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Sample records for syndromes systematic evaluation

  1. A systematic review and economic evaluation of diagnostic strategies for Lynch syndrome.

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    Snowsill, Tristan; Huxley, Nicola; Hoyle, Martin; Jones-Hughes, Tracey; Coelho, Helen; Cooper, Chris; Frayling, Ian; Hyde, Chris

    2014-09-01

    Lynch syndrome (LS) is an inherited autosomal dominant disorder characterised by an increased risk of colorectal cancer (CRC) and other cancers, and caused by mutations in the deoxyribonucleic acid (DNA) mismatch repair genes. To evaluate the accuracy and cost-effectiveness of strategies to identify LS in newly diagnosed early-onset CRC patients (aged strategies for individuals in whom LS is identified. Systematic reviews were conducted of the test accuracy of microsatellite instability (MSI) testing or immunohistochemistry (IHC) in individuals with CRC at risk of LS, and of economic evidence relating to diagnostic strategies for LS. Reviews were carried out in April 2012 (test accuracy); and in February 2012, repeated in February 2013 (economic evaluations). Databases searched included MEDLINE (1946 to April week 3, 2012), EMBASE (1980 to week 17, 2012) and Web of Science (inception to 30 April 2012), and risk of bias for test accuracy was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) quality appraisal tool. A de novo economic model of diagnostic strategies for LS was developed. Inconsistencies in study designs precluded pooling of diagnostic test accuracy results from a previous systematic review and nine subsequent primary studies. These were of mixed quality, with significant methodological concerns identified for most. IHC and MSI can both play a part in diagnosing LS but neither is gold standard. No UK studies evaluated the cost-effectiveness of diagnosing and managing LS, although studies from other countries generally found some strategies to be cost-effective compared with no testing. The de novo model demonstrated that all strategies were cost-effective compared with no testing at a threshold of £20,000 per quality-adjusted life-year (QALY), with the most cost-effective strategy utilising MSI and BRAF testing [incremental cost-effectiveness ratio (ICER) = £5491 per QALY]. The maximum health benefit to the

  2. Outcome reporting across randomised trials and observational studies evaluating treatments for Twin-Twin Transfusion Syndrome: a systematic review.

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    Perry, Helen; Duffy, James M N; Umadia, Ogochukwu; Khalil, Asma

    2018-04-01

    Twin-Twin Transfusion syndrome is associated with significant mortality and morbidity. Potential treatments require robust evaluation. The aim of this study was to evaluate outcome reporting across observational studies and randomised controlled trials assessing treatments for twin-twin transfusion syndrome (TTTS). Cochrane Central Register of Controlled Trials, EMBASE and Medline were searched from inception to August 2016. Observational studies and randomised controlled trials reporting outcomes following a treatment for TTTS in monochorionic-diamniotic twin pregnancies and monochorionic-triamniotic or dichorionic-triamniotic triplet pregnancies were included. We systematically extracted and categorised outcome reporting. Six randomised trials and 94 observational studies, reporting data from 20,071 maternal participants and 3,199 children, were included. Six different treatments were evaluated. Included studies reported sixty-two different outcomes, including 10 fetal, 28 neonatal, 6 early childhood and 18 maternal outcomes. The outcomes were inconsistently reported across trials. For example, when considering offspring mortality, 31 studies (31%) reported live birth, 31 studies (31%) reported intrauterine death, 49 studies (49%) reported neonatal mortality, and 17 studies (17%) reported perinatal mortality. Four studies (4%) reported respiratory distress syndrome. Only 19 (19%) of studies were designed for long-term follow-up and 11 of these studies (11%) reported cerebral palsy. Most studies evaluating treatments for TTTS, have often neglected to report clinically important outcomes, especially neonatal morbidity outcomes. Most studies are not designed for long-term follow-up. The development of a core outcome set could help standardised outcome collection and reporting in Twin-Twin Transfusion syndrome studies. This article is protected by copyright. All rights reserved.

  3. Dhat syndrome: a systematic review.

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    Udina, Marc; Foulon, Hubert; Valdés, Manuel; Bhattacharyya, Sagnik; Martín-Santos, Rocío

    2013-01-01

    Dhat syndrome is a widely recognized clinical condition often seen on the Indian subcontinent that is characterized by a preoccupation with semen loss in urine and other symptoms such as fatigue or depressed mood. Although it has been considered to be a culture-bound syndrome, it may also be regarded as a distinct manifestation of depression or another medical illness. The purpose of this paper was to carry out a systematic review on Dhat syndrome. A review of the literature published up until February 2012 was conducted using the key words [Dhat syndrome] or [semen-loss anxiety] or [semen-loss syndrome]. We included only original studies. The majority of studies reported patients from the Indian subcontinent. There was a high degree of heterogeneity among the studies. Dhat was a common condition in young people from certain cultures and origins. Depressive and anxiety symptoms were common, including fatigue, sleepiness, and sexual dysfunction. Good clinical engagement, social support, and sexual education were useful in some cases. Given the high rate of comorbid depressive symptoms, antidepressant has been used. In an increasingly globalized world, clinicians must be able to properly diagnose and treat patients from other cultures, who may report symptoms that are influenced by their beliefs, culture, or place of origin. Dhat may be a common manifestation of a depressive or anxiety disorder in certain cultures. Further research is needed to improve our understanding of this condition, to clarify its nosologic status, and to offer appropriate treatment to affected individuals. Copyright © 2013 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  4. A systematic method for using 3D echocardiography to evaluate tricuspid valve insufficiency in hypoplastic left heart syndrome

    Directory of Open Access Journals (Sweden)

    Christopher Robin Mart

    2014-01-01

    We have proposed a systematic method for evaluating and displaying the TV using 3DE which can provide significant insight into the mechanisms causing TVI in HLHS. This has the potential to improve both the surgical approach to repairing the valve and, ultimately, patient outcomes.

  5. Communication Intervention in Rett Syndrome: A Systematic Review

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    Sigafoos, Jeff; Green, Vanessa A.; Schlosser, Ralf; O'eilly, Mark F.; Lancioni, Giulio E.; Rispoli, Mandy; Lang, Russell

    2009-01-01

    We reviewed communication intervention studies involving people with Rett syndrome. Systematic searches of five electronic databases, selected journals, and reference lists identified nine studies meeting the inclusion criteria. These studies were evaluated in terms of: (a) participant characteristics, (b) target skills, (c) procedures, (d) main…

  6. The generalizability of the structure of substance abuse and antisocial behavioral syndromes : A systematic review

    NARCIS (Netherlands)

    Soe-Agnie, S E; Paap, M C S; VanDerNagel, J E L; Nijman, H. J. M.; de Jong, C. A. J.

    BACKGROUND: Although several authors have suggested that a single externalizing spectrum encompassing both antisocial behavioral syndromes and substance use disorder is to be preferred, this assumption has not been evaluated systematically throughout studies. PURPOSE: The objective was to establish

  7. Factors associated with patellofemoral pain syndrome: A systematic review

    NARCIS (Netherlands)

    N.E. Lankhorst (Nienke); S.M. Bierma-Zeinstra (Sita); M. van Middelkoop (Marienke)

    2013-01-01

    markdownabstractABSTRACT This review systematically summarises factors associated with patellofemoral pain syndrome (PFPS). A systematic literature search was conducted. Studies including ≥20 patients with PFPS that examined ≥1 possible factor associated with PFPS were included. A

  8. Assessing sensitivity and specificity of the Manchester Triage System in the evaluation of acute coronary syndrome in adult patients in emergency care: a systematic review protocol.

    Science.gov (United States)

    Nishi, Fernanda Ayache; de Motta Maia, Flávia Oliveira; de Lopes Monteiro da Cruz, Dina Almeida

    2015-11-01

    suspected ACS, several studies have reported the difficulties of evaluating patients with these conditions. Various factors can interfere with the outcome of this process, such as atypical presentation of symptoms, AMI classification, patient age, and professional skill.Primary studies have addressed the issue from different perspectives. Studies have been conducted to evaluate the ability of nurses using MTS to detect high-risk patients with chest pain, the impact of MTS on short-term mortality in AMI, and the sensitivity and specificity of MTS for patients with ACS, and to assess whether the MTS was used effectively in patients admitted to the hospital with a diagnosis of acute coronary syndrome.These studies concluded that use of the MTS by nurses is a sensitive method for identifying high risk cardiac chest pain, but further studies are required to assess whether additional training can improve the sensitivity of MTS. The MTS safeguards patients with typical AMI presentation and ST elevation during myocardial infarction, and who are under 70 years of age. The MTS has a high sensitivity in prioritization (immediate/very urgent) of patients with ACS. Additionally, most patients admitted for ACS are initially triaged as "orange" or "yellow", an indication for prompt assessment in the emergency department. This has a positive effect on time to first medical assessment, but has no effect on time to hospital admission.A systematic review addressing a similar theme was published. The review evaluated the efficacy of MTS for all groups of patients and included studies that evaluated the MTS in relation to different outcomes. This proposed review is different as it will include primary studies with a specific sub-population (patients with ACS). Another important difference lies in the fact that the published review did not include critical appraisal of the primary studies included in review. A systematic review that synthesizes the available evidence on the sensitivity of MTS to

  9. Serotonin Syndrome in Tapentadol Literature: Systematic Review of Original Research.

    Science.gov (United States)

    Gressler, Laura E; Hammond, Drayton A; Painter, Jacob T

    The potential association between serotonin syndrome and tapentadol is not well described in the literature. This study aimed to review the literature and identify methodological issues that could lead to inaccurately reported rates of serotonin syndrome associated with tapentadol use. A systematic review of English articles using MEDLINE, Cochrane Controlled Trials Register, and Scopus was performed. Additional studies were identified by cross-referencing article bibliographies. Original research that examined the safety of tapentadol in patients with nonconfounding indications were examined. In total, 22 studies met inclusion criteria. There were 13 randomized clinical trials, 7 open-label trials, and 2 observational studies. All studies either did not mention whether serotonergic medication use was prohibited or disallowed use. Frequently reported adverse events were nausea, diarrhea, constipation, fatigue, vomiting, and somnolence. No studies reported serotonin syndrome development. No included trials differentiated between the development of adverse events in patients taking serotonergic drugs and those who were not. This differentiation is necessary to evaluate the increased risk of adverse events in patients prescribed tapentadol concomitantly with other serotonergic medications. Therefore, the current tapentadol literature has important limitations that prevent the adequate characterization of the potential association between tapentadol and serotonin syndrome.

  10. Pain management in Guillain-Barre syndrome: a systematic review.

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    Peña, L; Moreno, C B; Gutierrez-Alvarez, A M

    2015-09-01

    Pain is a common symptom in patients with Guillain-Barre syndrome. Intensity is moderate to severe in most cases and pain may persist after resolution of the disease. Identify the most appropriate analgesic therapy for pain management in patients with Guillain-Barre syndrome. Systematic review and selection of scientific articles on treatment of pain in Guillain-Barre syndrome patients, published between January 1985 and December 2012. We included only randomised, double-blind, controlled trials assessing the effectiveness of drugs for pain management in these patients. Four articles met the inclusion criteria. One evaluated the use of gabapentin, another evaluated carbamazepine, a third compared gabapentin to carbamazepine, and the last evaluated use of methylprednisolone. Both carbamazepine and gabapentin were useful for pain management. Patients experienced lower-intensity pain with gabapentin treatment in the study comparing that drug to carbamazepine. Methylprednisolone was not shown to be effective for reducing pain. The published data did not permit completion of a meta-analysis. There is no robust evidence at present that would point to a single treatment option for this disorder. Further clinical studies of larger patient samples and with a longer duration are needed to characterise types of pain for each patient and measure pain intensity in an objective way. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  11. A systematic review of genetic syndromes with obesity.

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    Kaur, Y; de Souza, R J; Gibson, W T; Meyre, D

    2017-06-01

    Syndromic monogenic obesity typically follows Mendelian patterns of inheritance and involves the co-presentation of other characteristics, such as mental retardation, dysmorphic features and organ-specific abnormalities. Previous reviews on obesity have reported 20 to 30 syndromes but no systematic review has yet been conducted on syndromic obesity. We searched seven databases using terms such as 'obesity', 'syndrome' and 'gene' to conduct a systematic review of literature on syndromic obesity. Our literature search identified 13,719 references. After abstract and full-text review, 119 relevant papers were eligible, and 42 papers were identified through additional searches. Our analysis of these 161 papers found that 79 obesity syndromes have been reported in literature. Of the 79 syndromes, 19 have been fully genetically elucidated, 11 have been partially elucidated, 27 have been mapped to a chromosomal region and for the remaining 22, neither the gene(s) nor the chromosomal location(s) have yet been identified. Interestingly, 54.4% of the syndromes have not been assigned a name, whereas 13.9% have more than one name. We report on organizational inconsistencies (e.g. naming discrepancies and syndrome classification) and provide suggestions for improvements. Overall, this review illustrates the need for increased clinical and genetic research on syndromes with obesity. © 2017 World Obesity Federation.

  12. Psychometric properties of health related quality of life measures in acute coronary syndrome patients: a systematic review protocol.

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    Brasil, Virginia; Oliveira, Gabriela; Moraes, Katarinne Lima

    2018-02-01

    The objective of this systematic review is to evaluate the psychometric properties and clinical utility of patient-reported outcome measures that assess health-related quality of life in patients with a clinical diagnosis of acute coronary syndrome.

  13. Selenium intake and metabolic syndrome: A systematic review.

    Science.gov (United States)

    Retondario, Anabelle; Fernandes, Ricardo; Rockenbach, Gabriele; Alves, Mariane de Almeida; Bricarello, Liliana Paula; Trindade, Erasmo Benicio Santos de Moraes; Vasconcelos, Francisco de Assis Guedes de

    2018-03-02

    Metabolic syndrome is a multi-causal disease. Its treatment includes lifestyle changes with a focus on weight loss. This systematic review assessed the association between Selenium intake and metabolic syndrome. Data were collected mainly from four databases: PubMed, CENTRAL (Cochrane), Scopus and Web of Knowledge. Keywords related to metabolic syndrome, selenium, as well as metabolic syndrome features were searched. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. A systematic review protocol was registered at PROSPERO (n. 42016046321). Two reviewers independently screened 2957 abstracts. Six studies were included to perform data extraction with standardized spreadsheets. The risk of bias was assessed by using specific tools according to the design of the relevant studies. An assessment was carried out based on the appropriateness of the study reports accordingly to STROBE and the CONSORT-based checklist for each study design. Three studies found no association between Selenium intake and metabolic syndrome; two of them found an inverse association; and one study found a direct association between Selenium intake and metabolic syndrome. One study also showed an inverse association between Selenium intake and the prevalence of high waist circumference, high diastolic blood pressure, and hyperglycaemia in women. Overall, based on the argumentation and results of this study, it is possible to conclude that Selenium intake and metabolic syndrome are not clearly associated in adults and elderly. Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  14. Behaviour in Cornelia de Lange syndrome: a systematic review.

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    Mulder, Paul A; Huisman, Sylvia A; Hennekam, Raoul C; Oliver, Chris; van Balkom, Ingrid D C; Piening, Sigrid

    2017-04-01

    Careful study and accurate description of behaviour are important to understand developmental challenges for individuals with Cornelia de Lange syndrome (CdLS). Here we present a systematic review of current understanding of behaviour in CdLS. A systematic search was performed for articles published between January 1946 and December 2015 evaluating autism, self-injury, and/or cognition in CdLS. After study-selection, 43 papers were included. The Cochrane quality criteria were adjusted to assign quality scores to the included studies. Participants were mostly categorized in the severe/profound developmental level. Methodology and quality were very heterogeneous, as well as reporting occurrence of autism. Self-injurious behaviour was reported in 15 papers. Physical conditions were reported in 21 studies, mostly related to hearing and vision. Only nine studies mentioned details about medication. Comparison of presented results was hindered by heterogeneous assessment methods. Improving our understanding of behavioural characteristics in CdLS requires more uniform methodology. We propose a criterion standard of instruments that can ideally be used in assessment of behaviour and development. This will improve understanding of behaviour in the context of developmental level and daily functioning. © 2016 Mac Keith Press.

  15. Hormonal aspects of overtraining syndrome: a systematic review.

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    Cadegiani, Flavio A; Kater, Claudio E

    2017-01-01

    Overtraining syndrome (OTS), functional (FOR) and non-functional overreaching (NFOR) are conditions diagnosed in athletes with decreased performance and fatigue, triggered by metabolic, immune, hormonal and other dysfunctions and resulted from an imbalance between training stress and proper recovery. Despite previous descriptions, there is a lack of a review that discloses all hormonal findings in OTS/FOR/NFOR. The aim of this systematic review is to evaluate whether and which roles hormones play in OTS/FOR/NFOR. A systematic search up to June 15 th , 2017 was performed in the PUBMED, MEDLINE and Cochrane databases following PRISMA protocol, with the expressions: (1)overtraining, (2)overreaching, (3)overtrained, (4)overreached, or (5)underperformance, and (plus) (a)hormone, (b)hormonal, (c)endocrine, (d)adrenal, (e)cortisol, (f)GH, (g)ACTH, (h)testosterone, (i)IGF-1, (j)TSH, (k)T4, (l)T3, (m)LH, (n)FSH, (o)prolactin, (p) IGFBP-3 and related articles. A total of 38 studies were selected. Basal levels of hormones were mostly normal in athletes with OTS/FOR/NFOR compared with healthy athletes. Distinctly, stimulation tests, mainly performed in maximal exercise conditions, showed blunted GH and ACTH responses in OTS/FOR/NFOR athletes, whereas cortisol and plasma catecholamines showed conflicting findings and the other hormones responded normally. Basal hormone levels are not good predictor but blunted ACTH and GH responses to stimulation tests may be good predictors of OTS/FOR/NFOR.

  16. Ocular ischemic syndrome - a systematic review.

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    Terelak-Borys, Barbara; Skonieczna, Katarzyna; Grabska-Liberek, Iwona

    2012-08-01

    Ocular ischemic syndrome is a rare condition, which is caused by ocular hypoperfusion due to stenosis or occlusion of the common or internal carotid arteries. Atherosclerosis is the major cause of changes in the carotid arteries. Ocular ischemic syndrome is manifested as visual loss, orbital pain and, frequently, changes of the visual field, and various anterior and posterior segment signs. Anterior segment signs include iris neovascularization and secondary neovascular glaucoma, iridocyclitis, asymmetric cataract, iris atrophy and sluggish reaction to light. Posterior eye segment changes are the most characteristic, such as narrowed retinal arteries, perifoveal telangiectasias, dilated retinal veins, mid-peripheral retinal hemorrhages, microaneurysms, neovascularization at the optic disk and in the retina, a cherry-red spot, cotton-wool spots, vitreous hemorrhage and normal-tension glaucoma. Differential diagnosis of ocular ischemic syndrome includes diabetic retinopathy and moderate central retinal vein occlusion. Carotid artery imaging and fundus fluorescein angiography help to establish the diagnosis of ocular ischemic syndrome. The treatment can be local, for example, ocular (conservative, laser and surgical) or systemic (conservative and surgical treatment of the carotid artery). Since the condition does not affect the eyes alone, patients with ocular ischemic syndrome should be referred for consultation to the neurologist, vascular surgeon and cardiologist.

  17. Improving the management of non-ST elevation acute coronary syndromes: systematic evaluation of a quality improvement programme European QUality Improvement Programme for Acute Coronary Syndrome: The EQUIP-ACS project protocol and design

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    Bardaji Alfredo

    2010-01-01

    Full Text Available Abstract Background Acute coronary syndromes, including myocardial infarction and unstable angina, are important causes of premature mortality, morbidity and hospital admissions. Acute coronary syndromes consume large amounts of health care resources, and have a major negative economic and social impact through days lost at work, support for disability, and coping with the psychological consequences of illness. Several registries have shown that evidence based treatments are under-utilised in this patient population, particularly in high-risk patients. There is evidence that systematic educational programmes can lead to improvement in the management of these patients. Since application of the results of important clinical trials and expert clinical guidelines into clinical practice leads to improved patient care and outcomes, we propose to test a quality improvement programme in a general group of hospitals in Europe. Methods/Design This will be a multi-centre cluster-randomised study in 5 European countries: France, Spain, Poland, Italy and the UK. Thirty eight hospitals will be randomised to receive a quality improvement programme or no quality improvement programme. Centres will enter data for all eligible non-ST segment elevation acute coronary syndrome patients admitted to their hospital for a period of approximately 10 months onto the study database and the sample size is estimated at 2,000-4,000 patients. The primary outcome is a composite of eight measures to assess aggregate potential for improvement in the management and treatment of this patient population (risk stratification, early coronary angiography, anticoagulation, beta-blockers, statins, ACE-inhibitors, clopidogrel as a loading dose and at discharge. After the quality improvement programme, each of the eight measures will be compared between the two groups, correcting for cluster effect. Discussion If we can demonstrate important improvements in the quality of patient care as

  18. Definitions of traumatic conus medullaris and cauda equina syndrome: a systematic literature review

    NARCIS (Netherlands)

    Brouwers, E.M.; Meent, H. van de; Curt, A.; Starremans, B.; Hosman, A.J.; Bartels, R.H.M.A.

    2017-01-01

    STUDY DESIGN: A systematic review. OBJECTIVES: Conus medullaris syndrome (CMS) and cauda equina syndrome (CES) are well-known neurological entities. It is assumed that these syndromes are different regarding neurological and functional prognosis. However, literature concerning spinal trauma is

  19. Brief Report: Systematic Review of Rett Syndrome in Males

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    Reichow, Brian; George-Puskar, Annie; Lutz, Tara; Smith, Isaac C.; Volkmar, Fred R.

    2015-01-01

    Rett syndrome (RTT) is a neurogenetic disorder in which a period of typical development is followed by loss of previously acquired skills. Once thought to occur exclusively in females, increasing numbers of male cases of RTT have been reported. This systematic review included 36 articles describing 57 cases of RTT in males. Mutations of the MECP2…

  20. Communication Assessment for Individuals with Rett Syndrome: A Systematic Review

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    Sigafoos, Jeff; Kagohara, Debora; van der Meer, Larah; Green, Vanessa A.; O'Reilly, Mark F.; Lancioni, Giulio E.; Lang, Russell; Rispoli, Mandy; Zisimopoulos, Dimitrios

    2011-01-01

    We reviewed studies that aimed to determine whether behaviors, such as body movements, vocalizations, eye gaze, and facial expressions, served a communicative function for individuals with Rett syndrome. A systematic search identified eight studies, which were summarized in terms of (a) participants, (b) assessment targets, (c) assessment…

  1. Treatment of medial tibial stress syndrome: a systematic review

    NARCIS (Netherlands)

    Winters, Marinus; Eskes, Michel; Weir, Adam; Moen, Maarten H.; Backx, Frank J. G.; Bakker, Eric W. P.

    2013-01-01

    Medial tibial stress syndrome (MTSS) is a common exercise-induced leg injury among athletes and military personnel. Several treatment options have been described in the literature, but it remains unclear which treatment is most effective. The objective of this systematic review was to assess the

  2. The Metabolic Syndrome and Mind-Body Therapies: A Systematic Review

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    Joel G. Anderson

    2011-01-01

    Full Text Available The metabolic syndrome, affecting a substantial and increasing percentage of the worldwide population, is comprised of a cluster of symptoms associated with increased risk of type 2 diabetes, cardiovascular disease, and other chronic conditions. Mind-body modalities based on Eastern philosophy, such as yoga, tai chi, qigong, and meditation, have become increasingly popular worldwide. These complementary therapies have many reported benefits for improving symptoms and physiological measures associated with the metabolic syndrome. However, clinical trial data concerning the effectiveness of these practices on the syndrome as a whole have not been evaluated using a systematic and synthesizing approach. A systematic review was conducted to critically evaluate the data from clinical trials examining the efficacy of mind-body therapies as supportive care modalities for management of the metabolic syndrome. Three clinical trials addressing the use of mind-body therapies for management of the metabolic syndrome were identified. Findings from the studies reviewed support the potential clinical effectiveness of mind-body practices in improving indices of the metabolic syndrome.

  3. Assessing sensitivity and specificity of the Manchester Triage System in the evaluation of acute coronary syndrome in adult patients in emergency care: a systematic review.

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    Nishi, Fernanda Ayache; de Oliveira Motta Maia, Flávia; de Souza Santos, Itamar; de Almeida Lopes Monteiro da Cruz, Dina

    2017-06-01

    Triage is the first assessment and sorting process used to prioritize patients arriving in the emergency department (ED). As a triage tool, the Manchester Triage System (MTS) must have a high sensitivity to minimize the occurrence of under-triage, but must not compromise specificity to avoid the occurrence of overtriage. Sensitivity and specificity of the MTS can be calculated using the frequency of appropriately assigned clinical priority levels for patients presenting to the ED. However, although there are well established criteria for the prioritization of patients with suspected acute coronary syndrome (ACS), several studies have reported difficulties when evaluating patients with this condition. The objective of this review was to synthesize the best available evidence on assessing the sensitivity and specificity of the MTS for screening high-level priority adult patients presenting to the ED with ACS. The current review considered studies that evaluated the use of the MTS in the risk classification of adult patients in the ED. In this review, studies that investigated the priority level, as established by the MTS to screen patients under suspicion of ACS or the sensitivity and specificity of the MTS, for screening patients before the medical diagnosis of ACS were included. This review included both experimental and epidemiological study designs. The results were presented in a narrative synthesis. Six studies were appraised by the independent reviewers. All appraised studies enrolled a consecutive or random sample of patients and presented an overall moderate methodological quality, and all of them were included in this review. A total of 54,176 participants were included in the six studies. All studies were retrospective. Studies included in this review varied in content and data reporting. Only two studies reported sensitivity and specificity values or all the necessary data to calculate sensitivity and specificity. The remaining four studies presented

  4. Prenatal risk factors for Tourette Syndrome: a systematic review.

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    Chao, Ting-Kuang; Hu, Jing; Pringsheim, Tamara

    2014-01-30

    Tourette Syndrome (TS) appears to be an inherited disorder, although genetic abnormalities have been identified in less than 1% of patients, and the mode of inheritance is uncertain. Many studies have investigated environmental factors that might contribute to the onset and severity of tics and associated comorbidities such as obsessive compulsive disorder (OCD) and attention deficit hyperactive disorder (ADHD). A systematic review and qualitative analysis were performed to provide a broad view of the association between pre- and perinatal factors and TS. The Medline, Embase and PsycINFO databases were searched using terms specific to Tourette's syndrome and keywords such as "pregnancy", "prenatal", "perinatal", "birth" and "neonatal". Studies were limited to studies on human subjects published in English or French through October 2012. 22 studies were included. Studies were of limited methodological quality, with most samples derived from specialty clinics, and most exposures ascertained retrospectively. The majority of the results for demographic factors of parents, including age, education, socioeconomic status, and marital status, revealed no significant association with the onset of TS, or the presence of comorbidity. Many factors were reported to be significantly associated with the onset of TS, the presence of comorbidity and symptom severity, but the most consistently reported factors were maternal smoking and low birth weight. There are few studies evaluating the relationship between pre and perinatal events and TS, and existing studies have major limitations, including the use of clinic rather than epidemiologically derived samples, retrospective data collection on pre and perinatal events and multiple hypothesis testing without appropriate statistical correction. The mechanism by which prenatal and perinatal adversities could lead to TS onset or symptom severity is unknown, but may be related to changes in the dopaminergic system as a result of early

  5. Prenatal risk factors for Tourette Syndrome: a systematic review

    Science.gov (United States)

    2014-01-01

    Background Tourette Syndrome (TS) appears to be an inherited disorder, although genetic abnormalities have been identified in less than 1% of patients, and the mode of inheritance is uncertain. Many studies have investigated environmental factors that might contribute to the onset and severity of tics and associated comorbidities such as obsessive compulsive disorder (OCD) and attention deficit hyperactive disorder (ADHD). A systematic review and qualitative analysis were performed to provide a broad view of the association between pre- and perinatal factors and TS. Methods The Medline, Embase and PsycINFO databases were searched using terms specific to Tourette’s syndrome and keywords such as “pregnancy”, “prenatal”, “perinatal”, “birth” and “neonatal”. Studies were limited to studies on human subjects published in English or French through October 2012. Results 22 studies were included. Studies were of limited methodological quality, with most samples derived from specialty clinics, and most exposures ascertained retrospectively. The majority of the results for demographic factors of parents, including age, education, socioeconomic status, and marital status, revealed no significant association with the onset of TS, or the presence of comorbidity. Many factors were reported to be significantly associated with the onset of TS, the presence of comorbidity and symptom severity, but the most consistently reported factors were maternal smoking and low birth weight. Conclusions There are few studies evaluating the relationship between pre and perinatal events and TS, and existing studies have major limitations, including the use of clinic rather than epidemiologically derived samples, retrospective data collection on pre and perinatal events and multiple hypothesis testing without appropriate statistical correction. The mechanism by which prenatal and perinatal adversities could lead to TS onset or symptom severity is unknown, but may be related

  6. Systematic review of case reports of antiphospholipid syndrome following infection.

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    Abdel-Wahab, N; Lopez-Olivo, M A; Pinto-Patarroyo, G P; Suarez-Almazor, M E

    2016-12-01

    The objective of this study was to conduct a systematic review of case reports documenting the development of antiphospholipid syndrome or antiphospholipid syndrome-related features after an infection. We searched Medline, EMBASE, Web of Science, PubMed ePubs, and The Cochrane Library - CENTRAL through March 2015 without restrictions. Studies reporting cases of antiphospholipid syndrome or antiphospholipid syndrome-related features following an infection were included. Two hundred and fifty-nine publications met inclusion criteria, reporting on 293 cases. Three different groups of patients were identified; group 1 included patients who fulfilled the criteria for definitive antiphospholipid syndrome (24.6%), group 2 included patients who developed transient antiphospholipid antibodies with thromboembolic phenomena (43.7%), and group 3 included patients who developed transient antiphospholipid antibodies without thromboembolic events (31.7%). The most common preceding infection was viral (55.6%). In cases that developed thromboembolic events Human immunodeficiency and Hepatitis C viruses were the most frequently reported. Parvovirus B19 was the most common in cases that developed antibodies without thromboembolic events. Hematological manifestations and peripheral thrombosis were the most common clinical manifestations. Positive anticardiolipin antibodies were the most frequent antibodies reported, primarily coexisting IgG and IgM isotypes. Few patients in groups 1 and 2 had persistent antiphospholipid antibodies for more than 6 months. Outcome was variable with some cases reporting persistent antiphospholipid syndrome features and others achieving complete resolution of clinical events. Development of antiphospholipid antibodies with all traditional manifestations of antiphospholipid syndrome were observed after variety of infections, most frequently after chronic viral infections with Human immunodeficiency and Hepatitis C. The causal relationship between infection

  7. A systematic review of population screening for fragile X syndrome.

    Science.gov (United States)

    Hill, Melissa K; Archibald, Alison D; Cohen, Jonathan; Metcalfe, Sylvia A

    2010-07-01

    To conduct a systematic review of literature regarding population-based screening for fragile X syndrome in newborns and women of reproductive age, either before or during pregnancy. Seven electronic databases were searched for English language studies published between January 1991 and November 2009. Data extraction was performed for all included studies. Results were synthesized using a narrative approach. One article that examined offering newborn screening for fragile X syndrome and 10 that examined the offer of fragile X syndrome screening to women of reproductive age were identified. Two of these articles also addressed psychosocial aspects of population screening for fragile X syndrome such as attitudes to screening and experiences of screening, and a further nine addressed these issues alone. Studies exploring psychosocial issues demonstrated challenges for counseling arising from a lack of awareness or personal experience with fragile X syndrome in the general population. Targeted counseling and educational strategies will be essential to support women from the general population. It is crucial that future studies offering screening for fragile X syndrome explore a range of psychosocial aspects in addition to looking at uptake of testing and mutation frequency.

  8. Ulnar hammer syndrome: a systematic review of the literature.

    Science.gov (United States)

    Vartija, Larisa; Cheung, Kevin; Kaur, Manraj; Coroneos, Christopher James; Thoma, Achilleas

    2013-11-01

    Ulnar hammer syndrome is an uncommon form of arterial insufficiency. Many treatments have been described, and debate continues about the best option. The goal of this systematic review was to determine whether ulnar hammer syndrome has an occupational association, to identify the most reliable diagnostic test, and to determine the best treatment modality. A comprehensive literature search was conducted using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, and EMBASE. Data from articles meeting inclusion criteria were collected in duplicate. Methodological quality of studies was assessed using the Methodological Index for Nonrandomized Studies scale. Thirty studies were included in the systematic review. No randomized controlled trials were identified. There is low-quality evidence suggestive of an association between exposure to repetitive hand trauma and vibration and ulnar hammer syndrome. Various diagnostic investigations were used, but few were compared, making it difficult to determine the most reliable diagnostic test. Numerous nonoperative and operative treatments were reported. With nonoperative treatment, 12 percent had complete resolution and 70 percent had partial resolution of their symptoms. Of patients treated operatively, 42.5 percent had complete resolution and 42.5 percent had partial resolution of their symptoms. The heterogeneity in study design and outcome measures limits definitive conclusions about occupational association, best diagnostic test, and treatment for ulnar hammer syndrome. However, there is low-quality evidence that suggests that most patients with ulnar hammer syndrome will have partial relief of symptoms with nonoperative treatment, and operative treatment results in complete or partial resolution of symptoms in the majority of cases. Therapeutic, IV.

  9. Metabolic Syndrome in Schizophrenia: A Non‑systematic Review

    Directory of Open Access Journals (Sweden)

    Marta Nascimento

    2012-12-01

    Full Text Available Background: The link between mental illness and metabolic disturbances has been recognized since the beginning of the last century. The debate concerning medical morbidity in schizophrenia intensified during the last twenty years, especially after the introduction of atypical antipsychotics. Aims: To highlight some features of the metabolic syndrome in this population, specifically epidemiological data, underlying mechanisms and antipsychotic therapy. Methods: Non‑systematic review of literature. Results and Conclusions: Despite the different criteria used for the definition of metabolic syndrome, it is clear today that the schizophrenic population has the highest rate of metabolic syndrome. Additionally, the prevalence of the metabolic syndrome in this population demonstrates a geographical distribution similar to the general population. Although it hasn’t been recognized for years, schizophrenic patients’ vulnerability to develop metabolic disturbances isn’t entirely related to antipsychotic therapy. Actually, it results from an interaction of multiple factors, including hereditary, genetic, biochemical and environmental ones (which include antipsychotic therapy. Moreover, they are not exclusively explained by weight gain. Metabolic disturbances are one of the main concerns related to general psychopharmacology. The differences between typical and atypical antipsychotics in terms of metabolic syndrome are not completely established. However, clozapine and olanzapine are recognized to have the worst metabolic profile, amongst all atypical antipsychotics.

  10. Metabolic Syndrome in Schizophrenia: A Non‑systematic Review

    Directory of Open Access Journals (Sweden)

    Marta Nascimento

    2013-11-01

    Full Text Available Background: The link between mental illness and metabolic disturbances has been recognized since the beginning of the last century. The debate concerning medical morbidity in schizophrenia intensified during the last twenty years, especially after the introduction of atypical antipsychotics. Aims: To highlight some features of the metabolic syndrome in this population, specifically epidemiological data, underlying mechanisms and antipsychotic therapy. Methods: Non‑systematic review of literature. Results and Conclusions: Despite the different criteria used for the definition of metabolic syndrome, it is clear today that the schizophrenic population has the highest rate of metabolic syndrome. Additionally, the prevalence of the metabolic syndrome in this population demonstrates a geographical distribution similar to the general population. Although it hasn’t been recognized for years, schizophrenic patients’ vulnerability to develop metabolic disturbances isn’t entirely related to antipsychotic therapy. Actually, it results from an interaction of multiple factors, including hereditary, genetic, biochemical and environmental ones (which include antipsychotic therapy. Moreover, they are not exclusively explained by weight gain. Metabolic disturbances are one of the main concerns related to general psychopharmacology. The differences between typical and atypical antipsychotics in terms of metabolic syndrome are not completely established. However, clozapine and olanzapine are recognized to have the worst metabolic profile, amongst all atypical antipsychotics.

  11. Bipolar disorder and metabolic syndrome: a systematic review

    Directory of Open Access Journals (Sweden)

    Letícia Czepielewski

    2013-03-01

    Full Text Available OBJECTIVE: Summarize data on metabolic syndrome (MS in bipolar disorder (BD. METHODS: A systematic review of the literature was conducted using the Medline, Embase and PsycInfo databases, using the keywords "metabolic syndrome", "insulin resistance" and "metabolic X syndrome" and cross-referencing them with "bipolar disorder" or "mania". The following types of publications were candidates for review: (i clinical trials, (ii studies involving patients diagnosed with bipolar disorder or (iii data about metabolic syndrome. A 5-point quality scale was used to assess the methodological weight of the studies. RESULTS: Thirty-nine articles were selected. None of studies reached the maximum quality score of 5 points. The prevalence of MS was significantly higher in BD individuals when compared to a control group. The analysis of MS subcomponents showed that abdominal obesity was heterogeneous. Individuals with BD had significantly higher rates of hypertriglyceridemia than healthy controls. When compared to the general population, there were no significant differences in the prevalence of low HDL-c in individuals with BD. Data on hypertension were also inconclusive. Rates of hyperglycemia were significantly greater in patients with BD compared to the general population. CONCLUSIONS: The overall results point to the presence of an association between BD and MS, as well as between their subcomponents.

  12. Genetic Syndromes Associated with Congenital Cardiac Defects and Ophthalmologic Changes - Systematization for Diagnosis in the Clinical Practice

    Directory of Open Access Journals (Sweden)

    Priscila H. A. Oliveira

    Full Text Available Abstract Background: Numerous genetic syndromes associated with heart disease and ocular manifestations have been described. However, a compilation and a summarization of these syndromes for better consultation and comparison have not been performed yet. Objective: The objective of this work is to systematize available evidence in the literature on different syndromes that may cause congenital heart diseases associated with ocular changes, focusing on the types of anatomical and functional changes. Method: A systematic search was performed on Medline electronic databases (PubMed, Embase, Cochrane, Lilacs of articles published until January 2016. Eligibility criteria were case reports or review articles that evaluated the association of ophthalmic and cardiac abnormalities in genetic syndrome patients younger than 18 years. Results: The most frequent genetic syndromes were: Down Syndrome, Velo-cardio-facial / DiGeorge Syndrome, Charge Syndrome and Noonan Syndrome. The most associated cardiac malformations with ocular findings were interatrial communication (77.4%, interventricular communication (51.6%, patent ductus arteriosus (35.4%, pulmonary artery stenosis (25.8% and tetralogy of Fallot (22.5%. Conclusion: Due to their clinical variability, congenital cardiac malformations may progress asymptomatically to heart defects associated with high morbidity and mortality. For this reason, the identification of extra-cardiac characteristics that may somehow contribute to the diagnosis of the disease or reveal its severity is of great relevance.

  13. Treatment effect of cyclosporine A in patients with painful bladder syndrome/interstitial cystitis: A systematic review

    OpenAIRE

    WANG, ZHIKUI; ZHANG, LEI

    2016-01-01

    Cyclosporine A (CyA) is emerging as a potential therapeutic strategy for painful bladder syndrome/interstitial cystitis (PBS/IC), which is currently an incurable disease. The purpose of this systematic review was to evaluate the treatment effects of CyA in PBS/IC. Electronic and manual retrieval procedures were carried out to identify eligible references for the systematic review. The entire contents of the included articles were assessed, from study design to reported results. Eight studies,...

  14. Onset and Recurrence of Depression as Predictors of Cardiovascular Prognosis in Depressed Acute Coronary Syndrome Patients : A Systematic Review

    NARCIS (Netherlands)

    Zuidersma, Marij; Thombs, Brett D.; de Jonge, Peter

    2011-01-01

    Background: Depression after acute coronary syndrome (ACS) is associated with worse cardiac outcomes. This systematic review evaluated whether depressed ACS patients are at differential risk depending on the recurrence and timing of onset of depressive episodes. Methods: MEDLINE, EMBASE and PsycINFO

  15. Tourette's syndrome and associated disorders: a systematic review

    Directory of Open Access Journals (Sweden)

    Bárbara R. Ferreira

    2014-09-01

    Full Text Available Objective: To compile data on Tourette's syndrome (TS, tics and associated disorders.Methods: A systematic review of the literature was conducted using the 5S levels of organization of healthcare research evidence (systems, summaries, synopses, syntheses, studies, based on the model described by Haynes. The search keywords were Tourette, tics and comorbidity, which were cross-referenced. Studies provided by publishers and articles being processed on July 31, 2013, were also included.Results: Of all studies retrieved during the search, 64 were selected because they analyzed the epidemiology, clinical features and etiopathogenesis of TS and its comorbidities. TS is classified as a hyperkinetic movement disorder, and at least 90% of the patients have neuropsychiatric comorbidities, of which attention deficit hyperactivity and obsessive-compulsive disorders are the most common. The syndrome is clinically heterogeneous and has been associated with a dysfunction of cortico-striatal-thalamic-cortical circuits involving various neurotransmitters. Although its genetic etiology has been widely studied, other factors may be important to understand this syndrome and its associated disorders.Conclusions: TS is a neurodevelopmental disorder that results from the impact of stress factors on a vulnerable biological substrate during the critical periods of neurodevelopment. The study of TS and its comorbidities may contribute, at different levels, to the understanding of several neuropsychiatric disorders of clinical and therapeutic relevance.

  16. Determinants of the postpericardiotomy syndrome: a systematic review.

    Science.gov (United States)

    van Osch, Dirk; Nathoe, Hendrik M; Jacob, Kirolos A; Doevendans, Pieter A; van Dijk, Diederik; Suyker, Willem J; Dieleman, Jan M

    2017-06-01

    Postpericardiotomy syndrome (PPS) is a common complication following cardiac surgery; however, the exact pathogenesis remains uncertain. Identifying risk factors of PPS might help to better understand the syndrome. The aim of this study was to provide an overview of existing literature around determinants of PPS in adult cardiac surgery patients. Two independent investigators performed a systematic search in MEDLINE, EMBASE and the Cochrane Central Register. The search aimed to identify studies published between January 1950 and December 2015, in which determinants of PPS were reported. A total of 19 studies met the selection criteria. In these studies, 14 different definitions of PPS were used. The median incidence of PPS was 16%. After quality assessment, seven studies were considered eligible for this review. Lower preoperative interleukin-8 levels and higher postoperative complement conversion products were associated with a higher risk of PPS. Among other clinical factors, a lower age, transfusion of red blood cells and lower preoperative platelet and haemoglobin levels were associated with a higher risk of PPS. Colchicine use decreased the risk of PPS. We found that both the inflammatory response and perioperative bleeding and coagulation may play a role in the development of PPS, suggesting a multifactorial aetiology of the syndrome. Due to a lack of a uniform definition of PPS in the past, study comparability was poor across the studies. © 2017 Stichting European Society for Clinical Investigation Journal Foundation.

  17. Systematic evaluation program, status summary report

    International Nuclear Information System (INIS)

    1983-01-01

    Status reports are presented on the systematic evaluation program for the Big Rock Point reactor, Dresden-1 reactor, Dresden-2 reactor, Ginna-1 reactor, Connecticut Yankee reactor, LACBWR reactor, Millstone-1 reactor, Oyster Creek-1 reactor, Palisades-1 reactor, San Onofre-1 reactor, and Rowe Yankee reactor

  18. Systematization of clinical trials related to treatment of metabolic syndrome, 1980-2015.

    Science.gov (United States)

    Cardona Velásquez, Santiago; Guzmán Vivares, Laura; Cardona-Arias, Jaiberth Antonio

    2017-02-01

    Despite the clinical, epidemiological, and economic significance of metabolic syndrome, the profile of clinical trials on this disease is unknown. To characterize the clinical trials related to treatment of metabolic syndrome during the 1980-2015 period. Systematic review of the literature using an ex ante search protocol which followed the phases of the guide Preferred Reporting Items for Systematic Reviews and Meta-Analyses in four multidisciplinary databases with seven search strategies. Reproducibility and methodological quality of the studies were assessed. One hundred and six trials were included, most from the United States, Italy, and Spain, of which 63.2% evaluated interventions effective for several components of the syndrome such as diet (40.6%) or physical activity (22.6%). Other studies assessed drugs for a single factor such as hypertension (7.5%), hypertriglyceridemia (11.3%), or hyperglycemia (9.4%). Placebo was used as control in 54.7% of trials, and outcome measures included triglycerides (52.8%), HDL (48.1%), glucose (29.2%), BMI (33.0%), blood pressure (27.4%), waist circumference (26.4%), glycated hemoglobin (11.3%), and hip circumference (7.5%). It was shown that studies ob efficacy of treatment for metabolic syndrome are scarce and have mainly been conducted in the last five years and in high-income countries. Trials on interventions that affect three or more factors and assess several outcome measures are few, and lifestyle interventions (diet and physical activity) are highlighted as most important to impact on this multifactorial syndrome. Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Successful management of Barth syndrome: a systematic review highlighting the importance of a flexible and multidisciplinary approach

    Directory of Open Access Journals (Sweden)

    Reynolds S

    2015-07-01

    Full Text Available Stacey Reynolds Department of Occupational Therapy, Virginia Commonwealth University, Richmond, VA, USA Abstract: This review describes and summarizes the available evidence related to the treatment and management of Barth syndrome. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA standards were used to identify articles published between December 2004 and January 2015. The Cochrane Population, Intervention, Control, Outcome, Study Design (PICOS approach was used to guide the article selection and evaluation process. Of the 128 articles screened, 28 articles matched the systematic review inclusion criteria. The results of this review indicate the need for a flexible and multidisciplinary approach to manage the symptoms most commonly associated with Barth syndrome. It is recommended that a comprehensive care team should include individuals with Barth syndrome, their family members and caregivers, as well as medical, rehabilitative, nutritional, psychological, and educational professionals. The evidence for specific treatments, therapies, and techniques for individuals with Barth syndrome is currently lacking in both quality and quantity. Keywords: Barth syndrome, rare disorders, rehabilitation, cardiac, systematic review

  20. Trials of Pharmacological Interventions for Tourette Syndrome: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Karen Waldon

    2013-01-01

    Full Text Available Introduction: Gilles de la Tourette Syndrome (GTS is a childhood-onset hyperkinetic movement disorder defined by the chronic presence of multiple motor tics and at least one vocal tic and often complicated by co-morbid behavioural problems. The pharmacological treatment of GTS focuses on the modulation of monoaminergic pathways within the cortico-striato-thalamo-cortical circuitry. This paper aims to evaluate the efficacy and safety profiles of pharmacological agents used in the treatment of tics in patients with GTS, in order to provide clinicians with an evidence-based rationale for the pharmacological treatment in GTS.

  1. Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment-a Systematic Review.

    Science.gov (United States)

    Sorensen, Cecilia J; DeSanto, Kristen; Borgelt, Laura; Phillips, Kristina T; Monte, Andrew A

    2017-03-01

    Cannabinoid hyperemesis syndrome (CHS) is a syndrome of cyclic vomiting associated with cannabis use. Our objective is to summarize the available evidence on CHS diagnosis, pathophysiology, and treatment. We performed a systematic review using MEDLINE, Ovid MEDLINE, Embase, Web of Science, and the Cochrane Library from January 2000 through September 24, 2015. Articles eligible for inclusion were evaluated using the Grading and Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Data were abstracted from the articles and case reports and were combined in a cumulative synthesis. The frequency of identified diagnostic characteristics was calculated from the cumulative synthesis and evidence for pathophysiologic hypothesis as well as treatment options were evaluated using the GRADE criteria. The systematic search returned 2178 articles. After duplicates were removed, 1253 abstracts were reviewed and 183 were included. Fourteen diagnostic characteristics were identified, and the frequency of major characteristics was as follows: history of regular cannabis for any duration of time (100%), cyclic nausea and vomiting (100%), resolution of symptoms after stopping cannabis (96.8%), compulsive hot baths with symptom relief (92.3%), male predominance (72.9%), abdominal pain (85.1%), and at least weekly cannabis use (97.4%). The pathophysiology of CHS remains unclear with a dearth of research dedicated to investigating its underlying mechanism. Supportive care with intravenous fluids, dopamine antagonists, topical capsaicin cream, and avoidance of narcotic medications has shown some benefit in the acute setting. Cannabis cessation appears to be the best treatment. CHS is a cyclic vomiting syndrome, preceded by daily to weekly cannabis use, usually accompanied by symptom improvement with hot bathing, and resolution with cessation of cannabis. The pathophysiology underlying CHS is unclear. Cannabis cessation appears to be the best treatment.

  2. Evaluation of Data with Systematic Errors

    International Nuclear Information System (INIS)

    Froehner, F. H.

    2003-01-01

    Application-oriented evaluated nuclear data libraries such as ENDF and JEFF contain not only recommended values but also uncertainty information in the form of 'covariance' or 'error files'. These can neither be constructed nor utilized properly without a thorough understanding of uncertainties and correlations. It is shown how incomplete information about errors is described by multivariate probability distributions or, more summarily, by covariance matrices, and how correlations are caused by incompletely known common errors. Parameter estimation for the practically most important case of the Gaussian distribution with common errors is developed in close analogy to the more familiar case without. The formalism shows that, contrary to widespread belief, common ('systematic') and uncorrelated ('random' or 'statistical') errors are to be added in quadrature. It also shows explicitly that repetition of a measurement reduces mainly the statistical uncertainties but not the systematic ones. While statistical uncertainties are readily estimated from the scatter of repeatedly measured data, systematic uncertainties can only be inferred from prior information about common errors and their propagation. The optimal way to handle error-affected auxiliary quantities ('nuisance parameters') in data fitting and parameter estimation is to adjust them on the same footing as the parameters of interest and to integrate (marginalize) them out of the joint posterior distribution afterward

  3. NRC systematic evaluation program: seismic review

    International Nuclear Information System (INIS)

    Levin, H.A.

    1980-01-01

    The NRC Systematic Evaluation Program is currently making an assessment of the seismic design safety of 11 older nuclear power plant facilities. The general review philosophy and review criteria relative to seismic input, structural response, and equipment functionability are presented, including the rationale for the development of these guidelines considering the significant evolution of seismic design criteria since these plants were originally licensed. Technical approaches thought more realistic in light of current knowledge are utilized. Initial findings for plants designed to early seismic design procedures suggest that with minor exceptions, these plants possess adequate seismic design margins when evaluated against the intent of current criteria. However, seismic qualification of electrical equipment has been identified as a subject which requires more in-depth evaluation

  4. Effects of physiotherapy in patients with shoulder impingement syndrome: a systematic review of the literature.

    NARCIS (Netherlands)

    Kromer, T.O.; Tautenhahn, U.G.; Bie, R.A. de; Staal, J.B.; Bastiaenen, C.H.

    2009-01-01

    OBJECTIVE: To critically summarize the effectiveness of physio-therapy in patients presenting clinical signs of shoulder impingement syndrome. DESIGN: Systematic review. METHODS: Randomized controlled trials were searched electronically and manually from 1966 to December 2007. Study quality was

  5. Conservative or surgical treatment for subacromial impingement syndrome? A systematic review

    NARCIS (Netherlands)

    Dorrestijn, Oscar; Stevens, Martin; Winters, Jan C.; van der Meer, Klaas; Diercks, Ron L.

    2009-01-01

    Background: Patients with subacromial impingement syndrome are often operated on when conservative treatments fail. But does surgery really lead to better results than nonoperative measures? This systematic review compared effects of conservative and surgical treatment for subacromial impingement

  6. Raynaud's syndrome in children: systematic review and development of recommendations for assessment and monitoring

    OpenAIRE

    Pain, C. E.; Constantine, T.; Toplak, N.; Moll, M.; Iking-Konert, C.; Piotto, D. P.; Ayaz, N. Aktay; Nemcova, D.; Hoeger, P. H.; Cutolo, M.; Smith, Vanessa; Foeldvari, I.

    2016-01-01

    Objective. To develop recommendations for investigation and monitoring of children with Raynaud's syndrome, based on paediatric evidence collated by a systematic review. Method. A systematic review was undertaken to establish the paediatric evidence for assessment and monitoring of Raynaud's syndrome. An expert panel including members of the Paediatric Rheumatology European Society (PRES) Scleroderma Working Group, were invited to a consensus meeting where recommendations were developed based...

  7. Systematic review of chronic pain in persons with Marfan syndrome.

    Science.gov (United States)

    Velvin, G; Bathen, T; Rand-Hendriksen, S; Geirdal, A Ø

    2016-06-01

    The purpose of this study was to explore the literature on chronic pain in adults with Marfan syndrome (MFS), critically appraising and synthesizing relevant literature. A systematic review was conducted by searching the published literature databases using available medical, physical, psychological, social databases and other sources. All studies that addressed pain in MFS, published in peer-reviewed journals were assessed. Of 351 search results, 18 articles satisfied the eligibility criteria. All studies were cross-sectional and quantitative; no randomized controlled trials or intervention studies were found. Most studies had small sample sizes, low response rates and mainly dealt with other aspects of the diagnosis than pain. Only one article dealt mainly with pain. The research on chronic pain in MFS is limited in size and quality. Despite these limitations, studies describe that the prevalence of pain in patients with MFS is high, varying from 47 to 92% and affecting several anatomic sites. In addition, chronic pain limits daily function and few studies describe treatment options for pain in patients with MFS. Research is needed to obtain more evidence-based knowledge for developing more appropriate rehabilitation programs for people with MFS. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Hearing loss in Waardenburg syndrome: a systematic review.

    Science.gov (United States)

    Song, J; Feng, Y; Acke, F R; Coucke, P; Vleminckx, K; Dhooge, I J

    2015-06-22

    Waardenburg syndrome (WS) is a rare genetic disorder characterized by hearing loss (HL) and pigment disturbances of hair, skin and iris. Classifications exist based on phenotype and genotype. The auditory phenotype is inconsistently reported among the different Waardenburg types and causal genes, urging the need for an up-to-date literature overview on this particular topic. We performed a systematic review in search for articles describing auditory features in WS patients along with the associated genotype. Prevalences of HL were calculated and correlated with the different types and genes of WS. Seventy-three articles were included, describing 417 individual patients. HL was found in 71.0% and was predominantly bilateral and sensorineural. Prevalence of HL among the different clinical types significantly differed (WS1: 52.3%, WS2: 91.6%, WS3: 57.1%, WS4: 83.5%). Mutations in SOX10 (96.5%), MITF (89.6%) and SNAI2 (100%) are more frequently associated with hearing impairment than other mutations. Of interest, the distinct disease-causing genes are able to better predict the auditory phenotype compared with different clinical types of WS. Consequently, it is important to confirm the clinical diagnosis of WS with molecular analysis in order to optimally inform patients about the risk of HL. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Systematic feature evaluation for gene name recognition.

    Science.gov (United States)

    Hakenberg, Jörg; Bickel, Steffen; Plake, Conrad; Brefeld, Ulf; Zahn, Hagen; Faulstich, Lukas; Leser, Ulf; Scheffer, Tobias

    2005-01-01

    In task 1A of the BioCreAtIvE evaluation, systems had to be devised that recognize words and phrases forming gene or protein names in natural language sentences. We approach this problem by building a word classification system based on a sliding window approach with a Support Vector Machine, combined with a pattern-based post-processing for the recognition of phrases. The performance of such a system crucially depends on the type of features chosen for consideration by the classification method, such as pre- or postfixes, character n-grams, patterns of capitalization, or classification of preceding or following words. We present a systematic approach to evaluate the performance of different feature sets based on recursive feature elimination, RFE. Based on a systematic reduction of the number of features used by the system, we can quantify the impact of different feature sets on the results of the word classification problem. This helps us to identify descriptive features, to learn about the structure of the problem, and to design systems that are faster and easier to understand. We observe that the SVM is robust to redundant features. RFE improves the performance by 0.7%, compared to using the complete set of attributes. Moreover, a performance that is only 2.3% below this maximum can be obtained using fewer than 5% of the features.

  10. Gender differences in prevalence of the metabolic syndrome in Gulf Cooperation Council Countries: a systematic review.

    Science.gov (United States)

    Mabry, R M; Reeves, M M; Eakin, E G; Owen, N

    2010-05-01

    To systematically review studies documenting the prevalence of the metabolic syndrome among men and women in Member States of the Gulf Cooperative Council (GCC; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates)-countries in which obesity, Type 2 diabetes and related metabolic and cardiovascular diseases are highly prevalent. A search was conducted on PubMed and CINAHL using the term 'metabolic syndrome' and the country name of each GCC Member State. The search was limited to studies published in the English language. The metabolic syndrome was defined according to the Third Adult Treatment Panel (ATPIII) of the National Cholesterol Education Program (NCEP) and/or International Diabetes Federation (IDF) definitions. The methodological quality of each study was evaluated based on four criteria: a national-level population sample; equal gender representation; robustness of the sample size; an explicit sampling methodology. PubMed, CINAHL and reference list searches identified nine relevant studies. Only four were considered high quality and found that, for men, the prevalence of the metabolic syndrome ranged from 20.7% to 37.2% (ATPIII definition) and from 29.6% to 36.2% (IDF definition); and, for women, from 32.1% to 42.7% (ATPIII definition) and from 36.1% to 45.9% (IDF definition). Overall, the prevalence of the metabolic syndrome in the GCC states is some 10-15% higher than in most developed countries, with generally higher prevalence rates for women. Preventive strategies will require identifying socio-demographic and environmental correlates (particularly those influencing women) and addressing modifiable risk behaviours, including lack of physical activity, prolonged sitting time and dietary intake.

  11. Components of effective randomized controlled trials of hydrotherapy programs for fibromyalgia syndrome: A systematic review

    OpenAIRE

    Luke Perraton; Zuzana Machotka; Saravana Kumar

    2009-01-01

    Luke Perraton, Zuzana Machotka, Saravana KumarInternational Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, AustraliaAim: Previous systematic reviews have found hydrotherapy to be an effective management strategy for fibromyalgia syndrome (FMS). The aim of this systematic review was to summarize the components of hydrotherapy programs used in randomized controlled trials.Method: A systematic review of randomized controlled trials was conducted. Onl...

  12. A Systematic Review on the Existing Screening Pathways for Lynch Syndrome Identification

    Directory of Open Access Journals (Sweden)

    Alessia Tognetto

    2017-09-01

    Full Text Available BackgroundLynch syndrome (LS is the most common hereditary colon cancer syndrome, accounting for 3–5% of colorectal cancer (CRC cases, and it is associated with the development of other cancers. Early detection of individuals with LS is relevant, since they can take advantage of life-saving intensive care surveillance. The debate regarding the best screening policy, however, is far from being concluded. This prompted us to conduct a systematic review of the existing screening pathways for LS.MethodsWe performed a systematic search of MEDLINE, ISI Web of Science, and SCOPUS online databases for the existing screening pathways for LS. The eligibility criteria for inclusion in this review required that the studies evaluated a structured and permanent screening pathway for the identification of LS carriers. The effectiveness of the pathways was analyzed in terms of LS detection rate.ResultsWe identified five eligible studies. All the LS screening pathways started from CRC cases, of which three followed a universal screening approach. Concerning the laboratory procedures, the pathways used immunohistochemistry and/or microsatellite instability testing. If the responses of the tests indicated a risk for LS, the genetic counseling, performed by a geneticist or a genetic counselor, was mandatory to undergo DNA genetic testing. The overall LS detection rate ranged from 0 to 5.2%.ConclusionThis systematic review reported different existing pathways for the identification of LS patients. Although current clinical guidelines suggest to test all the CRC cases to identify LS cases, the actual implementation of pathways for LS identification has not been realized. Large-scale screening programs for LS have the potential to reduce morbidity and mortality for CRC, but coordinated efforts in educating all key stakeholders and addressing public needs are still required.

  13. The effectiveness of hydrotherapy in the management of fibromyalgia syndrome: a systematic review.

    Science.gov (United States)

    McVeigh, Joseph G; McGaughey, Helen; Hall, Melissa; Kane, Patricia

    2008-12-01

    Hydrotherapy is often used in the treatment of fibromyalgia syndrome (FMS), however there has been limited evaluation of its effectiveness. The aim of this systematic review was therefore to examine the effectiveness of hydrotherapy in the management of FMS. AMED, BNI, CINAHL, The Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, Science Direct and Web of Science were searched (1990-July 2006). Key words used 'fibromyalgia' and 'hydrotherapy', 'balneotherapy', 'aqua therapy', 'pool therapy', 'water therapy', 'swimming', 'hydrogalvanic', 'spa therapy', 'physiotherapy', 'physical therapy' and 'rehabilitation'. Searches were supplemented with hand searches of selected journals. Randomised controlled trials (RCTs) were assessed for methodological quality using the van Tulder scale. Ten RCTs met the inclusion criteria. Mean methodological quality was 4.5/9 on the van Tulder scale. Positive outcomes were reported for pain, health-status and tender point count. There is strong evidence for the use of hydrotherapy in the management of FMS.

  14. Determinants of the postpericardiotomy syndrome : A systematic review

    NARCIS (Netherlands)

    van Osch, Dirk; Nathoe, Hendrik M.|info:eu-repo/dai/nl/267961472; Jacob, Kirolos A.; Doevendans, Pieter A.|info:eu-repo/dai/nl/164248366; van Dijk, Diederik|info:eu-repo/dai/nl/241616301; Suyker, Willem J.|info:eu-repo/dai/nl/321847024; Dieleman, Jan M.|info:eu-repo/dai/nl/304817902

    Background: Postpericardiotomy syndrome (PPS) is a common complication following cardiac surgery; however, the exact pathogenesis remains uncertain. Identifying risk factors of PPS might help to better understand the syndrome. The aim of this study was to provide an overview of existing literature

  15. [Biological fragility syndrome in the elderly: systematic review].

    Science.gov (United States)

    Tribess, Sheilla; de Oliveira, Ricardo Jacó

    2011-10-01

    The aim of this study was to identify the prevalence and assessment strategies of Biological Fragility Syndrome in the Elderly. For the development of this study was it was done a search in electronic databases (Medline/PubMed) and the reference lists of articles identified using the following key words/terms in English: "frailty" and `frail" in conjunction with the terms "elderly", "aging" and "prevalence". These terms/descriptors were combined using the logical operators available in search engines. The initial electronic search resulted in 1 865 manuscripts. The process of analysis of the studies involved reading titles, abstracts and full texts. After all these phases, 35 manuscripts met the inclusion criteria of the review. The results indicated that women, with rage from 7.3 % to 21.6 %, are frailer than men, with percentages ranging from 4 % to 19.2 %. Differences in prevalence rates of prefrailty and frailty should be minimized, with stimulus for standardization for the evaluation of human frailty.

  16. Heart rate variability and the metabolic syndrome: a systematic review of the literature.

    Science.gov (United States)

    Stuckey, Melanie I; Tulppo, Mikko P; Kiviniemi, Antti M; Petrella, Robert J

    2014-11-01

    A number of cross-sectional studies have examined associations between heart rate variability and metabolic syndrome, but differences in study populations, data collection and analysis methodologies make synthesis difficult. The purpose of this study was to systematically review published primary research examining associations between heart rate variability and metabolic syndrome or its individual risk factors. A systematic literature search of PubMed and EMBASE was conducted to identify relevant articles published from January 1999 to December 2012. Studies were included if they examined associations between heart rate variability analysed by standard protocols and metabolic syndrome risk factors according to published definitions. All papers were scored with a modified Downs and Black instrument, and data were extracted. Fourteen studies were included. Heart rate variability generally was reduced in women with metabolic syndrome compared to those without, while results in men were inconsistent. Time and frequency domain heart rate variability parameters were associated with individual metabolic syndrome risk factors, though sex differences exist. Only two studies considered nonlinear and Poincaré plot heart rate variability parameters, which were reduced in metabolic syndrome. Heart rate variability is altered differently in men and women with metabolic syndrome. Future studies should follow consistent heart rate variability analysis protocols and metabolic syndrome definitions and include more comprehensive analyses to investigate potential mechanisms. Copyright © 2014 John Wiley & Sons, Ltd.

  17. Predictors of Success in the Treatment of Obstructive Sleep Apnea Syndrome with Mandibular Repositioning Appliance: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Saffer, Fernanda

    2014-10-01

    Full Text Available Introduction Obstructive sleep apnea syndrome affects up to 4% of middle-aged men and 2% of adult women. It is associated with obesity. Objective The objective of this article is to review the literature to determine which factors best correlate with treatment success in patients with obstructive sleep apnea syndrome treated with a mandibular repositioning appliance. Data Synthesis A search was performed of the PubMed, Cochrane, Lilacs, Scielo, and Web of Science databases of articles published from January 1988 to January 2012. Two review authors independently collected data and assessed trial quality. Sixty-nine articles were selected from PubMed and 1 from Cochrane library. Of these, 42 were excluded based on the title and abstract, and 27 were retrieved for complete reading. A total of 13 articles and 1 systematic review were considered eligible for further review and inclusion in this study: 6 studies evaluated anthropomorphic and physiologic factors, 3 articles addressed cephalometric and anatomic factors, and 4 studies evaluated variables related to mandibular repositioning appliance design and activation. All the studies evaluated had low to moderate methodologic quality and were not able to support evidence on prediction of treatment success. Conclusion Based on this systematic review on obstructive sleep apnea syndrome treatment, it remains unclear which predictive factors can be used with confidence to select patients suitable for treatment with a mandibular repositioning appliance.

  18. [Turner syndrome and genetic polymorphism: a systematic review].

    Science.gov (United States)

    Trovó de Marqui, Alessandra Bernadete

    2015-01-01

    To present the main results of the literature on genetic polymorphisms in Turner Syndrome and their association with the clinical signs and the etiology of this chromosomal disorder. The review was conducted in the PubMed database without any time limit, using the terms Turner syndrome and genetic polymorphism. A total of 116 articles were found, and based on the established inclusion and exclusion criteria 17 were selected for the review. The polymorphisms investigated in patients with Turner Syndrome were associated with growth deficit, causing short stature, low bone mineral density, autoimmunity and cardiac abnormalities, which are frequently found in patients with Turner Syndrome. The role of single nucleotide polymorphisms (SNPs) in the etiology of Turner syndrome, i.e., in chromosomal nondisjunction, was also confirmed. Genetic polymorphisms appear to be associated with Turner Syndrome. However, in view of the small number of published studies and their contradictory findings, further studies in different populations are needed in order to clarify the role of genetic variants in the clinical signs and etiology of the Turner Syndrome. Copyright © 2015 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

  19. A systematic review of the literature on cystodistension in bladder pain syndrome.

    Science.gov (United States)

    Olson, Louise E; Dyer, James E; Haq, Ahsanul; Ockrim, Jeremy; Greenwell, Tamsin J

    2018-02-01

    There is significant variability in technique for cystodistension and an international discrepancy in the role in its treatment of bladder pain syndrome (BPS). The authors evaluate the evidence base for the use of cystodistension for BPS with particular reference to patient-related outcomes. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement, a prospective search and evaluation protocol was prepared and registered with the PROSPERO database (ID CRD42017053710). A review of the literature was performed using the search terms cystodistension and hydrodistension of the bladder using the PubMed database on 6 October 2016. A total of 59 papers were reviewed, but only 17 studies contained original data available for analysis from 1975 to 2016. Ten studies evaluated the outcome of cystodistension in a single arm design or used cystodistension as the control for evaluating adjunctive treatments. Seven studies evaluated cystodistension in combination with other agents or therapies. The best symptomatic responses reported a subjective improvement in 56% of men with moderate to severe prostatitis and 57% in patients with "inflammatory cystitis" respectively. There were no studies that employed a validated outcome measure, neither a questionnaire nor an analogue scale, to assess the effect of cystodistension alone. Cystodistension is increasingly popular, despite a weak evidence base by current standards. The quality of available evidence falls below the level that would be expected of a new intervention. This review highlights the need for cystodistension to be further investigated with randomised control trials.

  20. Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review

    Directory of Open Access Journals (Sweden)

    Thiago R. T. Santos

    2015-06-01

    Full Text Available Introduction: Patellofemoral pain syndrome (PFPS is characterized by anterior knee pain, which may limit the performance of functional activities. The influence of hip joint motion on the development of this syndrome has already been documented in the literature. In this regard, studies have investigated the effectiveness of hip muscle strengthening in patients with PFPS. Objectives: The aims of this systematic review were (1 to summarize the literature related to the effects of hip muscle strengthening on pain intensity, muscle strength, and function in individuals with PFPS and (2 to evaluate the methodological quality of the selected studies. Method: A search for randomized controlled clinical trials was conducted using the following databases: Google Scholar, MEDLINE, PEDro, LILACS, and SciELO. The selected studies had to distinguish the effects of hip muscle strengthening in a group of patients with PFPS, as compared to non-intervention or other kinds of intervention, and had to investigate the following outcomes: pain, muscle strength, and function. The methodological quality of the selected studies was analyzed by means of the PEDro scale. Results: Seven studies were selected. These studies demonstrated that hip muscle strengthening was effective in reducing pain. However, the studies disagreed regarding the treatments' ability to improve muscle strength. Improvement in functional capabilities after hip muscle strengthening was found in five studies. Conclusion: Hip muscle strengthening is effective in reducing the intensity of pain and improving functional capabilities in patients with PFPS, despite the lack of evidence for its ability to increase muscle strength.

  1. Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review

    Science.gov (United States)

    Santos, Thiago R. T.; Oliveira, Bárbara A.; Ocarino, Juliana M.; Holt, Kenneth G.; Fonseca, Sérgio T.

    2015-01-01

    Introduction: Patellofemoral pain syndrome (PFPS) is characterized by anterior knee pain, which may limit the performance of functional activities. The influence of hip joint motion on the development of this syndrome has already been documented in the literature. In this regard, studies have investigated the effectiveness of hip muscle strengthening in patients with PFPS. Objectives: The aims of this systematic review were (1) to summarize the literature related to the effects of hip muscle strengthening on pain intensity, muscle strength, and function in individuals with PFPS and (2) to evaluate the methodological quality of the selected studies. Method: A search for randomized controlled clinical trials was conducted using the following databases: Google Scholar, MEDLINE, PEDro, LILACS, and SciELO. The selected studies had to distinguish the effects of hip muscle strengthening in a group of patients with PFPS, as compared to non-intervention or other kinds of intervention, and had to investigate the following outcomes: pain, muscle strength, and function. The methodological quality of the selected studies was analyzed by means of the PEDro scale. Results: Seven studies were selected. These studies demonstrated that hip muscle strengthening was effective in reducing pain. However, the studies disagreed regarding the treatments' ability to improve muscle strength. Improvement in functional capabilities after hip muscle strengthening was found in five studies. Conclusion: Hip muscle strengthening is effective in reducing the intensity of pain and improving functional capabilities in patients with PFPS, despite the lack of evidence for its ability to increase muscle strength. PMID:26039034

  2. Effectiveness of rehabilitation for patients with subacromial impingement syndrome: a systematic review.

    Science.gov (United States)

    Michener, Lori A; Walsworth, Matthew K; Burnet, Evie N

    2004-01-01

    Prior systematic reviews of rehabilitation for nondescript shoulder pain have not yielded clinically applicable results for those patients with subacromial impingement syndrome (SAIS). The purpose of this study was to examine the evidence for rehabilitation interventions for SAIS. The authors used data source as the method. The computerized bibliographic databases of Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Database of Systematic Reviews were searched from 1966 up to and including October 2003. Key words used were "shoulder," "shoulder impingement syndrome," "bursitis," and "rotator cuff" combined with "rehabilitation," "physical therapy," "electrotherapy," "ultrasound," "acupuncture," and "exercise," limited to clinical trials. Randomized clinical trials that investigated physical interventions used in the rehabilitation of patients with SAIS with clinically relevant outcome measures of pain and quality of life were selected. The search resulted in 635 potential studies, 12 meeting inclusion criteria. Two independent reviewers graded all 12 trials with a quality checklist averaged for a final quality score. The mean quality score for 12 trials was 37.6 out of a possible 69 points. Various treatments were evaluated: exercise in six trials, joint mobilizations in two trials, laser in three trials, ultrasound in two trials, and acupuncture in two trials. The limited evidence currently available suggests that exercise and joint mobilizations are efficacious for patients with SAIS. Laser therapy appears to be of benefit only when used in isolation, not in combination with therapeutic exercise. Ultrasound is of no benefit, and acupuncture trials present equivocal evidence. The low to mediocre methodologic quality, small sample sizes, and general lack of long-term follow-up limit these findings for the development of useful clinical practice guidelines. Further trials are needed to investigate these rehabilitation

  3. Work-related psychosocial factors and onset of metabolic syndrome among workers: a systematic review and meta-analysis protocol.

    Science.gov (United States)

    Sakuraya, Asuka; Watanabe, Kazuhiro; Kawakami, Norito; Imamura, Kotaro; Ando, Emiko; Asai, Yumi; Eguchi, Hisashi; Kobayashi, Yuka; Nishida, Norimitsu; Arima, Hideaki; Shimazu, Akihito; Tsutsumi, Akizumi

    2017-06-22

    Metabolic syndrome is an important public health target because of its high prevalence worldwide. Work-related psychosocial factors have been identified as determinants of metabolic syndrome components. However, there have been no systematic reviews or meta-analyses conducted to evaluate the relationship between work-related psychosocial factors and metabolic syndrome as an aggregated cluster. The aim of this study is to examine this association from published prospective studies. The systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (ie, PubMed, EMBASE, PsycINFO, PsycARTICLES and Japan Medical Abstracts Society). Studies that (1) examined the association between work-related psychosocial factors and the onset of metabolic syndrome, (2) had a longitudinal or prospective cohort design, (3) were conducted among workers, (4) provided sufficient data for calculating ORs or relative risk with a 95% CI, (5) were published as original articles written in English or Japanese, and (6) having been published until the end of 2016 will be included. Study selection, data collection, quality assessment and statistical syntheses will be conducted based on discussions among investigators. Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. The findings from this study could be useful for assessing metabolic syndrome risk factors in the workplace, and determining approaches for prevention of metabolic syndrome in the future. PROSPERO CRD42016039096 (http://www.crd.york.ac.uk/PROSPERO_REBRANDING/display_record.asp?ID=CRD42016039096). © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Evaluation of patients with acute vestibular syndrome.

    Science.gov (United States)

    Thabet, Elsaeid

    2008-03-01

    Acute vestibular syndrome is characterized by a rapid unilateral injury to either peripheral or central vestibular structures. It consists of severe vertigo, nausea and vomiting, spontaneous nystagmus, and postural instability. In many cases, a peripheral etiology is considered although it may be due to an underlying serious central pathology. The present study was designed to investigate the feasibility of differentiating the cause of acute vestibular syndrome in such patients using clinical, audiovestibular and radiologic tools. We performed a case series study of patients complaining of acute vertigo at a university referring center for hearing and balance disorders. Thirty patients with history of acute vertigo within 3 days onset with no history of previous otological or neurological disorders. Eighteen patients were due to acute peripheral vestibular lesion, 1 due to psychiatric illness under antidepressant drugs and 11 were of central vestibular lesion. The most important step in the diagnosis of acute vertigo is a thorough and detailed history. The common error of carrying out investigations in place of a detailed history is to be avoided. The clinical evaluation has the highest sensitivity and specificity in differentiating central from peripheral vestibular lesions.

