Best Level Of Evidence Research Articles

Erratum] Non-invasive brain stimulation in craving disorders: evidence-based umbrella review

INTRODUCTION: The use of brain stimulation in the control of craving disorders is controversial, mainly in relation to the best target, technique, duration, frequency and parameters. Several meta-analyses have been published, and their data should be summarized to support the best evidence-based clinical practice. OBJECTIVE: To provide the best level of evidence for the use of non-invasive brain stimulation (NIBS) in the control of craving disorders. METHODS: Umbrella review registraded on Prospero (CRD42021239577), and conducted according to PRISMA recommendations. The methodological quality and evidence level were assessed through AMSTAR, AMSTAR rank and GRADE. RESULTS: A total of 81 meta-analyses were screened and the final analysis was made on 10 studies including 224 randomized clinical trials (RCTs) enrolling 5,555 patients. The main targets of stimulation were the right, left and bi-hemispheric dorsolateral prefrontal cortices. The studies used anodal tDCS, and high-frequency rTMS. The protocols with the larger effect sizes were anodal tDCS with 2mA, for 30 minutes over the right DLPFC (g=0.45; 95%CI 0.328-0.583; p<0.001), and high-frequency rTMS (10Hz), with 100% of the resting motor threshold, over the left DLPFC (g=1.116; 95%CI 0.597-1.634; p<0.001). The quality of evidence ranged from very low to moderate because of inconsistencies mainly due to sample heterogeneity. CONCLUSION: The results of 10 meta-analyses assessing the efficacy of NIBS in the control of craving disorders are robust regarding the effect sizes and provide evidence that bi-hemispheric tDCS and high-frequency rTMS over the DLPFC are effective in the control of craving disorders. However, the evidence level is from low to moderate.

Effect of aerobic exercise on the improvement of executive function in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis.

Aerobic exercise (AE) interventions are beginning to be used as an emerging adjunctive treatment modality in the treatment of children with Attention Deficit Hyperactivity Disorder (ADHD). However, to date, there is no substantial evidence to support the improved effects of aerobic exercise intervention in children with ADHD aged 6-12 years. This study aims to investigate the effect of aerobic exercise therapy on executive function in children with attention deficit hyperactivity disorder aged 6-12 years. We conducted a systematic review and meta-analysis using PubMed and Web of Science. The cut-off date was June 1, 2023. The aim was to assess the impact of aerobic exercise interventions on children with ADHD and all randomized controlled trials eligible for aerobic exercise interventions for children with ADHD were included. Nine randomized controlled trials were screened for eligibility for systematic evaluation, and the nine studies were assessed for risk of bias using the PEDro score and the GRADE Quality of Evidence Evaluation System for quality grading of outcome indicators. After testing for heterogeneity, a random-effects model was selected for analysis. Finally, meta-analyses and regression analyses were performed on the core functions (inhibitory control, cognitive flexibility, and working memory) and subgroups of the nine studies on executive function using Revman 5.4 and Stata 16.0. The risk of bias evaluation showed a mean PEDro score of 7.78, and of the nine studies, two were rated as having excellent methodological quality, while the remaining seven had a good level of evidence, and the GRADE evidence evaluation showed that the outcome indicators were all of moderate quality. Inhibitory control [SMD = 0.83,95% CI (0.37-1.29), Z = 3.51, p = 0.0005], cognitive flexibility [SMD = 0.65,95% CI (0.37-0.93), Z = 4.58, p < 0.00001], and working memory [SMD = 0.48,95% CI (0.02-0.95), Z = 2.03, p = 0.04] were statistically significant, with effect sizes of moderate or higher; furthermore, in subgroup analyses type of intervention, duration, intensity, and medication use had different effects on inhibitory control and cognitive flexibility, and the combined IC, CF statistic found that a single category of aerobic exercise ( β = 0.867, p < 0.001), moderate intensity ( β = 0.928, p < 0.001), 6-12 weeks (β = 0.804, p < 0.001), 60-90 min ( β = 0.894, p < 0.001), and the use of medication ( β = 1.202, p = 0.002) were better for overall improvement in EF. Aerobic exercise therapy significantly improved executive functioning in children with ADHD, showing above moderate effect sizes especially in inhibitory control, cognitive flexibility, and working memory. Aerobic exercise therapy can be used as a reference in improving executive function in children with ADHD, but given the limitations of this study, it should be used with caution when applied in clinical settings.

