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BMJ Clinical Evidence Jun 2007Nearly two thirds of colorectal cancers occur in the rectum or sigmoid colon. It is the third most common cancer in resource-rich countries, accounting for about 20,000... (Review)
Review
INTRODUCTION
Nearly two thirds of colorectal cancers occur in the rectum or sigmoid colon. It is the third most common cancer in resource-rich countries, accounting for about 20,000 deaths each year in the UK, and 60,000 each year in the USA.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of screening for colorectal cancer? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2006 (BMJ Clinical evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: colonoscopy, computed tomography colography, double contrast barium enema, faecal occult blood testing, flexible sigmoidoscopy.
Topics: Colonoscopy; Colorectal Neoplasms; Evidence-Based Medicine; Humans; Incidence; Mass Screening; Occult Blood; Sigmoidoscopy
PubMed: 19454089
DOI: No ID Found -
Current Environmental Health Reports Dec 2016Published systematic reviews concluded that there is moderate to strong evidence to infer a potential role of lead and cadmium, widespread environmental metals, as... (Review)
Review
Published systematic reviews concluded that there is moderate to strong evidence to infer a potential role of lead and cadmium, widespread environmental metals, as cardiovascular risk factors. For other non-essential metals, the evidence has not been appraised systematically. Our objective was to systematically review epidemiologic studies on the association between cardiovascular disease in adults and the environmental metals antimony, barium, chromium, nickel, tungsten, uranium, and vanadium. We identified a total of 4 articles on antimony, 1 on barium, 5 on chromium, 1 on nickel, 4 on tungsten, 1 on uranium, and 0 on vanadium. We concluded that the current evidence is not sufficient to inform on the cardiovascular role of these metals because of the small number of studies. Few experimental studies have also evaluated the role of these metals in cardiovascular outcomes. Additional epidemiologic and experimental studies, including prospective cohort studies, are needed to understand the role of metals, including exposure to metal mixtures, in cardiovascular disease development.
Topics: Cadmium; Cardiovascular Diseases; Environmental Exposure; Environmental Pollutants; Humans; Lead; Metals; Risk Factors
PubMed: 27783356
DOI: 10.1007/s40572-016-0117-9 -
World Journal of Gastroenterology Apr 2012Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life, and this fact is consistent with the high rate at...
Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life, and this fact is consistent with the high rate at which health care is sought for this condition. The aim of this project was to develop a consensus for the diagnosis and treatment of chronic constipation and obstructed defecation. The commission presents its results in a "Question-Answer" format, including a set of graded recommendations based on a systematic review of the literature and evidence-based medicine. This section represents the consensus for the diagnosis. The history includes information relating to the onset and duration of symptoms and may reveal secondary causes of constipation. The presence of alarm symptoms and risk factors requires investigation. The physical examination should assess the presence of lesions in the anal and perianal region. The evidence does not support the routine use of blood testing and colonoscopy or barium enema for constipation. Various scoring systems are available to quantify the severity of constipation; the Constipation Severity Instrument for constipation and the obstructed defecation syndrome score for obstructed defecation are the most reliable. The Constipation-Related Quality of Life is an excellent tool for evaluating the patient's quality of life. No single test provides a pathophysiological basis for constipation. Colonic transit and anorectal manometry define the pathophysiologic subtypes. Balloon expulsion is a simple screening test for defecatory disorders, but it does not define the mechanisms. Defecography detects structural abnormalities and assesses functional parameters. Magnetic resonance imaging and/or pelvic floor sonography can further complement defecography by providing information on the movement of the pelvic floor and the organs that it supports. All these investigations are indicated to differentiate between slow transit constipation and obstructed defecation because the treatments differ between these conditions.