  5. Systematic review of randomized controlled trials in the treatment of dry eye disease in Sjogren syndrome.

    Science.gov (United States)

    Shih, Kendrick Co; Lun, Christie Nicole; Jhanji, Vishal; Thong, Bernard Yu-Hor; Tong, Louis

    2017-01-01

    Primary Sjögren's syndrome is an autoimmune disease characterized by dry eye and dry mouth. We systematically reviewed all the randomized controlled clinical trials published in the last 15 years that included ocular outcomes. We found 22 trials involving 9 topical, 10 oral, 2 intravenous and 1 subcutaneous modalities of treatment. Fluoromethalone eye drops over 8 weeks were more effective than topical cyclosporine in the treatment of dry eye symptoms and signs; similarly, indomethacin eye drops over 1 month were more efficacious than diclofenac eye drops. Oral pilocarpine 5 mg twice daily over 3 months was superior to use of lubricants or punctal plugs for treating dry eye, but 5% of participants had gastrointestinal adverse effects from pilocarpine, though none discontinued treatment. In contrast, etanercept, a TNF-alpha blocking antibody, administered as subcutaneous injections twice weekly, did not improve dry eye significantly compared to placebo injections. In conclusion, topical corticosteroids have been shown to be effective in dry eye associated with Sjögren's syndrome. As some topical non-steroidal anti-inflammatory drugs may be more effective than others, these should be further evaluated. Systemic secretagogues like pilocarpine have a role in Sjögren's syndrome but the adverse effects may limit their clinical use. It is disappointing that systemic cytokine therapy did not produce encouraging ocular outcomes but participants should have assessment of cytokine levels in such trials, as those with higher baseline cytokine levels may respond better. (229 words).

  6. Systematic review of randomized controlled trials in the treatment of dry eye disease in Sjogren syndrome

    Directory of Open Access Journals (Sweden)

    Kendrick Co Shih

    2017-11-01

    Full Text Available Abstract Primary Sjögren’s syndrome is an autoimmune disease characterized by dry eye and dry mouth. We systematically reviewed all the randomized controlled clinical trials published in the last 15 years that included ocular outcomes. We found 22 trials involving 9 topical, 10 oral, 2 intravenous and 1 subcutaneous modalities of treatment. Fluoromethalone eye drops over 8 weeks were more effective than topical cyclosporine in the treatment of dry eye symptoms and signs; similarly, indomethacin eye drops over 1 month were more efficacious than diclofenac eye drops. Oral pilocarpine 5 mg twice daily over 3 months was superior to use of lubricants or punctal plugs for treating dry eye, but 5% of participants had gastrointestinal adverse effects from pilocarpine, though none discontinued treatment. In contrast, etanercept, a TNF-alpha blocking antibody, administered as subcutaneous injections twice weekly, did not improve dry eye significantly compared to placebo injections. In conclusion, topical corticosteroids have been shown to be effective in dry eye associated with Sjögren’s syndrome. As some topical non-steroidal anti-inflammatory drugs may be more effective than others, these should be further evaluated. Systemic secretagogues like pilocarpine have a role in Sjögren’s syndrome but the adverse effects may limit their clinical use. It is disappointing that systemic cytokine therapy did not produce encouraging ocular outcomes but participants should have assessment of cytokine levels in such trials, as those with higher baseline cytokine levels may respond better. (229 words

  7. Personality as a risk factor for the metabolic syndrome: a systematic review.

    Science.gov (United States)

    Mommersteeg, Paula M C; Pouwer, François

    2012-11-01

    The metabolic syndrome is a cluster of risk factors for the development of cardiovascular disease and/or type 2 diabetes. Personality can be defined as a stable set of behavioral characteristics of a person. In this review we systematically reviewed whether different personality characteristics are associated with the risk of having or developing the metabolic syndrome. Systematic review. In total 18 studies were included. Thirteen cross-sectional analyses, and ten longitudinal analyses were grouped according to personality constructs: hostility, anger, and Type A behavior, temperament, neuroticism, and Type D personality. Conflicting evidence was reported on persons with high hostility, neuroticism, or Type D personality scores to be associated with an increased metabolic syndrome prevalence and development. All significant findings do point in the same direction: a more negative, or hostile personality type is associated with an increased prevalence of metabolic syndrome and its development over time. There was no clear association between personality measures and the occurrence and development of the metabolic syndrome. There is, however, a cluster of risk factors that include the presence of the metabolic syndrome, as well as a more negative prone personality style, that both predispose to the development of coronary heart disease and diabetes. Future studies should investigate the role of personality measures in the development of these conditions, while taking into account metabolic syndrome, lifestyle and socio-demographic factors. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. Acute respiratory distress syndrome: evaluation and management.

    Science.gov (United States)

    Cortés, I; Peñuelas, O; Esteban, A

    2012-03-01

    Acute respiratory distress syndrome (ARDS) is a life-threatening condition that affects patients admitted in the Intensive Care Units (ICUs) under mechanical ventilation. ARDS is a process of non-hydrostatic pulmonary edema and hypoxemia associated with a variety of conditions, resulting in a direct (e.g., pneumonia) or indirect (e.g., sepsis) lung injury and is associated with a significant morbidity and mortality. A large body of clinical and basic research has focused in ventilatory strategies and novel pharmacological therapies but, nowadays, treatment is mainly supportive. Mechanical ventilation is the hallmark of the management of these patients. In the last decades, the recognition that mechanical ventilation can contribute to harming the lung has changed the goals of this therapy and has driven research to focus in ventilatory strategies that mitigate lung injury. This review emphasizes clinical aspects in the evaluation and management of ARDS in the ICUs and updates the latest advances in these therapies.

  9. Paleolithic nutrition for metabolic syndrome: systematic review and meta-analysis.

    Science.gov (United States)

    Manheimer, Eric W; van Zuuren, Esther J; Fedorowicz, Zbys; Pijl, Hanno

    2015-10-01

    Paleolithic nutrition, which has attracted substantial public attention lately because of its putative health benefits, differs radically from dietary patterns currently recommended in guidelines, particularly in terms of its recommendation to exclude grains, dairy, and nutritional products of industry. We evaluated whether a Paleolithic nutritional pattern improves risk factors for chronic disease more than do other dietary interventions. We conducted a systematic review of randomized controlled trials (RCTs) that compared the Paleolithic nutritional pattern with any other dietary pattern in participants with one or more of the 5 components of metabolic syndrome. Two reviewers independently extracted study data and assessed risk of bias. Outcome data were extracted from the first measurement time point (≤6 mo). A random-effects model was used to estimate the average intervention effect. The quality of the evidence was rated with the use of the Grading of Recommendations Assessment, Development and Evaluation approach. Four RCTs that involved 159 participants were included. The 4 control diets were based on distinct national nutrition guidelines but were broadly similar. Paleolithic nutrition resulted in greater short-term improvements than did the control diets (random-effects model) for waist circumference (mean difference: -2.38 cm; 95% CI: -4.73, -0.04 cm), triglycerides (-0.40 mmol/L; 95% CI: -0.76, -0.04 mmol/L), systolic blood pressure (-3.64 mm Hg; 95% CI: -7.36, 0.08 mm Hg), diastolic blood pressure (-2.48 mm Hg; 95% CI: -4.98, 0.02 mm Hg), HDL cholesterol (0.12 mmol/L; 95% CI: -0.03, 0.28 mmol/L), and fasting blood sugar (-0.16 mmol/L; 95% CI: -0.44, 0.11 mmol/L). The quality of the evidence for each of the 5 metabolic components was moderate. The home-delivery (n = 1) and dietary recommendation (n = 3) RCTs showed similar effects with the exception of greater improvements in triglycerides relative to the control with the home delivery. None of the RCTs

  10. Paleolithic nutrition for metabolic syndrome: systematic review and meta-analysis12

    Science.gov (United States)

    Manheimer, Eric W; van Zuuren, Esther J; Fedorowicz, Zbys; Pijl, Hanno

    2015-01-01

    Background: Paleolithic nutrition, which has attracted substantial public attention lately because of its putative health benefits, differs radically from dietary patterns currently recommended in guidelines, particularly in terms of its recommendation to exclude grains, dairy, and nutritional products of industry. Objective: We evaluated whether a Paleolithic nutritional pattern improves risk factors for chronic disease more than do other dietary interventions. Design: We conducted a systematic review of randomized controlled trials (RCTs) that compared the Paleolithic nutritional pattern with any other dietary pattern in participants with one or more of the 5 components of metabolic syndrome. Two reviewers independently extracted study data and assessed risk of bias. Outcome data were extracted from the first measurement time point (≤6 mo). A random-effects model was used to estimate the average intervention effect. The quality of the evidence was rated with the use of the Grading of Recommendations Assessment, Development and Evaluation approach. Results: Four RCTs that involved 159 participants were included. The 4 control diets were based on distinct national nutrition guidelines but were broadly similar. Paleolithic nutrition resulted in greater short-term improvements than did the control diets (random-effects model) for waist circumference (mean difference: −2.38 cm; 95% CI: −4.73, −0.04 cm), triglycerides (−0.40 mmol/L; 95% CI: −0.76, −0.04 mmol/L), systolic blood pressure (−3.64 mm Hg; 95% CI: −7.36, 0.08 mm Hg), diastolic blood pressure (−2.48 mm Hg; 95% CI: −4.98, 0.02 mm Hg), HDL cholesterol (0.12 mmol/L; 95% CI: −0.03, 0.28 mmol/L), and fasting blood sugar (−0.16 mmol/L; 95% CI: −0.44, 0.11 mmol/L). The quality of the evidence for each of the 5 metabolic components was moderate. The home-delivery (n = 1) and dietary recommendation (n = 3) RCTs showed similar effects with the exception of greater improvements in

  11. Down Syndrome and the aging process: a systematic review

    Directory of Open Access Journals (Sweden)

    Bruno Sousa Lopes

    2015-05-01

    Full Text Available The study aimed to identify and update the knowledge about older people with Down Syndrome (DS, and to understand the peculiarities of the aging process in this population. Bibliographical research conducted by Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior and High Wire portal. Inclusion criteria were articles published in the last ten years with the words “Down Syndrome" and “Elderly”.  

  12. Measuring School Functioning in Students with Chronic Fatigue Syndrome: A Systematic Review

    Science.gov (United States)

    Tollit, Michelle; Politis, Jennifer; Knight, Sarah

    2018-01-01

    Background: It is often surmised that school functioning is significantly impacted in chronic fatigue syndrome (CFS); however, how this phenomenon manifests itself has rarely been characterized. Methods: This systematic review synthesized and critically appraised methods, constructs, and instruments used to assess school functioning in students…

  13. Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome

    DEFF Research Database (Denmark)

    Gluud, Lise L; Christensen, Kurt; Christensen, Erik

    2010-01-01

    Vasoconstrictor drugs may improve renal function in hepatorenal syndrome (HRS), but the effect on mortality has not been established. We therefore performed a systematic review of randomized trials on vasoconstrictor drugs for type 1 or type 2 HRS. Mortality was the primary outcome measure...

  14. Is salivary gland ultrasonography a useful tool in Sjogren's syndrome? A systematic review

    NARCIS (Netherlands)

    Jousse-Joulin, Sandrine; Milic, Vera; Jonsson, Malin V.; Plagou, Athena; Theander, Elke; Luciano, Nicoletta; Rachele, Pascale; Baldini, Chiara; Bootsma, Hendrika; Vissink, Arjan; Hocevar, Alojzija; De Vita, Salvatore; Tzioufas, Athanasios G.; Alavi, Zarin; Bowman, Simon J.; Devauchelle-Pensec, Valerie

    Objective. Ultrasonography (US) is a sensitive tool in the diagnosis of major salivary gland abnormalities in primary Sjogren's syndrome (pSS). The aim of this systematic review was to assess the metric properties of this technique. Methods. PUBMED and EMBASE databases were searched. All

  15. Adaptive Functioning in Williams Syndrome: A Systematic Review

    Science.gov (United States)

    Brawn, Gabrielle; Porter, Melanie

    2018-01-01

    Literature on the level of adaptive functioning and relative strengths and weaknesses in functioning of individuals with Williams syndrome (WS) was reviewed. The electronic databases PsycINFO, PubMed, Expanded Academic, Web of Science, Scopus and ProQuest were searched electronically for relevant articles and dissertations using the search terms…

  16. Nutrition-based interventions to address metabolic syndrome in the Navajo: a systematic review.

    Science.gov (United States)

    Nava, Lorenzo T; Zambrano, Jenelle M; Arviso, Karen P; Brochetti, Denise; Becker, Kathleen L

    2015-11-01

    The objective of this systematic review is to identify nutrition-based interventions that may be effective for the prevention and treatment of metabolic syndrome in the Navajo. Metabolic syndrome, a major risk factor for cardiovascular disease, affects almost half of the Navajo population. The diet of the Navajo, heavy in fat and refined carbohydrates, has been identified as an important contributing factor to the high rates of metabolic syndrome in this population. A search was conducted on PubMed, EMBASE and CINAHL to identify studies published before October, 2013, involving nutrition-based interventions in adult populations similar to the Navajo targeting at least one measure of metabolic syndrome. Data on efficacy and participation were gathered and synthesised qualitatively. Out of 19 studies included in this systematic review, 11 interventions were identified to be effective at improving at least one measure of metabolic syndrome. Level of exposure to the intervention, frequency of intervention activities, family and social support, cultural adaptation and case management were identified as factors that may improve the efficacy of an intervention. Multiple nutrition-based interventions have been found to be effective in populations similar to the Navajo. Development of a strategy to address metabolic syndrome in the Navajo may involve aspects from multiple interventions to increase efficacy and maximise participation. © 2015 John Wiley & Sons Ltd.

  17. Raynaud's syndrome in children: systematic review and development of recommendations for assessment and monitoring.

    Science.gov (United States)

    Pain, Clare E; Constantin, Tamás; Toplak, Natasa; Moll, Monica; Iking-Konert, Christof; Piotto, Daniella P; Aktay Ayaz, Nuray; Nemcova, Dana; Hoeger, Peter H; Cutolo, Maurizio; Smith, Vanessa; Foeldvari, Ivan

    2016-01-01

    To develop recommendations for investigation and monitoring of children with Raynaud's syndrome, based on paediatric evidence collated by a systematic review. A systematic review was undertaken to establish the paediatric evidence for assessment and monitoring of Raynaud's syndrome. An expert panel including members of the Paediatric Rheumatology European Society (PRES) Scleroderma Working Group, were invited to a consensus meeting where recommendations were developed based on evidence graded by the systematic review and where evidence was lacking, consensus opinion. A nominal technique was used where 75% consensus was taken as agreement. The expert panel recommended testing anti-nuclear antibody (ANA), more specific antibodies associated with connective tissue disease and nail-fold capillaroscopy in all children presenting with Raynaud's syndrome as data suggests these can be risk factors for evolution into a connective tissue disease. The frequency of follow-up recommended depends on presence of these risk factors with the aim to detect evolving connective tissue disease early in high risk individuals. Those with no abnormalities on capillaroscopy and negative autoantibodies were deemed low risk of progression, whereas those with ANA positivity, specific autoantibodies and/or nailfold capillary changes were deemed high risk and more frequent follow-up was recommended. Recommendations, primarily based on consensus opinion, were agreed regarding investigation and monitoring of children who present with Raynaud's syndrome. Further prospective studies are needed to better define the risk factors for progression to connective tissue disease.

  18. The influence of antidepressants on restless legs syndrome and periodic limb movements: A systematic review.

    Science.gov (United States)

    Kolla, Bhanu Prakash; Mansukhani, Meghna P; Bostwick, J Michael

    2018-04-01

    Restless legs syndrome is commonly co-morbid with medical conditions that are treated with antidepressant medications, such as depression, anxiety, fibromyalgia, and chronic insomnia disorder. Evidence from case reports and cross-sectional studies suggests that antidepressants may induce or worsen restless legs syndrome and increase periodic limb movements. We undertook a systematic review of the literature to identify and collate all prospective studies that measured restless legs syndrome symptoms and/or periodic limb movements following the introduction of an antidepressant. Eighteen studies were eligible for inclusion. Current data indicate that onset or exacerbation of restless legs syndrome and rise in frequency of periodic limb movements are uncommon following the initiation of an antidepressant. Among the various antidepressants, mirtazapine may be associated with higher rates of restless legs syndrome and periodic limb movements. One small study of normal volunteers suggested that venlafaxine may be associated with an increase in restless legs syndrome symptoms and periodic limb movements. Sertraline, fluoxetine, and amitriptyline appear to increase periodic limb movements that do not disrupt sleep and are thus unlikely to be clinically significant. On the other hand, bupropion may reduce restless legs syndrome symptoms, at least in the short term. Sedating antidepressants such as trazodone, nefazodone, and doxepin do not seem to aggravate periodic limb movements. The current evidence is limited by poor study design, inadequate use of standardized questionnaires, and heterogeneous populations studied for variable lengths of time. Future research should attempt to remedy these shortcomings. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Noninvasive diagnostic tools for pelvic congestion syndrome: a systematic review.

    Science.gov (United States)

    Steenbeek, Miranda P; van der Vleuten, Carine J M; Schultze Kool, Leo J; Nieboer, Theodoor E

    2018-01-30

    In the work-up of patients with suspected pelvic congestion syndrome, venography is currently the gold standard. Yet if non-invasive diagnostic tools are found to be accurate, invasive venography might no longer be indicated as necessary. A literature search in Pubmed and EMBASE was performed from inception until May 6th 2017. Studies comparing non-invasive diagnostic tools to a reference standard in the work-up of patients with (suspected) pelvic congestion syndrome were included. Relevant data were extracted and methodological quality of individual included studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Nine studies matched our inclusion criteria. Six studies compared ultrasonography to venography and three studies described a magnetic resonance imaging technique. In using transvaginal ultrasonography, the occurrence of a vein greater than five mm crossing the uterine body had a specificity of 91% (95% CI; 77-98%) and occurrence of pelvic varicoceles a sensitivity and specificity of 100% (95% CI; 89-100%) and 83-100% (95% CI; 66-93%), respectively. In transabdominal ultrasonography, reversed caudal flow in the ovarian vein accounted for a sensitivity of 100% (95% CI; 84-100%). Detection of pelvic congestion syndrome with magnetic resonance imaging techniques resulted in a sensitivity varying from 88 to 100%. The sensitivity of ultrasonography and magnetic resonance imaging seem to be adequate, which indicates a role for both tests in an early stage of the diagnostic workup. However, due to methodological flaws and diversity in outcome parameters, more high standard research is necessary to establish a clear advice for clinical practice. © 2018 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

  20. Systematic review of vestibular disorders related to human immunodeficiency virus and acquired immunodeficiency syndrome.

    Science.gov (United States)

    Heinze, B; Swanepoel, D W; Hofmeyr, L M

    2011-09-01

    Disorders of the auditory and vestibular system are often associated with human immunodeficiency virus infection and acquired immunodeficiency syndrome. However, the extent and nature of these vestibular manifestations are unclear. To systematically review the current peer-reviewed literature on vestibular manifestations and pathology related to human immunodeficiency virus and acquired immunodeficiency syndrome. Systematic review of peer-reviewed articles related to vestibular findings in individuals with human immunodeficiency virus infection and acquired immunodeficiency syndrome. Several electronic databases were searched. We identified 442 records, reduced to 210 after excluding duplicates and reviews. These were reviewed for relevance to the scope of the study. We identified only 13 reports investigating vestibular functioning and pathology in individuals affected by human immunodeficiency virus and acquired immunodeficiency syndrome. This condition can affect both the peripheral and central vestibular system, irrespective of age and viral disease stage. Peripheral vestibular involvement may affect up to 50 per cent of patients, and central vestibular involvement may be even more prevalent. Post-mortem studies suggest direct involvement of the entire vestibular system, while opportunistic infections such as oto- and neurosyphilis and encephalitis cause secondary vestibular dysfunction resulting in vertigo, dizziness and imbalance. Patients with human immunodeficiency virus and acquired immunodeficiency syndrome should routinely be monitored for vestibular involvement, to minimise functional limitations of quality of life.

  1. Conservative treatment in patients with mild to moderate carpal tunnel syndrome: A systematic review.

    Science.gov (United States)

    Jiménez Del Barrio, S; Bueno Gracia, E; Hidalgo García, C; Estébanez de Miguel, E; Tricás Moreno, J M; Rodríguez Marco, S; Ceballos Laita, L

    2016-07-22

    Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. It is characterised by the compression of the median nerve in the carpal tunnel. CTS presents a high prevalence and it is a disabling condition from the earliest stages. Severe cases are usually treated surgically, while conservative treatment is recommended in mild to moderate cases. The aim of this systematic review is to present the conservative treatments and determine their effectiveness in mild-to-moderate cases of CTS over the last 15 years. A systematic review was performed according to PRISMA criteria. We used the Medline, PEDro, and Cochrane databases to find and select randomised controlled clinical trials evaluating the effects of conservative treatment on the symptoms and functional ability of patients with mild to moderate CTS; 32 clinical trials were included. There is evidence supporting the effectiveness of oral drugs, although injections appear to be more effective. Splinting has been shown to be effective, and it is also associated with use of other non-pharmacological techniques. Assessments of the use of electrotherapy techniques alone have shown no conclusive results about their effectiveness. Other soft tissue techniques have also shown good results but evidence on this topic is limited. Various treatment combinations (drug and non-pharmacological treatments) have been proposed without conclusive results. Several conservative treatments are able to relieve symptoms and improve functional ability of patients with mild-to-moderate CTS. These include splinting, oral drugs, injections, electrotherapy, specific manual techniques, and neural gliding exercises as well as different combinations of the above. We have been unable to describe the best technique or combination of techniques due to the limitations of the studies; therefore, further studies of better methodological quality are needed. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S

  2. Systematic review of percutaneous adhesiolysis and management of chronic low back pain in post lumbar surgery syndrome.

    Science.gov (United States)

    Epter, Richard S; Helm, Standiford; Hayek, Salim M; Benyamin, Ramsin M; Smith, Howard S; Abdi, Salahadin

    2009-01-01

    Post lumbar surgery syndrome or failed back surgery syndrome with persistent pain continues to increase over the years. The speculated causes of post lumbar laminectomy syndrome include acquired stenosis, epidural fibrosis, arachnoiditis, radiculopathy, and recurrent disc herniation. Epidural fibrosis may account for as much as 20% to 36% of all cases of failed back surgery syndrome. Percutaneous epidural adhesiolysis has been employed in interventional pain management in the treatment of chronic, refractory low back and lower extremity pain after back surgery. A systematic review of randomized trials and observational studies. To evaluate the effectiveness of percutaneous adhesiolysis in managing chronic low back and lower extremity pain due to post lumbar surgery syndrome. A comprehensive literature search was conducted utilizing electronic databases, as well as systematic reviews and cross references from 1966 through December 2008. The quality of individual articles used in this analysis was assessed by modified Cochrane review criteria for randomized trials and the Agency for Healthcare Research and Quality (AHRQ) criteria for assessment of observational studies. Clinical relevance was evaluated using 5 questions according to the criteria recommended by the Cochrane Review Back Group. Analysis was conducted using 5 levels of evidence, ranging from Level I to III, with 3 subcategories in Level II. The primary outcome measure was pain relief (short-term relief of at least 6 months and long-term relief of more than 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and change in opioid intake. Of the 13 studies considered for inclusion, 3 randomized trials and 4 observational studies met the inclusion criteria for methodologic quality assessment and evidence synthesis based on methodologic quality scores of 50 or more. Evidence of percutaneous adhesiolysis in the management of chronic low back pain

  3. The evaluation of immediate behavioural outcomes of the syndromic ...

    African Journals Online (AJOL)

    The evaluation of immediate behavioural outcomes of the syndromic case management approach for the treatement of patients with sexually transmitted infections at PHC centres of South Africa: Knowledge, attitudes, beliefs and sexual behaviour.

  4. A systematic literature review of observational studies of the bidirectional association between metabolic syndrome and migraine.

    Science.gov (United States)

    Andreeva, V A; Galan, P; Julia, C; Fezeu, L; Hercberg, S; Kesse-Guyot, E

    2017-12-13

    To evaluate all epidemiological evidence in the literature linking the metabolic syndrome (MetS) and migraine in adults. Database (Medline, Embase; published reports up to November 2017) and manual searches were performed. Information on data collection, sample characteristics, study design, MetS and migraine assessment, and results was extracted from each relevant publication. The methodological quality of each study was also assessed. A total of 15 observational epidemiological studies in adults, published between 2009 and 2017, were retrieved. Of these, one employed a prospective design, while the rest had a cross-sectional (13 studies) or case-control (one study) design. Five studies assessed the presence of migraine in individuals with MetS, whereas 10 studies assessed the presence or risk of MetS in migraineurs. Most participants were female hospital outpatients. The sole prospective cohort study reported 11-year MetS incidence of 21.8% in migraineurs with aura, 16.8% in migraineurs without aura and 14.5% in subjects without headaches. Most studies (60%) provided no statistical estimates of association. Methodological flaws included selection biases, lack of power analysis, unsuitable research plans and no multivariable analyses. Meta-analysis was not feasible with the available data. Our systematic review has identified major gaps in knowledge and weaknesses in research that should provide an impetus for future epidemiological investigations using more rigorous methodology, large general-population prospective cohorts, and substantial data on dietary behaviours and lifestyle. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  5. Deep Brain Stimulation for Tourette-Syndrome: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Baldermann, Juan Carlos; Schüller, Thomas; Huys, Daniel; Becker, Ingrid; Timmermann, Lars; Jessen, Frank; Visser-Vandewalle, Veerle; Kuhn, Jens

    2016-01-01

    A significant proportion of patients with Tourette syndrome (TS) continue to experience symptoms across adulthood that in severe cases fail to respond to standard therapies. For these cases, deep brain stimulation (DBS) is emerging as a promising treatment option. We conducted a systematic literature review to evaluate the efficacy of DBS for GTS. Individual data of case reports and series were pooled; the Yale Global Tic Severity Scale (YGTSS) was chosen as primary outcome parameter. In total, 57 studies were eligible, including 156 cases. Overall, DBS resulted in a significant improvement of 52.68% (IQR = 40.74, p stimulation versus off stimulation with a standardized mean difference of 0.96 (95% CI: 0.36-1.56). Disentangling different target points revealed significant YGTSS reductions after stimulation of the thalamus, the posteroventrolateral part and the anteromedial part of the globus pallidus internus, the anterior limb of the internal capsule and nucleus accumbens with no significant difference between these targets. A significant negative correlation of preoperative tic scores with the outcome of thalamic stimulation was found. Despite small patient numbers, we conclude that DBS for GTS is a valid option for medically intractable patients. Different brain targets resulted in comparable improvement rates, indicating a modulation of a common network. Future studies might focus on a better characterization of the clinical effects of distinct regions, rather than searching for a unique target. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Digital pathology: A systematic evaluation of the patent landscape

    OpenAIRE

    Cucoranu, Ioan C.; Parwani, Anil V.; Vepa, Suryanarayana; Weinstein, Ronald S.; Pantanowitz, Liron

    2014-01-01

    Introduction: Digital pathology is a relatively new field. Inventors of technology in this field typically file for patents to protect their intellectual property. An understanding of the patent landscape is crucial for companies wishing to secure patent protection and market dominance for their products. To our knowledge, there has been no prior systematic review of patents related to digital pathology. Therefore, the aim of this study was to systematically identify and evaluate United State...

  7. Effectiveness of probiotics in irritable bowel syndrome: Updated systematic review with meta-analysis

    Science.gov (United States)

    Didari, Tina; Mozaffari, Shilan; Nikfar, Shekoufeh; Abdollahi, Mohammad

    2015-01-01

    AIM: To investigate the efficacy of probiotics in irritable bowel syndrome (IBS) patients. METHODS: PubMed, Cochrane library, Scopus, Google Scholar, and Clinicaltrial.gov databases were searched for literature published between September 2007 and December 2013. The applied Mesh terms were “probiotics,” “irritable bowel syndrome,” and “irritable bowel syndrome treatment.” The collected data contained24 clinical trials, of which 15 were eligible for meta-analysis and nine were reviewed systematically. All studies were randomized placebo-controlled trials in patients with IBS that investigated the efficacy of probiotics in IBS improvement. The Jadad score was used to assess the methodological quality of trials. The quality scale ranges from 0 to 5 points, with a score ≤ 2 indicating a low quality report, and a score of ≥ 3 indicating a high quality report. Relative risk (RR), standardized effect size, and 95%CI were calculated using the DerSimonian-Laird method. The Cochran Q test was used to test heterogeneity with P probiotics to placebo was 1.96 (95%CI: 1.14-3.36; P = 0.01). RR of responders to therapies based on a global symptom score in IBS patients for two included trials comparing probiotics with placebo was 2.43 (95%CI: 1.13-5.21; P = 0.02). For adequate improvement of general symptoms in IBS patients, the RR of seven included trials (six studies) comparing probiotics with placebo was 2.14 (95%CI: 1.08-4.26; P = 0.03). Distension, bloating, and flatulence were evaluated using an IBS severity scoring system in three trials (two studies) to compare the effect of probiotic therapy in IBS patients with placebo, the standardized effect size of mean differences for probiotics therapy was -2.57 (95%CI: -13.05--7.92). CONCLUSION: Probiotics reduce pain and symptom severity scores. The results demonstrate the beneficial effects of probiotics in IBS patients in comparison with placebo. PMID:25780308

  8. The Hematopoietic Syndrome of the Acute Radiation Syndrome in Rhesus Macaques: A Systematic Review of the Lethal Dose Response Relationship.

    Science.gov (United States)

    MacVittie, Thomas J; Farese, Ann M; Jackson, William

    2015-11-01

    Well characterized animal models that mimic the human response to potentially lethal doses of radiation are required to assess the efficacy of medical countermeasures under the criteria of the U.S. Food and Drug Administration "animal rule." Development of a model requires the determination of the radiation dose response relationship and time course of mortality and morbidity across the hematopoietic acute radiation syndrome. The nonhuman primate, rhesus macaque, is a relevant animal model that may be used to determine the efficacy of medical countermeasures to mitigate major signs of morbidity and mortality at selected lethal doses of total body irradiation. A systematic review of relevant studies that determined the dose response relationship for the hematopoietic acute radiation syndrome in the rhesus macaque relative to radiation quality, dose rate, and exposure uniformity has never been performed. The selection of data cohorts was made from the following sources: Ovid Medline (1957-present), PubMed (1954-present), AGRICOLA (1976-present), Web of Science (1954-present), and U.S. HHS REPORT (2002 to present). The following terms were used: Rhesus, total body-irradiation, total body x irradiation, TBI, irradiation, gamma radiation, hematopoiesis, LD50/60, Macaca mulatta, whole-body irradiation, nonhuman primate, NHP, monkey, primates, hematopoietic radiation syndrome, mortality, and nuclear radiation. The reference lists of all studies, published and unpublished, were reviewed for additional studies. The total number of hits across all search sites was 3,001. There were a number of referenced, unpublished, non-peer reviewed government reports that were unavailable for review. Fifteen studies, 11 primary (n = 863) and four secondary (n = 153) studies [n = 1,016 total nonhuman primates (NHP), rhesus Macaca mulatta] were evaluated to provide an informative and consistent review. The dose response relationships (DRRs) were determined for uniform or non-uniform total

  9. Stigma in youth with Tourette's syndrome: a systematic review and synthesis

    OpenAIRE

    Malli, M.; Forrester-Jones, Rachel; Murphy, Glynis H.

    2015-01-01

    Tourette's syndrome (TS) is a childhood onset neurodevelopmental disorder, characterised by tics. To our knowledge, no systematic reviews exist which focus on examining the body of literature on stigma in association with children and adolescents with TS. The aim of the article is to provide a review of the existing research on (1) social stigma in relation to children and adolescents with TS, (2) self-stigma and (3) courtesy stigma in family members of youth with TS. Three electronic databas...

  10. [Evaluation of the primary caregiver syndrome when caring for elderly adults with immobility syndrome].

    Science.gov (United States)

    Morales-Cariño, Elizabeth María; Jiménez-Herrera, Blanca L; Serrano-Miranda, Tirzo A

    2012-01-01

    Caregiver syndrome may develop in caregivers of elderly adults. To evaluate the repercussions of the immobility syndrome present in elderly adults on their primary caregivers as well as to determine the clinical and socio-demographic characteristics of the elderly adult and caregiver. The study population included patients over 65 recruited in the Geriatric Rehabilitation Department, with the diagnosis of immobility syndrome and that required a primary caregiver. A questionnaire including socio-demographic variables was applied to all patients and caregivers, and the Zarit scale was also applied to caregivers in order to determine the presence of caregiver syndrome. Analysis was performed with descriptive statistical methods; Student's t test and Fisher's test were used for comparisons between strata. 75 patients and their caregivers were evaluated; patient average age was 75.9 years and 85.3% were female. 50.7% (38 cases) had mild immobility. The average caregiver's age was 50.6%, 70.7% were female and 57.3% were the patient's daughter. Caregiver syndrome was detected in 60% of them: 57.7% had mild symptoms and in 42.2%, symptoms were moderate to severe. No statistically significant association was established between the development of caregiver syndrome and the degree of patient immobility. Caregivers of patients with immobility syndrome are at high risk of developing caregiver syndrome, thus underscoring the need to include primary caregiver support programs.

  11. Metabolic syndrome and quality of life: a systematic review.

    Science.gov (United States)

    Saboya, Patrícia Pozas; Bodanese, Luiz Carlos; Zimmermann, Paulo Roberto; Gustavo, Andréia da Silva; Assumpção, Caroline Melo; Londero, Fernanda

    2016-11-28

    to present currently available evidence to verify the association between metabolic syndrome and quality of life. Cochrane Library, EMBASE, Medline and LILACS databases were studied for all studies investigating the association with metabolic syndrome and quality of life. Two blinded reviewers extracted data and one more was chosen in case of doubt. a total of 30 studies were included, considering inclusion and exclusion criteria, which involved 62.063 patients. Almost all studies suggested that metabolic syndrome is significantly associated with impaired quality of life. Some, however, found association only in women, or only if associated with depression or Body Mass Index. Merely one study did not find association after adjusted for confounding factors. although there are a few studies available about the relationship between metabolic syndrome and quality of life, a growing body of evidence has shown significant association between metabolic syndrome and the worsening of quality of life. However, it is necessary to carry out further longitudinal studies to confirm this association and verify whether this relationship is linear, or only an association factor. apresentar as evidências disponíveis atuais para verificar a associação entre síndrome metabólica e qualidade de vida. Cochrane Library, EMBASE, Medline e LILACS foram as bases de dados consultadas na identificação de todos os estudos que investigavam a associação entre síndrome metabólica e qualidade de vida. Dois revisores de forma independente e cegados extraíram os dados e, em caso de dúvidas, um outro revisor foi escolhido. um total de 30 estudos foram incluídos, considerando os critérios de inclusão e exclusão, os quais envolveram 62.063 pacientes. A maioria dos estudos sugerem que a síndrome metabólica é significativamente associada à piora da qualidade de vida. Alguns, no entanto, demonstram associação apenas em mulheres, ou somente se associadas à depressão ou índice de

  12. Systematic review: Complementary and alternative medicine in the irritable bowel syndrome.

    LENUS (Irish Health Repository)

    Hussain, Z

    2012-02-03

    BACKGROUND: Complementary and alternative medical therapies and practices are widely employed in the treatment of the irritable bowel syndrome. AIM: To review the usage of complementary and alternative medicine in the irritable bowel syndrome, and to assess critically the basis and evidence for its use. METHODS: A systematic review of complementary and alternative medical therapies and practices in the irritable bowel syndrome was performed based on literature obtained through a Medline search. RESULTS: A wide variety of complementary and alternative medical practices and therapies are commonly employed by irritable bowel syndrome patients both in conjunction with and in lieu of conventional therapies. As many of these therapies have not been subjected to controlled clinical trials, some, at least, of their efficacy may reflect the high-placebo response rate that is characteristic of irritable bowel syndrome. Of those that have been subjected to clinical trials most have involved small poor quality studies. There is, however, evidence to support efficacy for hypnotherapy, some forms of herbal therapy and certain probiotics in irritable bowel syndrome. CONCLUSIONS: Doctors caring for irritable bowel syndrome patients need to recognize the near ubiquity of complementary and alternative medical use among this population and the basis for its use. All complementary and alternative medicine is not the same and some, such as hypnotherapy, forms of herbal therapy, specific diets and probiotics, may well have efficacy in irritable bowel syndrome. Above all, we need more science and more controlled studies; the absence of truly randomized placebo-controlled trials for many of these therapies has limited meaningful progress in this area.

  13. Syndromic Hirschsprung's disease and associated congenital heart disease: a systematic review.

    Science.gov (United States)

    Duess, Johannes W; Puri, Prem

    2015-08-01

    Hirschsprung's disease (HD) occurs as an isolated phenotype in 70% of infants and is associated with additional congenital anomalies or syndromes in approximately 30% of patients. The cardiac development depends on neural crest cell proliferation and is closely related to the formation of the enteric nervous system. HD associated with congenital heart disease (CHD) has been reported in 5-8% of cases, with septation defects being the most frequently recorded abnormalities. However, the prevalence of HD associated with CHD in infants with syndromic disorders is not well documented. This systematic review was designed to determine the prevalence of CHD in syndromic HD. A systematic review of the literature using the keywords "Hirschsprung's disease", "aganglionosis", "congenital megacolon", "congenital heart disease" and "congenital heart defect" was performed. Resulting publications were reviewed for epidemiology and morbidity. Reference lists were screened for additional relevant studies. A total of fifty-two publications from 1963 to 2014 reported data on infants with HD associated with CHD. The overall reported prevalence of HD associated with CHD in infants without chromosomal disorders was 3%. In infants with syndromic disorders, the overall prevalence of HD associated with CHD ranged from 20 to 80 % (overall prevalence 51%). Septation defects were recorded in 57% (atrial septal defects in 29%, ventricular septal defects in 32%), a patent ductus arteriosus in 39%, vascular abnormalities in 16%, valvular heart defects in 4% and Tetralogy of Fallot in 7%. The prevalence of HD associated with CHD is much higher in infants with chromosomal disorders compared to infants without associated syndromes. A routine echocardiogram should be performed in all infants with syndromic HD to exclude cardiac abnormalities.

  14. Anxiety Disorders in Williams Syndrome Contrasted with Intellectual Disability and the General Population: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Royston, R.; Howlin, P.; Waite, J.; Oliver, C.

    2017-01-01

    Individuals with specific genetic syndromes associated with intellectual disability (ID), such as Williams syndrome (WS), are at increased risk for developing anxiety disorders. A systematic literature review identified sixteen WS papers that could generate pooled prevalence estimates of anxiety disorders for WS. A meta-analysis compared these…

  15. Systematic evaluation program: status summary report

    International Nuclear Information System (INIS)

    1982-01-01

    The status of safety evaluation issues is reviewed for the following reactors: Big Rock Point reactor; Dresden-1 reactor; Dresden-2 reactor; Ginna-1 reactor; Connecticut Yankee reactor; LACBWR reactor; Millstone-1 reactor; Oyster Creek-1 reactor; Palisades-1 reactor; San Onofre-1 reactor; and Rowe Yankee reactor

  16. Systematic evaluation of safety in old nuclear power plants

    International Nuclear Information System (INIS)

    Dredemis, G.; Fourest, B.

    1984-11-01

    A systematic evaluation program of the early nuclear power plant has been conducted by the French safety authorities. This examination is concerned with the remodelling of safety documents (safety reports, operation general regulations, incident and accident procedures, internal emergency plans and organization manuals for quality), with an analysis of the operating experience in frequently utilized circuits and with a systematic analysis of safeguards circuits. These evaluations are based on the experience of the Ardennes nuclear power plant, operating 15 years. This paper also describes the main studies and modifications undertaken in this power plant [fr

  17. Systematic review: quality of trials on the symptomatic effects of the low FODMAP diet for irritable bowel syndrome

    DEFF Research Database (Denmark)

    Krogsgaard, L. R.; Lyngesen, M.; Bytzer, P.

    2017-01-01

    Background The low Fermentable Oligo-, Di- Monosaccharides, and Polyoles (FODMAP) diet is a new treatment option for irritable bowel syndrome (IBS). Experts refer to the diet as supported by high level of evidence, but an evaluation of the quality of trials is lacking. Aim To provide a systematic...... review of the quality of trials on the symptomatic effects of the low FODMAP diet for IBS. Methods Pubmed and EMBASE were searched for randomised controlled trials (RCTs) reporting effect of the low FODMAP diet on IBS symptoms. The quality of trials was evaluated by estimating risk of bias and assessing...... trial methodology. Results Nine RCTs were eligible, including 542 patients. The intervention period was from 2 days to 6 weeks and one trial included a 6-month follow-up. Three trials intervened by providing meals, controlling with a diet high in FODMAP content. In six trials, the intervention...

  18. Systematic comparison of sporadic and syndromic pancreatic islet cell tumors.

    Science.gov (United States)

    Erlic, Zoran; Ploeckinger, Ursula; Cascon, Alberto; Hoffmann, Michael M; von Duecker, Laura; Winter, Aurelia; Kammel, Gerit; Bacher, Janina; Sullivan, Maren; Isermann, Berend; Fischer, Lars; Raffel, Andreas; Knoefel, Wolfram Trudo; Schott, Matthias; Baumann, Tobias; Schaefer, Oliver; Keck, Tobias; Baum, Richard P; Milos, Ioana; Muresan, Mihaela; Peczkowska, Mariola; Januszewicz, Andrzej; Cupisti, Kenko; Tönjes, Anke; Fasshauer, Mathias; Langrehr, Jan; von Wussow, Peter; Agaimy, Abbas; Schlimok, Günter; Lamberts, Regina; Wiech, Thorsten; Schmid, Kurt Werner; Weber, Alexander; Nunez, Mercedes; Robledo, Mercedes; Eng, Charis; Neumann, Hartmut P H

    2010-12-01

    Pancreatic islet cell tumors (ICTs) occur as sporadic neoplasias or as a manifestation of multiple endocrine neoplasia type 1 (MEN1) and von Hippel-Lindau disease (VHL). Molecular classification of ICTs is mandatory for timely diagnosis and surveillance. Systematic comparison of VHL-ICTs and sporadic ICTs has been lacking. Our registry-based approaches used the German NET-Registry with 259 patients with neuroendocrine tumors (NETs), who were primarily diagnosed with NETs, and the German VHL-Registry with 485 molecular genetically confirmed patients who had undergone magnetic resonance imaging or computed tomography of the abdomen. All patients provided blood DNA for testing of the MEN1 and VHL genes for intragenic mutations and large deletions. In the NET-Registry, 9/101 patients (8.9%) with ICTs had germline mutations, 8 in MEN1 and 1 in VHL. In the VHL-Registry, prevalence of NETs was 52/487 (10.6%), and all were ICTs. Interestingly, of those with VHL p.R167W, 47% developed ICTs, compared to 2% of those with p.Y98H. In total, there were 92 truly sporadic, i.e. mutation-negative ICT patients. Comparing these with the 53 VHL-ICT patients, the statistically significant differences were predominance of female gender (P=0.01), multifocal ICTs (P=0.0029), and lower malignancy rate (PICTs compared to sporadic cases. VHL was prevalent in ICTs, which are rarely the first presentation. Patients with NETs should not be subjected to genetic testing of the VHL gene, unless they have multifocal ICTs, other VHL-associated tumors, and/or a family history for VHL.

  19. Association of Down's syndrome and water fluoride level: a systematic review of the evidence

    Directory of Open Access Journals (Sweden)

    McDonagh Marian

    2001-07-01

    Full Text Available Abstract Background A review of the safety and efficacy of drinking water fluoridation was commissioned by the UK Department of Health to investigate whether the evidence supported a beneficial effect of water fluoridation and whether there was any evidence of adverse effects. Down's syndrome was one of the adverse effects reported. The aim of this review is to examine the evidence for an association between water fluoride level and Down's syndrome. Methods A systematic review of research. Studies were identified through a comprehensive literature search, scanning citations and online requests for papers. Studies in all languages which investigated the incidence of Down's syndrome in areas with different levels of fluoride in their water supplies were included. Study inclusion and quality was assessed independently by 2 reviewers. A qualitative analysis was conducted. Results Six studies were included. All were ecological in design and scored poorly on the validity assessment. The estimates of the crude relative risk ranged from 0.84 to 3.0. Four studies showed no significant associations between the incidence of Down's syndrome and water fluoride level and two studies by the same author found a significant (p Conclusions The evidence of an association between water fluoride level and Down's syndrome incidence is inconclusive.

  20. Effects of physiotherapy in patients with shoulder impingement syndrome: a systematic review of the literature.

    Science.gov (United States)

    Kromer, Thilo O; Tautenhahn, Ulrike G; de Bie, Rob A; Staal, J Bart; Bastiaenen, Caroline H G

    2009-11-01

    To critically summarize the effectiveness of physio-therapy in patients presenting clinical signs of shoulder impingement syndrome. Systematic review. Randomized controlled trials were searched electronically and manually from 1966 to December 2007. Study quality was independently assessed by 2 reviewers using the Physiotherapy Evidence Database (PEDro) scale. If possible, relative risks and weighted mean differences were calculated for individual studies, and relative risks or standardized mean differences for pooled data, otherwise results were summarized in a best evidence synthesis. Sixteen studies were included, with a mean quality score of 6.8 points out of 10. Many different diagnostic criteria for shoulder impingement syndrome were applied. Physio-therapist-led exercises and surgery were equally effective treatments for shoulder impingement syndrome in the long term. Also, home-based exercises were as effective as combined physiotherapy interventions. Adding manual therapy to exercise programmes may have an additional benefit on pain at 3 weeks follow-up. Moderate evidence exists that passive treatments are not effective and cannot be justified. This review shows an equal effectiveness of physiotherapist-led exercises compared with surgery in the long term and of home-based exercises compared with combined physiotherapy interventions in patients with shoulder impingement syndrome in the short and long term; passive treatments cannot be recommended for shoulder impingement syndrome. However, in general, the samples were small, and different diagnostic criteria were applied, which makes a firm conclusion difficult. More high-quality trials with longer follow-ups are recommended.

  1. Effectiveness of osteopathic manipulative therapy for managing symptoms of irritable bowel syndrome: a systematic review.

    Science.gov (United States)

    Müller, Axel; Franke, Helge; Resch, Karl-Ludwig; Fryer, Gary

    2014-06-01

    Irritable bowel syndrome (IBS) is a common and often lifelong functional gastrointestinal disorder. There is a scarcity of effective management options for IBS. To assess the effectiveness of osteopathic manipulative therapy (OMTh) for managing the symptoms of IBS. Articles without language or publication-date restriction were searched in PubMed, Embase, Cochrane Library, PEDro, OSTMED.DR, and Osteopathic Research Web. Search terms included irritable bowel syndrome, IBS, functional colonic disease, colon irritable, osteopath*, osteopathic manipulation, osteopathic medicine, clinical trial, and randomized clinical trial. Experts in the field of visceral osteopathy were also contacted to identify additional studies. The authors evaluated randomized controlled trials (RCTs) of OMTh for IBS in adults in whom IBS was diagnosed using Rome (I-III) criteria. If OMTh was not the sole intervention in the intervention group and if the same additional interventions were not applied to the control group, the study was excluded. Citation identification, study selection, and data extraction were independently undertaken by 2 reviewers with a data extraction form from the Cochrane Collaboration. A consensus method was used to resolve disagreements concerning the assessment of the methodologic quality of the RCTs that were reviewed. The search identified 10 studies that examined OMTh for patients with IBS; 5 studies (204 patients) met the inclusion criteria. All studies were assessed as having low risk of bias according to the Cochrane Collaboration criteria, although there was heterogeneity in the outcome measures and control interventions. Three studies used visual analog scales for abdominal pain, whereas others used the IBS severity score and the Functional Bowel Disorder Severity Index. A variety of secondary outcomes were used. All studies reported more pronounced short-term improvements with OMTh compared with sham therapy or standard care only. These differences remained

  2. Systematic safety evaluation of old nuclear power plants

    International Nuclear Information System (INIS)

    Dredemis, G.; Fourest, B.

    1984-01-01

    The French safety authorities have undertaken a systematic evaluation of the safety of old nuclear power plants. Apart from a complete revision of safety documents (safety analysis report, general operating rules, incident and accident procedures, internal emergency plan, quality organisation manual), this examination consisted of analysing the operating experience of systems frequently challenged and a systematic examination of the safety-related systems. This paper is based on an exercise at the Ardennes Nuclear Power Plant which has been in operation for 15 years. This paper also summarizes the main surveys and modifications relating to this power plant. (orig.)

  3. Management of Upper Airway Resistance Syndrome: A Systematic Literature Review

    Directory of Open Access Journals (Sweden)

    Ranjan Mathur

    2015-01-01

    Full Text Available Background : This disorder, also known by terms such as obstructive sleep apnea (OSA, upper airway sleep disorder and snoring. Snoring has also been identified as a possible risk factor for hyper tension, ischemic heart disease and stroke. The role of dentistry in sleep disorders is becoming more significant, especially in co- managing patients with simple snoring and mild to moderate OSA. The practicing dental professional has the opportunity to assist patients at a variety of levels, starting with the recognition of a sleep -related disorder, referring patients to a physician for evaluation and assisting in the management of sleep disorders. The first and simplest option would be behaviour modification, followed by insertion of oral devices suited to the patient, especially in those with mild to moderate OSA. Continuous positive airway pressure (CPAP and surgic al options are chosen for patients with moderate to severe OSA.

  4. The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis.

    Science.gov (United States)

    Hanratty, Catherine E; McVeigh, Joseph G; Kerr, Daniel P; Basford, Jeffrey R; Finch, Michael B; Pendleton, Adrian; Sim, Julius

    2012-12-01

    To evaluate the effectiveness of exercise in the treatment of people with subacromial impingement syndrome (SAIS). A systematic review and meta-analysis were conducted. Ten electronic databases were searched from the dates of their inception until August 2010. Included studies were randomized controlled trials investigating exercise in the management of SAIS. Outcomes were pain, strength, function, and quality of life. Data were summarized qualitatively using a best evidence synthesis. Treatment effect size and variance of individual studies were used to give an overall summary effect and data were converted to standardized mean difference with 95% confidence intervals (standardized mean difference (SMD) (CI)). Sixteen studies were included (n = 1162). There was strong evidence that exercise decreases pain and improves function at short-term follow-up. There was also moderate evidence that exercise results in short-term improvement in mental well-being and a long-term improvement in function for those with SAIS. The most common risk of bias across the studies was inadequately concealed treatment allocation. Six studies in the review were suitable for meta-analysis. Exercise had a small positive effect on strength of the rotator cuff in the short term (SMD -0.46 (-0.76, 0.16); P = 0.003) and a small positive effect on long-term function (SMD -0.31 (-0.57, 0.04); P = 0.02). Physiotherapy exercises are effective in the management of SAIS. However, heterogeneity of the exercise interventions, coupled with poor reporting of exercise protocols, prevented conclusions being drawn about which specific components of the exercise protocols (ie, type, intensity, frequency and duration) are associated with best outcomes. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. A systematic review on the prevalence of metabolic syndrome in Iranian children and adolescents

    Directory of Open Access Journals (Sweden)

    Roya Kelishadi

    2016-01-01

    Full Text Available Background: Metabolic syndrome (MetS, a cluster of cardiovascular risk factors, is one of the most common metabolic disorders, which lead to many chronic diseases. The link between childhood MetS and occurrence of atherosclerosis and its sequels in adulthood is well documented. This study aims to systematically review the prevalence of MetS among Iranian children and adolescents. Materials and Methods: An electronic search was conducted on studies published from January 1990 to January 2015. The main international electronic data sources were PubMed and the NLM Gateway (for MEDLINE, Institute of Scientific Information (ISI, and SCOPUS. For Persian databases, we used domestic databases. We included all available population-based studies and national surveys conducted in the pediatric age group aged 3–21-year-old. Results: In this review, 2138 articles were identified (PubMed: 265; SCOPUS: 368; ISI: 465; Scientific Information Database: 189; IranMedex: 851; Irandoc: 46. After quality assessment, 13 qualified articles were evaluated. The number of total population and points of data were 24,772 and 125, respectively. Regarding the geographical distribution, we found 2 national, 6 provincial, and 5 district level points of data. The prevalence range of MetS among children was 1–22% using different definitions. Reported range of pediatric MetS defined by different criteria was as follows: National Cholesterol Education Program-Adult Treatment Panel III; 3–16%, International Diabetes Federation; 0–8%, American Heart Association; 4–9.5%, The National Health and Nutrition Examination Survey III; 1–18%, de Ferranti; 0–22%. Conclusion: MetS is a common metabolic disorder among Iranian children and adolescents, with increasing trends during the last decades. This finding provides baseline useful information for health policy makers to implement evidence based-health promotion for appropriate controlling of this growing health problem for the

  6. Terlipressin versus norepinephrine in the treatment of hepatorenal syndrome: a systematic review and meta-analysis.

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    Antonio Paulo Nassar Junior

    Full Text Available BACKGROUND: Hepatorenal syndrome (HRS is a severe and progressive functional renal failure occurring in patients with cirrhosis and ascites. Terlipressin is recognized as an effective treatment of HRS, but it is expensive and not widely available. Norepinephrine could be an effective alternative. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of norepinephrine compared to terlipressin in the management of HRS. METHODS: We searched the Medline, Embase, Scopus, CENTRAL, Lilacs and Scielo databases for randomized trials of norepinephrine and terlipressin in the treatment of HRS up to January 2014. Two reviewers collected data and assessed the outcomes and risk of bias. The primary outcome was the reversal of HRS. Secondary outcomes were mortality, recurrence of HRS and adverse events. RESULTS: Four studies comprising 154 patients were included. All trials were considered to be at overall high risk of bias. There was no difference in the reversal of HRS (RR = 0.97, 95% CI = 0.76 to 1.23, mortality at 30 days (RR = 0.89, 95% CI = 0.68 to 1.17 and recurrence of HRS (RR = 0.72; 95% CI = 0.36 to 1.45 between norepinephrine and terlipressin. Adverse events were less common with norepinephrine (RR = 0.36, 95% CI = 0.15 to 0.83. CONCLUSIONS: Norepinephrine seems to be an attractive alternative to terlipressin in the treatment of HRS and is associated with less adverse events. However, these findings are based on data extracted from only four small studies.

  7. Components of effective randomized controlled trials of hydrotherapy programs for fibromyalgia syndrome: A systematic review

    Directory of Open Access Journals (Sweden)

    Luke Perraton

    2009-11-01

    Full Text Available Luke Perraton, Zuzana Machotka, Saravana KumarInternational Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, AustraliaAim: Previous systematic reviews have found hydrotherapy to be an effective management strategy for fibromyalgia syndrome (FMS. The aim of this systematic review was to summarize the components of hydrotherapy programs used in randomized controlled trials.Method: A systematic review of randomized controlled trials was conducted. Only trials that have reported significant FMS-related outcomes were included. Data relating to the components of hydrotherapy programs (exercise type, duration, frequency and intensity, environmental factors, and service delivery were analyzed.Results: Eleven randomized controlled trials were included in this review. Overall, the quality of trials was good. Aerobic exercise featured in all 11 trials and the majority of hydrotherapy programs included either a strengthening or flexibility component. Great variability was noted in both the environmental components of hydrotherapy programs and service delivery.Conclusions: Aerobic exercise, warm up and cool-down periods and relaxation exercises are common features of hydrotherapy programs that report significant FMS-related outcomes. Treatment duration of 60 minutes, frequency of three sessions per week and an intensity equivalent to 60%–80% maximum heart rate were the most commonly reported exercise components. Exercise appears to be the most important component of an effective hydrotherapy program for FMS, particularly when considering mental health-related outcomes.Keywords: hydrotherapy, fibromyalgia syndrome, exercise, effective, components

  8. [Systematic economic assessment and quality evaluation for traditional Chinese medicines].

    Science.gov (United States)

    Sun, Xiao; Guo, Li-ping; Shang, Hong-cai; Ren, Ming; Lei, Xiang

    2015-05-01

    To learn about the economic studies on traditional Chinese medicines in domestic literatures, in order to analyze the current economic assessment of traditional Chinese medicines and explore the existing problems. Efforts were made to search CNKI, VIP, Wanfang database and CBM by computer and include all literatures about economic assessment of traditional Chinese medicines published on professional domestic journals in the systematic assessment and quality evaluation. Finally, 50 articles were included in the study, and the systematic assessment and quality evaluation were made for them in terms of titles, year, authors' identity, expense source, disease type, study perspective, study design type, study target, study target source, time limit, cost calculation, effect indicator, analytical technique and sensitivity analysis. The finally quality score was 0.74, which is very low. The results of the study showed insufficient studies on economics of traditional Chinese medicines, short study duration and simple evaluation methods, which will be solved through unremitting efforts in the future.

  9. Systematic evaluation of observational methods assessing biomechanical exposures at work

    DEFF Research Database (Denmark)

    Takala, Esa-Pekka; Irmeli, Pehkonen; Forsman, Mikael

    2009-01-01

      Systematic evaluation of observational methods assessing biomechanical exposures at work   Esa-Pekka Takala 1, Irmeli Pehkonen 1, Mikael Forsman 2, Gert-Åke Hansson 3, Svend Erik Mathiassen 4, W. Patrick Neumann 5, Gisela Sjøgaard 6, Kaj Bo Veiersted 7, Rolf Westgaard 8, Jørgen Winkel 9   1...... University of Science and Technology, Trondheim, 9 University of Gothenburg and National Research Centre for the Working Environment, Copenhagen   The aim of this project was to identify and systematically evaluate observational methods to assess workload on the musculoskeletal system. Searches...... by sorting the methods according to the several items evaluated.   Numerous methods have been developed to assess physical workload (biomechanical exposures) in order to identify hazards leading to musculoskeletal disorders, to monitor the effects of ergonomic changes, and for research. No indvidual method...

  10. What Definition Is Used to Describe Second Impact Syndrome in Sports? A Systematic and Critical Review.

    Science.gov (United States)

    Stovitz, Steven D; Weseman, Jonathan D; Hooks, Matthew C; Schmidt, Robert J; Koffel, Jonathan B; Patricios, Jon S

    Concern about what has been termed, "second impact syndrome" (SIS) is a major factor determining return-to-play decisions after concussion. However, definitions of SIS vary. We used Scopus to conduct a systematic review and categorize the definitions used to describe SIS. Of the 91 sources identified, 79 (87%) clearly specified that SIS involved either cerebral edema or death after a concussion when a prior concussion had not resolved. Twelve articles (13%) could be interpreted as merely the events of two consecutive concussions. Among the articles that listed mortality rates, nearly all (33/35, 94%) said the rate of death was "high" (e.g., 50% to 100%). Our review found that most articles define SIS as a syndrome requiring catastrophic brain injury after consecutive concussive episodes. Given that it is unclear how common it is to have a second concussion while not fully recovered from a first concussion, the actual mortality rate of SIS is unknown.

  11. Urea for management of the syndrome of inappropriate secretion of ADH: A systematic review.

    Science.gov (United States)

    de Solà-Morales, Oriol; Riera, Maribel

    2014-11-01

    Urea has been recently proposed for the management of hyponatremia linked to the syndrome of inappropriate secretion of ADH (SIADH). The objective of the study was to review the levels of evidence for treatment of hyponatremia associated with SIADH with urea. We performed a: systematic review of experimental trials and grading according to SIGN. No clinical trials were found. The 6 studies analysed had methodological limitations and were prone to biases. In conclusion, there is no evidence to support the efficacy of urea for the treatment of hyponatremia following SIADH. Copyright © 2014 SEEN. Published by Elsevier Espana. All rights reserved.

  12. Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome

    DEFF Research Database (Denmark)

    Gluud, Lise L; Christensen, Kurt; Christensen, Erik

    2010-01-01

    Vasoconstrictor drugs may improve renal function in hepatorenal syndrome (HRS), but the effect on mortality has not been established. We therefore performed a systematic review of randomized trials on vasoconstrictor drugs for type 1 or type 2 HRS. Mortality was the primary outcome measure....... Overall, vasoconstrictor drugs used alone or with albumin reduced mortality compared with no intervention or albumin (relative risk [RR], 0.82; 95% confidence interval [CI], 0.70-0.96). In subgroup analyses, the effect on mortality was seen at 15 days (RR, 0.60; 95% CI, 0.37-0.97) but not at 30 days (RR...

  13. A systematic review of new advances in the management of mucopolysaccharidosis VI (Maroteaux-Lamy syndrome: focus on galsulfase

    Directory of Open Access Journals (Sweden)

    Regina P El Dib

    2009-09-01

    Full Text Available Regina P El Dib1, Gregory M Pastores21Department of Surgery, McMaster University, McMaster Institute of Urology, Hamilton, Ontario, Canada; 2Department of Neurology and Pediatrics, New York University School of Medicine, New York, NY, USAIntroduction: Mucopolysaccharidosis type VI (MPS VI, Maroteaux-Lamy syndrome is an autosomal recessive lysosomal storage disorder, characterized primarily by skeletal dysplasia and joint contracture. It is caused by a deficiency of N-acetylgalactosamine-4-sulfatase (arylsulfatase B, for which a recombinant formulation (galsulfase is available as replacement therapy. Objective: To evaluate the effectiveness and safety of galsulfase compared to placebo or no interventions, for treating MPS VI. We also considered studies evaluating different doses of galsulfase.Methods: A systematic review of the literature was conducted. A computerized electronic search in MEDLINE, EMBASE, CENTRAL, SciELO, and LILACS was carried on to identify any randomized trials that met our inclusion criteria.Results: Two studies were included in the review. Because the number of studies was small, our analysis probably did not find any statistically significant difference. Long-term follow-up will be required to ascertain full clinical benefit, on both event-free survival and quality of life measures.Conclusions: There is some evidence to support the use of galsulfase in the treatment of MPS VI; however due to the very low quantity of included studies we could not analyze it in an appropriate way. This review highlights the need for continued research into the use of enzyme replacement therapy for MPS VI.Keywords: mucopolysaccharidosis VI, Maroteaux-Lamy syndrome, galsulfase, naglazyme, systematic review

  14. Systematic Task Allocation Evaluation in Distributed Software Development

    Science.gov (United States)

    Münch, Jürgen; Lamersdorf, Ansgar

    Systematic task allocation to different development sites in global software development projects can open business and engineering perspectives and help to reduce risks and problems inherent in distributed development. Relying only on a single evaluation criterion such as development cost when distributing tasks to development sites has shown to be very risky and often does not lead to successful solutions in the long run. Task allocation in global software projects is challenging due to a multitude of impact factors and constraints. Systematic allocation decisions require the ability to evaluate and compare task allocation alternatives and to effectively establish customized task allocation practices in an organization. In this article, we present a customizable process for task allocation evaluation that is based on results from a systematic interview study with practitioners. In this process, the relevant criteria for evaluating task allocation alternatives are derived by applying principles from goal-oriented measurement. In addition, the customization of the process is demonstrated, related work and limitations are sketched, and an outlook on future work is given.

  15. Radiological evaluation of the chronic venous stasis syndrome

    International Nuclear Information System (INIS)

    Train, J.S.; Schanzer, H.; Peirce, E.C. II; Dan, S.J.; Mitty, H.A.

    1987-01-01

    Chronic venous stasis is an extremely complex clinical syndrome of pain and changes in the skin that can involve the superficial, deep, and perforating veins. This syndrome is commonly referred to as the postphlebitic syndrome, implying that thrombophlebitis is its sole etiology. To test this hypothesis, the authors performed ascending venography on 51 limbs of patients with the chromic venous stasis syndrome and demonstrated that 32 had no radiological evidence of recent or old thrombophlebitis. Instead, they had normal-appearing veins, suggesting primary incompetence of the deep and/or perforating venous valves rather than thrombophlebitis as the etiology. Since various operations have recently been proposed to correct or bypass malfunctioning valves, precise demonstration of pathological change is required to choose the appropriate procedure and to evaluate results. Descending venograms were combined with the ascending studies in 42 limbs for this purpose. In addition to outlining the abnormalities responsible for chronic venous stasis syndrome in individual cases, interesting conclusions regarding the syndrome itself were reached

  16. Evaluation of Wet Cupping Therapy: Systematic Review of Randomized Clinical Trials.

    Science.gov (United States)

    Al Bedah, Abdullah M N; Khalil, Mohamed K M; Posadzki, Paul; Sohaibani, Imen; Aboushanab, Tamer Shaaban; AlQaed, Meshari; Ali, Gazzaffi I M

    2016-10-01

    Wet cupping is a widely used traditional therapy in many countries, which justifies a continuous scientific evaluation of its efficacy and safety. To perform a systematic review to critically evaluate and update the available evidence of wet cupping in traditional and complementary medicine. Ten electronic databases were searched from their inceptions to February 2016. Included studies were randomized clinical trials (RCTs) that evaluated wet cupping against any type of control interventions in patients with any clinical condition, as well as healthy individuals. Cochrane risk of bias tool was used to appraise the included RCTs. Fourteen RCTs met the eligibility criteria. The included studies evaluated the following clinical conditions: nonspecific low back pain (NSLBP), hypertension, brachialgia, carpal tunnel syndrome (CTS), chronic neck pain, metabolic syndrome, migraine headaches, oxygen saturation in smokers with chronic obstructive pulmonary disease (COPD), and oral and genital ulcers due to Behçet disease. Two RCTs evaluated physiologic and biochemical parameters of healthy individuals. Overall, 9 RCTs favored wet cupping over various control interventions in NSLBP (n = 2), hypertension (n = 1), brachialgia (n = 1), CTS (n = 1), chronic neck pain (n = 2), oxygen saturation in smokers with COPD (n = 1), and oral and genital ulcers due to Behçet disease (n = 1). Five RCTs showed no statistically significant between-group differences: NSLBP (n = 1), metabolic syndrome (n = 1), migraine headaches (n = 1), and physiologic and biochemical parameters of healthy individuals (n = 2). Included RCTs had a variable risk of bias across all domains and suffered methodologic limitations. There is a promising evidence in favor of the use of wet cupping for musculoskeletal pain, specifically NSLBP, neck pain, CTS, and brachialgia. Better-quality trials are needed to generate solid evidence and firmly inform policy makers.

  17. Hair cortisol in the evaluation of Cushing syndrome.

    Science.gov (United States)

    Hodes, Aaron; Lodish, Maya B; Tirosh, Amit; Meyer, Jerrold; Belyavskaya, Elena; Lyssikatos, Charalampos; Rosenberg, Kendra; Demidowich, Andrew; Swan, Jeremy; Jonas, Nichole; Stratakis, Constantine A; Zilbermint, Mihail

    2017-04-01

    Hair cortisol evaluation has been used to help detect patients with suspected Cushing syndrome. Our goal was to correlate segmental hair cortisol with biochemical testing in patients with Cushing syndrome and controls. This study was a prospective analysis of hair cortisol in confirmed Cushing syndrome cases over 16 months. Thirty-six subjects (26.5 ± 18.9 years, 75% female, and 75% Caucasian) were analyzed by diurnal serum cortisol, 24 h urinary free cortisol corrected for body surface area (UFC/BSA), and 24 h urinary 17-hydroxysteroids corrected for creatinine (17OHS/Cr). Thirty patients were diagnosed with Cushing syndrome, and six were defined as controls. 3-cm hair samples nearest to the scalp, cut into 1-cm segments (proximal, medial, and distal), were analyzed for cortisol by enzyme immunoassay and measured as pmol cortisol/g dry hair. Hair cortisol levels were compared with laboratory testing done within previous 2 months of the evaluation. Proximal hair cortisol was higher in Cushing syndrome patients (266.6 ± 738.4 pmol/g) than control patients (38.9 ± 25.3 pmol/g) (p = 0.003). Proximal hair cortisol was highest of all segments in 25/36 (69%) patients. Among all subjects, proximal hair cortisol was strongly correlated with UFC/BSA (r = 0.5, p = 0.005), midnight serum cortisol (r = 0.4, p = 0.03), and 17OHS/Cr, which trended towards significance (r = 0.3, p = 0.06). Among the three examined hair segments, proximal hair contained the highest cortisol levels and correlated the most with the initial biochemical tests for Cushing syndrome in our study. Further studies are needed to validate proximal hair cortisol in the diagnostic workup for Cushing syndrome.

  18. Pain evaluation during gynaecological surveillance in women with Lynch syndrome

    NARCIS (Netherlands)

    Helder-Woolderink, Jorien; de Bock, Geertruida; Hollema, Harry; van Oven, Magda; Mourits, Marian

    To evaluate perceived pain during repetitive annual endometrial sampling at gynaecologic surveillance in asymptomatic women with Lynch syndrome (LS) over time and in addition to symptomatic women without LS, undergoing single endometrial sampling. In this prospective study, 52 women with LS or first

  19. A Systematic Review and Meta-Analysis of Qigong for the Fibromyalgia Syndrome

    Directory of Open Access Journals (Sweden)

    Romy Lauche

    2013-01-01

    Full Text Available Objectives. The fibromyalgia syndrome (FMS is a chronic condition with only few evidence-based complementary and alternative therapies available. This paper presents a systematic review and meta-analysis of the effectiveness of Qigong for fibromyalgia syndrome. Methods. The PubMed/MEDLINE, Cochrane Library, Embase, PsycINFO, and Cambase databases were screened in December 2012 to identify randomized controlled trials comparing Qigong to control interventions. Major outcome measures were pain and quality of life; and secondary outcomes included sleep quality, fatigue, depression, and safety. Standardized mean differences (SMD and 95% confidence intervals were calculated. Results. Seven trials were located with a total of 395 FMS patients. Analyses revealed low quality evidence for short-term improvement of pain, quality of life, and sleep quality and very low quality evidence for improvement of fatigue after Qigong for FMS, when compared to usual care. No evidence was found for superiority of Qigong compared to active treatments. No serious adverse events were reported. Discussion. This systematic review found that Qigong may be a useful approach for FMS patients. According to the quality of evidence, only a weak recommendation for Qigong can be made at this point. Further high quality RCTs are required for the conclusive judgment of its long-term effects.

  20. Shoulder impingement syndrome: a systematic review of clinical trial participant selection criteria.

    Science.gov (United States)

    Watts, Amy R; Williams, Ben; Kim, Susan W; Bramwell, Donald C; Krishnan, Jeganath

    2017-01-01

    Shoulder impingement syndrome (SIS) is a common diagnosis for patients with pain and dysfunction of the shoulder. Variations in the signs and symptoms might lead to uncertainty regarding the definition of SIS. The aim of this review is to explore the participant selection criteria used in the literature when investigating SIS and to assess differences in criteria among treating professions. This is a PRISMA systematic review of publications from 2009 to 2014 from MEDLINE, PubMed, The Cochrane Library, Embase, Scopus and CINAHL. Ninety-seven articles met inclusion criteria for this review. Twenty-five different surgical and nonsurgical treatments were investigated. Impingement-specific index tests were used in all studies. Exclusion index tests were used in 62% of studies. Twenty index tests were identified. Radiological investigations were reported in 53% of all studies, of which a further 53% reported using two or more radiological investigations. This systematic review has illustrated that studies investigating SIS test for various signs and symptoms, which is in keeping with describing the condition as a 'syndrome'. However, there are inconsistencies in participant selection criteria between health disciplines, highlighting a need for harmonization of the selection criteria in the form of an international editorial consensus.

  1. Does taping in addition to physiotherapy improve the outcomes in subacromial impingement syndrome? A systematic review.

    Science.gov (United States)

    Saracoglu, Ismail; Emuk, Yusuf; Taspinar, Ferruh

    2018-04-01

    Taping is used with or without other interventions for many purposes, especially to manage pain and improve functional activity in patients with shoulder pain. The aim of this review was to determine whether any taping technique in addition to physiotherapy care is more effective than physiotherapy care alone in patients with shoulder impingement syndrome. A systematic search of Cochrane Database of Systematic Review, MEDLINE (EBSCO), Physiotherapy Evidence Database (PEDro), CINAHL (EBSCO), PUBMED, AMED, EMBASE (OVID), The Kinesio Kinesio® Taping Method, Kinesio® Tex Tape UK and International websites ( www.kinesiotaping.co.uk ; www.kinesiotaping.com ) was conducted to June 2015. The outcome measures were pain, disability, range of motion and muscle strength. As data were not suitable for meta-analysis, narrative synthesis were applied. Three randomized controlled trials and one controlled trial (135 patients) were included. The results were conflicting and weak on the effectiveness of taping as an adjunct therapy for improvement of pain, disability, range of motion and muscle strength. Clinical taping in addition to physiotherapy interventions (e.g. exercise, electrotherapy, and manual therapy) might be an optional modality for managing patients with shoulder impingement syndrome, especially for the initial stage of the treatment; however, we need further robust, placebo controlled and consistent studies to prove whether it is more effective than physiotherapy interventions without taping.

  2. Evaluating CHARGE syndrome in congenital hypogonadotropic hypogonadism patients harboring CHD7 variants.

    Science.gov (United States)

    Xu, Cheng; Cassatella, Daniele; van der Sloot, Almer M; Quinton, Richard; Hauschild, Michael; De Geyter, Christian; Flück, Christa; Feller, Katrin; Bartholdi, Deborah; Nemeth, Attila; Halperin, Irene; Pekic Djurdjevic, Sandra; Maeder, Philippe; Papadakis, Georgios; Dwyer, Andrew A; Marino, Laura; Favre, Lucie; Pignatelli, Duarte; Niederländer, Nicolas J; Acierno, James; Pitteloud, Nelly

    2017-11-16

    PurposeCongenital hypogonadotropic hypogonadism (CHH), a rare genetic disease caused by gonadotropin-releasing hormone deficiency, can also be part of complex syndromes (e.g., CHARGE syndrome). CHD7 mutations were reported in 60% of patients with CHARGE syndrome, and in 6% of CHH patients. However, the definition of CHD7 mutations was variable, and the associated CHARGE signs in CHH were not systematically examined.MethodsRare sequencing variants (RSVs) in CHD7 were identified through exome sequencing in 116 CHH probands, and were interpreted according to American College of Medical Genetics and Genomics guidelines. Detailed phenotyping was performed in CHH probands who were positive for CHD7 RSVs, and genotype-phenotype correlations were evaluated.ResultsOf the CHH probands, 16% (18/116) were found to harbor heterozygous CHD7 RSVs, and detailed phenotyping was performed in 17 of them. Of CHH patients with pathogenic or likely pathogenic CHD7 variants, 80% (4/5) were found to exhibit multiple CHARGE features, and 3 of these patients were reclassified as having CHARGE syndrome. In contrast, only 8% (1/12) of CHH patients with nonpathogenic CHD7 variants exhibited multiple CHARGE features (P = 0.01).ConclusionPathogenic or likely pathogenic CHD7 variants rarely cause isolated CHH. Therefore a detailed clinical investigation is indicated to clarify the diagnosis (CHH versus CHARGE) and to optimize clinical management.Genetics in Medicine advance online publication, 16 November 2017; doi:10.1038/gim.2017.197.