Current practices of psychoeducation interventions with persons with bipolar disorders: a literature review.

This review sought to summarize the literature on current practices and forms of psychoeducation in the management of patients with bipolar disorder (BD), including only randomized controlled trials to ensure the best level of evidence. An extensive review of the available literature was conducted using PubMed/MEDLINE, Embase, and PsychInfo databases from inception to April 28th, 2022. The search yielded 381 studies. Seventy articles were included after removing duplicates and applying the inclusion/exclusion criteria. A best-evidence synthesis was used to identify the key results of each study and summarize the outcomes. Eleven descriptive categories were made. They encompass different forms of psychoeducation compared or combined with other psychosocial interventions, varying in setting (individual or group), with or without family members, structured or unstructured, mediated or not by digital tools (smartphone, internet). Globally, these studies show that psychoeducation is important in the treatment of BD, as it leads to a decrease in relapses, mood episodes, hospitalizations, and improved functioning or quality of life. Some studies also showed the benefits of psychoeducation on the patient's level of knowledge of pharmacological treatment and the disorder or compliance with medication, as well as reduced self-stigma. The limitations of this review are linked to the selection of only RCTs and the reliance on their post-hoc analyses. This review confirms the benefit of psychoeducation and psychosocial interventions on the evolution of BD (in different outcomes, including quality of life, relapse, and rehospitalization rates, for example). More recent interventions, such as mindfulness or online psychoeducation, represent an interesting option but more evidence is needed.

OP159 Quality Of Evidence For Clinical Benefit Of Cancer Medicines Assessed For Funding In Australia

IntroductionThis study aimed to describe the type of evidence available for and the clinical benefit of cancer medicines assessed for funding in Australia by the Pharmaceutical Benefits Advisory Committee (PBAC). The evidence was assessed with the European Society of Medical Oncology Magnitude of Clinical Benefit Scale version 1.1 (ESMO-MCBS).MethodsAll data on applications submitted to PBAC between 2010 and 2020 were independently extracted in duplicate from PBAC Public Summary Documents available online. Any disagreements were resolved through discussion. ESMO-MCBS ratings were retrieved from the ESMO-MCBS website. Substantial benefit for the ESMO-MCBS was defined as a grade A or B for (neo)adjuvant intent and four or five for palliative intent.ResultsIn the study period, 182 cancer indications for 100 cancer medicines were examined by PBAC, including 124 (68%) for solid tumors (116 in the palliative setting) and 58 (32%) for hematological cancers. A total of 138 (76%) indications were recommended for public funding, 40 (22%) were rejected, and four (2%) were deferred. Randomized controlled trials (RCTs) were the main source of evidence in 154 indications (85%) and single-arm studies in 27 (15%) indications. RCTs were available in 113 (91%) and 41 (71%) of the solid tumor and hematological cancer indications, respectively. In submissions with RCTs, mature overall survival (OS) was reported in 81 (53%) indications. For indications with a statistically significant improvement in OS, the median gain was 3.0 months (range 0.9 to 17.0) for solid tumors and 8.2 months (range 1 to 9.1) for hematological cancers. The ESMO-MCBS score was available for 99 solid tumor indications. For indications in the palliative setting, 47 (52%) had substantial clinical benefit according to ESMO-MCBS v1.1, including 35 (51%) indications recommended by PBAC and six (35%) indications that were rejected.ConclusionsThese results show that only a minority of cancer medicine indications considered by PBAC are supported by a good level of evidence and provide a modest extension of patient survival.

Effectiveness of group aerobic and/or resistance exercise programs associated with pelvic floor muscle training during prenatal care for the prevention and treatment of urinary incontinence: A systematic review.

