Evidence-based Systematic Review Research Articles

Review of randomized controlled trials of nutritional supplementation in people living with HIV

Review of randomized controlled trials of nutritional supplementation in people living with HIV Alicia Sneij, Adriana Campa, Marianna K Baum Stempel College of Public Health and Social Work, Florida International University, Modesto Maidique Campus, Miami, FL, USA Background: Nutritional deficiencies are widespread in people living with HIV (PLWH), prior to the antiretroviral treatment (ART). Nutrient deficiencies and other nutrition-related conditions, however, have been identified in patients receiving ART. Trials of nutritional supplementation have been conducted to alleviate these nutritional conditions and improve or reverse nutrition-related outcomes. This review aims to evaluate the benefits of supplementation, its unintended adverse effects, and the difference in approach and focus, research design, formulations, and outcomes between those randomized clinical trials (RCTs) conducted before and after the initiation of ART. Methods: An evidence-based systematic review of the literature was conducted using electronic databases and the resources of the Florida International University Research Library. Forty-two RCTs were selected for review, and their design and outcomes were compared and contrasted conceptually and in the form of tables. Results: Most of the RCTs (n=31) were conducted before the advent of ART, and their aims were delaying disease progression, reversing malnutrition, and improving pregnancy outcomes in women and infants infected with HIV. The RCTs conducted with coadministration of ART were fewer (n=11), with relative smaller sample size, of shorter duration, and mainly focused on preventing or ameliorating the nutrition-related conditions generated by the chronic infection, its treatment, and the aging of PLWH. Conclusion: As ART is becoming more accessible worldwide, and people are living longer with the disease, more longitudinal trials of nutritional interventions with larger sample sizes are needed to study the nutritional consequences and potential treatments for PLWH. Keywords: HIV, antiretroviral therapy, micronutrients, probiotics, AIDS, randomization, clinical trial

Sexually transmitted infections in children as a marker of child sexual abuse and direction of future research.

This review considers recent evidence on sexually transmitted infections (STIs) as a marker of child sexual abuse (CSA), when diagnosed after the neonatal period. It also aims to identify if there are specific areas where additional research is required. An evidence-based systematic review using strict inclusion criteria shows that CSA is a major cause of STIs in children. In children 12 years and below, 36-83% of Neisseria gonorrhoeae and 75-94% of Chlamydia trachomatis infections are due to CSA; for children 14 years and younger, 31-58% of anogenital warts are due to CSA. In child genital sampling, genital human papillomavirus (HPV) types were more common in those considered abused (13.7%) than nonabused (1.3%). HPV typing of genital warts in children were all of genital type 6. Subsequent research, into N. gonorrhoeae, C. trachomatis, Trichomonas vaginalis and syphilis in children including ophthalmic infection, found that 13 of 15 cases were confirmed/likely due to CSA. Recent data indicate that bacterial vaginosis and Mycoplasma genitalium are related to sexual activity in adults but did not assess children. STIs in children under 13-14 years may indicate CSA. Genital HPV types are associated with CSA. Research is required of sufficient standard to contribute to the evidence base.

The use of magnetically controlled growing rod device for pediatric scoliosis.

Objective:To study the safety and efficacy of an innovative device using distraction-based magnetically controlled growing rods (MCGR) for the treatment of pediatric scoliosis.Methods:This is an evidence-based systematic review of literature for the surgical management of patients with pediatric scoliosis using MCGR technique. Six clinical studies regarding the use of MCGR were included in this review, with a total of 68 patients, and mean age of 8.38 years. The dual-rod (DR) technique of rod construct with MCGR was used in 33.85% and the single-rod (SR) in 66.15% of the patients.Results:The mean preoperative main coronal curve for the DR was 65.9°, and for the SR was 69.6° (p>0.05). At the latest follow-up, it was 36.8° for DR and 43.0° for SR (p<0.05). The mean preoperative T1-S1 spinal length was 298.7 mm for the DR and 303.5 mm for the SR group (p<0.05). According to the latest follow-up, using the DR construct, the spinal length increased to 347 mm with 13.92% of total lengthening; and using the SR construct, the average lengthening was 339 mm, with 10.48% of total lengthening (p<0.05). Postoperative complications were similar, 25% in DR and 31.57% in the SR group (p>0.05).Conclusion:Level IV of medical evidence supports the use of MCGR as a safe and effective alternative for the treatment of severe pediatric scoliosis. Recommendation Grade C supports the role of MCGR with DR construct as an option to achieve a better correction of the scoliotic curve and to maximize the postoperative T1-S1 spinal length.