  3. Prevalence of metabolic syndrome in Bangladesh: a systematic review and meta-analysis of the studies.

    Science.gov (United States)

    Chowdhury, Mohammad Ziaul Islam; Anik, Ataul Mustufa; Farhana, Zaki; Bristi, Piali Dey; Abu Al Mamun, B M; Uddin, Mohammad Jasim; Fatema, Jain; Akter, Tanjila; Tani, Tania Akhter; Rahman, Meshbahur; Turin, Tanvir C

    2018-03-02

    Metabolic syndrome (MS) is a cluster of health problems that set the stage for serious health conditions and places individuals at higher risk of cardiovascular disease, diabetes and stroke. The worldwide prevalence of MS in the adult population is on the rise and Bangladesh is no exception. According to some epidemiological study, MS is highly prevalent in Bangladesh and has increased dramatically in last few decades. To provide a clear picture of the current situation, we conducted a systematic review and meta-analysis with an objective to assess the prevalence of metabolic syndrome among the Bangladeshi population using data already published in the scientific literature. We searched MEDLINE, EMBASE and PubMed and manually checked references of all identified relevant publications that described the prevalence of MS in Bangladesh. Random effects meta-analysis was used to pool the prevalence. Heterogeneity was explored using formal tests and subgroup analyses. Study quality and publication bias was also explored. Electronic and grey literature search retrieved 491 potentially relevant papers. After removing duplicates, reviewing titles and abstracts and screening full texts, 10 studies were finally selected. Most of the studies were conducted in rural populations and study participants were mostly females. The weighted pooled prevalence of metabolic syndrome regardless of gender and criteria used to define metabolic syndrome, was 30.0% with high heterogeneity observed. Weighted pooled prevalence of metabolic syndrome is higher in females (32%) compared to males (25%) though not statistically significant (p = 0.434). Prevalence was highest (37%) when Modified NCEP ATP III criteria was used to define MS, while it was lowest (20%) when WHO criteria was used. In most cases, geographical area (urban/rural) was identified as a source of heterogeneity between the studies. Most of the studies met study quality assessment criteria's except adequate sample size

  4. Trends in pharmacological therapy following an acute coronary syndrome in Portugal: a systematic review.

    Science.gov (United States)

    Pereira, Marta; Lopes-Conceição, Luisa; Bennett, Kathleen; Dias, Paula; Laszczynska, Olga; Lunet, Nuno; Azevedo, Ana

    2016-09-01

    To assess time trends in the use of main drug classes for secondary prevention, during hospitalization and at hospital discharge, following an acute coronary syndrome, in Portugal, using a systematic review. We searched PubMed, from inception until 2012, to identify studies reporting the proportion of acute coronary syndrome patients treated with main pharmacological therapy. We used linear regression to quantify the annual variation in use of drugs, adjusting for the proportion of men in the sample and patients' mean age, and including a quadratic term of data collection year when relevant. In 25 eligible studies, including patients treated from 1993 to 2009, we observed an increase in the prescription of pharmacological treatments at hospital discharge. Extrapolating from these data, and assuming a mean patient age of 65 years and 70% of men, we estimate that in 2008, 95% of patients would have been discharged with aspirin, 92% with clopidogrel, 82% with β-blockers, 80% with angiotensin-converting enzyme inhibitors and 91% with statins. Treatment during hospitalization followed a similar pattern, except for a steeper increase in angiotensin-converting enzyme inhibitors use, which was initially lower, but reached similar levels to those at discharge in recent years. In Portugal, there was an increase in the use of recommended pharmacological therapy for secondary prevention after an acute coronary syndrome over the last 15 years, during hospitalization and at hospital discharge.

  5. Wernicke-Korsakoff syndrome not related to alcohol use: a systematic review.

    Science.gov (United States)

    Scalzo, Simon J; Bowden, Stephen C; Ambrose, Margaret L; Whelan, Greg; Cook, Mark J

    2015-12-01

    Although Wernicke-Korsakoff syndrome (WKS) is a common condition, diagnosis remains difficult. WKS not associated with alcohol is rare and thought to present differently to alcohol-related WKS. We conducted a systematic review of WKS not related to alcohol to enhance understanding of WKS not related to alcohol and WKS in general. A systematic review was conducted of case reports, published in English, of Wernicke's encephalopathy and WKS in patients without a history of alcohol-use disorder. Main data sources: MEDLINE, Index Medicus. Eligible cases totaled 623. Publication dates ranged from 1867 to 2014. Comparisons of clinical presentation were made with published data on samples comprising, almost exclusively, alcohol-related WKS. A wide array of illnesses precipitated WKS. When diagnosis of WKS was performed postmortem, non-alcohol-related cases presented a similar number of signs of the classic triad as alcohol-related cases (p=0.662, Cohen's w=0.12) but more signs when diagnosed antemortem (pKorsakoff syndrome or ongoing memory impairment was reported in 25% of non-alcohol-related WKS, although cognitive status was not explicitly reported in many cases. When duration of memory impairment was reported, 56% had clinically obvious memory impairment lasting beyond the period of acute presentation. Non-alcohol-related WKS was more often associated with female gender, younger age, shorter duration of precipitating illness and better survival rate compared to alcohol-related WKS. Thiamine deficiency in the absence of an alcohol-use disorder can cause the full clinical spectrum of WKS, including chronic cognitive impairment and Korsakoff syndrome. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  6. Pediatric primary Sjögren syndrome presenting with bilateral ranulas: A case report and systematic review of the literature.

    Science.gov (United States)

    Means, Casey; Aldape, Mark A; King, Ericka

    2017-10-01

    Primary Sjögren syndrome is uncommon in children, and the standard clinical criteria used in diagnosis of adult Sjögren syndrome will miss many children with the disease. Floor of mouth ranulas have not been described in Sjögren syndrome. This study aims to describe a novel presentation of juvenile primary Sjögren syndrome, and to present a comprehensive systematic review of the literature regarding the presentation and diagnosis of Sjögren syndrome in children. Ovid MEDLINE. A MEDLINE literature search was performed using the following search terms: primary, Sjögren, disease, and children. Results were limited to human subjects and articles written in English between 1981 and 2014. Applicable articles were reviewed and qualitatively summarized. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRIMA). Initial MEDLINE search yielded 146 articles, 80 of which were excluded as not clinically pertaining to Sjögren syndrome. An additional 25 were excluded due to lack of pediatric-specific data. Systematic review of the literature revealed no reports of ranula in association with Sjögren syndrome. 6 papers were manually included from review of reference lists of included articles. Our review indicated that recurrent parotitis is the most commonly reported presenting symptom in children, followed by ocular and oral symptoms, musculoskeletal, and renal symptoms. Compared to adults, children are less likely to present with dry eyes and mouth. All studies were retrospective chart reviews, case series or case reports. This is the first report of a child presenting with floor of mouth ranulas in association with Sjögren syndrome. While recurrent parotitis is the most common presentation in children, other salivary gland and extra-salivary manifestations may be seen, and the clinician must maintain a high index of suspicion for underlying Sjögren syndrome. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Evaluation of Kinesiophobia and Its Correlations with Pain and Fatigue in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome Hypermobility Type

    Directory of Open Access Journals (Sweden)

    Claudia Celletti

    2013-01-01

    Full Text Available Ehlers-Danlos syndrome hypermobility type a. k. a. joint hypermobility syndrome (JHS/EDS-HT is a hereditary musculoskeletal disorder associating generalized joint hypermobility with chronic pain. Anecdotal reports suggest a prominent role for kinesiophobia in disease manifestations, but no study has systematically addressed this point. Objective. To investigate the impact of kinesiophobia and its relationship with pain, fatigue, and quality of life in JHS/EDS-HT. Design. Cross-sectional study. Subjects/Patients. 42 patients (40 female and 2 male with JHS/EDS-HT diagnosis following standardized diagnostic criteria were selected. Methods. Disease features were analyzed by means of specific questionnaires and scales evaluating kinesiophobia, pain, fatigue, and quality of life. The relationships among variables were investigated using the Spearman bivariate analysis. Results. Kinesiophobia resulted predominantly in the patients’ sample. The values of kinesiophobia did not correlate with intensity of pain, quality of life, and (or the single component of fatigue. A strong correlation was discovered between kinesiophobia and general severity of fatigue. Conclusions. In JHS/EDS-HT, the onset of pain-avoiding strategies is related to the presence of pain but not to its intensity. The clear-cut correlation between kinesiophobia and severity of fatigue suggests a direct link between musculoskeletal pain and fatigue. In JHS/EDS-HT, the underlying mechanism is likely to be facilitated by primary disease characteristics, including hypotonia.

  8. Health information systems evaluation frameworks: A systematic review.

    Science.gov (United States)

    Eslami Andargoli, Amirhossein; Scheepers, Helana; Rajendran, Diana; Sohal, Amrik

    2017-01-01

    Evaluation of health information systems (HISs) is complicated because of the complex nature of the health care domain. Various studies have proposed different frameworks to reduce the complexity in the assessment of these systems. The aim of these frameworks is to provide a set of guidelines for the evaluation of the adequacy of health care information systems. This paper aims to analyse studies on the evaluation of HISs by applying a content, context and process (CCP) framework to address the 'who', 'what', 'how', 'when', and 'why' of the evaluation processes used. This will allow for a better understanding of the relative strengths and weaknesses of various HISs evaluation frameworks, and will pave the way for developing a more complete framework for HISs. A systematic literature review on HIS evaluation studies was undertaken to identify the currently available HIS evaluation frameworks. Five academic databases were selected to conduct this systematic literature review. Most of the studies only address some, but not all, of the five main questions, i.e. the who, what, how, when, why, and that there was a lack of consensus in the way these questions were addressed. The critical role of context was also largely neglected in these studies. Evaluation of HISs is complex. The health care domain is highly context sensitive and in order to have a complete assessment of HISs, consideration of contextual factors is necessary. Specifically, to have the right set of criteria to measure the 'what', the answer to the 'who' of the evaluation is necessary. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Outcome of Surgical Treatment for Thoracic Outlet Syndrome: Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Peek, Jesse; Vos, Cornelis G; Ünlü, Çağdaş; van de Pavoordt, Henricus D W M; van den Akker, Peter J; de Vries, Jean-Paul P M

    2017-04-01

    Many publications report outcomes of surgical treatment for thoracic outlet syndrome (TOS); however, high-quality reviews and meta-analyses are lacking. This systematic review and meta-analysis summarizes and compares the outcomes and major complications of the surgical procedures for the 3 types of TOS: arterial, venous, and neurogenic. MEDLINE, EMBASE, and CINAHL databases, and the Cochrane Database of Systematic Reviews were searched for papers published between January 1980 and February 2015, using the keywords thoracic outlet syndrome, and treatment and surgical. Articles were eligible for inclusion if the following criteria were met: studies describing outcomes of surgery for TOS, published in English, human studies, and available full-text. The exclusion criteria were case-series and case reports (n < 5), reviews, abstracts, and studies of endoscopic-assisted or robotic endoscopic-assisted transaxillary first rib resection. A total of 12 papers met our inclusion criteria and were finally included in this systematic review. All included articles showed improvement of complaints after surgical treatment. In our meta-analysis, improvement to Derkash's classification category excellent/good was achieved in 90% of the arterial and venous TOS groups. Preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand scores show improvement of 28.3 points after operative treatment of neurogenic TOS. In conclusion, surgical treatment of TOS seems to be beneficial in most patients and is relatively safe. The largest challenge remains the diagnosis of TOS, especially neurogenic TOS, because standardized diagnostic criteria are lacking. Future studies should focus on the diagnostic work-up of TOS. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Treatment effect of cyclosporine A in patients with painful bladder syndrome/interstitial cystitis: A systematic review.

    Science.gov (United States)

    Wang, Zhikui; Zhang, Lei

    2016-07-01

    Cyclosporine A (CyA) is emerging as a potential therapeutic strategy for painful bladder syndrome/interstitial cystitis (PBS/IC), which is currently an incurable disease. The purpose of this systematic review was to evaluate the treatment effects of CyA in PBS/IC. Electronic and manual retrieval procedures were carried out to identify eligible references for the systematic review. The entire contents of the included articles were assessed, from study design to reported results. Eight studies, comprising three randomized controlled trials (RCTs), four prospective studies and one retrospective cohort study, were included, involving a total of 298 subjects. Meta-analysis was not implemented due to heterogeneity of the manner of reporting the outcome parameters. All studies reported an improvement in symptoms following treatment with CyA. The results of the three RCTs implied that the treatment effects of CyA were better than those of pentosan polysulfate sodium. Some adverse events, for example, elevation of serum creatinine levels and an increase in blood pressure, were noted in five studies. In conclusion, the evidence from the studies implied that treatment of CyA can result in a long-term benefit in patients of PBS/IC; however, further evidence is required to verify this.

  11. Treatment effect of cyclosporine A in patients with painful bladder syndrome/interstitial cystitis: A systematic review

    Science.gov (United States)

    WANG, ZHIKUI; ZHANG, LEI

    2016-01-01

    Cyclosporine A (CyA) is emerging as a potential therapeutic strategy for painful bladder syndrome/interstitial cystitis (PBS/IC), which is currently an incurable disease. The purpose of this systematic review was to evaluate the treatment effects of CyA in PBS/IC. Electronic and manual retrieval procedures were carried out to identify eligible references for the systematic review. The entire contents of the included articles were assessed, from study design to reported results. Eight studies, comprising three randomized controlled trials (RCTs), four prospective studies and one retrospective cohort study, were included, involving a total of 298 subjects. Meta-analysis was not implemented due to heterogeneity of the manner of reporting the outcome parameters. All studies reported an improvement in symptoms following treatment with CyA. The results of the three RCTs implied that the treatment effects of CyA were better than those of pentosan polysulfate sodium. Some adverse events, for example, elevation of serum creatinine levels and an increase in blood pressure, were noted in five studies. In conclusion, the evidence from the studies implied that treatment of CyA can result in a long-term benefit in patients of PBS/IC; however, further evidence is required to verify this. PMID:27347076

  12. Effects of exercise on functional aerobic capacity in adults with fibromyalgia syndrome: A systematic review of randomized controlled trials.

    Science.gov (United States)

    García-Hermoso, Antonio; Saavedra, Jose M; Escalante, Yolanda

    2015-01-01

    Patients with fibromyalgia present a reduced capacity of upper and lower limb physical performance and affect their independence in performing everyday activities. The purpose of the present systematic review was to summarize evidence for the effectiveness and structure of exercise programs on functional aerobic capacity in patients with fibromyalgia syndrome. Keyword searches were made of seven databases. The systematic review was limited to English language studies of people with FM that evaluated the effects of exercise programs on functional aerobic capacity (6-minute walk test). The criteria for inclusion were satisfied by 12 randomized controlled trial (RCT) studies. The main cumulative evidence indicates that the programs based on aerobic exercise alone and on aquatic exercises have large (effect size = 0.85) and moderate (effect size = 0.44) effects. Aerobic and aquatic exercises at the proper intensity favour the increased functional aerobic capacity of fibromyalgia patients; however, most works do not adequately detail the intensity of the exercises. Moderate intensity exercise (aerobic and aquatic exercise) performed at least two times per week and 30-60 minutes a day is effective for increasing functional aerobic capacity, favouring the daily activities of daily living in this population.

  13. Systematic evaluations of probabilistic floor response spectrum generation

    International Nuclear Information System (INIS)

    Lilhanand, K.; Wing, D.W.; Tseng, W.S.

    1985-01-01

    The relative merits of the current methods for direct generation of probabilistic floor response spectra (FRS) from the prescribed design response spectra (DRS) are evaluated. The explicit probabilistic methods, which explicitly use the relationship between the power spectral density function (PSDF) and response spectra (RS), i.e., the PSDF-RS relationship, are found to have advantages for practical applications over the implicit methods. To evaluate the accuracy of the explicit methods, the root-mean-square (rms) response and the peak factor contained in the PSDF-RS relationship are systematically evaluated, especially for the narrow-band floor spectral response, by comparing the analytical results with simulation results. Based on the evaluation results, a method is recommended for practical use for the direct generation of probabilistic FRS. (orig.)

  14. Economic evaluation of vaccines in Canada: A systematic review.

    Science.gov (United States)

    Chit, Ayman; Lee, Jason K H; Shim, Minsup; Nguyen, Van Hai; Grootendorst, Paul; Wu, Jianhong; Van Exan, Robert; Langley, Joanne M

    2016-05-03

    Economic evaluations should form part of the basis for public health decision making on new vaccine programs. While Canada's national immunization advisory committee does not systematically include economic evaluations in immunization decision making, there is increasing interest in adopting them. We therefore sought to examine the extent and quality of economic evaluations of vaccines in Canada. We conducted a systematic review of economic evaluations of vaccines in Canada to determine and summarize: comprehensiveness across jurisdictions, studied vaccines, funding sources, study designs, research quality, and changes over time. Searches in multiple databases were conducted using the terms "vaccine," "economics" and "Canada." Descriptive data from eligible manuscripts was abstracted and three authors independently evaluated manuscript quality using a 7-point Likert-type scale scoring tool based on criteria from the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). 42/175 articles met the search criteria. Of these, Canada-wide studies were most common (25/42), while provincial studies largely focused on the three populous provinces of Ontario, Quebec and British Columbia. The most common funding source was industry (17/42), followed by government (7/42). 38 studies used mathematical models estimating expected economic benefit while 4 studies examined post-hoc data on established programs. Studies covered 10 diseases, with 28/42 addressing pediatric vaccines. Many studies considered cost-utility (22/42) and the majority of these studies reported favorable economic results (16/22). The mean quality score was 5.9/7 and was consistent over publication date, funding sources, and disease areas. We observed diverse approaches to evaluate vaccine economics in Canada. Given the increased complexity of economic studies evaluating vaccines and the impact of results on public health practice, Canada needs improved, transparent and consistent processes

  15. Components of effective randomized controlled trials of hydrotherapy programs for fibromyalgia syndrome: A systematic review.

    Science.gov (United States)

    Perraton, Luke; Machotka, Zuzana; Kumar, Saravana

    2009-11-30

    Previous systematic reviews have found hydrotherapy to be an effective management strategy for fibromyalgia syndrome (FMS). The aim of this systematic review was to summarize the components of hydrotherapy programs used in randomized controlled trials. A systematic review of randomized controlled trials was conducted. Only trials that have reported significant FMS-related outcomes were included. Data relating to the components of hydrotherapy programs (exercise type, duration, frequency and intensity, environmental factors, and service delivery) were analyzed. Eleven randomized controlled trials were included in this review. Overall, the quality of trials was good. Aerobic exercise featured in all 11 trials and the majority of hydrotherapy programs included either a strengthening or flexibility component. Great variability was noted in both the environmental components of hydrotherapy programs and service delivery. Aerobic exercise, warm up and cool-down periods and relaxation exercises are common features of hydrotherapy programs that report significant FMS-related outcomes. Treatment duration of 60 minutes, frequency of three sessions per week and an intensity equivalent to 60%-80% maximum heart rate were the most commonly reported exercise components. Exercise appears to be the most important component of an effective hydrotherapy program for FMS, particularly when considering mental health-related outcomes.

  16. Non-pharmacological interventions for restless legs syndrome: a systematic review of randomised controlled trials.

    Science.gov (United States)

    Harrison, Eloise G; Keating, Jennifer L; Morgan, Prue E

    2018-03-21

    Restless legs syndrome (RLS) is a sensorimotor disorder characterised by an uncomfortable urge to move the legs. Management is primarily pharmacological. Effects for non-pharmacological, non-surgical options are published but lack systematic examination. To synthesise results of non-pharmacological/non-surgical treatment compared to no-treatment controls or alternative treatment for RLS on any relevant outcome. Databases and reference lists of reviews were searched for randomised controlled trials (RCTs) comparing non-pharmacological treatment to alternative or no treatment controls for idiopathic RLS. Search results were independently screened for inclusion by two researchers; disagreements regarding eligibility were resolved with discussion. Outcomes were summarised, and pooled where possible in meta-analysis. The search yielded 442 articles. Eleven trials met inclusion criteria. Repetitive transcranial magnetic stimulation, exercise, compression devices, counterstrain manipulation, infrared therapy, and standard acupuncture were significantly more effective for RLS severity than control conditions. Vibration pads, cryotherapy, and transcranial direct current stimulation were ineffective in reducing RLS severity. Vibration pads, cryotherapy, yoga, compression devices, and acupuncture significantly improved some sleep-related outcomes. Few studies were identified and quality of evidence was not high. Some non-pharmacological interventions may be beneficial for reducing RLS severity and enhancing sleep. Implications for Rehabilitation The current management of restless leg syndrome is primarily pharmacological, and medications can have unwanted side effects. Repetitive transcranial magnetic stimulation, exercise, compression devices, counterstrain manipulation, infrared therapy, and standard acupuncture may reduce restless leg syndrome severity. Vibration pads, cryotherapy, yoga, compression devices, and acupuncture may improve some sleep-related outcomes in

  17. Evaluation of Marfan syndrome: MR imaging versus CT

    International Nuclear Information System (INIS)

    Soulen, R.L.; Fishman, E.K.; Pyeritz, R.E.; Gott, V.L.; Zerhouni, E.A.

    1986-01-01

    Twenty-five patients with Marfan, syndrome underwent both CT and MR imaging. MR imaging were interpreted in blinded fashion and then compared with CT scans MR imaging was found to be equivalent to CT in the detection of aortic, dural, and hip abnormalities in patients not operated on. MR imaging was superior to CT in the evaluation of postoperative patients because the artifact produced by Bjork-Shirley or St. Jude valves precludes adequate evaluation of the aortic root on CT while producing only a small inferior field distortion (a ''pseudo-ventricular septal defect'') on MR imaging. The absence of radiation exposure is another major advantage of MR imaging in this relatively young population requiring serial studies. The authors conclude that MR imaging is the modality of choice for the evaluation and follow-up of patients with Marfan syndrome and offers an appropriate means of screening their kindred

  18. Prognostic evaluation of Guillain-Barre' syndrome

    International Nuclear Information System (INIS)

    Shah, F.U.; Saeed, A.M.; Badsha, M.; Tariq, M.

    2001-01-01

    Objective: To study the mortality morbidity and the role of specific therapy in guillain-bare' syndrome (GBS). Design: This was a prospective study. Place and Duration of Study: This study was conducted in the department of Neurology, PIMS, Islamabad from January, 1999 to September, 2000. Subjects and Methods: Forty-eight patients with acute symmetrical flaccid motor weakness, which developed with-in a period of four weeks, were included. These patients were assessed at admission discharge and after 2 and 6 months according to the modified Rankin Scale Scope. Patients with sensory level and those having marked and persistent asymmetry of neurological signs were excluded from the study. Results: The modified disability score (DS) n the patients at admission was 2.-5 in 2,11,19 and 16 patients respectively. Respiratory failure was present in 16 patient. Six patients expired. After 2 months, 19 recovered, 10 were lost and diability was present in 13 patients. After 6 months, 20 recovered and 5 were disabled. Specific treatment was given to 23 patients, plasmaphaeresis was done in 10 patients, gammaglobulin given to 4 patients and both in 9 patients. In plasmaphaeresis group at admission DS was 4, 5 and 7 in 3 patients respectively. Three patients expired. At 2 months, 2 recovered, 3 disable while 2 patient were lost, at 6 months 2 recovered, 1 disable while 4 were lost. Similarly, in gammaglobulin group DS was 4 and 5 in 3 and 1 patient at admission. At 2 months, 3 recovered and 1 was disable. In the combined group, admission DS was 4 in 1 and 5 in the 8 patients. At 2 months, 3 recovered, 5 disabled and 1 patient was lost. At 6 months, 3 recovered and 1 patient was lost. At 6 months, 3 recovered and 2 patients were disabled. In the non-specific treatment group, DS was 2 and 3 in 2 and 11 patients at admission. At 2 months, 9 recovered and 3 were disabled while 1 was lost. At 6 months, 11 patients recovered and 2 were disabled. In the control group, at admission, DS

  19. Systematic Review and Meta-Analysis of Intravesical Hyaluronic Acid and Hyaluronic Acid/Chondroitin Sulfate Instillation for Interstitial Cystitis/Painful Bladder Syndrome

    OpenAIRE

    Jung-Soo Pyo; Won Jin Cho

    2016-01-01

    Background/Aims: To assess the efficacy of intravesical hyaluronic acid (HA) and HA/chondroitin sulfate (CS) instillation in patients with interstitial cystitis/painful bladder syndrome by systematic review and meta-analysis. Methods: A systematic literature search was performed using the keywords: ‘interstitial cystitis' or ‘painful bladder syndrome' or ‘bladder pain syndrome' and ‘hyaluronic acid', up to March 31, 2016. The primary outcome was visual analogue scale related pain symptom (VAS...

  20. Shoulder impingement syndrome : evaluation of the causes with MRI

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Yong Ho; Song, In Sup; Chung, Hun Young; Yoon, Sang Jin; Kim, Yang Soo; Shim, Hyung Jin; Choi, Young Hee; Lee, Jong Beum; Lee, Yong Chul; Kim, Kun Sang [Chungang Univ. College of Medicine, Seoul (Korea, Republic of); Choi, Yun Sun [Eulji Hospital, College of Medicine, Seoul (Korea, Republic of)

    1999-12-01

    Various mechanical causes which induce shoulder impingement syndrome have been identified with the help of MRI. The aim of this study is to evaluate the incidence of such causes. A total of 54 patients with clinically confirmed shoulder impingement syndrome and a normal control group(n=20) without symptoms were included. We evaluated the incidence of hook shaped acromion, low lying acromion, downward slope of the acromion, subacromial spur, acromioclavicular joint hypertrophy, coracoacromial ligament hypertrophy, high cuff muscle bulk, and os acromiale. Among the 54 patients, the following conditions were present: acromioclavicular joint hypertrophy(n=36), coracoacromial ligament hypertrophy(n=20), subacromial spur(n=18), downward sloping of the acromion(n=16), hook shaped acromion(n=11), relatively high cuff muscle bulk(n=6), low lying acromion relative to the clavicle(n=3), and os acromiale(n=1). In the normal control group there were nine cases of acromioclavicular joint hypertrophy, nine of coracoacromial ligament hypertrophy, nine of downward sloping acromion, and three of low lying acromion, but hook shaped acromion, high cuff muscle bulk, and os acromiale were not found. Among 54 patients, the syndrome was due to five simultancous causes in one patient, four causes in two, three causes in 12, two causes in 22, and one cause in 17. Hook shaped acromion and subacromial spur are the statistically significant causes of shoulder impingement syndrome. In 69% of patients, the condition was due to more than one cause.

  1. Shoulder impingement syndrome : evaluation of the causes with MRI

    International Nuclear Information System (INIS)

    Choi, Yong Ho; Song, In Sup; Chung, Hun Young; Yoon, Sang Jin; Kim, Yang Soo; Shim, Hyung Jin; Choi, Young Hee; Lee, Jong Beum; Lee, Yong Chul; Kim, Kun Sang; Choi, Yun Sun

    1999-01-01

    Various mechanical causes which induce shoulder impingement syndrome have been identified with the help of MRI. The aim of this study is to evaluate the incidence of such causes. A total of 54 patients with clinically confirmed shoulder impingement syndrome and a normal control group(n=20) without symptoms were included. We evaluated the incidence of hook shaped acromion, low lying acromion, downward slope of the acromion, subacromial spur, acromioclavicular joint hypertrophy, coracoacromial ligament hypertrophy, high cuff muscle bulk, and os acromiale. Among the 54 patients, the following conditions were present: acromioclavicular joint hypertrophy(n=36), coracoacromial ligament hypertrophy(n=20), subacromial spur(n=18), downward sloping of the acromion(n=16), hook shaped acromion(n=11), relatively high cuff muscle bulk(n=6), low lying acromion relative to the clavicle(n=3), and os acromiale(n=1). In the normal control group there were nine cases of acromioclavicular joint hypertrophy, nine of coracoacromial ligament hypertrophy, nine of downward sloping acromion, and three of low lying acromion, but hook shaped acromion, high cuff muscle bulk, and os acromiale were not found. Among 54 patients, the syndrome was due to five simultancous causes in one patient, four causes in two, three causes in 12, two causes in 22, and one cause in 17. Hook shaped acromion and subacromial spur are the statistically significant causes of shoulder impingement syndrome. In 69% of patients, the condition was due to more than one cause

  2. Evaluating hearing aid handling skills: A systematic and descriptive review.

    Science.gov (United States)

    Bennett, Rebecca J; Taljaard, Dunay S; Brennan-Jones, Christopher G; Tegg-Quinn, Susan; Eikelboom, Robert H

    2015-01-01

    To review and appraise the content and quality of surveys that evaluate hearing aid handling. A systematic and descriptive review. Twelve surveys were identified as containing at least one item evaluating hearing aid handling. Fifteen aspects of hearing aid handling were evaluated. None of the surveys evaluated all aspects of handling skills identified. While the majority of studies reported some psychometric evaluation during survey development, the quality of the methodology used and extent of psychometric evaluation reported varied considerably. There is currently no single survey that evaluates handling skills comprehensively. In the absence of an ideal survey, the Practical Hearing aid Skills Test appears to be the most inclusive clinician-administered survey and the Hearing aid User's Questionnaire appears to be the most inclusive self-report survey evaluating hearing aid handling precision; however, there are limitations in the analysis of their psychometric properties. Nonetheless, use of these surveys in clinical practice could identify areas of handling that warrant additional training in order to improve hearing aid success. Research identifying the full range of hearing aid handling skills necessary for successful hearing aid use will further contribute knowledge to the complex construct of successful hearing aid-use.

  3. Acupuncture for irritable bowel syndrome: systematic review and meta-analysis

    Science.gov (United States)

    Manheimer, Eric; Wieland, L. Susan; Cheng, Ke; Li, Shih Min; Shen, Xueyong; Berman, Brian M.; Lao, Lixing

    2013-01-01

    Objective Evidence-based treatment guidelines have been unable to provide evidence-based guidance on the effects of acupuncture for irritable bowel syndrome (IBS) because the only previous systematic review included only small, heterogeneous and methodologically unsound trials. We conducted a new systematic review and meta-analysis of randomized controlled trials (RCTs) to estimate the effects of acupuncture for treating IBS. Methods MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, Cumulative Index to Nursing and Allied Health, and the Chinese databases Sino-Med, CNKI, and VIP were searched through November 2011. Eligible RCTs compared acupuncture with sham acupuncture, other active treatments, or no (specific) treatment, and evaluated acupuncture as an adjuvant to another treatment. Our outcomes were overall IBS symptom severity and health-related quality of life. Dichotomous data were pooled to provide a relative risk (RR) of substantial improvement after treatment, and continuous data were pooled to provide a standardized mean difference (SMD) in post-treatment scores between groups. Results Seventeen RCTs (N=1806) were included. We found no evidence of an improvement with acupuncture relative to sham acupuncture on symptom severity (SMD = −0.11, 95% confidence interval: −0.35 to 0.13; 4 RCTs) or quality of life (SMD = −0.03, −0.27 to 0.22; 3 RCTs). Because of the homogeneity of the results of the sham-controlled trials, results were unaffected by restriction to the 4 sham-controlled RCTs that used adequate randomization, blinding, and had few withdrawals/drop-outs. Among RCTs that did not use a placebo control, acupuncture was more effective than pharmacological therapy (RR of symptom improvement=1.28, 1.12 to 1.45; 5 RCTs) and no (specific) treatment (RR = 2.11, 1.18 to 3.79; 2 RCTs). There was no difference between acupuncture and Bifidobacterium (RR = 1.07, 0.90 to 1.27; 2 RCTs) or between acupuncture and psychotherapy (RR=1.05, 0

  4. Systematic Review of Oral Therapy for the Treatment of Symptoms of Bladder Pain Syndrome: The Brazilian Guidelines.

    Science.gov (United States)

    Santos, Thaís Guimarães Dos; Miranda, Isabela Albuquerque Severo de; Nygaard, Christiana Campani; Schreiner, Lucas; Castro, Rodrigo de Aquino; Haddad, Jorge Milhen

    2018-02-01

    Interstitial cystitis (IC), including bladder pain syndrome (BPS), is a chronic and debilitating disease that mainly affects women. It is characterized by pelvic pain associated with urinary urgency, frequency, nocturia and negative urine culture, with normal cytology. In 2009, the Society for Urodynamics and Female Urology (SUFU) defined the term IC/BPS as "an unpleasant sensation (pain, pressure, and discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms for more than 6 weeks duration, in the absence of infection or other identifiable causes." This is the definition used by the American Urological Association (AUA) in the most recent guidelines on IC/BPS. Interstitial cystitis may be sufficiently severe to have a devastating effect on the quality of life, but it may also be associated with moderate symptoms whose effects are less debilitating. Although there are several clinical trials to assess oral and intravesical therapies, the treatment for IC remains far from ideal. This systematic assessment evaluates published randomized clinical trials on oral medications used to treat symptoms of BPS. This study was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method. Two independent reviewers screened the studies to determine their inclusion or exclusion and to perform the methodological analysis. The inclusion criteria included randomized studies published between April of 1988 and April of 2016 that used oral medications to treat symptoms of BPS or IC. According to the systematic review performed, we should consider pentosan polysulfate as one of the best options of oral drugs for the treatment of BPS symptoms. However, this drug is not an available option in Brazil. Orally administered amitriptyline is an efficacious medical treatment for BPS, and it should be the first treatment offered. Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.

  5. Economic evaluations in gastroenterology in Brazil: A systematic review.

    Science.gov (United States)

    de Paiva Haddad, Luciana Bertocco; Decimoni, Tassia Cristina; Turri, Jose Antonio; Leandro, Roseli; de Soárez, Patrícia Coelho

    2016-02-06

    To systematically review economic evaluations in gastroenterology, relating to Brazil, published between 1980 and 2013. We selected full and partial economic evaluations from among those retrieved by searching the following databases: MEDLINE (PubMed); Excerpta Medica; the Latin American and Caribbean Health Sciences Literature database; the Scientific Electronic Library Online; the database of the Centre for Reviews and Dissemination; the National Health Service (NHS) Economic Evaluation Database; the NHS Health Technology Assessment database; the Health Economics database of the Brazilian Virtual Library of Health; Scopus; Web of Science; and the Brazilian Network for the Evaluation of Health Technologies. Two researchers, working independently, selected the studies and extracted the data. We identified 535 health economic evaluations relating to Brazil and published in the 1980-2013 period. Of those 535 articles, only 40 dealt with gastroenterology. Full and partial economic evaluations respectively accounted for 23 (57.5%) and 17 (42.5%) of the 40 studies included. Among the 23 full economic evaluations, there were 11 cost-utility analyses, seven cost-effectiveness analyses, four cost-consequence analyses, and one cost-minimization analysis. Of the 40 studies, 25 (62.5%) evaluated medications; 7 (17.5%) evaluated procedures; and 3 (7.5%) evaluated equipment. Most (55%) of the studies were related to viral hepatitis, and most (63.4%) were published after 2010. Other topics included gastrointestinal cancer, liver transplantation, digestive diseases and hernias. Over the 33-year period examined, the number of such economic evaluations relating to Brazil, especially of those evaluating medications for the treatment of hepatitis, increased considerably. Further studies are needed in order to ensure that expenditures on health care in Brazil are made as fairly and efficiently as possible.

  6. Does Cardiac Rehabilitation After an Acute Cardiac Syndrome Lead to Changes in Physical Activity Habits? Systematic Review

    NARCIS (Netherlands)

    ter Hoeve, Nienke; Huisstede, Bionka M. A.; Stam, Henk J.; van Domburg, Ron T.; Sunamura, Madoka; van den Berg-Emons, Rita J. G.

    Background. Optimal physical activity levels have health benefits for patients with acute coronary syndrome (ACS) and are an important goal of cardiac rehabilitation (CR). Purpose. The purpose of this study was to systematically review literature regarding short-term effects (= 6 months after

  7. Gut-directed hypnotherapy for functional abdominal pain or irritable bowel syndrome in children: a systematic review

    NARCIS (Netherlands)

    Rutten, Juliette M. T. M.; Reitsma, Johannes B.; Vlieger, Arine M.; Benninga, Marc A.

    2013-01-01

    Gut directed hypnotherapy (HT) is shown to be effective in adult functional abdominal pain (FAP) and irritable bowel syndrome (IBS) patients. We performed a systematic review to assess efficacy of HT in paediatric FAP/IBS patients. We searched Medline, Embase, PsychINFO, Cumulative Index to Nursing

  8. Recurrent twin-twin transfusion syndrome after selective fetoscopic laser photocoagulation: a systematic review of the literature.

    LENUS (Irish Health Repository)

    Walsh, C A

    2012-11-01

    Selective fetoscopic laser photocoagulation (SFLP) is now the treatment of choice for twin-twin transfusion syndrome (TTTS). The incidence of recurrent TTTS following SFLP has been inconsistently reported across different studies. We performed a systematic review of TTTS recurrence following SFLP.

  9. Systematic evaluation of atmospheric chemistry-transport model CHIMERE

    Science.gov (United States)

    Khvorostyanov, Dmitry; Menut, Laurent; Mailler, Sylvain; Siour, Guillaume; Couvidat, Florian; Bessagnet, Bertrand; Turquety, Solene

    2017-04-01

    Regional-scale atmospheric chemistry-transport models (CTM) are used to develop air quality regulatory measures, to support environmentally sensitive decisions in the industry, and to address variety of scientific questions involving the atmospheric composition. Model performance evaluation with measurement data is critical to understand their limits and the degree of confidence in model results. CHIMERE CTM (http://www.lmd.polytechnique.fr/chimere/) is a French national tool for operational forecast and decision support and is widely used in the international research community in various areas of atmospheric chemistry and physics, climate, and environment (http://www.lmd.polytechnique.fr/chimere/CW-articles.php). This work presents the model evaluation framework applied systematically to the new CHIMERE CTM versions in the course of the continuous model development. The framework uses three of the four CTM evaluation types identified by the Environmental Protection Agency (EPA) and the American Meteorological Society (AMS): operational, diagnostic, and dynamic. It allows to compare the overall model performance in subsequent model versions (operational evaluation), identify specific processes and/or model inputs that could be improved (diagnostic evaluation), and test the model sensitivity to the changes in air quality, such as emission reductions and meteorological events (dynamic evaluation). The observation datasets currently used for the evaluation are: EMEP (surface concentrations), AERONET (optical depths), and WOUDC (ozone sounding profiles). The framework is implemented as an automated processing chain and allows interactive exploration of the results via a web interface.

  10. Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors

    OpenAIRE

    Waryasz, Gregory R; McDermott, Ann Y

    2008-01-01

    Background Patellofemoral Pain Syndrome (PFPS), a common cause of anterior knee pain, is successfully treated in over 2/3 of patients through rehabilitation protocols designed to reduce pain and return function to the individual. Applying preventive medicine strategies, the majority of cases of PFPS may be avoided if a pre-diagnosis can be made by clinician or certified athletic trainer testing the current researched potential risk factors during a Preparticipation Screening Evaluation (PPSE)...

  11. Spondylocarpotarsal synostosis syndrome: MRI evaluation of vertebral and disk malformation

    Energy Technology Data Exchange (ETDEWEB)

    Breitling, Magnus; Rabin, Michael [University of Saskatchewan, Department of Medical Imaging, Saskatoon, Saskatchewan (Canada); Lemire, Edmond G. [University of Saskatchewan, Division of Medical Genetics, Department of Pediatrics, Saskatoon (Canada)

    2006-08-15

    Spondylocarpotarsal synostosis syndrome (SSS) is a rare autosomal recessive condition characterized primarily by vertebral malsegmentation, carpal/tarsal coalition, and a dysmorphic appearance. Differentiating SSS from other congenital scoliosis syndromes requires evaluation of the vertebrae, ribs, soft tissues, and spinal cord. The enhanced resolution over plain radiographs seen with MRI allows more detailed assessment of vertebral malformation and surrounding anatomy. Diagnosis of the underlying cause of congenital scoliosis might be enhanced using this technology. We report on a 12-year-old girl of unaffected parents with SSS who was evaluated with MRI sequences of the spine to show various types of malsegmentation. Additionally, there is the new finding of fusion of teeth, with developmental failure of a canine incisor. (orig.)

  12. Cauda equina syndrome in the dog: radiographic evaluation

    International Nuclear Information System (INIS)

    Morgan, J.P.; Bailey, C.S.

    1990-01-01

    Dogs with clinical signs typical of cauda equina syndrome require careful evaluation to determine the cause of the disease as this strongly influences choice of treatment. Possible aetiologies include congenital or developmental, inflammatory, traumatic, neoplastic, and degenerative lesions that may involve vertebrae, vertebral joints, intervertebral discs, spinal cord, spinal nerves, or meninges. It must be determined whether clinical signs are due to musculoskeletal or neurological disease before performing special radiographic procedures. Non-contrast radiography permits false-positive diagnosis of obvious degenerative changes involving the L-S disc that may be without clinical signs or permits a false-negative diagnosis due to the failure to appreciate soft tissue lesions not seen radiographically. Special radiographic techniques are recommended and include: (1) stress radiography, (2) discography, and (3) epidural myelography. Evaluation of the results of these studies assists in determining the cause of the cauda equina syndrome and the type of therapy required

  13. WS1 gene mutation analysis of Wolfram syndrome in a Chinese patient and a systematic review of literatures.

    Science.gov (United States)

    Yu, Guang; Yu, Man-li; Wang, Jia-feng; Gao, Cong-rong; Chen, Zhong-jin

    2010-10-01

    Wolfram syndrome is a rare hereditary disease characterized by diabetes mellitus and optic atrophy. The outcome of this disease is always poor. WFS1 gene mutation is the main cause of this disease. A patient with diabetes mellitus, diabetes insipidus, renal tract disorder, psychiatric abnormality, and cataract was diagnosed with Wolfram syndrome. Mutations in open reading frame (ORF) of WFS1 gene was analyzed by sequencing. Mutations in WFS1 gene was also summarized by a systematic review in Pubmed and Chinese biological and medical database. Sequencing of WFS1 gene in this patient showed a new mutation, 1962G>A, and two other non-sense mutations, 2433A>G and 2565G>A. Systematic review included 219 patients in total and identified 172 WFS1 gene mutations, most of which were located in Exon 8. These mutations in WFS1 gene might be useful in prenatal diagnosis of Wolfram syndrome.

  14. Assessment of activity limitations and participation restrictions with persons with chronic fatigue syndrome: a systematic review.

    Science.gov (United States)

    Vergauwen, Kuni; Huijnen, Ivan P J; Kos, Daphne; Van de Velde, Dominique; van Eupen, Inge; Meeus, Mira

    2015-01-01

    To summarize measurement instruments used to evaluate activity limitations and participation restrictions in patients with chronic fatigue syndrome (CFS) and review the psychometric properties of these instruments. General information of all included measurement instruments was extracted. The methodological quality was evaluated using the COSMIN checklist. Results of the measurement properties were rated based on the quality criteria of Terwee et al. Finally, overall quality was defined per psychometric property and measurement instrument by use of the quality criteria by Schellingerhout et al. A total of 68 articles were identified of which eight evaluated the psychometric properties of a measurement instrument assessing activity limitations and participation restrictions. One disease-specific and 37 generic measurement instruments were found. Limited evidence was found for the psychometric properties and clinical usability of these instruments. However, the CFS-activities and participation questionnaire (APQ) is a disease-specific instrument with moderate content and construct validity. The psychometric properties of the reviewed measurement instruments to evaluate activity limitations and participation restrictions are not sufficiently evaluated. Future research is needed to evaluate the psychometric properties of the measurement instruments, including the other properties of the CFS-APQ. If it is necessary to use a measurement instrument, the CFS-APQ is recommended. Chronic fatigue syndrome (CFS). Chronic fatigue syndrome causes activity limitations and participation restrictions in one or more areas of life. Standardized, reliable and valid measurement instruments are necessary to identify these limitations and restrictions. Currently, no measurement instrument is sufficiently evaluated with persons with CFS. If a measurement instrument is needed to identify activity limitations and participation restrictions with persons with CFS, it is recommended to use

  15. Behavior Therapy for Tourette Syndrome: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Wile, Daryl J; Pringsheim, Tamara M

    2013-08-01

    When tics caused by Tourette Syndrome cause meaningful impairment for patients, a comprehensive treatment approach includes education of patients, peers, and family, treatment of comorbid behavioral disorders if present, and consideration of behavior therapy and pharmacotherapy for tics themselves. This systematic review and meta-analysis demonstrates that behavior therapies based on Habit Reversal Therapy, including the Comprehensive Behavioral Intervention for Tics are effective in reducing tic severity when compared with supportive psychotherapy. When these behavior therapies are unavailable, Exposure with Response Prevention may also be effective. Both face-to-face and telehealth delivery methods for behavior therapy improve tic severity, and broader distribution of behavior therapy through increased training or telehealth methods is encouraged. High-quality randomized trials comparing behavior therapies for tics with pharmacotherapy are needed.

  16. Co-occurrence of Pain Symptoms and Somatosensory Sensitivity in Burning Mouth Syndrome: A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Xavier Moisset

    Full Text Available Burning mouth syndrome (BMS is a chronic and spontaneous oral pain with burning quality in the tongue or other oral mucosa without any identifiable oral lesion or laboratory finding. Pathogenesis and etiology of BMS are still unknown. However, BMS has been associated with other chronic pain syndromes including other idiopathic orofacial pain, the dynias group and the family of central sensitivity syndromes. This would imply that BMS shares common mechanisms with other cephalic and/or extracephalic chronic pains. The primary aim of this systematic review was to determine whether BMS is actually associated with other pain syndromes, and to analyze cephalic and extracephalic somatosensory sensitivity in these patients.This report followed the PRISMA Statement. An electronic search was performed until January 2015 in PubMed, Cochrane library, Wiley and ScienceDirect. Searched terms included "burning mouth syndrome OR stomatodynia OR glossodynia OR burning tongue OR oral burning". Studies were selected according to predefined inclusion criteria (report of an association between BMS and other pain(s symptoms or of cutaneous cephalic and/or extracephalic quantitative sensory testing in BMS patients, and a descriptive analysis conducted.The search retrieved 1512 reports. Out of these, twelve articles met criteria for co-occurring pain symptoms and nine studies for quantitative sensory testing (QST in BMS patients. The analysis reveals that in BMS patients co-occurring pain symptoms are rare, assessed by only 0.8% (12 of 1512 of the retrieved studies. BMS was associated with headaches, TMD, atypical facial pain, trigeminal neuralgia, post-herpetic facial pain, back pain, fibromyalgia, joint pain, abdominal pain, rectal pain or vulvodynia. However, the prevalence of pain symptoms in BMS patients is not different from that in the age-matched general population. QST studies reveal no or inconsistent evidence of abnormal cutaneous cephalic and extracephalic

  17. Intravesical Botulinum Toxin A Injections for Bladder Pain Syndrome/Interstitial Cystitis: A Systematic Review and Meta-Analysis of Controlled Studies

    OpenAIRE

    Wang, Junpeng; Wang, Qiang; Wu, Qinghui; Chen, Yang; Wu, Peng

    2016-01-01

    Background The role of intravesical botulinum toxin A (BTX-A) injections in bladder pain syndrome/interstitial cystitis (BPS/IC) has not been clearly defined. The aim of this study was to evaluate high-level evidence regarding the efficacy and safety of BTX-A injections for BPS/IC. Material/Methods We conducted a comprehensive search of PubMed, Embase, and Web of Science, and conducted a systematic review and meta-analysis of all available randomized controlled trials (RCTs) and controlled st...

  18. Evaluation of Ashwagandha in alcohol withdrawal syndrome

    Directory of Open Access Journals (Sweden)

    Ruby B

    2012-10-01

    Full Text Available Objective: To evaluate the effect of Ashwagandha (ASW in attenuation of alcohol withdrawal in ethanol withdrawal mice model. Methods: Alcohol dependence was induced in mice by the oral, once-daily administration of 10% v/v ethanol (2 g/kg for one week. Once the animals were withdrawn from alcohol, the efficacy of ASW (200mg/kg and 500mg/kg in comparison with diazepam (1 mg/kg in the attenuation of withdrawal was studied using, pentylenetetrazole (PTZ kindling test for seizure threshold, forced swim test (FST for depression and locomotor activity (LCA in open field test (OFT. 6 hours after the last ethanol administration, seizure threshold was measured in all the groups by administering the convulsant drug, PTZ with a subconvulsive dose of 30 mg/kg i.p. In FST, mice were forced to swim and the total duration of immobility (seconds was measured during the last 4 min of a single 6-min test session. In OFT, number of crossings of the lines marked on the floor was recorded for a period of 5 min. Results: Compared to ethanol group, ASW (500 mg/Kg has suppressed the PTZ kindling seizures in ethanol withdrawal animals [0% convulsion], FST has shown decreased immobility time and OFT has exhibited increase in the number of line crossing activity by mice which may be the consequence of anxiolytic activity of ASW similar to that of diazepam. Conclusions: The present study provides satisfactory evidence to use ASW as a safe and reliable alternative to diazepam in alcohol withdrawal conditions.

  19. Methadone dose and neonatal abstinence syndrome-systematic review and meta-analysis.

    LENUS (Irish Health Repository)

    Cleary, Brian J

    2012-02-01

    AIM: To determine if there is a relationship between maternal methadone dose in pregnancy and the diagnosis or medical treatment of neonatal abstinence syndrome (NAS). METHODS: PubMed, EMBASE, the Cochrane Library and PsychINFO were searched for studies reporting on methadone use in pregnancy and NAS (1966-2009). The relative risk (RR) of NAS was compared for methadone doses above versus below a range of cut-off points. Summary RRs and 95% confidence intervals (CI) were estimated using random effects meta-analysis. Sensitivity analyses explored the impact of limiting meta-analyses to prospective studies or studies using an objective scoring system to diagnose NAS. RESULTS: A total of 67 studies met inclusion criteria for the systematic review; 29 were included in the meta-analysis. Any differences in the incidence of NAS in infants of women on higher compared with lower doses were statistically non-significant in analyses restricted to prospective studies or to those using an objective scoring system to diagnose NAS. CONCLUSIONS: Severity of the neonatal abstinence syndrome does not appear to differ according to whether mothers are on high- or low-dose methadone maintenance therapy.

  20. Antiphospholipid syndrome and recurrent miscarriage: A systematic review and meta-analysis.

    Science.gov (United States)

    Santos, Thaís da Silva; Ieque, Andressa Lorena; de Carvalho, Hayalla Corrêa; Sell, Ana Maria; Lonardoni, Maria Valdrinez Campana; Demarchi, Izabel Galhardo; de Lima Neto, Quirino Alves; Teixeira, Jorge Juarez Vieira

    2017-09-01

    Antiphospholipid syndrome (APS) is an autoimmune condition that is associated with thrombosis and morbidity in pregnancy. The exact mechanisms by which these associations occur appear to be heterogeneous and are not yet well understood. The aim of this study was to identify and analyze publications in recent years to better understand the diagnosis and its contribution to monitoring APS among women with recurrent miscarriage (RM). This systematic review and meta-analysis was conducted using the PubMed and Web of Knowledge databases, with articles published between 2010 and 2014, according to the PRISMA statement. Of the 85 identified studies, nine were selected. Most of the studies reported an association between recurrent miscarriage and specific antiphospholipid antibodies, as anticardiolipin antibodies (aCL), lupus anticoagulant (LA), anti-β2-glycoprotein I antibodies (aβ2GPI) and antiphosphatidylserine (aPS), which showed a relationship with RM. The main result of the meta-analysis revealed association between antiphospholipid antibodies (aPLs) and/or APS compared to the patients with RM (OR: 0.279; 95% CI: 0.212-0.366) and APS cases compared to the patients with RM (OR: 0.083; 95% CI: 0.036-0.189). High heterogeneity among these studies (I 2 =100.0%, p antiphospholipid antibodies and/or antiphospholipid syndrome in patients with recurrent miscarriage. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Dopamine dysregulation syndrome in Parkinson's disease: a systematic review of published cases.

    Science.gov (United States)

    Warren, Nicola; O'Gorman, Cullen; Lehn, Alexander; Siskind, Dan

    2017-12-01

    Dopamine dysregulation syndrome (DDS) is an uncommon complication of the treatment of Parkinson's disease, characterised by addictive behaviour and excessive use of dopaminergic medication. DDS may frequently go unrecognised or misdiagnosed. We aimed to clarify current understanding of presentation, risk factors, comorbidities and management of DDS. Case reports were identified through a systematic search of databases (PubMed, Embase) with the following terms: dopaminergic dysregulation syndrome, hedonistic homeostatic dysregulation, dopamine/levodopa addiction. We reviewed 390 articles, identifying 98 cases of DDS. Early-onset Parkinson's disease (67%) and male gender (83%) were common. DDS presented with significant physical and social impairment, actions to enable or prevent detection of overuse, as well as mood, anxiety and motor fluctuations. All DDS cases met DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) substance use disorder criteria. Past substance and psychiatric history was present in 15.3% and 10.2% of cases. Comorbid impulse control disorders (61%), psychosis (32%) and panic attacks (14%) were common. A large variety of management strategies were used; only 56% of cases resolving. Sodium valproate was successful in 5/5 cases. The response to deep brain stimulation varied. Given the functional impairment, medical and psychiatric consequences and the difficulties of treatment, early identification of DDS should be a priority. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. Descending pain modulation in irritable bowel syndrome (IBS): a systematic review and meta-analysis.

    Science.gov (United States)

    Chakiath, Rosemary J; Siddall, Philip J; Kellow, John E; Hush, Julia M; Jones, Mike P; Marcuzzi, Anna; Wrigley, Paul J

    2015-12-10

    Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. While abdominal pain is a dominant symptom of IBS, many sufferers also report widespread hypersensitivity and present with other chronic pain conditions. The presence of widespread hypersensitivity and extra-intestinal pain conditions suggests central nervous dysfunction. While central nervous system dysfunction may involve the spinal cord (central sensitisation) and brain, this review will focus on one brain mechanism, descending pain modulation. We will conduct a comprehensive search for the articles indexed in the databases Ovid MEDLINE, Ovid Embase, Ovid PsycINFO and Cochrane Central Register of Controlled Trial (CENTRAL) from their inception to August 2015, that report on any aspect of descending pain modulation in irritable bowel syndrome. Two independent reviewers will screen studies for eligibility, assess risk of bias and extract relevant data. Results will be tabulated and, if possible, a meta-analysis will be carried out. The systematic review outlined in this protocol aims to summarise current knowledge regarding descending pain modulation in IBS. PROSPERO CRD42015024284.

  3. School-based vaccination: a systematic review of process evaluations.

    Science.gov (United States)

    Cooper Robbins, Spring Chenoa; Ward, Kirsten; Skinner, S Rachel

    2011-12-06

    School-based vaccination is becoming a more widely used method of vaccine delivery. However, evaluations of school-based vaccination program implementation have not been systematically reviewed. This paper describes the results of a systematic review of the literature on process (or implementation) evaluations of school-based vaccination delivery. Search terms: "school based vaccination" OR (("schools" OR "school") AND ("immunisation" OR "immunization" OR "vaccination")). Humans; English language; Age: 6-18 (school-age children and adolescents); No editorials; No letters. Databases: PUBMED; Embase.com; Cochrane Database of Systematic Reviews; Cinahl; Web of Science; PsycINFO. Inclusions: Articles must have originated from an advanced economic 'developed' country, be peer-reviewed, available in English, randomised or non-randomised controlled design, published from 1970 to August 2010 and focused on vaccinations provided in the school setting and during school time which reported one or more outcomes. qualitative or descriptive papers without any evaluation component; papers that only reported on impact evaluation (i.e. number of students vaccinated); and those published before 1970. A total of 14 articles were identified as including some element of a process evaluation of a school-based vaccination program. Nurses, parents, teachers, and adolescents were involved in measures of procedural factors related to school-based vaccination implementation. Outcomes included return rates of consent forms; knowledge about the specific vaccine offered; attitudes toward vaccination and school-based vaccination; reasons for non-vaccination; resources, support, and procedures related to implementation; and environmental factors within the school that may impact vaccination success. Vaccination coverage was also reported in the majority of papers. Many studies reported on the importance of ensuring all stakeholders (school nurses, parents, teachers, and adolescents) receive

  4. Systematic Evaluation of Uncertainty in Material Flow Analysis

    DEFF Research Database (Denmark)

    Laner, David; Rechberger, Helmut; Astrup, Thomas Fruergaard

    2014-01-01

    Material flow analysis (MFA) is a tool to investigate material flows and stocks in defined systems as a basis for resource management or environmental pollution control. Because of the diverse nature of sources and the varying quality and availability of data, MFA results are inherently uncertain....... Uncertainty analyses have received increasing attention in recent MFA studies, but systematic approaches for selection of appropriate uncertainty tools are missing. This article reviews existing literature related to handling of uncertainty in MFA studies and evaluates current practice of uncertainty analysis......) and exploratory MFA (identification of critical parameters and system behavior). Whereas mathematically simpler concepts focusing on data uncertainty characterization are appropriate for descriptive MFAs, statistical approaches enabling more-rigorous evaluation of uncertainty and model sensitivity are needed...

  5. Vitamin and mineral status in chronic fatigue syndrome and fibromyalgia syndrome: A systematic review and meta-analysis.

    Science.gov (United States)

    Joustra, Monica L; Minovic, Isidor; Janssens, Karin A M; Bakker, Stephan J L; Rosmalen, Judith G M

    2017-01-01

    Many chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS) patients (35-68%) use nutritional supplements, while it is unclear whether deficiencies in vitamins and minerals contribute to symptoms in these patients. Objectives were (1) to determine vitamin and mineral status in CFS and FMS patients as compared to healthy controls; (2) to investigate the association between vitamin and mineral status and clinical parameters, including symptom severity and quality of life; and (3) to determine the effect of supplementation on clinical parameters. The databases PubMed, EMBASE, Web of Knowledge, and PsycINFO were searched for eligible studies. Articles published from January 1st 1994 for CFS patients and 1990 for FMS patients till March 1st 2017 were included. Articles were included if the status of one or more vitamins or minerals were reported, or an intervention concerning vitamins or minerals was performed. Two reviewers independently extracted data and assessed the risk of bias. A total of 5 RCTs and 40 observational studies were included in the qualitative synthesis, of which 27 studies were included in the meta-analyses. Circulating concentrations of vitamin E were lower in patients compared to controls (pooled standardized mean difference (SMD): -1.57, 95%CI: -3.09, -0.05; p = .042). However, this difference was not present when restricting the analyses to the subgroup of studies with high quality scores. Poor study quality and a substantial heterogeneity in most studies was found. No vitamins or minerals have been repeatedly or consistently linked to clinical parameters. In addition, RCTs testing supplements containing these vitamins and/or minerals did not result in clinical improvements. Little evidence was found to support the hypothesis that vitamin and mineral deficiencies play a role in the pathophysiology of CFS and FMS, and that the use of supplements is effective in these patients. Study methods were documented in an international prospective

  6. Vitamin and mineral status in chronic fatigue syndrome and fibromyalgia syndrome: A systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Monica L Joustra

    Full Text Available Many chronic fatigue syndrome (CFS and fibromyalgia syndrome (FMS patients (35-68% use nutritional supplements, while it is unclear whether deficiencies in vitamins and minerals contribute to symptoms in these patients. Objectives were (1 to determine vitamin and mineral status in CFS and FMS patients as compared to healthy controls; (2 to investigate the association between vitamin and mineral status and clinical parameters, including symptom severity and quality of life; and (3 to determine the effect of supplementation on clinical parameters.The databases PubMed, EMBASE, Web of Knowledge, and PsycINFO were searched for eligible studies. Articles published from January 1st 1994 for CFS patients and 1990 for FMS patients till March 1st 2017 were included. Articles were included if the status of one or more vitamins or minerals were reported, or an intervention concerning vitamins or minerals was performed. Two reviewers independently extracted data and assessed the risk of bias.A total of 5 RCTs and 40 observational studies were included in the qualitative synthesis, of which 27 studies were included in the meta-analyses. Circulating concentrations of vitamin E were lower in patients compared to controls (pooled standardized mean difference (SMD: -1.57, 95%CI: -3.09, -0.05; p = .042. However, this difference was not present when restricting the analyses to the subgroup of studies with high quality scores. Poor study quality and a substantial heterogeneity in most studies was found. No vitamins or minerals have been repeatedly or consistently linked to clinical parameters. In addition, RCTs testing supplements containing these vitamins and/or minerals did not result in clinical improvements.Little evidence was found to support the hypothesis that vitamin and mineral deficiencies play a role in the pathophysiology of CFS and FMS, and that the use of supplements is effective in these patients.Study methods were documented in an international

  7. Psychosocial Risk Factors and the Association With Carpal Tunnel Syndrome: A Systematic Review.

    Science.gov (United States)

    Mansfield, Michael; Thacker, Michael; Sandford, Fiona

    2017-10-01

    Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Research has shown that associative factors for CTS include occupational and biomechanical elements, gender, and age. To date, no systematic review has been undertaken to determine specifically whether there are any psychosocial risk factors in developing CTS. The objective is to determine whether psychosocial factors are associated with and/or predict the development of CTS. A systematic review was conducted including searches of PubMed (MEDLINE), EMBASE, and CINAHL from inception to May 30, 2017. Quantitative studies must have investigated a minimum of 1 or more psychosocial factors-cognitive, affective, behavioral, vocational, or interpersonal processes (eg, social support)-and include a point or risk estimate. One reviewer conducted the search and 2 reviewers independently assessed eligibility and completed methodological quality assessment using a modified Downs and Black checklist. Data were analyzed narratively. Six moderate- to high-quality studies were included in the final review. Five studies reported a positive association between psychosocial factors and CTS, where psychosocial factors were more in those who reported CTS. One study reported no positive or negative association with CTS development. Four studies reported a negative association between psychosocial factors and CTS, where psychosocial factors were less in those who reported CTS. There is limited evidence for a positive association between psychosocial factors and CTS. However, this was not a consistent finding across all included studies. Further research is indicated in standardizing CTS diagnostic criteria and investigating other working environments.

  8. Usability evaluation techniques in mobile commerce applications: A systematic review

    Science.gov (United States)

    Hussain, Azham; Mkpojiogu, Emmanuel O. C.

    2016-08-01

    Obviously, there are a number of literatures concerning the usability of mobile commerce (m-commerce) applications and related areas, but they do not adequately provide knowledge about usability techniques used in most of the empirical usability evaluation for m-commerce application. Therefore, this paper is aimed at producing the usability techniques frequently used in the aspect of usability evaluation for m-commerce applications. To achieve the stated objective, systematic literature review was employed. Sixty seven papers were downloaded in usability evaluation for m-commerce and related areas; twenty one most relevant studies were selected for review in order to extract the appropriate information. The results from the review shows that heuristic evaluation, formal test and think aloud methods are the most commonly used methods in m-commerce application in comparison to cognitive walkthrough and the informal test methods. Moreover, most of the studies applied control experiment (33.3% of the total studies); other studies that applied case study for usability evaluation are 14.28%. The results from this paper provide additional knowledge to the usability practitioners and research community for the current state and use of usability techniques in m-commerce application.

  9. Pelvic floor electrostimulation in women with urinary incontinence and/or overactive bladder syndrome: a systematic review.

    Science.gov (United States)

    Jerez-Roig, J; Souza, D L B; Espelt, A; Costa-Marín, M; Belda-Molina, A M

    2013-01-01

    Electrostimulation (ES) is one of the techniques employed in conservative treatment of urinary incontinence (UI) and/or overactive bladder syndrome (OAB). Nevertheless, there is controversy in the scientific literature regarding its effectiveness as monotherapy. To evaluate the scientific evidence on ES of the pelvic floor in women with UI and with/without OAB. A systematic review of clinical trials was carried out in the following databases: PubMed, Cochrane, PEDro, Elsevier (Doyma) and EnFisPo (1980-2011). Quality of study registries was evaluated and information was obtained from those that presented the inclusion criteria established in the review. The 27 clinical trials were included in the review: 13 randomized controlled trials, 11 randomized non-controlled trials and 3 non-randomized trials. Most of the clinical trials conclude that ES is effective in the treatment of UI and OAB in women. However, better methodological quality studies are needed to obtain a higher level of scientific evidence and to know the optimal current modality, type and parameters for each type of UI and OAB. Copyright © 2012 AEU. Published by Elsevier Espana. All rights reserved.

  10. Effects of Kinesio Taping versus McConnell Taping for Patellofemoral Pain Syndrome: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Wen-Dien Chang

    2015-01-01

    Full Text Available Objectives. To conduct a systematic review comparing the effects of Kinesio taping with McConnell taping as a method of conservative management of patients with patellofemoral pain syndrome (PFPS. Methods. MEDLINE, PUBMED, EMBASE, AMED, and the Cochrane Central Register of Control Trials electronic databases were searched through July 2014. Controlled studies evaluating the effects of Kinesio or McConnell taping in PFPS patients were retrieved. Results. Ninety-one articles were selected from the articles that were retrieved from the databases, and 11 articles were included in the analysis. The methods, evaluations, and results of the articles were collected, and the outcomes of patellar tapings were analyzed. Kinesio taping can reduce pain and increase the muscular flexibility of PFPS patients, and McConnell taping also had effect in pain relief and patellar alignment. Meta-analysis showed small effect in pain reduction and motor function improvement and moderate effect in muscle activity change among PFPS patients using Kinesio taping. Conclusions. Kinesio taping technique used for muscles can relieve pain but cannot change patellar alignment, unlike McConnell taping. Both patellar tapings are used differently for PFPS patients and substantially improve muscle activity, motor function, and quality of life.

  11. Assisting allied health in performance evaluation: a systematic review.

    Science.gov (United States)

    Lizarondo, Lucylynn; Grimmer, Karen; Kumar, Saravana

    2014-11-14

    Performance evaluation raises several challenges to allied health practitioners and there is no agreed approach to measuring or monitoring allied health service performance. The aim of this review was to examine the literature on performance evaluation in healthcare to assist in the establishment of a framework that can guide the measurement and evaluation of allied health clinical service performance. This review determined the core elements of a performance evaluation system, tools for evaluating performance, and barriers to the implementation of performance evaluation. A systematic review of the literature was undertaken. Five electronic databases were used to search for relevant articles: MEDLINE, Embase, CINAHL, PsychInfo, and Academic Search Premier. Articles which focussed on any allied health performance evaluation or those which examined performance in health care in general were considered in the review. Content analysis was used to synthesise the findings from individual articles. A total of 37 articles were included in the review. The literature suggests there are core elements involved in performance evaluation which include prioritising clinical areas for measurement, setting goals, selecting performance measures, identifying sources of feedback, undertaking performance measurement, and reporting the results to relevant stakeholders. The literature describes performance evaluation as multi-dimensional, requiring information or data from more than one perspective to provide a rich assessment of performance. A range of tools or instruments are available to capture various perspectives and gather a comprehensive picture of health care quality. Every allied health care delivery system has different performance needs and will therefore require different approaches. However, there are core processes that can be used as a framework to evaluate allied health performance. A careful examination of barriers to performance evaluation and subsequent tailoring of

  12. Evaluation and Treatment of Pericarditis: A Systematic Review.

    Science.gov (United States)

    Imazio, Massimo; Gaita, Fiorenzo; LeWinter, Martin

    2015-10-13

    Pericarditis is the most common form of pericardial disease and a relatively common cause of chest pain. To summarize published evidence on the causes, diagnosis, therapy, prevention, and prognosis of pericarditis. A literature search of BioMedCentral, Google Scholar, MEDLINE, Scopus, and the Cochrane Database of Systematic Reviews was performed for human studies without language restriction from January 1, 1990, to August 31, 2015. After literature review and selection of meta-analyses, randomized clinical trials, and large observational studies, 30 studies (5 meta-analyses, 10 randomized clinical trials, and 16 cohort studies) with 7569 adult patients were selected for inclusion. The etiology of pericarditis may be infectious (eg, viral and bacterial) or noninfectious (eg, systemic inflammatory diseases, cancer, and post-cardiac injury syndromes). Tuberculosis is a major cause of pericarditis in developing countries but accounts for less than 5% of cases in developed countries, where idiopathic, presumed viral causes are responsible for 80% to 90% of cases. The diagnosis is based on clinical criteria including chest pain, a pericardial rub, electrocardiographic changes, and pericardial effusion. Certain features at presentation (temperature >38°C [>100.4°F], subacute course, large effusion or tamponade, and failure of nonsteroidal anti-inflammatory drug [NSAID] treatment) indicate a poorer prognosis and identify patients requiring hospital admission. The most common treatment for idiopathic and viral pericarditis in North America and Europe is NSAID therapy. Adjunctive colchicine can ameliorate the initial episode and is associated with approximately 50% lower recurrence rates. Corticosteroids are a second-line therapy for those who do not respond, are intolerant, or have contraindications to NSAIDs and colchicine. Recurrences may occur in 30% of patients without preventive therapy. Pericarditis is the most common form of pericardial disease worldwide and may

  13. Evaluation of Health Economics in Radiation Oncology: A Systematic Review

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Timothy K.; Goodman, Chris D. [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Boldt, R. Gabriel [London Health Sciences Centre, London, Ontario (Canada); Warner, Andrew; Palma, David A. [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Rodrigues, George B. [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Department of Epidemiology and Biostatistics, Western University, London, Ontario (Canada); Lock, Michael I. [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Mishra, Mark V. [Department of Radiation Oncology, University of Maryland, Baltimore, Maryland (United States); Zaric, Gregory S. [Department of Epidemiology and Biostatistics, Western University, London, Ontario (Canada); Ivey Business School, Western University, London, Ontario (Canada); Louie, Alexander V., E-mail: Dr.alexlouie@gmail.com [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Department of Epidemiology and Biostatistics, Western University, London, Ontario (Canada)

    2016-04-01

    Purpose: Despite the rising costs in radiation oncology, the impact of health economics research on radiation therapy practice analysis patterns is unclear. We performed a systematic review of cost-effectiveness analyses (CEAs) and cost-utility analyses (CUAs) to identify trends in reporting quality in the radiation oncology literature over time. Methods and Materials: A systematic review of radiation oncology economic evaluations up to 2014 was performed, using MEDLINE and EMBASE databases. The Consolidated Health Economic Evaluation Reporting Standards guideline informed data abstraction variables including study demographics, economic parameters, and methodological details. Tufts Medical Center CEA registry quality scores provided a basis for qualitative assessment of included studies. Studies were stratified by 3 time periods (1995-2004, 2005-2009, and 2010-2014). The Cochran-Armitage trend test and linear trend test were used to identify trends over time. Results: In total, 102 articles were selected for final review. Most studies were in the context of a model (61%) or clinical trial (28%). Many studies lacked a conflict of interest (COI) statement (67%), a sponsorship statement (48%), a reported study time horizon (35%), and the use of discounting (29%). There was a significant increase over time in the reporting of a COI statement (P<.001), health care payer perspective (P=.019), sensitivity analyses using multivariate (P=.043) or probabilistic methods (P=.011), incremental cost-effectiveness threshold (P<.001), secondary source utility weights (P=.010), and cost effectiveness acceptability curves (P=.049). There was a trend toward improvement in Tuft scores over time (P=.065). Conclusions: Recent reports demonstrate improved reporting rates in economic evaluations; however, there remains significant room for improvement as reporting rates are still suboptimal. As fiscal pressures rise, we will rely on economic assessments to guide our practice decisions

  14. Evaluation of Health Economics in Radiation Oncology: A Systematic Review.

    Science.gov (United States)

    Nguyen, Timothy K; Goodman, Chris D; Boldt, R Gabriel; Warner, Andrew; Palma, David A; Rodrigues, George B; Lock, Michael I; Mishra, Mark V; Zaric, Gregory S; Louie, Alexander V

    2016-04-01

    Despite the rising costs in radiation oncology, the impact of health economics research on radiation therapy practice analysis patterns is unclear. We performed a systematic review of cost-effectiveness analyses (CEAs) and cost-utility analyses (CUAs) to identify trends in reporting quality in the radiation oncology literature over time. A systematic review of radiation oncology economic evaluations up to 2014 was performed, using MEDLINE and EMBASE databases. The Consolidated Health Economic Evaluation Reporting Standards guideline informed data abstraction variables including study demographics, economic parameters, and methodological details. Tufts Medical Center CEA registry quality scores provided a basis for qualitative assessment of included studies. Studies were stratified by 3 time periods (1995-2004, 2005-2009, and 2010-2014). The Cochran-Armitage trend test and linear trend test were used to identify trends over time. In total, 102 articles were selected for final review. Most studies were in the context of a model (61%) or clinical trial (28%). Many studies lacked a conflict of interest (COI) statement (67%), a sponsorship statement (48%), a reported study time horizon (35%), and the use of discounting (29%). There was a significant increase over time in the reporting of a COI statement (P<.001), health care payer perspective (P=.019), sensitivity analyses using multivariate (P=.043) or probabilistic methods (P=.011), incremental cost-effectiveness threshold (P<.001), secondary source utility weights (P=.010), and cost effectiveness acceptability curves (P=.049). There was a trend toward improvement in Tuft scores over time (P=.065). Recent reports demonstrate improved reporting rates in economic evaluations; however, there remains significant room for improvement as reporting rates are still suboptimal. As fiscal pressures rise, we will rely on economic assessments to guide our practice decisions and policies. We recommend improved adherence to

  15. Evaluation of Health Economics in Radiation Oncology: A Systematic Review

    International Nuclear Information System (INIS)

    Nguyen, Timothy K.; Goodman, Chris D.; Boldt, R. Gabriel; Warner, Andrew; Palma, David A.; Rodrigues, George B.; Lock, Michael I.; Mishra, Mark V.; Zaric, Gregory S.; Louie, Alexander V.