To evaluate the effectiveness of aerobic and/or resistance group exercise programs associated with pelvic floor muscle training (PFMT) during prenatal care for the prevention and treatment of urinary incontinence (UI) using the best level of evidence. A search was carried out in the MEDLINE/PubMed, LILACS, PEDro, CENTRAL, and SCOPUS databases, without restrictions. The terms "urinary incontinence" and "pregnant woman" were used. Randomized and quasi-randomized clinical trials were included using aerobic and/or resistance exercise programs plus PFMT as an intervention compared to usual care. The Cochrane tool (RoB 2.0) and GRADE were used to assess risk of bias and certainty of evidence, respectively. Quantitative analysis was assessed by meta-analyses. Five publications were included. There was a reduction in the reports of UI postintervention at 16 weeks (RR: 0.83; 95% CI: 0.74-0.93, one study, 762 women, random effects: p = 0.002) and after 3 months (RR: 0.76; 95% CI: 0.60-0.95, one study, 722 women, random effects: p = 0.02), based on moderate certainty of evidence and improvement in UI-specific quality of life (MD: -2.42; 95% CI: -3.32 to -1.52, one study, 151 women, random effects: p < 0.00001), based on low quality of evidence. Other results showed no difference between the postintervention groups, with low and very low evidence. There is moderate evidence that the aerobic and/or resistance exercise program associated with PFMT compared to usual care can reduce postintervention UI, as well as 3 months postintervention, and that it can improve UI-specific quality of life, but with low-evidence certainty.

Non-invasive brain stimulation in craving disorders: evidence-based umbrella review

INTRODUCTION: The use of brain stimulation in the control of craving disorders is controversial, mainly in relation to the best target, technique, duration, frequency and parameters. Several meta-analyses have been published, and their data should be summarized to support the best evidence-based clinical practice. OBJECTIVE: To provide the best level of evidence for the use of non-invasive brain stimulation (NIBS) in the control of craving disorders. METHODS: Umbrella review registraded on Prospero (CRD42021239577), and conducted according to PRISMA recommendations. The methodological quality and evidence level were assessed through AMSTAR, AMSTAR rank and GRADE. RESULTS: A total of 81 meta-analyses were screened and the final analysis was made on 10 studies including 224 randomized clinical trials (RCTs) enrolling 5,555 patients. The main targets of stimulation were the right, left and bi-hemispheric dorsolateral prefrontal cortices. The studies used anodal tDCS, and high-frequency rTMS. The protocols with the larger effect sizes were anodal tDCS with 2mA, for 30 minutes over the right DLPFC (g=0.45; 95%CI 0.328-0.583; p&lt;0.001), and high-frequency rTMS (10Hz), with 100% of the resting motor threshold, over the left DLPFC (g=1.116; 95%CI 0.597-1.634; p&lt;0.001). The quality of evidence ranged from very low to moderate because of inconsistencies mainly due to sample heterogeneity. CONCLUSION: The results of 10 meta-analyses assessing the efficacy of NIBS in the control of craving disorders are robust regarding the effect sizes and provide evidence that bi-hemispheric tDCS and high-frequency rTMS over the DLPFC are effective in the control of craving disorders. However, the evidence level is from low to moderate.

Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS®) Society Recommendations Part 2-Emergency Laparotomy: Intra- and Postoperative Care.

This is Part 2 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy (EL) using an Enhanced Recovery After Surgery (ERAS) approach. This paper addresses intra- and postoperative aspects of care. Experts in aspects of management of high-risk and emergency general surgical patients were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and Medline database searches were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized clinical trials, systematic reviews, meta-analyses, and large cohort studies and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on elective patients when appropriate. A modified Delphi method was used to validate final recommendations. Some ERAS® components covered in other guideline papers are outlined only briefly, with the bulk of the text focusing on key areas pertaining specifically to EL. Twenty-three components of intraoperative and postoperative care were defined. Consensus was reached after three rounds of a modified Delphi Process. These guidelines are based on best available evidence for an ERAS® approach to patients undergoing EL. These guidelines are not exhaustive but pull together evidence on important components of care for this high-risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies.

Peri-implantitis as the consequence of errors in implant therapy.