Topics: Chronic Disease; Constipation; Defecography; Evidence-Based Medicine; Gastrointestinal Transit; Humans; Manometry; Quality of Life; Severity of Illness Index
PubMed: 22529683
DOI: 10.3748/wjg.v18.i14.1555 -
The Cochrane Database of Systematic... Sep 2012Primary aspiration of food and fluid is commonly seen in children with feeding and swallowing difficulties associated with a range of diseases and complex medical... (Review)
Review
BACKGROUND
Primary aspiration of food and fluid is commonly seen in children with feeding and swallowing difficulties associated with a range of diseases and complex medical conditions. Respiratory sequelae and pneumonia are known to be associated with primary aspiration of ingested material, however causality between primary aspiration of specific food and fluid types and pulmonary effects in children is yet to be established in controlled trials. The relative pulmonary morbidity of aspiration of ingested food and fluid materials versus other causes of respiratory disease such as viral and bacterial causes, secondary aspiration of gastrointestinal contents and predisposing lung conditions such as chronic neonatal lung disease in a developing immune system is also unclear. Current management decisions for children who aspirate have to optimise oral nutrition and hydration, while reducing the risk of aspiration to preserve pulmonary integrity. This generally includes restricting aspirated food or fluids and providing texture-modified diets and thickened fluids. Young children frequently refuse thickened fluids providing a management dilemma for both families and health professionals.
OBJECTIVES
Our objective was to evaluate the efficacy of restriction of oral water ingestion on the pulmonary status of children with thin fluid aspiration demonstrated on a modified barium swallow study.
SEARCH METHODS
The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Airways Collaborative Review Group Specialised Register, MEDLINE, EMBASE and CINAHL databases were searched by the Cochrane Airways Group. The latest search was performed in May 2102.
SELECTION CRITERIA
All randomised controlled trials comparing restriction of oral intake of water with unlimited oral water ingestion were eligible to be included.
DATA COLLECTION AND ANALYSIS
Results of searches were reviewed against a pre-determined criteria for inclusion. No eligible trials were identified for a paediatric population and thus no data were available for analysis. One trial in an adult population was identified and reported.
MAIN RESULTS
No randomised controlled trials examining the efficacy of restriction of oral intake of water in the management of children with thin fluid aspiration were found. In a single study in an adult population with stroke, no significant differences were seen between a control group of oral water restriction and the experimental group of unlimited oral water ingestion on outcomes such as pneumonia, total oral fluid intake and dehydration.
AUTHORS' CONCLUSIONS
There are no trials that have adequately evaluated the pulmonary effects of allowing or restricting oral water ingestion in children known to have primary aspiration of thin fluids. Thus, there is currently an absence of evidence to support a strict approach of full restriction of oral intake of water or support a more liberal approach of allowing oral water ingestion in children with primary aspiration of thin fluids.
Topics: Child; Child, Preschool; Drinking Water; Humans; Infant; Pneumonia, Aspiration
PubMed: 22972084
DOI: 10.1002/14651858.CD005303.pub3 -
Laryngoscope Investigative... Apr 2024Previous studies have shown an association between environmental exposure to heavy metals and hearing loss. However, the findings regarding the relationship between... (Review)
Review
BACKGROUND AND OBJECTIVES
Previous studies have shown an association between environmental exposure to heavy metals and hearing loss. However, the findings regarding the relationship between exposure to different metals and hearing loss development are inconsistent. To address this, we conducted a meta-analysis to explore the link between common heavy metal exposures and hearing loss. This study examined the effects of lead (Pb), cadmium (Cd), and mercury (Hg) pollution on hearing loss at various levels, and systematically reviewed the literature on manganese (Mn), barium (Ba), arsenic (As), and hearing loss.
METHODS
We conducted systematic searches in five major databases, including PubMed, Web of Science, Embase, Cochrane Library, and Scopus. In addition, we searched three Chinese digital libraries: CNKI, Wanfang Data, and Wipu. From an initial pool of 649 articles, we carefully screened and selected 15 articles for further analysis. The effect sizes from these selected studies were synthesized through a meta-analysis to calculate the overall effect size.
RESULTS
Our findings showed that: (1) There was a significant association between Pb and Cd exposure and hearing loss; (2) There is a proportional relationship between the increase of metal index detected in blood and hearing loss; (3) In the PTA measurement of hearing loss at different frequencies, the 4 kHz high frequency range had a stronger correlation with hearing loss than the low frequency, with OR 1.44 (1.22, 1.71); and (4) There was a more significant correlation between Barium (Ba) levels in nails and hair than in urine.