    2016-01-01

    Purpose: Despite the rising costs in radiation oncology, the impact of health economics research on radiation therapy practice analysis patterns is unclear. We performed a systematic review of cost-effectiveness analyses (CEAs) and cost-utility analyses (CUAs) to identify trends in reporting quality in the radiation oncology literature over time. Methods and Materials: A systematic review of radiation oncology economic evaluations up to 2014 was performed, using MEDLINE and EMBASE databases. The Consolidated Health Economic Evaluation Reporting Standards guideline informed data abstraction variables including study demographics, economic parameters, and methodological details. Tufts Medical Center CEA registry quality scores provided a basis for qualitative assessment of included studies. Studies were stratified by 3 time periods (1995-2004, 2005-2009, and 2010-2014). The Cochran-Armitage trend test and linear trend test were used to identify trends over time. Results: In total, 102 articles were selected for final review. Most studies were in the context of a model (61%) or clinical trial (28%). Many studies lacked a conflict of interest (COI) statement (67%), a sponsorship statement (48%), a reported study time horizon (35%), and the use of discounting (29%). There was a significant increase over time in the reporting of a COI statement (P<.001), health care payer perspective (P=.019), sensitivity analyses using multivariate (P=.043) or probabilistic methods (P=.011), incremental cost-effectiveness threshold (P<.001), secondary source utility weights (P=.010), and cost effectiveness acceptability curves (P=.049). There was a trend toward improvement in Tuft scores over time (P=.065). Conclusions: Recent reports demonstrate improved reporting rates in economic evaluations; however, there remains significant room for improvement as reporting rates are still suboptimal. As fiscal pressures rise, we will rely on economic assessments to guide our practice decisions

  16. Bone mineral density is decreased in fibromyalgia syndrome: a systematic review and meta-analysis.

    Science.gov (United States)

    Upala, Sikarin; Yong, Wai Chung; Sanguankeo, Anawin

    2017-04-01

    Previous studies have shown that fibromyalgia syndrome (FMS) is associated with low level of physical activity and exercise, which may lead to an increased risk of osteoporosis. However, studies of bone mineral density (BMD) in fibromyalgia have shown conflicting results. Thus, we conducted a systematic review and meta-analysis to better characterize the association between FMS and BMD. A comprehensive search of the databases MEDLINE and EMBASE was performed from inception through May 2016. The inclusion criterion was the observational studies' assessment of the association between fibromyalgia and bone mineral density in adult subjects. Fibromyalgia was diagnosed in accordance with the American College of Rheumatology criteria for the diagnosis of fibromyalgia syndrome. BMD was measured at the lumbar spine and femoral neck by dual-energy X-ray absorptiometry. Pooled mean difference (MD) of BMD at each site and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. The between-study heterogeneity of effect size was quantified using the Q statistic and I 2 . Data were extracted from four observational studies involving 680 subjects. At lumbar spine (L2-L4), BMD is significantly decreased in patients with FMS compared with controls with pooled MD of -0.02 (95% CI -0.03 to -0.01, P value = 0.003, I 2  = 0%) (Fig. 1). At femoral neck, BMD is not significantly decreased in patients with FMS compared with controls with pooled MD of 0.01 (95% CI -0.02 to 0.01, P value = 0.23, I 2  = 0%) (Fig. 2). In this meta-analysis, we observe that BMD at lumbar spine is decreased in FMS compared with normal individuals. Patients with FMS should be assessed for risk of osteoporosis. Fig. 1 Forest plot of bone mineral density at the lumbar spine, for patients with and without fibromyalgia syndrome. CI-confidence interval Fig. 2 Forest plot of bone mineral density at the femoral neck, for patients with and without fibromyalgia

  17. Oral conditions in patients with Sjögren’s Syndrome: a Systematic Review - doi:10.5020/18061230.2006.p234

    Directory of Open Access Journals (Sweden)

    Marina Fernandes de Sena

    2012-01-01

    Full Text Available The aim of this study was to investigate through a systematic review, the oral manifestations of Sjögren’s syndrome. It had as research sources: manual searches in publications, sites and electronic data bases such as MEDLINE, LILACS and BBO. As its inclusion criteria: cross-sectional, case-control and cohort studies which data collection was done by means of clinical indexes for dental caries, periodontal disease and oral mucosa. The selected idioms were: Portuguese, English and Spanish; in the period of 1990 to 2003. Searching strategies used included the following words: Sjögren, dmf, caries, decay, periodontal, plaque and gingivitis. Thirteen studies were selected, one of these in Spanish and the others in English. All delineations were case-control, 54% of these aimed at evaluating the relationship between patients with the syndrome and caries presence, 85% with periodontal disease and 32% relating to the alterations of oral mucosa. The analyzed studies showed that the main symptom of Sjögren’s syndrome is xerostomy and that exist a slight association between syndromic patients and dental caries index and some alterations of oral mucosa and a weak association with periodontal diseases.

  18. Proteomic biomarkers of preterm birth risk in women with polycystic ovary syndrome (PCOS: a systematic review and biomarker database integration.

    Directory of Open Access Journals (Sweden)

    Nicolas Galazis

    Full Text Available BACKGROUND: Preterm Birth (PTB is a major cause of neonatal mortality and morbidity. Women with Polycystic Ovary Syndrome (PCOS are at high risk of PTB. There is a need for research studies to investigate the mechanisms linking PCOS and PTB, to facilitate screening, and develop novel preventative strategies. OBJECTIVE: To list all the proteomic biomarkers of PTB and integrate this list with the PCOS biomarker database to identify commonly expressed biomarkers of the two conditions. SEARCH STRATEGY: A systematic review of PTB biomarkers and update of PCOS biomarker database. All eligible published studies on proteomic biomarkers for PTB and PCOS identified through various databases were evaluated. SELECTION CRITERIA: For the identification of the relevant studies, the following search terms were used: "proteomics", "proteomic", "preterm birth", "preterm labour", "proteomic biomarker" and "polycystic ovary syndrome". This search was restricted to humans only DATA COLLECTION AND ANALYSIS: A database on proteomic biomarkers for PTB was created while an already existing PCOS biomarker database was updated. The two databases were integrated and biomarkers that were co-expressed in both women with PCOS and PTB were identified and investigated. RESULTS: A panel of six proteomic biomarkers was similarly differentially expressed in women with PTB and women with PCOS compared to their respective controls (normal age-matched women in the case of PCOS studies and women with term pregnancy in the case of PTB studies. These biomarkers include Pyruvate kinase M1/M2, Vimentin, Fructose bisphosphonate aldolase A, Heat shock protein beta-1, Peroxiredoxin-1 and Transferrin. CONCLUSIONS: These proteomic biomarkers (Pyruvate kinase M1/M2, Vimentin, Fructose bisphosphonate aldolase A, Heat shock protein beta-1, Peroxiredoxin-1 and Transferrin can be potentially used to better understand the pathophysiological mechanisms linking PCOS and PTB. This would help to

  19. Systematic evaluation of nuclear operator team skills training

    International Nuclear Information System (INIS)

    Harrington, D.K.; Kello, J.E.

    1991-01-01

    In recent years, the nuclear industry has increasingly recognized with the technical training given its control room operators. As yet, however, little has been done to determine the actual effectiveness of such nontechnical training. Thus, the questions of how team training should be carried out for maximum impact on the safety and efficiency of control room operation and just what the benefits of such training might be remain open. We are in the early stages of establishing a systematic evaluation process that will help nuclear utilities assess the effectiveness of their existing team skills training programs for control room operators. Research focuses on defining the specific behavioral and attitudinal objectives of team skills training. Simply put, what does good practice look like and sound like in the control room environment? What specific behaviors and attitudes should the training be directed toward? Obviously, the answers to the questions have clear implications for the design of nuclear team skills training programs

  20. Evaluating barriers to adopting telemedicine worldwide: A systematic review.

    Science.gov (United States)

    Scott Kruse, Clemens; Karem, Priyanka; Shifflett, Kelli; Vegi, Lokesh; Ravi, Karuna; Brooks, Matthew

    2018-01-01

    Introduction and objective Studies on telemedicine have shown success in reducing the geographical and time obstacles incurred in the receipt of care in traditional modalities with the same or greater effectiveness; however, there are several barriers that need to be addressed in order for telemedicine technology to spread. The aim of this review is to evaluate barriers to adopting telemedicine worldwide through the analysis of published work. Methods The authors conducted a systematic literature review by extracting the data from the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PubMed (MEDLINE) research databases. The reviewers in this study analysed 30 articles (nine from CINAHL and 21 from Medline) and identified barriers found in the literature. This review followed the checklist from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009. The reviewers organized the results into one table and five figures that depict the data in different ways, organized by: barrier, country-specific barriers, organization-specific barriers, patient-specific barriers, and medical-staff and programmer-specific barriers. Results The reviewers identified 33 barriers with a frequency of 100 occurrences through the 30 articles. The study identified the issues with technically challenged staff (11%), followed by resistance to change (8%), cost (8%), reimbursement (5%), age of patient (5%), and level of education of patient (5%). All other barriers occurred at or less than 4% of the time. Discussion and conclusions Telemedicine is not yet ubiquitous, and barriers vary widely. The top barriers are technology-specific and could be overcome through training, change-management techniques, and alternating delivery by telemedicine and personal patient-to-provider interaction. The results of this study identify several barriers that could be eliminated by focused policy. Future work should evaluate policy to identify which one to lever to

  1. The Evaluation of Diastolic Hypertention in Sleep Overlap Syndrome

    Directory of Open Access Journals (Sweden)

    Fariba Rezaeetalab

    2015-01-01

    Full Text Available Introduction: The overlap syndrome, consisting ofobstructive sleep apnea hypopnea syndrome (OSAHS and chronic obstructvie pulmonary disease (COPD is a major problem in COPD patients. OSHAS corresponds to the likelihood of systemic hypertension.The present study was aimed to evaluate the association between apnea-hypopnea index and diastolic blood presssure (DBP in overlap  patients. Materials and Methods: We conducted a cross-sectional study involving overnight polysomnography after measurment of resting diastolic blood pressure (DBP in patients with overlap syndrome in Sleep Laboartory of Imam Reza Hospital, Mashhad, Iran from October 2011 to December 2012. Participants were divided into four subgroups regarding to their Apnea-Hypopnea Index (AHI (AHI 30.Descriptive statistics included age, body mass index (BMI, OSA, Apnea-Hypopnea Index (AHI, DBP, and neck circumference. Results: Sixty participants ranged between from 46 to 82 years old were entered into this study. There was statistically significant difference in mean DBP among different AHI subgroups (80±0.50, 95±0.60, and 105±0.65, respectively (p

  2. Approach for systematic evaluation of transuranic waste management alternatives

    International Nuclear Information System (INIS)

    Hong, K.; Koebnick, B.; Kotek, T.

    1994-01-01

    This paper describes an approach for systematic evaluation of management alternatives that are being considered for the treatment, storage, and disposal of transuranic waste (TRUW) at U.S. Department of Energy sites. The approach, which is currently under development, would apply WASTE-MGMT, a database application model developed at Argonne National Laboratory, to estimate projected environmental releases and would evaluate impact measures such as health risk and costs associated with each of the waste management alternatives. The customized application would combine site-specific TRUW inventory and characterization data with treatment and transportation parameters to estimate the quantities and characteristics of the wastes to be treated, emissions of hazardous substances from the treatment facilities, and the quantities and characteristics of the wastes to be shipped between sites. These data would then be used to estimate for several TRUW management scenarios the costs and health risks of constructing and operating the required treatment facilities and of transporting TRUW for treatment and final disposal. Treatment, storage, and disposal of TRUW at DOE sites is composed of many variables and options at each stage. The approach described in this paper would provide for efficient consideration of all of these facets when evaluating potentially feasible TRUW management alternatives. By expanding existing databases, this model could eventually be adapted to accommodate the introduction of new treatment technologies, updated TRUW characterization data, and/or revised waste acceptance criteria

  3. A systematic approach to CT evaluation of orbital trauma.

    Science.gov (United States)

    Betts, Aaron M; O'Brien, William T; Davies, Brett W; Youssef, Omaya H

    2014-10-01

    Computed tomography (CT) is widely used in the initial evaluation of patients with craniofacial trauma. Due to anatomical proximity, craniofacial trauma often involves concomitant injury to the eye and orbit. These injuries may have devastating consequences to vision, ocular motility, and cosmesis. CT imaging provides a rapid and detailed evaluation of bony structures and soft tissues of the orbit, is sensitive in detection of orbital foreign bodies, and often guides clinical and surgical management decisions in orbital trauma. For this reason, radiologists should be prepared to rapidly recognize common orbital fracture patterns, accurately describe soft tissue injuries of the orbit, detect and localize retained foreign bodies within the globe and orbit, and recognize abnormalities of the contents and integrity of the globe. In this review, we present a systematic approach to assist radiologists in the rapid evaluation of orbital trauma using the "BALPINE" mnemonic-bones, anterior chamber, lens, posterior globe structures, intraconal orbit, neurovascular structures, and extraocular muscles/extraconal orbit. Using this approach, we describe common traumatic findings within each of these spaces, and present common postsurgical appearances that can mimic findings of acute trauma.

  4. Better duplicate detection for systematic reviewers: evaluation of Systematic Review Assistant-Deduplication Module.

    Science.gov (United States)

    Rathbone, John; Carter, Matt; Hoffmann, Tammy; Glasziou, Paul

    2015-01-14

    A major problem arising from searching across bibliographic databases is the retrieval of duplicate citations. Removing such duplicates is an essential task to ensure systematic reviewers do not waste time screening the same citation multiple times. Although reference management software use algorithms to remove duplicate records, this is only partially successful and necessitates removing the remaining duplicates manually. This time-consuming task leads to wasted resources. We sought to evaluate the effectiveness of a newly developed deduplication program against EndNote. A literature search of 1,988 citations was manually inspected and duplicate citations identified and coded to create a benchmark dataset. The Systematic Review Assistant-Deduplication Module (SRA-DM) was iteratively developed and tested using the benchmark dataset and compared with EndNote's default one step auto-deduplication process matching on ('author', 'year', 'title'). The accuracy of deduplication was reported by calculating the sensitivity and specificity. Further validation tests, with three additional benchmarked literature searches comprising a total of 4,563 citations were performed to determine the reliability of the SRA-DM algorithm. The sensitivity (84%) and specificity (100%) of the SRA-DM was superior to EndNote (sensitivity 51%, specificity 99.83%). Validation testing on three additional biomedical literature searches demonstrated that SRA-DM consistently achieved higher sensitivity than EndNote (90% vs 63%), (84% vs 73%) and (84% vs 64%). Furthermore, the specificity of SRA-DM was 100%, whereas the specificity of EndNote was imperfect (average 99.75%) with some unique records wrongly assigned as duplicates. Overall, there was a 42.86% increase in the number of duplicates records detected with SRA-DM compared with EndNote auto-deduplication. The Systematic Review Assistant-Deduplication Module offers users a reliable program to remove duplicate records with greater sensitivity

  5. Global economic evaluations of rotavirus vaccines: A systematic review.

    Science.gov (United States)

    Kotirum, Surachai; Vutipongsatorn, Naaon; Kongpakwattana, Khachen; Hutubessy, Raymond; Chaiyakunapruk, Nathorn

    2017-06-08

    World Health Organization (WHO) recommends Rotavirus vaccines to prevent and control rotavirus infections. Economic evaluations (EE) have been considered to support decision making of national policy. Summarizing global experience of the economic value of rotavirus vaccines is crucial in order to encourage global WHO recommendations for vaccine uptake. Therefore, a systematic review of economic evaluations of rotavirus vaccine was conducted. We searched Medline, Embase, NHS EED, EconLit, CEA Registry, SciELO, LILACS, CABI-Global Health Database, Popline, World Bank - e-Library, and WHOLIS. Full economic evaluations studies, published from inception to November 2015, evaluating Rotavirus vaccines preventing Rotavirus infections were included. The methods, assumptions, results and conclusions of the included studies were extracted and appraised using WHO guide for standardization of EE of immunization programs. 104 relevant studies were included. The majority of studies were conducted in high-income countries. Cost-utility analysis was mostly reported in many studies using incremental cost-effectiveness ratio per DALY averted or QALY gained. Incremental cost per QALY gained was used in many studies from high-income countries. Mass routine vaccination against rotavirus provided the ICERs ranging from cost-saving to highly cost-effective in comparison to no vaccination among low-income countries. Among middle-income countries, vaccination offered the ICERs ranging from cost-saving to cost-effective. Due to low- or no subsidized price of rotavirus vaccines from external funders, being not cost-effective was reported in some high-income settings. Mass vaccination against rotavirus was generally found to be cost-effective, particularly in low- and middle-income settings according to the external subsidization of vaccine price. On the other hand, it may not be a cost-effective intervention at market price in some high-income settings. This systematic review provides

  6. Effects of percutaneous tibial nerve stimulation on adult patients with overactive bladder syndrome: a systematic review.

    Science.gov (United States)

    Moossdorff-Steinhauser, Heidi F A; Berghmans, Bary

    2013-03-01

    To assess the effectiveness of percutaneous tibial nerve stimulation (PTNS) on adult patients with overactive bladder syndrome, using a systematic review of randomized controlled trials (RCTs), clinical controlled trials (CCTs), and prospective observational cohort studies. A computer-aided literature search was performed in: PubMed, EMBASE and CENTRAL (2000 to November 15, 2011) to identify RCTs, CCTs, and prospective observational cohort studies. The study had to investigate the effect of PTNS on overactive bladder syndrome. The methodological quality of each study was assessed and a qualitative analysis was performed to establish the levels of evidence. Four RCTs and six prospective observational cohort studies were identified. There is strong evidence for the efficacy of PTNS versus a sham treatment. There is limited evidence that the use of PTNS and tolterodine ER is equally effective. No additional effect of a combination of Stoller afferent nerve stimulation (SANS) and anticholinergic medication compared to SANS alone. Most cohort studies suggested decreased frequency and improvement of incontinence and nocturia. However, the level of evidence was insufficient to make any firm conclusions. Because the total duration of all included trials varied between 6 and 12 weeks, so far there is little information on treatment periods. PTNS is efficacious for frequency and urgency urinary incontinence. More high quality studies are needed to improve the level of evidence concerning the efficacy of PTNS with regard to urgency and nocturia, to specify patient selection criteria, optimal treatment modalities and long-term effects as well as the effectiveness in more pragmatic trials. Copyright © 2012 Wiley Periodicals, Inc.

  7. The prevalence of metabolic syndrome in Latin America: a systematic review.

    Science.gov (United States)

    Márquez-Sandoval, F; Macedo-Ojeda, G; Viramontes-Hörner, D; Fernández Ballart, J D; Salas Salvadó, J; Vizmanos, B

    2011-10-01

    To assess the available data on the prevalence of metabolic syndrome (MS) in Latin-American countries. Systematic review. Searches were carried out in PubMed, ISIWeb, SCielo and Redalyc, using 'metabolic syndrome x' and 'prevalence' as keywords for titles and/or abstracts. Articles selected were cross-sectional studies in Latin-American countries, whose main objective was to study MS and whose study population is described below. MS must be determined using Adult Treatment Panel III criteria. Twelve studies with these criteria were selected, one of which was multi-centric. Latin America. Apparently healthy subjects aged 18-65 years (including young adult, mature adult and elderly populations) of both genders. The general prevalence (weighted mean) of MS in Latin-American countries was 24·9 (range: 18·8-43·3) %. MS was slightly more frequent in women (25·3 %) than in men (23·2 %), and the age group with the highest prevalence of MS consisted of those over 50 years of age. The most frequent components of MS were low HDL cholesterol levels (62·9 %) and abdominal obesity (45·8 %). Similar outcomes were obtained from the multi-centre study on Latin-American populations analysed. The present review brings us closer to an understanding of the prevalence of MS in Latin-American countries. However, it is not possible to know the full scope of the problem, partly because data from some countries are not available, and because the methodological differences among the studies published up to the present limit a joint analysis of their results.

  8. Bipolar disorder in adults with Asperger׳s Syndrome: a systematic review.

    Science.gov (United States)

    Vannucchi, Giulia; Masi, Gabriele; Toni, Cristina; Dell'Osso, Liliana; Erfurth, Andreas; Perugi, Giulio

    2014-10-01

    Asperger׳s Syndrome (AS) is a neurodevelopmental disorder included in the Autism Spectrum (ASD). The current literature shows growing evidence of a high rate of comorbidity between AS and other psychiatric disorders, particularly Bipolar Disorder (BD). We reviewed available epidemiological and clinical data on BD-AS comorbidity and its diagnostic and therapeutic implications A systematic review of the literature was conducted through PubMed, Scopus and Psych-Info using combinations of the following search terms: Asperger׳s Syndrome, Bipolar Disorder, depression, mood disorder, psychiatric comorbidity, treatment, mood stabilizers, anticonvulsants, antipsychotics, and antidepressants. BD prevalence in adults with AS ranges from 6% to 21.4% of the cases. Relatives of patients with AS showed a doubled risk of being affected by BD and a BD prevalence near to 10%. When comorbid with AS, BD assumes peculiar features which might shape its under-recognition or misdiagnosis (especially schizophrenia when psychotic symptoms are prominent). Although controlled data on pharmacological treatments in BD-AS comorbidity are substantially lacking, information is derived by open observations, case series and chart reviews. Mood stabilizers should be considered the first choice, and antipsychotics, especially second generation drugs (SGA) with 5-HT2a antagonism, have been shown useful in controlling psychotic and behavioral symptoms and improving social withdrawal. Some evidence of efficacy for the treatment of anxiety, obsessive-compulsive symptoms and depression is reported for SSRI antidepressants. The use of these drugs should be carefully monitored, because activation with hypomanic or manic switches is reported up to 54% of the treated subjects. BD in AS patients is frequent, usually it onsets during adolescence and is often characterized by atypical presentation, making its correct identification particularly difficult. A correct diagnosis of BD in AS individuals has relevant

  9. The appraisal of chronic stress and the development of the metabolic syndrome: a systematic review of prospective cohort studies

    Science.gov (United States)

    Bergmann, N; Gyntelberg, F; Faber, J

    2014-01-01

    Chronic psychosocial stress has been proposed as a risk factor for the development of the metabolic syndrome (MES). This review gives a systematic overview of prospective cohort studies investigating chronic psychosocial stress as a risk factor for incident MES and the individual elements of MES. Thirty-nine studies were included. An association between chronic psychosocial stress and the development of MES was generally supported. Regarding the four elements of MES: i) weight gain: the prospective studies supported etiological roles for relationship stress, perceived stress, and distress, while the studies on work-related stress (WS) showed conflicting results; ii) dyslipidemi: too few studies on psychosocial stress as a risk factor for dyslipidemia were available to draw a conclusion; however, a trend toward a positive association was present; iii) type 2 diabetes mellitus (DM2): prospective studies supported perceived stress and distress as risk factors for the development of DM2 among men, but not among women, while WS was generally not supported as a risk factor among neither men nor women; iv) hypertension: marital stress and perceived stress might have an influence on blood pressure (BP), while no association was found regarding distress. Evaluating WS the results were equivocal and indicated that different types of WS affected the BP differently between men and women. In conclusion, a longitudinal association between chronic psychosocial stress and the development of MES seems present. However, the number of studies with sufficient quality is limited and the design of the studies is substantially heterogeneous. PMID:24743684

  10. A core outcome set for neonatal abstinence syndrome: study protocol for a systematic review, parent interviews and a Delphi survey.

    Science.gov (United States)

    Kelly, Lauren E; Jansson, Lauren M; Moulsdale, Wendy; Pereira, Jodi; Simpson, Sarah; Guttman, Astrid; Allegaert, Karel; Askie, Lisa; Roukema, Henry; Lacaze, Thierry; Davis, Jonathan M; Finnegan, Loretta; Williamson, Paula; Offringa, Martin

    2016-11-08

    The prevalence of neonatal abstinence syndrome (NAS) is increasing globally resulting in an increased incidence of adverse neonatal outcomes and health system costs. Evidence regarding the effectiveness of NAS prevention and management strategies is very weak and further research initiatives are critically needed to support meta-analysis and clinical practice guidelines. In NAS research, the choice of outcomes and the use of valid, responsive and feasible measurement instruments are crucial. There is currently no consensus and evidence-based core outcome set (COS) for NAS. The development of the NAS-COS will include five stages led by an international Multidisciplinary Steering Committee: (1) qualitative interviews with parents/families and a systematic review (SR) to identify items for inclusion in a COS. The SR will also identify participants for the Delphi survey, (2) a three-round Delphi survey to gain expert opinion on the importance of health outcomes influencing NAS management decisions, (3), a consensus meeting to finalize the items and definitions with experts and COS users, (4) feasibility and pilot testing, development of the COS and explanatory document and (5) implementation planning. Since standardized outcome measurement and reporting will improve NAS clinical research consistency, efficacy and impact, this COS will reflect the minimum set of health outcomes which should be measured in trials evaluating interventions for preventing or treating NAS.

  11. Distress in significant others of patients with chronic fatigue syndrome: A systematic review of the literature.

    Science.gov (United States)

    Harris, Kamelia; Band, Rebecca J; Cooper, Hazel; Macintyre, Vanessa G; Mejia, Anilena; Wearden, Alison J

    2016-11-01

    The objective of this study was to systematically review existing empirical research assessing levels and correlates of distress in significant others of patients with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Systematic searches in CINAHL, Web of Science and PsycINFO were conducted in August 2014. The search was repeated in January 2015 to check for newly published articles. Studies published in English with quantitative, qualitative, or mixed designs exploring distress, poor subjective health, poor mental health, reduced quality of life and well-being, and symptoms of depression and anxiety in significant others (>18 years) of children and adults with CFS/ME were included. Quality appraisal of included studies was carried out. Quantitative and qualitative studies were summarized separately. Six articles met eligibility criteria. Two quantitative studies with significant others of adult patients, and one quantitative and two mixed-methods studies with significant others of child patients showed moderate to high levels of distress. One qualitative study (adult patients) found minimal evidence of distress and that acceptance of CFS/ME was related to better adjustment. In the quantitative and mixed-methods studies, significant others who attributed some level of responsibility for symptoms to the patient, or who were female, or whose partners had poorer mental health, had higher levels of distress. The small number of studies to date, the contrary evidence from a qualitative study, and the limited data available on levels of distress in significant others of patients with CFS/ME mean that our conclusion that distress levels are elevated is provisional. We recommend that future qualitative studies focus on this particular topic. Further longitudinal studies exploring correlates of distress within the context of a predictive theoretical model would be helpful. Statement of contribution What is already known on this subject? Chronic fatigue syndrome

  12. Systematic review of clinical studies related to pork intake and metabolic syndrome or its components

    Directory of Open Access Journals (Sweden)

    Stettler N

    2013-09-01

    Full Text Available Nicolas Stettler,1 Mary M Murphy,1 Leila M Barraj,1 Kimberly M Smith,2 Rexford S Ahima3 1Exponent Inc, Washington, DC, USA; 2Exponent Inc, Derby, United Kingdom; 3Translational Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Abstract: Globally, both the incidence of type 2 diabetes and the consumption of meat, in particular pork meat, have increased, concurrently. Processed meats have been associated with an increased risk for diabetes in observational studies. Therefore, it is important to understand the possible mechanisms of this association and the impact of meats from different species. The goal of this systematic review was to assess experimental human studies of the impact of pork intake compared with other protein sources on early markers for the development of diabetes, ie, insulin resistance, glucose intolerance, and the components of the metabolic syndrome. A systematic review was conducted searching PubMed and EMBASE and using the Cochrane and PRISMA guidelines. Eight studies were eligible and critically reviewed. Five studies were based on a single meal or single day exposure to pork, as compared with other sources of protein. The glucose-insulin response following the pork meals did not differ compared with beef, shrimp, or mixed sources of proteins. However, compared with eggs, ham (processed meat led to a larger insulin response in nonobese subjects. Compared with whey, ham led to a smaller insulin response and a larger glucose response. These findings suggest possible mechanisms for the association between processed meat and the development of diabetes. Nonprocessed pork meats were not compared with eggs or whey. The three longer interventions (11 days to 6 months did not show a significant impact of pork on the components of the metabolic syndrome, with the exception of a possible benefit on waist circumference and high-density lipoprotein cholesterol (one study each with

  13. Polycystic ovary syndrome and mental disorders: a systematic review and exploratory meta-analysis

    Directory of Open Access Journals (Sweden)

    Blay SL

    2016-11-01

    Full Text Available Sergio Luís Blay,1 João Vicente Augusto Aguiar,2 Ives Cavalcante Passos3 1Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina – UNIFESP, São Paulo, SP, Brazil; 2Department of Psychiatry, Fortaleza University, Fortaleza, Ceará, Brazil; 3Laboratory of Molecular Psychiatry and Department of Psychiatry, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil Background: The association between depression, anxiety, and polycystic ovary syndrome (PCOS is still unclear. Therefore, a systematic review and meta-analysis was conducted to assess the rates of comorbid psychiatric disorders among women with PCOS compared to women without it. Methods: PubMed/MEDLINE, Embase, PsycINFO, and Web of Science databases were searched from inception to November 27, 2015. Studies were eligible for inclusion if they were original reports in which the rates of mood (bipolar disorder, dysthymia, or major depressive disorder, obsessive–compulsive spectrum disorders, trauma- and stressor-related disorders, anxiety disorders or psychotic disorders, somatic symptom and related disorders, or eating disorders had been investigated among women with an established diagnosis of PCOS and compared with women without PCOS. Psychiatric diagnosis should have been established by means of a structured diagnostic interview or through a validated screening tool. Data were extracted and pooled using random effects models. Results: Six studies were included in the meta-analysis; of these, five reported the rates of anxiety and six provided data on the rates of depression. The rate of subjects with anxiety symptoms was higher in patients with PCOS compared to women without PCOS (odds ratio (OR =2.76; 95% confidence interval (CI 1.26 to 6.02; Log OR =1.013; P=0.011. The rate of subjects with depressive symptoms was higher in patients with PCOS compared to women without PCOS (OR =3.51; 95% CI 1.97 to 6.24; Log OR =1.255; P<0

  14. Complementary and alternative medicine for patients with chronic fatigue syndrome: A systematic review

    Directory of Open Access Journals (Sweden)

    Cao Huijuan

    2011-10-01

    Full Text Available Abstract Background Throughout the world, patients with chronic diseases/illnesses use complementary and alternative medicines (CAM. The use of CAM is also substantial among patients with diseases/illnesses of unknown aetiology. Chronic fatigue syndrome (CFS, also termed myalgic encephalomyelitis (ME, is no exception. Hence, a systematic review of randomised controlled trials of CAM treatments in patients with CFS/ME was undertaken to summarise the existing evidence from RCTs of CAM treatments in this patient population. Methods Seventeen data sources were searched up to 13th August 2011. All randomised controlled trials (RCTs of any type of CAM therapy used for treating CFS were included, with the exception of acupuncture and complex herbal medicines; studies were included regardless of blinding. Controlled clinical trials, uncontrolled observational studies, and case studies were excluded. Results A total of 26 RCTs, which included 3,273 participants, met our inclusion criteria. The CAM therapy from the RCTs included the following: mind-body medicine, distant healing, massage, tuina and tai chi, homeopathy, ginseng, and dietary supplementation. Studies of qigong, massage and tuina were demonstrated to have positive effects, whereas distant healing failed to do so. Compared with placebo, homeopathy also had insufficient evidence of symptom improvement in CFS. Seventeen studies tested supplements for CFS. Most of the supplements failed to show beneficial effects for CFS, with the exception of NADH and magnesium. Conclusions The results of our systematic review provide limited evidence for the effectiveness of CAM therapy in relieving symptoms of CFS. However, we are not able to draw firm conclusions concerning CAM therapy for CFS due to the limited number of RCTs for each therapy, the small sample size of each study and the high risk of bias in these trials. Further rigorous RCTs that focus on promising CAM therapies are warranted.

  15. Clinical characteristics of the asthma-COPD overlap syndrome--a systematic review.

    Science.gov (United States)

    Nielsen, Mia; Bårnes, Camilla Boslev; Ulrik, Charlotte Suppli

    2015-01-01

    In recent years, the so-called asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) has received much attention, not least because elderly individuals may present characteristics suggesting a diagnosis of both asthma and COPD. At present, ACOS is described clinically as persistent airflow limitation combined with features of both asthma and COPD. The aim of this paper is, therefore, to review the currently available literature focusing on symptoms and clinical characteristics of patients regarded as having ACOS. Based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a systematic literature review was performed. A total of 11 studies met the inclusion criteria for the present review. All studies dealing with dyspnea (self-reported or assessed by the Medical Research Council dyspnea scale) reported more dyspnea among patients classified as having ACOS compared to the COPD and asthma groups. In line with this, ACOS patients have more concomitant wheezing and seem to have more cough and sputum production. Compared to COPD-only patients, the ACOS patients were found to have lower FEV1% predicted and FEV1/FVC ratio in spite of lower mean life-time tobacco exposure. Furthermore, studies have revealed that ACOS patients seem to have not only more frequent but also more severe exacerbations. Comorbidity, not least diabetes, has also been reported in a few studies, with a higher prevalence among ACOS patients. However, it should be acknowledged that only a limited number of studies have addressed the various comorbidities in patients with ACOS. The available studies indicate that ACOS patients may have more symptoms and a higher exacerbation rate than patients with asthma and COPD only, and by that, probably a higher overall respiratory-related morbidity. Similar to patients with COPD, ACOS patients seem to have a high occurrence of comorbidity, including diabetes. Further research into the ACOS, not least

  16. Disease Beyond the Arch: A Systematic Review of Middle Aortic Syndrome in Childhood.

    Science.gov (United States)

    Rumman, Rawan K; Nickel, Cheri; Matsuda-Abedini, Mina; Lorenzo, Armando J; Langlois, Valerie; Radhakrishnan, Seetha; Amaral, Joao; Mertens, Luc; Parekh, Rulan S

    2015-07-01

    Middle aortic syndrome (MAS) is a rare clinical entity in childhood, characterized by a severe narrowing of the distal thoracic and/or abdominal aorta, and associated with significant morbidity and mortality. MAS remains a relatively poorly defined disease. This paper systematically reviews the current knowledge on MAS with respect to etiology, clinical impact, and therapeutic options. A systematic search of 3 databases (Embase, MEDLINE, and Cochrane Central Register of Controlled Trials) yielded 1,252 abstracts that were screened based on eligibility criteria resulting in 184 full-text articles with 630 reported cases of childhood MAS. Data extracted included patient characteristics, clinical presentation, vascular phenotype, management, and outcomes. Most cases of MAS are idiopathic (64%), 15% are associated with Mendelian disorders, and 17% are related to inflammatory diseases. Extra-aortic involvement including renal (70%), superior mesenteric (30%), and celiac (22%) arteries is common, especially among those with associated Mendelian disorders. Inferior mesenteric artery involvement is almost never reported. The majority of cases (72%) undergo endovascular or surgical management with residual hypertension reported in 34% of cases, requiring medication or reintervention. Clinical manifestations and extent of extra-aortic involvement are lacking. MAS presents with significant involvement of visceral arteries with over two thirds of cases having renal artery stenosis, and one third with superior mesenteric artery stenosis. The extent of disease is worse among those with genetic and inflammatory conditions. Further studies are needed to better understand etiology, long-term effectiveness of treatment, and to determine the optimal management of this potentially devastating condition. © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Is hydroxychloroquine effective in treating primary Sjogren's syndrome: a systematic review and meta-analysis.

    Science.gov (United States)

    Wang, Shi-Qin; Zhang, Li-Wei; Wei, Pan; Hua, Hong

    2017-05-12

    To systematically review and assess the efficacy and safety of hydroxychloroquine (HCQ) for treating primary Sjogren's syndrome (pSS). Five electronic databases (Pubmed, EMBASE, Web of science, Ovid, Cochrane Library) were searched for randomized controlled trials and retrospective or prospective studies published in English that reported the effect of HCQ on pSS. The subjective symptoms (sicca symptoms, fatigue and pain) and the objective indexes (erythrocyte sedimentation rate and Schirmer test) were assessed as main outcome measures. A meta-analysis and descriptive study on the efficacy and safety of HCQ were conducted. The estimate of the effect of HCQ treatment was expressed as a proportion together with 95% confidence interval, and plotted on a forest plot. Four trials with totals of 215 SS patients, including two randomized controlled trials, one double blind crossover trial and one retrospective open-label study, were analyzed in this review. For dry mouth and dry eyes, the effectiveness of HCQ treatment was essentially the same as placebo treatment. For fatigue, the effectiveness of HCQ was lower than placebo. The efficacy of HCQ in treating pain associated with pSS was superior to that of the placebo. There was no significant difference between HCQ-treated groups and controls in terms of Schirmer test results, but HCQ could reduce the erythrocyte sedimentation rate compare with placebo. A descriptive safety assessment showed that gastrointestinal adverse effects were the most common adverse effects associated with HCQ. This systematic review showed that there is no significant difference between HCQ and placebo in the treatment of dry mouth and dry eye in pSS. Well-designed, randomized, controlled trials are needed to provide higher-quality evidence to confirm our findings, and future studies should focus on some other index or extraglandular measures, such as cutaneous manifestations, to further explore the therapeutic effect of HCQ in

  18. Prevalence of Metabolic Syndrome Among People Living with HIV in Developing Countries: A Systematic Review.

    Science.gov (United States)

    Naidu, Sivaraj; Ponnampalvanar, Sasheela; Kamaruzzaman, Shahrul Bahyah; Kamarulzaman, Adeeba

    2017-01-01

    Metabolic syndrome (MS) is a group of components associated with cardiovascular disease and type 2 diabetes mellitus. The prevalence of MS in the HIV population is increasing in epidemic proportions globally. However, the magnitude and characteristics of MS are not fully elucidated in developing countries. The aim of this systematic review was to assess the prevalence of MS and its components among people living with HIV (PLWH) in developing countries. Searches were carried out in MEDLINE, Embase, Web of Science, CINAHL, Cochrane Central Register of Controlled Trials, Scopus, other web sources, and by hand search. Articles were restricted to English language studies reporting on the prevalence of MS among PLWH in developing countries. Eighteen articles were included in the review. The studies were divided into Africa, South America, and Asia regions. The most frequent criterion used in the review was the National Cholesterol Education Program: Adult Treatment Program III 2001 definition. The prevalence of MS among PLWH ranged from 8.4% to 47% across the developing regions and comparable to the overall prevalence across the developed regions (7.8-52.2%). The mean prevalence was 30.5%, 21.5%, and 21.4% in Africa, Asia, and South America, respectively. The most frequent component observed was low high-density lipoprotein cholesterol (50.1%). This systematic review provides an essential overview on the distribution of MS in the HIV population across the developing regions. As these prevalences were comparably high in the developed regions, this review highlights the need for more robust research in developing countries.

  19. Complementary and alternative medicine for patients with chronic fatigue syndrome: A systematic review

    Science.gov (United States)

    2011-01-01

    Background Throughout the world, patients with chronic diseases/illnesses use complementary and alternative medicines (CAM). The use of CAM is also substantial among patients with diseases/illnesses of unknown aetiology. Chronic fatigue syndrome (CFS), also termed myalgic encephalomyelitis (ME), is no exception. Hence, a systematic review of randomised controlled trials of CAM treatments in patients with CFS/ME was undertaken to summarise the existing evidence from RCTs of CAM treatments in this patient population. Methods Seventeen data sources were searched up to 13th August 2011. All randomised controlled trials (RCTs) of any type of CAM therapy used for treating CFS were included, with the exception of acupuncture and complex herbal medicines; studies were included regardless of blinding. Controlled clinical trials, uncontrolled observational studies, and case studies were excluded. Results A total of 26 RCTs, which included 3,273 participants, met our inclusion criteria. The CAM therapy from the RCTs included the following: mind-body medicine, distant healing, massage, tuina and tai chi, homeopathy, ginseng, and dietary supplementation. Studies of qigong, massage and tuina were demonstrated to have positive effects, whereas distant healing failed to do so. Compared with placebo, homeopathy also had insufficient evidence of symptom improvement in CFS. Seventeen studies tested supplements for CFS. Most of the supplements failed to show beneficial effects for CFS, with the exception of NADH and magnesium. Conclusions The results of our systematic review provide limited evidence for the effectiveness of CAM therapy in relieving symptoms of CFS. However, we are not able to draw firm conclusions concerning CAM therapy for CFS due to the limited number of RCTs for each therapy, the small sample size of each study and the high risk of bias in these trials. Further rigorous RCTs that focus on promising CAM therapies are warranted. PMID:21982120

  20. Systematic review: serotonergic modulators in the treatment of irritable bowel syndrome--influence on psychiatric and gastrointestinal symptoms.

    Science.gov (United States)

    Kilkens, T O C; Honig, A; Rozendaal, N; Van Nieuwenhoven, M A; Brummer, R-J M

    2003-01-01

    Both central and peripheral serotonergic modulators are used in the treatment of irritable bowel syndrome. The majority of patients with irritable bowel syndrome presenting to a gastroenterologist demonstrate affective dysregulation. Serotonin may play a regulatory role in both gastrointestinal motility and sensitivity, as well as in affective dysregulation, in irritable bowel syndrome. To analyse, systematically, randomized controlled trials studying the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome, in order to elucidate baseline irritable bowel syndrome symptomatology and possible differential effects of serotonergic modulation on this symptomatology. A standardized qualitative analysis was performed of studies investigating the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome using a blind review approach. The studies were ranked according to their total quality score (maximum 100 points). Eleven studies fulfilled the entry criteria, six of which scored above 55 points. An association between gastroenterological and psychiatric changes was present in five of the six studies. The results strengthen the serotonergic association between gastroenterological and psychiatric symptoms. Adjusted guidelines for combined gastrointestinal and psychiatric assessments are recommended in order to further elucidate the serotonergic interaction between gastrointestinal and psychiatric symptoms.

  1. Anterior process calcaneal fractures: a systematic evaluation of associated conditions

    Energy Technology Data Exchange (ETDEWEB)

    Petrover, David [NYU Hospital for Joint Disease, Radiology Department, New York, NY (United States); Hopital Beaujon, Service de Radiologie, Paris (France); Schweitzer, Mark E. [NYU Hospital for Joint Disease, Radiology Department, New York, NY (United States); Laredo, J.D. [Hopital Lariboisiere, Service de Radiologie, Paris (France)

    2007-07-15

    The objective was to evaluate the association, by MRI, of anterior calcaneal process fractures with tarsal coalitions, ankle sprains, and bifurcate ligament abnormalities. A retrospective review of 1,479 foot and ankle MR images was performed, over a period of 5 years, for isolated anterior process fractures of the calcaneus. Fifteen 1.5-T MR examinations were systematically evaluated by two radiologists in consensus. Marrow edema patterns, presence of a calcaneonavicular coalition, as well as bifurcate and anterior talofibular ligaments, were evaluated. There were 15 fractures of the anterior calcaneal process with an incidence of 1%. The average patient age was 51 years (range 25-82). Twelve patients were women and 3 were men. The majority of the fractures (14 out of 15) presented as an edema pattern on T2-weighted images, either diffuse (9 out of 15), or vertical (5 out of 15). One case did not show marrow edema, but rather a hypointense line. Nine patients (60%) demonstrated calcaneonavicular coalition and anterior calcaneal process fracture. In 6 patients (50%) the anterior talofibular ligament (ATFL) was thickened. Three patients did not have axial images, and were classified as non-conclusive for the ATFL evaluation. The bifurcate ligament was thickened with hyperintense signal demonstrating a sprain in 9 out of 13 (69%). Only 2 patients (16.5%) had an anterior calcaneal process fracture without any associated abnormality. We believe that there is a probable association of anterior process fractures and calcaneonavicular coalitions. We also feel, based on our results and the prior literature that there is likely also an association with both ATFL injuries and bifurcate ligament injuries. (orig.)

  2. Anterior process calcaneal fractures: a systematic evaluation of associated conditions

    International Nuclear Information System (INIS)

    Petrover, David; Schweitzer, Mark E.; Laredo, J.D.

    2007-01-01

    The objective was to evaluate the association, by MRI, of anterior calcaneal process fractures with tarsal coalitions, ankle sprains, and bifurcate ligament abnormalities. A retrospective review of 1,479 foot and ankle MR images was performed, over a period of 5 years, for isolated anterior process fractures of the calcaneus. Fifteen 1.5-T MR examinations were systematically evaluated by two radiologists in consensus. Marrow edema patterns, presence of a calcaneonavicular coalition, as well as bifurcate and anterior talofibular ligaments, were evaluated. There were 15 fractures of the anterior calcaneal process with an incidence of 1%. The average patient age was 51 years (range 25-82). Twelve patients were women and 3 were men. The majority of the fractures (14 out of 15) presented as an edema pattern on T2-weighted images, either diffuse (9 out of 15), or vertical (5 out of 15). One case did not show marrow edema, but rather a hypointense line. Nine patients (60%) demonstrated calcaneonavicular coalition and anterior calcaneal process fracture. In 6 patients (50%) the anterior talofibular ligament (ATFL) was thickened. Three patients did not have axial images, and were classified as non-conclusive for the ATFL evaluation. The bifurcate ligament was thickened with hyperintense signal demonstrating a sprain in 9 out of 13 (69%). Only 2 patients (16.5%) had an anterior calcaneal process fracture without any associated abnormality. We believe that there is a probable association of anterior process fractures and calcaneonavicular coalitions. We also feel, based on our results and the prior literature that there is likely also an association with both ATFL injuries and bifurcate ligament injuries. (orig.)

  3. Vitamin and mineral status in chronic fatigue syndrome and fibromyalgia syndrome : A systematic review and meta-analysis

    NARCIS (Netherlands)

    Joustra, Monica L; Minovic, Isidor; Janssens, Karin A M; Bakker, Stephan J L; Rosmalen, Judith G M

    2017-01-01

    BACKGROUND: Many chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS) patients (35-68%) use nutritional supplements, while it is unclear whether deficiencies in vitamins and minerals contribute to symptoms in these patients. Objectives were (1) to determine vitamin and mineral status in

  4. Financial evaluations of antibiotic stewardship programs - a systematic review

    Directory of Open Access Journals (Sweden)

    Jan-Willem Hendrik Dik

    2015-04-01

    Full Text Available IntroductionThere is an increasing awareness to counteract problems due to incorrect antimicrobial use. Interventions that are implemented are often part of an Antimicrobial Stewardship Program (ASPs. Studies publishing results from these interventions are increasing, including reports on the economical effects of ASPs. This review will look at the economical sections of these studies and the methods that were used. MethodsA systematic review was performed of articles found in the PubMed and EMBASE databases published from 2000 until November 2014. Included studies found were scored for various aspects and the quality of the papers was assessed following an appropriate check list (CHEC criteria list.Results1233 studies were found, of which 149 were read completely. 99 were included in the final review. Of these studies, 57 only mentioned the costs associated with the antimicrobial medication. Others also included operational costs (n=23, costs for hospital stay (n=18 and/or other costs (n=19. 9 studies were further assessed for their quality. These studies scored between 2 and 14 out of a potential total score of 19.ConclusionsThis review gives an extensive overview of the current financial evaluation of ASPs and the quality of these economical studies. We show that there is still major potential to improve financial evaluations of ASPs. Studies do not use similar nor consistent methods or outcome measures, making it impossible draw sound conclusions and compare different studies. Finally, we make some recommendations for the future.

  5. The incidence of intensive care unit-acquired weakness syndromes: A systematic review.

    Science.gov (United States)

    Appleton, Richard Td; Kinsella, John; Quasim, Tara

    2015-05-01

    We conducted a literature review of the intensive care unit-acquired weakness syndromes (critical illness polyneuropathy, critical illness myopathy and critical illness neuromyopathy) with the primary objective of determining their incidence as a combined group. Studies were identified through MEDLINE, Embase, Cochrane Database and article reference list searches and were included if they evaluated the incidence of one or more of these conditions in an adult intensive care unit population. The incidence of an intensive care unit-acquired weakness syndrome in the included studies was 40% (1080/2686 patients, 95% confidence interval 38-42%). The intensive care unit populations included were heterogeneous though largely included patients receiving mechanical ventilation for seven or more days. Additional prespecified outcomes identified that the incidence of intensive care unit-acquired weakness varied with the diagnostic technique used, being lower with clinical (413/1276, 32%, 95% CI 30-35%) compared to electrophysiological techniques (749/1591, 47%, 95% CI 45-50%). Approximately a quarter of patients were not able to comply with clinical evaluation and this may be responsible for potential underreporting of this condition.

  6. Advanced and standardized evaluation of neurovascular compression syndromes

    Science.gov (United States)

    Hastreiter, Peter; Vega Higuera, Fernando; Tomandl, Bernd; Fahlbusch, Rudolf; Naraghi, Ramin

    2004-05-01

    Caused by a contact between vascular structures and the root entry or exit zone of cranial nerves neurovascular compression syndromes are combined with different neurological diseases (trigeminal neurolagia, hemifacial spasm, vertigo, glossopharyngeal neuralgia) and show a relation with essential arterial hypertension. As presented previously, the semi-automatic segmentation and 3D visualization of strongly T2 weighted MR volumes has proven to be an effective strategy for a better spatial understanding prior to operative microvascular decompression. After explicit segmentation of coarse structures, the tiny target nerves and vessels contained in the area of cerebrospinal fluid are segmented implicitly using direct volume rendering. However, based on this strategy the delineation of vessels in the vicinity of the brainstem and those at the border of the segmented CSF subvolume are critical. Therefore, we suggest registration with MR angiography and introduce consecutive fusion after semi-automatic labeling of the vascular information. Additionally, we present an approach of automatic 3D visualization and video generation based on predefined flight paths. Thereby, a standardized evaluation of the fused image data is supported and the visualization results are optimally prepared for intraoperative application. Overall, our new strategy contributes to a significantly improved 3D representation and evaluation of vascular compression syndromes. Its value for diagnosis and surgery is demonstrated with various clinical examples.

  7. Metabolic Syndrome in Apparently “Healthy” Ghanaian Adults: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Richard Ofori-Asenso

    2017-01-01

    Full Text Available Background. Metabolic syndrome (MetS is a major public health problem in Sub-Saharan Africa. We systematically reviewed the literature towards estimating the prevalence of MetS among apparently “healthy” Ghanaian adults. Methods. We searched PubMed, Web of Science, Scopus, Africa Journals Online, African Index Medicus, and Google scholar as well as the websites of the Ministry of Health and Ghana Health service through September 2016. Only studies conducted among apparently “healthy” (no established disease, e.g., diabetes and hypertension adults aged ≥ 18 years were considered. Only studies that utilised the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP, World Health Organization (WHO, or International Diabetes Federation (IDF classifications for MetS were included. Results. Data from nine studies involving 1,559 individuals were pooled. The prevalence of MetS based on NCEP-ATP, WHO, and IDF classifications was 12.4% (95% confidence interval [CI] = 8.3–17.4%, 6.0% (95% CI = 1.4–13.1%, and 21.2% (95% CI = 12.4–30.9, respectively. Prevalence of MetS was higher among women than men. Conclusion. Among a population of adult Ghanaians deemed “healthy,” there is a high prevalence of MetS. Preventive measures are required to address the risk components of MetS such as obesity and hypertension which are rapidly rising in Ghana.

  8. Stigma in youth with Tourette's syndrome: a systematic review and synthesis.

    Science.gov (United States)

    Malli, Melina A; Forrester-Jones, Rachel; Murphy, Glynis

    2016-02-01

    Tourette's syndrome (TS) is a childhood onset neurodevelopmental disorder, characterised by tics. To our knowledge, no systematic reviews exist which focus on examining the body of literature on stigma in association with children and adolescents with TS. The aim of the article is to provide a review of the existing research on (1) social stigma in relation to children and adolescents with TS, (2) self-stigma and (3) courtesy stigma in family members of youth with TS. Three electronic databases were searched: PsycINFO, PubMed and Web of Science. Seventeen empirical studies met the inclusion criteria. In relation to social stigma in rating their own beliefs and behavioural intentions, youth who did not have TS showed an unfavourable attitude towards individuals with TS in comparison to typically developing peers. Meanwhile, in their own narratives about their lives, young people with TS themselves described some form of devaluation from others as a response to their disorder. Self-degrading comments were denoted in a number of studies in which the children pointed out stereotypical views that they had adopted about themselves. Finally, as regards courtesy stigma, parents expressed guilt in relation to their children's condition and social alienation as a result of the disorder. Surprisingly, however, there is not one study that focuses primarily on stigma in relation to TS and further studies that examine the subject from the perspective of both the 'stigmatiser' and the recipient of stigma are warranted.

  9. Restless legs syndrome associated with major diseases: A systematic review and new concept.

    Science.gov (United States)

    Trenkwalder, Claudia; Allen, Richard; Högl, Birgit; Paulus, Walter; Winkelmann, Juliane

    2016-04-05

    Recent publications on both the genetics and environmental factors of restless legs syndrome (RLS) defined as a clinical disorder suggest that overlapping genetic risk factors may play a role in primary (idiopathic) and secondary (symptomatic) RLS. Following a systematic literature search of RLS associated with comorbidities, we identified an increased prevalence of RLS only in iron deficiency and kidney disease. In cardiovascular disease, arterial hypertension, diabetes, migraine, and Parkinson disease, the methodology of studies was poor, but an association might be possible. There is insufficient evidence for conditions such as anemia (without iron deficiency), chronic obstructive pulmonary disease, multiple sclerosis, headache, stroke, narcolepsy, and ataxias. Based on possible gene-microenvironmental interaction, the classifications primary and secondary RLS may suggest an inappropriate causal relation. We recognize that in some conditions, treatment of the underlying disease should be achieved as far as possible to reduce or eliminate RLS symptoms. RLS might be seen as a continuous spectrum with a major genetic contribution at one end and a major environmental or comorbid disease contribution at the other. © 2016 American Academy of Neurology.

  10. Rubella and Congenital Rubella Syndrome in the Philippines: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Anna Lena Lopez

    2016-01-01

    Full Text Available Background. As part of regional elimination efforts, rubella-containing vaccines (RCV have recently been introduced in the Philippines, yet the true burden of rubella and congenital rubella syndrome (CRS in the country is largely unknown. Objective. To provide baseline information on rubella and CRS prior to routine vaccine introduction in the Philippines. Methods. We conducted a systematic literature review on rubella and CRS in the Philippines, including a cross-sectional study conducted in 2002 among 383 pregnant women attending the obstetric outpatient clinic of the Philippine General Hospital to assess rubella susceptibility of women of childbearing age. Results. 15 locally published and unpublished studies were reviewed. Susceptibility to rubella among women of childbearing age was higher in rural communities. Retrospective reviews revealed congenital heart diseases, cataracts, and hearing impairments to be most common presentations in children of CRS. In the cross-sectional study, 59 (15.4% of the 383 pregnant women enrolled were seronegative for rubella IgG. Conclusion. Similar to other countries introducing RCV, it was only recently that surveillance for rubella has been established. Previous studies show substantial disabilities due to CRS and a substantial proportion of susceptible women who are at risk for having babies affected with CRS. Establishment of CRS surveillance and enhanced awareness on rubella case detection should be prioritized.

  11. Treatment of bladder pain syndrome and interstitial cystitis: a systematic review.

    Science.gov (United States)

    Pazin, Carolina; de Souza Mitidieri, Andréia Moreira; Silva, Ana Paula Moreira; Gurian, Maria Beatriz Ferreira; Poli-Neto, Omero Benedicto; Rosa-E-Silva, Julio Cesar

    2016-05-01

    Bladder pain syndrome/interstitial cystitis (BPS/IC) has various treatments; however, no standardized treatment has been established. The aim was to analyze different types of treatment of BPS/IC and their effectiveness. A literature review with a search strategy for articles related to BPS/IC published between 1990 and 2014 was conducted on MEDLINE, PUBMED, and SCOPUS. Only randomized controlled trials in women were included in the meta-analysis, while other experimental studies were used as bases for a systematic review of the topic. Clinical trial quality was defined according to the Jadad scale. Of 356 articles, 13 were included in the analysis. The intervention methods were as follows: instillation of hyaluronic acid, botulinum toxin A, intravesical lidocaine, hyperbaric chamber, massage, physiotherapy, phosphate-buffered saline, piroxicam in combination with doxepin, and others. We did not find any treatment with at least two randomized controlled trials for meta-analysis. Among the assessment tools for symptoms of BPS/IC, the most frequently used were the visual analogue scale, voiding record, and the O'Leary-Sant questionnaire. Existing studies were not able to define the best approach for the treatment of BPS/IC. The lack of standardized treatment may be related to the diversity of interventions used; therefore, further studies with better methodological quality are needed.

  12. Occupational health of patients with obstructive sleep apnea syndrome: a systematic review.

    Science.gov (United States)

    Guglielmi, Ottavia; Jurado-Gámez, Bernabé; Gude, Francisco; Buela-Casal, Gualberto

    2015-03-01

    The aim of this systematic literature review was to assess the impact of obstructive sleep apnea syndrome (OSAS) on patients' occupational health. We selected 19 studies that dealt with issues related to job performance and productivity, absenteeism, and psychosocial health of patients with OSAS and assessed the risk of bias in their conclusions. Although methodologically rigorous studies are needed to confirm these findings, the results obtained suggest the existence of multiple relationships between OSAS and work limitations of patients (i.e., difficulties maintaining attention, learning new tasks, or performing monotonous tasks). The studies reviewed reached more scientifically consistent conclusions about such patients' risk of taking more days of sick leave or having work disability, particularly if they reported excessive daytime sleepiness. Very few studies have explored the relationship between OSAS and psychosocial occupational health of patients. Thus, there is a need for research to clarify these aspects of occupational medicine. OSAS has numerous effects on patients' occupational health, yet, in general, results should be confirmed by studies with sufficiently large samples in which OSAS is diagnosed with reliable methods and occupational variables are assessed with standardized and validated questionnaires.

  13. Metabolic Syndrome Is Associated with Increased Breast Cancer Risk: A Systematic Review with Meta-Analysis

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    Ruchi Bhandari

    2014-01-01

    Full Text Available Background. Although individual metabolic risk factors are reported to be associated with breast cancer risk, controversy surrounds risk of breast cancer from metabolic syndrome (MS. We report the first systematic review and meta-analysis of the association between MS and breast cancer risk in all adult females. Methods. Studies were retrieved by searching four electronic reference databases [PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL, Web of Science, and ProQuest through June 30, 2012] and cross-referencing retrieved articles. Eligible for inclusion were longitudinal studies reporting associations between MS and breast cancer risk among females aged 18 years and older. Relative risks and 95% confidence intervals were calculated for each study and pooled using random-effects models. Publication bias was assessed quantitatively (Trim and Fill and qualitatively (funnel plots. Heterogeneity was examined using Q and I2 statistics. Results. Representing nine independent cohorts and 97,277 adult females, eight studies met the inclusion criteria. A modest, positive association was observed between MS and breast cancer risk (RR: 1.47, 95% CI, 1.15–1.87; z=3.13; p=0.002; Q=26.28, p=0.001; I2=69.55%. No publication bias was observed. Conclusions. MS is associated with increased breast cancer risk in adult women.

  14. A systematic review on the association of serum selenium and metabolic syndrome

    Directory of Open Access Journals (Sweden)

    Mohammad Hasan Tajaddini

    2015-01-01

    Full Text Available Background: This systematic review paper aims to study the experimental and human studies on the relationship between metabolic syndrome (MetS, its component and selenium (Se concentration. Materials and Methods: The literature was searched in PubMed, Scopus, and Google Scholar databases with no time limitation using MetS X and Se key words in medical subject heading. The related papers were selected in three phases. After quality assessment, two reviewers extracted the data, whereas the third reviewer checked their extracted data. All evidence comes from experimental and laboratory studies. Results: Finally, 18 articles were included. While, some studies documented that as an antioxidant agent, Se might be correlated with endothelial function, large controversy exists about the type of correlation including positive, negative, and no correlation between MetS and Se levels in body. Some of the reviewed studies were focused on antioxidant supplementation effects on MetS, results also varied in this regard. Conclusion: This inconsistency could be because of diversity in study design, population, lack of special focus on Se and MetS, and finally the complex nature of MetS.

  15. Systematic review and meta-analysis of the association between psoriasis and metabolic syndrome.

    Science.gov (United States)

    Rodríguez-Zúñiga, Milton José Max; García-Perdomo, Herney Andrés

    2017-10-01

    Several studies have shown a relationship between psoriasis and metabolic syndrome (MS), but no meta-analysis has been restricted to studies that adjusted for confounders. To determine the association between psoriasis and MS. A systematic review and meta-analysis of observational studies on psoriasis and MS in adults was performed from MEDLINE, Scopus, SciELO, Google Scholar, Science Direct, and LILACS from inception to January 2016. We performed a random effects model meta-analysis for those studies reporting adjusted odds ratios (ORs) with 95% confidence intervals (CIs). The subgroup analysis was related to geographic location, diagnosis criteria and risk of bias. In all, 14 papers including a total of 25,042 patients with psoriasis were analyzed. We found that MS was present in 31.4% of patients with psoriasis (OR, 1.42; 95% CI, 1.28-1.65). Middle Eastern studies (in Israel, Turkey, and Lebanon) (OR, 1.76, 95% CI, 0.86-2.67) reported a greater risk for MS than European studies (in Germany, Italy, the United Kingdom, Norway, and Denmark) (OR, 1.40; 95% CI, 1.25-1.55). Few adjusted studies existed, and there was inconsistency between publications. Because of the increased risk for MS, clinicians should consider screening patients with psoriasis for metabolic risk factors. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  16. Should we systematically test patients with clinically isolated syndrome for auto-antibodies?

    Science.gov (United States)

    Negrotto, Laura; Tur, Carmen; Tintoré, Mar; Arrambide, Georgina; Sastre-Garriga, Jaume; Río, Jordi; Comabella, Manuel; Nos, Carlos; Galán, Ingrid; Vidal-Jordana, Angela; Simon, Eva; Castilló, Joaquín; Palavra, Filipe; Mitjana, Raquel; Auger, Cristina; Rovira, Àlex; Montalban, Xavier

    2015-12-01

    Several autoimmune diseases (ADs) can mimic multiple sclerosis (MS). For this reason, testing for auto-antibodies (auto-Abs) is often included in the diagnostic work-up of patients with a clinically isolated syndrome (CIS). The purpose was to study how useful it was to systematically determine antinuclear-antibodies, anti-SSA and anti-SSB in a non-selected cohort of CIS patients, regarding the identification of other ADs that could represent an alternative diagnosis. From a prospective CIS cohort, we selected 772 patients in which auto-Ab levels were tested within the first year from CIS. Baseline characteristics of auto-Ab positive and negative patients were compared. A retrospective revision of clinical records was then performed in the auto-Ab positive patients to identify those who developed ADs during follow-up. One or more auto-Ab were present in 29.4% of patients. Only 1.8% of patients developed other ADs during a mean follow-up of 6.6 years. In none of these cases the concurrent AD was considered the cause of the CIS. In all cases the diagnosis of the AD resulted from the development of signs and/or symptoms suggestive of each disease. Antinuclear-antibodies, anti-SSA and anti-SSB should not be routinely determined in CIS patients but only in those presenting symptoms suggestive of other ADs. © The Author(s), 2015.

  17. Chinese herbal medicine for severe acute respiratory syndrome

    DEFF Research Database (Denmark)

    Liu, Jianping; Manheimer, Eric; Shi, Yi

    2004-01-01

    To review randomized controlled trials (RCTs) evaluating the effects of Chinese herbal medicine for treating severe acute respiratory syndrome (SARS) systematically.......To review randomized controlled trials (RCTs) evaluating the effects of Chinese herbal medicine for treating severe acute respiratory syndrome (SARS) systematically....

  18. Economic evaluation of emergency obstetric care training: a systematic review.

    Science.gov (United States)

    Banke-Thomas, Aduragbemi; Wilson-Jones, Megan; Madaj, Barbara; van den Broek, Nynke

    2017-12-04

    Training healthcare providers in Emergency Obstetric Care (EmOC) has been shown to be effective in improving their capacity to provide this critical care package for mothers and babies. However, little is known about the costs and cost-effectiveness of such training. Understanding costs and cost-effectiveness is essential in guaranteeing value-for-money in healthcare spending. This study systematically reviewed the available literature on cost and cost-effectiveness of EmOC trainings. Peer-reviewed and grey literature was searched for relevant papers published after 1990. Studies were included if they described an economic evaluation of EmOC training and the training cost data were available. Two reviewers independently searched, screened, and selected studies that met the inclusion criteria, with disagreements resolved by a third reviewer. Quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards statement. For comparability, all costs in local currency were converted to International dollar (I$) equivalents using purchasing power parity conversion factors. The cost per training per participant was calculated. Narrative synthesis was used to summarise the available evidence on cost effectiveness. Fourteen studies (five full and nine partial economic evaluations) met the inclusion criteria. All five and two of the nine partial economic evaluations were of high quality. The majority of studies (13/14) were from low- and middle-income countries. Training equipment, per diems and resource person allowance were the most expensive components. Cost of training per person per day ranged from I$33 to I$90 when accommodation was required and from I$5 to I$21 when training was facility-based. Cost-effectiveness of training was assessed in 5 studies with differing measures of effectiveness (knowledge, skills, procedure cost and lives saved) making comparison difficult. Economic evaluations of EmOC training are limited. There is a

  19. Systematic review of model-based cervical screening evaluations.

    Science.gov (United States)

    Mendes, Diana; Bains, Iren; Vanni, Tazio; Jit, Mark

    2015-05-01

    Optimising population-based cervical screening policies is becoming more complex due to the expanding range of screening technologies available and the interplay with vaccine-induced changes in epidemiology. Mathematical models are increasingly being applied to assess the impact of cervical cancer screening strategies. We systematically reviewed MEDLINE®, Embase, Web of Science®, EconLit, Health Economic Evaluation Database, and The Cochrane Library databases in order to identify the mathematical models of human papillomavirus (HPV) infection and cervical cancer progression used to assess the effectiveness and/or cost-effectiveness of cervical cancer screening strategies. Key model features and conclusions relevant to decision-making were extracted. We found 153 articles meeting our eligibility criteria published up to May 2013. Most studies (72/153) evaluated the introduction of a new screening technology, with particular focus on the comparison of HPV DNA testing and cytology (n = 58). Twenty-eight in forty of these analyses supported HPV DNA primary screening implementation. A few studies analysed more recent technologies - rapid HPV DNA testing (n = 3), HPV DNA self-sampling (n = 4), and genotyping (n = 1) - and were also supportive of their introduction. However, no study was found on emerging molecular markers and their potential utility in future screening programmes. Most evaluations (113/153) were based on models simulating aggregate groups of women at risk of cervical cancer over time without accounting for HPV infection transmission. Calibration to country-specific outcome data is becoming more common, but has not yet become standard practice. Models of cervical screening are increasingly used, and allow extrapolation of trial data to project the population-level health and economic impact of different screening policy. However, post-vaccination analyses have rarely incorporated transmission dynamics. Model calibration to country

  20. Prevalence of covert duplicate publications in Budd-Chiari syndrome articles in China: a systematic analysis.

    Science.gov (United States)

    Qi, Xingshun; Ren, Weirong; Liu, Lei; Yang, Zhiping; Yang, Man; Fan, Daiming; Han, Guohong

    2013-07-01

    Covert duplicate publication is unquestionably unethical and problematic. Approximately 3000 articles describing Budd-Chiari syndrome in China have been published. However, no study has yet explored the prevalence of covert duplicate publications among these articles. We retrieved original articles regarding Budd-Chiari syndrome in China via the PubMed, Chinese Scientific and Technological Journal (VIP), and China National Knowledge Infrastructure databases. The prevalence of covert duplicate publications was evaluated across publication dates, institutional grades, and academic levels of the journals. Overall, 1914 articles were included in our analysis. These articles were produced by 632 institutions and published in 463 journals. Overall, 10% (184/1914) of the articles, 10% (62/632) of the institutions, and 26% (119/463) of the journals were involved in covert duplicate publications. A decreasing trend in the prevalence of covert duplicate publications over time was observed. The prevalence of covert duplicate publications was significantly higher in tertiary hospitals than in primary hospitals or unclassified institutions (10.0% vs 3.8%, P = .038), but the prevalence was similar between tertiary and secondary hospitals (10.0% vs 9.3%, P = .72). The prevalence of covert duplicate publications was significantly higher in Science Citation Index journals than in Chinese Academic Core journals (23.9% vs 10.3%, P = .001) and other journals (23.9% vs 8.3%, P articles on Budd-Chiari syndrome in China. The high prevalence of covert duplicate publication in Science Citation Index journals should remind English-language journal editors to verify whether the articles submitted by Chinese researchers have been published in Chinese-language journals. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Current evidence for effectiveness of interventions for cubital tunnel syndrome, radial tunnel syndrome, instability, or bursitis of the elbow: a systematic review.

    Science.gov (United States)

    Rinkel, Willem D; Schreuders, Ton A R; Koes, Bart W; Huisstede, Bionka M A

    2013-12-01

    To provide an evidence-based overview of the effectiveness of interventions for 4 nontraumatic painful disorders sharing the anatomic region of the elbow: cubital tunnel syndrome, radial tunnel syndrome, elbow instability, and olecranon bursitis. The Cochrane Library, PubMed, Embase, PEDro, and CINAHL were searched to identify relevant reviews and randomized clinical trials (RCTs). Two reviewers independently extracted data and assessed the quality of the methodology. A best-evidence synthesis was used to summarize the results. One systematic review and 6 RCTs were included. For the surgical treatment of cubital tunnel syndrome (1 review, 3 RCTs), comparing simple decompression with anterior ulnar nerve transposition, no evidence was found in favor of either one of these. Limited evidence was found in favor of medial epicondylectomy versus anterior transposition and for early postoperative therapy versus immobilization. No evidence was found for the effect of local steroid injection in addition to splinting. No RCTs were found for radial tunnel syndrome. For olecranon bursitis (1 RCT), limited evidence for effectiveness was found for methylprednisolone acetate injection plus naproxen. Concerning elbow instability, including 2 RCTs, one showed that nonsurgical treatment resulted in similar results compared with surgery, whereas the other found limited evidence for the effectiveness in favor of early mobilization versus 3 weeks of immobilization after surgery. In this review no, or at best, limited evidence was found for the effectiveness of nonsurgical and surgical interventions to treat painful cubital tunnel syndrome, radial tunnel syndrome, elbow instability, or olecranon bursitis. Well-designed and well-conducted RCTs are clearly needed in this field.

  2. Prevalence and trends of metabolic syndrome among adults in the asia-pacific region: a systematic review

    Directory of Open Access Journals (Sweden)

    P. Ranasinghe

    2017-01-01

    Full Text Available Abstract Background The Asia-Pacific region is home to nearly half of the world’s population. The region has seen a recent rapid increase in the prevalence of obesity, type-2 diabetes and cardiovascular disease. The present systematic review summarizes the recent prevalence and trends of Metabolic Syndrome (MetS among adults in countries of the Asia-Pacific Region. Methods Data on MetS in Asia-Pacific countries were obtained using a stepwise process by searching the online Medline database using MeSH terms ‘Metabolic Syndrome X’ and ‘Epidemiology/EP’. For the purpose of describing prevalence data for the individual countries, studies that were most recent, nationally representative or with the largest sample size were included. When evaluating secular trends in prevalence in a country we only considered studies that evaluated the temporal change in prevalence between similar populations, prospective studies based on the same population or National surveys conducted during different time periods. Results This literature search yielded a total of 757 articles, and five additional article were identified by screening of reference lists. From this total, 18 studies were eligible to be included in the final analysis. Of the 51 Asia-Pacific countries (WHO we only located data for 15. There was wide between country variation in prevalence of MetS. A national survey from Philippines conducted in 2003 revealed the lowest reported prevalence of 11.9% according to NCEP ATP III criteria. In contrast, the highest recorded prevalence in the region (49.0% came from a study conducted in urban Pakistan (Karachchi, 2004. Most studies reported a higher prevalence of MetS in females and urban residents. Data on secular trends were available for China, South Korea and Taiwan. An increase in the prevalence of MetS was observed in all three countries. Conclusion Despite differences in methodology, diagnostic criteria and age of subjects studied, the Asia

  3. Evaluating the core microbiota in complex communities: A systematic investigation.

    Science.gov (United States)

    Astudillo-García, Carmen; Bell, James J; Webster, Nicole S; Glasl, Bettina; Jompa, Jamaluddin; Montoya, Jose M; Taylor, Michael W

    2017-04-01

    The study of complex microbial communities poses unique conceptual and analytical challenges, with microbial species potentially numbering in the thousands. With transient or allochthonous microorganisms often adding to this complexity, a 'core' microbiota approach, focusing only on the stable and permanent members of the community, is becoming increasingly popular. Given the various ways of defining a core microbiota, it is prudent to examine whether the definition of the core impacts upon the results obtained. Here we used complex marine sponge microbiotas and undertook a systematic evaluation of the degree to which different factors used to define the core influenced the conclusions. Significant differences in alpha- and beta-diversity were detected using some but not all core definitions. However, findings related to host specificity and environmental quality were largely insensitive to major changes in the core microbiota definition. Furthermore, none of the applied definitions altered our perception of the ecological networks summarising interactions among bacteria within the sponges. These results suggest that, while care should still be taken in interpretation, the core microbiota approach is surprisingly robust, at least for comparing microbiotas of closely related samples. © 2017 Society for Applied Microbiology and John Wiley & Sons Ltd.

  4. A Systematic Review of Economic Evaluations of Pacemaker Telemonitoring Systems.

    Science.gov (United States)

    López-Villegas, Antonio; Catalán-Matamoros, Daniel; Martín-Saborido, Carlos; Villegas-Tripiana, Irene; Robles-Musso, Emilio

    2016-02-01

    Over the last decade, telemedicine applied to pacemaker monitoring has undergone extraordinary growth. It is not known if telemonitoring is more or less efficient than conventional monitoring. The aim of this study was to carry out a systematic review analyzing the available evidence on resource use and health outcomes in both follow-up modalities. We searched 11 databases and included studies published up until November 2014. The inclusion criteria were: a) experimental or observational design; b) studies based on complete economic evaluations; c) patients with pacemakers, and d) telemonitoring compared with conventional hospital monitoring. Seven studies met the inclusion criteria, providing information on 2852 patients, with a mean age of 81 years. The main indication for device implantation was atrioventricular block. With telemonitoring, cardiovascular events were detected and treated 2 months earlier than with conventional monitoring, thus reducing length of hospital stay by 34% and reducing routine and emergency hospital visits as well. There were no significant intergroup differences in perceived quality of life or number of adverse events. The cost of telemonitoring was 60% lower than that of conventional hospital monitoring. Compared with conventional monitoring, cardiovascular events were detected earlier and the number or hospitalizations and hospital visits was reduced with pacemaker telemonitoring. In addition, the costs associated with follow-up were lower with telemonitoring. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  5. Outcomes following Hip and Quadriceps Strengthening Exercises for Patellofemoral Syndrome: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Adebisi Bisi-Balogun

    2015-10-01

    Full Text Available There is growing evidence to support change in the rehabilitation strategy of patellofemoral pain syndrome (PFPS from traditional quadriceps strengthening exercises to inclusion of hip musculature strengthening in individuals with PFPS. Several studies have evaluated effects of quadriceps and hip musculature strengthening on PFPS with varying outcomes on pain and function. This systematic review and meta-analysis aims to synthesize outcomes of pain and function post-intervention and at follow-up to determine whether outcomes vary depending on the exercise strategy in both the short and long term. Electronic databases including MEDLINE, EMBASE, CINAHL, Web of Science, PubMed, Pedro database, Proquest, Science direct, and EBscoHost databases were searched for randomized control trials published between 1st of January 2005 and 31st of June 2015, comparing the outcomes of pain and function following quadriceps strengthening and hip musculature strengthening exercises in patients with PFPS. Two independent reviewers assessed each paper for inclusion and quality. Means and SDs were extracted from each included study to allow effect size calculations and comparison of results. Six randomized control trials met the inclusion criteria. Limited to moderate evidence indicates that hip abductor strengthening was associated with significantly lower pain post-intervention (SMD −0.88, −1.28 to −0.47 95% CI, and at 12 months (SMD −3.10, −3.71 to −2.50 95% CI with large effect sizes (greater than 0.80 compared to quadriceps strengthening. Our findings suggest that incorporating hip musculature strengthening in management of PFPS tailored to individual ability will improve short-term and long-term outcomes of rehabilitation. Further research evaluating the effects of quadriceps and hip abductors strengthening focusing on reduction in anterior knee pain and improvement in function in management of PFPS is needed.

  6. Incident Cardiovascular Events and Death in Individuals With Restless Legs Syndrome or Periodic Limb Movements in Sleep: A Systematic Review.