Peri-implantitis is a plaque-associated pathologic condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. It is a highly prevalent disease, as extensively estimated by large-population, cross-sectional studies. As peri-implant diseases represent opportunistic infections, it is reasonable to assume that nonideal conditions, local and/or general, may favor the progression of peri-implant inflammation. Some of these conditions could be a result of poor planning and/or inadequate execution of any step of the entire process treatment. This article describes the major possible factors in implant therapy that may lead to peri-implantitis. For some of these (ie, inappropriate patient selection, insufficient periodontal therapy, lack of diagnosis and management of peri-implant mucositis, erratic supportive peri-implant/periodontal therapy) there is a good level of evidence, whereas for others (ie, wrong implant placement, poor postoperative care, inadequate prosthetic reconstruction, lack of assessment and management of peri-implant soft-tissue deficiencies) there is little scientific evidence. More research is therefore needed to clearly identify the errors and/or complications possibly leading to peri-implantitis, particularly over the long term.

밀러피셔 증후군의 한의학적 치료에 대한 국내 연구 현황

Objectives This study aimed to analyze the Korean medical treatment methods for Miller-Fisher syndrome from January 01, 2000 to December 31, 2021. Methods Six online databases (KISS, SCIENCEON, DBpia, RISS, KMBASE, and KoreaMed) were searched for clinical studies related to Miller-Fisher syndrome. Results Thirteen case reports were selected out of the 85 studies, and a total of 13 cases were analyzed. There were five kinds of Korean medicine treatment that were used in these studies. Acupuncture and herbal medicine were the most used interventions. Conclusions Korean medical treatment is found to be effective for Miller-Fisher syndrome. Although several limits remain, we expect that further research will be conducted to provide a better level of evidence.

Conservative Non-surgical Options for Erectile Dysfunction.

This study aimed to review recent evidence on conservative non-surgical options for erectile dysfunction (ED) in men. A narrative review of the literature was performed. A comprehensive search in the MEDLINE, Embase, and Cochrane databases was done. Papers in English language, published from May 2017 until May 2022, were included. Papers reporting basic research or animal research were excluded, as long as reviews or meta-analyses. Congress reports, clinical cases, or clinical trials protocols with no results were also excluded. We found a multitude of different treatment modalities for ED. We must take into account the type of patient, their comorbidities, the origin of their ED, and its severity in order to reproduce effective results using these therapies. Some of the treatments show good results with a good level of evidence (new IPDE5 formulations, intracavernous injections, shock wave therapy, hormonal theraphy, psycho-sexual theraphy). However, others (some new molecules, stem cell theraphy, platelet-rich plasma injections, oxygenation-based therapy, nutraceuticals), although some of them present promising results, require randomized studies with a larger number of patients and a longer follow-up time to be able to establish firm recommendations. Regarding the conservative treatment of erectile dysfunction, in recent years, some therapies have been consolidated as effective and safe for certain types of patients. On the other hand, other treatment modalities, although promising, still lack the evidence and the necessary follow-up to be recommended in daily practice.

Measuring subjective aspects of participation in adults with disabilities: A systematic review of the coverage, content validity and internal structure of standardised instruments

Objective To systematically review evidence on the coverage, content validity and internal structure of self-report measures capturing subjective aspects of participation for adults with disabilities. Data sources EMBASE, MEDLINE and reference lists were searched until July 10th, 2022 for articles on measurement properties of instruments measuring participation as defined in the International Classification of Functioning, Disability and Health, from a subjective perspective. Method Each instrument was assessed for its coverage of subjective aspects of participation. The Consensus-based Standards for the Selection of Health Measurement Instruments were used to assess the quality of each study. Content validity and internal structure (structural validity, internal consistency and cross-cultural validity) were rated against published standards and qualified by the adapted Grading of Recommendations Assessment, Development and Evaluation. Results Thirty-eight studies regarding 10 instruments were analysed. Most instruments mix activity and participation items. Only the Measure of Experiential Aspects of Participation (with high-quality evidence of sufficient structural validity and generally sufficient internal consistency), the Participation Enfranchisement and the Community Integration Measure showed adequate coverage. For all instruments, evidence of content validity is of low- to very low quality. There is high-quality evidence that the Participation Scale is not unidimensional. Conclusion In general, the coverage and the evidence for content validity and internal structure of measures capturing experiential aspects of participation are limited. The Measure of Experiential Aspects of Participation has the best level of evidence in support of its use. The score of the Participation Scale cannot be considered an adequate reflection of participation.