CONCLUSIONS
The study presented evidence of a significant association between human hearing loss and exposure to lead (Pb) and cadmium (Cd). It not only revealed a positive correlation between blood heavy metal concentrations and the incidence of hearing loss but also highlighted that long-term exposure indicators of heavy metals were more indicative of the correlation with hearing loss. Lastly, the study recommends utilizing high frequency 4 kHz for the effective assessment and diagnosis of hearing loss caused by exposure to heavy metals.
PubMed: 38562156
DOI: 10.1002/lio2.1230 -
Global Spine Journal Sep 2022Systematic review. Surgical decompression for degenerative cervical myelopathy (DCM) is associated with perioperative complications, including difficulty or discomfort...
STUDY DESIGN
Systematic review. Surgical decompression for degenerative cervical myelopathy (DCM) is associated with perioperative complications, including difficulty or discomfort with swallowing (dysphagia) as well as changes in sound production (dysphonia). This systematic review aims to (1) outline how dysphagia and dysphonia are defined in the literature and (2) assess the quality of definitions using a novel 4-point rating system.
METHODS
An electronic database search was conducted for studies that reported on dysphagia, dysphonia or other related complications of DCM surgery. Data extracted included study design, surgical details, as well as definitions and rates of surgical complications. A 4-point rating scale was developed to assess the quality of definitions for each complication.
RESULTS
Our search yielded 2,673 unique citations, 11 of which met eligibility criteria and were summarized in this review. Defined complications included odynophagia (n = 1), dysphagia (n = 11), dysphonia (n = 2), perioperative swelling complications (n = 2), and soft tissue swelling (n = 3). Rates of dysphagia varied substantially (0.0%-50.0%) depending on whether this complication was patient-reported (4.4%); patient-reported using a modified Swallowing Quality of Life questionnaire (43.1%) or the Bazaz criteria (8.8%-50.0%); or diagnosed using an extensive protocol consisting of clinical assessment, a bedside swallowing test, evaluation by a speech and language pathologist and a modified barium swallowing test/fiberoptic endoscopy (42.9%). The reported incidences of dysphonia also ranged significantly from 0.6% to 38.0%.
CONCLUSION
There is substantial variability in reported rates of dysphagia and dysphonia due to differences in data collection methods, diagnostic strategies, and definitions. Consolidation of nomenclature will improve evaluation of the overall safety of surgery.
PubMed: 34409882
DOI: 10.1177/21925682211035714 -
Iranian Journal of Public Health Dec 2020Classroom is where children spend much of their time in; this study aimed to identify the concentration of heavy metals in the classroom dust based on the results of... (Review)
Review
BACKGROUND
Classroom is where children spend much of their time in; this study aimed to identify the concentration of heavy metals in the classroom dust based on the results of various studies in the world using the published data up to years 2018.
METHODS
Fifteen studies were selected for the study according to the inclusion and exclusion criteria. The mean concentration of 11 heavy metals including arsenic, barium, cadmium, cobalt, chromium, copper, iron, lead, manganese, nickel, and zinc was extracted.
RESULTS
The highest mean concentration of heavy metal (mg/kg) in classroom dust was related to iron (3904.7, 95%CI: 3657.1-8154.3), zinc (429.9, 95%CI: 182.8-677.1) and barium (419.2, 95%CI: 274.7-253.7), respectively. Subgroup analysis showed the maximum concentration (mg/kg) of iron in Iran (16945.5), zinc in Hong Kong (2293.5), barium in China (979.8), manganese in Iran (288.9), lead in Iran (258.8), chromium in Ghana (381.3), copper in Hong Kong (274.4), nickel in Iran (50.1), cobalt in China(43.4), arsenic in China(13.7) and cadmium in Hong Kong(8.7).
CONCLUSION
Even safe and healthy classrooms can threaten children's health by heavy metals. These metals are important since they are naturally found throughout the earth's crust, accumulate in the food chain and contaminate drinking water as well as alloys in school equipment.