Reconstructive surgery for hypospadias: A systematic review of long-term patient satisfaction with cosmetic outcomes.

Introduction:Research on long-term results of hypospadias has focused on surgical techniques and functional outcomes, and it is only recently that patient satisfaction with appearance and psychosocial outcomes have been considered. The aim of this study was to provide an evidence-based systematic review of adolescent and adult patient perceptions of cosmetic outcomes following childhood surgery for hypospadias.Methods:A systematic review was performed in accordance with the PRISMA and PICO guidelines, and studies assessed using the Oxford Centre for Evidence-Based Medicine system. MEDLINE, PsycInfo, EMBASE, and CINAHL databases were searched from 1974 to 2014 for clinical studies containing patient perceptions of appearance, deformity, and social embarrassment following hypospadias surgery.Results:A total of 495 publications were retrieved, of which 28 met the inclusion criteria. Due to study design/outcome measure, heterogeneity data were synthesized narratively. Results indicate (i) patient perceptions of penile size do not differ greatly from the norm; (ii) perceptions of appearance findings are inconsistent, partially due to improving surgical techniques; (iii) patients who are approaching, or have reached, sexual maturity hold more negative perceptions and are more critical about the cosmetic outcomes of surgery than their prepubertal counterparts; (iv) patients report high levels of perceptions of deformity and social embarrassment; and (v) there is a lack of data using validated measurement tools assessing long-term patient perceptions of cosmetic outcomes, particularly with patients who have reached genital maturity.Conclusions:Protocols for clinical postpuberty follow-up and methodologically sound studies, using validated assessment tools, are required for the accurate assessment of cosmetic and psychological outcomes of hypospadias surgery.

Efficacy and safety of botulinum toxin injection for benign prostatic hyperplasia: a systematic review and meta-analysis.

The aim of this study was to overcome the limitation of overlooking the placebo effect in previous studies and to demonstrate the overall treatment efficacy and safety of botulinum toxin type A (BTX-A) compared with placebo. We conducted a systematic review and meta-analysis of the published literature in PubMed, Cochrane Library, and Embase reporting on BTX use in lower urinary tract symptoms (LUTS)/benign prostate hyperplasia (BPH). Single-group analysis for the placebo effect and meta-regression analysis for the moderator effect were performed with high-quality RCTs compared with placebo. A total of three studies were included, with a total sample size of 522 subjects (260 subjects in the experimental group and 262 subjects in the control group). Study duration ranged from 8 to 24 weeks. The pooled overall SMD in the mean change in IPSS for the BTX-A group versus the placebo group was -1.02 (95 % CI -1.97, -0.07). The other outcomes (Q max, prostate volume, and post-voided residual volume) were not statistically different between the two groups. The placebo effect in single-group analysis ranged from 0 to 27.9 % for IPSS, and from -1.1 to 28.7 % for Q max (lowest to highest, respectively). This evidence-based systematic review and meta-analysis of the BTX-A injection for LUTS/BPH showed no differences in efficacy compared with placebo and also showed no difference in procedure-related adverse events occurred. Thus, the results of this study do not provide evidence of clinical benefits of using the BTX-A injection for LUTS/BPH in real clinical practice.

Clinical perspectives on medical marijuana (cannabis) for neurologic disorders.