Promoting Comfort: A Clinician Guide and Evidence-Based Skin Care Plan in the Prevention and Management of Radiation Dermatitis for Patients with Breast Cancer.

Patients with breast cancer may be offered adjuvant radiation therapy (RT) after surgery. Up to 95% of these patients develop radiation dermatitis (RD) during or following RT. Randomized clinical trials and other literature provide evidence that RD can be prevented or reduced. The aim of this article is to propose a Clinician Guide and Evidence-based Skin Care Plan to prevent and/or reduce radiation dermatitis and promote the comfort of breast cancer patients receiving RT. As an integrative review, the databases searched were CINAHL and Medline, using the key terms: breast cancer, skin care, radiation, radiation therapy, radiotherapy, radiation dermatitis, and radiation skin reaction, prevention, and management. Search criteria included English language, full text, published between 2012 through 2020, and peer-reviewed. The search yielded 320 articles. Relevant articles were evaluated using the Quality Assessment Tool (QAT), and highly rated articles were selected to be included in the review of literature. The outcomes were the development of a Clinician Guide to offer holistic, patient-centered care and an Evidence-based Skin Care Plan. The research literature supports a standard skin care regimen, along with use of an emollient cream to the treatment area, use of deodorants depending on patient preferences, and application of a topical steroid cream daily throughout treatment and two weeks post RT. Clinician’s weekly assessments of patients offers therapeutic support and ensures optimal skin care during and post-RT. The comfort of breast cancer patients receiving RT requires the best level of evidence regarding the efficacy of interventions, coupled with clinician’s judgement, and patient’s preferences and wishes. The clinician-patient relationship is essential in addressing the physical, emotional, social, spiritual, and functional challenges associated with a cancer diagnosis and adjunctive radiation therapy to improve long-term survival.

Increasing Levels of Evidence in Rhinoplasty: Stepping Up Our Role as Leaders in the Specialty.

Increasing Levels of Evidence in Rhinoplasty: Stepping Up Our Role as Leaders in the Specialty.

Development of a Designer’s Checklist for the Designing of an Optimal Healing Environment in Primary, Secondary, and Tertiary Healthcare Facilities (HFCS)

The purpose of this research is to develop a designer’s checklist encompassing the various categories of healthcare facilities (HCFs). This checklist is based on the research available about the elements/factors of the healing environment. An evidence-based design was used to conduct this study. Online database searches on Google Scholar, JSTOR, Scopus, and PubMed using various keywords, such as healing environment, evidence-based design, patient safety, infection, medical errors, patient falls, stress reduction, social support, single bedroom, views of nature, daylighting, music therapy, and noise levels in a healthcare setting were used for data collection. The collected data was analyzed based on the level of evidence and sorted accordingly for the development of three types of a designer’s checklist encompassing optimal healing environments. All the elements/ factors of environmental design were coded according to their level of evidence and were sorted into three categories: 1) Fair level of evidence (F) comprising expert opinions, case series, and case reports, 2) Good level of evidence (G) comprising cohort studies and case-control studies, and 3) Excellent level of evidence (E) comprising randomized controlled trials and systematic reviews. To create an optimal healing environment, this study proposes three different levels of healing environments corresponding with the three levels of HCFs as follows: 1)healing environment Level-I for tertiary HCFs includes elements/ factors of environmental design with E, G, and F levels of evidence, 2)healing environment Level-II for secondary HCFs includes elements/ factors of environmental design with E and G levels of evidence, and 3)healing environment Level-III for primary HCFs includes elements/ factors of environmental design with E level of evidence. This study makes the designing and renovation of HCFs to create an optimal healing environment easily measurable and achievable.&#x0D; Keywords: Checklist, healing environment, healthcare facilities (HCFs), hospital design, measurement

Protocol for the clinical practice of photodynamic therapy in endodontics: assessment of guideline quality using the AGREE II instrument

