial was at high risk of bias.
AUTHORS' CONCLUSIONS
There was not enough evidence available to permit any conclusions to be drawn regarding the use of NPWT for treatment of partial-thickness burn wounds.
Topics: Burns; Humans; Negative-Pressure Wound Therapy; Occlusive Dressings; Randomized Controlled Trials as Topic; Suction; Wound Healing
PubMed: 25500895
DOI: 10.1002/14651858.CD006215.pub4 -
Medicine Jul 2018Placement of closed suction drains after total knee arthroplasty is an age-old practice; however, benefits and disadvantages of this procedure remain disputable in... (Review)
Review
BACKGROUND
Placement of closed suction drains after total knee arthroplasty is an age-old practice; however, benefits and disadvantages of this procedure remain disputable in various studies.
METHODS
We performed an electronic database search in Medline/PubMed, the Cochrane Library, and Embase to retrieve publications with respect to this issue and then screened reference lists of related articles manually to obtain any additional ones. Randomized controlled trials (RCTs) evaluating the use of closed suction drains after primary total knee arthroplasty were eligible for this study. Useful data were extracted to calculate the pooled risk ratios (RRs) or weighted mean differences (WMDs) as well as corresponding 95% confidence intervals (CIs) as summary estimates.
RESULTS
Nineteen RCTs were included in the quantitative analysis. Compared with patients in the nondrainage group, those in the drainage group were significantly correlated with a decreased need of dressing change (RR = 0.31, 95% CI 0.12 to 0.79, P = .015) but an increased risk of homologous transfusion (RR = 1.38, 95% CI: 1.04-1.83) and longer time to regain straight-leg raising (WMD = 0.97 d, 95% CI: 0.48-1.46). Two groups showed no significant difference in total blood loss, hemoglobin drop, superficial wound infection, prosthetic joint infection, formation of deep vein thrombosis, duration of hospital stay, and range of movement.
CONCLUSIONS
Based on this analysis, the use of closed suction drains after total knee arthroplasty is probably not superior to no drains for most outcome measures and therefore surgeons may wish to reconsider the routine use of this empirical practice until there is further evidence.
Topics: Arthroplasty, Replacement, Hip; Humans; Postoperative Complications; Risk Assessment; Suction
PubMed: 30045254
DOI: 10.1097/MD.0000000000011290 -
Journal of Personalized Medicine Mar 2024The use of closed suction drains post posterior spinal fusion for adolescent idiopathic scoliosis (AIS) is common practice, although evidence on its impact is limited... (Review)
Review
The use of closed suction drains post posterior spinal fusion for adolescent idiopathic scoliosis (AIS) is common practice, although evidence on its impact is limited compared to that for knee and hip arthroplasty. This study aimed to assess the effect of closed suction drainage on short-term post-operative outcomes in AIS surgery. A systematic review following PRISMA guidelines was conducted, including studies comparing outcomes with and without drainage. Data on blood loss, transfusions, hospital stay, and complications were collected and subjected to meta-analysis. Five studies involving 772 patients were analyzed. The meta-analysis found no significant difference in blood transfusion rates ( = 0.107) or hospital stay ( = 0.457) between groups. Complications, including surgical site infections, were more common without drainage, though not statistically significant ( = 0.356). Reintervention rates were higher in the no-drainage group, but not significantly ( = 0.260). Overall, this review found no significant short-term outcome differences, suggesting clinical judgment should guide drainage decisions. Further research, particularly with enhanced recovery protocols, is warranted to clarify drainage's role in AIS surgery.
PubMed: 38672966
DOI: 10.3390/jpm14040339 -
PloS One 2013To evaluate whether external suction is more advantageous than water seal in patients undergoing selective pulmonary resection (SPR) for lung neoplasm. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate whether external suction is more advantageous than water seal in patients undergoing selective pulmonary resection (SPR) for lung neoplasm.
SUMMARY OF BACKGROUND DATA
Whether external suction should be routinely applied in postoperative chest drainage is still unclear, particularly for lung neoplasm patients. To most surgeons, the decision is based on their clinical experience.
METHODS
Randomized control trials were selected. The participants were patients undergoing SPR with lung neoplasm. Lung volume reduction surgery and pneumothorax were excluded. Suction versus non-suction for the intervention. The primary outcome was the incidence of persistent air leak (PAL). The definition of PAL was air leak for more than 3-7 days. The secondary outcomes included air leak duration, time of drainage, postoperative hospital stay and the incidence of postoperative pneumothorax. Studies were identified from literature collections through screening. Bias was analyzed and meta-analysis was used.