The American Academy of Neurology published an evidence-based systematic review of randomized controlled trials using marijuana (Cannabis sativa) or cannabinoids in neurologic disorders. Several cannabinoids showed effectiveness or probable effectiveness for spasticity, central pain, and painful spasms in multiple sclerosis. The review justifies insurance coverage for dronabinol and nabilone for these indications. Many insurance companies already cover these medications for other indications. It is unlikely that the review will alter coverage for herbal marijuana. Currently, no payers cover the costs of herbal medical marijuana because it is illegal under federal law and in most states. Cannabinoid preparations currently available by prescription may have a role in other neurologic conditions, but quality scientific evidence is lacking at this time.

Spinal cord stimulation for Parkinson's disease: a systematic review.

Axial symptoms are a late-developing phenomenon in the course of Parkinson's disease (PD) and represent a therapeutic challenge given their poor response to levodopa therapy and deep brain stimulation. Spinal cord stimulation (SCS) may be a new therapeutic approach for the alleviation of levodopa-resistant motor symptoms of PD. Our purpose was to systematically review the effectiveness of SCS for the treatment of motor symptoms of PD and to evaluate the technical and pathophysiological mechanisms that may influence the outcome efficacy of SCS. A comprehensive literature search was conducted using electronic databases for the period from January 1966 through April 2014. The methodology utilized in this work follows a review process derived from evidence-based systematic review and meta-analysis of randomized trials described in the PRISMA statement. Reports examining SCS for the treatment of PD are limited. Eight studies with a total of 24 patients were included in this review. The overall motor score of the Unified Parkinson's Disease Rating Scale in the on/off-stimulation condition remained unchanged in 6 patients and improved in 18 patients after SCS. SCS appears to yield positive results for PD symptoms, especially for impairments in gait function and postural stability. However, evidence is limited and long-term prospective studies will be required to identify the optimal candidates for SCS and the best parameters of stimulation and to fully characterize the effects of stimulation on motor and nonmotor symptoms of PD.

Epidemiology and burden of alopecia areata: a systematic review.

BackgroundAlopecia areata (AA) is an autoimmune disorder characterized by patches of non-scarring alopecia affecting scalp and body hair that can be psychologically devastating. AA is clinically heterogenous, and its natural history is unpredictable. There is no preventative therapy or cure.ObjectiveThe objective of this study is to provide an evidence-based systematic review on the epidemiology and the burden of AA.Methods and selection criteriaA search was conducted of the published, peer-reviewed literature via PubMed, Embase, and Web of Science. Studies published in English within the last 51 years that measured AA’s incidence, prevalence, distribution, disability-adjusted life years (DALYs), quality of life, and associated psychiatric and medical comorbidities were included. Two authors assessed studies and extracted the data.ResultsThe lifetime incidence of AA is approximately 2% worldwide. Both formal population studies found no sex predominance. First onset is most common in the third and fourth decades of life but may occur at any age. An earlier age of first onset corresponds with an increased lifetime risk of extensive disease. Global DALYs for AA were calculated at 1,332,800 in 2010. AA patients are at risk for depression and anxiety, atopy, vitiligo, thyroid disease, and other autoimmune conditions.ConclusionAA is the most prevalent autoimmune disorder and the second most prevalent hair loss disorder after androgenetic alopecia, and the lifetime risk in the global population is approximately 2%. AA is associated with psychiatric and medical comorbidities including depression, anxiety, and several autoimmune disorders, and an increased global burden of disease.

Evidence-Based Systematic Review: Effects of Speech-Language Pathology Treatment for Individuals With Paradoxical Vocal Fold Motion.