BackgroundThe choice of parameters in Photodynamic Therapy for endodontic treatment, such as wavelength, energy, application time, and number of sessions can vary based on the characteristics of the procedure and the patient. Providing information supported by scientific evidence in an accessible way to clinicians who are unfamiliar with the literature is necessary. Thus, this study aimed to synthesize a clinical protocol for the use of photodynamic therapy in endodontics in permanent teeth. MethodsProtocols with high methodological quality were identified using a literature search and the Appraisal of Guidelines Research and Evaluation Instrument (AGREE II), a validated tool for assessing quality. The recommendations of these studies were synthesized and submitted to a group of experts for evaluation and adaptation, and consensus was assessed using the Delphi methodology. ResultsThe analysis of the literature on the application of antimicrobial photodynamic therapy in endodontics showed that clinical trials with good levels of evidence and clinical recommendations have been reported previously, with two studies identified as having a clinical recommendation level of A1A and an evidence level of A. ConclusionThe written protocol was considered to be satisfactory and as having appropriate content validity during the second round of evaluation by the experts. The studies included in this research were predominantly explanatory in nature, highlighting the need for pragmatic designs to increase the degree of clinical applicability.

Brazilian Guidelines for Nutrition in Cystic Fibrosis.

ABSTRACTObjective To develop a scientific consensus on nutrition in cystic fibrosis.Methods Sixteen coordinators elaborated relevant questions on nutritional therapy in cystic fibrosis, which were divided into six sections: nutritional assessment, nutritional recommendations, nutritional intervention, dietary counseling, special situations and enzyme replacement, and gastrointestinal manifestations. Two to three specialists in the field were responsible for each section and obtaining answers formulated based on standardized bibliographic searches. The available literature was searched in the PubMed®/MEDLINE database, after training and standardization of search strategies, to write the best level of evidence for the questions elaborated. Issues related to disagreement were discussed until a consensus was reached among specialists, based on the current scientific literature.Results Forty-two questions were prepared and objectively answered, resulting in a consensus of nutritional therapy in cystic fibrosis.Conclusion This work enabled establishing a scientific consensus for nutritional treatment of cystic fibrosis patients.

Balneotherapy in spondyloarthropathy: A systematic review

To evaluate the effectiveness of balneotherapy on spondyloarthritis. Two authors independently searched the CENTRAL, MEDLINE, SCOPUS, EMBASE and WEB OF SCIENCE databases until July 2017, for randomized controlled trials published in French or English, that included participants, and interventions: adults with spondyloarthritis, treated by balneotherapy program or one of its components and compared with any other intervention or no treatment. Internal validity, external validity, quality of the statistical analysis, and publication bias were systematically evaluated. We report the best level of evidence. Nine articles were selected; the internal validity was high in two studies, average in one study, and low in six studies. With high internal validity, one study found a difference for pain between immersion in radon-rich water and tap water for the whole population or rheumatic disease, but the BASFI is not improved for the subgroup of patients with spondyloarthritis. The other study with high validity reported a significant 28-week improvement in quality of life and a composite index. In a study with moderate internal validity involving ankylosing spondylitis patients with associated with inflammatory bowel disease, a balneotherapy program demonstrated a relevant clinical improvement when compared to patients on waiting list. With low internal validity, TNFa inhibitors+spa therapy were found to be superior to a treatment with TNFa inhibitors alone in patients with psoriatic arthritis. Two trials with high validity demonstrated improvements, but this systematic review is not sufficient to prove the efficacy of balneotherapy in spondyloarthritis. More trials are needed with larger sample size to confirm the preliminary results observed and conclusively determine the benefits of balneotherapy.

Performance of custom made videolaryngoscope for endotracheal intubation: A systematic review.