RESULTS
From the 1824 potentially relevant trials, 6 randomized control trials involving 676 patients were included. There was no difference between external suction and water seal in decreasing the incidence of PAL [95% confidence interval (CI) 0.81-2.16; z = 1.10; P = 0.27]. Regarding secondary outcomes, there were no differences in time of drainage (95% CI-0.36-1.56, P = 0.22), postoperative hospital stay (95% CI -.31-.54, P = 0.87) or incidence of postoperative pneumothorax (95% CI 0.18-.02, P = 0.05) between external suction and water seal.
CONCLUSIONS
For participants, no differences are identified in terms of PAL incidence, drainage time, length of postoperative hospital stay or incidence of postoperative pneumothorax between external suction and water seal. The bias analysis should be emphasized. To the limitations of the bias and methodological differences among the included studies, we have no recommendation on whether external suction should be routinely applied after lung neoplasm SPR. More high-quality randomized controlled trials are needed.
SYSTEMATIC REVIEW REGISTRATION
None.
Topics: Drainage; Humans; Lung Neoplasms; Pneumonectomy; Pneumothorax; Postoperative Care; Postoperative Complications; Randomized Controlled Trials as Topic; Suction
PubMed: 23874505
DOI: 10.1371/journal.pone.0068087 -
Iranian Journal of Public Health Aug 2020It is of paramount importance to reduce the probability of clinical risks to improve the quality of health care services, make the relationship between service providers... (Review)
Review
BACKGROUND
It is of paramount importance to reduce the probability of clinical risks to improve the quality of health care services, make the relationship between service providers and patients more effective, enhance patient satisfaction, and decrease the rate of complaints regarding medical errors in hospitals. This study aimed at detecting potential and unacceptable risks occurring in the hospital ICUs.
METHODS
In this systematic review, all studies examining the risk assessment of ICUs in hospitals using Failure Mode and Effect Analysis method were reviewed. Google scholar, PubMed, Scopus, SID, Magiran and Web of Science databases were searched to find relevant articles published from 1980 to 2019.
RESULTS
The most frequent failures detected in the reviewed articles consisted of high risk of infection inwards for medical and nursing operations, high infection rates inwards for medical devices' operation within the unit, and early discharge. Moreover, the processes through which potential high-risk Failures were examined in these studies were injection or prescription process, suction process, the process of inserting or removing endotracheal tubes, the process of transferring patients from the operation room to the unit or vice versa, pressure ulcers, and processes related to the medical devices' operation.
CONCLUSION
There are many possible reasons for failure occurring throughout these processes, and the failure modes occurring in these processes are more probable to cause serious damages to patients, have high repeatability with low probability of failure detection as the failures cannot be discovered by the personnel.
PubMed: 33083318
DOI: 10.18502/ijph.v49i8.3865 -
International Journal of Hyperthermia :... 2024Caesarean scar pregnancy (CSP) presents a significant clinical challenge owing to the associated risks of uterine scar rupture, severe haemorrhage and adverse maternal... (Meta-Analysis)
Meta-Analysis Review
Efficacy and safety of high-intensity focused ultrasound combined with suction curettage for the treatment of caesarean scar pregnancy: a systematic review and single-arm meta-analysis.
PURPOSE
Caesarean scar pregnancy (CSP) presents a significant clinical challenge owing to the associated risks of uterine scar rupture, severe haemorrhage and adverse maternal outcomes. This study aimed to assess the safety and efficacy of combining high-intensity focused ultrasound (HIFU) with suction curettage for treating CSP.
METHODS
We conducted a comprehensive search in four databases, namely PubMed, Web of Science, Embase and Cochrane Library, to identify published studies evaluating the use of HIFU combined with suction curettage to treat CSP. Intraoperative blood loss, treatment success rate, and reproductive results were the primary outcomes assessed.