In this article, our goal was to determine the state of the evidence and the effect of speech-language pathology (SLP) treatment for individuals with paradoxical vocal fold motion (PVFM). The American Speech-Language-Hearing Association's National Center for Evidence-Based Practice in Communication Disorders searched 22 electronic databases using key words related to PVFM, speech or voice treatment, and behavioral intervention for articles published through July 2013. Identified articles were systematically evaluated to assess the quality of the evidence using a modification of the American Speech-Language-Hearing Association's critical appraisal scheme. Sixty-five articles met the search criteria. Only 2 out of the 65 articles were judged to contain adequate evidence to evaluate the effect of SLP treatment for PVFM. All 65 articles exemplify the state of the evidence for SLP treatment for PVFM. The state of the evidence for the use of SLP treatment is in its infancy, with a majority of articles in the exploratory stage of research. Consequently, few clinical implications can be drawn at this time. SLP treatment for PVFM is promising; however, there is clearly a pressing need for systematic experimental studies that involve a control group to further the evidence base.

Analysis Of The Relationship Between Economic Cycle Swings And Adoption Rate Models Of Financial Innovation Diffusion

The United States financial crisis, starting with the credit boom of 2007 and ending with the failure of Lehman Brothers in September 2008, has led to a loss of confidence in the United States financial system. The Financial Crisis Inquiry Commission indicated that the financial crisis affected over 26 million Americans. Many scholars have attributed the crisis to financial innovations, such as mortgage backed securities, adjustable rate mortgages and no-income verified loans, as key innovations that led to the market collapse. Financial innovations have had both positive and negative impacts on the financial industry. Providing a framework that describes the relationship between economic cycle swings and adoption rates of innovative financial instruments can provide greater stability and predictability in financial innovation diffusion, which can lead to more stable returns for shareholders and enhance the public interest through a healthy, innovative and more stable financial industry. An abbreviated evidence-based systematic review was completed on financial innovations that led to the financial crisis of 2007. The research suggests that there is an equilibrium period of time that financial organizations can adopt innovation to avoid unintended consequences like the recent financial crisis. Providing a framework of adoption time can demonstrate where financial innovations can be absorbed to provide the organization with the ability to financially innovate during pro and counter cyclical economic periods. Through an understanding of the timing of financial innovations as they occur in economic cycles, managers of financial organizations can choose the adoption period of time more carefully which could have averted the financial crisis that affected millions of Americans.

An Evidence-Based Systematic Review on the Diagnostic Accuracy of Hearing Screening Instruments for Preschool- and School-Age Children.

The purpose of this article is to conduct an evidence-based systematic review on the accuracy of pure-tone or otoacoustic emission (OAE) screening for identifying hearing loss in preschool- and school-age children. A systematic search of the literature published between 1975 and 2013 was conducted. Articles meeting the selection criteria were critically appraised for quality. Selection criteria required that behavioral thresholds be measured in children failing the screen and in at least a subset of children passing the screen. Sensitivity and specificity were used to calculate positive and negative likelihood ratios that could be compared between instruments. Eighteen studies were included in the final analysis. There was considerable variability among studies on stimulus levels, response criteria, and definition of hearing loss. Approximately half of positive and negative likelihood ratio pairs for OAEs (52%) and pure-tone screening (45%) were considered suggestive or informative for identifying hearing loss. Both pure-tone and OAE screening can identify hearing loss in preschool- and school-age children. Studies that compared both tools in the same population concluded that pure-tone screening had higher sensitivity than OAE screening and thus was considered the preferred tool. Future research should incorporate standard stimulus levels, response criteria, and definitions of hearing loss.

Schisandra: An Evidence-Based Systematic Review by the Natural Standard Research Collaboration

Alternative and Complementary TherapiesVol. 21, No. 1 Schisandra: An Evidence-Based Systematic Review by the Natural Standard Research CollaborationPublished Online:18 Feb 2015https://doi.org/10.1089/act.2015.21105AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Schisandra: An Evidence-Based Systematic Review by the Natural Standard Research Collaboration." , 21(1), pp. 42–43FiguresReferencesRelatedDetails Volume 21Issue 1Feb 2015 Information© 2015, Mary Ann Liebert, Inc.To cite this article:Schisandra: An Evidence-Based Systematic Review by the Natural Standard Research Collaboration.Alternative and Complementary Therapies.Feb 2015.42-43.http://doi.org/10.1089/act.2015.21105Published in Volume: 21 Issue 1: February 18, 2015PDF download

Nonpharmacological interventions to prevent delirium: an evidence-based systematic review.