    Science.gov (United States)

    Kendzerska, Tetyana; Kamra, Maneesha; Murray, Brian J; Boulos, Mark I

    2017-03-01

    To systematically review the current evidence examining restless legs syndrome (RLS) and periodic limb movements in sleep (PLMS) as prognostic factors for all-cause mortality and incident cardiovascular events (CVE) in longitudinal studies published in the adult population. All English language studies (from 1947 to 2016) found through Medline and Embase, as well as bibliographies of identified articles, were considered eligible. Quality was evaluated using published guidelines. Among 18 cohorts (reported in 13 manuscripts), 15 evaluated the association between RLS and incident CVE and/or all-cause mortality and 3 between PLMS and CVE and mortality. The follow-up periods ranged from 2 to 20 years. A significant relationship between RLS and CVE was reported in four cohorts with a greater risk suggested for severe RLS with longer duration and secondary forms of RLS. Although a significant association between RLS and all-cause mortality was reported in three cohorts, a meta-analysis we conducted of the four studies of highest quality found no association (pooled hazard ratio = 1.09, 95% confidence interval: 0.80-1.78). A positive association between PLMS and CVE and/or mortality was demonstrated in all included studies with a greater risk attributed to PLMS with arousals. The available evidence on RLS as a prognostic factor for incident CVE and all-cause mortality was limited and inconclusive; RLS duration, severity, and secondary manifestations may be important in understanding a possible relationship. Although very limited, the current evidence suggests that PLMS may be a prognostic factor for incident CVE and mortality. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

  7. Effectiveness of conservative treatments for the lumbosacral radicular syndrome: A systematic review

    NARCIS (Netherlands)

    P.A.J. Luijsterburg (Pim); A.P. Verhagen (Arianne); R.W.J.G. Ostelo (Raymond); T.A.G. van Os (Ton); W.C. Peul (Wilco); B.W. Koes (Bart)

    2007-01-01

    textabstractPatients with a lumbosacral radicular syndrome are mostly treated conservatively first. The effect of the conservative treatments remains controversial. To assess the effectiveness of conservative treatments of the lumbosacral radicular syndrome (sciatica). Relevant electronic databases

  8. Ultrasound evaluation of metabolic syndrome patients with hepatosteatosis

    Directory of Open Access Journals (Sweden)

    Mehmet Emin Demir

    2013-01-01

    Full Text Available Objective: The exact incidence of hepatosteatosis in patients with metabolic syndrome (MetS is unknown; also there is no valid, simple and inexpensive method to evaluate and follow-up for patients with MetS. In our study, we aimed to demonstrate the frequency of hepatosteatosis, and whether demonstrate presence and degree of steatosis using liver ultrasonography may provide additional benefit for evaluating and following-up in MetS patients with non-alcoholic fatty liver disease. Methods: One hundred and twelve patients with MetS were included to the study. Patients divided into three groups; control group (n= 36 consisted of patients without hepatosteatosis, group 1 (n=43 consisted of patients with grade 1 hepatosteatosis. Finally, group 2 (n= 33 consisted of patients with grade 2 hepatosteatosis. The relationship between the presence and degree of the hepatosteatosis and MetS parameters were analyzed.Results: The incidence of hepatosteatosis was found 69.4% in patients with MetS. There were significantly differences in HOMA-IR, AST, ALT and GGT levels among control group and group 1 (p0.05 for all. Besides, there were significantly differences in waist circumferences, fasting insulin, HOMA-IR, GGT, uric acid, CRP levels among group 1 and 2 (p<0.05 for all.Conclusion: Our study indicates that MetS related parameters; especially insulin resistance, were significantly different in patients with hepatosteatosis compared to patients without hepatosteatosis. Because of the different measurment of waist circumferences among groups, we recommend to use liver ultrasonography and waist circumference together to evaluate and follow-up for MetS patients with hepatosteatosis. J Clin Exp Invest 2013; 4 (2: 153-158Key words: Fatty Liver, metabolic syndrome X, ultrasonography

  9. Associations between Yogurt Consumption and Weight Gain and Risk of Obesity and Metabolic Syndrome: A Systematic Review1234

    Science.gov (United States)

    Martínez-González, Miguel A; Bes-Rastrollo, Maira

    2017-01-01

    The role of yogurt consumption in the risk of developing overweight, obesity, or metabolic syndrome has been the subject of epidemiologic studies over the last 10 y. A comprehensive literature search on MEDLINE and ISI Web of Knowledge from 1966 through June 2016 was conducted to examine the relation between yogurt consumption and weight gain, as well as the risk of overweight, obesity, or metabolic syndrome, in prospective cohort studies. Ten articles met all the inclusion criteria and were included in our systematic review. Of the 10 cohort studies, 3 analyzed the relation between yogurt consumption and the risk of overweight or obesity, 8 analyzed changes in waist circumference or weight changes, 3 studied the association with the risk of developing metabolic syndrome, and 1 studied the probability of abdominal obesity reversion. Although an inverse association between yogurt consumption and the risk of developing overweight or obesity was not fully consistent or always statistically significant, all studies but one showed in their point estimates inverse associations between yogurt consumption and changes in waist circumference, changes in weight, risk of overweight or obesity, and risk of metabolic syndrome during follow-up, although not all estimates were statistically significant (2 studies). Prospective cohort studies consistently suggested that yogurt consumption may contribute to a reduction in adiposity indexes and the risk of metabolic syndrome. Therefore, there is a need for more prospective studies and high-quality randomized clinical trials to confirm this apparent inverse association. PMID:28096138

  10. Digital pathology: A systematic evaluation of the patent landscape.

    Science.gov (United States)

    Cucoranu, Ioan C; Parwani, Anil V; Vepa, Suryanarayana; Weinstein, Ronald S; Pantanowitz, Liron

    2014-01-01

    Digital pathology is a relatively new field. Inventors of technology in this field typically file for patents to protect their intellectual property. An understanding of the patent landscape is crucial for companies wishing to secure patent protection and market dominance for their products. To our knowledge, there has been no prior systematic review of patents related to digital pathology. Therefore, the aim of this study was to systematically identify and evaluate United States patents and patent applications related to digital pathology. Issued patents and patent applications related to digital pathology published in the United States Patent and Trademark Office (USPTO) database (www.uspto.gov) (through January 2014) were searched using the Google Patents search engine (Google Inc., Mountain View, California, USA). Keywords and phrases related to digital pathology, whole-slide imaging (WSI), image analysis, and telepathology were used to query the USPTO database. Data were downloaded and analyzed using the Papers application (Mekentosj BV, Aalsmeer, Netherlands). A total of 588 United States patents that pertain to digital pathology were identified. In addition, 228 patent applications were identified, including 155 that were pending, 65 abandoned, and eight rejected. Of the 588 patents granted, 348 (59.18%) were specific to pathology, while 240 (40.82%) included more general patents also usable outside of pathology. There were 70 (21.12%) patents specific to pathology and 57 (23.75%) more general patents that had expired. Over 120 unique entities (individual inventors, academic institutions, and private companies) applied for pathology specific patents. Patents dealt largely with telepathology and image analysis. WSI related patents addressed image acquisition (scanning and focus), quality (z-stacks), management (storage, retrieval, and transmission of WSI files), and viewing (graphical user interface (GUI), workflow, slide navigation and remote control). An

  11. Digital pathology: A systematic evaluation of the patent landscape

    Directory of Open Access Journals (Sweden)

    Ioan C. Cucoranu

    2014-01-01

    Full Text Available Introduction: Digital pathology is a relatively new field. Inventors of technology in this field typically file for patents to protect their intellectual property. An understanding of the patent landscape is crucial for companies wishing to secure patent protection and market dominance for their products. To our knowledge, there has been no prior systematic review of patents related to digital pathology. Therefore, the aim of this study was to systematically identify and evaluate United States patents and patent applications related to digital pathology. Materials and Methods: Issued patents and patent applications related to digital pathology published in the United States Patent and Trademark Office (USPTO database (www.uspto.gov (through January 2014 were searched using the Google Patents search engine (Google Inc., Mountain View, California, USA. Keywords and phrases related to digital pathology, whole-slide imaging (WSI, image analysis, and telepathology were used to query the USPTO database. Data were downloaded and analyzed using the Papers application (Mekentosj BV, Aalsmeer, Netherlands. Results: A total of 588 United States patents that pertain to digital pathology were identified. In addition, 228 patent applications were identified, including 155 that were pending, 65 abandoned, and eight rejected. Of the 588 patents granted, 348 (59.18% were specific to pathology, while 240 (40.82% included more general patents also usable outside of pathology. There were 70 (21.12% patents specific to pathology and 57 (23.75% more general patents that had expired. Over 120 unique entities (individual inventors, academic institutions, and private companies applied for pathology specific patents. Patents dealt largely with telepathology and image analysis. WSI related patents addressed image acquisition (scanning and focus, quality (z-stacks, management (storage, retrieval, and transmission of WSI files, and viewing (graphical user interface (GUI

  12. Economic evaluation studies in reproductive medicine: a systematic review of methodologic quality

    NARCIS (Netherlands)

    Moolenaar, Lobke M.; Vijgen, Sylvia M. C.; Hompes, Peter; van der Veen, Fulco; Mol, Ben Willem J.; Opmeer, Brent C.

    2013-01-01

    To evaluate the methodologic quality of economic analyses published in the field of reproductive medicine. Systematic review. Centers for reproductive care. Infertility patients. We performed a Medline search to identify economic evaluation studies in reproductive medicine. We included studies that

  13. Clinical diagnostic evaluation for scaphoid fractures: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Mallee, Wouter H.; Henny, Erik P.; van Dijk, C. Niek; Kamminga, Sjoerd P.; van Enst, Wynanda A.; Kloen, Peter

    2014-01-01

    To provide an overview of available clinical evaluation tests for scaphoid fractures and to compare their diagnostic accuracies. PWe performed a systematic review of all studies assessing diagnostic characteristics of clinical evaluation in scaphoid fractures by searching MEDLINE, EMBASE, Cochrane,

  14. Evaluation of Gastroesophageal Reflux in Anesthetized Dogs with Brachycephalic Syndrome.

    Science.gov (United States)

    Shaver, Stephanie L; Barbur, Laura A; Jimenez, David A; Brainard, Benjamin M; Cornell, Karen K; Radlinsky, MaryAnn G; Schmiedt, Chad W

    Brachycephalic airway syndrome may predispose to gastroesophageal reflux (GER) because of the high negative intrathoracic pressures required to overcome conformational partial upper airway obstruction. To investigate this, 20 dogs presenting for elective correction of brachycephalic airway syndrome (cases) and 20 non-brachycephalic dogs (controls) undergoing other elective surgeries were prospectively enrolled. Dogs underwent a standardized anesthetic protocol, and esophageal pH was monitored. Signalment, body weight, historical gastrointestinal and respiratory disease, complete blood count, serum biochemical values, radiographic findings, and anesthetic and surgical time were compared between cases and controls, and dogs that did and did not have basic (pH > 7.5), acidic (pH dogs were evaluated, dogs with GER had increased creatinine (P = .01), % positive for esophageal fluid on radiographs (P = .05), and body weight (P = .04) compared to those without GER. GER was common in both cases and controls, and cases had lower esophageal pH; however, greater numbers are required to determine if a true difference exists in % GER.

  15. Evaluation of the anterior chamber angle in pseudoexfoliation syndrome.

    Science.gov (United States)

    Iwanejko, Małgorzata; Turno-Kręcicka, Anna; Tomczyk-Socha, Martyna; Kaczorowski, Kamil; Grzybowski, Andrzej; Misiuk-Hojło, Marta

    2017-08-01

    Pseudoexfoliation syndrome (PEX) is the most frequently identifiable cause of secondary open-angle glaucoma, known as pseudoexfoliation glaucoma. The exact pathophysiology and etiology of PEX and associated glaucoma remains obscure. The purpose of this study was to determine the differences in the morphology of the anterior chamber angle in people with pseudoexfoliation syndrome and pseudoexfoliation glaucoma compared to a control group. We also evaluated the correlation between intraocular pressure (IOP) and pigmentation of the angle with the amount of exfoliated material in the anterior segment. The study group was composed of 155 eyes from 103 patients aged between 43 and 86 years. Each patient underwent a complete ophthalmological examination. Some difference was found in intraocular pressure between the PEX group and the control group and between the pseudoexfoliation glaucoma group and the control group, but no significant difference was found between the 2 study groups. There was a significant difference in the incidence of some degree of pigmentation in the anterior chamber angle and no difference in the widths of the angle between each group. A significant positive relationship was observed between intraocular pressure and the degree of pigmentation of the anterior chamber angle in both the PEX group and the pseudoexfoliation glaucoma group. The results of this study indicate that the amount of pigmentation and exfoliation material in the anterior segment significantly correlates with the level of IOP and possibly with the degree of trabecular dysfunction. It seems that for clear identification of PEX and pseudoexfoliation glaucoma factors, clinical assessment appears to be insufficient.

  16. Metabolic syndrome and dietary patterns: a systematic review and meta-analysis of observational studies.

    Science.gov (United States)

    Rodríguez-Monforte, Míriam; Sánchez, Emília; Barrio, Francisco; Costa, Bernardo; Flores-Mateo, Gemma

    2017-04-01

    Lifestyle is linked to the risk of developing metabolic syndrome (MetS); however, its relationship with dietary patterns remains unclear. This systematic review and meta-analysis aims to analyse the association of a posteriori dietary patterns with the metabolic syndrome. The PubMed, CINAHL and Scopus databases were searched for epidemiological studies of dietary patterns and MetS. The association between dietary patterns and MetS was estimated using a random-effects meta-analysis with 95 % confidence intervals (CIs). A total of 28 cross-sectional studies and three cohort studies were included in the meta-analysis. In a comparison of the highest to the lowest category of prudent/healthy dietary patterns, the pooled odds ratio (OR) for MetS was 0.83 (95 % CI 0.76, 0.90; P for heterogeneity =0.0; and I 2  = 72.1 %) in cross-sectional studies, and the pooled relative risk (RR) for MetS in cohort studies was 0.91 (95 % CI 0.68, 1.21; P for heterogeneity =0.005; I 2  = 81.1 %). The pooled OR for MetS in a comparison of the highest to the lowest category of Western dietary patterns was 1.28 (95 % CI 1.17, 1.40; P for heterogeneity =0.0; and I 2  = 72.0 %) in cross-sectional studies, and the RR was 0.96 (95 % CI 0.53, 1.73; P for heterogeneity =0.102; I 2  = 62.6 %) in cohort studies. The results from cross-sectional studies showed that a prudent/healthy pattern is associated with a lower prevalence of MetS, whereas a Western/unhealthy is associated with an increased risk for MetS. Additional prospective studies are needed to confirm the association between dietary patterns and MetS.

  17. Systematic reviews of health economic evaluations: a protocol for a systematic review of characteristics and methods applied.

    Science.gov (United States)

    Luhnen, Miriam; Prediger, Barbara; Neugebauer, Edmund A M; Mathes, Tim

    2017-12-02

    The number of systematic reviews of economic evaluations is steadily increasing. This is probably related to the continuing pressure on health budgets worldwide which makes an efficient resource allocation increasingly crucial. In particular in recent years, the introduction of several high-cost interventions presents enormous challenges regarding universal accessibility and sustainability of health care systems. An increasing number of health authorities, inter alia, feel the need for analyzing economic evidence. Economic evidence might effectively be generated by means of systematic reviews. Nevertheless, no standard methods seem to exist for their preparation so far. The objective of this study was to analyze the methods applied for systematic reviews of health economic evaluations (SR-HE) with a focus on the identification of common challenges. The planned study is a systematic review of the characteristics and methods actually applied in SR-HE. We will combine validated search filters developed for the retrieval of economic evaluations and systematic reviews to identify relevant studies in MEDLINE (via Ovid, 2015-present). To be eligible for inclusion, studies have to conduct a systematic review of full economic evaluations. Articles focusing exclusively on methodological aspects and secondary publications of health technology assessment (HTA) reports will be excluded. Two reviewers will independently assess titles and abstracts and then full-texts of studies for eligibility. Methodological features will be extracted in a standardized, beforehand piloted data extraction form. Data will be summarized with descriptive statistical measures and systematically analyzed focusing on differences/similarities and methodological weaknesses. The systematic review will provide a detailed overview of characteristics of SR-HE and the applied methods. Differences and methodological shortcomings will be detected and their implications will be discussed. The findings of our

  18. Relative risk of diabetes, dyslipidaemia, hypertension and the metabolic syndrome in people with severe mental illnesses: Systematic review and metaanalysis

    Directory of Open Access Journals (Sweden)

    King Michael B

    2008-09-01

    Full Text Available Abstract Background Severe mental illnesses (SMI may be independently associated with cardiovascular risk factors and the metabolic syndrome. We aimed to systematically assess studies that compared diabetes, dyslipidaemia, hypertension and metabolic syndrome in people with and without SMI. Methods We systematically searched MEDLINE, EMBASE, CINAHL & PsycINFO. We hand searched reference lists of key articles. We employed three search main themes: SMI, cardiovascular disease, and each cardiovascular risk factor. We selected cross-sectional, case control, cohort or intervention studies comparing one or more risk factor in both SMI and a reference group. We excluded studies without any reference group. We extracted data on: study design, cardiovascular risk factor(s and their measurement, diagnosis of SMI, study setting, sampling method, nature of comparison group and data on key risk factors. Results Of 14592 citations, 134 papers met criteria and 36 were finally included. 26 reported on diabetes, 12 hypertension, 11 dyslipidaemia, and 4 metabolic syndrome. Most studies were cross sectional, small and several lacked comparison data suitable for extraction. Meta-analysis was possible for diabetes, cholesterol and hypertension; revealing a pooled risk ratio of 1.70 (1.21 to 2.37 for diabetes and 1.11 (0.91 to 1.35 of hypertension. Restricting SMI to schizophreniform illnesses yielded a pooled risk ratio for diabetes of 1.87 (1.68 to 2.09. Total cholesterol was not higher in people with SMI (Standardized Mean Difference -0.10 (-0.55 to 0.36 and there were inconsistent data on HDL, LDL and triglycerides with some, but not all, reporting lower levels of HDL cholesterol and raised triglyceride levels. Metabolic syndrome appeared more common in SMI. Conclusion Diabetes (but not hypertension is more common in SMI. Data on other risk factors were limited by poor quality or inconsistent research findings, but a small number of studies show greater prevalence

  19. [Evaluation of ear acupressure on painful shoulder syndrome: case study].

    Science.gov (United States)

    Zanelatto, Ana Paula

    2013-01-01

    The Painful Shoulder Syndrome (PSS) is defined as pain and functional limitation resulting from impairment of static and dynamic structures of the shoulder, such as ligaments, capsule and muscles. It is one of the most common and disabling of the musculoskeletal system in the general population with prevalence estimated between 15-25%. This study aimed to evaluate the results of auricular acupressure when used as therapy in the treatment of chronic pain secondary to SOD, and the analgesic effect and therapeutic satisfactory and the estimated time of treatment. To obtain the objective was to perform a case study was to intervene with auricular acupressure beads and crystals as an indicator of the outcome questionnaire Penn Shoulder Score (PSS - Brazil). Data were analyzed qualitatively and quantitatively. We conclude that auriculotherapy is an important therapeutic technique, because the study showed an improvement in the total score of the PSS - Brazil at 34.3%.

  20. Relationship between obstructive sleep apnoea syndrome and sleep bruxism: a systematic review.

    Science.gov (United States)

    Jokubauskas, L; Baltrušaitytė, A

    2017-02-01

    Obstructive sleep apnoea syndrome (OSAS) is a clinical risk factor for sleep bruxism (SB). Both OSAS and SB are reported to be associated with sleep-related arousal reactions, although no clear causative link has been established. An electronic literature search was conducted of the MEDLINE, ScienceDirect, Wiley Online Library, SAGE Journals and EBSCOhost databases covering the period January 2006 and September 2016. Sequential screenings at the title, abstract and full-text levels were performed. The review included observational studies in the English language with a clearly established aim to assess the relationship between OSAS and SB using full-night PSG. The seven-item quality-assessment tool for experimental bruxism studies was used to assess the methodology across the studies. After a comprehensive screening of titles, abstracts and full texts, only three studies that met the pre-defined criteria were finally included in this systematic review. Two studies gave evidence that OSAS is associated with the occurrence of SB events: (i) SB events frequently occur during micro-arousal events consequent on apnoea-hypopnoea (AH) events and (ii) most SB events occur in temporal conjunction with AH events termination. However, one study did not report a strong association between AH and SB events. It can be concluded that there are not enough scientific data to define a clear causative link between OSAS and SB. However, they appear to share common clinical features. Further studies should focus on the intermediate mechanisms between respiratory and SB events. © 2016 John Wiley & Sons Ltd.

  1. Use of ghrelin in cachexia syndrome: a systematic review of clinical trials.

    Science.gov (United States)

    Mansson, Jéssica V; Alves, Fernanda D; Biolo, Andréia; Souza, Gabriela C

    2016-11-01

    Ghrelin is a hormone that stimulates weight gain and increases appetite. For these reasons, it has been used for treatment of cachexia syndrome. The aim of this systematic review was to examine the use of ghrelin in cachexia patients to better understand the most prevalent clinical outcomes, particularly since the type and dosage of hormone used and the route and duration of administration often varies. A search of electronic databases (MEDLINE, SciELO, Embase, Cochrane Library, and Clinical Trials.gov) was limited to original articles describing interventions in adult humans, with no limits for publication date or language. Articles were searched independently by 2 reviewers, from October 2013 to April 2015. Studies were eligible for inclusion if they were conducted in adult patients with a diagnosis of cachexia and provided information on type of ghrelin or analogue used, route of administration and dose administered, duration of intervention, outcomes, and clinical trial study design. Data were extracted independently by 2 reviewers using a preconstructed spreadsheet. Initially, 573 references were identified. Seven articles describing 379 participants were selected for review. Ghrelin was found to have a predominantly positive effect on growth hormone plasma levels, weight gain, increases in lean mass, and reductions in loss of adipose tissue. Although the studies reviewed here report positive results, there is still little evidence available on the use of ghrelin to treat cachexia. Further research is required to determine conclusively whether the use of ghrelin in patients with cachexia is a viable therapy. © The Author(s) 2016. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  2. Economic evaluation of dental sealants: A systematic literature review.

    Science.gov (United States)

    Akinlotan, Marvellous; Chen, Bradley; Fontanilla, Tiana M; Chen, Annie; Fan, Victoria Y

    2018-02-01

    To systematically review the literature on economic evaluations of dental sealants and examine the costs and effectiveness of caries prevention using sealants. Of 21 full-text articles examined, a total of 13 were included in this study. These studies are grouped by the type of intervention as follows: (i) sealants compared with no sealants; (ii) sealants compared with other forms of caries prevention; (iii) resin-based sealants compared with glass-ionomer sealants; (iv) different sealing strategies in primary teeth; (v) different sealing strategies in permanent teeth; and (vi) sealants based on school- or clinic-based setting of delivery. All currency is reported in constant 2010 US$. Cost-effectiveness analyses differed due to varying study designs, assumptions, sealant delivery settings, outcomes, caries risk assessment and study durations. Findings varied on the cost-effectiveness of sealants compared with other caries-preventive strategies. Under the assumption of equal caries risk, always sealing primary molars appeared to be the most effective strategy, whereas risk-based sealing was the optimal strategy with differing caries risk. Studies that assessed sealing strategies in permanent teeth reported that risk-based sealing was more cost-effective than not sealing, but they differed on the cost-effectiveness of risk-based seal compared with non-risk-based seal. Sealants delivered in school settings had mixed results on costs but were as equally effective as sealants delivered in private practices. The cost-effectiveness of sealants is dependent on the conditions of delivery. The list of cost-effectiveness ratios for each intervention can support policy makers to estimate expected returns on their investments in dental sealants. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Newman P

    2013-11-01

    Full Text Available Phil Newman, Jeremy Witchalls, Gordon Waddington, Roger Adams Faculty of Health, Physiotherapy, University of Canberra, Bruce, ACT, Australia Background: Medial tibial stress syndrome (MTSS affects 5%–35% of runners. Research over the last 40 years investigating a range of interventions has not established any clearly effective management for MTSS that is better than prolonged rest. At the present time, understanding of the risk factors and potential causative factors for MTSS is inconclusive. The purpose of this review is to evaluate studies that have investigated various risk factors and their association with the development of MTSS in runners. Methods: Medical research databases were searched for relevant literature, using the terms “MTSS AND prevention OR risk OR prediction OR incidence”. Results: A systematic review of the literature identified ten papers suitable for inclusion in a meta-analysis. Measures with sufficient data for meta-analysis included dichotomous and continuous variables of body mass index (BMI, ankle dorsiflexion range of motion, navicular drop, orthotic use, foot type, previous history of MTSS, female gender, hip range of motion, and years of running experience. The following factors were found to have a statistically significant association with MTSS: increased hip external rotation in males (standard mean difference [SMD] 0.67, 95% confidence interval [CI] 0.29–1.04, P10 mm (RR 1.99, 95% CI 1.00–3.96, P=0.05. Conclusion: Female gender, previous history of MTSS, fewer years of running experience, orthotic use, increased body mass index, increased navicular drop, and increased external rotation hip range of motion in males are all significantly associated with an increased risk of developing MTSS. Future studies should analyze males and females separately because risk factors vary by gender. A continuum model of the development of MTSS that links the identified risk factors and known processes is proposed

  4. PP105. Mental health problems following preeclampsia or HELLP syndrome: Do we have a case? A systematic review.

    Science.gov (United States)

    Delahaije, D; Dirksen, C; Peeters, L; Smits, L

    2012-07-01

    Women who suffered from pregnancy complications seem at higher risk for mental health problems. A common pregnancy complication is preeclampsia (PE) and the HELLP syndrome. To review the literature and to investigate whether former PE/HELLP patients are more likely to have mental health problems or more severe mental health problems, as compared to women without a history of PE/HELLP, and to investigate whether PE/HELLP is an independent risk factor for developing mental health problems. We performed a systematic search on PubMed and PsycInfo in July 2011. Studies had to present original data, consider postpartum depression, anxiety, or posttraumatic stress as outcomes, include both women with a history of PE/HELLP syndrome and at least one comparison group of women who had not experienced PE/HELLP, present the results for each group separately, or present the results of a multivariate regression analysis in which the diagnosis of PE/HELLP was considered as a factor, or both. Information on study design, participants and outcomes of interest for the current review were extracted using a prespecified form. Furthermore, a short critical appraisal checklist was used in order to evaluate the appropriateness of the studies in light of our specific review questions. For the purpose of the second review question, confounder control and handling of intermediate variables were specifically considered important. The search resulted in 227 articles, of which six were included. Four studies were historical cohort studies, two prospective. With respect to depression, the evidence is mixed. Out of the six studies addressing depression, all studies showed positive associations between PE/HELLP and the prevalence of depression or severity of depressive symptoms. However, the results of three of them were not statistically significant. The two studies addressing anxiety did not show a statistically significant association between PE and anxiety scores, although differences were in

  5. A Systematic Overview of Reviews for Complementary and Alternative Therapies in the Treatment of the Fibromyalgia Syndrome

    Directory of Open Access Journals (Sweden)

    Romy Lauche

    2015-01-01

    Full Text Available Objectives. This systematic overview of reviews aimed to summarize evidence and methodological quality from systematic reviews of complementary and alternative medicine (CAM for the fibromyalgia syndrome (FMS. Methods. The PubMed/MEDLINE, Cochrane Library, and Scopus databases were screened from their inception to Sept 2013 to identify systematic reviews and meta-analyses of CAM interventions for FMS. Methodological quality of reviews was rated using the AMSTAR instrument. Results. Altogether 25 systematic reviews were found; they investigated the evidence of CAM in general, exercised-based CAM therapies, manipulative therapies, Mind/Body therapies, acupuncture, hydrotherapy, phytotherapy, and homeopathy. Methodological quality of reviews ranged from lowest to highest possible quality. Consistently positive results were found for tai chi, yoga, meditation and mindfulness-based interventions, hypnosis or guided imagery, electromyogram (EMG biofeedback, and balneotherapy/hydrotherapy. Inconsistent results concerned qigong, acupuncture, chiropractic interventions, electroencephalogram (EEG biofeedback, and nutritional supplements. Inconclusive results were found for homeopathy and phytotherapy. Major methodological flaws included missing details on data extraction process, included or excluded studies, study details, and adaption of conclusions based on quality assessment. Conclusions. Despite a growing body of scientific evidence of CAM therapies for the management of FMS systematic reviews still show methodological flaws limiting definite conclusions about their efficacy and safety.

  6. Undiscovered resource evaluation: Towards applying a systematic approach to uranium

    International Nuclear Information System (INIS)

    Fairclough, M.; Katona, L.

    2014-01-01

    Evaluations of potential mineral resource supply range from spatial to aspatial, and everything in between across a range of scales. They also range from qualitative to quantitative with similar hybrid examples across the spectrum. These can compromise detailed deposit-specific reserve and resource calculations, target generative processes and estimates of potential endowments in a broad geographic or geological area. All are estimates until the ore has been discovered and extracted. Contemporary national or provincial scale evaluations of mineral potential are relatively advanced and some include uranium, such as those for South Australia undertaken by the State Geological Survey. These play an important role in land-use planning as well as attracting exploration investment and range from datato knowledge-driven approaches. Studies have been undertaken for the Mt Painter region, as well as for adjacent basins. The process of estimating large-scale potential mineral endowments is critical for national and international planning purposes but is a relatively recent and less common undertaking. In many cases, except at a general level, the data and knowledge for a relatively immature terrain is lacking, requiring assessment by analogy with other areas. Commencing in the 1980s, the United States Geological Survey, and subsequently the Geological Survey of Canada evaluated a range of commodities ranging from copper to hydrocarbons with a view to security of supply. They developed innovative approaches to, as far as practical, reduce the uncertainty and maximise the reproducibility of the calculations in information-poor regions. Yet the approach to uranium was relatively ad hoc and incomplete (such as the US Department of Energy NURE project). Other historic attempts, such as the IAEA-NEA International Uranium Resource Evaluation Project (IUREP) in the 1970s, were mainly qualitative. While there is still no systematic global evaluation of undiscovered uranium resources

  7. Anxiety and depression following preeclampsia or hemolysis, elevated liver enzymes, and low platelets syndrome. A systematic review.

    Science.gov (United States)

    Delahaije, Denise H J; Dirksen, Carmen D; Peeters, Louis L; Smits, Luc J

    2013-07-01

    Women who suffered from pregnancy complications are at increased risk for anxiety and depression. The aim of this study was to evaluate whether having suffered from preeclampsia (PE) or HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is associated with anxiety and depression, and whether PE/HELLP is an independent risk factor for developing anxiety and depression. Systematic search on PubMed and PsycInfo with no time limit. Studies presenting original data, including women with a history of PE/HELLP and at least one comparison group of women without PE/HELLP, reporting the results for each group separately or in a multivariate regression analysis with PE/HELLP as an independent variable. Study characteristics and outcomes were extracted using a prespecified form. If necessary, additional calculations were performed. The search yielded 267 articles, with only six being suitable for inclusion in this review. Studies on depression (six studies) showed generally positive associations between PE/HELLP and the prevalence of depression or severity of depressive symptoms. However, the results of three studies were not statistically significant. Studies addressing anxiety (two studies) did not show significant associations between PE/HELLP and anxiety scores. Associations between post-traumatic stress and PE/HELLP, investigated in four studies, were often nonsignificant. Due to heterogeneity of study methods, a meta-analysis of the results was not possible. In most studies, confounder control was poor. Evidence is mixed but generally points to positive associations between various forms of psychopathology and previous PE/HELLP. Causality of the associations can, however, not be judged adequately. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  8. Creatinine Change on Vasoconstrictors as Mortality Surrogate in Hepatorenal Syndrome: Systematic Review & Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Justin M Belcher

    Full Text Available Hepatorenal syndrome is a severe complication of cirrhosis and associates with significant mortality. Vasoconstrictor medications improve renal function in patients with hepatorenal syndrome. However, it is unclear to what extent changes in serum creatinine during treatment may act as a surrogate for changes in mortality. We have performed a meta-analysis of randomized trials of vasoconstrictors assessing the association between changes in serum creatinine, taken as a continuous variable, and mortality, both while on treatment and during the follow-up period for survivors.The electronic databases of PubMed, Web of Science and Embase were searched for randomized trials evaluating the efficacy of vasoconstrictor therapy for treatment of HRS type 1 or 2. The relative risk (RR for mortality was calculated against delta creatinine. The proportion of treatment effect explained (PTE was calculated for delta creatinine.Seven trials enrolling 345 patients were included. The correlation between delta creatinine and ln (RR was moderately good (R2 = 0.61. The intercept and parameter estimate indicated a fall in creatinine while on treatment of 1 mg/dL resulted in a 27% reduction in RR for mortality compared to the control arm. In patients surviving the treatment period, a fall in creatinine while on treatment of 1 mg/dL resulted in a 16% reduction in RR for post-treatment mortality during follow-up. The PTE of delta creatinine for overall mortality was 0.91 and 0.26 for post-treatment mortality.Changes in serum creatinine in response to vasoconstrictor therapy appear to be a valid surrogate for mortality, even in the period following the completion of treatment.

  9. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis.

    Science.gov (United States)

    Moran, Lisa J; Misso, Marie L; Wild, Robert A; Norman, Robert J

    2010-01-01

    BACKGROUND Polycystic ovary syndrome (PCOS) is a common condition in reproductive-aged women associated with impaired glucose tolerance (IGT), type 2 diabetes mellitus (DM2) and the metabolic syndrome. METHODS A literature search was conducted (MEDLINE, CINAHL, EMBASE, clinical trial registries and hand-searching) identifying studies reporting prevalence or incidence of IGT, DM2 or metabolic syndrome in women with and without PCOS. Data were presented as odds ratio (OR) [95% confidence interval (CI)] with fixed- and random-effects meta-analysis by Mantel-Haenszel methods. Quality testing was based on Newcastle-Ottawa Scaling and The Cochrane Collaboration's risk of bias assessment tool. Literature searching, data abstraction and quality appraisal were performed by two investigators. RESULTS A total of 2192 studies were reviewed and 35 were selected for final analysis. Women with PCOS had increased prevalence of IGT (OR 2.48, 95% CI 1.63, 3.77; BMI-matched studies OR 2.54, 95% CI 1.44, 4.47), DM2 (OR 4.43, 95% CI 4.06, 4.82; BMI-matched studies OR 4.00, 95% CI 1.97, 8.10) and metabolic syndrome (OR 2.88, 95% CI 2.40, 3.45; BMI-matched studies OR 2.20, 95% CI 1.36, 3.56). One study assessed IGT/DM2 incidence and reported no significant differences in DM2 incidence (OR 2.07, 95% CI 0.68, 6.30). One study assessed conversion from normal glucose tolerance to IGT/DM2 (OR 2.4, 95% CI 0.7, 8.0). No studies reported metabolic syndrome incidence. CONCLUSIONS Women with PCOS had an elevated prevalence of IGT, DM2 and metabolic syndrome in both BMI and non-BMI-matched studies. Few studies have determined IGT/DM2 or metabolic syndrome incidence in women with and without PCOS and further research is required.

  10. [Serial clinical and echocardiographic evaluation in children with Marfan syndrome].

    Science.gov (United States)

    Lopez, Victor Manuel Oporto; Perez, Ana Beatriz Alvarez; Moisés, Valdir Ambrósio; Gomes, Lourdes; Pedreira, Patricia da Silveira; Silva, Célia C; Campos Filho, Orlando; Carvalho, Antônio Carlos C

    2005-11-01

    To describe the clinical cardiac manifestations and temporal evolution of Marfan syndrome in children; to estimate the incidence of annuloaortic ectasia and mitral valve prolapse; and to evaluate tolerability and efficacy of beta-blockers in these patients. During one year, 21 children with Marfan syndrome underwent serial clinical and echocardiographic examinations. Echocardiograms assessed: the presence of mitral valve prolapse, aortic root diameter, mitral and aortic valves regurgitation, and aortic enlargement during beta-blocker therapy. Eleven patients had two measurements of the aortic root taken one year apart. The children were asymptomatic throughout the study. Mitral prolapse was found in 11 (52%) children. Annuloaortic ectasia occurred in 16 (76%) patients and found to be mild in 42.8%, moderate in 9.5%, and severe in 23.8%. One of these patients underwent aortic valve replacement and repair of the ascending aorta by the Bentall-De Bono technique, with good results. Heart rate decreased by 13.6% (from 85 to 73 bpm; p < 0.009) with the use of beta-blockers; however, aortic root diameter increased by 1.4 mm/year (p < 0.02). One child could not be given beta-blockers due to bronchial asthma, and no significant side effects were observed in the remaining children, including one who also had bronchial asthma. The children remained asymptomatic throughout the study, the use of beta-blockers led to a significant decrease in heart rate, and no significant adverse effects were observed. Contrary to the literature, incidence of annuloaortic ectasia was high among the study population, greater than that of mitral valve prolapse, even during beta-blocker therapy.

  11. Evaluation of metabolic syndrome in adults of Talca city, Chile

    Directory of Open Access Journals (Sweden)

    Moore-Carrasco Rodrigo

    2008-05-01

    Full Text Available Abstract Objective- Insulin resistance (IR is an important risk factor for type 2 Diabetes Mellitus (DM2 and cardiovascular disease (CVD. Metabolic Syndrome (MS is a clustering of metabolic alterations associated to IR; however, there is no international consensus for defining its diagnosis. Our objective was to evaluate the prevalence and characteristics of MS identified by the ATP III and IDF criteria in adults from Talca city. Research and methods- We studied 1007 individuals, aged 18–74, and residents from Talca. MS subjects were defined according to ATP III (three altered factors and IDF criteria (patients with waist circumference >80/90 cm (W/M and two others altered factors. Results- The prevalence of metabolic syndrome according to the IDF and ATP III criteria was 36.4% and 29.5%, respectively after adjustment for age and sex. The agreement for both criteria was 89%. The prevalence in men was higher than in women for both MS definitions, although not significant. MS probability increased with age, and the highest risk was in the 57–68 age group (ATP-MS and 53–72 age group (IDF-MS. Hypertension, high triglycerides and abdominal obesity are the most frequent alterations in MS. Conclusion- MS prevalence in adults was higher when diagnosed with IDF than with ATP criterion; in both, age is directly related with the MS presence. The MS subjects showed higher levels of blood pressure, waist circumference and plasma triglycerides. Considering our results, it is worrisome that one third of our population has a high risk of developing DM2 and CVD in the future.

  12. Process variables in organizational stress management intervention evaluation research: a systematic review

    NARCIS (Netherlands)

    Havermans, B.M.; Schelvis, R.M.C.; Boot, C.R.L.; Brouwers, E.P.M.; Anema, J.R.; Beek, A.J. van der

    2016-01-01

    Objectives This systematic review aimed to explore which process variables are used in stress management intervention (SMI) evaluation research. Methods A systematic review was conducted using seven electronic databases. Studies were included if they reported on an SMI aimed at primary or secondary

  13. Can clinical evaluation predict return to sport after acute hamstring injuries? : a systematic review

    NARCIS (Netherlands)

    Schut, Lotte; Wangensteen, Arnlaug; Maaskant, Jolanda; Tol, Johannes L.; Bahr, Roald; Moen, Maarten

    2016-01-01

    BACKGROUND: The current literature on the value of clinical evaluation for predicting time to return to sport (RTS) after acute hamstring injuries has not been systematically summarised. OBJECTIVES: The aim of this study was to systematically review the literature on the prognostic value of clinical

  14. Evaluating interventions to improve somatic health in severe mental illness : A systematic review

    NARCIS (Netherlands)

    van Hasselt, F.M.; Krabbe, P.F.M.; van Ittersum, D.G.; Postma, M.J.; Loonen, Anton J. M.

    2013-01-01

    Objective: To present a systematic review of the evaluation of randomized interventions directed toward improving somatic health for patients with severe mental illness (SMI). Method: A systematic search in PubMed, Embase, Cinahl, and PsycInfo was performed. The scope of the search was prospective

  15. A systematic review of economic evaluations of cardiac rehabilitation

    Directory of Open Access Journals (Sweden)

    Wong Wai

    2012-08-01

    Full Text Available Abstract Background Cardiac rehabilitation (CR, a multidisciplinary program consisting of exercise, risk factor modification and psychosocial intervention, forms an integral part of managing patients after myocardial infarction (MI, revascularization surgery and percutaneous coronary interventions, as well as patients with heart failure (HF. This systematic review seeks to examine the cost-effectiveness of CR for patients with MI or HF and inform policy makers in Singapore on published cost-effectiveness studies on CR. Methods Electronic databases (EMBASE, MEDLINE, NHS EED, PEDro, CINAHL were searched from inception to May 2010 for published economic studies. Additional references were identified through searching bibliographies of included studies. Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Quality assessment of economic evaluations was undertaken using Drummond’s checklist. Results A total of 22 articles were selected for review. However five articles were further excluded because they were cost-minimization analyses, whilst one included patients with stroke. Of the final 16 articles, one article addressed both centre-based cardiac rehabilitation versus no rehabilitation, as well as home-based cardiac rehabilitation versus no rehabilitation. Therefore, nine studies compared cost-effectiveness between centre-based supervised CR and no CR; three studies examined that between centre- and home based CR; one between inpatient and outpatient CR; and four between home-based CR and no CR. These studies were characterized by differences in the study perspectives, economic study designs and time frames, as well as variability in clinical data and assumptions made on costs. Overall, the studies suggested that: (1 supervised centre-based CR was highly cost-effective and the dominant strategy when compared to no CR; (2 home-based CR was no different from centre-based CR; (3 no difference existed

  16. Evaluation of the temporal bone malformations by HRCT in 17 patients with Treacher Collins Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Chihara, Yasuhiro [Kanto Medical Center NTT EC, Tokyo (Japan); Takegoshi, Hideki [Saitama Medical School, Moroyama (Japan); Kaga, Kimitaka [Tokyo Univ. (Japan). Faculty of Medicine

    2003-05-01

    Patients with Treacher Collins Syndrome have severe middle ear malformations. We have studied high-resolution computed tomography (HRCT) of seventeen patients with Treacher Collins Syndrome by using Jahrsdoerfer's grading system. Four patients underwent canalplasty. The appearance of the auricle (which we evaluated by using Marx's grading system) was correlated with the development of the middle ear in patients with Treacher Collins Syndrome. The four cases who underwent canalplasty were using a canal type hearing aid. (author)

  17. Systematic identification of placental epigenetic signatures for the noninvasive prenatal detection of Edwards syndrome.

    Directory of Open Access Journals (Sweden)

    Dana W Y Tsui

    Full Text Available BACKGROUND: Noninvasive prenatal diagnosis of fetal aneuploidy by maternal plasma analysis is challenging owing to the low fractional and absolute concentrations of fetal DNA in maternal plasma. Previously, we demonstrated for the first time that fetal DNA in maternal plasma could be specifically targeted by epigenetic (DNA methylation signatures in the placenta. By comparing one such methylated fetal epigenetic marker located on chromosome 21 with another fetal genetic marker located on a reference chromosome in maternal plasma, we could infer the relative dosage of fetal chromosome 21 and noninvasively detect fetal trisomy 21. Here we apply this epigenetic-genetic (EGG chromosome dosage approach to detect Edwards syndrome (trisomy 18 in the fetus noninvasively. PRINCIPAL FINDINGS: We have systematically identified methylated fetal epigenetic markers on chromosome 18 by methylated DNA immunoprecipitation (MeDIP and tiling array analysis with confirmation using quantitative DNA methylation assays. Methylated DNA sequences from an intergenic region between the VAPA and APCDD1 genes (the VAPA-APCDD1 DNA were detected in pre-delivery, but not post-delivery, maternal plasma samples. The concentrations correlated positively with those of an established fetal genetic marker, ZFY, in pre-delivery maternal plasma. The ratios of methylated VAPA-APCDD1(chr18 to ZFY(chrY were higher in maternal plasma samples of 9 male trisomy 18 fetuses than those of 27 male euploid fetuses (Mann-Whitney test, P=0.029. We defined the cutoff value for detecting trisomy 18 fetuses as mean+1.96 SD of the EGG ratios of the euploid cases. Eight of 9 trisomy 18 and 1 of 27 euploid cases showed EGG ratios higher than the cutoff value, giving a sensitivity of 88.9% and a specificity of 96.3%. CONCLUSIONS: Our data have shown that the methylated VAPA-APCDD1 DNA in maternal plasma is predominantly derived from the fetus. We have demonstrated that this novel fetal epigenetic marker

  18. Invited Commentary: Evaluation of Horner Syndrome in the MRI Era.

    Science.gov (United States)

    Kawasaki, Aki

    2018-03-01

    This Invited Commentary discusses the following article: BACKGROUND:: To identify the etiologies of adult Horner syndrome (HS) in the MRI era using a targeted evaluation approach and to assess the value and yield of targeted imaging. A retrospective chart review was performed of 200 adult outpatients with HS, confirmed with cocaine eyedrop testing. Patients were divided into subgroups based on the presence or absence of symptoms and those who did or did not receive additional testing with hydroxyamphetamine drops. Imaging was obtained based on pharmacologic localization and/or clinical evaluation. The etiology of HS and the yield of imaging were determined in all subgroups. Imaging showed causative lesions in 24 of 179 (12.84%) imaged patients with HS, and 13 (69.0%) were determined "idiopathic." Of the patients who underwent testing with hydroxyamphetamine drops (132 patients), 86 had a postganglionic localization with an imaging yield of 8.1%, and 46 had preganglionic cause with an imaging yield of 21.7%. Fifty-three patients (26.5%) never noticed ptosis/anisocoria before examination, and the imaging yield in this subgroup was 2.8%. Eighteen of the 200 patients (9.0%) had serious pathology, including carotid artery dissection, brain, or neck mass, and 6 of these (31.6%) had acute symptoms and/or pain. HS is most often idiopathic with serious pathology being relatively infrequent. When determining etiology, the absence of symptoms is not predictive of the pathology. However, acute onset of symptoms and/or pain are possible indicators for serious pathology. Localizing the lesion using hydroxyamphetamine drops whenever obtainable and available is still an efficient way to target imaging evaluation.

  19. Systematization of simplified J-integral evaluation method for flaw evaluation at high temperature

    International Nuclear Information System (INIS)

    Miura, Naoki; Takahashi, Yukio; Nakayama, Yasunari; Shimakawa, Takashi

    2000-01-01

    J-integral is an effective inelastic fracture parameter for the flaw evaluation of cracked components at high temperature. The evaluation of J-integral for an arbitrary crack configuration and an arbitrary loading condition can be generally accomplished by detailed numerical analysis such as finite element analysis, however, it is time-consuming and requires a high degree of expertise for its implementation. Therefore, it is important to develop simplified J-integral estimation techniques from the viewpoint of industrial requirements. In this study, a simplified J-integral evaluation method is proposed to estimate two types of J-integral parameters. One is the fatigue J-integral range to describe fatigue crack propagation behavior, and the other is the creep J-integral to describe creep crack propagation behavior. This paper presents the systematization of the simplified J-integral evaluation method incorporated with the reference stress method and the concept of elastic follow-up, and proposes a comprehensive evaluation procedure. The verification of the proposed method is presented in Part II of this paper. (author)

  20. Evaluation and management of superior canal dehiscence syndrome

    NARCIS (Netherlands)

    Niesten, M.E.F.

    2014-01-01

    Superior canal dehiscence (SCD) syndrome is a rare disorder involving the inner ear that was first described by Lloyd Minor in 1998. Patients with SCD syndrome can present with a range of auditory and/or vestibular signs and symptoms that are associated with a bony defect of one or both superior

  1. Foetal alcohol syndrome: an osteometric evaluation in the wistar rat ...

    African Journals Online (AJOL)

    Background: Foetal alcohol syndrome had been reported as a common feature in the off – springs of alcoholic mothers; and craniofacial and limb bones anomalies are usually some of the cardinal features of foetal alcohol syndrome (FAS). Methods: These features were osteometrically assessed in the cranial and limb ...

  2. Aortopathies in Turner syndrome -- new strategies for evaluation and treatment.

    Science.gov (United States)

    Kriksciuniene, Ruta; Ostrauskas, Rytas; Zilaitiene, Birute

    2015-01-01

    Turner syndrome is a rare genetic disorder which impairs women's growth, reproductive function, cardiovascular development and other functions. This syndrome has been proposed as an independent risk marker for cardiovascular disease. Despite this, life-threatening cardiovascular outcomes affecting young women are dismissed because of incomplete follow up. During assessment due to their smaller stature, it should be noted that, although the ascending aorta diameter is normal in absolute terms, after indexation for body size, patients with Turner syndrome may have a dilated aorta.Based on recent guidelines and the latest studies, there is new evidence on the use of magnetic resonance imaging in diagnosing aortic lesions. New management possibilities of aortopathies have also been discussed. This approach should optimise medical care for women with Turner syndrome, but many areas of uncertainty still remain in the diagnosis and management of this syndrome, and new prospective studies are needed.

  3. Tics and Tourette syndrome: clinical evaluation of 44 cases

    Directory of Open Access Journals (Sweden)

    Teive Hélio A.G.

    2001-01-01

    Full Text Available We evaluated 44 patients with tics and Tourette's syndrome (TS emphasising the age of onset of symptoms, sex, classification and localization of tics, associated symptoms and signs and comorbidities. Thirty-three patients (75.2% had TS defined criteria whereas 10 (22.7% had chronic motor and/or vocal tics. Simple motor tics were found in 43 cases (97.7%, mainly affecting the eyes (43.2%, mouth (43.2%, face (34.1%. Simple vocal tics occurred in 33 (75%. Coprolalia was found in just 6 cases (13.6% and copropraxia in just 2 (4.5%. Obsessive compulsive disorder and/or symptoms were found in 26 cases (59.1% and attention deficit in 17 (38.6%. Eighteen patients (40.9% had other disorders, such as alcoholism, tabagism, drug abuse, affective disorders, anxiety, sleep and learning disorders. The data obtained are similar to those found by other authors. We highlight the low frequency of coprolalia, as well as the associated neuropsychiatric disorders.

  4. Pathophysiology, Evaluation, and Management of Edema in Childhood Nephrotic Syndrome.

    Science.gov (United States)

    Ellis, Demetrius

    2015-01-01

    Generalized edema is a major presenting clinical feature of children with nephrotic syndrome (NS) exemplified by such primary conditions as minimal change disease (MCD). In these children with classical NS and marked proteinuria and hypoalbuminemia, the ensuing tendency to hypovolemia triggers compensatory physiological mechanisms, which enhance renal sodium (Na(+)) and water retention; this is known as the "underfill hypothesis." Edema can also occur in secondary forms of NS and several other glomerulonephritides, in which the degree of proteinuria and hypoalbuminemia, are variable. In contrast to MCD, in these latter conditions, the predominant mechanism of edema formation is "primary" or "pathophysiological," Na(+) and water retention; this is known as the "overfill hypothesis." A major clinical challenge in children with these disorders is to distinguish the predominant mechanism of edema formation, identify other potential contributing factors, and prevent the deleterious effects of diuretic regimens in those with unsuspected reduced effective circulatory volume (i.e., underfill). This article reviews the Starling forces that become altered in NS so as to tip the balance of fluid movement in favor of edema formation. An understanding of these pathomechanisms then serves to formulate a more rational approach to prevention, evaluation, and management of such edema.

  5. Acute Coronary Syndrome: Emergency Department Evaluation and Management.

    Science.gov (United States)

    Veauthier, Brian; Sievers, Karlynn; Hornecker, Jaime

    2015-10-01

    Patients with chest pain who present to emergency departments have a significantly higher incidence of acute coronary syndrome (ACS) than patients with chest pain presenting to outpatient settings, so emergency department clinicians should have a lower threshold for considering ACS as an etiology. Evaluating patients with suspected ACS in the emergency department involves obtaining a history, physical examination, electrocardiograms (ECGs), and cardiac troponin measurements in conjunction with risk calculators. These parameters cannot be used individually because, for example, a normal ECG result does not exclude ACS and troponin levels can be elevated in many conditions. All patients with suspected ACS should receive aspirin, if not contraindicated, as soon as possible. Those with an ST-segment elevation myocardial infarction (STEMI) or those without STEMI who are in unstable condition should be triaged to undergo reperfusion therapy, typically via percutaneous coronary intervention (PCI), within 120 minutes of first medical contact. If that time limit cannot be met because the patient must be transferred to a PCI-capable facility, fibrinolytic therapy should be initiated within 30 minutes of presentation if STEMI is present. (Fibrinolytic therapy is contraindicated for myocardial infarction without STEMI.) Patients also should receive nitroglycerin to relieve angina and beta blockers if not contraindicated. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  6. Pathophysiology, Evaluation, and Management of Edema in Childhood Nephrotic Syndrome

    Science.gov (United States)

    Ellis, Demetrius

    2016-01-01

    Generalized edema is a major presenting clinical feature of children with nephrotic syndrome (NS) exemplified by such primary conditions as minimal change disease (MCD). In these children with classical NS and marked proteinuria and hypoalbuminemia, the ensuing tendency to hypovolemia triggers compensatory physiological mechanisms, which enhance renal sodium (Na+) and water retention; this is known as the “underfill hypothesis.” Edema can also occur in secondary forms of NS and several other glomerulonephritides, in which the degree of proteinuria and hypoalbuminemia, are variable. In contrast to MCD, in these latter conditions, the predominant mechanism of edema formation is “primary” or “pathophysiological,” Na+ and water retention; this is known as the “overfill hypothesis.” A major clinical challenge in children with these disorders is to distinguish the predominant mechanism of edema formation, identify other potential contributing factors, and prevent the deleterious effects of diuretic regimens in those with unsuspected reduced effective circulatory volume (i.e., underfill). This article reviews the Starling forces that become altered in NS so as to tip the balance of fluid movement in favor of edema formation. An understanding of these pathomechanisms then serves to formulate a more rational approach to prevention, evaluation, and management of such edema. PMID:26793696

  7. Pathophysiology, Evaluation and Management of Edema in Childhood Nephrotic Syndrome

    Directory of Open Access Journals (Sweden)

    Demetrius eEllis

    2016-01-01

    Full Text Available Generalized edema is a major presenting clinical feature of children with nephrotic syndrome (NS exemplified by such primary conditions as minimal change disease (MCD. In these children with classical NS and marked proteinuria and hypoalbuminemia, the ensuing tendency to hypovolemia triggers compensatory physiologic mechanisms which enhance renal sodium (Na+ and water retention; this is known as the underfill hypothesis. Edema can also occur in secondary forms of NS and several other glomerulonephritides, in which the degree of proteinuria and hypoalbuminemia, are variable. In contrast to MCD, in these latter conditions the predominant mechanism of edema formation is primary or pathophysiologic, Na+ and water retention; this is known as the overfill hypothesis. A major clinical challenge in children with these disorders is to distinguish the predominant mechanism of edema formation, identify other potential contributing factors, and prevent the deleterious effects of diuretic regimens in those with unsuspected reduced effective circulatory volume (i.e., underfill. This article reviews the Starling forces that become altered in NS so as to tip the balance of fluid movement in favor of edema formation. An understanding of these pathomechanisms then serves to formulate a more rational approach to prevention, evaluation and management of such edema

  8. Smith-Magenis syndrome: clinical evaluation in seven Brazilian patients.

    Science.gov (United States)

    Gamba, B F; Vieira, G H; Souza, D H; Monteiro, F F; Lorenzini, J J; Carvalho, D R; Morreti-Ferreira, D

    2011-10-31

    Smith-Magenis syndrome (SMS) is a complex congenital anomaly characterized by craniofacial anomalies, neurological and behavioral disorders. SMS is caused by a deletion in region 17p11.2, which includes the RAI1 gene (90% of cases), or by point mutation in the RAI1 gene (10% of cases). Laboratory diagnosis is through cytogenetic analysis by GTG banding and molecular cytogenetic analysis by FISH. We carried out an active search for patients in Associations of Parents and Friends of Exceptional Children (APAE) of São Paulo and genetic centers in Brazil. Forty-eight patients were screened for mental retardation, craniofacial abnormalities and stereotyped behavior with a diagnosis of SMS. In seven of them, chromosome banding at high resolution demonstrated chromosome 17p11.2 deletions, confirmed by FISH. We also made a meta-analysis of 165 cases reported between 1982 and 2010 to compare with the clinical data of our sample. We demonstrated differences between the frequencies of clinical signs among the cases reported and seven Brazilian cases of this study, such as dental anomalies, strabismus, ear infections, deep hoarse voice, hearing loss, and cardiac defects. Although the gold standard for diagnosis of SMS is FISH, we found that the GTG banding technique developed to evaluate chromosome 17 can be used for the SMS diagnosis in areas where the FISH technique is not available.

  9. Yield and Costs of Evaluating Children with Cyclic Vomiting Syndrome.

    Science.gov (United States)

    Lucia-Casadonte, Chantal; Whaley, Kaitlin; Chogle, Ashish

    2018-01-25

    Cyclic vomiting syndrome (CVS) clinical guidelines recommend an algorithm of basic testing for standard patients, and more targeted testing, including laboratory and imaging studies, in the presence of specific red flags. The cost effectiveness of this screening of children with suspected CVS is lacking. To determine if screening studies in CVS patients results in diagnostic change, and to estimate their healthcare cost. Charts of patients (1-18 years) with suspected CVS were retrospectively reviewed at a single center. Results and cost of laboratory and imaging studies were analyzed. 503 charts were reviewed from electronic medical records with the ICD9 code 536.2 or search terms "CVS, cyclic vomiting, persistent emesis/vomiting, hyperemesis, or intractable/ periodic vomiting". Of these, 165 (33%) had a diagnosis of CVS and 135 (82%) children (mean age 7.7 ± 4.3; 73 (54%) females) met CVS criteria based on NASPGHAN diagnostic criteria. Of those meeting CVS criteria, 6 (4%) had a change in management based on the CVS screening evaluation. The mean cost of screening per patient that met CVS criteria was $6,125.02 USD and the estimated total cost for all patients who met CVS criteria was $826,877.88 USD. The screening metabolic labs, pelvic ultrasound, MRI, and upper endoscopy resulted in a diagnosis change in few patients screened for CVS. Most children who met criteria for CVS did not benefit from screening evaluation as results did not change clinical diagnosis or management, and were associated with higher cost.

  10. The relationship between epicardial fat and indices of obesity and the metabolic syndrome: a systematic review and meta-analysis.

    Science.gov (United States)

    Rabkin, Simon W

    2014-02-01

    Epicardial fat (epicardial adipose tissue, EAT) has been implicated in the pathogenesis of coronary artery disease (CAD). The objective of this study was to examine the relationship between EAT and generalized obesity, central or visceral adipose tissue (VAT), and the components of the metabolic syndrome--systolic blood pressure (SBP), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), and fasting blood glucose (FBG)--that are linked to CAD. A systematic review of the literature, following meta-analysis guidelines, was conducted until May, 2013, using the search strategy "Obesity" OR "abdominal obesity" OR "metabolic syndrome" OR "metabolic syndrome X" AND "epicardial fat". Thirty-eight studies fulfilled the criteria. There was a highly significant (Pcorrelation between EAT and body mass index (BMI), waist circumference (WC), or VAT. The correlation between EAT and VAT was significantly (Pcorrelation between EAT and WC, which in turn was significantly greater than the correlation between EAT and BMI. Overall, EAT was 7.5 ± 0.1 mm in thickness in the metabolic syndrome (n=427) compared to 4.0 ± 0.1 mm in controls (n=301). EAT correlated significantly (PHDL, and FBG, but the strength of the association was less than one-half of the relationship of EAT to indices of obesity. The results of multivariate analysis were less consistent but show a relationship between EAT and metabolic syndrome independent of BMI. In summary, the very strong correlation between EAT and VAT suggests a relationship between these two adipose tissue depots. Measurement of EAT can be useful to indicate VAT. Whereas EAT correlates significantly with each of the components of the metabolic syndrome- SBP, TGs, HDL, or FBG-the magnitude of the relationship is considerably and significantly less than the relationship of EAT to BMI. These data show the strong relationship between EAT and BMI but especially with WC and VAT. They also demonstrate the smaller magnitude of the

  11. Mind-Body Interventions for Irritable Bowel Syndrome Patients in the Chinese Population: a Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Wang, Weidong; Wang, Fang; Fan, Feng; Sedas, Ana Cristina; Wang, Jian

    2017-04-01

    The aim of this study is to identify and assess evidence related to the efficacy of mind-body interventions on irritable bowel syndrome (IBS) in the Chinese population. Drawn from Chinese databases, nine RCTs and three Q-E studies were included in the systematic review. The methodological quality of RCTs was evaluated based on the following criteria: adequate sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting, and other potential biases. For continuous variables, the effect size (ES) was determined by calculating the standardized mean difference between groups. For dichotomous variables, the ES was determined by calculating the risk ratio (RR) between groups. Given the heterogeneity between the trials and the small number of studies included, both random effects and fixed effects models were used. The inverse variance method was used for pooling. Statistical analyses were performed using Review Manager version 5.0. The total number of papers identified was 710: 462 from English language databases and 248 from Chinese language databases. Twelve studies met our eligibility criteria. Among the studies selected, three were Q-E studies the rest RCTs. Two studies described the randomization process. None of the studies reported allocation concealment nor blinding. Seven studies reported no dropouts. One of the studies mentioned the total amount of dropouts; though the reason for dropping out was not referenced. The other four studies did not clearly report dropouts. With the exception of three studies, there was inadequate information to determine biased reporting for the majority; the level of risk for bias in these studies is unclear. Finally, six meta-analyses were performed. One was conducted with four randomized controlled trials (RCTs) that used cure rate as outcome measures to evaluate gastrointestinal (GI) symptoms, which suggested that mind-body interventions were effective in improving GI symptoms (random

  12. Chinese Medicinal Herbs in the Treatment of Upper Airway Cough Syndrome: A Systematic Review of Randomized, Controlled Trials.

    Science.gov (United States)

    Jiang, Hongli; Liu, Wei; Li, Guanhong; Fan, Tao; Mao, Bing

    2016-03-01

    Context • Upper airway cough syndrome (UACS), previously called postnasal drip syndrome (PNDS), has been considered universally to be one of the most common causes of chronic cough. As an important part of complementary and alternative therapy, traditional Chinese medicine (TCM) has found an exact curative therapy for chronic cough through clinical practice for thousands of years. Objective • The aim of the current review was to investigate systematically the beneficial and adverse effects of Chinese medicinal herbs (CMH) in the treatment of UACS. Design • The research team performed searches in 11 main databases from respective inception to October 31, 2015, supplemented with manual retrieval of other data. Only randomized, controlled trials (RCTs) reporting on the effectiveness of CMH in patients with UACS were included. Descriptive and quantitative data on the studies' designs, population demographics, interventions, outcomes, and methodological quality were extracted and tabulated. Methodological quality was assessed using the Cochrane risk-of-bias system and the quality of the evidence was evaluated using the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) system. Participants • The reviewed studies included 1355 participants-720 in the CMH groups and 635 in the control groups-of both genders, from various professional and ethnic groups, and with a wide range of ages. They all had a duration of cough symptoms of longer than 8 wk and a clinical diagnosis of chronic cough induced by UACS that was supported by appropriate physical findings. Outcome Measures • The primary outcomes included (1) TCM recovery rate and (2) TCM cough symptom score. TCM's curative effect was calculated as the cumulative percentage of the symptom-score reduction (PSSR), estimated between baseline and postintervention. The cough symptom scores were graded according to the Chinese Criteria Guiding Principle of Clinical Research on New Drugs of TCM, with

  13. Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review.

    Science.gov (United States)

    Cerqueira, Raphael O; Frey, Benicio N; Leclerc, Emilie; Brietzke, Elisa

    2017-12-01

    The objective of this study was to evaluate whether Vitex agnus castus is a safe and effective treatment for PMS and premenstrual dysphoric disorder (PMDD) and to discuss the implications of these findings for clinical practice. A systematic review of literature was conducted using PubMed and Scielo databases. The inclusion criteria were randomized controlled trials (RCT) using V. agnus castus in individuals with PMS or PMDD that compared this intervention with placebo or an active comparator and included a description of blinding and dropouts/withdrawals. The search was conducted by two independent investigators who reached consensus on the included trials. A total of eight RCTs were included in this study. Most studies focused on PMS, and the diagnostic criteria of PMS and PMDD changed over the years. Three different preparations of V. agnus castus (VAC) were tested, and there was significant variability in the measurement of treatment outcomes between the studies. Nevertheless, all eight studies were positive for VAC in the treatment of PMS or PMDD and VAC was overall well tolerated. Main limitations were differences in definition of diagnostic criteria, the instruments used as main outcome measures, and different preparations of VAC extracts limit the comparison of results between studies. In conclusion, the RCTs using VAC for treatment of PMS/PMDD suggested that the VAC extract is a safe and efficacious alternative to be considered for the treatment of PMS/PMDD symptoms.

  14. Systematic review: The placebo effect of psychological interventions in the treatment of irritable bowel syndrome

    NARCIS (Netherlands)

    Flik, Carla E.; Bakker, Laura; Laan, Wijnand; van Rood, Yanda R.; Smout, André J. P. M.; de Wit, Niek J.

    2017-01-01

    To determine the placebo response rate associated with different types of placebo interventions used in psychological intervention studies for irritable bowel syndrome. Randomized controlled trials comparing psychological interventions (stress management/relaxation therapy (cognitive) behavioral

  15. Research Design Characteristics of Published Pharmacologic Randomized Clinical Trials for Irritable Bowel Syndrome and Chronic Pelvic Pain Conditions: An ACTTION Systematic Review.

    Science.gov (United States)

    Gewandter, Jennifer S; Chaudari, Jenna; Iwan, Katarzyna B; Kitt, Rachel; As-Sanie, Sawsan; Bachmann, Gloria; Clemens, Quentin; Lai, H Henry; Tu, Frank; Verne, G Nicholas; Vincent, Katy; Wesselmann, Ursula; Zhou, QiQi; Turk, Dennis C; Dworkin, Robert H; Smith, Shannon M

    2018-02-02

    Chronic pain conditions occurring in the lower abdomen and pelvis are common, often challenging to manage, and can negatively affect health-related quality of life. Methodological challenges in designing randomized clinical trials (RCTs) for these conditions likely contributes to the limited number of available treatments. The goal of this systematic review of RCTs of pharmacologic treatments for irritable bowel syndrome and 3 common chronic pelvic pain conditions are to: 1) summarize the primary end points and entry criteria, and 2) evaluate the clarity of reporting of important methodological details. In total, 127 RCTs were included in the analysis. The most common inclusion criteria were a minimum pain duration (81%), fulfilling an established diagnostic criteria (61%), and reporting a minimum pain intensity (42%). Primary end points were identified for only 57% of trials. These end points, summarized in this article, were highly variable. The results of this systematic review can be used to inform future research to optimize the entry criteria and outcome measures for pain conditions occurring in the lower abdomen and pelvis, to increase transparency in reporting to allow for proper interpretation of RCT results for clinical and policy applications, and to facilitate the aggregation of data in meta-analyses. This article summarizes entry criteria and outcome measures and the clarity of reporting of these important design features in RCTs of irritable bowel syndrome and 3 common chronic pelvic pain conditions. These results can be used to improve design of future trials of these largely unaddressed pain conditions. Copyright © 2018 The American Pain Society. Published by Elsevier Inc. All rights reserved.

  16. A systematic review of the oral and craniofacial manifestations of cri du chat syndrome.

    Science.gov (United States)

    Corcuera-Flores, José-Ramón; Casttellanos-Cosano, Lizett; Torres-Lagares, Daniel; Serrera-Figallo, María Ángeles; Rodríguez-Caballero, Ángela; Machuca-Portillo, Guillermo

    2016-07-01

    Cri du chat syndrome is an autosomal disorder. Because it affects few people in the population it is considered a rare disease, yet it is one of the most common autosomal chromosomal syndromes in humans. It entails pathognomonic alterations that affect the craniofacial and oral anatomy of patients. The aim of this study is to review these craniofacial and oral abnormalities in patients with Cri du chat syndrome. The PubMed Medline database was searched using two different strategies. First, we used "Dentistry" and "Cri du chat" as keywords; second, we used "Cri du chat" and "craniofacial." Seven articles in which the main orofacial and cranio-skeletal characteristics of patients with Cri du chat syndrome were described were selected according to the inclusion and exclusion criteria. Cri du Chat syndrome entails pathognomonic characteristics in the craniofacial area (epicanthus, short philtrum, and wide nasal bridge), the oral area (mandibular retrognathism and anterior open bite) and the cranial region (alterations at the cranial base angle and a small upper airway). However, more studies on larger samples are needed to specify the orofacial and craniofacial characteristics of patients with Cri du chat syndrome more accurately. Clin. Anat. 29:555-560, 2016. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  17. Cardiac evaluation in children with Prader-Willi syndrome.

    NARCIS (Netherlands)

    Marcus, K.A.; Alfen-van der Velden, J. van; Otten, B.J.; Weijers, G.; Yntema, H.G.; Korte, C.L. de; Kapusta, L.

    2012-01-01

    AIM: To assess cardiac anatomy and myocardial systolic function in children with Prader-Willi syndrome (PWS). METHODS: Physical examination, electrocardiographic (ECG) recordings and transthoracic echocardiograms including two-dimensional speckle tracking echocardiography (2DSTE) were performed and

  18. Systematic Differences across Evaluation Schemes and Educational Choice

    DEFF Research Database (Denmark)

    Rangvid, Beatrice Schindler

    consequential in a school system like the Danish, where post-compulsory education choices are made on ability signals only from teacher scores, as external assessments are not available until after these choices are made. I document that educationally disadvantaged groups (boys, low-SES, and migrant pupils......) receive systematically lower teacher scores for equal exam scores than their advantaged peers. Using sibling fixed effects methods, I then simulate changes in educational choices for disadvantaged groups were they graded by their teachers as their advantaged peers. The results show an increase in low...

  19. Respiratory Disturbances in Rett Syndrome: Don't Forget to Evaluate Upper Airway Obstruction

    NARCIS (Netherlands)

    Hagebeuk, Eveline E. O.; Bijlmer, Rob P. G. M.; Koelman, Johannes H. T. M.; Poll-The, Bwee Tien

    2012-01-01

    Rett syndrome is characterized by loss of motor and social functions, development of stereotypic hand movements, seizures, and breathing disturbances. This study evaluates the presence of overnight respiratory disturbances. Polysomnography in combination with a questionnaire (the Sleep Disturbance

  20. Surgical reconstruction of aortic root in Marfan syndrome patients: a systematic review.

    Science.gov (United States)

    Hu, Rui; Wang, Zhiwei; Hu, Xiaoping; Wu, Hongbing; Wu, Zhiyong; Zhou, Zhen

    2014-07-01

    Several recent studies have compared the clinical results of valve-sparing (VS) surgery and composite valve graft (CVG) surgery in the aortic root reconstruction of Marfan syndrome (MS) patients. The study aim was to investigate whether it is appropriate to preserve the native aortic valve in root surgery of MFS patients when taking the short-term and long-term prognoses into consideration. A thorough literature search of PubMed, Embase and Cochrane library was conducted to identify studies comparing the outcomes of VS and CVG surgery in MFS patients. The Newcastle-Ottawa Scale evaluation scheme was used to assess the methodological quality of the included articles. Data were extracted from reports and analyzed using Revman 5.0, supplied by Cochrane collaboration. Six clinical trials incorporating 539 patients were included. Compared to CVG, VS surgery was associated with a lower risk for re-exploration (RR 0.48, 95% CI 0.24-0.97; p = 0.04), thromboembolic events (RR 0.17, 95% CI 0.05-0.57; p = 0.004) and endocarditis (RR 0.31, 95% CI 0.11-0.94; p = 0.04). Despite an inherent incidence of aortic regurgitation, VS surgery resulted in an elevation of long-term survival rate; however, no statistical differences were found between groups with regards to reoperation (RR 1.07, 95% CI 0.35-3.27; p = 0.91). Root reconstruction with VS surgery can effectively improve the prognosis of MFS patients and provide a promising alternative for surgical treatment. However, the results must be interpreted with caution due to the retrospective nature of the included studies; large-scale prospective control trials are needed to confirm these findings.

  1. Ageing of people with Down's syndrome: a systematic literature review from 2000 to 2014.

    Science.gov (United States)

    Covelli, Venusia; Raggi, Alberto; Meucci, Paolo; Paganelli, Chiara; Leonardi, Matilde

    2016-03-01

    Life expectancy of people with Down's syndrome (DS) has increased considerably, now exceeding 60 years. People with DS start to get old around the age of 45. By referring to the WHO's International Classification of Functioning, Disability and Health (ICF) biopsychosocial perspective, this study aimed to present an up-to-date review of the past 14 years of literature concerning the ageing of people with DS. PUBMED, PsycInfo and the Social Sciences Citation Index were searched for studies published between 2000 and 2014. Studies were selected if they were written in English, focused on people more than 45 years of age with DS, and if terms related to DS and ageing appeared in either the title or the abstract. A total of 30 studies were retrieved and their meaningful concepts were linked to the ICF. In total, 38 ICF categories were identified that were mainly related to intellectual functions (b117) (19%), general metabolic functions (b540) (7.4%), mobility of joint functions (b710), muscle power functions (b730) (4.2%), gait pattern functions (b770) (4.2%) and structure of the brain (s110) (4.3%). Only two studies considered environmental factors, and only one considered the joint analysis of health condition and environmental factors. Data about the ageing of people with DS are predominantly based on medical evaluations and descriptions of their physical impairments. Few attempts have been made towards a comprehensive assessment of elderly people with DS with a joint analysis of their health condition and its interaction with environmental factors.

  2. Zinc supplementation as an adjunct to standard therapy in childhood nephrotic syndrome - a systematic review.

    Science.gov (United States)

    Bhatt, Girish Chandra; Jain, Shikha; Das, Rashmi Ranjan

    2016-11-08

    To evaluate the role of zinc as add on treatment to the "recommended treatment" of nephrotic syndrome (NS) in children. All the published literature through the major databases including Medline/Pubmed, Embase, and Google Scholar were searched till 31 st December 2015. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved papers concerning the role of zinc in childhood NS were reviewed by the authors, and the data were extracted using a standardized data collection tool. Randomized trials (RCTs) comparing zinc vs placebo was included. Effect of zinc was studied in both steroid sensitive and steroid dependent/frequent relapsing NS. The primary outcome measure was the risk of relapse in 12 mo. The secondary outcome measures were mean relapse rate per patient in 12 mo, mean relapse rate per patient in 6 mo, risk of infection associated relapse in 12 mo, cumulative dose of steroids in two groups, mean length of time to next relapse, adverse effects of therapy, and change in serum zinc levels. Of 54 citations retrieved, a total of 6 RCTs were included. Zinc was used at a dose of 10-20 mg/d, for the duration that varied from 6-12 mo. Compared to placebo, zinc reduced the frequency of relapses, induced sustained remission/no relapse, reduced the proportion of infection episodes associated with relapse with a mild adverse event in the form of metallic taste. The GRADE evidence generated was of "very low-quality". Zinc may be a useful additive in the treatment of childhood NS. The evidence generated mostly was of "very low-quality". We need more good quality RCTs in different country setting as well different subgroups of children before any firm recommendation can be made.