RESULTS
A total of 18 studies involving 1251 patients with CSP, all of whom received preoperative HIFU therapy were included. The average hospital stay was 6.22 days, the intraoperative blood loss was 26.29 ml and the incidence of adverse events was 15.60%, including abdominal or lower limb pain, fever, vaginal bleeding, haematuria and vomiting. Furthermore, post-treatment follow-up showed that serum β-human chorionic gonadotropin levels were rapidly normalized (average of 25.48 days) and menstruation returned (average of 33.03 days). The treatment had a remarkable success rate of 97.60% and a subsequent pregnancy rate of 68.70%.
CONCLUSION
While the combination of HIFU and suction-curettage may induce common adverse effects such as lower abdominal or limb pain, these reactions typically do not necessitate therapeutic intervention. Additionally, the size of the gestational sac is a determinant of the procedure's success. In conclusion, HIFU combined with suction curettage demonstrates promising clinical efficacy, safety and favourable reproductive outcomes in managing CSP.
Topics: Humans; Female; Pregnancy; Blood Loss, Surgical; Vacuum Curettage; Cicatrix; Pain; Cesarean Section
PubMed: 38329796
DOI: 10.1080/02656736.2024.2310019 -
Respiratory Care Mar 2023Several studies have investigated postextubation complications of the positive-pressure and suctioning techniques; however, these studies yielded inconsistent results.... (Review)
Review
BACKGROUND
Several studies have investigated postextubation complications of the positive-pressure and suctioning techniques; however, these studies yielded inconsistent results. Therefore, in this systematic review, we aimed to assess and compare the risk of complications between these techniques after extubation.
METHODS
This study was registered with the International Prospective Register of Systematic Reviews (CRD42021272068). We searched for randomized controlled trials (RCT) or observational studies that compared positive-pressure and suctioning extubation techniques in medical literature databases. Our search was conducted from the databases' inception to July 7, 2022. The included studies were assessed for quality by using a risk of bias tool.
RESULTS
Six RCTs and 1 non-randomized controlled study were included in this systematic review ( 1,575 subjects), wherein the positive-pressure and suctioning techniques were applied to 762 and 813 subjects, respectively. Three studies were conducted in operating rooms, and 4 studies were conducted in ICUs. Five studies were conducted among adults, and 2 studies were conducted among children or neonates. All the studies except 1 RCT showed that the positive-pressure technique tended to have a lower but not statistically different risk of complications, including desaturation, airway obstruction, pneumonia, aspiration, atelectasis, and re-intubation, than the suctioning technique. Three of the 6 RCTs were determined to have a high risk of bias and the 1 non-randomized controlled study was determined to have a serious risk of bias.
CONCLUSIONS
The positive-pressure technique tended to have a lower risk of complications than the suctioning technique. Further high-quality studies are warranted.
Topics: Adult; Child; Humans; Infant, Newborn; Airway Obstruction; Intensive Care Units; Intubation, Intratracheal; Suction; Airway Extubation; Controlled Clinical Trials as Topic
PubMed: 36828583
DOI: 10.4187/respcare.10326 -
Journal of Rehabilitation Research and... 2015This review is an attempt to untangle the complexity of transtibial prosthetic socket fit, determine the most important characteristic for a successful fitting, and... (Meta-Analysis)
Meta-Analysis Review
This review is an attempt to untangle the complexity of transtibial prosthetic socket fit, determine the most important characteristic for a successful fitting, and perhaps find some indication of whether a particular prosthetic socket type might be best for a given situation. Further, it is intended to provide directions for future research. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used medical subject headings and standard key words to search for articles in relevant databases. No restrictions were made on study design or type of outcome measure. From the obtained search results (n = 1,863), 35 articles were included. The relevant data were entered into a predefined data form that incorporated the Downs and Black risk of bias assessment checklist. Results for the qualitative outcomes (n = 19 articles) are synthesized. Total surface bearing sockets lead to greater activity levels and satisfaction in active persons with amputation, those with a traumatic cause of amputation, and younger persons with amputation than patellar tendon bearing sockets. Evidence on vacuum-assisted suction and hydrostatic sockets is inadequate, and further studies are much needed. To improve the scientific basis for prescription, comparison of and correlation between mechanical properties of interface material, socket designs, user characteristics, and outcome measures should be conducted and reported in future studies.
Topics: Amputation, Surgical; Amputation Stumps; Artificial Limbs; Humans; Pressure; Prosthesis Design; Stress, Mechanical; Surface Properties; Tibia; Weight-Bearing
PubMed: 26436666
DOI: 10.1682/JRRD.2014.08.0183