Studies Of High Methodological Quality Research Articles

The Effect of Spiritual Therapies on the Quality of Life of Women with Breast Cancer: A Systematic Review.

The number of studies investigating the effects of spiritual therapies on the quality of life of women diagnosed with breast cancer is quite limited. This systematic review searched the databases "Scopus, Web of Science, PubMed" using the keywords "Breast cancer," "Spirituality" and "Spiritual therapies" and found a total of four studies. The scanning was conducted by two independent reviewers between March 19 and 22, 2024. Included studies were published between 2013 and 2024. These studies found that spiritual therapy has positive effects on the quality of life of women with breast cancer. It is recommended that studies of high methodological quality are conducted to investigate the effect of spiritual therapy on the quality of life of women with breast cancer.

Effect of aromatherapy on pruritus in people receiving hemodialysis treatment: Systematic review.

Lack of a complete understanding of the pathophysiology of pruritus directs patients to different treatments. There is little data on the effect of aromatherapy on itching in patients receiving hemodialysis treatment. However, the effect of aromatherapy on pruritus in patients receiving hemodialysis treatment remains unclear. The aim of this study is to investigate the effect of aromatherapy on pruritus in hemodialysis patients. The protocol of this systematic review study was registered with PROSPERO (CRD42024522699) and PRISMA guidelines were followed in reporting the study. The search was conducted in Pubmed, Web of Science and Scopus databases without year restriction. Inclusion and exclusion criteria were established according to the PICOS criteria. Study selection and quality assessment of the reviewed studies were performed by two independent researchers. A total of eight studies (461 participants), including two randomized controlled trials and six quasi-experimental studies, were included in the systematic review. All included studies concluded that aromatherapy reduces pruritus. The studies reported no adverse effects of aromatherapy. The studies included in this systematic review found that aromatherapy has a positive effect on reducing pruritus in hemodialysis patients. It is recommended that studies of high methodological quality be conducted to investigate the efficacy of aromatherapy on pruritus in people undergoing hemodialysis treatment.

Prevention and management of urinary incontinence-associated dermatitis: A systematic review

BackgroundTo prevent incontinence-associated dermatitis (IAD) and manage the treatment, the cause of IAD must be determined correctly and distinguished from other skin problems. IAD can be prevented with professional care. AimThis systematic review aims to systematically examine the methods used in the prevention and treatment of urinary incontinence-associated dermatitis. Materials and methodsThe PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) criteria were taken as the basis for creating the systematic review protocol and writing the article. In this systematic review, the scans are combinations of words and word groups determined by the MeSH (Medical Subject Headings) terms “incontinence”, “incontinence-associated dermatitis”, “prevention of urinary incontinence”, “treatment of urinary incontinence” and “randomized controlled”. Studies conducted in the last eight years were examined in the PubMed, Cochrane Library, Web of Science, and Scopus databases between January and March 2024. Studies were selected by determining inclusion and exclusion criteria according to the PICOS method and these studies included in the review were evaluated according to the Joanna Briggs Institute (JBI) critical evaluation lists according to their types. ResultsFive randomized controlled trials with a total of 644 participants were included in this systematic review. In all five studies included in the review, it was determined that pharmacological and non-pharmacological methods significantly reduced dermatitis associated with urinary incontinence. ConclusionIn the reviewed studies, it was observed that pharmacological and non-pharmacological methods had a positive effect on dermatitis in individuals with IAD. It is recommended to conduct more studies of high methodological quality, using larger sample groups, with different interventions and randomization and blinding methods, and examining the effectiveness of pharmacological and non-pharmacological methods in individuals with urinary incontinence-associated dermatitis.

Adjunctive Approach to Therapeutic Laser and Exercise Therapies in Alleviating Pain and Disability in Patients with Low Back Pain: A Systematic Review.

Low back pain (LBP), a globally prevalent musculoskeletal condition, affects mobility, mental well-being, and overall quality of life. It is generally caused by disc degeneration, muscular strain, ligamentous sprain, or a disease located at the lumbar spine. Owing to this disability, the social and occupational interactions of an individual might get affected. Modern medicine frequently combines exercise therapy with light amplification by stimulated emission of radiation (LASER) therapy, especially high intensity LASER therapy (HILT) or low level LASER therapy (LLLT), to increase the efficacy of the treatment modalities for LBP. This review aimed to determine the effect of the combined approach of LASER and exercise therapies in managing pain and reducing disability in patients with LBP. PubMed, Google Scholar, Cochrane Library, MEDLINE, and PEDro were searched for full-text research articles published from 2000 to 2023. Overall, 3,913 records were screened from these databases and six high methodological quality studies (PEDro ≥ 5) were included in this review after eligibility assessment. Review manager 5.4.1 was utilized to evaluate the overall quality of the review articles. In conclusion, HILT and LLLT serve as effective adjuncts to exercise therapy in treating LBP, contributing to pain reduction and disability alleviation.