  3. Metformin and lifestyle modification in polycystic ovary syndrome: systematic review and meta-analysis.

    Science.gov (United States)

    Naderpoor, Negar; Shorakae, Soulmaz; de Courten, Barbora; Misso, Marie L; Moran, Lisa J; Teede, Helena J

    2015-01-01

    Polycystic ovary syndrome (PCOS) is a common endocrine disorder with diverse reproductive and metabolic features. It is underpinned by insulin resistance that is exacerbated by obesity. Lifestyle modification is the first line treatment in PCOS, but it is associated with low adherence and sustainability. In small studies, metformin improves outcomes such as hyperinsulinaemia, ovulation and menstrual cyclicity. We conducted a systematic review and meta-analysis to compare the effect of lifestyle modification + metformin with lifestyle modification ± placebo, and of metformin alone with lifestyle modification ± placebo in PCOS on anthropometric, metabolic, reproductive and psychological outcomes. Databases including MEDLINE, EMBASE, Pubmed, Scopus, Cochrane, PsycINFO, CINAHL, Clinical Trials registry and ANZCTR were searched for RCTs conducted on humans and published in English up to August 2014. Inclusion criteria were diagnosis of PCOS based on Rotterdam criteria (inclusive of National Institutes of Health criteria) at any age and with any BMI. Interventions of interest included lifestyle + metformin (with any dose and any duration) or metformin alone compared with lifestyle ± placebo. Of 2372 identified studies, 12 RCTs were included for analysis comprising 608 women with PCOS. Lifestyle + metformin were associated with lower BMI (mean difference (MD) -0.73 kg/m(2), 95% confidence intervals (CI) -1.14, -0.32, P = 0.0005) and subcutaneous adipose tissue (MD -92.49 cm(2), 95% CI -164.14, -20.84, P = 0.01) and increased number of menstrual cycles (MD 1.06, 95% CI 0.30, 1.82, P = 0.006) after 6 months compared with lifestyle ± placebo. There were no differences in other anthropometric, metabolic (surrogate markers of insulin resistance, fasting and area under the curve glucose, lipids and blood pressure), reproductive (clinical and biochemical hyperandrogenism), and psychological (quality of life) outcomes after 6 months between lifestyle + metformin compared with

  4. Distribution of Behçet's Syndrome in the World and in Iran: A Systematic Review and Meta Analysis

    Directory of Open Access Journals (Sweden)

    Dorna Ghafari

    2016-06-01

    Full Text Available ​Background and objectives : Behçet's syndrome is an inflammatory disorder of unknown etiology that has a unique worldwide prevalence and distribution. The aim of this study was to estimate the prevalence of Behçet's syndrome in the world and in Iran using a systematic review and meta-analysis approach. Material and Methods: Data banks of Ovid, MEDLINE, Rheumatology, Google scholar, Springer, PubMed, Science direct, Wiley, Magiran, SID, Iranmedex and Irandoc from 1990 onwards were searched. All cross-sectional studies relevant to the prevalence of Behçet's in the world and in Iran were studied. Prevalence rate of Behçet's syndrome with 95% confidence limits was calculated. For statistical analysis, prevalence rates were entered in the Comprehensive Meta Analysis (CMA software. The prevalence of Behçet's was mapped with the Geographic Information Systems (GIS. Results: In this study, 23 articles were finally accepted. The overall prevalence of Behçet's syndrome in the world was 42.4 per 100000 (95% CI: 0.382 -0.465. Heterogeneity rate with 23 studies was 1127.5, and with 21 studies were 490.3. The highest rates were reported from Turkey with the overall prevalence of 4.2 per 1000 (95% CI: 4.073- 4.327. Conclusion: Our findings showed that the highest occurrence of Behçet's disease was observed in Turkey, Palestine and Iran. It is also, however, common in Europe, America and other Asian countries.

  5. Evaluation of three different measurement methods for dural ectasia in Marfan syndrome

    International Nuclear Information System (INIS)

    Weigang, E.; Ghanem, N.; Chang, X.-C.; Richter, H.; Frydrychowicz, A.; Szabo, G.; Dudeck, O.; Knirsch, W.; Samson, P. von; Langer, M.; Beyersdorf, F.

    2006-01-01

    Aim: Dural ectasia is a major diagnostic criterion for Marfan syndrome using the Ghent nosology. Our aim was to evaluate the efficacy of three different radiological methods previously proposed for the assessment of dural sac diameter in Marfan syndrome. Methods: Marfan syndrome was diagnosed in our study using the Ghent criteria, disregarding dural ectasia as a criterion. Three proposed radiological methods were applied to measure dural sac diameter, examined for 41 patients (18 patients with and 23 without Marfan syndrome) by computed tomography or magnetic resonance imaging. Results: Using Oosterhof's method, 94% of the patients with and 44% of the patients without Marfan syndrome fulfilled the criteria of dural ectasia. According to Villeirs, dural ectasia was diagnosed in 18% of the patients with and in none of the patients without Marfan syndrome. With Ahn's method, dural ectasia was found in 72% of the patients with and in 44% of the patients without Marfan syndrome. In only two patients with Marfan syndrome was dural ectasia diagnosed by all three methods. Conclusion: Our results reveal overt discrepancy between the three methods of assessing dural ectasia. Considering the key role played by dural ectasia in reinforcing the diagnosis of Marfan syndrome according to the Ghent nosology, a standardized and reliable method should be sought

  6. Evaluation of three different measurement methods for dural ectasia in Marfan syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Weigang, E.; Ghanem, N.; Chang, X.-C.; Richter, H.; Frydrychowicz, A.; Szabo, G.; Dudeck, O.; Knirsch, W.; Samson, P. von; Langer, M.; Beyersdorf, F

    2006-11-15

    Aim: Dural ectasia is a major diagnostic criterion for Marfan syndrome using the Ghent nosology. Our aim was to evaluate the efficacy of three different radiological methods previously proposed for the assessment of dural sac diameter in Marfan syndrome. Methods: Marfan syndrome was diagnosed in our study using the Ghent criteria, disregarding dural ectasia as a criterion. Three proposed radiological methods were applied to measure dural sac diameter, examined for 41 patients (18 patients with and 23 without Marfan syndrome) by computed tomography or magnetic resonance imaging. Results: Using Oosterhof's method, 94% of the patients with and 44% of the patients without Marfan syndrome fulfilled the criteria of dural ectasia. According to Villeirs, dural ectasia was diagnosed in 18% of the patients with and in none of the patients without Marfan syndrome. With Ahn's method, dural ectasia was found in 72% of the patients with and in 44% of the patients without Marfan syndrome. In only two patients with Marfan syndrome was dural ectasia diagnosed by all three methods. Conclusion: Our results reveal overt discrepancy between the three methods of assessing dural ectasia. Considering the key role played by dural ectasia in reinforcing the diagnosis of Marfan syndrome according to the Ghent nosology, a standardized and reliable method should be sought.

  7. Specific or general exercise strategy for subacromial impingement syndrome-does it matter? A systematic literature review and meta analysis.

    Science.gov (United States)

    Shire, Alison R; Stæhr, Thor A B; Overby, Jesper B; Bastholm Dahl, Mathias; Sandell Jacobsen, Julie; Høyrup Christiansen, David

    2017-04-17

    Exercise is frequently suggested as a treatment option for patients presenting with symptoms of subacromial impingement syndrome. Some would argue implementing a specific exercise strategy with special focus on correction of kinematic deficits would be superior to general exercise strategy. There is however a lack of evidence comparing such exercise strategies to determine which is the most effective in the treatment of subacromial impingement syndrome. The aim of this review is to evaluate whether implementing specific exercise strategies involving resistive exercises are more effective than a general exercise strategy for the treatment of patients with subacromial impingement syndrome. Randomized controlled trials were identified through an electronic search on PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and PEDro. In addition, article reference lists and Clinicaltrials.gov were searched. Studies were considered eligible if they included interventions with resistive specific exercises as compared to general resistance exercise. Four reviewers assessed risk of bias and methodological quality guided by Cochrane recommendations. Results were synthesised qualitatively or quantitatively, where appropriate. Six randomized controlled trials were included with 231 participants who experienced symptoms of subacromial impingement syndrome. Four studies evaluated the effectiveness of specific scapular exercise strategy and two studies evaluated the effectiveness of specific proprioceptive strategy. Five studies were of moderate quality and one study was of low quality. No consistent statistical significant differences in outcomes between treatment groups were reported in the studies. Standardized mean difference (SMD) for pain was SMD -0.19 (95% CI -0.61, 0.22) and SMD 0.30 (95% CI -0.16, 0.76) for function. There is insufficient evidence to support or refute the effectiveness of specific resistive exercise strategies in the

  8. Outcome of genetic evaluation of patients with kidney cancer referred for suspected hereditary cancer syndromes.

    Science.gov (United States)

    Stratton, Kelly L; Alanee, Shaheen; Glogowski, Emily A; Schrader, Kasmintan A; Rau-Murthy, Rohini; Klein, Robert; Russo, Paul; Coleman, Jonathan; Offit, Kenneth

    2016-05-01

    To analyze patients with kidney cancer referred for evaluation at a high-volume genetics service at a comprehensive cancer center and identify factors associated with positive tests for hereditary cancer syndromes. A retrospective review of patients referred to the Clinical Genetics Service at Memorial Sloan-Kettering Cancer Center was performed, and patients with a personal history of kidney cancer were identified. Patient and disease characteristics were reviewed. In all, 4 variables including age at diagnosis of kidney tumor, presence of syndromic manifestations, family history of kidney cancer, and number of primary malignancies were evaluated for association with positive test results in 2 groups: patients tested for renal cell carcinoma syndromes and Lynch syndrome. Guidance for genetic testing strategy in patients with kidney cancer is provided. Between 1999 and 2012, 120 patients with a history of kidney cancer were evaluated by the Clinical Genetics Service. The mean age at kidney cancer diagnosis was 52 years (interquartile range: 42-63), with 57% being women. A family history of kidney cancer was reported by 39 patients (33%). Time between diagnosis of first cancer and genetic consultation was 5 years in the remaining 23%. Overall, 95 patients were tested for genetic abnormalities with 27 (28%) testing positive. Testing for renal cell carcinoma (RCC)-related syndromes was performed on 43 patients, with 13 testing positive (30%). Lynch syndrome testing was positive in 9 patients (32%) after 28 were tested. In RCC-associated syndromes, young age of diagnosis was associated with positive test results. Conversely, syndromic manifestations and increasing number of primary malignancies were associated with positive Lynch testing. The discovery of inherited kidney cancer syndromes has provided a unique opportunity to identify patients at increased risk for cancer. Factors associated with positive genetic testing are unique to different syndromes. These data

  9. Anamorelin for cancer anorexia-cachexia syndrome: a systematic review and meta-analysis.

    Science.gov (United States)

    Bai, Yu; Hu, Yunxia; Zhao, Yanhua; Yu, Xizhong; Xu, Junwei; Hua, Zhiyun; Zhao, Zhiqiang

    2017-05-01

    The aim of this study was to evaluate the therapeutic effects of Anamorelin on patients with cancer anorexia-cachexia syndrome (CACS) based on a meta-analysis of published randomized trials. We searched PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials databases. Data from each selected study were evaluated individually. All continuous outcomes were calculated by the mean difference or standardized mean difference with 95% confidence interval for each study. Heterogeneity was assessed by using the Chi 2 test at a significance level of P  50% indicated substantial heterogeneity). At last, four studies were included from 284 records. In three studies, lean body mass was reported and there was a significant difference between placebo and Anamorelin groups (P < 0.00001), without significant heterogeneity (I 2  = 0%). All the four studies reported the body weight change from baseline, and there was significant difference between placebo and Anamorelin groups (P = 0.007), but with high heterogeneity (I 2  = 97%). Two studies reported Anderson Symptom Assessment Scale (ASAS) score, and Anamorelin significantly increased the total ASAS score of CACS patients (P < 0.00001), without any heterogeneity (I 2  = 0%). Three studies reported non-dominant handgrip strength, and there was no significant difference between Anamorelin and placebo groups (P = 0.16). Three studies reported insulin-like growth factor-1 level, and there was significant difference between Anamorelin and placebo groups (P = 0.02), but with high heterogeneity (I 2  = 96%). Three studies reported IGF binding protein-3 concentration. Anamorelin significantly increased such concentration compared with placebo did (P < 0.00001). However, there was still higher heterogeneity (I 2  = 59%). All the included studies reported adverse events. Compared with placebo, Anamorelin induced fewer adverse events, but there was no significant difference between the two

  10. Effects of superfoods on risk factors of metabolic syndrome: a systematic review of human intervention trials.

    Science.gov (United States)

    van den Driessche, José J; Plat, Jogchum; Mensink, Ronald P

    2018-03-20

    Functional foods can be effective in the prevention of metabolic syndrome and subsequently the onset of cardiovascular diseases and type II diabetes mellitus. More recently, however, another term was introduced to describe foods with additional health benefits: "superfoods", for which, to date, no generally accepted definition exists. Nonetheless, their consumption might contribute to the prevention of metabolic syndrome, for example due to the presence of potentially bioactive compounds. This review provides an overview of controlled human intervention studies with foods described as "superfoods" and their effects on metabolic syndrome parameters. First, an Internet search was performed to identify foods described as superfoods. For these superfoods, controlled human intervention trials were identified until April 2017 investigating the effects of superfood consumption on metabolic syndrome parameters: waist circumference or BMI, blood pressure, or concentrations of HDL cholesterol, triacylglycerol or glucose. Seventeen superfoods were identified, including a total of 113 intervention trials: blueberries (8 studies), cranberries (8), goji berries (3), strawberries (7), chili peppers (3), garlic (21), ginger (10), chia seed (5), flaxseed (22), quinoa (1), cocoa (16), maca (1), spirulina (7), wheatgrass (1), acai berries (0), hemp seed (0) and bee pollen (0). Overall, only limited evidence was found for the effects of the foods described as superfoods on metabolic syndrome parameters, since results were not consistent or the number of controlled intervention trials was limited. The inconsistencies might have been related to intervention-related factors, such as duration or dose. Furthermore, conclusions may be different if other health benefits are considered.

  11. Wernicke-Korsakoff syndrome in patients with cancer: a systematic review.

    Science.gov (United States)

    Isenberg-Grzeda, Elie; Rahane, Sudhanshu; DeRosa, Antonio P; Ellis, Janet; Nicolson, Stephen E

    2016-04-01

    Wernicke-Korsakoff syndrome in patients with cancer is understudied. Much of what is known-that significant under-recognition and delays in treatment exist-comes from studies of alcohol misuse disorders or non-alcohol-related Wernicke-Korsakoff syndrome in patients. We investigated the frequency and associated features of cancer-related Wernicke-Korsakoff syndrome in the published literature. We included 90 articles reporting on 129 patients. Only 38 (30%) of 128 patients with data available exhibited the entire triad of classic features of Wernicke-Korsakoff syndrome: confusion, ataxia, and ophthalmoplegia or nystagmus. Diagnosis during life was missed altogether in 22 (17%) of 128 patients. The operational diagnostic criteria (at least two of the following: nutritional deficiency, ocular signs, cerebellar signs, and either altered mental status or mild memory impairment), which are considered more reliable than the classical triad, were used in only nine (7%) cases, yet 120 (94%) met the operational criteria for diagnosis at the time of presentation when applied retroactively. Complete recovery was reported in only 47 (36%) cases. Given that oncologists or haematologists accounted for only 17 (19%) first authors among the articles included, it is important that oncologists are aware of the risk factors for cancer-related Wernicke-Korsakoff syndrome, and that they are vigilant about diagnosing and treating the disease especially in the absence of alcohol misuse disorders. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Genetic evaluation of the serotonergic system in chronic fatigue syndrome.

    Science.gov (United States)

    Smith, Alicia K; Dimulescu, Irina; Falkenberg, Virginia R; Narasimhan, Supraja; Heim, Christine; Vernon, Suzanne D; Rajeevan, Mangalathu S

    2008-02-01

    Chronic fatigue syndrome (CFS) is a debilitating disorder of unknown etiology with no known lesions, diagnostic markers or therapeutic intervention. The pathophysiology of CFS remains elusive, although abnormalities in the central nervous system (CNS) have been implicated, particularly hyperactivity of the serotonergic (5-hydroxytryptamine; 5-HT) system and hypoactivity of the hypothalamic-pituitary-adrenal (HPA) axis. Since alterations in 5-HT signaling can lead to physiologic and behavioral changes, a genetic evaluation of the 5-HT system was undertaken to identify serotonergic markers associated with CFS and potential mechanisms for CNS abnormality. A total of 77 polymorphisms in genes related to serotonin synthesis (TPH2), signaling (HTR1A, HTR1E, HTR2A, HTR2B, HTR2C, HTR3A, HTR3B, HTR4, HTR5A, HTR6, and HTR7), transport (SLC6A4), and catabolism (MAOA) were examined in 137 clinically evaluated subjects (40 CFS, 55 with insufficient fatigue, and 42 non-fatigued, NF, controls) derived from a population-based CFS surveillance study in Wichita, Kansas. Of the polymorphisms examined, three markers (-1438G/A, C102T, and rs1923884) all located in the 5-HT receptor subtype HTR2A were associated with CFS when compared to NF controls. Additionally, consistent associations were observed between HTR2A variants and quantitative measures of disability and fatigue in all subjects. The most compelling of these associations was with the A allele of -1438G/A (rs6311) which is suggested to have increased promoter activity in functional studies. Further, in silico analysis revealed that the -1438 A allele creates a consensus binding site for Th1/E47, a transcription factor implicated in the development of the nervous system. Electrophoretic mobility shift assay supports allele-specific binding of E47 to the A allele but not the G allele at this locus. These data indicate that sequence variation in HTR2A, potentially resulting in its enhanced activity, may be involved in the

  13. Systematic Review of Health Economic Impact Evaluations of Risk Prediction Models: Stop Developing, Start Evaluating.

    Science.gov (United States)

    van Giessen, Anoukh; Peters, Jaime; Wilcher, Britni; Hyde, Chris; Moons, Carl; de Wit, Ardine; Koffijberg, Erik

    2017-04-01

    Although health economic evaluations (HEEs) are increasingly common for therapeutic interventions, they appear to be rare for the use of risk prediction models (PMs). To evaluate the current state of HEEs of PMs by performing a comprehensive systematic review. Four databases were searched for HEEs of PM-based strategies. Two reviewers independently selected eligible articles. A checklist was compiled to score items focusing on general characteristics of HEEs of PMs, model characteristics and quality of HEEs, evidence on PMs typically used in the HEEs, and the specific challenges in performing HEEs of PMs. After screening 791 abstracts, 171 full texts, and reference checking, 40 eligible HEEs evaluating 60 PMs were identified. In these HEEs, PM strategies were compared with current practice (n = 32; 80%), to other stratification methods for patient management (n = 19; 48%), to an extended PM (n = 9; 23%), or to alternative PMs (n = 5; 13%). The PMs guided decisions on treatment (n = 42; 70%), further testing (n = 18; 30%), or treatment prioritization (n = 4; 7%). For 36 (60%) PMs, only a single decision threshold was evaluated. Costs of risk prediction were ignored for 28 (46%) PMs. Uncertainty in outcomes was assessed using probabilistic sensitivity analyses in 22 (55%) HEEs. Despite the huge number of PMs in the medical literature, HEE of PMs remains rare. In addition, we observed great variety in their quality and methodology, which may complicate interpretation of HEE results and implementation of PMs in practice. Guidance on HEE of PMs could encourage and standardize their application and enhance methodological quality, thereby improving adequate use of PM strategies. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  14. Systematic shifts of evaluated charge centroid for the cathode read-out multiwire proportional chamber

    International Nuclear Information System (INIS)

    Endo, I.; Kawamoto, T.; Mizuno, Y.; Ohsugi, T.; Taniguchi, T.; Takeshita, T.

    1981-01-01

    We have investigated the systematic error associtated with the charge centroid evaluation for the cathode read-out multiwire proportional chamber. Correction curves for the systematic error according to six centroid finding algorithms have been obtained by using the charge distribution calculated in a simple electrostatic mode. They have been experimentally examined and proved to be essential for the accurate determination of the irradiated position. (orig.)

  15. Evaluating clinical ethics support in mental healthcare: a systematic literature review.

    NARCIS (Netherlands)

    Hem, M.H.; Pedersen, R.; Norvoll, R.; Molewijk, A.C.

    2015-01-01

    A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five

  16. ROLE OF MRI IN EVALUATION OF MRKH SYNDROME

    Directory of Open Access Journals (Sweden)

    Lalitha Kumari

    2015-11-01

    Full Text Available : MRKH Syndrome is one of diverse spectrum of congenital mullerian duct anamolies ranging from complete absence to hypoplasia of uterus and upper 2/3rd of vagina owing to their embryological origin. This is the second most common cause of primary amennorhoea in young females who shows normal development of secondary sexual characters and endocrine profile with essential normal female phenotype & genotype (46 XX. Our study is to emphasis the role of MRI in diagnosis of this syndrome non-invasively without exposure to radiation. The excellent soft tissue anatomical details by MRI provides the diagnosis with accuracy along with information of adjacent viscera and other associated systemic anamolies.

  17. Painful bladder syndrome/interstitial cystitis: Aetiology, evaluation and management

    Directory of Open Access Journals (Sweden)

    William Rourke

    2014-06-01

    Full Text Available Interstitial cystitis or bladder pain syndrome (BPS is often a chronic debilitating condition characterised by predominantly storage symptoms and associated frequently with pelvic pain that varies with bladder filling. The aetiology is uncertain as the condition occurs in the absence of a urinary tract infection or other obvious pathology. Resulting discomfort may vary and ranges from abdominal tenderness to intense bladder spasms. Diagnosis and management of this syndrome may be difficult and is often made by its typical cystoscopic features. This review discusses the diagnosis and management of interstitial cystitis according to the current available best evidence and advises a multimodal approach in its management.

  18. Sacral Neuromodulation for Refractory Bladder Pain Syndrome/Interstitial Cystitis: a Global Systematic Review and Meta-analysis

    OpenAIRE

    Wang, Junpeng; Chen, Yang; Chen, Jiawei; Zhang, Guihao; Wu, Peng

    2017-01-01

    Bladder pain syndrome/interstitial cystitis (BPS/IC) is a common debilitating disease and there has not been consistently effective treatment. We aimed to evaluate all available literature regarding the efficacy and safety of sacral neuromodulation (SNM) for refractory BPS/IC. A comprehensive search of Pubmed, Web of Science and Cochrane Library through May 2016 was conducted. A total of 17 studies enrolling 583 patients were identified. Pooled analyses demonstrated that SNM was associated wi...

  19. Systematic review of endovascular therapy for nutcracker syndrome and case presentation.

    Science.gov (United States)

    Quevedo, Henry C; Arain, Salman A; Abi Rafeh, Nidal

    2014-01-01

    The left renal vein (LRV) entrapment syndrome is a rare condition. Here, we present a 22-year-old female presenting with recurrent nausea, vomiting, weight loss and evidence of the LRV compression by the superior mesenteric artery and the abdominal aorta. Hemodynamic assessment confirmed a pressure gradient of >3 mmHg between the LRV and the inferior vena cava. A self-expandable stent was then deployed in the LRV. Subsequent clinical follow-ups ensure full resolution of the patient's symptoms. Multilingual search was performed in PubMed, Google scholar, Scielo, Korea Med and EMBASE with the medical subheadings "nutcracker syndrome", "nutcracker phenomenon" and "compression vein syndrome" from January 1983 to September 2013. Review of the literature exhibited a plethora of individual case reports (291 citations). Importantly, few retrospective case series [5] comprising a total of 157 patients included successful endovascular interventions. Endovascular therapy for nutcracker syndrome represents a safe and suitable treatment option, but prospective studies are needed to confirm these data. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Systematic review : knowledge and educational needs of patients with irritable bowel syndrome

    NARCIS (Netherlands)

    Flik, Carla E.; van Rood, Yanda R.; de Wit, NJ

    Educational programs have been used as a control condition in trials on psychological therapies for irritable bowel syndrome (IBS). An optimal control condition should have all logistic features of the experimental intervention, except the active component, but also have basic therapeutic benefit

  1. Evaluation of acute compartment syndrome of extremities in ...

    African Journals Online (AJOL)

    The aim of this study was to analyze the clinical signs of diagnosis, treatment and followup of the pediatric population presenting with acute compartment syndrome in the emergency room at an Institutional Level II trauma center. The study is a prospective case series. Thirty-two samples were selected from Institutional ...

  2. Infantile Short Bowel Syndrome: short and long term evaluation

    NARCIS (Netherlands)

    J.F. Olieman (Joanne)

    2009-01-01

    textabstractInfantile short bowel syndrome is a condition which is characterized by malabsorption of nutrients, as a result of congenital intestinal shortening or massive small bowel resection. Survival rates have improved over the years, but morbidity remains high and clinical management of these

  3. Evaluation of acute compartment syndrome of extremities in ...

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    necrotic tissue in the histological examination. In our study, we also observed patchy necrosis of muscle fibers with perifascicular oedema3. We observed ischemic contractures in about 18.7% of our cases. In a series of 24 children with acute compartment syndrome, chronic contractures were reported only in 4.2% cases3.

  4. Evaluation Of Irritable Bowel Syndrome Symptoms Amongst Warsaw University Students

    OpenAIRE

    Niemyjska Sylwia; Ukleja Anna; Ławiński Michał

    2015-01-01

    Irritable bowel syndrome (IBS) belongs to functional gastrointestinal disorders and is characterized by abdominal pain and change in stool consistency and/or bowel habits. Etiological factors include gastrointestinal peristalsis disturbances, visceral hypersensitivity, chronic inflammation of the mucous membrane, dysbacteremia, intestinal infections, psychosomatic and nutritional factors. Gastrointestinal motility disturbances in case of IBS are manifested by the inhibition of the intestinal ...

  5. The evaluation of immediate behavioural outcomes of the syndromic ...

    African Journals Online (AJOL)

    Enrique

    syndromic case management approach for the treatment of patients with sexually transmitted infections at PHC centres in. South Africa: Knowledge, attitudes, beliefs and sexual behaviour. L C Simbayi,A Strebel, M Andipatin, C Potgieter, K Ratele, N Shabalala,T Shefer,T Wilson. ABSTRACT. This study aimed to determine ...

  6. Fall and its association with the frailty syndrome in the elderly: systematic review with meta-analysis

    Directory of Open Access Journals (Sweden)

    Jack Roberto Silva Fhon

    Full Text Available Abstract OBJECTIVE To analyze the prevalence of falls and frailty syndrome and the association between these two syndromes in the elderly population. METHOD Systematic review, without restriction of dates, in English, Portuguese and Spanish languages, in the databases PubMed, CINAHL, LILACS and in the SciElo virtual library. The association between both variables was extracted from the studies (Odds Ratio and 95% Confidence Intervals. RESULTS The review included 19 studies published between 2001 and 2015. The prevalence of falls in the frail elderly population was between 6.7% and 44%; in the pre-frail, between 10.0% and 52.0%, and in the non-frail, between 7.6% and 90.4%. The association between both variables presented a value of OR 1.80 (95% CI 1.51-2.13. CONCLUSION There is evidence that falls are associated to the frailty in the elderly. Other factors may influence this association, such as age, sex, data collection instrument of the studies, place where they live and the process of senescence.

  7. Systematic biomarker discovery and coordinative validation for different primary nephrotic syndromes using gas chromatography-mass spectrometry.

    Science.gov (United States)

    Lee, Jung-Eun; Lee, Yu Ho; Kim, Se-Yun; Kim, Yang Gyun; Moon, Ju-Young; Jeong, Kyung-Hwan; Lee, Tae Won; Ihm, Chun-Gyoo; Kim, Sooah; Kim, Kyoung Heon; Kim, Dong Ki; Kim, Yon Su; Kim, Chan-Duck; Park, Cheol Whee; Lee, Do Yup; Lee, Sang-Ho

    2016-07-01

    The goal of this study is to identify systematic biomarker panel for primary nephrotic syndromes from urine samples by applying a non-target metabolite profiling, and to validate their utility in independent sampling and analysis by multiplex statistical approaches. Nephrotic syndrome (NS) is a nonspecific kidney disorder, which is mostly represented by minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), and membranous glomerulonephritis (MGN). Since urine metabolites may mirror disease-specific functional perturbations in kidney injury, we examined urine samples for distinctive metabolic changes to identify biomarkers for clinical applications. We developed unbiased multi-component covarianced models from a discovery set with 48 samples (12 healthy controls, 12 MCD, 12 FSGS, and 12 MGN). To extensively validate their diagnostic potential, new batch from 54 patients with primary NS were independently examined a year after. In the independent validation set, the model including citric acid, pyruvic acid, fructose, ethanolamine, and cysteine effectively discriminated each NS using receiver operating characteristic (ROC) analysis except MCD-MGN comparison; nonetheless an additional metabolite multi-composite greatly improved the discrimination power between MCD and MGN. Finally, we proposed the re-constructed metabolic network distinctively dysregulated by the different NSs that may deepen comprehensive understanding of the disease mechanistic, and help the enhanced identification of NS and therapeutic plans for future. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. [Definition, classification, clinical diagnosis and prognosis of fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles].

    Science.gov (United States)

    Eich, W; Bär, K-J; Bernateck, M; Burgmer, M; Dexl, C; Petzke, F; Sommer, C; Winkelmann, A; Häuser, W

    2017-06-01

    The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A systematic search of the literature from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. The clinical diagnosis of fibromyalgia syndrome can be established by the American College of Rheumatology (ACR) 1990 classification criteria (with examination of tender points) or without the examination of tender points by the modified preliminary diagnostic ACR 2010 or 2011 criteria.

  9. Scintigraphic and Endoscopic Evaluation of Radiation-induced Acute Gastrointestinal Syndrome in Micro-pig Model

    International Nuclear Information System (INIS)

    Lee, Seung-Sook; Kim, Kyung-Min; Kim, Jin; Jang, Won-Suk; Lee, Jung-Eun; Kim, Noo-Ri; Lee, Sun-Joo; Kim, Mi-Sook; Ji, Young-Hoon; Cheon, Gi-Jeong; Lim, Sang-Moo

    2007-01-01

    Micro-pig model can be served as a proper substitute for humans in studying acute radiation syndrome following radiation-exposure accidents, especially showing similar clinico-pathologic response of hematopoietic and gastrointestinal (GI) syndrome to human. Among acute GI syndrome induced by radiation, GI motility disturbance has not been studied, however, it would be important in a viewpoint of affecting infectious progression from GI tract. Here, we employed scintigraphy of GI transit time and sequential endoscopic examination and tissue sampling in micropigs followed by abdominal radiation exposure. The specific aims of this study are to evaluate objective evidence of GI motility disturbance by scintigraphic evaluation and to find corresponding clinicoapthologic changes in radiation-induced acute GI syndrome

  10. A Systematic Review of Health Economic Evaluations of Diagnostic Biomarkers.

    Science.gov (United States)

    Oosterhoff, Marije; van der Maas, Marloes E; Steuten, Lotte M G

    2016-02-01

    Diagnostic biomarkers have multiple applications along the care process and have a large potential in optimizing treatment decisions. However, many diagnostic biomarkers struggle to gain market access and obtain appropriate coverage because of a lack of evidence on their health economic impact. The aim was to review the (methodological) characteristics of recent economic evaluations on diagnostic biomarkers and examine whether these studies dealt with specific issues such as different payer perspectives, preference heterogeneity, and multiple applications in subpopulations. The PubMed database and the National Health Service Economic Evaluation Database were searched. Full economic evaluations published after 2009 assessing diagnostic biomarkers for the main non-communicable diseases in middle-income or high-income countries were considered eligible. Empirical and methodological study characteristics were summarized, as was the handling of specific issues related to the economic evaluation of personalized medicine. Thirty-three economic evaluations were included, of which 25 were model-based analyses. The number of strategies compared ranged from two to 17 per study, and was especially large in studies assessing genetic testing in patients and their relatives. Cost-effectiveness results were most sensitive to test accuracy and costs of the biomarker (N = 7), the relative risk of an event (N = 4), and the proportion of people accepting genetic testing (N = 2). One study incorporated patient preferences, and none of the studies considered different payer perspectives, cost sharing arrangements or variable opportunity costs due to population density variability. Published health economic evaluations of biomarkers used for diagnosing, staging diseases, and guiding treatment selection are characterized by a large number of comparators to model the potential clinical applications and to determine their value. Assessing outcomes beyond health as well as specific

  11. [Function of the present systematic evaluation in establishment of guidance for clinical practice].

    Science.gov (United States)

    Yang, Jin-Hong; Hu, Jing; Yang, Feng-Chun; Zhang, Ning; Wang, Bing; Li, Xin

    2012-07-01

    Treatment of insomnia with acupuncture is taken as an example to explore the significance and problems existed in the present systematic evaluation in establishment of guidance for clinical practice. Fifteen articles on systematic evaluation of both English and Chinese were retrieved and studied carefully, their basic information was analyzed. Through study on the establishing process of the guidance of clinical practice, researches were focused on the possible significance of the articles to the guidance as well as the notes in the reuse of those articles since problem still existed. It is held that the systematic evaluation has great significance on the establishment of the guidance from the aspects of applicable people, recommended standards of diagnosis and therapeutic evaluation, extended recommendation and methodology. Great importance should also be attached to the direct application of the research result and understanding of the evaluation result. The data should be rechecked when necessary. Great guiding function can be found on the systematic evaluation of articles to the guidance. Moreover, if information needed to be taken into a full play, specific analysis should also be done on the concrete research targets.

  12. A Systematic Review of Probiotic Interventions for Gastrointestinal Symptoms and Irritable Bowel Syndrome in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME).

    Science.gov (United States)

    Corbitt, Matthew; Campagnolo, N; Staines, D; Marshall-Gradisnik, S

    2018-02-20

    Gastrointestinal (GI) symptoms and irritable bowel (IB) symptoms have been associated with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). The aim of this study was to conduct a systematic review of these symptoms in CFS/ME, along with any evidence for probiotics as treatment. Pubmed, Scopus, Medline (EBSCOHost) and EMBASE databases were searched to source relevant studies for CFS/ME. The review included any studies examining GI symptoms, irritable bowel syndrome (IBS) and/or probiotic use. Studies were required to report criteria for CFS/ME and study design, intervention and outcome measures. Quality assessment was also completed to summarise the level of evidence available. A total of 3381 publications were returned using our search terms. Twenty-five studies were included in the review. Randomised control trials were the predominant study type (n = 24). Most of the studies identified examined the effect of probiotic supplementation on the improvement of IB symptoms in IBS patients, or IB symptoms in CFS/ME patients, as well as some other significant secondary outcomes (e.g. quality of life, other gastrointestinal symptoms, psychological symptoms). The level of evidence identified for the use of probiotics in IBS was excellent in quality; however, the evidence available for the use of probiotic interventions in CFS/ME was poor and limited. There is currently insufficient evidence for the use of probiotics in CFS/ME patients, despite probiotic interventions being useful in IBS. The studies pertaining to probiotic interventions in CFS/ME patients were limited and of poor quality overall. Standardisation of protocols and methodology in these studies is required.

  13. Clinical evaluation of balance in hemiparetic adults: a systematic review

    Directory of Open Access Journals (Sweden)

    Carla Bambirra

    Full Text Available Introduction Hemiparesis is a common post-stroke impairment often associated with balance deficits. Standardized instruments for balance assessment may be useful in identifying individuals at risk of falling and evaluating intervention outcomes. Objectives To identify instruments with adequate psychometric properties and clinical application to assess balance in hemiparetic cases within the scope of physiotherapy and to verify tools most frequently used in studies that evaluated the effects of therapeutic interventions in order to improve the balance of hemiparetic patients. Methods A search was conducted in the Medline, Lilacs, PEDro, and Web of Science databases by two independent researchers, who selected and analyzed studies that evaluated the reliability and validity of balance assessment instruments and intervention results. Results and discussion The Berg Balance Scale was the most frequently used instrument in the intervention studies. Nine single-task tests (timed up and go, functional reach test, step test, four-square step test, side step test, supported standing balance, standing arm raise, static tandem standing, and weight shifting and six multiple-task tests (Berg balance scale, Brunel balance assessment, Fugl-Meyer Assessment/balance section, mini balance evaluation systems test, and postural assessment scale for stroke patients demonstrated adequate psychometric properties and clinical applications to assess balance in hemiparetic individuals. Conclusions The Berg Balance Scale had the most widely studied psychometric properties and was the most frequently used scale in the intervention studies. Further studies are required to validate and adapt other instruments for the Brazilian population.

  14. Optimal plateau pressure for patients with acute respiratory distress syndrome: a protocol for a systematic review and meta-analysis with meta-regression.

    Science.gov (United States)

    Yasuda, Hideto; Nishimura, Tetsuro; Kamo, Tetsuro; Sanui, Masamitsu; Nango, Eishu; Abe, Takayuki; Takebayashi, Toru; Lefor, Alan Kawarai; Hashimoto, Satoru

    2017-05-29

    Lower tidal volume ventilation in patients with acute respiratory distress syndrome (ARDS) is a strategy to reduce the plateau pressure and driving pressure to limit ventilator-induced lung injury (VILI). Several randomised controlled trials (RCTs) and meta-analyses showed that limiting both the plateau pressure and the tidal volume decreased mortality, but the optimal plateau pressure to demonstrate a benefit is uncertain. The aim of this systematic review is to investigate the optimal upper limit of plateau pressure in patients with ARDS to prevent VILI and improve clinical outcomes using meta-analysis with and without meta-regression. RCTs comparing two mechanical ventilation strategies will be included, with lower plateau pressure and with higher plateau pressure, among patients with ARDS and acute lung injury. Data sources include MEDLINE via the NCBI Entrez system, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and Ichushi, a database of papers in Japanese. Two of three physicians will independently screen trials obtained by search for eligibility, and extract data from included studies onto standardised data recording forms. For each included trial, the risk of bias and the quality of evidence will be evaluated using the Grading of Recommendation Assessment Development and Evaluation system. This study does not require ethical approval. The results of this systematic review and meta-analysis with and without meta-regression will be disseminated through conference presentation and publication in a peer-reviewed journal. CRD42016041924. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Evaluation of effectiveness of orlistat in complexed obesity treatment in teenagers with metabolic syndrome

    OpenAIRE

    G A Mel'nichenko; V A Peterkova; L V Savel'eva; N A Zubkova

    2011-01-01

    An open, comparative, randomized study of orlistat in the combined treatment of obesity in adolescents with metabolic syndrome (IIIb phase) was held. Objective: to evaluate the efficacy and safety of the orlistat in adolescents 12-17 years with high risk of cardiovascular disease and type 2 diabetes. The study included 60 adolescents with obesity and metabolic syndrome. The main group (n=30) followed a hypocaloric diet and aerobic exercises and took orlistat 120 mg 3 times daily with...

  16. ERESYE - a expert system for the evaluation of uncertainties related to systematic experimental errors

    International Nuclear Information System (INIS)

    Martinelli, T.; Panini, G.C.; Amoroso, A.

    1989-11-01

    Information about systematic errors are not given In EXFOR, the data base of nuclear experimental measurements: their assessment is committed to the ability of the evaluator. A tool Is needed which performs this task in a fully automatic way or, at least, gives a valuable aid. The expert system ERESYE has been implemented for investigating the feasibility of an automatic evaluation of the systematic errors in the experiments. The features of the project which led to the implementation of the system are presented. (author)

  17. Systematic Quantification of Uncertainties for Evaluated Prompt Fission Neutron Spectra and Multiplicities

    Directory of Open Access Journals (Sweden)

    Prinja Anil

    2012-05-01

    Full Text Available Uncertainties associated with evaluated average prompt fission neutron spectra and multiplicities are obtained for a suite of actinides in the Los Alamos model formalism. Systematics for the model input parameters are taken from the literature and used as prior values in a Bayesian updating procedure. Posterior systematics as well as associated posterior uncertainties are inferred. In addition, cross-isotope correlations are evaluated for the first time. The quantification of uncertainties associated with advanced Monte Carlo Hauser-Feshbach calculations of prompt fission neutron spectra is also discussed.

  18. Hormone-induced rat model of polycystic ovary syndrome: A systematic review.

    Science.gov (United States)

    Noroozzadeh, Mahsa; Behboudi-Gandevani, Samira; Zadeh-Vakili, Azita; Ramezani Tehrani, Fahimeh

    2017-12-15

    Despite polycystic ovary syndrome (PCOS) being one of the most common endocrine disorders affecting reproductive-aged women, the etiopathogenesis and mechanisms of this syndrome remain unclear. Considering the ethical limitations in human studies, animal models that reflect many features of PCOS are crucial resources to investigate this syndrome. We aimed to introduce the most suitable rat model of PCOS that closely mimics the endocrine, ovarian and metabolic disturbances of human PCOS phenotype, while maintaining normal reproductive system morphology in adulthood, in order to further more detailed investigations about PCOS. We searched Pubmed, Science direct, and Web of science between 1990 and 2016, for relevant English manuscripts, using keywords including the "Polycystic Ovary Syndrome AND Rat Model" to generate a subset of citations relevant to our research. Included were those articles that compared at least both ovarian histology or estrous cycle and reproductive hormonal profiles in hormone-induced rat model of PCOS and controls. Differences in the findings between hormone-induced PCOS rats appear to be a result of the degree of transplacental transfer of the steroid administered into the fetus, dose and type of hormone, route of administration and timing and duration of exposure. We conclude that prenatal hormone-induced rat model with a lower dose and shorter time of exposure during the critical period of fetal development that exhibits endocrine, ovarian and metabolic disturbances similar to PCOS in women, while maintaining normal reproductive system morphology in adulthood is more suitable than postnatal hormone-induced rat model to facilitate studies regarding PCOS. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Systematic evaluation of photodetector performance for plastic scintillation dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Boivin, Jonathan, E-mail: jonathan.boivin.1@ulaval.ca; Beaulieu, Luc [Département de Physique, de Génie physique et d’Optique, et Centre de recherche sur le cancer, Université Laval, Québec, Québec G1V 0A6, Canada and Département de Radio-Oncologie et Axe oncologie du Centre de recherche du CHU de Québec, CHU de Québec, Québec, Québec G1R 2J6 (Canada); Beddar, Sam [Department of Radiation Physics, University of Texas, MD Anderson Cancer Center, Houston, Texas 77030 (United States); Guillemette, Maxime [Département de Physique, de Génie physique et d’Optique, Université Laval, Québec, Québec G1V 0A6, Canada and Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec G1V 4G5 (Canada)

    2015-11-15

    Purpose: The authors’ objective was to systematically assess the performance of seven photodetectors used in plastic scintillation dosimetry. The authors also propose some guidelines for selecting an appropriate detector for a specific application. Methods: The plastic scintillation detector (PSD) consisted of a 1-mm diameter, 10-mm long plastic scintillation fiber (BCF-60), which was optically coupled to a clear 10-m long optical fiber of the same diameter. A light-tight plastic sheath covered both fibers and the scintillator end was sealed. The clear fiber end was connected to one of the following photodetectors: two polychromatic cameras (one with an optical lens and one with a fiber optic taper replacing the lens), a monochromatic camera with an optical lens, a PIN photodiode, an avalanche photodiode (APD), or a photomultiplier tube (PMT). A commercially available W1 PSD was also included in the study, but it relied on its own fiber and scintillator. Each PSD was exposed to both low-energy beams (120, 180, and 220 kVp) from an orthovoltage unit and high-energy beams (6 and 23 MV) from a linear accelerator. Various dose rates were tested to identify the operating range and accuracy of each photodetector. Results: For all photodetectors, the relative uncertainty was less than 5% for dose rates higher than 3 mGy/s. The cameras allowed multiple probes to be used simultaneously, but they are less sensitive to low-light signals. The PIN, APD, and PMT had higher sensitivity, making them more suitable for low dose rate and out-of-field dose monitoring. The relative uncertainty of the PMT was less than 1% at the lowest dose rate achieved (0.10 mGy/s), suggesting that it was optimal for use in live dosimetry. Conclusions: For dose rates higher than 3 mGy/s, the PIN diode is the most effective photodetector in terms of performance/cost ratio. For lower dose rates, such as those seen in interventional radiology or high-gradient radiotherapy, PMTs are the optimal choice.

  20. Metabolic syndrome prevalence in Iran: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Farajolah Maleki

    2014-07-01

    Full Text Available Background: Metabolic syndrome (MetS is a complex of risk factors which increase the risk of cardiovascular diseases, type 2 diabetes, morbidity and mortality in people. The aim of this study was to analyze the prevalence of MetS in Iran using a meta-analysis study. Methods: The SID, Magiran, Irandoc, Medlib, Google Scholar and PubMed databases were searched for MetS prevalence. 26 articles conducted between 2003 and 2013 in Iran were selected and the obtained data were analyzed by a meta-analysis using random-effects model. Heterogeneity was assessed using I2 statistics. Data were analyzed by R software and STATA (Ver. 11.2. Results: The total sample size was 60635 people with the age range of 3-90 years. The metabolic syndrome prevalence based on IDF definition was 36% (95% CI: 0.32-0.40 and based to ATPIII was 27% (95% CI: 0.22-0.32. Based on IDF definition, the MetS prevalence rates in women and men were0.39 (95% CI: 0.19-0.59 and 0.20 (95% CI: 0.10-0.29, respectively. Conclusion: The findings showed a high prevalence of metabolic syndrome in Iran, especially in women, which increases with age in both sexes. Health care providers and policy makers need to find solutions to reduce MetS risk in the society.

  1. A systematic review of COTS evaluation and selection approaches

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2017-11-01

    Full Text Available In the past decades, a number of researchers have made their significant contributions to develop different approaches for solving a very challenging problem of commercial off-the shelf (COTS selection. The development of software with high quality and minimum development time has always been a difficult job for the software developers. Therefore, in today’s scenario, software developers move towards the implementation of component based software engineering that relies on the integration of small pieces of code namely (COTS. In this study, we present a comprehensive descriptive explanation of the various COTS evaluation and selection approaches developed by various researchers in the past to understand the concept of COTS selection. The advantages and disadvantages of each COTS selection approach are also provided, which will give a better prospect to the readers to understand the various existing COTS evaluation and selection approaches.

  2. Environmental scan and evaluation of best practices for online systematic review resources.

    Science.gov (United States)

    Parker, Robin M N; Boulos, Leah M; Visintini, Sarah; Ritchie, Krista; Hayden, Jill

    2018-04-01

    Online training for systematic review methodology is an attractive option due to flexibility and limited availability of in-person instruction. Librarians often direct new reviewers to these online resources, so they should be knowledgeable about the variety of available resources. The objective for this project was to conduct an environmental scan of online systematic review training resources and evaluate those identified resources. The authors systematically searched for electronic learning resources pertaining to systematic review methods. After screening for inclusion, we collected data about characteristics of training resources and assigned scores in the domains of (1) content, (2) design, (3) interactivity, and (4) usability by applying a previously published evaluation rubric for online instruction modules. We described the characteristics and scores for each training resource and compared performance across the domains. Twenty training resources were evaluated. Average overall score of online instructional resources was 61%. Online courses (n=7) averaged 73%, web modules (n=5) 64%, and videos (n=8) 48%. The top 5 highest scoring resources were in course or web module format, featured high interactivity, and required a longer (>5hrs) time commitment from users. This study revealed that resources include appropriate content but are less likely to adhere to principles of online training design and interactivity. Awareness of these resources will allow librarians to make informed recommendations for training based on patrons' needs. Future online systematic review training resources should use established best practices for e-learning to provide high-quality resources, regardless of format or user time commitment.

  3. Global economic evaluation of oral cholera vaccine: A systematic review.

    Science.gov (United States)

    Teoh, Siew Li; Kotirum, Surachai; Hutubessy, Raymond C W; Chaiyakunapruk, Nathorn

    2018-02-01

    World Health Organization recommends oral cholera vaccine (OCV) to prevent and control cholera, but requires cost-effectiveness evidence. This review aimed to provide a critical appraisal and summary of global economic evaluation (EE) studies involving OCV to guide future EE study. Full EE studies, published from inception to December 2015, evaluating OCV against cholera disease were included. The included studies were appraised using WHO guide for standardization of EE of immunization programs. Out of 14 included studies, almost all (13/14) were in low- and middle-income countries. Most studies (11/14) evaluated mass vaccination program. Most of the studies (9/14) incorporated herd protective effect. The most common influential parameters were cholera incidence, OCV coverage, herd protection and OCV price. OCV vaccination is likely to be cost-effective when targeted at the population with high-risk of cholera and poor access to health care facilities when herd protection effect is incorporated and OCV price is low.

  4. AN INDIVIDUALIZED APPROACH TO THE EVALUATION OF CUSHING SYNDROME.

    Science.gov (United States)

    Sharma, Susmeeta T

    2017-06-01

    Cushing syndrome (CS) is caused by chronic exposure to excess glucocorticoids. Early recognition and treatment of hypercortisolemia can lead to decreased morbidity and mortality. The diagnosis of CS and thereafter, establishing the cause can often be difficult, especially in patients with mild and cyclic hypercortisolism. Surgical excision of the cause of excess glucocorticoids is the optimal treatment for CS. Medical therapy (steroidogenesis inhibitors, medications that decrease adrenocorticotropic hormone [ACTH] levels or glucocorticoid antagonists) and pituitary radiotherapy may be needed as adjunctive treatment modalities in patients with residual, recurrent or metastatic disease, in preparation for surgery, or when surgery is contraindicated. A multidisciplinary team approach, individualized treatment plan and long-term follow-up are important for optimal management of hypercortisolemia and the comorbidities associated with CS. ACTH = adrenocorticotropic hormone; BIPSS = bilateral inferior petrosal sinus sampling; CBG = corticosteroid-binding globulin; CD = Cushing disease; CRH = corticotropin-releasing hormone; CS = Cushing syndrome; Dex = dexamethasone; DST = dexamethasone suppression test; EAS = ectopic ACTH syndrome; FDA = U.S. Food & Drug Administration; HDDST = high-dose DST; IPS/P = inferior petrosal sinus to peripheral; MRI = magnetic resonance imaging; NET = neuroendocrine tumor; PET = positron emission tomography; UFC = urinary free cortisol.

  5. User Experience Evaluations in Rehabilitation Video Games for Children: A Systematic Mapping of the Literature.

    Science.gov (United States)

    Rico-Olarte, Carolina; López, Diego M; Blobel, Bernd; Kepplinger, Sara

    2017-01-01

    In recent years, the interest in user experience (UX) evaluation methods for assessing technology solutions, especially in health systems for children with special needs like cognitive disabilities, has increased. Conduct a systematic mapping study to provide an overview in the field of UX evaluations in rehabilitation video games for children. The definition of research questions, the search for primary studies and the extraction of those studies by inclusion and exclusion criteria lead to the mapping of primary papers according to a classification scheme. Main findings from this study include the detection of the target population of the selected studies, the recognition of two different ways of evaluating UX: (i) user evaluation and (ii) system evaluation, and UX measurements and devices used. This systematic mapping specifies the research gaps identified for future research works in the area.

  6. Aerobic Exercise Training in Post-Polio Syndrome: Process Evaluation of a Randomized Controlled Trial

    NARCIS (Netherlands)

    Voorn, Eric L.; Koopman, Fieke S.; Brehm, Merel A.; Beelen, Anita; de Haan, Arnold; Gerrits, Karin H. L.; Nollet, Frans

    2016-01-01

    To explore reasons for the lack of efficacy of a high intensity aerobic exercise program in post-polio syndrome (PPS) on cardiorespiratory fitness by evaluating adherence to the training program and effects on muscle function. A process evaluation using data from an RCT. Forty-four severely fatigued

  7. Methods for systematic reviews of health economic evaluations: a systematic review, comparison, and synthesis of method literature.

    Science.gov (United States)

    Mathes, Tim; Walgenbach, Maren; Antoine, Sunya-Lee; Pieper, Dawid; Eikermann, Michaela

    2014-10-01

    The quality of systematic reviews of health economic evaluations (SR-HE) is often limited because of methodological shortcomings. One reason for this poor quality is that there are no established standards for the preparation of SR-HE. The objective of this study is to compare existing methods and suggest best practices for the preparation of SR-HE. To identify the relevant methodological literature on SR-HE, a systematic literature search was performed in Embase, Medline, the National Health System Economic Evaluation Database, the Health Technology Assessment Database, and the Cochrane methodology register, and webpages of international health technology assessment agencies were searched. The study selection was performed independently by 2 reviewers. Data were extracted by one reviewer and verified by a second reviewer. On the basis of the overlaps in the recommendations for the methods of SR-HE in the included papers, suggestions for best practices for the preparation of SR-HE were developed. Nineteen relevant publications were identified. The recommendations within them often differed. However, for most process steps there was some overlap between recommendations for the methods of preparation. The overlaps were taken as basis on which to develop suggestions for the following process steps of preparation: defining the research question, developing eligibility criteria, conducting a literature search, selecting studies, assessing the methodological study quality, assessing transferability, and synthesizing data. The differences in the proposed recommendations are not always explainable by the focus on certain evaluation types, target audiences, or integration in the decision process. Currently, there seem to be no standard methods for the preparation of SR-HE. The suggestions presented here can contribute to the harmonization of methods for the preparation of SR-HE. © The Author(s) 2014.

  8. Reactive endplate marrow changes: a systematic morphologic and epidemiologic evaluation

    International Nuclear Information System (INIS)

    Karchevsky, Michael; Schweitzer, Mark E.; Carrino, John A.; Zoga, Adam; Montgomery, Douglas; Parker, Laurence

    2005-01-01

    To evaluate the morphology and location of vertebral endplate changes, and to analyze their association with age, gender, and body mass index (BMI). At 1.5 T (T1-weighted, T2-weighted/STIR) 100 lumbar spines were evaluated separately by three observers. The readers classified the endplate bone marrow abnormalities on sagittal MR images according to the definitions of Modic et al. Findings were localized by disc segment; whether in the upper and/or lower endplate; and within each endplate divided into 15 segments. Disc space narrowing, as well as disc desiccation, was also noted at each vertebral level. In addition, endplate changes were correlated with age, gender, and BMI (weight(kg)/height(m) 2 ). A total of 15,000 data points were studied and 422 total changes recorded. A total of 99 vertebral levels were affected in 58 patients. Of these, 171 were of type I, 242 were of type II, and 9 were of type III. L4 - L5 and L5 - S1 vertebral levels were most commonly involved, having (142, 4.73%) and (116, 3.87%) changes respectively (P<0.0001). The upper and lower aspects of the endplate were affected similarly. Changes most frequently occurred at the anterior aspect of the endplate (P<0.0001). Endplate marrow changes were associated with increasing age (P<0.0001) and, surprisingly, male gender (P<0.0001). Endplate changes were not associated with BMI. The fatty pattern was most common, with the sclerotic pattern being rare. Endplate marrow changes most often occurred at the anterior aspect of the endplate, particularly at L4 - L5 and L5 - S1 levels. Modic changes occur more frequently with aging, evidence of their degenerative etiology. They were, however, not related to body habitus, but to weight and male gender. (orig.)

  9. Reactive endplate marrow changes: a systematic morphologic and epidemiologic evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Karchevsky, Michael [Hahnemann University Hospital, Department of Radiology, Philadelphia (United States); Thomas Jefferson University Hospital, Department of Radiology, Philadelphia (United States); Schweitzer, Mark E. [Hospital for Joint Diseases, Department of Radiology, New York (United States); Carrino, John A.; Zoga, Adam; Montgomery, Douglas; Parker, Laurence [Thomas Jefferson University Hospital, Department of Radiology, Philadelphia (United States)

    2005-03-01

    To evaluate the morphology and location of vertebral endplate changes, and to analyze their association with age, gender, and body mass index (BMI). At 1.5 T (T1-weighted, T2-weighted/STIR) 100 lumbar spines were evaluated separately by three observers. The readers classified the endplate bone marrow abnormalities on sagittal MR images according to the definitions of Modic et al. Findings were localized by disc segment; whether in the upper and/or lower endplate; and within each endplate divided into 15 segments. Disc space narrowing, as well as disc desiccation, was also noted at each vertebral level. In addition, endplate changes were correlated with age, gender, and BMI (weight(kg)/height(m){sup 2}). A total of 15,000 data points were studied and 422 total changes recorded. A total of 99 vertebral levels were affected in 58 patients. Of these, 171 were of type I, 242 were of type II, and 9 were of type III. L4 - L5 and L5 - S1 vertebral levels were most commonly involved, having (142, 4.73%) and (116, 3.87%) changes respectively (P<0.0001). The upper and lower aspects of the endplate were affected similarly. Changes most frequently occurred at the anterior aspect of the endplate (P<0.0001). Endplate marrow changes were associated with increasing age (P<0.0001) and, surprisingly, male gender (P<0.0001). Endplate changes were not associated with BMI. The fatty pattern was most common, with the sclerotic pattern being rare. Endplate marrow changes most often occurred at the anterior aspect of the endplate, particularly at L4 - L5 and L5 - S1 levels. Modic changes occur more frequently with aging, evidence of their degenerative etiology. They were, however, not related to body habitus, but to weight and male gender. (orig.)

  10. The Impact of Bariatric Surgery on Polycystic Ovary Syndrome: a Systematic Review and Meta-analysis.

    Science.gov (United States)

    Skubleny, Daniel; Switzer, Noah J; Gill, Richdeep S; Dykstra, Mark; Shi, Xinzhe; Sagle, Margaret A; de Gara, Christopher; Birch, Daniel W; Karmali, Shahzeer

    2016-01-01

    Bariatric surgery has been proven to be a successful management strategy for morbid obesity, but limited studies exist on its effect on polycystic ovary syndrome (PCOS). A comprehensive search of electronic databases was completed. Meta-analysis was performed on PCOS, hirsutism, and menstrual irregularity outcomes following bariatric surgery. Thirteen primary studies involving a total of 2130 female patients were identified. The incidence of PCOS preoperatively was 45.6 %, which significantly decreased to 6.8 % (P Bariatric surgery effectively attenuates PCOS and its clinical symptomatology including hirsutism and menstrual irregularity in severely obese women.

  11. Economic evaluations of hepatitis B vaccination strategies - A systematic review of the literature

    NARCIS (Netherlands)

    Wit GA de; Welte R; CZO

    National and international economic evaluations of universal vaccination against hepatitis B were systematically selected from the literature. Only the studies meeting the following criteria were selected: (a) original data reported in Dutch, English, French or German; (b) at least one universal

  12. Inter-rater agreement in evaluation of disability: systematic review of reproducibility studies

    OpenAIRE

    Barth, Jürgen; de Boer, Wout E L; Busse, Jason W; Hoving, Jan L; Kedzia, Sarah; Couban, Rachel; Fischer, Katrin; von Allmen, David Y; Spanjer, Jerry; Kunz, Regina

    2017-01-01

    OBJECTIVES To explore agreement among healthcare professionals assessing eligibility for work disability benefits. DESIGN Systematic review and narrative synthesis of reproducibility studies. DATA SOURCES Medline, Embase, and PsycINFO searched up to 16 March 2016, without language restrictions, and review of bibliographies of included studies. ELIGIBILITY CRITERIA Observational studies investigating reproducibility among healthcare professionals performing disability evaluations using a globa...

  13. Evaluating the Validity of Systematic Reviews to Identify Empirically Supported Treatments

    Science.gov (United States)

    Slocum, Timothy A.; Detrich, Ronnie; Spencer, Trina D.

    2012-01-01

    The "best available evidence" is one of the three basic inputs into evidence-based practice. This paper sets out a framework for evaluating the quality of systematic reviews that are intended to identify empirically supported interventions as a way of summarizing the best available evidence. The premise of this paper is that the process of…

  14. Limitations of previously published systematic reviews evaluating the outcome of endodontic treatment

    NARCIS (Netherlands)

    Wu, M.K.; Shemesh, H.; Wesselink, P.R.

    2009-01-01

    The aim of this work was to identify the limitations of previously published systematic reviews evaluating the outcome of root canal treatment. Traditionally, periapical radiography has been used to assess the outcome of root canal treatment with the absence of a periapical radiolucency being

  15. A Systematic Approach to Process Evaluation in the Central Oklahoma Turning Point (COTP) Partnership

    Science.gov (United States)

    Tolma, Eleni L.; Cheney, Marshall K.; Chrislip, David D.; Blankenship, Derek; Troup, Pam; Hann, Neil

    2011-01-01

    Formation is an important stage of partnership development. Purpose: To describe the systematic approach to process evaluation of a Turning Point initiative in central Oklahoma during the formation stage. The nine-month collaborative effort aimed to develop an action plan to promote health. Methods: A sound planning framework was used in the…

  16. Impact of screening for metabolic syndrome on the evaluation of obese living kidney donors.

    Science.gov (United States)

    Marcusa, Daniel P; Schaubel, Douglas E; Woodside, Kenneth J; Sung, Randall S

    2018-01-01

    We report our experience with metabolic syndrome screening for obese living kidney donor candidates to mitigate the long-term risk of CKD. We retrospectively reviewed 814 obese (BMI≥30) and 993 nonobese living kidney donor evaluations over 12 years. Using logistic regression, we explored interactions between social/clinical variables and candidate acceptance before and after policy implementation. Obese donor candidate acceptance decreased after metabolic syndrome screening began (56.3%, 46.3%, p metabolic syndrome, there was no significant change in how age, sex, race, or BMI affected a donor candidate's probability of acceptance. Metabolic syndrome screening is a simple stratification tool for centers with liberal absolute BMI cut-offs to exclude potentially higher-risk obese candidates. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Rituximab Effectiveness and Safety for Treating Primary Sjögren’s Syndrome (pSS): Systematic Review and Meta-Analysis

    Science.gov (United States)

    Souza, Francine Bertolais do Valle; Porfírio, Gustavo José Martiniano; Andriolo, Brenda Nazaré Gomes; de Albuquerque, Julia Vajda; Trevisani, Virginia Fernandes Moça

    2016-01-01

    Background Primary Sjögren’s Syndrome (pSS) is a systemic autoimmune disease that involves the exocrine glands and internal organs. pSS leads to destruction and loss of secretory function due to intense lymphoplasmacytic infiltration. Therapeutic options include mainly symptomatic and supportive measures, and traditional immunosuppressant drugs have shown no effectiveness in randomized trials. Rituximab (RTX) is a chimeric antibody anti-CD20 that leads to B cell depletion by diverse mechanisms. There is evidence that this drug may be effective for treating pSS. The objective of this systematic review was to evaluate Rituximab effectiveness and safety for treating pSS. Methods and Findings We conducted a systematic review of RCTs published until December 2015, with no language restriction. We registered a protocol on Plataforma Brasil (40654814.6.0000.5505) and developed search strategies for the following scientific databases: MEDLINE, EMBASE, CENTRAL and LILACS. We included adults with established pSS diagnosis and considered the use of Rituximab as intervention and the use of other drugs or placebo as control. Four studies met our eligibility criteria: three with low risk of bias and one with uncertain risk of bias. The total number of participants was 276 (145 RTX, 131 placebo). We assessed the risk of bias of each included study and evaluated the following as primary outcomes: lacrimal gland function, salivary gland function, fatigue improvement and adverse events. We found no significant differences between the groups in the Schirmer test at week 24 meta-analysis (MD 3.59, 95% CI -2.89 to 10.07). Only one study evaluated the lissamine green test and reported a statistically significant difference between the groups at week 24 (MD -2.00, 95% CI -3.52 to -0.48). There was a significant difference between the groups regarding salivary flow rate (MD 0.09, 95% CI 0.02 to 0.16) and improvement in fatigue VAS at weeks 6 (RR 3.98, 95% CI 1.61 to 9.82) and week 16

  18. Rituximab Effectiveness and Safety for Treating Primary Sjögren's Syndrome (pSS): Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Souza, Francine Bertolais do Valle; Porfírio, Gustavo José Martiniano; Andriolo, Brenda Nazaré Gomes; Albuquerque, Julia Vajda de; Trevisani, Virginia Fernandes Moça

    2016-01-01

    Primary Sjögren's Syndrome (pSS) is a systemic autoimmune disease that involves the exocrine glands and internal organs. pSS leads to destruction and loss of secretory function due to intense lymphoplasmacytic infiltration. Therapeutic options include mainly symptomatic and supportive measures, and traditional immunosuppressant drugs have shown no effectiveness in randomized trials. Rituximab (RTX) is a chimeric antibody anti-CD20 that leads to B cell depletion by diverse mechanisms. There is evidence that this drug may be effective for treating pSS. The objective of this systematic review was to evaluate Rituximab effectiveness and safety for treating pSS. We conducted a systematic review of RCTs published until December 2015, with no language restriction. We registered a protocol on Plataforma Brasil (40654814.6.0000.5505) and developed search strategies for the following scientific databases: MEDLINE, EMBASE, CENTRAL and LILACS. We included adults with established pSS diagnosis and considered the use of Rituximab as intervention and the use of other drugs or placebo as control. Four studies met our eligibility criteria: three with low risk of bias and one with uncertain risk of bias. The total number of participants was 276 (145 RTX, 131 placebo). We assessed the risk of bias of each included study and evaluated the following as primary outcomes: lacrimal gland function, salivary gland function, fatigue improvement and adverse events. We found no significant differences between the groups in the Schirmer test at week 24 meta-analysis (MD 3.59, 95% CI -2.89 to 10.07). Only one study evaluated the lissamine green test and reported a statistically significant difference between the groups at week 24 (MD -2.00, 95% CI -3.52 to -0.48). There was a significant difference between the groups regarding salivary flow rate (MD 0.09, 95% CI 0.02 to 0.16) and improvement in fatigue VAS at weeks 6 (RR 3.98, 95% CI 1.61 to 9.82) and week 16 (RR 3.08, 95% CI 1.21 to 7

  19. Rituximab Effectiveness and Safety for Treating Primary Sjögren's Syndrome (pSS: Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Francine Bertolais do Valle Souza

    Full Text Available Primary Sjögren's Syndrome (pSS is a systemic autoimmune disease that involves the exocrine glands and internal organs. pSS leads to destruction and loss of secretory function due to intense lymphoplasmacytic infiltration. Therapeutic options include mainly symptomatic and supportive measures, and traditional immunosuppressant drugs have shown no effectiveness in randomized trials. Rituximab (RTX is a chimeric antibody anti-CD20 that leads to B cell depletion by diverse mechanisms. There is evidence that this drug may be effective for treating pSS. The objective of this systematic review was to evaluate Rituximab effectiveness and safety for treating pSS.We conducted a systematic review of RCTs published until December 2015, with no language restriction. We registered a protocol on Plataforma Brasil (40654814.6.0000.5505 and developed search strategies for the following scientific databases: MEDLINE, EMBASE, CENTRAL and LILACS. We included adults with established pSS diagnosis and considered the use of Rituximab as intervention and the use of other drugs or placebo as control. Four studies met our eligibility criteria: three with low risk of bias and one with uncertain risk of bias. The total number of participants was 276 (145 RTX, 131 placebo. We assessed the risk of bias of each included study and evaluated the following as primary outcomes: lacrimal gland function, salivary gland function, fatigue improvement and adverse events. We found no significant differences between the groups in the Schirmer test at week 24 meta-analysis (MD 3.59, 95% CI -2.89 to 10.07. Only one study evaluated the lissamine green test and reported a statistically significant difference between the groups at week 24 (MD -2.00, 95% CI -3.52 to -0.48. There was a significant difference between the groups regarding salivary flow rate (MD 0.09, 95% CI 0.02 to 0.16 and improvement in fatigue VAS at weeks 6 (RR 3.98, 95% CI 1.61 to 9.82 and week 16 (RR 3.08, 95% CI 1.21 to

  20. Post-operative outcomes after cleft palate repair in syndromic and non-syndromic children: a systematic review protocol.

    Science.gov (United States)

    Zhang, Zach; Stein, Michael; Mercer, Nigel; Malic, Claudia

    2017-03-09

    There is a lack of high-level evidence on the surgical management of cleft palate. An appreciation of the differences in the complication rates between different surgical techniques and timing of repair is essential in optimizing cleft palate management. A comprehensive electronic database search will be conducted on the complication rates associated with cleft palate repair using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. Two independent reviewers with expertise in cleft pathology will screen all appropriate titles, abstracts, and full-text publications prior to deciding whether each meet the predetermined inclusion criteria. The study findings will be tabulated and summarized. The primary outcomes will be the rate of palatal fistula, the incidence and severity of velopharyngeal insufficiency, and the rate of maxillary hypoplasia with different techniques and also the timing of the repair. A meta-analysis will be conducted using a random effects model. The evidence behind the optimal surgical approach to cleft palate repair is minimal, with no gold standard technique identified to date for a certain type of cleft palate. It is essential to appreciate how the complication rates differ between each surgical technique and each time point of repair, in order to optimize the management of these patients. A more critical evaluation of the outcomes of different cleft palate repair methods may also provide insight into more effective surgical approaches for different types of cleft palates.

  1. Systematic review of the clinical and genetic aspects of Prader-Willi syndrome

    Directory of Open Access Journals (Sweden)

    Dong Kyu Jin

    2011-02-01

    Full Text Available Prader-Willi syndrome (PWS is a complex multisystem genetic disorder that is caused by the lack of expression of paternally inherited imprinted genes on chromosome 15q11&#8211;q13. This syndrome has a characteristic phenotype including severe neonatal hypotonia, early-onset hyperphagia, development of morbid obesity, short stature, hypogonadism, learning disabilities, behavioral problems, and psychiatric problems. PWS is an example of a genetic condition caused by genomic imprinting. It can occur via 3 main mechanisms that lead to the absence of expression of paternally inherited genes in the 15q11.2&#8211;q13 region: paternal microdeletion, maternal uniparental disomy, and an imprinting defect. Over 99% of PWS cases can be diagnosed using DNA methylation analysis. Early diagnosis of PWS is important for effective long-term management. Growth hormone (GH treatment improves the growth, physical phenotype, and body composition of patients with PWS. In recent years, GH treatment in infants has been shown to have beneficial effects on the growth and neurological development of patients diagnosed during infancy. There is a clear need for an integrated multidisciplinary approach to facilitate early diagnosis and optimize management to improve quality of life, prevent complications, and prolong life expectancy in patients with PWS.

  2. Performance Evaluation of Bluetooth Low Energy: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Jacopo Tosi

    2017-12-01

    Full Text Available Small, compact and embedded sensors are a pervasive technology in everyday life for a wide number of applications (e.g., wearable devices, domotics, e-health systems, etc.. In this context, wireless transmission plays a key role, and among available solutions, Bluetooth Low Energy (BLE is gaining more and more popularity. BLE merges together good performance, low-energy consumption and widespread diffusion. The aim of this work is to review the main methodologies adopted to investigate BLE performance. The first part of this review is an in-depth description of the protocol, highlighting the main characteristics and implementation details. The second part reviews the state of the art on BLE characteristics and performance. In particular, we analyze throughput, maximum number of connectable sensors, power consumption, latency and maximum reachable range, with the aim to identify what are the current limits of BLE technology. The main results can be resumed as follows: throughput may theoretically reach the limit of ~230 kbps, but actual applications analyzed in this review show throughputs limited to ~100 kbps; the maximum reachable range is strictly dependent on the radio power, and it goes up to a few tens of meters; the maximum number of nodes in the network depends on connection parameters, on the network architecture and specific device characteristics, but it is usually lower than 10; power consumption and latency are largely modeled and analyzed and are strictly dependent on a huge number of parameters. Most of these characteristics are based on analytical models, but there is a need for rigorous experimental evaluations to understand the actual limits.

  3. Performance Evaluation of Bluetooth Low Energy: A Systematic Review.

    Science.gov (United States)

    Tosi, Jacopo; Taffoni, Fabrizio; Santacatterina, Marco; Sannino, Roberto; Formica, Domenico

    2017-12-13

    Small, compact and embedded sensors are a pervasive technology in everyday life for a wide number of applications (e.g., wearable devices, domotics, e-health systems, etc.). In this context, wireless transmission plays a key role, and among available solutions, Bluetooth Low Energy (BLE) is gaining more and more popularity. BLE merges together good performance, low-energy consumption and widespread diffusion. The aim of this work is to review the main methodologies adopted to investigate BLE performance. The first part of this review is an in-depth description of the protocol, highlighting the main characteristics and implementation details. The second part reviews the state of the art on BLE characteristics and performance. In particular, we analyze throughput, maximum number of connectable sensors, power consumption, latency and maximum reachable range, with the aim to identify what are the current limits of BLE technology. The main results can be resumed as follows: throughput may theoretically reach the limit of ~230 kbps, but actual applications analyzed in this review show throughputs limited to ~100 kbps; the maximum reachable range is strictly dependent on the radio power, and it goes up to a few tens of meters; the maximum number of nodes in the network depends on connection parameters, on the network architecture and specific device characteristics, but it is usually lower than 10; power consumption and latency are largely modeled and analyzed and are strictly dependent on a huge number of parameters. Most of these characteristics are based on analytical models, but there is a need for rigorous experimental evaluations to understand the actual limits.

  4. Evaluation of insulin sensitivity status in polycystic ovarian syndrome

    Directory of Open Access Journals (Sweden)

    Wilma Delphine Silvia C

    2011-03-01

    Full Text Available Objective: To identify the risk arising from polycystic ovarian syndrome (PCOS which would help the clinician to make early interventions. Methods: Fasting and postprandial serum glucose and serum insulin levels were estimated in 26 cases of PCOS and 26 healthy women were selected as controls. Calculation of quantitative insulin sensitivity check index (QUICKI in all the subjects was utilized to analyze its sensitivity and reliability. Also body mass index and waist circumference in all these subjects were measured as obesity plays a key role in the pathogenesis of PCOS. Results: Hyperglycemia was observed in 11% of the cases and hyperinsulinemia was a consistent feature in 46% of the patients. The postprandial insulin levels in cases were statistically significant (P=0.006. Sensitivity to insulin as indicated by QUICKI in the postprandial state was less in cases than in controls (P=0.13. The BMI was markedly raised in 15% and moderately raised in about 38% of the cases (P=0.024. Waist circumference was significantly raised in about 61% of the cases (>80 cm (P<0.001. Conclusions: Our study indicates that QUICKI, BMI and waist circumference are simple, quick and may act as early markers in identifying the risks of developing metabolic syndrome. Obesity, being a consistent finding in most cases suggested its key role in the pathogenesis of PCOS.

  5. Oral findings in Rett syndrome: a systematic review of the dental literature.

    Science.gov (United States)

    Fuertes-González, María-Cristina; Silvestre, Francisco-Javier; Almerich-Silla, José-Manuel

    2011-01-01

    Rett syndrome (RS) is a chromosome X-linked genetic neurological disorder characterized by developmental regression, particularly in relation to expressive language and use of the hands, together with profound mental retardation, that almost exclusively affects females. The present review describes the 35 cases of RS published in the indexed literature (Medline)--the first corresponding to 1985 and the last to the year 2007. Certain oral manifestations of the disease are derived from the drug treatment prescribed to control the disease, while others are common to other clinical conditions characterized by convulsion activity, difficulties for correct oral hygiene, walking problems and/or an excess of oral/digital-manual habits. In any case, bruxism is the oral habit most frequently associated with RS--the treatment of which remains the subject of controversy.