PubMed: 34178735
DOI: 10.18502/ijph.v49i12.4809 -
The British Journal of Radiology Jun 2016To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To investigate the impact of radiographer advanced practice on patient outcomes and health service quality.
METHODS
Using the World Health Organization definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs, and data were systematically extracted using electronic data extraction pro forma.
RESULTS
407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n = 7) focusing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The articles were generally considered to be of low-to-moderate quality, with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, the included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No articles reported data relating to time to diagnosis, time to recovery or patient mortality.
CONCLUSION
Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited.
ADVANCES IN KNOWLEDGE
This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality.
Topics: Health Care Costs; Humans; Internationality; Outcome Assessment, Health Care; Patient Satisfaction; Practice Patterns, Physicians'; Quality Improvement; Radiography; Time-to-Treatment
PubMed: 27008104
DOI: 10.1259/bjr.20151066 -
Environmental Science and Pollution... Mar 2023The golden eagle (Aquila chrysaetos) and the white-tailed eagle (Haliaeetus albicilla), being apex predators and facultative scavengers, can bioaccumulate different...
The golden eagle (Aquila chrysaetos) and the white-tailed eagle (Haliaeetus albicilla), being apex predators and facultative scavengers, can bioaccumulate different environmental contaminants, including toxic elements that may adversely affect their health. We analyzed the levels of cadmium (Cd), lead (Pb), and other metals and metalloids, including arsenic (As), barium (Ba), beryllium (Be), cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), magnesium (Mg), manganese (Mn), molybdenum (Mo), selenium (Se), thorium (Th), thallium (Tl), uranium (U), vanadium (V), and zinc (Zn) in liver samples taken from three golden eagles and 36 white-tailed eagles that were found dead across Poland to verify their exposure. We also used a systematic review to summarize the available literature data on Cd, Pb, and other studied elements in the liver of both eagle species. Analyses of trace elements in the liver samples of the Polish eagles revealed interspecific differences in Cd, Cu, and Mn and differences in Co, Mn, Tl, and Zn among study regions. All elements tested except Pb were below the suggested thresholds linked with adverse health effects in birds. The hepatic Pb found in almost half of all the tested individuals suggests environmental exposure to this toxic element. One of the tested white-tailed eagles had hepatic Pb above the threshold of sublethal poisoning. Although our results seem optimistic, as previous Polish studies showed a higher prevalence of birds with hepatic Pb exceeding the toxicity threshold, they indicate that exposure to this toxic metal could still pose an additional threat to the health of Polish eagles.
Topics: Humans; Animals; Trace Elements; Cadmium; Eagles; Poland; Lead; Manganese; Liver; Cobalt; Thallium
PubMed: 36585589
DOI: 10.1007/s11356-022-25024-y -
American Journal of Speech-language... Mar 2021Purpose Despite the emphasis on using evidence-based practice for patient care, as clinicians, we sometimes find that there is insufficient evidence to support our...
Purpose Despite the emphasis on using evidence-based practice for patient care, as clinicians, we sometimes find that there is insufficient evidence to support our clinical practices. One example of this is the "contentious" inclusion of routine, standardized visualization of the esophagus during modified barium swallow studies (MBSSs). This review sought to investigate the evidence for inclusion of routine esophageal visualization during the MBSS, a practice that is supported by the long-established interrelationship between all aspects of the oral, pharyngeal, and esophageal swallowing continuum. Method Searches were conducted in PubMed, Scopus, and CINAHL databases. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed to identify articles that met prespecified inclusion and exclusion terms. Results Five articles were included in this review, which identified that esophageal findings were present in 48.67% of those participants whose MBSS included esophageal visualization. Conclusion This review supports a standardized, validated, reliable visualization protocol of the esophagus during the MBSS as a critical component to the accurate diagnosis and formulation of treatment recommendations for patients with swallowing disorders.
Topics: Barium; Deglutition; Deglutition Disorders; Fluoroscopy; Humans
PubMed: 33734825
DOI: 10.1044/2020_AJSLP-20-00255