IntroductionVideolaryngoscope is regarded as the standard of care for airway management in well-resourced setups however the technology is largely inaccessible and costly in middle and low-income countries. An improvised and cost-effective form of customized videolaryngoscope was proposed and studied for patient care in underprivileged areas however there were no distinct conclusions on its performances.MethodThe study follows PRISMA guidelines for systematic review and the protocol in International Prospective Register for Systematic Reviews. The primary aim was to assess the first attempt success of customized videolaryngoscope for endotracheal intubation. The secondary objective was to evaluate the number of attempts, laryngoscopic view in terms of Cormack Lehane score and Percentage of glottic opening, use of external laryngeal maneuver and stylet and, the airway injuries after the endotracheal intubation.ResultFive studies were analyzed for risk of bias using the National Institute of Health Quality Assessment Tool for cross-sectional studies. Most of the studies had a poor to a fair level of evidence with only one study with a good level of evidence. Certainty of evidence was “very low” for all eligible studies when graded using the Grading of Recommendation, Assessment, Development and Evaluation approach for systematic review.ConclusionsThe certainty of the evidence regarding performance of custom-made videolaryngoscope compared to conventional laryngoscope was very low and the study was performed in small numbers with fair to the poor risk of bias. It was difficult to establish and do further analysis regarding whether the customized form of videolaryngoscope will improve the first attempt success rate for tracheal intubation, reduce the number of attempts, improve the laryngoscopic view, require fewer external aids and reduce the incidences of airway injury with the given low-grade evidence. Some properly conducted randomised clinical trials will be required to further analyze the outcome and make the strong recommendations.

ERGOGENIC AIDS IN COMPETITIVE HANDBALL PLAYERS: A NARRATIVE REVIEW

&#x0D; &#x0D; &#x0D; Handball performance is a team-sport characterized by high intensity efforts interspersed with recovery periods. Due to high demands of handball performance, the use of ergogenic aids is a common strategy of handball players with the aim of enhancing handball performance, to allow more effective training, and to increase the rate of recovery. Although the use of ergogenic aids is generalized in the whole spectrum of competitive handball (e.g., from recreational to professional players), only a few ergogenic aids have been investigated to test their effectiveness to increase handball performance. In addition, no previous study has summarized the scientific literature on this topic to determine the ergogenic aids with good level of evidence regarding their effectiveness to increase handball physical performance. Thus, the aim of this narrative review was to describe the prevalence in the use of ergogenic aids in handball players and to analyse this information to identify which of these substances may increase physical performance in an intermittent sport such as competitive handball.&#x0D; &#x0D; &#x0D;

Nimotuzumab as Additional Therapy for GLIOMA in Pediatric and Adolescent: A Systematic Review.

IntroductionPediatric gliomas represent the most common brain tumor in children and its higher grades are associated with higher recurrence and low survival rate. All therapeutic modalities are reported to be insufficient to achieve satisfactory result, with follow-up treatment such as adjuvant radiotherapy and chemotherapy recommended to increase survival and hinder tumor progression. Nimotuzumab is a monoclonal antibody that acts as an inhibitor of epidermal growth factor receptor found on the surface of glioma cells and had been studied for its usage in pediatric gliomas in recent years.MethodsA systematic review is performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A through literature search was conducted on PubMed, Scopus, Cochrane, and clinicaltrials.gov database. Articles were selected systematically based on the PRISMA protocol and reviewed completely. The relevant data were summarized and discussed. We measured overall survival, progression-free survival, and adverse Events (AE) for nimotuzumab usage as an adjunct therapy in pediatric glioma population.ResultFrom 5 studies included for qualitative analysis, 151 patients are included with overall survival (OS) that vary from 3.2–22.8 mo, progression-free survival (PFS) from 1.7–21.6 mo, and relatively low serious adverse events (0–21) are recorded. Follow-up ranged from 2.4–66 mo with four studies reporting diffuse intrinsic pontine glioma (DIPG) patients and only one study reporting nimotuzumab usage in pediatric high-grade glioma (HGG) patients with better outcome in HGG patients than DIPG.ConclusionThere are no significant differences in the PFS and OS of nimotuzumab as adjunct therapy for pediatric compared to result of standard therapy in majority of previous studies. There were also no differences in the AE of nimotuzumab for pediatric glioma between studies, and low event of serious adverse events indicating its safety. But still there is an evidence of possible benefit of nimotuzumab as adjuvant therapy in pediatric glioma. We recommend further studies with larger number of patients that may lead to possibly different results. There should also be more studies with better level of evidence to further validate the effect of nimozutumab on pediatric glioma.