  6. Mortality in Pediatric Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Wong, Judith Ju-Ming; Jit, Mark; Sultana, Rehena; Mok, Yee Hui; Yeo, Joo Guan; Koh, Jia Wen Janine Cynthia; Loh, Tsee Foong; Lee, Jan Hau

    2017-01-01

    Sparse and conflicting evidence exists regarding mortality risk from pediatric acute respiratory distress syndrome (ARDS). We aimed to determine the pooled mortality in pediatric ARDS and to describe its trend over time. MEDLINE, EMBASE, and Web of Science were searched from 1960 to August 2015. Keywords or medical subject headings (MESH) terms used included "respiratory distress syndrome, adult," "acute lung injury," "acute respiratory insufficiency," "acute hypoxemic respiratory failure," "pediatrics," and "child." Study inclusion criteria were (1) pediatric patients aged 0 days to 18 years, (2) sufficient baseline data described in the pediatric ARDS group, and (3) mortality data. Randomized controlled trials (RCTs) and prospective observational studies were eligible. Data on study characteristics, patient demographics, measures of oxygenation, and mortality were extracted using a standard data extraction form. Independent authors conducted the search, applied the selection criteria, and extracted the data. Methodological quality of studies was assessed. Meta-analysis using a random-effects model was performed to obtain pooled estimates of mortality. Meta-regression was performed to analyze variables contributing to change in mortality over time. Eight RCTs and 21 observational studies (n = 2274 patients) were included. Pooled mortality rate was 24% (95% confidence interval [CI]: 19-31). There was a decrease in mortality rates over 3 epochs (≤2000, 2001-2009, and ≥2010: 40% [95% CI: 24-59], 35% [95% CI: 21-51], and 18% [95% CI: 12-26], respectively, P < .001). Observational studies reported a higher mortality rate than RCTs (27% [95% CI: 24-29] versus 16% [95% CI: 12-20], P < .001). Earlier year of publication was an independent factor associated with mortality. Overall mortality rate in pediatric ARDS is approximately 24%. Studies conducted and published later were associated with better survival.

  7. Efficacy of hypnosis/guided imagery in fibromyalgia syndrome - a systematic review and meta-analysis of controlled trials

    Science.gov (United States)

    2011-01-01

    Background Recent systematic reviews on psychological therapies of fibromyalgia syndrome (FMS) did not consider hypnosis/guided imagery (H/GI). Therefore we performed a systematic review with meta-analysis of the efficacy of H/GI in FMS. Methods We screened http://ClinicalTrials.gov, Cochrane Library, MEDLINE, PsycINFO and SCOPUS (through December 2010). (Quasi-) randomized controlled trials (CTs) comparing H/GI with controls were analyzed. Outcomes were pain, sleep, fatigue, depressed mood and health-related quality of life (HRQOL). Effects were summarized using standardized mean differences (SMD). Results Six CTs with 239 subjects with a median of 9 (range 7-12) H/GI-sessions were analysed. The median number of patients in the H/GI groups was 20 (range 8-26). Three studies performed follow-ups. H/GI reduced pain compared to controls at final treatment (SMD -1.17 [95% CI -2.21, -0.13]; p = 0.03). H/GI did not reduce limitations of HRQOL at final treatment (SMD -0.90 [95% CI -2.55, 0.76]; p = 0.29) compared to controls. Effect sizes on fatigue, sleep and depressed mood at final treatment and follow-up and on pain and HRQOL at follow-up were not calculated because of limited data available. The significant effect on pain at final treatment was associated with low methodological and low treatment quality. Conclusion Further studies with better treatment quality and adequate methodological quality assessing all key domains of FMS are necessary to clarify the efficacy of H/GI in FMS. PMID:21676255

  8. The Effectiveness of Oral Pain Medication and Corticosteroid Injections for Carpal Tunnel Syndrome-A Systematic Review.

    Science.gov (United States)

    Huisstede, Bionka Ma; Randsdorp, Manon S; van den Brink, Janneke; Franke, Thierry Pc; Koes, Bart W; Hoogvliet, Peter

    2018-04-04

    To present an evidence-based overview of the effectiveness of oral pain medication and corticosteroid injections to treat carpal tunnel syndrome (CTS). The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs). Two reviewers independently selected the studies, extracted the data on pain (VAS), function or recovery and assessed the methodological quality. A best-evidence synthesis was performed to summarize the results of the included studies. Four reviews and nine RCTs were included. For oral pain medication strong and moderate evidence was found for the effectiveness of oral steroids versus placebo in the short-term. Moderate evidence was found in favor of oral steroids versus splinting in the short-term. No evidence was found for the effectiveness of oral steroids in the long-term. For corticosteroid injections, strong evidence was found in favor of a corticosteroid injection versus a placebo injection and moderate evidence was found in favor of corticosteroid injection versus oral steroids in the short-term. Also in short-term, moderate evidence was found in favor of a local versus a systematic corticosteroid injection. Higher doses of corticosteroid injections seem to be more effective in the midterm, however the benefits of corticosteroid injections were not maintained in the long-term. The reviewed evidence supports that oral steroids and corticosteroid injections benefit patient with CTS particular in the short-term. Although a higher dose of steroid injections seems to be more effective in the midterm, the benefits of oral pain medication and corticosteroid injections were not maintained in the long-term. Copyright © 2018. Published by Elsevier Inc.

  9. Efficacy of vitamin C in preventing complex regional pain syndrome after wrist fracture: A systematic review and meta-analysis.

    Science.gov (United States)

    Aïm, F; Klouche, S; Frison, A; Bauer, T; Hardy, P

    2017-05-01

    Complex regional pain syndrome type I (CRPS-I), previously known as reflex sympathetic dystrophy, is common after conservatively or surgically treated wrist fractures. Several studies support the efficacy of vitamin C in preventing CRPS-I, although the data are somewhat conflicting. The primary objective of this systematic literature review and meta-analysis was to assess the efficacy of vitamin C therapy in preventing CRPS-I after a wrist fracture. Randomised, placebo-controlled trials of vitamin C to prevent CRPS-I after wrist fractures were sought in the three main databases: PubMed (1980 to December 2015), CENTRAL (Central 2015, number 12), and Embase (1980 to December 2015). Two authors worked independently to select articles. Data from selected articles were collected independently. Three randomised placebo-controlled trials in a total of 875 patients were included. Treatment was non-operative in 758/890 (85.1%) fractures and operative in 132 (14.9%) fractures. Vitamin C supplementation was started on the day of the injury and continued for 50 days. In the group given 500mg of vitamin C daily, the risk ratio for CRPS-I was 0.54 (95%CI, 0.33-0.91; P=0.02). Thus, the risk of developing CRPS-I was significantly decreased by prophylactic treatment with 500mg of vitamin C per day. The heterogeneity rate was 65% (non-significant). Daily supplementation with 500mg of vitamin C per day for 50 days decreases the 1-year risk of CRPS-I after wrist fracture. II, systematic review of level I and II studies. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  10. Efficacy of acupuncture in fibromyalgia syndrome--a systematic review with a meta-analysis of controlled clinical trials.

    Science.gov (United States)

    Langhorst, Jost; Klose, Petra; Musial, Frauke; Irnich, Dominik; Häuser, Winfried

    2010-04-01

    To systematically review the efficacy of acupuncture in fibromyalgia syndrome (FMS). MEDLINE, PsychInfo, EMBASE, CAMBASE and the Cochrane Library were screened (through July 2009). The reference sections of original studies and systematic reviews for randomized controlled trials (RCTs) on acupuncture in FMS were searched. Seven RCTs with a median treatment time of 9 (range 6-25) sessions and 385 patients were included. Outcomes of interest were key symptoms of FMS, namely pain, fatigue, sleep disturbances, reduced physical function and side effects at post-treatment. Follow-up of two RCTs with a median follow-up of 26 weeks was available. Standardized mean differences (SMDs) comparing verum and control acupuncture were calculated. Strong evidence for the reduction of pain (SMD -0.25; 95% CI -0.49, -0.02; P = 0.04) was found at post-treatment. There was no evidence for the reduction of fatigue and sleep disturbances, or the improvement of physical function at post-treatment. There was no evidence for the reduction of pain and improvement of physical function at the latest follow-up. Subgroup analyses resulted in moderate evidence for a significant and small reduction of pain at post-treatment in studies with electro-stimulation and individualized acupuncture. Stratifying the type of controls (penetrating vs non-penetrating control acupuncture) did not change the results. Significant reduction of pain was only present in studies with risk of bias. Side effects were inconsistently reported. A small analgesic effect of acupuncture was present, which, however, was not clearly distinguishable from bias. Thus, acupuncture cannot be recommended for the management of FMS.

  11. Evaluation of uric acid levels, thyroid function, and anthropometric parameters in Japanese children with Down syndrome.

    Science.gov (United States)

    Niegawa, Tomomi; Takitani, Kimitaka; Takaya, Ryuzo; Ishiro, Manabu; Kuroyanagi, Yuichi; Okasora, Keisuke; Minami, Yukako; Matsuda, Takuya; Tamai, Hiroshi

    2017-09-01

    Down syndrome, caused by trisomy 21, is characterized by congenital abnormalities as well as mental retardation. From the neonatal stage through adolescence, patients with Down syndrome often have several complications. Thus, it is important to attain knowledge of the prevalence of these comorbidities in children with Down syndrome. We, therefore, evaluated the biochemical data, thyroid function, and anthropometric parameters, and analyzed the association among them in Japanese children and early adolescents with Down syndrome. There was no difference in the prevalence of obesity and overweight between boys and girls. The level of uric acid was higher in boys than in girls. Moreover, the prevalence of hyperuricemia was also higher in boys than in girls (approximately 32% and 10%, respectively). The prevalence of subclinical hypothyroidism in children with Down syndrome was approximately 20%, with no significant sex differences. The levels of uric acid and dehydroepiandrosterone-sulfate were positively associated with age, while the levels of thyroid-stimulating hormone and free thyroxine had a negative association with age. Overall, children with Down syndrome, exhibit a higher incidence of hyperuricemia. Therefore, uric acid levels, as well as thyroid function, from childhood to early adulthood should be monitored in this patient cohort.

  12. Vaginal discharge: aetiological agents and evaluation of syndromic management in Lagos.

    Science.gov (United States)

    Onyekonwu, C L; Olumide, Y M; Oresanya, F A; Onyekonwu, G C

    2011-01-01

    The WHO introduced the syndromic management to help in the control of STIs in resource-poor settings. This needs to be adapted to local settings taking into consideration the prevalence of the various organisms causing STIs. This has given rise to a need to validate the algorithm. The study aimed to correlate the syndromic management treatment algorithm for vaginal discharge with the aetiological diagnosis based on laboratory investigations. Specifically, the sensitivity, specificity and positive predictive values of the syndromic management against a gold standard laboratory diagnosis were evaluated. A total of 195 consecutive patients presenting to the study sites with vaginal discharge were enrolled in the study. Information on sociodemographic data was obtained with the aid of questionnaires. Samples were taken and examined for candida, trichomonas, bacterial vaginosis (BV), chlamydia and gonorrheal infections, after speculum and vaginal examinations. The sensitivity and positive predictive values (PPV) of the syndromic management in detecting vaginal infections performed better than corresponding values for cervicitis. The algorithm for cervicitis improved on addition of speculum examination (36% and 32.1% for sensitivity and PPV respectively). The study shows that the syndromic diagnosis for vaginal discharge fares better for vaginitis, especially with addition of speculum examination. The application of syndromic diagnosis for cervicitis resulted in omission of patients who had evidence of cervical infections by bacteriologic examination.

  13. [Evaluation on methodological problems in reports concerning quantitative analysis of syndrome differentiation of diabetes mellitus].

    Science.gov (United States)

    Chen, Bi-Cang; Wu, Qiu-Ying; Xiang, Cheng-Bin; Zhou, Yi; Guo, Ling-Xiang; Zhao, Neng-Jiang; Yang, Shu-Yu

    2006-01-01

    To evaluate the quality of reports published in recent 10 years in China about quantitative analysis of syndrome differentiation for diabetes mellitus (DM) in order to explore the methodological problems in these reports and find possible solutions. The main medical literature databases in China were searched. Thirty-one articles were included and evaluated by the principles of clinical epidemiology. There were many mistakes and deficiencies in these articles, such as clinical trial designs, diagnosis criteria for DM, standards of syndrome differentiation of DM, case inclusive and exclusive criteria, sample size and estimation, data comparability and statistical methods. It is necessary and important to improve the quality of reports concerning quantitative analysis of syndrome differentiation of DM in light of the principles of clinical epidemiology.

  14. Evaluation of a new method for librarian-mediated literature searches for systematic reviews.

    Science.gov (United States)

    Bramer, Wichor M; Rethlefsen, Melissa L; Mast, Frans; Kleijnen, Jos

    2017-10-26

    To evaluate and validate the time of completion and results of a new method of searching for systematic reviews, the exhaustive search method (ESM), using a pragmatic comparison. Single-line search strategies were prepared in a text document. Term completeness was ensured with a novel optimization technique. Macros in MS Word converted the syntaxes between databases and interfaces almost automatically. We compared search characteristics, such as number of search terms and databases, and outcomes, such as number of included and retrieved references and precision, from ESM searches and other Dutch academic hospitals identified by searching PubMed for systematic reviews published between 2014 and 2016. We compared time to perform the ESM with a secondary comparator of recorded search times from published literature and contact with authors to acquire unpublished data. We identified 73 published Erasmus MC systematic reviews and 258 published by other Dutch academic hospitals meeting our criteria. We pooled search time data from 204 other systematic reviews. The ESM searches differed by using 2 times more databases, retrieving 44% more references, including 20% more studies in the final systematic review, but the time needed for the search was 8% of that of the control group. Similarities between methods include precision and the number of search terms. The evaluated similarities and differences suggest that the ESM is a highly efficient way to locate more references meeting the specified selection criteria in systematic reviews than traditional search methods. Further prospective research is required. © 2017 The Authors. Research Synthesis Methods Published by John Wiley & Sons Ltd.

  15. Nonthyroidal illness syndrome: evaluation of thyroid function in sick patients.

    Science.gov (United States)

    Langton, Joanne E; Brent, Gregory A

    2002-03-01

    Altered thyroid function tests as a consequence of illness have been recognized for many years, yet the cause and clinical implications remains uncertain. The routine testing of thyroid function in hospitalized patients should be discouraged, as the results are less predictive of primary thyroid disease than in ambulatory patients. Clinicians should be aware of the methods used for thyroid function testing, as the effect of illness on thyroid function varies among the different tests. The most commonly used free T4 assays likely are influenced significantly by nonthyroidal illness. Advances in understanding the basic mechanisms of thyroid hormone metabolism and thyroid hormone action have given insights into the changes in thyroid function tests as a consequence of nonthyroidal illness. In the future, thyroid hormone receptor isoform-specific agonists and antagonists may allow for more specific treatment of select patients with nonthyroidal illness syndrome.

  16. Standardizing the evaluation criteria on treatment outcomes of mandibular implant overdentures: a systematic review

    Science.gov (United States)

    Kim, Ha-Young; Shin, Sang-Wan

    2014-01-01

    PURPOSE The aim of this review was to analyze the evaluation criteria on mandibular implant overdentures through a systematic review and suggest standardized evaluation criteria. MATERIALS AND METHODS A systematic literature search was conducted by PubMed search strategy and hand-searching of relevant journals from included studies considering inclusion and exclusion criteria. Randomized clinical trials (RCT) and clinical trial studies comparing attachment systems on mandibular implant overdentures until December, 2011 were selected. Twenty nine studies were finally selected and the data about evaluation methods were collected. RESULTS Evaluation criteria could be classified into 4 groups (implant survival, peri-implant tissue evaluation, prosthetic evaluation, and patient satisfaction). Among 29 studies, 21 studies presented implant survival rate, while any studies reporting implant failure did not present cumulative implant survival rate. Seventeen studies evaluating peri-implant tissue status presented following items as evaluation criteria; marginal bone level (14), plaque Index (13), probing depth (8), bleeding index (8), attachment gingiva level (8), gingival index (6), amount of keratinized gingiva (1). Eighteen studies evaluating prosthetic maintenance and complication also presented following items as evaluation criteria; loose matrix (17), female detachment (15), denture fracture (15), denture relining (14), abutment fracture (14), abutment screw loosening (11), and occlusal adjustment (9). Atypical questionnaire (9), Visual analog scales (VAS) (4), and Oral Health Impact Profile (OHIP) (1) were used as the format of criteria to evaluate patients satisfaction in 14 studies. CONCLUSION For evaluation of implant overdenture, it is necessary to include cumulative survival rate for implant evaluation. It is suggested that peri-implant tissue evaluation criteria include marginal bone level, plaque index, bleeding index, probing depth, and attached gingiva

  17. Clinical Efficacy of 1-Year Intensive Systematic Dietary Manipulation as Complementary and Alternative Medicine Therapies on Female Patients With Interstitial Cystitis/Bladder Pain Syndrome.

    Science.gov (United States)

    Oh-Oka, Hitoshi

    2017-08-01

    To evaluate the clinical efficacy of intensive systematic dietary manipulation (ISDM) for female patients with interstitial cystitis (IC)/bladder pain syndrome (BPS) in stable condition who were followed up in our hospital. In cooperation with the nutrition control team, we created a basic IC/BPS diet menu for 1 month. Data regarding daily food intake and food-related symptoms were collected by conducting a detailed interview of each patient, and we set meal menu to control IC/BPS symptoms and advised the patients to reduce the intake of specific food items to the maximum possible extent. The following food items were removed from or restricted in the diet of patients: tomatoes, tomato products, soybean, tofu product, spices, excessive potassium, citrus, high-acidity-inducing substances, etc. We evaluated the following factors 3 months and 1 year after the start of the intervention: O'Leary-Sant symptom index, O'Leary-Sant problem index, urgency visual analogue scale score, bladder or pelvic pain visual analogue scale score, and numerical patient-reported quality of life index. All evaluated factors improved statistically significantly when the intensive group was compared with the nonintensive group (baseline to 3 months and 3 months to 1 year ISDM, P <.05, respectively). ISDM was found to alleviate the symptoms of IC/BPS in almost 3 months and continued clinical efficacy for at least 1 year. ISDM as one of the conservative treatment modality for IC/BPS should be attempted more strictly because of its noninvasiveness, without alterations to the other treatments. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Systematic effects of participant role on evaluation of the psychotherapy session.

    Science.gov (United States)

    Eugster, S L; Wampold, B E

    1996-10-01

    This study identified systematic differences between therapists (n = 114) and patients (n = 119) in the process components that predict evaluation of psychotherapy sessions. The Comprehensive Scale of Psychotherapy Session Constructs was developed to measure 9 process variables and their relationships to session evaluation from the perspectives of therapist and patient. Regression equations predicting session evaluation from the process components for the 2 groups were significantly different. Therapist session evaluation was best predicted by therapist expertness, and patient session evaluation was best predicted by the therapist real relationship. The therapist real relationship negatively predicted therapist session evaluation when all process variables were considered simultaneously. Patient progress and patient involvement significantly and positively predicted both therapist and patient evaluation.

  19. Identifying the incidence of rash, Stevens-Johnson syndrome and toxic epidermal necrolysis in patients taking lamotrigine: a systematic review of 122 randomized controlled trials.

    Science.gov (United States)

    Bloom, Romi; Amber, Kyle T

    2017-01-01

    Lamotrigine is an antiepileptic drug used for the treatment of epilepsy, bipolar disorder and numerous off-label uses. The development of rash significantly affects its use. The most concerning of these adverse reactions is Stevens-Johnson syndrome/toxic epidermal necrolysis. We performed a systematic review of randomized controlled trials using lamotrigine as a monotherapy to quantify the incidence of cutaneous reactions, particularly Stevens-Johnson syndrome/toxic epidermal necrolysis. Of a total of 4,364 papers regarding lamotrigine, 122 studies met our inclusion and exclusion criteria. In total, 18,698 patients were included with 1,570 (8.3%) of patients experiencing an adverse dermatologic reaction. The incidence of Stevens-Johnson syndrome/toxic epidermal necrolysis was 0.04%.

  20. Effect of cardiac rehabilitation on metabolic syndrome and its components: A systematic review and meta-analysis.

    Science.gov (United States)

    Sadeghi, Masoumeh; Salehi-Abargouei, Amin; Kasaei, Zahra; Sajjadieh-Khajooie, Hamidreza; Heidari, Ramin; Roohafza, Hamidreza

    2016-01-01

    Although the effect of cardiac rehabilitation (CR) on cardiovascular disease (CVD) prognosis has been well-documented by several systematic reviews, none have focused on the effect of CR on metabolic syndrome (MetS) and its related components. Therefore, the present systematic review and meta-analysis was conducted to assess the effect of CR on MetS and its components. PubMed, SCOPUS, Cochrane library, and Google Scholar database were searched up to February 2014 with no date and language restrictions. The random effects model was used to assess the overall effect of CR on MetS prevalence and the change in metabolic or anthropometric measures. Fifteen studies with 19,324 subjects were included in the present systematic review and meta-analysis. Our analysis showed that the CR could significantly reduce MetS prevalence [reduction rate: 0.25, 95% confidence interval (CI): 0.21, 0.3, P value <0.001; P value for heterogeneity <0.001, I-squared: 86.2%]. Additionally, results showed the protective role of CR on all MetS components including high density lipoprotein cholesterol [mean difference (MD): 2.13 mg/dL, 95% CI: 1.17, 3.1], triglyceride (MD: -27.45 mg/dL, 95% CI: -36.92, -17.98), systolic blood pressure (SBP) (MD: -6.20 mmHg, 95% CI: -8.41, -3.99), diastolic blood pressure (DBP) (MD: -2.53 mmHg, 95% CI: -3.64, -1.41), fasting blood sugar (FBS) (MD: -6.42 mg/dL, 95% CI: -6.85, -5.99), and waist circumference (WC) (MD: -2.25 cm, 95% CI: -3.15, -1.35). CR has resulted in improvement in MetS and its entire components, and could be considered as a useful tool for MetS patients, especially among those with CVD.

  1. A systematic review of evaluation research in integrated behavioral health care: Operational and financial characteristics.

    Science.gov (United States)

    Muse, Amelia R; Lamson, Angela L; Didericksen, Katharine W; Hodgson, Jennifer L

    2017-06-01

    Integrated behavioral health care (IBHC) is an emerging solution for the delivery of behavioral health in primary care contexts. Although IBHC has been implemented and studied for more than 2 decades, little seems to be known about how it is best evaluated. This article illustrates a framework for IBHC evaluation based on the Three World view (with a focus on the operational and financial worlds) and delivers results from a systematic review on the operational and financial characteristics of existing IBHC research. This study identified original reports of research that included an evaluation or assessment of the operational or financial success or sustainability of IBHC sites or programs. A total of 3,386 articles were found through the selected databases and 46 articles were found to meet the inclusion criteria. From the 46 articles that contained an IBHC evaluation including operational or financial variables, 9 operational and 11 financial characteristics were identified as barriers or strengths to sustainability or success. The characteristics of the evaluation participants, IBHC settings, and method of evaluation were also coded and analyzed. As a result of this systematic review of articles, evaluation of the success and sustainability of the operational and financial worlds can now be conceptualized at provider and practice levels. Collaboration and communication between medical and behavioral health providers was a significant operational characteristic related to success and sustainability. Financial characteristics indicated that continuous financial evaluation throughout implementation was important to success and sustainability. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  2. Fish consumption and its possible preventive role on the development and prevalence of metabolic syndrome - a systematic review.

    Science.gov (United States)

    Tørris, Christine; Molin, Marianne; Cvancarova Småstuen, Milada

    2014-01-01

    Metabolic syndrome (MetS) has a huge impact on public health, and today lifestyle interventions remain the primary mode for MetS therapy. It is therefore important to elucidate the possible preventive effects of diet and foods, and their MetS-related health implications. To examine how fish consumption affects the development and prevalence of MetS, we systematically reviewed cross-sectional, prospective cohort, and intervention studies conducted among adults (humans) and, reporting consumption of fish or seafood as being related to MetS (prevalence or incidence), where MetS was defined via an established definition. The literature search in PubMed identified 502 citations, and after screening, 49 full-text articles were retrieved and assessed for eligibility. After excluding duplicates and those not meeting the inclusion criteria, seven studies from Croatia, Finland, France, Iceland, Iran, Korea, and US were included. Four studies (one follow-up and three cross-sectional) found associations between fish consumption and MetS (three among men, and one among women), suggesting that fish consumption may prevent or improve metabolic health and have a protective role in MetS prevention. This protective role might be related to gender, and men may benefit more from the consumption of fish. However, lack of controlling for potential confounders may also inflict the results. Additional research is required to further explore fish consumption and its potential role in improving or reversing MetS and its components.

  3. The impact of subacromial impingement syndrome on muscle activity patterns of the shoulder complex: a systematic review of electromyographic studies

    Directory of Open Access Journals (Sweden)

    Smith Toby O

    2010-03-01

    Full Text Available Abstract Background Subacromial impingement syndrome (SIS is a commonly reported cause of shoulder pain. The purpose of this study was to systematically review the literature to examine whether a difference in electromyographic (EMG activity of the shoulder complex exists between people with SIS and healthy controls. Methods Medline, CINAHL, AMED, EMBASE, and grey literature databases were searched from their inception to November 2008. Inclusion, data extraction and trial quality were assessed in duplicate. Results Nine studies documented in eleven papers, eight comparing EMG intensity and three comparing EMG onset timing, representing 141 people with SIS and 138 controls were included. Between one and five studies investigated each muscle totalling between 20 and 182 participants. The two highest quality studies of five report a significant increase in EMG intensity in upper trapezius during scaption in subjects with SIS. There was evidence from 2 studies of a delayed activation of lower trapezius in patients with SIS. There was otherwise no evidence of a consistent difference in EMG activity between the shoulders of subjects with painful SIS and healthy controls. Conclusions A difference may exist in EMG activity within some muscles, in particular upper and lower trapezius, between people with SIS and healthy controls. These muscles may be targets for clinical interventions aiding rehabilitation for people with SIS. These differences should be investigated in a larger, high quality survey and the effects of therapeutically targeting these muscles in a randomised controlled trial.

  4. Electromyographic activity of the shoulder muscles during rehabilitation exercises in subjects with and without subacromial pain syndrome: a systematic review.

    Science.gov (United States)

    Kinsella, Rita; Pizzari, Tania

    2017-04-01

    Subacromial pain syndrome (SPS) is a common cause of shoulder pain and muscle activity deficits are postulated to contribute to the development and progression of the disorder. The purpose of this systematic review was to definitively determine whether evidence exists of differences in electromyography (EMG) characteristics between subjects with and without SPS. Six key databases were searched: MEDLINE, EMBASE, CINAHL, SPORTdiscus, PEDro and The Cochrane Library (inception to May 2016). The search yielded 1414 records using terms relating to shoulder impingement, EMG, scapular and rotator cuff muscles. Twenty-two papers remained once duplicates were removed and selection criteria applied. Data extraction, quality assessment and data synthesis were performed. Effect sizes and 95% confidence intervals were calculated. There was limited evidence that serratus anterior has lower amplitude, delayed activation and earlier termination in SPS participants. For the majority of muscles, regardless of task, load or arm position, significant differences were not demonstrated or results were contradictory. The understanding of SPS is changing and EMG appears unable to capture the complexities associated with this condition. Addressing aberrant movement patterns and facilitating balanced activation of all shoulder muscles may be a more appropriate treatment direction for the future.

  5. N-Acetylcysteine for Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials

    Directory of Open Access Journals (Sweden)

    Divyesh Thakker

    2015-01-01

    Full Text Available Objective. To review the benefits and harms of N-acetylcysteine (NAC in women with polycystic ovary syndrome (PCOS. Method. Literature search was conducted using the bibliographic databases, MEDLINE (Ovid, CINAHL, EMBASE, Scopus, PsyInfo, and PROQUEST (from inception to September 2013 for the studies on women with PCOS receiving NAC. Results. Eight studies with a total of 910 women with PCOS were randomized to NAC or other treatments/placebo. There were high risk of selection, performance, and attrition bias in two studies and high risk of reporting bias in four studies. Women with NAC had higher odds of having a live birth, getting pregnant, and ovulation as compared to placebo. However, women with NAC were less likely to have pregnancy or ovulation as compared to metformin. There was no significant difference in rates of the miscarriage, menstrual regulation, acne, hirsutism, and adverse events, or change in body mass index, testosterone, and insulin levels with NAC as compared to placebo. Conclusions. NAC showed significant improvement in pregnancy and ovulation rate as compared to placebo. The findings need further confirmation in well-designed randomized controlled trials to examine clinical outcomes such as live birth rate in longer follow-up periods. Systematic review registration number is CRD42012001902.

  6. Systematic Review and Meta-Analysis of Intravesical Hyaluronic Acid and Hyaluronic Acid/Chondroitin Sulfate Instillation for Interstitial Cystitis/Painful Bladder Syndrome

    Directory of Open Access Journals (Sweden)

    Jung-Soo Pyo

    2016-09-01

    Full Text Available Background/Aims: To assess the efficacy of intravesical hyaluronic acid (HA and HA/chondroitin sulfate (CS instillation in patients with interstitial cystitis/painful bladder syndrome by systematic review and meta-analysis. Methods: A systematic literature search was performed using the keywords: ‘interstitial cystitis' or ‘painful bladder syndrome' or ‘bladder pain syndrome' and ‘hyaluronic acid', up to March 31, 2016. The primary outcome was visual analogue scale related pain symptom (VAS. Secondary outcomes were the O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI and Problem Index (ICPI, frequency, nocturia, bladder volume, and voided urine volume. Results: Ten articles involving 390 patients were retrieved and assessed in analysis. A significant improvement in mean VAS on fixed-effect and random-effect models (mean difference [MD] -3.654, 95% confidence interval [CI] -3.814 to -3.495, and MD -3.206, 95% CI -4.156 to -2.257, respectively was found. Significant improvements were found in the ICSI (MD -3.223, 95% CI -4.132 to -2.315 and ICPI (MD -2.941, 95% CI -3.767 to -2.116. Similarly, the other outcomes were significantly improved. Conclusion: Intravesical HA and HA/CS instillation improved pain symptom, quality of life, and other outcomes and could be included as therapeutic modality of interstitial cystitis/painful bladder syndrome.

  7. Systematic Review and Meta-Analysis of Intravesical Hyaluronic Acid and Hyaluronic Acid/Chondroitin Sulfate Instillation for Interstitial Cystitis/Painful Bladder Syndrome.

    Science.gov (United States)

    Pyo, Jung-Soo; Cho, Won Jin

    2016-01-01

    To assess the efficacy of intravesical hyaluronic acid (HA) and HA/chondroitin sulfate (CS) instillation in patients with interstitial cystitis/painful bladder syndrome by systematic review and meta-analysis. A systematic literature search was performed using the keywords: 'interstitial cystitis' or 'painful bladder syndrome' or 'bladder pain syndrome' and 'hyaluronic acid', up to March 31, 2016. The primary outcome was visual analogue scale related pain symptom (VAS). Secondary outcomes were the O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Problem Index (ICPI), frequency, nocturia, bladder volume, and voided urine volume. Ten articles involving 390 patients were retrieved and assessed in analysis. A significant improvement in mean VAS on fixed-effect and random-effect models (mean difference [MD] -3.654, 95% confidence interval [CI] -3.814 to -3.495, and MD -3.206, 95% CI -4.156 to -2.257, respectively) was found. Significant improvements were found in the ICSI (MD -3.223, 95% CI -4.132 to -2.315) and ICPI (MD -2.941, 95% CI -3.767 to -2.116). Similarly, the other outcomes were significantly improved. Intravesical HA and HA/CS instillation improved pain symptom, quality of life, and other outcomes and could be included as therapeutic modality of interstitial cystitis/painful bladder syndrome. © 2016 The Author(s) Published by S. Karger AG, Basel.

  8. [Etiology and pathophysiology of fibromyalgia syndrome : Updated guidelines 2017, overview of systematic review articles and overview of studies on small fiber neuropathy in FMS subgroups].

    Science.gov (United States)

    Üçeyler, N; Burgmer, M; Friedel, E; Greiner, W; Petzke, F; Sarholz, M; Schiltenwolf, M; Winkelmann, A; Sommer, C; Häuser, W

    2017-06-01

    The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was planned for April 2017. The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A systematic search of the literature from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Prospective population-based studies and systematic reviews with meta-analyses of case control studies were taken into consideration for the statements. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The statements were generated by multiple step formalized procedures. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. Current data do not enable identification of distinct factors in the etiology and pathophysiology of fibromyalgia syndrome. Fibromyalgia syndrome can be associated with inflammatory rheumatic diseases, gene polymorphisms, life style factors (e.g. smoking, obesity and lack of physical activity), depressive disorders as well as physical and sexual abuse in childhood and adulthood. Fibromyalgia syndrome is most probably the end result of various pathogenetic factors and pathophysiological mechanisms.

  9. Bisphosphonates for treatment of Complex Regional Pain Syndrome type 1: A systematic literature review and meta-analysis of randomized controlled trials versus placebo.

    Science.gov (United States)

    Chevreau, Maxime; Romand, Xavier; Gaudin, Philippe; Juvin, Robert; Baillet, Athan

    2017-07-01

    Complex Regional Pain Syndrome Type 1 is a severely disabling pain syndrome with no definite established treatment. We have performed a systematic literature review and meta-analysis of all randomized controlled trials to assess the benefit of bisphosphonates on pain and function in patients with Complex Regional Pain Syndrome Type 1. A systematic literature search was performed in the Medline, Embase and Cochrane databases. Two authors selected independently blinded randomized trials comparing bisphosphonates to placebo on short-term (J30 to J40) and medium term pain (M2-M3), safety and function in patients with CRPS 1. The methodological quality of the studies was analyzed. Data were aggregated using the method of the inverse of the variance. 258 articles were identified. Four trials of moderate to good quality comprising 181 patients (90 in the bisphosphonate group and 91 in the placebo group) were included in this meta-analysis. Short-term pain Visual Analog Scale was significantly lower in the bisphosphonate group versus the placebo group (SMD=-2.6, 95%CI [-1.8, -3.4], PComplex Regional Pain Syndrome type 1. Other studies are needed to determine their effectiveness. Copyright © 2017. Published by Elsevier SAS.

  10. The Evaluation of a Personal Narrative Language Intervention for School-Age Children with Down Syndrome

    Science.gov (United States)

    Finestack, Lizbeth; O'Brien, Katy H.; Hyppa-Martin, Jolene; Lyrek, Kristen A.

    2017-01-01

    The purpose of this study was to evaluate the feasibility of an intervention focused on improving personal narrative skills of school-age children with Down syndrome (DS) using an approach involving visual supports. Four females with DS, ages 10 through 15 years, participated in this multiple baseline across participants single-subject…

  11. Preliminary early evaluation of radiation acute syndrome severity in an animal model

    International Nuclear Information System (INIS)

    Gimenez, J.C.; Nasazzi, N.B.; Taja, M.R.; Nagle, C.; Dubner, D.; Di Rizzio, C.

    1992-01-01

    To improve the knowledge of Radiation Acute Syndrome radiopathological picture, whole body x-rays irradiation at 2Gy of a primate (Cebus apella paraguayanus) used as model has been performed. Early evaluations of clinical symptoms and dose and damage biological indicators have shown that this primate has given out similar responses to those of man. (author)

  12. Evaluation of a Behavioral Treatment Package to Reduce Sleep Problems in Children with Angelman Syndrome

    Science.gov (United States)

    Allen, Keith D.; Kuhn, Brett R.; DeHaai, Kristi A.; Wallace, Dustin P.

    2013-01-01

    The purpose of this investigation was to evaluate the effectiveness of a behavioral treatment package to reduce chronic sleep problems in children with Angelman Syndrome. Participants were five children, 2-11 years-of-age. Parents maintained sleep diaries to record sleep and disruptive nighttime behaviors. Actigraphy was added to provide…

  13. Uncommon presentation of a common disease - Bouveret's syndrome: A case report and systematic literature review.

    Science.gov (United States)

    Al-Habbal, Yahya; Ng, Matthew; Bird, David; McQuillan, Trevor; Al-Khaffaf, Haytham

    2017-01-27

    To investigate and summarise the current evidence surrounding management of Bouveret's syndrome (BS). A MEDLINE search was performed for the BS. The search was conducted independently by two clinicians (Yahya AL-Habbal and Matthew Ng) in April 2016. A case of BS is also described. A total of 315 articles, published from 1967 to 2016, were found. For a clinically meaningful clinical review, articles published before 01/01/1990 and were excluded, leaving 235 unique articles to review. Twenty-seven articles were not available (neither by direct communication nor through inter-library transfer). These were also excluded. The final number of articles reviewed was 208. There were 161 case reports, 13 reviews, 23 images (radiological and clinical images), and 11 letters to editor. Female to male ratio was 1.82. Mean age was 74 years. Treatment modalities included laparotomy in the majority of cases, laparoscopic surgery, endoscopic surgery and shockwave lithotripsy. There is limited evidence in the literature about the appropriate approach. We suggest an algorithm for management of BS.

  14. Effects of dietary polyphenols on metabolic syndrome features in humans: a systematic review.

    Science.gov (United States)

    Amiot, M J; Riva, C; Vinet, A

    2016-07-01

    Dietary polyphenols constitute a large family of bioactive substances potential beneficial effect on metabolic syndrome (MetS). This review summarizes the results of clinical studies on patients with MetS involving the chronic supplementation of a polyphenol-rich diet, foods, extracts or with single phenolics on the features of MetS (obesity, dyslipidemia, blood pressure and glycaemia) and associated complications (oxidative stress and inflammation). Polyphenols were shown to be efficient, especially at higher doses, and there were no specific foods or extracts able to alleviate all the features of MetS. Green tea, however, significantly reduced body mass index and waist circumference and improved lipid metabolism. Cocoa supplementation reduced blood pressure and blood glucose. Soy isoflavones, citrus products, hesperidin and quercetin improved lipid metabolism, whereas cinnamon reduced blood glucose. In numerous clinical studies, antioxidative and anti-inflammatory effects were not significant after polyphenol supplementation in patients with MetS. However, some trials pointed towards an improvement of endothelial function in patients supplemented with cocoa, anthocyanin-rich berries, hesperidin or resveratrol. Therefore, diets rich in polyphenols, such as the Mediterranean diet, which promote the consumption of diverse polyphenol-rich products could be an effective nutritional strategy to improve the health of patients with MetS. © 2016 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity. © 2016 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity.

  15. The effect of obesity on polycystic ovary syndrome: a systematic review and meta-analysis.

    Science.gov (United States)

    Lim, S S; Norman, R J; Davies, M J; Moran, L J

    2013-02-01

    While many women with polycystic ovary syndrome (PCOS) are overweight, obese or centrally obese, the effect of excess weight on the outcomes of PCOS is inconsistent. The review aimed to assess the effects of overweight, obesity and central obesity on the reproductive, metabolic and psychological features of PCOS. MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL) and PSYCINFO were searched for studies reporting outcomes according to body mass index categories or body fat distribution. Data were presented as mean difference or risk ratio (95% confidence interval). This review included 30 eligible studies. Overweight or obese women with PCOS had decreased sex hormone-binding globulin (SHBG), increased total testosterone, free androgen index, hirsutism, fasting glucose, fasting insulin, homeostatic model assessment-insulin resistance index and worsened lipid profile. Obesity significantly worsened all metabolic and reproductive outcomes measured except for hirsutism when compared to normal weight women with PCOS. Overweight women had no differences in total testosterone, hirsutism, total-cholesterol and low-density lipoprotein-cholesterol compared to normal weight women and no differences in SHBG and total testosterone compared to obese women. Central obesity was associated with higher fasting insulin levels. These results suggest that prevention and treatment of obesity is important for the management of PCOS. © 2012 The Authors. obesity reviews © 2012 International Association for the Study of Obesity.

  16. Population incidence of Guillain-Barré syndrome: a systematic review and meta-analysis.

    Science.gov (United States)

    Sejvar, James J; Baughman, Andrew L; Wise, Matthew; Morgan, Oliver W

    2011-01-01

    Population incidence of Guillain-Barré syndrome (GBS) is required to assess changes in GBS epidemiology, but published estimates of GBS incidence vary greatly depending on case ascertainment, definitions, and sample size. We performed a meta-analysis of articles on GBS incidence by searching Medline (1966-2009), Embase (1988-2009), Cinahl (1981-2009) and CABI (1973-2009) as well as article bibliographies. We included studies from North America and Europe with at least 20 cases, and used population-based data, subject matter experts to confirm GBS diagnosis, and an accepted GBS case definition. With these data, we fitted a random-effects negative binomial regression model to estimate age-specific GBS incidence. Of 1,683 nonduplicate citations, 16 met the inclusion criteria, which produced 1,643 cases and 152.7 million person-years of follow-up. GBS incidence increased by 20% for every 10-year increase in age; the risk of GBS was higher for males than females. The regression equation for calculating the average GBS rate per 100,000 person-years as a function of age in years was exp[-12.0771 + 0.01813(age in years)] × 100,000. Our findings provide a robust estimate of background GBS incidence in Western countries. Our regression model may be used in comparable populations to estimate the background age-specific rate of GBS incidence for future studies. Copyright © 2011 S. Karger AG, Basel.

  17. Serum Vitamin D Levels and Polycystic Ovary syndrome: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Chunla He

    2015-06-01

    Full Text Available Vitamin D deficiency (VDD is common in women with and without polycystic ovary syndrome (PCOS and may be associated with metabolic and endocrine disorders in PCOS. The aim of this meta-analysis is to assess the associations of serum vitamin D levels with metabolic and endocrine dysregulations in women with PCOS, and to determine effects of vitamin D supplementation on metabolic and hormonal functions in PCOS patients. The literature search was undertaken through five databases until 16 January 2015 for both observational and experimental studies concerning relationships between vitamin D and PCOS. A total of 366 citations were identified, of which 30 were selected (n = 3182. We found that lower serum vitamin D levels were related to metabolic and hormonal disorders in women with PCOS. Specifically, PCOS patients with VDD were more likely to have dysglycemia (e.g., increased levels of fasting glucose and homeostatic model assessment-insulin resistance index (HOMA-IR compared to those without VDD. This meta-analysis found no evidence that vitamin D supplementation reduced or mitigated metabolic and hormonal dysregulations in PCOS. VDD may be a comorbid manifestation of PCOS or a minor pathway in PCOS associated metabolic and hormonal dysregulation. Future prospective observational studies and randomized controlled trials with repeated VDD assessment and better characterization of PCOS disease severity at enrollment are needed to clarify whether VDD is a co-determinant of hormonal and metabolic dysregulations in PCOS, represents a consequence of hormonal and metabolic dysregulations in PCOS or both.

  18. [Sleep apnea-hypopnea syndrome: risk factors in children and adolescents; a systematic review].

    Science.gov (United States)

    Aguilar Cordero, M J; Sánchez López, A M; Mur Villar, N; García García, I; Guisado Barrilao, R

    2013-11-01

    The sleep apnea-hypopnea syndrome (SAHS) is a disorder that currently affects a large number of children and adolescents. The aim of this review is to assess the factors causing this condition and the risk of suffering another disease associated with SAHS. The 50 articles selected for inclusion in this review were identified through GOOGLE SCHOLAR. The validity of the items was established by the degree of evidence obtained, by recommendations made in this respect and by the applicability to the situation observed. The review considers studies of SAHS in children and adolescents, taking into account those relating this disorder with obesity, hypertension, physical activity and other variables. The studies reviewed show that SAHS is associated with childhood obesity and that it increases the risk of cerebro-cardiovascular disease. It is also shown that SAHS decreases children's and adolescents' physical capacity and quality of life. Psychological aspects are also affected, impacting on academic performance, which is poorer than in healthy children. Therefore, early paediatric diagnosis of SAHS is important in order to prevent associated disorders. Copyright AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.

  19. Zika Virus Infection as a Cause of Congenital Brain Abnormalities and Guillain-Barré Syndrome: Systematic Review.

    Directory of Open Access Journals (Sweden)

    Fabienne Krauer

    2017-01-01

    Full Text Available The World Health Organization (WHO stated in March 2016 that there was scientific consensus that the mosquito-borne Zika virus was a cause of the neurological disorder Guillain-Barré syndrome (GBS and of microcephaly and other congenital brain abnormalities based on rapid evidence assessments. Decisions about causality require systematic assessment to guide public health actions. The objectives of this study were to update and reassess the evidence for causality through a rapid and systematic review about links between Zika virus infection and (a congenital brain abnormalities, including microcephaly, in the foetuses and offspring of pregnant women and (b GBS in any population, and to describe the process and outcomes of an expert assessment of the evidence about causality.The study had three linked components. First, in February 2016, we developed a causality framework that defined questions about the relationship between Zika virus infection and each of the two clinical outcomes in ten dimensions: temporality, biological plausibility, strength of association, alternative explanations, cessation, dose-response relationship, animal experiments, analogy, specificity, and consistency. Second, we did a systematic review (protocol number CRD42016036693. We searched multiple online sources up to May 30, 2016 to find studies that directly addressed either outcome and any causality dimension, used methods to expedite study selection, data extraction, and quality assessment, and summarised evidence descriptively. Third, WHO convened a multidisciplinary panel of experts who assessed the review findings and reached consensus statements to update the WHO position on causality. We found 1,091 unique items up to May 30, 2016. For congenital brain abnormalities, including microcephaly, we included 72 items; for eight of ten causality dimensions (all except dose-response relationship and specificity, we found that more than half the relevant studies supported

  20. Zika Virus Infection as a Cause of Congenital Brain Abnormalities and Guillain-Barré Syndrome: Systematic Review.

    Science.gov (United States)

    Krauer, Fabienne; Riesen, Maurane; Reveiz, Ludovic; Oladapo, Olufemi T; Martínez-Vega, Ruth; Porgo, Teegwendé V; Haefliger, Anina; Broutet, Nathalie J; Low, Nicola

    2017-01-01

    The World Health Organization (WHO) stated in March 2016 that there was scientific consensus that the mosquito-borne Zika virus was a cause of the neurological disorder Guillain-Barré syndrome (GBS) and of microcephaly and other congenital brain abnormalities based on rapid evidence assessments. Decisions about causality require systematic assessment to guide public health actions. The objectives of this study were to update and reassess the evidence for causality through a rapid and systematic review about links between Zika virus infection and (a) congenital brain abnormalities, including microcephaly, in the foetuses and offspring of pregnant women and (b) GBS in any population, and to describe the process and outcomes of an expert assessment of the evidence about causality. The study had three linked components. First, in February 2016, we developed a causality framework that defined questions about the relationship between Zika virus infection and each of the two clinical outcomes in ten dimensions: temporality, biological plausibility, strength of association, alternative explanations, cessation, dose-response relationship, animal experiments, analogy, specificity, and consistency. Second, we did a systematic review (protocol number CRD42016036693). We searched multiple online sources up to May 30, 2016 to find studies that directly addressed either outcome and any causality dimension, used methods to expedite study selection, data extraction, and quality assessment, and summarised evidence descriptively. Third, WHO convened a multidisciplinary panel of experts who assessed the review findings and reached consensus statements to update the WHO position on causality. We found 1,091 unique items up to May 30, 2016. For congenital brain abnormalities, including microcephaly, we included 72 items; for eight of ten causality dimensions (all except dose-response relationship and specificity), we found that more than half the relevant studies supported a causal

  1. Zika Virus Infection as a Cause of Congenital Brain Abnormalities and Guillain–Barré Syndrome: Systematic Review

    Science.gov (United States)

    Reveiz, Ludovic; Oladapo, Olufemi T.; Martínez-Vega, Ruth; Haefliger, Anina

    2017-01-01

    Background The World Health Organization (WHO) stated in March 2016 that there was scientific consensus that the mosquito-borne Zika virus was a cause of the neurological disorder Guillain–Barré syndrome (GBS) and of microcephaly and other congenital brain abnormalities based on rapid evidence assessments. Decisions about causality require systematic assessment to guide public health actions. The objectives of this study were to update and reassess the evidence for causality through a rapid and systematic review about links between Zika virus infection and (a) congenital brain abnormalities, including microcephaly, in the foetuses and offspring of pregnant women and (b) GBS in any population, and to describe the process and outcomes of an expert assessment of the evidence about causality. Methods and Findings The study had three linked components. First, in February 2016, we developed a causality framework that defined questions about the relationship between Zika virus infection and each of the two clinical outcomes in ten dimensions: temporality, biological plausibility, strength of association, alternative explanations, cessation, dose–response relationship, animal experiments, analogy, specificity, and consistency. Second, we did a systematic review (protocol number CRD42016036693). We searched multiple online sources up to May 30, 2016 to find studies that directly addressed either outcome and any causality dimension, used methods to expedite study selection, data extraction, and quality assessment, and summarised evidence descriptively. Third, WHO convened a multidisciplinary panel of experts who assessed the review findings and reached consensus statements to update the WHO position on causality. We found 1,091 unique items up to May 30, 2016. For congenital brain abnormalities, including microcephaly, we included 72 items; for eight of ten causality dimensions (all except dose–response relationship and specificity), we found that more than half the

  2. Ultrasonographic evaluation of liver volume and the metabolic syndrome in obese women.

    Science.gov (United States)

    Santini, F; Giannetti, M; Mazzeo, S; Fierabracci, P; Scartabelli, G; Marsili, A; Valeriano, R; Pucci, A; Anselmino, M; Zampa, V; Vitti, P; Pinchera, A

    2007-02-01

    Non-alcoholic fatty liver disease is a common finding in obese subjects, and increasing evidence has been provided suggesting that it represents the hepatic component of the metabolic syndrome. The aim of this study was to evaluate whether the extent of liver enlargement is related to the severity of the metabolic syndrome in obese women. The relationship between ultrasound- measured hepatic left lobe volume (HLLV) and various features of the metabolic syndrome was evaluated in 85 obese women. The mean+/-SD value of HLLV in obese women was 431+/-214 ml (range 46-1019 ml) while it was 187+/-31 ml (range 143-258 ml) in lean subjects. In a multiple logistic regression analysis, ultrasound-measured intra-abdominal fat was the only anthropometric measure independently associated with HLLV. A strong positive association was found between HLLV and serum liver enzymes, triglycerides, glucose, insulin, uric acid, C reactive protein, systolic and diastolic blood pressure, while a negative correlation was observed between HLLV and HDL cholesterol. The values of HLLV corresponding to the cut-off values of various risk factors for the diagnosis of the metabolic syndrome were calculated, yielding a mean value of 465 ml. In conclusion, ultrasound measurement of HLLV represents a simple, reliable and low-cost tool for the evaluation of liver involvement in the metabolic syndrome. The strong association between liver enlargement and various cardiovascular risk factors associated with insulin resistance supports the role of liver steatosis as an important link among the many facets of the metabolic syndrome in human obesity.

  3. Surgical management of aortic root disease in Marfan syndrome: a systematic review and meta-analysis.

    Science.gov (United States)

    Benedetto, Umberto; Melina, Giovanni; Takkenberg, Johanna J M; Roscitano, Antonino; Angeloni, Emiliano; Sinatra, Riccardo

    2011-06-01

    Surgical treatment of aortic root aneurysm in Marfan syndrome (MFS) patients. To compare results of total root replacement versus valve-sparing aortic root replacement in MFS patients. PubMed, Embase and Cochrane library were searched from January 1966 until February 2010 looking for papers reporting on aortic root operations in MFS patients. 530 studies were retrieved. Finally, 11 publications were enrolled. Inclusion criteria were observational studies reporting valve-related morbidity and mortality after total root replacement (TTR) and/or valve-sparing root replacement (VSRR) in patients with MFS and study size n≥30, reflecting the centre's experience. Data obtained from papers reporting both TRR and VSRR cohorts were analysed separately. In case of multiple publications, the most recent and complete report was selected. If the total number of patient-years was not provided, we calculated it by multiplying the number of hospital survivors with the mean follow-up duration of that study. Overall, 1,385 patients were analysed (972 patients had TTR and 413 patients had VSRR). Reintervention rate was 0.3%/year (95% CI 0.1 to 0.5) versus 1.3%/year (95% CI 0.3 to 2.2) (p=0.02) and thromboembolic events rate was 0.7%/year (95% CI 0.5 to 0.9) versus 0.3%/year (95% CI 0.1 to 0.6) (p=0.01) after TRR and VSRR, respectively. When composite valve-related events were compared, no difference existed between the two surgical strategies (p=0.41). Among patients undergoing VSRR, reimplantation was associated with a reduced rate of reintervention compared with remodelling (0.7%/year vs 2.4%/year, p=0.02). VSRR may represent a valuable option for patients with MFS with aortic aneurysm. However, this technique should be used with caution in patients with valve characteristics at risk for decreased durability.

  4. The Effect of Endothelin Receptor Antagonists in Patients with Eisenmenger Syndrome: A Systematic Review.

    Science.gov (United States)

    Elshafay, Abdelrahman; Truong, Duy Hieu; AboElnas, Mohamed M; Idrees, Hossam; Metwali, Hatem G; Vuong, Nguyen Lam; Saad, Omar Ahmed; Hirayama, Kenji; Huy, Nguyen Tien

    2018-04-01

    The efficacy of endothelin receptor antagonists (ERAs) in the management of Eisenmenger syndrome (ES) remains controversial. The aim of this study is to systemically review the safety and effects of ERAs in improving the quality of life and basic cardiac functions of these patients. Twelve databases were searched, including PubMed, Web of Science, Scopus, Virtual Health Library, World Health Organization (WHO) Global Health Library, Google Scholar, POPLINE, Systems for Information of Grey Literature in Europe, New York Academy of Medicine, ClinicalTrials.gov, metaRegister of Controlled Trials and the WHO International Clinical Trials Registry Platform, through August 2016. We included randomized clinical trials addressing the effect of ERAs on cardiac functions in patients with ES. The quality of studies was assessed using the Cochrane Collaboration tool. We included two trials represented by four papers, of which three papers reported the efficacy of bosentan against placebo and one paper reported the results of a combination of bosentan and sildenafil versus placebo and bosentan. One trial showed a significant effect of bosentan treatment over placebo on indexed pulmonary vascular resistance and mean pulmonary artery pressure, but a non-significant increase in 6-min walk distance and a non-significant effect on systemic pulse oximetry. The other trial reported the safe but non-significant effect of combination therapy of bosentan and sildenafil compared with bosentan and placebo. This study demonstrated safety and improved hemodynamic effects of bosentan in ES, with a controversial effect on exercise capacity. Further randomized controlled trials with longer follow-up duration are needed to confirm these results.

  5. Efficacy of selective serotonin-reuptake inhibitors in premenstrual syndrome: a systematic review.

    Science.gov (United States)

    Dimmock, P W; Wyatt, K M; Jones, P W; O'Brien, P M

    2000-09-30

    Selective serotonin-reuptake inhibitors (SSRIs) are increasingly being used as first-line therapy for severe premenstrual syndrome (PMS). We undertook a meta-analysis on the efficacy of SSRIs in this disorder. We searched medical and scientific databases, approached pharmaceutical companies, and reviewed citations of relevant articles to identify 29 studies of the use of SSRIs in PMS. 14 were excluded (no placebo group, preliminary report of included trial, or low quality). 15 randomised placebo-controlled trials were included. Information on study design, participants, drugs used and dosing regimens, outcome measures, side-effects, and sources of funding was extracted. Standardised mean differences between treatment and placebo groups were calculated to obtain an overall estimate of efficacy. The primary outcome measure was a reduction in overall PMS symptoms. The primary analysis included data on 904 women (570 assigned active treatment and 435 assigned placebo, including 101 in crossover trials). The overall standardised mean difference was -1.066 (95% CI -1.381 to -0.750), which corresponds to an odds ratio of 6.91 (3.90 to 12.2) in favour of SSRIs. SSRIs were effective in treating physical and behavioural symptoms. There was no significant difference in symptom reduction between continuous and intermittent dosing or between trials funded by pharmaceutical companies and those independently funded. Withdrawal due to side-effects was 2.5 times more likely in the active-treatment group than in the placebo group. SSRIs are an effective first-line therapy for severe PMS. The safety of these drugs has been demonstrated in trials of affective disorder, and the side-effects at low doses are generally acceptable.

  6. Prevalence of antidepressant prescription or use in patients with acute coronary syndrome: a systematic review.

    Directory of Open Access Journals (Sweden)

    Matthew J Czarny

    Full Text Available Depression is common among acute coronary syndrome (ACS patients and is associated with poor prognosis. Cardiac side effects of older antidepressants were well-known, but newer antidepressants are generally thought of as safe to use in patients with heart disease. The objective was to assess rates of antidepressant use or prescription to patients within a year of an ACS.PubMed, PsycINFO, and CINAHL databases searched through May 29, 2009; manual searching of 33 journals from May 2009 to September 2010. Articles in any language were included if they reported point or period prevalence of antidepressant use or prescription in the 12 months prior or subsequent to an ACS for ≥100 patients. Two investigators independently selected studies for inclusion/exclusion and extracted methodological characteristics and outcomes from included studies (study setting, inclusion/exclusion criteria, sample size, prevalence of antidepressant prescription/use, method of assessing antidepressant prescription/use, time period of assessment.A total of 24 articles were included. The majority were from North America and Europe, and most utilized chart review or self-report to assess antidepressant use or prescription. Although there was substantial heterogeneity in results, overall, rates of antidepressant use or prescription increased from less than 5% prior to 1995 to 10-15% after 2000. In general, studies from North America reported substantially higher rates than studies from Europe, approximately 5% higher among studies that used chart or self-report data.Antidepressant use or prescription has increased considerably, and by 2005 approximately 10% to 15% of ACS patients were prescribed or using one of these drugs.

  7. [Complementary and alternative therapies for fibromyalgia syndrome. Systematic review, meta-analysis and guideline].

    Science.gov (United States)

    Langhorst, J; Häuser, W; Bernardy, K; Lucius, H; Settan, M; Winkelmann, A; Musial, F

    2012-06-01

    The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011. The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinären Vereinigung für Schmerztherapie", DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The recommendations were based on level of evidence, efficacy (meta-analysis of the outcomes pain, sleep, fatigue and health-related quality of life), acceptability (total dropout rate), risks (adverse events) and applicability of treatment modalities in the German health care system. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies. Meditative movement therapies (qi gong, tai chi, yoga) are strongly recommended. Acupuncture can be considered. Mindfulness-based stress reduction as monotherapy and dance therapy as monotherapy are not recommended. Homeopathy is not recommended. In a minority vote, homeopathy was rated as "can be considered". Nutritional supplements and reiki are not recommended. The English full-text version of this article is available at SpringerLink (under "Supplemental").

  8. Allelopathic potential and systematic evaluation of organic extracts from Canavalia ensiformis leaves (Jack beans).

    Science.gov (United States)

    Santos, Sonia; de Moraes, Maria de Lourdes Leite; da Silva Souza Filho, Antonio Pedro; Rezende, Maria Olímpia Oliveira

    2005-01-01

    This article describes the assessment of possible allelopathic potential of organic extracts obtained from leaves of Canavalia ensiformis under laboratory conditions. Furthermore, a systematic evaluation of these extracts was carried out using specific protocols developed in capillary electrophoresis (CE) to determine some groups of secondary metabolites. After the identification and quantification of compounds, the effects of compounds on germination of some common weeds was investigated, which are becoming a real problem in pastures in the state of Pará, Brazil.

  9. A systematic review of factors influencing student ratings in undergraduate medical education course evaluations

    OpenAIRE

    Schiekirka, Sarah; Raupach, Tobias

    2015-01-01

    Background Student ratings are a popular source of course evaluations in undergraduate medical education. Data on the reliability and validity of such ratings have mostly been derived from studies unrelated to medical education. Since medical education differs considerably from other higher education settings, an analysis of factors influencing overall student ratings with a specific focus on medical education was needed. Methods For the purpose of this systematic review, online databases (Pu...

  10. Systematic and Stereoselective Total Synthesis of Mannosylerythritol Lipids and Evaluation of Their Antibacterial Activity.

    Science.gov (United States)

    Nashida, Junki; Nishi, Nobuya; Takahashi, Yoshiaki; Hayashi, Chigusa; Igarashi, Masayuki; Takahashi, Daisuke; Toshima, Kazunobu

    2018-03-13

    The total synthesis of the 20 homogeneous members of mannosylerythritol lipids (MELs) with different alkyl chain lengths was effectively and systematically accomplished from a strategically designed common key intermediate that was stereoselectively constructed by the borinic acid catalyzed β-mannosylation reaction. In addition, their antibacterial activities against Gram-positive bacteria were evaluated. Our results demonstrated that not only the length of the alkyl chains but also the pattern of Ac groups on the mannose moiety were important factors for antibacterial activity.

  11. Evaluation models and criteria of the quality of hospital websites: a systematic review study

    OpenAIRE

    Jeddi, Fatemeh Rangraz; Gilasi, Hamidreza; Khademi, Sahar

    2017-01-01

    Introduction Hospital websites are important tools in establishing communication and exchanging information between patients and staff, and thus should enjoy an acceptable level of quality. The aim of this study was to identify proper models and criteria to evaluate the quality of hospital websites. Methods This research was a systematic review study. The international databases such as Science Direct, Google Scholar, PubMed, Proquest, Ovid, Elsevier, Springer, and EBSCO together with regiona...

  12. Systematic evaluation of non-animal test methods for skin sensitisation safety assessment

    OpenAIRE

    Reisinger, Kerstin; Hoffmann, Sebastian; Alépée, Nathalie; Ashikaga, Takao; Barroso, Joao; Elcombe, Cliff; Gellatly, Nicola; Galbiati, Valentina; Gibbs, Susan; Groux, Hervé; Hibatallah, Jalila; Keller, Donald; Kern, Petra; Klaric, Martina; Kolle, Susanne

    2015-01-01

    The need for non-animal data to assess skin sensitisation properties of substances, especially cosmetics ingredients, has spawned the development of many in vitro methods. As it is widely believed that no single method can provide a solution, the Cosmetics Europe Skin Tolerance Task Force has defined a three-phase framework for the development of a non-animal testing strategy for skin sensitisation potency prediction. The results of the first phase - systematic evaluation of 16 test methods -...

  13. CT evaluation of soft tissue and muscle infection and inflammation: A systematic compartmental approach

    International Nuclear Information System (INIS)

    Beauchamp, N.J. Jr.; Scott, W.W. Jr.; Gottlieb, L.M.; Fishman, E.K.

    1995-01-01

    This essay presents a systematic approach to the evaluation of soft tissue and muscle infection by defining the various pathologic processes and then illustrating them through a series of CT studies with corresponding schematic diagrams. The specific processes discussed are cellulitis, lymphangitis/lymphedema, necrotizing fascitis, myositis/myonecrosis, and abscess. Key points in the differential diagnosis of these entities are discussed and illustrated. The clinical management of the specific pathologic processes is also discussed. (orig./MG)

  14. Prognosis, with evaluation of general biochemistry, of liver disease in lymphoedema cholestasis syndrome 1 (LCS1/Aagenaes syndrome).

    Science.gov (United States)

    Drivdal, Monica; Trydal, Torleif; Hagve, Tor-Arne; Bergstad, Ingunn; Aagenaes, Oystein

    2006-04-01

    To investigate the prognosis of liver disease in Aagenaes syndrome (lymphoedema cholestasis syndrome 1 (LCS1)), which is an autosomal recessive inherited syndrome consisting of neonatal cholestasis with intermittent cholestatic episodes in childhood into adulthood and development of lymphoedema. Forty Norwegian patients are known to have this condition, 25 of whom are alive. A clinical description of the liver disease is supplied with a case-control study. In this paper we review the course of the liver disease in the Norwegian cohort of patients and present results from a case-control study in the patients above 10 years of age. The case-control study was performed on 15 patients without clinical cholestasis (itching and sometimes jaundice) at the time of the study. An evaluation of 11 patients above 15 years of age without chronic biochemical cholestasis (increased alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT) and/or serum bile acids) was also carried out. For each patient one randomly identified control person was included (15 in one study, 11 in the other). Cirrhosis with either transplantation or death in infancy or early childhood occurred in six patients; slowly developing cirrhosis occurred in three patients. Two patients may be in the process of developing cirrhosis. Significantly increased ALP and GGT levels were found in patients with normal liver biochemistry in the preceding years when compared with the case control group. Additionally, albumin was found to be lower in older patients. Compared with that for other types of hereditary neonatal cholestasis, patients with LCS1 have a relatively good prognosis. More than 50% can expect a normal life span.

  15. Evaluation of 2-stage Treatment for Cervical Dorsal Rami Entrapment Syndrome: A Randomized, Controlled Trial.

    Science.gov (United States)

    Li, Qi; Wang, Jing-Wu; Zeng, Bing-Fang; Cai, Yi-Ming; Zhang, Chang-Qing

    2017-09-01

    To evaluate the effectiveness of a 2-stage nonoperative treatment for patients with cervical dorsal rami entrapment syndrome. The study included 66 patients diagnosed with cervical dorsal rami entrapment syndrome randomized to an experimental group (n=33) and control group (n=33). The experimental group was treated with additional diagnostic block if regular 2 weeks medication was not effective. The control group only received nonsteroidal anti-inflammatory drugs for 2 weeks. A visual analog scale (VAS) and pain treatment satisfaction scale (PTSS) were used to assess pain. Muscle power in the upper limbs was also assessed. The registration number of this study is ChiCTR-IIR-15007565. The VAS scores of the experimental group were significantly lower at 2, 4, and 6 months after treatment compared with baseline and the VAS scores of the control group (all Prami entrapment syndrome.

  16. Evaluation of drug treatment in irritable bowel syndrome

    Science.gov (United States)

    Talley, Nicholas J

    2003-01-01

    The irritable bowel syndrome (IBS) remains a therapeutic challenge in part because of the limited understanding of the pathophysiology. The placebo response rate varies in randomized controlled trials from 20 to 70%, and can persist for up to at least 1 year. It is contentious whether dietary fibre and bulking agents relieve the symptoms of IBS; constipation probably improves. Anticholinergic and antispasmodic agents are of questionable benefit in IBS despite positive meta-analyses of poor quality trials. A meta-analysis concluded that the tricyclic antidepressants were superior to placebo in IBS, although the individual trial results were variable. Selective serotonin reuptake inhibitors are of uncertain benefit. Laxatives are used for constipation but probably poorly control the IBS symptom complex. Loperamide is superior to placebo in improvement of diarrhoea but not abdominal pain in IBS. Tegaserod is a well- tolerated aminoguanidine indole derivative of serotonin that is a partial 5HT4–receptor agonist with prokinetic properties; a therapeutic gain over placebo of 5% to 15% has been observed in constipation-predominant IBS in females. Alosetron is a 5HT3-receptor antagonist that is efficacious in females with diarrhoea-predominant IBS, with a 12% to 17% therapeutic gain; the risk of ischaemic colitis is 1 in 350, with very severe constipation occurring in about 1 in 1000. Optimizing study design remains a challenge in IBS. New visceral analgesic and motility modifying agents, as well as anti-inflammatory agents are in trials, and hopefully additional efficacious therapeutic options for patients with IBS will soon emerge. PMID:12968980

  17. Quality Assessment of Studies Published in Open Access and Subscription Journals: Results of a Systematic Evaluation.

    Directory of Open Access Journals (Sweden)

    Roberta Pastorino

    Full Text Available Along with the proliferation of Open Access (OA publishing, the interest for comparing the scientific quality of studies published in OA journals versus subscription journals has also increased. With our study we aimed to compare the methodological quality and the quality of reporting of primary epidemiological studies and systematic reviews and meta-analyses published in OA and non-OA journals.In order to identify the studies to appraise, we listed all OA and non-OA journals which published in 2013 at least one primary epidemiologic study (case-control or cohort study design, and at least one systematic review or meta-analysis in the field of oncology. For the appraisal, we picked up the first studies published in 2013 with case-control or cohort study design from OA journals (Group A; n = 12, and in the same time period from non-OA journals (Group B; n = 26; the first systematic reviews and meta-analyses published in 2013 from OA journals (Group C; n = 15, and in the same time period from non-OA journals (Group D; n = 32. We evaluated the methodological quality of studies by assessing the compliance of case-control and cohort studies to Newcastle and Ottawa Scale (NOS scale, and the compliance of systematic reviews and meta-analyses to Assessment of Multiple Systematic Reviews (AMSTAR scale. The quality of reporting was assessed considering the adherence of case-control and cohort studies to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE checklist, and the adherence of systematic reviews and meta-analyses to Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA checklist.Among case-control and cohort studies published in OA and non-OA journals, we did not observe significant differences in the median value of NOS score (Group A: 7 (IQR 7-8 versus Group B: 8 (7-9; p = 0.5 and in the adherence to STROBE checklist (Group A, 75% versus Group B, 80%; p = 0.1. The results did not change after

  18. Quality Assessment of Studies Published in Open Access and Subscription Journals: Results of a Systematic Evaluation

    Science.gov (United States)

    Pastorino, Roberta; Milovanovic, Sonja; Stojanovic, Jovana; Efremov, Ljupcho; Amore, Rosarita; Boccia, Stefania

    2016-01-01

    Introduction Along with the proliferation of Open Access (OA) publishing, the interest for comparing the scientific quality of studies published in OA journals versus subscription journals has also increased. With our study we aimed to compare the methodological quality and the quality of reporting of primary epidemiological studies and systematic reviews and meta-analyses published in OA and non-OA journals. Methods In order to identify the studies to appraise, we listed all OA and non-OA journals which published in 2013 at least one primary epidemiologic study (case-control or cohort study design), and at least one systematic review or meta-analysis in the field of oncology. For the appraisal, we picked up the first studies published in 2013 with case-control or cohort study design from OA journals (Group A; n = 12), and in the same time period from non-OA journals (Group B; n = 26); the first systematic reviews and meta-analyses published in 2013 from OA journals (Group C; n = 15), and in the same time period from non-OA journals (Group D; n = 32). We evaluated the methodological quality of studies by assessing the compliance of case-control and cohort studies to Newcastle and Ottawa Scale (NOS) scale, and the compliance of systematic reviews and meta-analyses to Assessment of Multiple Systematic Reviews (AMSTAR) scale. The quality of reporting was assessed considering the adherence of case-control and cohort studies to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist, and the adherence of systematic reviews and meta-analyses to Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) checklist. Results Among case-control and cohort studies published in OA and non-OA journals, we did not observe significant differences in the median value of NOS score (Group A: 7 (IQR 7–8) versus Group B: 8 (7–9); p = 0.5) and in the adherence to STROBE checklist (Group A, 75% versus Group B, 80%; p = 0.1). The

  19. Quality Assessment of Studies Published in Open Access and Subscription Journals: Results of a Systematic Evaluation.

    Science.gov (United States)

    Pastorino, Roberta; Milovanovic, Sonja; Stojanovic, Jovana; Efremov, Ljupcho; Amore, Rosarita; Boccia, Stefania

    2016-01-01

    Along with the proliferation of Open Access (OA) publishing, the interest for comparing the scientific quality of studies published in OA journals versus subscription journals has also increased. With our study we aimed to compare the methodological quality and the quality of reporting of primary epidemiological studies and systematic reviews and meta-analyses published in OA and non-OA journals. In order to identify the studies to appraise, we listed all OA and non-OA journals which published in 2013 at least one primary epidemiologic study (case-control or cohort study design), and at least one systematic review or meta-analysis in the field of oncology. For the appraisal, we picked up the first studies published in 2013 with case-control or cohort study design from OA journals (Group A; n = 12), and in the same time period from non-OA journals (Group B; n = 26); the first systematic reviews and meta-analyses published in 2013 from OA journals (Group C; n = 15), and in the same time period from non-OA journals (Group D; n = 32). We evaluated the methodological quality of studies by assessing the compliance of case-control and cohort studies to Newcastle and Ottawa Scale (NOS) scale, and the compliance of systematic reviews and meta-analyses to Assessment of Multiple Systematic Reviews (AMSTAR) scale. The quality of reporting was assessed considering the adherence of case-control and cohort studies to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist, and the adherence of systematic reviews and meta-analyses to Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) checklist. Among case-control and cohort studies published in OA and non-OA journals, we did not observe significant differences in the median value of NOS score (Group A: 7 (IQR 7-8) versus Group B: 8 (7-9); p = 0.5) and in the adherence to STROBE checklist (Group A, 75% versus Group B, 80%; p = 0.1). The results did not change after adjustment

  20. Efficacy of Botulinum toxin A for the treatment of Bladder pain syndrome: A systematic review.

    Science.gov (United States)

    Ochoa Vargas, D C; García Perdómo, H A

    2017-07-04

    To determine the efficacy and safety of BTX-A, compared with other interventions for the treatment of BPS to improve quality of life. This systematic review fulfils all the requirements of the Cochrane manual and PRISMA reporting guidelines. The PROSPERO registration number is: CRD42016039480.Clinical trials without language discrimination were included. BPS patients over 18 y/o that were treated with BTX-A were included. Studies were searched in published databases and no published literature from inception to the present day. Risk of bias analysis was done using the Cochrane risk of bias tool. 88 articles were found with the designed search strategies. After exclusions, four studies were included in the qualitative analyses. Kasyan et al., 2012 compared BTX-A with hydrodistention. Manning et al., 2014 compared the injection of BTX-A with the injection of normal saline in previously hydrodistended bladders. In both cases, primary end point was measured by the O'Leary-Sant questionnaire score. El-Bahnasy et al., 2009 compared BTX-A with BCG administration, through Global Response Assessment. Kuo et al., 2015 compared hydrodistention plus suburothelial injections of BTX-A with hydrodistension plus normal saline injections. Reduction in pain was estimated by VAS bladder pain score. A similar efficacy to their controls had been found in Kasyan and Manning studies. El-Bahnasy had found improvement in BTX-A in all parameters. Kuo el al. 2015, found a significantly reduction in pain in the BTX-A group. Regarding the risk of bias, three studies did not have adequate descriptions of selection, performance and detection bias. The study of Manning had low risk of selection, attrition and reporting bias. There is not enough evidence to conclude the efficacy of BTX-A for the treatment of interstitial cystitis to improve quality of life. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Evaluation of cardiovascular anomalies in patients with asymptomatic turner syndrome using multidetector computed tomography.

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    Lee, Sun Hee; Jung, Ji Mi; Song, Min Seob; Choi, Seok jin; Chung, Woo Yeong

    2013-08-01

    Turner syndrome is well known to be associated with significant cardiovascular abnormalities. This paper studied the incidence of cardiovascular abnormalities in asymptomatic adolescent patients with Turner syndrome using multidetector computed tomography (MDCT) instead of echocardiography. Twenty subjects diagnosed with Turner syndrome who had no cardiac symptoms were included. Blood pressure and electrocardiography (ECG) was checked. Cardiovascular abnormalities were checked by MDCT. According to the ECG results, 11 had a prolonged QTc interval, 5 had a posterior fascicular block, 3 had a ventricular conduction disorder. MDCT revealed vascular abnormalities in 13 patients (65%). Three patients had an aberrant right subclavian artery, 2 had dilatation of left subclavian artery, and others had an aortic root dilatation, aortic diverticulum, and abnormal left vertebral artery. As for venous abnormalities, 3 patients had partial anomalous pulmonary venous return and 2 had a persistent left superior vena cava. This study found cardiovascular abnormalities in 65% of asymptomatic Turner syndrome patients using MDCT. Even though, there are no cardiac symptoms in Turner syndrome patients, a complete evaluation of the heart with echocardiography or MDCT at transition period to adults must be performed.