Development of delirium in critical care patients is associated with increased length of stay, hospital costs, and mortality. Delirium occurs across all inpatient settings, although critically ill patients who require mechanical ventilation are at the highest risk. Overall, evidence to support the use of antipsychotics to either prevent or treat delirium is lacking, and these medications can have adverse effects. The pain, agitation, and delirium guidelines of the American College of Critical Care Medicine provide the strongest level of recommendation for the use of nonpharmacological approaches to prevent delirium, but questions remain about which nonpharmacological interventions are beneficial.

Early identification of treatable inborn errors of metabolism in children with intellectual disability: The Treatable Intellectual Disability Endeavor protocol in British Columbia.

Intellectual disability (ID) is a lifelong, debilitating condition affecting 2% to 3% Canadians (1). It is defined by deficits in cognitive functioning (IQ 2 developmental domains, eg, fine/gross motor skills, speech and interaction) (2,3). In Canada, approximately 7600 to 11,500 children are born with GDD annually (1). In the present commentary, the term ID will be used to refer to ID/GDD.

An Evidence-Based Systematic Review of Beta-Glucan by the Natural Standard Research Collaboration

ABSTRACTAn evidence-based systematic review of beta-glucan by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated, reproducible grading rationale. This article includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

Degenerative changes of the sacroiliac joint after spinal fusion: an evidence-based systematic review.

The rate of fusion surgery of the lumbar spine has remarkably increased over the past 30 years. We performed a comprehensive search of studies addressing the assessment of sacroiliac joint (SIJ) after lumbar spinal fusion surgery on PubMed, OVID/Medline, Cochrane, CINAHL, Google scholar and Embase. The fusion of spinal segments leads to degenerative changes in the mobile segments above or below the fused spine, because of the increase of the stresses imposed on the adjacent levels. There is no consensus about prevalence and potential risk factors contributing to SIJ degenerative changes in patients undergoing fusion surgery. Studies using radiographic evaluation to detect degenerative changes of the SIJ are being performed. No definitive estimation about the prevalence of degenerative changes of the SIJ after fusion surgery can be provided. Further studies are required to identify the risk factors involved in post-fusion degenerative changes of the SIJ.

Coenzyme Q10: An Evidence-Based Systematic Review by the Natural Standard Research Collaboration

Coenzyme Q10: An Evidence-Based Systematic Review by the Natural Standard Research Collaboration

An Evidence-Based Systematic Review of Black cohosh (Cimicifuga racemosa, Actaea racemosa) by the Natural Standard Research Collaboration

ABSTRACTAn evidence-based systematic review of black cohosh (Cimicifuga racemosa, Actaea racemosa) by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated, reproducible grading rationale. This article includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

GRAPPA treatment recommendations: an update from the GRAPPA 2013 Annual Meeting.

Psoriatic arthritis (PsA) is a chronic systemic inflammatory disorder characterized by the association of arthritis and periarticular inflammation in patients with psoriasis. In addition to a heterogeneous and variable clinical course, PsA is complex and multifaceted and may include prominent involvement in the peripheral and axial diarthrodial joints, the skin and nails, and in periarticular structures such as entheses. A central mission of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) is to develop guidelines, based upon the best scientific evidence, for the optimal treatment of patients with PsA. Guidelines were previously published in 2009 based on an evidence-based systematic review. Given important recent developments and robust ongoing research into the treatment of PsA, GRAPPA undertook to update the guidelines. Herein we outline the specific methods and procedures used both in the initial and the current evidence-based, systematic reviews of treatments for PsA. We also review the numerous discussions regarding how best to finalize and publish these new guidelines in 2014.

An Evidence-Based Systematic Review of Kudzu (Pueraria lobata) by the Natural Standard Research Collaboration

ABSTRACTAn evidence-based systematic review of kudzu (Pueraria lobata) by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated, reproducible grading rationale. This article includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.