  2. Resiliency and the subjective evaluation of health in mothers of children with Asperger’s syndrome

    Directory of Open Access Journals (Sweden)

    Arleta Kasprzak

    2014-02-01

    Full Text Available Background Parents caring for children with developmental disorders are exposed to much higher levels of stress than parents of typically developing children. It has also been proved that parents of children with developmental disorders experience mental health deterioration, a sense of guilt, physical weakness, fatigue and exhaustion. Resiliency conditions cognitive and emotional flexibility, and enables an individual to adjust their own behavior to particular circumstances. The present study aims to verify whether there is a relationship between resiliency and the subjective evaluation of health under stress in a group of mothers of children with Asperger’s syndrome. Participants and procedure The three measures used in the study were The Polish Resiliency Assessment Scale, The Subjective Evaluation of Health Scale, and a personal questionnaire. A group of 31 mothers of children with Asperger’s syndrome and a group of 31 mothers whose children were not chronically ill and developed typically were examined. Results Mothers of children with Asperger’s syndrome have similar levels of resiliency and its contributing factors compared to mothers with healthy children. However, when compared to mothers of healthy children, mothers of children with Asperger’s syndrome show a more negative subjective evaluation of health. Moreover, we found that some resiliency factors (The ability to tolerate failures and view life as a challenge, and Optimism in life and the ability to focus in adversity correlate positively only in the group of mothers of children with Asperger’s syndrome. Conclusions Findings obtained in the study allow us to consider resiliency along with having a healthy child, as a factor contributing to a positive evaluation of health.

  3. The etiology of idiopathic carpal tunnel syndrome. Evaluation from the viewpoint of magnetic resonance imaging

    International Nuclear Information System (INIS)

    Ikeda, Jun

    2003-01-01

    The etiology of idiopathic carpal tunnel syndrome has not been clarified. A cross sectional area of carpal tunnel, flexor tendons, median nerve, and thickness of transverse carpal ligament were evaluated by MRI. Twenty-six patients who were electrophysiologically diagnosed with idiopathic carpal tunnel syndrome were tested by MRI. All patients were females; the mean age was sixty-four years old. The cross sectional area of carpal tunnel, the median nerve area, the area of the flexor tendons and its synovium in carpal tunnel, and thickness of the transverse carpal ligament were calculated. The following are of a seuere type carpal tunnel syndrome: Mean area of the flexor tendons and its synovium in carpal tunnel, 110.5±25.5 mm 2 (control group; 79.3±13.8 mm 2 ); ratio of flexor tendons and its synovium area to carpal tunnel area, 51.6±8.8% (control; 40.5±2.3%); and thickness of the transverse carpal ligament, 3.3±0.4 mm (control; 2.4±0.4 mm). These mean areas in severe carpal tunnel syndrome were significantly greater than those in mild type (p<0.05 or p<0.01). From the viewpoint of this result, it is possible that tenosynovitis is strongly to the etiology of idiopathic carpal tunnel syndrome. In other words, synovium edema causes chronic high pressure environment in carpal tunnel. Moreover, we classified these MRI findings into the following subgroups: enlargement of cross sectional area of flexor tendon and its synovia (n=8; 25.8%), thickened transverse carpal ligament (n=11; 35.5%), and combined type (n=7; 22.6%). This classification by MRI imaging was related to a clinical course and electro-physiologic severity. The present study suggests that to evaluate the cross sectional, area of an MRI image is useful for diagnosis and cure of idiopathic carpal tunnel syndrome. (author)

  4. Systematic Review of Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome

    Science.gov (United States)

    Qin, Zongshi; Wu, Jiani; Zhou, Jing; Liu, Zhishun

    2016-01-01

    Abstract Acupuncture is a promising therapy for relieving symptoms in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), which affects >15% of adult men worldwide. The aim of the study was to assess the effects and safety of the use of acupuncture for CP/CPPS. MEDLINE, EMBASE, CENTRAL, Web of Science, CBM, CNKI, Wang-Fang Database, JCRM, and CiNii were searched from their inception through 30 November 2015. Grey literature databases and websites were also searched. No language limits were applied. Only randomized controlled trials (RCTs) with CP/CPPS treated by acupuncture were included. Two reviewers extracted data and assessed the risk of bias of RCTs using the Cochrane Risk of Bias Tools, respectively. Seven trials were included, involving 471 participants. The result of meta-analysis indicated that compared with sham acupuncture (MD: −6.09 [95%CI: −8.12 to −5.68]) and medicine (Levofloxacinand, Ibuprofen, and Tamsulosin) (MD: −4.57 [95%CI: −7.58 to −1.56]), acupuncture was more effective at decreasing the total NIH-CPSI score. Real acupuncture was superior to sham acupuncture in improving symptoms (pain, voiding) and quality of life (Qof) domain subscores. Compared to sham acupuncture and medicine, acupuncture appears to be more effective at improving the global assessment. Two trials found that there is no significant difference between acupuncture and sham acupuncture in decreasing the IPSS score. Acupuncture failed to show more favorable effects in improving both symptoms and the Qof domain compared with medicine. Overall, current evidence supports acupuncture as an effective treatment for CP/CPPS-induced symptoms, particularly in relieving pain. Based on the meta-analysis, acupuncture is superior to sham acupuncture in improving symptoms and Qof. Acupuncture might be similar to medicine (Levofloxacinand, Ibuprofen, and Tamsulosin) in its long-term effects, but evidence was limited due to high ROB among included trials as well as

  5. Systematic Review of Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome.

    Science.gov (United States)

    Qin, Zongshi; Wu, Jiani; Zhou, Jing; Liu, Zhishun

    2016-03-01

    Acupuncture is a promising therapy for relieving symptoms in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), which affects >15% of adult men worldwide. The aim of the study was to assess the effects and safety of the use of acupuncture for CP/CPPS. MEDLINE, EMBASE, CENTRAL, Web of Science, CBM, CNKI, Wang-Fang Database, JCRM, and CiNii were searched from their inception through 30 November 2015. Grey literature databases and websites were also searched. No language limits were applied. Only randomized controlled trials (RCTs) with CP/CPPS treated by acupuncture were included. Two reviewers extracted data and assessed the risk of bias of RCTs using the Cochrane Risk of Bias Tools, respectively. Seven trials were included, involving 471 participants. The result of meta-analysis indicated that compared with sham acupuncture (MD: -6.09 [95%CI: -8.12 to -5.68]) and medicine (Levofloxacinand, Ibuprofen, and Tamsulosin) (MD: -4.57 [95%CI: -7.58 to -1.56]), acupuncture was more effective at decreasing the total NIH-CPSI score. Real acupuncture was superior to sham acupuncture in improving symptoms (pain, voiding) and quality of life (Qof) domain subscores. Compared to sham acupuncture and medicine, acupuncture appears to be more effective at improving the global assessment. Two trials found that there is no significant difference between acupuncture and sham acupuncture in decreasing the IPSS score. Acupuncture failed to show more favorable effects in improving both symptoms and the Qof domain compared with medicine. Overall, current evidence supports acupuncture as an effective treatment for CP/CPPS-induced symptoms, particularly in relieving pain. Based on the meta-analysis, acupuncture is superior to sham acupuncture in improving symptoms and Qof. Acupuncture might be similar to medicine (Levofloxacinand, Ibuprofen, and Tamsulosin) in its long-term effects, but evidence was limited due to high ROB among included trials as well as potential heterogeneity

  6. Effects and treatment methods of acupuncture and herbal medicine for premenstrual syndrome/premenstrual dysphoric disorder: systematic review

    Science.gov (United States)

    2014-01-01

    Background During their reproductive years about 10% of women experience some kind of symptoms before menstruation (PMS) in a degree that affects their quality of life (QOL). Acupuncture and herbal medicine has been a recent favorable therapeutic approach. Thus we aimed to review the effects of acupuncture and herbal medicine in the past decade as a preceding research in order to further investigate the most effective Korean Medicine treatment for PMS/PMDD. Methods A systematic literature search was conducted using electronic databases on studies published between 2002 and 2012. Our review included randomized controlled clinical trials (RCTs) of acupuncture and herbal medicine for PMS/PMDD. Interventions include acupuncture or herbal medicine. Clinical information including statistical tests was extracted from the articles and summarized in tabular form or in the text. Study outcomes were presented as the rate of improvement (%) and/or end-of-treatment scores. Results The search yielded 19 studies. In screening the RCTs, 8 studies in acupuncture and 11 studies in herbal medicine that matched the criteria were identified. Different acupuncture techniques including traditional acupuncture, hand acupuncture and moxibustion, and traditional acupuncture technique with auricular points, have been selected for analysis. In herbal medicine, studies on Vitex Agnus castus, Hypericum perforatum, Xiao yao san, Elsholtzia splendens, Cirsium japonicum, and Gingko biloba L. were identified. Experimental groups with Acupuncture and herbal medicine treatment (all herbal medicine except Cirsium japonicum) had significantly improved results regarding PMS/PMDD. Conclusions Limited evidence supports the efficacy of alternative medicinal interventions such as acupuncture and herbal medicine in controlling premenstrual syndrome and premenstrual dysphoric disorder. Acupuncture and herbal medicine treatments for premenstrual syndrome and premenstrual dysphoric disorder showed a 50% or

  7. Animal health syndromic surveillance: a systematic literature review of the progress in the last 5 years (2011–2016

    Directory of Open Access Journals (Sweden)

    Dórea FC

    2016-11-01

    Full Text Available Fernanda C Dórea,1 Flavie Vial2 1Department of Disease Control and Epidemiology, National Veterinary Institute (SVA, Uppsala, 2Epi-Connect, Skogås, Sweden Abstract: This review presents the current initiatives and potential for development in the field of animal health surveillance (AHSyS, 5 years on from its advent to the front of the veterinary public health scene. A systematic review approach was used to document the ongoing AHSyS initiatives (active systems and those in pilot phase and recent methodological developments. Clinical data from practitioners and laboratory data remain the main data sources for AHSyS. However, although not currently integrated into prospectively running initiatives, production data, mortality data, abattoir data, and new media sources (such as Internet searches have been the objective of an increasing number of publications seeking to develop and validate new AHSyS indicators. Some limitations inherent to AHSyS such as reporting sustainability and the lack of classification standards continue to hinder the development of automated syndromic analysis and interpretation. In an era of ubiquitous electronic collection of animal health data, surveillance experts are increasingly interested in running multivariate systems (which concurrently monitor several data streams as they are inferentially more accurate than univariate systems. Thus, Bayesian methodologies, which are much more apt to discover the interplay among multiple syndromic data sources, are foreseen to play a big part in the future of AHSyS. It has become clear that early detection of outbreaks may not be the principal expected benefit of AHSyS. As more systems will enter an active prospective phase, following the intensive development stage of the last 5 years, the study envisions AHSyS, in particular for livestock, to significantly contribute to future international-, national-, and local-level animal health intelligence, going beyond the detection and

  8. Fall and its association with the frailty syndrome in the elderly: systematic review with meta-analysis.

    Science.gov (United States)

    Fhon, Jack Roberto Silva; Rodrigues, Rosalina Aparecida Partezani; Neira, Wilmer Fuentes; Huayta, Violeta Magdalena Rojas; Robazzi, Maria Lucia do Carmo Cruz

    2016-01-01

    To analyze the prevalence of falls and frailty syndrome and the association between these two syndromes in the elderly population. Systematic review, without restriction of dates, in English, Portuguese and Spanish languages, in the databases PubMed, CINAHL, LILACS and in the SciElo virtual library. The association between both variables was extracted from the studies (Odds Ratio and 95% Confidence Intervals). The review included 19 studies published between 2001 and 2015. The prevalence of falls in the frail elderly population was between 6.7% and 44%; in the pre-frail, between 10.0% and 52.0%, and in the non-frail, between 7.6% and 90.4%. The association between both variables presented a value of OR 1.80 (95% CI 1.51-2.13). There is evidence that falls are associated to the frailty in the elderly. Other factors may influence this association, such as age, sex, data collection instrument of the studies, place where they live and the process of senescence. Analisar a prevalência de quedas e da síndrome da fragilidade e a associação entre essas duas síndromes na população idosa. Revisão sistemática, sem restrição de datas, nos idiomas inglês, português e espanhol, nas bases de dados PubMed, CINAHL, LILACS e na biblioteca virtual SciElo. A associação entre ambas as variáveis foi extraída dos próprios artigos (Odds Ratio e os Intervalos de Confiança de 95%). Foram incluídos na revisão 19 artigos publicados entre 2001 e 2015. A prevalência de queda no idoso frágil esteve entre 6,7% e 44%; nos pré-frágeis, entre 10,0% e 52,0%, e nos não frágeis, entre 7,6% e 90,4%. A associação entre ambas as variáveis apresentou o valor de OR 1,80 (IC 95% 1,51-2,13). Há evidências de que a queda está associada à fragilidade do idoso. Outros fatores podem influenciar essa associação, como idade, sexo, instrumento de coleta de dados dos estudos, local onde vive e o próprio processo de senescência.

  9. Meta-evaluation of published studies on evaluation of health disaster preparedness exercises through a systematic review.

    Science.gov (United States)

    Sheikhbardsiri, Hojjat; Yarmohammadian, Mohammad H; Khankeh, Hamid Reza; Nekoei-Moghadam, Mahmoud; Raeisi, Ahmad Reza

    2018-01-01

    Exercise evaluation is one of the most important steps and sometimes neglected in designing and taking exercises, in this stage of exercise, it systematically identifying, gathering, and interpreting related information to indicate how an exercise has fulfilled its objectives. The present study aimed to assess the most important evaluation techniques applied in evaluating health exercises for emergencies and disasters. This was meta-evaluation study through a systematic review. In this research, we searched papers based on specific and relevant keywords in research databases including ISI web of science, PubMed, Scopus, Science Direct, Ovid, ProQuest, Wiley, Google Scholar, and Persian database such as ISC and SID. The search keywords and strategies are followed; "simulation," "practice," "drill," "exercise," "instrument," "tool," "questionnaire," " measurement," "checklist," "scale," "test," "inventory," "battery," "evaluation," "assessment," "appraisal," "emergency," "disaster," "cricise," "hazard," "catastrophe,: "hospital", "prehospital," "health centers," "treatment centers," were used in combination with Boolean operators OR and AND. The research findings indicate that there are different techniques and methods for data collection to evaluate performance exercises of health centers and affiliated organizations in disasters and emergencies including debriefing inventories, self-report, questionnaire, interview, observation, shooting video, and photographing, electronic equipment which can be individually or collectively used depending on exercise objectives or purposes. Taking exercise in the health sector is one of the important steps in preparation and implementation of disaster risk management programs. This study can be thus utilized to improve preparedness of different sectors of health system according to the latest available evaluation techniques and methods for better implementation of disaster exercise evaluation stages.

  10. Accuracy of non-invasive prenatal testing using cell-free DNA for detection of Down, Edwards and Patau syndromes: a systematic review and meta-analysis

    Science.gov (United States)

    Taylor-Phillips, Sian; Freeman, Karoline; Geppert, Julia; Agbebiyi, Adeola; Uthman, Olalekan A; Madan, Jason; Clarke, Angus; Quenby, Siobhan; Clarke, Aileen

    2016-01-01

    Objective To measure test accuracy of non-invasive prenatal testing (NIPT) for Down, Edwards and Patau syndromes using cell-free fetal DNA and identify factors affecting accuracy. Design Systematic review and meta-analysis of published studies. Data sources PubMed, Ovid Medline, Ovid Embase and the Cochrane Library published from 1997 to 9 February 2015, followed by weekly autoalerts until 1 April 2015. Eligibility criteria for selecting studies English language journal articles describing case–control studies with ≥15 trisomy cases or cohort studies with ≥50 pregnant women who had been given NIPT and a reference standard. Results 41, 37 and 30 studies of 2012 publications retrieved were included in the review for Down, Edwards and Patau syndromes. Quality appraisal identified high risk of bias in included studies, funnel plots showed evidence of publication bias. Pooled sensitivity was 99.3% (95% CI 98.9% to 99.6%) for Down, 97.4% (95.8% to 98.4%) for Edwards, and 97.4% (86.1% to 99.6%) for Patau syndrome. The pooled specificity was 99.9% (99.9% to 100%) for all three trisomies. In 100 000 pregnancies in the general obstetric population we would expect 417, 89 and 40 cases of Downs, Edwards and Patau syndromes to be detected by NIPT, with 94, 154 and 42 false positive results. Sensitivity was lower in twin than singleton pregnancies, reduced by 9% for Down, 28% for Edwards and 22% for Patau syndrome. Pooled sensitivity was also lower in the first trimester of pregnancy, in studies in the general obstetric population, and in cohort studies with consecutive enrolment. Conclusions NIPT using cell-free fetal DNA has very high sensitivity and specificity for Down syndrome, with slightly lower sensitivity for Edwards and Patau syndrome. However, it is not 100% accurate and should not be used as a final diagnosis for positive cases. Trial registration number CRD42014014947. PMID:26781507

  11. Evaluation of Patients with Painful Bladder Syndrome/Interstitial Cystitis

    Directory of Open Access Journals (Sweden)

    Jean Jacques Wyndaele

    2005-01-01

    Full Text Available This review looks into the evaluation of patients with interstitial cystitis (IC. Interstitial cystitis is not easy to define. There is a lot of activity in this domain and a great international effort is made to get to a generally accepted definition and standardised protocols for diagnosis and treatment. We have not reached this point so far.

  12. Placebo responses in long-standing complex regional pain syndrome: a systematic review and meta-analysis.

    Science.gov (United States)

    Mbizvo, Gashirai K; Nolan, Sarah J; Nurmikko, Turo J; Goebel, Andreas

    2015-02-01

    The typical placebo response (ie, the nonspecific effects in the placebo group including benign natural course, regression to the mean, expectation/conditioning effects, and others) in randomized trials in complex regional pain syndrome (CRPS) is unknown. We recently observed a surprising near-absence of placebo response in a randomized controlled trial we conducted on patients with long-standing (≥6 months) CRPS. To investigate the idea that there may be an absence of placebo response in long-standing CRPS further, we conducted a systematic review and meta-analysis of placebo responses in randomized controlled trials conducted in patients with CRPS of ≥6 months. We systematically identified suitable randomized controlled trials published between 1966 and September 2013. We calculated the mean difference and standard error of the mean difference for placebo responses and synthesized individual effect sizes at 4 specified time periods of interest (15-30 minutes, 1 week, 3-4 weeks, and 6 weeks or more) via meta-analysis using the method of inverse-variance. Heterogeneity was assessed according to the I(2) statistic. For primary analysis, we pooled trial-specific effect sizes over the 4 time points. We analyzed data from 340 participants from 18 trials out of a possible 361 participants from 20 trials (94% of participants analyzed). Significant heterogeneity was present between trials; therefore, we interpreted trends from visual inspection of individual trials and pooled estimates. Placebo response was significant at the earliest time period (15-30 minutes). There was no significant evidence of placebo response at any of the other time periods. These results inform the design of future trials, and they caution against the "therapeutic" use of placebo in long-standing CRPS. In this meta-analysis of placebo responses in randomized controlled trials in long-standing CRPS, published during 1966 to 2013, we found no evidence for placebo analgesia, except at

  13. Consensus Recommendations for Systematic Evaluation of Drug-Drug Interaction Evidence for Clinical Decision Support

    Science.gov (United States)

    Scheife, Richard T.; Hines, Lisa E.; Boyce, Richard D.; Chung, Sophie P.; Momper, Jeremiah; Sommer, Christine D.; Abernethy, Darrell R.; Horn, John; Sklar, Stephen J.; Wong, Samantha K.; Jones, Gretchen; Brown, Mary; Grizzle, Amy J.; Comes, Susan; Wilkins, Tricia Lee; Borst, Clarissa; Wittie, Michael A.; Rich, Alissa; Malone, Daniel C.

    2015-01-01

    Background Healthcare organizations, compendia, and drug knowledgebase vendors use varying methods to evaluate and synthesize evidence on drug-drug interactions (DDIs). This situation has a negative effect on electronic prescribing and medication information systems that warn clinicians of potentially harmful medication combinations. Objective To provide recommendations for systematic evaluation of evidence from the scientific literature, drug product labeling, and regulatory documents with respect to DDIs for clinical decision support. Methods A conference series was conducted to develop a structured process to improve the quality of DDI alerting systems. Three expert workgroups were assembled to address the goals of the conference. The Evidence Workgroup consisted of 15 individuals with expertise in pharmacology, drug information, biomedical informatics, and clinical decision support. Workgroup members met via webinar from January 2013 to February 2014. Two in-person meetings were conducted in May and September 2013 to reach consensus on recommendations. Results We developed expert-consensus answers to three key questions: 1) What is the best approach to evaluate DDI evidence?; 2) What evidence is required for a DDI to be applicable to an entire class of drugs?; and 3) How should a structured evaluation process be vetted and validated? Conclusion Evidence-based decision support for DDIs requires consistent application of transparent and systematic methods to evaluate the evidence. Drug information systems that implement these recommendations should be able to provide higher quality information about DDIs in drug compendia and clinical decision support tools. PMID:25556085

  14. Evaluation of children with steroid-sensitive nephrotic syndrome in terms of allergies.

    Science.gov (United States)

    Yılmaz, Dilek; Yenigün, Ayşe; Sönmez, Ferah; Kurt Ömürlü, İmran

    2015-04-01

    The etiology of minimal-change disease is not fully known, it is believed to be mediated by the immune system. Minimal-change disease also reported as having association with atopy. In this study, atopy history, the levels of serum IgE, and skin prick test in children with steroid-sensitive nephrotic syndrome were investigated. A group of 30 children (mean age 7.7 ± 2.2 years, 56.6% male) diagnosed with steroid-sensitive nephrotic syndrome were included in the study. Serum immunoglobulin E levels and eosinophil counts were evaluated in children with steroid-sensitive nephrotic syndrome both in relapse and remission. Skin prick test was performed in remission. Of the 30 children investigated, 11 (36.7%) had a history of atopy. The median serum total IgE levels in nephrotic children in relapse, with (445 IU/mL) and without atopy (310 IU/mL) were significantly higher than those in remission (respectively, 200 IU/mL, p = 0.021, and 42 IU/mL, p = 0.001). The skin prick tests for all the allergens were evaluated as negative in all the patients. It was thought that increased IgE may reflect the activation of immune mechanism following various stimuli rather than a direct association with atopy in children with steroid-sensitive nephrotic syndrome.

  15. The Usefulness of the Preoperative Magnetic Resonance Imaging Findings in the Evaluation of Tarsal Tunnel Syndrome

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    Jung, Hyun Jin; Lee, Sheen Woo; Jeong, Yu Mi; Choi, Hye Young; Kim, Hyung Sik [Dept. of Radiology, Gil Hospital, Gacheon University College of Medicine, Incheon (Korea, Republic of); Park, Hong Gi; Kwak, Ji Hoon [Dept. of Orthopedic Surgery, Gil Hospital, Gacheon University College of Medicine, Incheon (Korea, Republic of)

    2012-02-15

    The purpose of this study was to access the diverse conditions that lead to the clinical manifestations of tarsal tunnel syndrome and evaluate the usefulness of magnetic resonance imaging (MRI) in preoperative evaluation. Thirty-three patients who underwent ankle MRI and surgery under the impression of tarsal tunnel syndrome were retrospectively analyzed. The findings on ankle MRI were categorized into space occupying lesions within the tarsal tunnel, space occupying lesions of the tunnel wall, and non-space occupying lesions. Associated plantar muscle atrophy was also evaluated. Medical records were reviewed for correlation of nerve conduction velocity (NCV) and surgical findings. There were 21 space occupying lesions of the tarsal tunnel, and eight lesions of tarsal tunnel wall. There were three cases with accessory muscle, three with tarsal coalition, five with ganglion cysts, one neurogenic tumor, five flexor retinaculum hypertrophy, three varicose veins, and nine with tenosynovitis of the posterior tibialis, flexor digitorum longus, or flexor hallucis longus tendon. One patient was found to have a deltoid ligament sprain. Of the 32, eight patients experienced fatty atrophic change within any one of the foot muscles. NCV was positive in 79% of the MRI-positive lesions. MRI provides detailed information on ankle anatomy, which includes that of tarsal tunnel and beyond. Pathologic conditions that cause or mimic tarsal tunnel syndrome are well demonstrated. MRI can enhance surgical planning by indicating the extent of decompression required, and help with further patient management. Patients with tarsal tunnel syndrome can greatly benefit from preoperative MRI. However, it should be noted that not all cases with tarsal tunnel syndrome have MRI-demonstrable causes.

  16. The Usefulness of the Preoperative Magnetic Resonance Imaging Findings in the Evaluation of Tarsal Tunnel Syndrome

    International Nuclear Information System (INIS)

    Jung, Hyun Jin; Lee, Sheen Woo; Jeong, Yu Mi; Choi, Hye Young; Kim, Hyung Sik; Park, Hong Gi; Kwak, Ji Hoon

    2012-01-01

    The purpose of this study was to access the diverse conditions that lead to the clinical manifestations of tarsal tunnel syndrome and evaluate the usefulness of magnetic resonance imaging (MRI) in preoperative evaluation. Thirty-three patients who underwent ankle MRI and surgery under the impression of tarsal tunnel syndrome were retrospectively analyzed. The findings on ankle MRI were categorized into space occupying lesions within the tarsal tunnel, space occupying lesions of the tunnel wall, and non-space occupying lesions. Associated plantar muscle atrophy was also evaluated. Medical records were reviewed for correlation of nerve conduction velocity (NCV) and surgical findings. There were 21 space occupying lesions of the tarsal tunnel, and eight lesions of tarsal tunnel wall. There were three cases with accessory muscle, three with tarsal coalition, five with ganglion cysts, one neurogenic tumor, five flexor retinaculum hypertrophy, three varicose veins, and nine with tenosynovitis of the posterior tibialis, flexor digitorum longus, or flexor hallucis longus tendon. One patient was found to have a deltoid ligament sprain. Of the 32, eight patients experienced fatty atrophic change within any one of the foot muscles. NCV was positive in 79% of the MRI-positive lesions. MRI provides detailed information on ankle anatomy, which includes that of tarsal tunnel and beyond. Pathologic conditions that cause or mimic tarsal tunnel syndrome are well demonstrated. MRI can enhance surgical planning by indicating the extent of decompression required, and help with further patient management. Patients with tarsal tunnel syndrome can greatly benefit from preoperative MRI. However, it should be noted that not all cases with tarsal tunnel syndrome have MRI-demonstrable causes.

  17. Evidence-based interventions in primary care following acute coronary syndrome in Australia and New Zealand: a systematic scoping review.

    Science.gov (United States)

    Bhagwat, Manavi M; Woods, John A; Dronavalli, Mithilesh; Hamilton, Sandra J; Thompson, Sandra C

    2016-11-09

    Coronary artery disease has a significant disease burden, but there are many known barriers to management of acute coronary syndrome (ACS). General practitioners (GPs) bear considerable responsibility for post-discharge management of ACS in Australia and New Zealand (NZ), but knowledge about the extent and efficacy of such management is limited. This systematic review summarises published evidence from Australia and New Zealand regarding management in primary care after discharge following ACS. A search of PubMed, Scopus, CINAHL-Plus and PSYCINFO databases in August 2015 was supplemented by citation screening and hand-searching. Literature was selected based on specified criteria, and assessed for quality using the Mixed Methods Appraisal Tool (MMAT). Extracted data was related to evidence-based interventions specified by published guidelines. The search yielded 19 publications, most of which reported on quantitative and observational studies from Australia. The majority of studies scored at least 75 % on the MMAT. Diverse aspects of management by GPs are presented according to categories of evidence-based guidelines. Data suggests that GPs are more likely to prescribe ACS medications than to assist in lifestyle or psychological management. GP referral to cardiac rehabilitation varied, and one study showed an improvement in the number of ACS patients with documented ACS management plans. Few studies described successful interventions to improve GP management, though some quality improvement efforts through education and integration of care with hospitals were beneficial. Limited data was published about interventions effective in rural, minority, and Indigenous populations. Research reflects room for improvement in GP post-discharge ACS management, but little is known about effective methods for improvement. Additional research, both observational and interventional, would assist GPs in improving the quality of post-discharge ACS care.

  18. Effectiveness of body awareness interventions in fibromyalgia and chronic fatigue syndrome: a systematic review and meta-analysis.

    Science.gov (United States)

    Courtois, Imke; Cools, Filip; Calsius, Joeri

    2015-01-01

    Patients with long-lasting pain problems often complain of lack of confidence and trust in their body. Through physical experiences and reflections they can develop a more positive body- and self-experience. Body awareness has been suggested as an approach for treating patients with chronic pain and other psychosomatic conditions. The aim of this systematic review is to assess the effectiveness of body awareness interventions (BAI) in fibromyalgia (FM) and chronic fatigue syndrome (CFS). Two independent readers conducted a search on Medline, Cochrane Central, PsycINFO, Web of knowledge, PEDro and Cinahl for randomized controlled trials. We identified and screened 7.107 records of which 29 articles met the inclusion criteria. Overall, there is evidence that BAI has positive effects on the Fibromyalgia Impact Questionnaire (FIQ) (MD -5.55; CI -8.71 to -2.40), pain (SMD -0.39, CI -0.75 to -0.02), depression (SMD -0.23, CI -0.39 to -0.06), anxiety (SMD -0.23, CI -0.44 to -0.02) and Health Related Quality of Life (HRQoL) (SMD 0.62, CI 0.35-0.90) when compared with control conditions. The overall heterogeneity is very strong for FIQ (I(2) 92%) and pain (I(2) 97%), which cannot be explained by differences in control condition or type of BAI (hands-on/hands-off). The overall heterogeneity for anxiety, depression and HRQoL ranges from low to moderate (I(2) 0%-37%). Body awareness seems to play an important role in anxiety, depression and HRQoL. Still, interpretations have to be done carefully since the lack of high quality studies. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis.

    Science.gov (United States)

    Ford, Alexander C; Quigley, Eamonn M M; Lacy, Brian E; Lembo, Anthony J; Saito, Yuri A; Schiller, Lawrence R; Soffer, Edy E; Spiegel, Brennan M R; Moayyedi, Paul

    2014-09-01

    Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder. Evidence relating to the treatment of this condition with antidepressants and psychological therapies continues to accumulate. We performed an updated systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to December 2013). Trials recruiting adults with IBS, which compared antidepressants with placebo, or psychological therapies with control therapy or "usual management," were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). The search strategy identified 3,788 citations. Forty-eight RCTs were eligible for inclusion: thirty-one compared psychological therapies with control therapy or "usual management," sixteen compared antidepressants with placebo, and one compared both psychological therapy and antidepressants with placebo. Ten of the trials of psychological therapies, and four of the RCTs of antidepressants, had been published since our previous meta-analysis. The RR of IBS symptom not improving with antidepressants vs. placebo was 0.67 (95% CI=0.58-0.77), with similar treatment effects for both tricyclic antidepressants and selective serotonin reuptake inhibitors. The RR of symptoms not improving with psychological therapies was 0.68 (95% CI=0.61-0.76). Cognitive behavioral therapy, hypnotherapy, multicomponent psychological therapy, and dynamic psychotherapy were all beneficial. Antidepressants and some psychological therapies are effective treatments for IBS. Despite the considerable number of studies published in the intervening 5 years since we last examined this issue, the overall summary estimates of treatment effect have remained remarkably stable.

  20. Non-pharmacological treatment of psychiatric disorders in individuals with 22q11.2 deletion syndrome; a systematic review.

    Science.gov (United States)

    Buijs, Petra C M; Bassett, Anne S; Boot, Erik

    2018-01-24

    22q11.2 deletion syndrome (22q11.2DS) is associated with high rates of anxiety disorders, psychotic disorders, and other psychiatric conditions. In the general population, psychiatric disorders are treated with proven pharmacological and non-pharmacological therapies, such as cognitive behavioral therapy (CBT). To begin to assess the feasibility and efficacy of non-pharmacological therapies in 22q11.2DS, we performed a systematic search to identify literature on non-pharmacological interventions for psychiatric disorders in individuals with 22q11.2DS. Of 1,240 individual publications up to mid-2016 initially identified, 11 met inclusion criteria. There were five literature reviews, five publications reporting original research (two originating from a single study), and one publication not fitting either category that suggested adaptations to an intervention without providing scientific evidence. None of the original research involved direct study of the evidence-based non-pharmacological therapies available for psychiatric disorders. Rather, these four studies involved computer-based or group interventions aimed at improving neuropsychological deficits that may be associated with psychiatric disorders. Although the sample sizes were relatively small (maximum 28 participants in the intervention group), these reports documented the promising feasibility of these interventions, and improvements in domains of neuropsychological functioning, including working memory, attention, and social cognition. The results of this review underline the need for research into the feasibility and efficacy of non-pharmacological treatments of psychiatric disorders in individuals with 22q11.2DS to inform clinical care, using larger samples, and optimally, standard randomized, placebo-controlled, clinical trials methodology. © 2018 Wiley Periodicals, Inc.

  1. Efficacy and safety of metformin during pregnancy in women with gestational diabetes mellitus or polycystic ovary syndrome: a systematic review.

    Science.gov (United States)

    Lautatzis, Maria-Elena; Goulis, Dimitrios G; Vrontakis, Maria

    2013-11-01

    Metformin is an effective oral anti-hyperglycemic agent that is widely used to manage diabetes mellitus type 2 in the general population and more recently, in pregnancy. However, as metformin crosses the placenta, its use during pregnancy raises concerns regarding potential adverse effects on the mother and fetus. (i) To provide background for the use of metformin during pregnancy through a narrative review and (ii) to critically appraise the published evidence on the efficacy and safety of using metformin during pregnancy through a systematic review. Metformin appears to be effective and safe for the treatment of gestational diabetes mellitus (GDM), particularly for overweight or obese women. However, patients with multiple risk factors for insulin resistance may not meet their treatment goals with metformin alone and may require supplementary insulin. Evidence suggests that there are potential advantages for the use of metformin over insulin in GDM with respect to maternal weight gain and neonatal outcomes. Furthermore, patients are more accepting of metformin than insulin. The use of metformin throughout pregnancy in women with polycystic ovary syndrome reduces the rates of early pregnancy loss and preterm labor and protects against fetal growth restriction. There have been no demonstrable teratogenic effects, intra-uterine deaths or developmental delays with the use of metformin. The publications reviewed in this paper support the efficacy and safety of metformin during pregnancy with respect to immediate pregnancy outcomes. Because there are no guidelines for the continuous use of metformin in pregnancy, the duration of treatment is based on clinical judgment and experience on a case-by-case basis. © 2013.

  2. The efficacy of rituximab in treatment of childhood steroid resistant and steroid dependent nephrotic syndrome: a systematic review and Meta-analysis

    Directory of Open Access Journals (Sweden)

    Hamid Mohammadjafar

    2013-05-01

    Full Text Available Corticosteroid resistant and dependent nephrotic syndrome in children is a challenge and there are some difficulties in treating such patients. We reviewed the current studies that evaluated therapeutic role of a relatively new immunosuppressive drug “rituximab” in reducing proteinuria and reduction of relapse rate in less than 16 year old patients with non-responsive or steroid dependent nephrotic syndrome. We searched Medline, Embase, web of science and Cochrane library with appropriate keywords and conducted the complete remission, relapse rate and the mean number of relapses 12 month after therapy on Meta-analysis. We put the data on two different subgroups; steroid resistant nephrotic syndrome and steroid dependent or frequent relapser nephrotic syndrome. In Steroid Resistant Nephrotic syndrome children, the complete remission was 0.27 (0.2- 0.34. In Steroid Dependent Nephrotic syndrome patients, the overall standard mean differences of mean number of relapses 12 mo after treatment in pooled four studies (56 cases was 2.63 (2.03, 3.24. In these dependent patients, the data on relapse rate after treatment pooled on 6 studies (162 cases and yield to the rate of 0.42 (0.15, 0.69 with the range of 0.09 to 0.83. In conclusion, Rituximab is a reasonable therapy for Steroid Dependent and Steroid Resistant Nephrotic syndrome children. In view of paucity of randomized data, we suggest to perform newer controlled multicenter studies

  3. Measurement properties of exsisting clinical assessment methods evaluating scapular positioning and function. A systematic review

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie; Juul-Kristensen, B; Lund, H

    MEASUREMENT PROPERTIES OF EXISTING CLINICAL ASSESSMENT METHODS EVALUATING SCAPULAR POSITIONING AND FUNCTION. A SYSTEMATIC REVIEW1,2Camilla Marie Larsen, 1,3Birgit Juul-Kristensen, 1,3Hans Lund, 1Karen Søgaard1Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark2...... of the available clinical scapular assessment methods and critically appraise the methodological quality of the involved studies. METHODS A systematic, computer-assisted literature search using Medline, CINAHL, SportDiscus and EMBASE was performed from inception to October 2013. Reference lists in articles were...... kinematics in asymptomatic subjects. Journal of Electromyography and Kinesiology, 23:326-33, 20134.Johnson MP, et al. New Method to Assess Scapular Upward Rotation in Subjects With Shoulder Pathology, Journal of Orthopaedic & Sports Physical Therapy,31(2):81-89, 2001....

  4. Herbal medicine for hand-foot syndrome induced by fluoropyrimidines: A systematic review and meta-analysis.

    Science.gov (United States)

    Deng, Bo; Sun, Wei

    2018-04-16

    The aims of this study were to evaluate the efficacy of herbal medicine for the prevention and management of hand-foot syndrome (HFS) induced by fluoropyrimidines and to identify herbs associated with HFS alleviation for further research. The PubMed, Cochrane, Springer, China National Knowledge Infrastructure, and Wanfang databases were searched up to May 2017 for randomized controlled trials (RCTs) that evaluated herbal medicine for relieving HFS in patients undergoing fluoropyrimidine-based chemotherapy. Study evaluation and synthesis methods were in accordance with the Cochrane Handbook, and data were analyzed using RevMan 5.3. In total, 35 RCTs (2,668 participants) were included. Meta-analysis showed that the addition of herbal medicine significantly reduced the incidences of all-grade and high-grade HFS. The total effective rate and complete remission rate of HFS patients increased significantly with herbal medicine arm. Further sensitivity analysis identified Paeoniae Radix Alba, Carthami Flos, Cinnamomi Ramulus, and Glycyrrhizae Radix et Rhizoma as being consistently associated with significant reductions in HFS incidence without important heterogeneity. However, the lack of blinding in most studies may have led to overestimation of these effects. More high-quality RCTs and experimental research are needed to confirm and investigate the efficacy of the herbs identified in this study. Copyright © 2018 John Wiley & Sons, Ltd.

  5. The Performance of the Vaginal Discharge Syndromic Management in Treating Vaginal and Cervical Infection: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Zemouri, Charifa; Wi, Teodora Elvira; Kiarie, James; Seuc, Armando; Mogasale, Vittal; Latif, Ahmed; Broutet, Nathalie

    2016-01-01

    This review aimed to synthesize and analyze the diagnostic accuracy and the likelihood of providing correct treatment of the syndromic approach Vaginal Discharge Flowchart in managing cervical infections caused by Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT), and vaginal infections caused by Trichomonas vaginalis (TV) and Bacterial vaginosis (BV) and Candida albicans. This review will inform updating the WHO 2003 guidelines on Vaginal Discharge syndromic case management. A systematic review was conducted on published studies from 01-01-2000 to 30-03-2015 in multiple databases. Studies evaluating the diagnostic accuracy and validation of the WHO Vaginal Discharge Flowchart were included. Validation parameters including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and the 95% confidence intervals for the different types of the flowchart were taken as outcomes, re-calculated, and analysed using a fixed model meta-analysis for data pooling. The level of agreement between the index and reference test were determined by the Cohen's Kappa co-efficiency test. Each individual study was assessed on quality using the QUADAS-2 tool. The search yielded 2,845 studies of which 16 met the eligibility criteria for final analysis. The diagnostic performance to identify cervical infections was low and resulted in a high proportion of over and missed treatment. The four flowcharts had a sensitivity between 27.37% in history and risk assessment and 90.13% with microscopy, with the inverse in specificity rates. The treatment performances between the flowcharts were inconsistent. The same applies to the use of vaginal discharge flowchart for treating vaginal infections. For vaginal infections the vaginal discharge flowchart had a good performance in flowchart 3 with 91.68% of sensitivity; 99.97% specificity; 99.93% PPV and 0.02% who missed their treatment and 8.32% of women who were over treated by the vaginal discharge

  6. Consumer evaluation of food with nutritional benefits: a systematic review and narrative synthesis.

    Science.gov (United States)

    Mogendi, Joseph Birundu; De Steur, Hans; Gellynck, Xavier; Makokha, Anselimo

    2016-06-01

    As a consequence of the growing interest in, and development of, various types of food with nutritional benefits, the modern consumer views their kitchen cabinet more and more as a medicine cabinet. Given that consumer evaluation of food is considered key to the successful production, marketing and finally consumption of food, a procedure commonly used in medical fields was employed to systematically review and summarize evidence of consumer evaluation studies on nutritious foods. The focus is primarily on consumer understanding of nutritious food and the underlying determinants of consumer evaluation. Our results highlight four groups of key determinants: (1) nutrition knowledge and information; (2) attitudes, beliefs, perceptions and behavioural determinants; (3) price, process and product characteristics; and (4) socio-demographics. The findings also point to the importance of understanding consumer acceptance as one many concepts in the consumer evaluation process, and provide support for developing appropriate strategies for improving health and well-being of consumers.

  7. Integrated Plant Safety Assessment, Systematic Evaluation Program: Yankee Nuclear Power Station (Docket No. 50-29)

    International Nuclear Information System (INIS)

    1987-10-01

    The US Nuclear Regulatory Commission (NRC) has prepared Supplement 1 to the final Integrated Plant Safety Assessment Report (IPSAR) (NUREG-0825), under the scope of the Systematic Evaluation Program (SEP), for Yankee Atomic Electric Company's Yankee Nuclear Power Station located in Rowe, Massachusetts. The SEP was initiated by the NRC to review the design of older operating nuclear power plants to reconfirm and document their safety. This report documents the review completed under the SEP for those issues that required refined engineering evaluations or the continuation of ongoing evaluations after the Final IPSAR for the Yankee plant was issued. The review has provided for (1) an assessment of the significance of differences between current technical positions on selected safety issues and those that existed when Yankee was licensed, (2) a basis for deciding how these differences should be resolved in an integrated plant review, and (3) a documented evaluation of plant safety. 2 tabs

  8. A systematic review of studies evaluating diffusion and dissemination of selected cancer control interventions.

    Science.gov (United States)

    Ellis, Peter; Robinson, Paula; Ciliska, Donna; Armour, Tanya; Brouwers, Melissa; O'Brien, Mary Ann; Sussman, Jonathan; Raina, Parminder

    2005-09-01

    With this review, the authors sought to determine what strategies have been evaluated (including the outcomes assessed) to disseminate cancer control interventions that promote the uptake of behavior change. Five topic areas along the cancer care continuum (smoking cessation, healthy diet, mammography, cervical cancer screening, and control of cancer pain) were selected to be representative. A systematic review was conducted of primary studies evaluating dissemination of a cancer control intervention. Thirty-one studies were identified that evaluated dissemination strategies in the 5 topic areas. No strong evidence currently exists to recommend any one dissemination strategy as effective in promoting the uptake of cancer control interventions. The authors conclude that there is a strong need for more research into dissemination of cancer control interventions. Future research should consider methodological issues such as the most appropriate study design and outcomes to be evaluated. (c) 2005 APA, all rights reserved

  9. Efficacy of pelvic floor muscle training in women with overactive bladder syndrome: a systematic review.

    Science.gov (United States)

    Monteiro, Silvia; Riccetto, Cassio; Araújo, Angélica; Galo, Laryssa; Brito, Nathália; Botelho, Simone

    2018-04-11

    Our objective was to evaluate the effectiveness of pelvic floor muscle training (PFMT) in reducing overactive bladder (OAB) symptoms in women. Searches were performed at MEDLINE, PubMed, Physiotherapy Evidence Database (PEDro), Scielo, and Central Cochrane Library PubMed until January 2017. Controlled trials were researched by two independent reviewers. Eligible studies were restricted to random and controlled clinical trials that investigated the effectiveness of PFMT in decreasing OAB symptoms. Qualitative methodology was evaluated using the PEDro scale. Data was analyzed and interpreted qualitatively. The final search retrieved eight studies (n = 1161 women with urgency symptoms), which were published between 2002 and 2016. The methodological scores varied between 4 and 7 in the PEDro scale. PFMT, with the objective of controlling urgent micturition, demonstrated improvements in quality of life in women with OAB. Most data in this revision came from small- to moderate-sized trials, with different and inconsistent outcome measures, which could have impacted the end results. The literature regarding the effectiveness of PFMT in OAB remains heterogeneous and inconclusive.

  10. Student Teachers' Evaluations of Slides of Children with Down Syndrome: Impact of Facial Plastic Surgery, Labelling and Factual Knowledge.

    Science.gov (United States)

    Elkabetz, R.; And Others

    1990-01-01

    This study examined the impact of facial plastic surgery, labeling (mentally retarded, normal, Down's syndrome), and level of knowledge of Down's syndrome on 127 student teachers' evaluations of slides of persons with such characteristics. Although there was no overall significant main effect for the pre-post operation condition, there was a…

  11. CLINICAL-EVALUATION OF PAIN TREATMENT WITH ELECTROSTIMULATION - A STUDY OF TENS IN PATIENTS WITH DIFFERENT PAIN SYNDROMES

    NARCIS (Netherlands)

    MEYLER, WJ; DEJONGSTE, MJL; ROLF, CAM

    Objective: We evaluated the clinical efficacy and the unwanted side effects of transcutaneous electrical nerve stimulation (TENS) in a consecutive group of patients with intractable pain due to different pain syndromes. Methods: Two hundred eleven patients with different pain syndromes, coded

  12. Increased Need for Gastrointestinal Surgery and Increased Risk of Surgery-Related Complications in Patients with Ehlers-Danlos Syndrome: A Systematic Review.

    Science.gov (United States)

    Kulas Søborg, Marie-Louise; Leganger, Julie; Rosenberg, Jacob; Burcharth, Jakob

    2017-01-01

    Ehlers-Danlos syndromes (EDSs) constitute a rare group of inherited connective tissue diseases, characterized by multisystemic manifestations and general tissue fragility. Most severe complications include vascular and gastrointestinal (GI) emergencies requiring acute surgery. The purpose of this systematic review was to assess the causes of GI-related surgery and related mortality and morbidity in patients with EDSs. A systematic search was conducted in PubMed, Embase, and Scopus to identify relevant studies. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for systematic reviews were followed. According to eligibility criteria, data were extracted and systematically screened by 2 authors. Screening process identified 11 studies with a total of 1,567 patients. Findings indicated that patients with EDSs had a higher occurrence of surgery demanding GI manifestations, including perforation, hemorrhage, rupture of intra-abdominal organs, and rectal prolapse. Most affected was the vascular subtype, of which up to 33% underwent GI surgery and suffered from a lowered average life expectancy of 48 years (range 6-78). Secondary complications of surgery were common in all patients with EDSs. Studies suggested that patients with EDSs present an increased need for GI surgery, but also an increased risk of surgery-related complications, most predominantly seen in the vascular subtype. © 2016 S. Karger AG, Basel.

  13. Systematic evaluation of satellite remote sensing for identifying uranium mines and mills.

    Energy Technology Data Exchange (ETDEWEB)

    Blair, Dianna Sue; Stork, Christopher Lyle; Smartt, Heidi Anne; Smith, Jody Lynn

    2006-01-01

    In this report, we systematically evaluate the ability of current-generation, satellite-based spectroscopic sensors to distinguish uranium mines and mills from other mineral mining and milling operations. We perform this systematic evaluation by (1) outlining the remote, spectroscopic signal generation process, (2) documenting the capabilities of current commercial satellite systems, (3) systematically comparing the uranium mining and milling process to other mineral mining and milling operations, and (4) identifying the most promising observables associated with uranium mining and milling that can be identified using satellite remote sensing. The Ranger uranium mine and mill in Australia serves as a case study where we apply and test the techniques developed in this systematic analysis. Based on literature research of mineral mining and milling practices, we develop a decision tree which utilizes the information contained in one or more observables to determine whether uranium is possibly being mined and/or milled at a given site. Promising observables associated with uranium mining and milling at the Ranger site included in the decision tree are uranium ore, sulfur, the uranium pregnant leach liquor, ammonia, and uranyl compounds and sulfate ion disposed of in the tailings pond. Based on the size, concentration, and spectral characteristics of these promising observables, we then determine whether these observables can be identified using current commercial satellite systems, namely Hyperion, ASTER, and Quickbird. We conclude that the only promising observables at Ranger that can be uniquely identified using a current commercial satellite system (notably Hyperion) are magnesium chlorite in the open pit mine and the sulfur stockpile. Based on the identified magnesium chlorite and sulfur observables, the decision tree narrows the possible mineral candidates at Ranger to uranium, copper, zinc, manganese, vanadium, the rare earths, and phosphorus, all of which are

  14. Photogrammetry as a tool for the postural evaluation of the spine: A systematic review.

    Science.gov (United States)

    Furlanetto, Tássia Silveira; Sedrez, Juliana Adami; Candotti, Cláudia Tarragô; Loss, Jefferson Fagundes

    2016-02-18

    To evaluate the use of photogrammetry and identify the mathematical procedures applied when evaluating spinal posture. A systematic search using keywords was conducted in the PubMed, EMBASE, Scopus, Science and Medicine(®) databases. The following inclusion criteria adopted were: (1) the use of photogrammetry as a method to evaluate spinal posture; (2) evaluations of spinal curvature in the sagittal and/or frontal plane; (3) studies published within the last three decades; and (4) written entirely in English. The exclusion criteria were: (1) studies which objective involved the verification of some aspect of validation of instruments; (2) studies published as abstracts and those published in scientific events; and (3) studies using evaluation of the anteriorization of the head to determine the angular positioning of the cervical spine. The articles in this review were included and evaluated for their methodological quality, based on the Downs and Black scale, by two independent reviewers. Initially, 1758 articles were found, 76 of which were included upon reading the full texts and 29 were included in accordance with the predetermined criteria. In addition, after analyzing the references in those articles, a further six articles were selected, so that 35 articles were included in this review. This systematic review revealed that the photogrammetry has been using in observational studies. Furthermore, it was also found that, although the data collection methodologies are similar across the studies, in relation to aspects of data analysis, the methodologies are very different, especially regarding the mathematical routines employed to support different postural evaluation software. With photogrammetry, the aim of the assessment, whether it is for clinical, research or collective health purposes, must be considered when choosing which protocol to use to evaluate spinal posture.

  15. The Systematic Approach to Training: Analysis and Evaluation in the Department of Safeguards

    International Nuclear Information System (INIS)

    Ticevic, S.; Weichselbraun, A.; Pickett, S.; Crete, J.-M.

    2015-01-01

    In applying a systematic approach to training (SAT), identifying the learning needs is the first step - a learning needs analysis allows the organization to identify the competencies required to perform a particular job. A systematic approach can provide a clear structure for training and education programme development as well as the necessary evaluation and feedback so that the organization can adjust the development accordingly and deliver the optimal learning experience. In this presentation we will describes two key elements of a SAT used in the Safeguards Training Section in the Department of Safeguards: Analysis and Evaluation. Analysis is the first part of a SAT needed to define competencies for Safeguards staff in order to improve training development within the Department. We describe the training needs analysis used to capture and articulate the various competencies required for safeguards implementation based upon an analysis of tasks and activities carried out by staff members in the Department. Firstly, we highlight the different qualitative methods used to gather information from staff and the process of evaluating and organizing this information into a structured framework. Secondly, we describe how this framework provides the necessary reference to specify learning objectives, evaluate training effectiveness, review and revise training offerings, and select appropriate training paths based on identified needs. In addition, as part of the SAT, evaluation is performed to identify the usefulness of course outcomes and improvements for future offerings based on lessons learned, to ensure that appropriate knowledge and skills are being taught and to demonstrate the value of training by meeting the organization's needs. We present how the Kirkpatrick four-level evaluation model has been implemented by Safeguards Training Section in order to evaluate course effectiveness after the training has been completed, and discuss how the current evaluation

  16. DEVELOPMENT OF A GAME FOR THE EVALUATION OF OPERATIVE STRUCTURE IN TEENAGERS WITH DOWN SYNDROME

    Directory of Open Access Journals (Sweden)

    Flávio Cezar Amate

    2014-05-01

    Full Text Available When an individual presents some type of mental deficiency, there is a tendency to expose him to innumerous evaluations, repeating them several times in a short period so as to verify his development. In some cases, the evaluation is tiring and could lead to the desistance of the person evaluated and to the   exhaustion of the appraiser. In this article a computational game was developed in Flash for teenagers with the Down Syndrome that demonstrate light or moderate mental deficiency to evaluate cognitive seriation functions and classes inclusion based on the Jean Piaget theory. The game is set up in a kitchen where the individual  to be evaluated  helps the principal character in achieving tasks. After the termination of the activities a report is made with the  analysis  of the operative structures  demonstrated. To evaluate the efficiency of the game, the subjects went through the evaluation of the operative tests and then played the game. Two pilot tests were made and applied to 13 teenagers with the Down Syndrome. The analysis showed that the method minimizes subjectivity and manipulation of the material needing less time making the report as the  game is produced immediately. There was a bigger interest because the game contextualizes the tests even when the individual had verbal difficulty  the evaluation access was possible through the game which didn´t occur when applied in the real tests

  17. Systematic evaluation of non-animal test methods for skin sensitisation safety assessment.

    Science.gov (United States)

    Reisinger, Kerstin; Hoffmann, Sebastian; Alépée, Nathalie; Ashikaga, Takao; Barroso, Joao; Elcombe, Cliff; Gellatly, Nicola; Galbiati, Valentina; Gibbs, Susan; Groux, Hervé; Hibatallah, Jalila; Keller, Donald; Kern, Petra; Klaric, Martina; Kolle, Susanne; Kuehnl, Jochen; Lambrechts, Nathalie; Lindstedt, Malin; Millet, Marion; Martinozzi-Teissier, Silvia; Natsch, Andreas; Petersohn, Dirk; Pike, Ian; Sakaguchi, Hitoshi; Schepky, Andreas; Tailhardat, Magalie; Templier, Marie; van Vliet, Erwin; Maxwell, Gavin

    2015-02-01

    The need for non-animal data to assess skin sensitisation properties of substances, especially cosmetics ingredients, has spawned the development of many in vitro methods. As it is widely believed that no single method can provide a solution, the Cosmetics Europe Skin Tolerance Task Force has defined a three-phase framework for the development of a non-animal testing strategy for skin sensitization potency prediction. The results of the first phase – systematic evaluation of 16 test methods – are presented here. This evaluation involved generation of data on a common set of ten substances in all methods and systematic collation of information including the level of standardisation, existing test data,potential for throughput, transferability and accessibility in cooperation with the test method developers.A workshop was held with the test method developers to review the outcome of this evaluation and to discuss the results. The evaluation informed the prioritisation of test methods for the next phase of the non-animal testing strategy development framework. Ultimately, the testing strategy – combined with bioavailability and skin metabolism data and exposure consideration – is envisaged to allow establishment of a data integration approach for skin sensitisation safety assessment of cosmetic ingredients.

  18. Systematic Review of Health Economic Evaluation Studies Developed in Brazil from 1980 to 2013.

    Science.gov (United States)

    Decimoni, Tassia Cristina; Leandro, Roseli; Rozman, Luciana Martins; Craig, Dawn; Iglesias, Cynthia P; Novaes, Hillegonda Maria Dutilh; de Soárez, Patrícia Coelho

    2018-01-01

    Brazil has sought to use economic evaluation to support healthcare decision-making processes. While a number of health economic evaluations (HEEs) have been conducted, no study has systematically reviewed the quality of Brazilian HEE. The objective of this systematic review was to provide an overview regarding the state of HEE research and to evaluate the number, characteristics, and quality of reporting of published HEE studies conducted in a Brazilian setting. We systematically searched electronic databases (MEDLINE, EMBASE, Latin American, and Caribbean Literature on Health Sciences Database, Scientific Electronic Library Online, NHS Economic Evaluation Database, health technology assessment Database, Bireme, and Biblioteca Virtual em Saúde Economia da Saúde ); citation indexes (SCOPUS, Web of Science), and Sistema de Informação da Rede Brasileira de Avaliação de Tecnologia em Saúde . Partial and full HEEs published between 1980 and 2013 that referred to a Brazilian setting were considered for inclusion. In total, 535 studies were included in the review, 36.8% of these were considered to be full HEE. The category of healthcare technologies more frequently assessed were procedures (34.8%) and drugs (28.8%) which main objective was treatment (72.1%). Forty-four percent of the studies reported their funding source and 36% reported a conflict of interest. Overall, the full HEE quality of reporting was satisfactory. But some items were generally poorly reported and significant improvement is required: (1) methods used to estimate healthcare resource use quantities and unit costs, (2) methods used to estimate utility values, (3) sources of funding, and (4) conflicts of interest. A steady number of HEE have been published in Brazil since 1980. To improve their contribution to inform national healthcare policy efforts need to be made to enhance the quality of reporting of HEEs and promote improvements in the way HEEs are designed, implemented (i.e., using sound

  19. Association between Sarcopenia and Metabolic Syndrome in Middle-Aged and Older Non-Obese Adults: A Systematic Review and Meta-Analysis

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    Huaqi Zhang

    2018-03-01

    Full Text Available The associations between sarcopenia and metabolic syndrome (MetS in non-obese middle-aged and older adults remain controversial. Thus, this meta-analysis aimed to evaluate the overall prevalence of MetS and the correlations between sarcopenia and MetS in middle-aged and older non-obese adults. We performed a systematic searched strategy using PUBMED, EMBASE and Web of Science databases for relevant observational studies investigating sarcopenia and MetS up to 11 May 2017. The polled prevalence of MetS and odds ratios with 95% confidence intervals (CI, as well as subgroup analyses were calculated using a random effects model. Twelve articles with a total of 35,581 participants were included. The overall prevalence of MetS was 36.45% (95% CI, 28.28–45.48% in middle-aged and older non-obese adults with sarcopenia. Our analysis demonstrated a positive association between sarcopenia and MetS (OR = 2.01, 95% CI, 1.63–2.47. The subgroup analysis showed that both larger cohort size and the use of dual-energy X-ray absorptiometry to measure body composition can enhance the relationship. Our study revealed that a higher proportion of MetS in middle-aged and older non-obese people with sarcopenia. Moreover, sarcopenia was positively associated with MetS in this population. Further large-scale prospective cohort studies are needed to investigate the causality between sarcopenia and MetS.

  20. Efficacy, tolerability and safety of cannabinoids in chronic pain associated with rheumatic diseases (fibromyalgia syndrome, back pain, osteoarthritis, rheumatoid arthritis): A systematic review of randomized controlled trials.

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    Fitzcharles, M-A; Baerwald, C; Ablin, J; Häuser, W

    2016-02-01

    In the absence of an ideal treatment for chronic pain associated with rheumatic diseases, there is interest in the potential effects of cannabinoid molecules, particularly in the context of global interest in the legalization of herbal cannabis for medicinal use. A systematic search until April 2015 was conducted in Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, www.cannabis-med.org and clinicaltrials.gov for randomized controlled trials with a study duration of at least 2 weeks and at least ten patients per treatment arm with herbal cannabis or pharmaceutical cannabinoid products in fibromyalgia syndrome (FMS), osteoarthritis (OA), chronic spinal pain, and rheumatoid arthritis (RA) pain. Outcomes were reduction of pain, sleep problems, fatigue and limitations of quality of life for efficacy, dropout rates due to adverse events for tolerability, and serious adverse events for safety. The methodology quality of the randomized controlled trials (RCTs) was evaluated by the Cochrane Risk of Bias Tool. Two RCTs of 2 and 4 weeks duration respectively with nabilone, including 71 FMS patients, one 4-week trial with nabilone, including 30 spinal pain patients, and one 5-week study with tetrahydrocannbinol/cannabidiol, including 58 RA patients were included. One inclusion criterion was pain refractory to conventional treatment in three studies. No RCT with OA patients was found. The risk of bias was high for three studies. The findings of a superiority of cannabinoids over controls (placebo, amitriptyline) were not consistent. Cannabinoids were generally well tolerated despite some troublesome side effects and safe during the study duration. Currently, there is insufficient evidence for recommendation for any cannabinoid preparations for symptom management in patients with chronic pain associated with rheumatic diseases.

  1. Treatment management during the adolescent transition period of girls and young women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS: a systematic literature review

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    Anke Wagner

    2016-11-01

    Full Text Available Abstract Introduction In health services research, there is a special emphasis on the transition from adolescence into adulthood. During this transition period, adolescents change from pediatric to adult medical care. This process must be carefully structured, particularly when special medical care is required. Challenges and difficulties become apparent particularly in the case of rare diseases. This is increasingly so when the rare disease affects the adolescence-specific development of patients, such as Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS, also known as Müllerian agenesis. Methods A systematic literature review identified the care requirements of girls and young women with MRKHS, as well as studies of medical care during the adolescent transition period for various other diseases. This investigation was carried out in the years 2012 and 2013, and was updated in 2014/2015. In addition, the reference lists of the identified studies were reviewed. Results Nine publications on MRKHS and ten publications on the transition from adolescence to adulthood were included. Medical care requirements and measures were identified for the following areas: diagnosis during adolescence and organization of medical care, reactions to the diagnosis, functional infertility, psychological stress and threat to self-image, contact with others, and dealing with MRKHS coping strategies. Discussion There is still a great demand for research in the area of care during the transition period from adolescence into adulthood, particularly for rare diseases. The recommendations for treating MRKHS patients derived from the literature should be implemented and evaluated with regard to their effectiveness.

  2. Critical evaluation of paliperidone in the treatment of schizophrenia in Chinese patients: a systematic literature review

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    Zhang, LiLi; Li, JiTao; Zhao, YanJie; Su, Yun’Ai; Si, Tianmei

    2016-01-01

    Background Paliperidone (9-hydroxyrisperidone), the major active metabolite of risperidone, has been introduced as a novel atypical antipsychotic agent in many countries. It is available both as an oral extended-release (ER) formulation and as a long-acting injection (paliperidone palmitate, PP), which have been approved for treating schizophrenia in the People’s Republic of China since 2009 and 2012, respectively. This systematic review summarizes the efficacy, effectiveness, and safety of paliperidone in the treatment of schizophrenia in the Chinese population. Methods A systematic literature search was conducted on the databases covering international and Chinese core journals, published from January 1, 2008, to May 22, 2015. Results A total of 122 publications were retrieved, of which 63 studies were identified for inclusion; most studies were related to paliperidone ER (n=53), nine were related to PP, and one study was related to both agents. Paliperidone ER demonstrated at least comparable efficacy with active comparators, including risperidone, olanzapine, ziprasidone, or aripiprazole, and was found to be superior with respect to the onset of action and improvement in the Personal and Social Performance Scale score. Paliperidone ER appeared to be associated with a lower risk of metabolic syndromes; the most common treatment-emergent adverse events were extrapyramidal symptoms, akathisia, insomnia, and somnolence. Results from interventional and observational studies showed that PP was also an effective and well-tolerated treatment for Chinese patients with schizophrenia. The findings were generally consistent with those observed in non-Chinese populations. Conclusion Both paliperidone ER and PP were effective and well-tolerated agents for the treatment of schizophrenia in the Chinese population according to the data we reviewed. No new safety signals specific for the Chinese population were raised for paliperidone. Further studies may be needed to collect

  3. Fluorescent in situ hybridization for evaluation of Prader-Willi and Angelman syndromes

    Energy Technology Data Exchange (ETDEWEB)

    Wenger, S.L.; Cummins, J.H. [Univ. of Pittsburgh, PA (United States)

    1995-07-17

    We have found fluorescence in situ hybridization (FISH) results more reliavle than high resolution chromosome analysis for the diagnosis of Prader-Willi (PWS) or Angelman syndromes (AS). Specifically, we have found success in the detection of 15q11q13 deletions among 55 cases. Our study suggests that FISH analysis using PWS/AS probes can facilitate diagnostic evaluation of these cases for deletions. 2 refs., 1 tab.

  4. Indigenous health program evaluation design and methods in Australia: a systematic review of the evidence.

    Science.gov (United States)

    Lokuge, Kamalini; Thurber, Katherine; Calabria, Bianca; Davis, Meg; McMahon, Kathryn; Sartor, Lauren; Lovett, Raymond; Guthrie, Jill; Banks, Emily

    2017-10-01

    Indigenous Australians experience a disproportionately higher burden of disease compared to non-Indigenous Australians. High-quality evaluation of Indigenous health programs is required to inform health and health services improvement. We aimed to quantify methodological and other characteristics of Australian Indigenous health program evaluations published in the peer-reviewed literature. Systematic review of peer-reviewed literature (November 2009-2014) on Indigenous health program evaluation. We identified 118 papers describing evaluations of 109 interventions; 72.0% were university/research institution-led. 82.2% of evaluations included a quantitative component; 49.2% utilised quantitative data only and 33.1% used both quantitative and qualitative data. The most common design was a before/after comparison (30.5%, n=36/118). 7.6% of studies (n=9/118) used an experimental design: six individual-level and three cluster-randomised controlled trials. 56.8% (67/118) reported on service delivery/process outcomes (versus health or health risk factor outcomes) only. Given the number of Indigenous health programs that are implemented, few evaluations overall are published in the peer-reviewed literature and, of these, few use optimal methodologies such as mixed methods and experimental design. Implications for public health: Multiple strategies are required to increase high-quality, accessible evaluation in Indigenous health, including supporting stronger research-policy-practice partnerships and capacity building for evaluation by health services and government. © 2017 The Authors.

  5. Is the evaluation of risk of bias in periodontology and implant dentistry comprehensive? A systematic review.

    Science.gov (United States)

    Faggion, Clovis Mariano; Listl, Stefan; Alarcón, Marco Antonio

    2015-05-01

    The objective of this study was to assess how authors of systematic reviews (SRs) with meta-analyses published in periodontology and implant dentistry evaluate risk of bias (ROB) in primary studies included in these reviews. A literature search for SRs with meta-analyses was performed in PubMed and Cochrane library databases up to July 20th 2014. The reference lists of included articles were screened for further reviews. The standards of evaluating ROB in primary studies were evaluated by using a 14-item checklist based on the Cochrane approach for evaluating ROB. Standards in ROB evaluations in Cochrane and paper-based SRs were compared using the Fisher's exact test. All searches, data extraction and evaluations were performed independently and in duplicate. Seventy SRs were included (45 paper-based and 25 Cochrane SRs, respectively). The median percentage of items addressed was 58% (interquartile range 4-100%). Cochrane SRs more frequently included ROB assessments than paper-based reviews in terms of examiner blinding (p = 0.0026), selective outcome reporting (p = 0.0207) and other bias (p = 0.0241). The ROB evaluation in primary studies currently included in SRs with meta-analyses in periodontology and implant dentistry is not sufficiently comprehensive. Cochrane SRs have more comprehensive ROB evaluation than paper-based reviews. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. The effect of relaxation therapy on autonomic functioning, symptoms and daily functioning, in patients with chronic fatigue syndrome or fibromyalgia: a systematic review.

    Science.gov (United States)

    Meeus, Mira; Nijs, Jo; Vanderheiden, Tanja; Baert, Isabel; Descheemaeker, Filip; Struyf, Filip

    2015-03-01

    To establish the effects of relaxation therapy on autonomic function, pain, fatigue and daily functioning in patients with chronic fatigue syndrome or fibromyalgia. A systematic literature study was performed. Using specific keywords related to fibromyalgia or chronic fatigue syndrome and relaxation therapy, the electronic databases PubMed and Web of Science were searched. Included articles were assessed for their risk of bias and relevant information regarding relaxation was extracted. The review was conducted and reported according to the PRISMA-statement. Thirteen randomized clinical trials of sufficient quality were included, resulting in a total of 650 fibromyalgia patients (11 studies) and 88 chronic fatigue syndrome patients (3 studies). None of the studies reported effects on autonomic function. Six studies reported the effect of guided imagery on pain and daily functioning in fibromyalgia. The acute effect of a single session of guided imagery was studied in two studies and seems beneficial for pain relief. For other relaxation techniques (eg. muscle relaxation, autogenic training) no conclusive evidence was found for the effect on pain and functioning in fibromyalgia patients comparison to multimodal treatment programs. For fatigue a multimodal approach seemed better than relaxation, as shown in the sole three studies on chronic fatigue syndrome patients. There is moderate evidence for the acute effect of guided imagery on pain, although the content of the visualization is a matter of debate. Other relaxation formats and the effects on functionality and autonomic function require further study. © The Author(s) 2014.

  7. [Evaluating the relation of premenstrual syndrome and primary dysmenorrhea in women diagnosed with fibromyalgia].

    Science.gov (United States)

    Terzi, Rabia; Terzi, Hasan; Kale, Ahmet

    2015-01-01

    In this study, we aimed to investigate the presence of premenstrual syndrome (PMS), primary dysmenorrhea (PD) and depression among women with fibromyalgia (FM) and healthy females and to determine possible factors related with PMS and PD in FM. The present study was conducted on 98 female patients diagnosed with FM and 102 age and sex-matched healthy controls. All patients were evaluated for premenstrual syndrome (PMS) and primary dysmenorrhea (PD). Premenstrual syndrome was assessed among the patients for the presence of one or more affective or somatic symptoms within the five days preceding menses. The diagnosis of primary dysmenorrhea was defined as having abdominal pain or lower back pain lasting at least two days during a menstrual period. Dysmenorrhea was assessed via visual analog scale. Dysmenorrhea was rated via Multidimensional Scoring System. The Hamilton depression scale was applied to all patients. Primary dysmenorrhea was established in 41% of FM patients and 28% of the control group. A statistically significant difference was found in PD between the two groups (p=0.03). PMS was established in 42% of the FM patients and 25% of the control group. A statistically significant difference was found in PMS between the two groups (p=0.03). There is an increased frequency of premenstrual syndrome and dysmenorrhea in FM patients. The patients with high symptom severity scores and high depression scores among the FM patients are at risk of PMS and PD. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

  8. Evaluation of surgical treatment of carpal tunnel syndrome using local anesthesia

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    Marco Felipe Francisco Honorato Barros

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the results and complications from surgical treatment of carpal tunnel syndrome by means of an open route, using a local anesthesia technique comprising use of a solution of lidocaine, epinephrine and sodium bicarbonate. MATERIAL AND METHODS: This was a cohort study conducted through evaluating the medical files of 16 patients who underwent open surgery to treat carpal tunnel syndrome, with use of local anesthesia consisting of 20 mL of 1% lidocaine, adrenaline at 1:100,000 and 2 mL of sodium bicarbonate. The DASH scores before the operation and six months after the operation were evaluated. Comparisons were made regarding the intensity of pain at the time of applying the anesthetic and during the surgical procedure, and in relation to other types of procedure. RESULTS: The DASH score improved from 65.17 to 16.53 six months after the operation (p < 0.01. In relation to the anesthesia, 75% of the patients reported that this technique was better than or the same as venous puncture and 81% reported that it was better than a dental procedure. Intraoperative pain occurred in two cases. There were no occurrences of ischemia. CONCLUSION: Use of local anesthesia for surgically treating carpal tunnel syndrome is effective for performing the procedure and for the final result.

  9. Successful Management of Pregnancy Complicated by Klippel-Trenaunay Syndrome Using MR Angiography-Based Evaluation

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    Reiko Tanaka

    2011-01-01

    Full Text Available Klippel-Trenaunay syndrome (KTS is a rare congenital disease, and extensive cutaneous hemangiomas and abnormal venous vessels are characteristic. In our case, to manage her pregnancy with KTS, whole-body MRA was performed before delivery. A 29-year-old woman was referred at 28 weeks because of prominent vulvovaginal varicosities due to KTS. At 35 weeks, hypertrophy and multiple venous varicosities of her leg as well as massive vulvovaginal varicosities became prominent with a normal coagulation profile. Systematic MRAs revealed hemangiomas and varicosities in the right leg, the lower abdomen, and the pubic region, while no obvious AVM was detected around the bronchial tube and spine. We decided to deliver her baby by cesarean section at 37 weeks under general anesthesia, and a healthy baby was delivered. No blood transfusion was required. Prophylaxis against thrombosis was performed after the operation. She was discharged with her baby. Her vulvovaginal varicosities shrunk considerably one month later.

  10. How Executive Functions Are Evaluated in Children and Adolescents with Cerebral Palsy? A Systematic Review.

    Science.gov (United States)

    Pereira, Armanda; Lopes, Sílvia; Magalhães, Paula; Sampaio, Adriana; Chaleta, Elisa; Rosário, Pedro

    2018-01-01

    Aims: The aim of the present study was to examine how executive functions are assessed in children and adolescents with Cerebral Palsy. Method: A systematic literature review was conducted using four bibliographic databases (WebScience, Scopus, PubMed, and Psycinfo), and only studies that evaluated at least one executive function were selected. Both the research and reporting of results were based on Cochrane's recommendations and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Results: The instrument most frequently used was the D-KEFS. All studies point to the existence of impairments in the executive functions among children and adolescents with Cerebral Palsy with an impact on several cognitive and life domains. Interpretation: There is a need to further systematize the research protocols to study the executive functions and their assessment in the intervention context. Findings of this review presented a diversity of tests (e.g., D-KEFS) or tasks (e.g., The inhibitory ability task) used with children with Cerebral Palsy. However, no information was given about adaptations performed to the test/task to meet Cerebral Palsy's specificities. Future research could consider including this information, which is key both to researchers and practitioners. The results of this study have important implications and suggestions for future avenues and guidelines for research and practice.

  11. Patient involvement in a systematic review: Development and pilot evaluation of a patient workshop.

    Science.gov (United States)

    Brütt, Anna Levke; Meister, Ramona; Bernges, Tabea; Moritz, Steffen; Härter, Martin; Kriston, Levente; Kühne, Franziska

    2017-11-01

    Patient involvement (PI) in research is increasingly required as a means to improve relevance and meaningfulness of research results. PI has been widely promoted by the National Institute for Health Research in England in the last years. In Germany, widespread involvement of patients in research is still missing. The methods used to realize PI have been developed mainly in English research contexts, and detailed information on how to involve patients in systematic reviews is rare. Therefore, the aim of the study was that patients contribute and prioritize clinically relevant outcomes to a systematic review on meta-cognitive interventions, and to evaluate a patient workshop as well as patients' perceptions of research involvement. Seven patients with experience in psychiatric care participated in our workshop. They focused on outcomes pre-defined in the review protocol (e.g., meta-cognitive or cognitive changes, symptomatology, quality of life), neglected other outcomes (like satisfaction with treatment, acceptability), and added relevant new ones (e.g., scope of action/autonomy, applicability). Altogether, they valued the explicit workshop participation positively. However, some suggested to involve patients at an earlier stage and to adapt the amount of information given. Further systematic reviews would benefit from the