Inflammatory Hematological Ratios in Adolescents with Mental Disorders: A Scoping Review.

Inflammatory hematological ratios (IHRs), such as neutrophil to lymphocyte, monocyte to lymphocyte, and platelet to lymphocyte ratios, are associated with mental disorders, symptoms severity, and the disease phase. Evidence from the studies in adult patients has been summarized in systematic reviews and meta-analyses. The results of the studies in adolescents remain poorly systematized. To summarize the findings from the studies that investigated the relationship of IHRs with mental disorders in adolescent patients. This scoping review included studies of IHRs in patients aged 10-19 years with mental disorders (other than anorexia nervosa), published in English by December 31, 2023. The search for relevant papers was performed in MEDLINE. The studies were categorized into two groups: studies with external controls (healthy adolescents) and studies with internal controls (patients in different phases of mental disorder, with or without self-harm/suicidal behaviors). A total of 11 studies were included in the review (all cross-sectional ones). The results of these studies demonstrate that 1) adolescents with mental disorders (major depressive disorder, psychotic disorders, obsessive-compulsive disorder, attention deficit hyperactivity disorder, substance use disorders) have higher IHR values than individuals of the same age without corresponding disorders (5 studies); 2) IHR values are positively correlated with the severity of psychopathological symptoms (1 study); 3) higher IHR values are associated with the phase of the mental disorder - manic episode in bipolar disorder (1 study) and exacerbation of psychosis in psychotic disorders (1 study); and 4) higher IHR values are associated with self-harm/suicidal behaviors - suicide attempts (1 study) and non-suicidal self-injury (1 study). IHRs are associated with mental disorders in adolescents, and higher IHR values are associated with a more severe/acute clinical presentation (severity of symptoms, mania, acute psychosis, self-harm/suicidal behaviors). Further studies of higher methodological quality are needed to evaluate the diagnostic and prognostic value of IHRs as biomarkers of mental disorders in adolescence.

Educational needs and preferences of adult patients with acute pain: a mixed-methods systematic review.

Many patients experience acute pain, which has been associated with numerous negative consequences. Pain education has been proposed as a strategy to improve acute pain management. However, studies report limited effects with educational interventions for acute pain in adults, which can be explained by the underuse of the person-centered approach. Thus, we aimed to systematically review and synthetize current evidence from quantitative, qualitative and mixed-methods studies describing patients' needs and preferences for acute pain education in adults. We searched original studies and gray literature in 7 databases, from January 1990 to October 2023. Methodological quality was assessed with the Mixed Methods Appraisal Tool. A total of 32 studies were included (n = 1847 patients), two-thirds of which were qualitative studies of high methodological quality. Most of the studies were conducted over the last 15 years in patients with postsurgical and posttraumatic pain, identified as White, with a low level of education. Patients expressed the greatest need for education when it came to what to expect in pain intensity and duration, as well how to take the medication and its associated adverse effects. The most frequently reported educational preferences were for in-person education while involving caregivers and to obtain information first from physicians, then by other professionals. This review has highlighted the needs and preferences to be considered in pain education interventions, which should be embedded in an approach cultivating communication and partnership with patients and their caregivers. The results still need to be confirmed with different patient populations.

Pharmacological Treatment of Primary Insomnia in Senior Citizens in Spain

The article examines the problem of primary insomnia in older adults in Spain, focusing on its prevalence and health consequences. It highlights that, unlike secondary insomnia, primary insomnia has no identifiable cause and may be related to factors such as stress, emotional distress, travel and shift work. Using data from the Spanish National Institute of Statistics, the prevalence of insomnia in older adults is analysed, highlighting a higher incidence in women and the 75+ age group. The importance of addressing this problem is emphasised, as insomnia in older adults is associated with serious consequences such as depressive episodes, increased risk of falls, cognitive impairment and reduced quality of life. The study aims to comprehensively examine the management of primary insomnia in this population, evaluating the efficacy of various pharmacological treatments, such as cognitive behavioural therapy, benzodiazepines, benzodiazepine receptor agonists (Z-drugs), antidepressants, melatonin and other options. The pros and cons of each treatment are discussed, including special considerations for older adults. The article highlights the importance of future research to improve the understanding and management of chronic insomnia, underlining the need for large-scale studies of high methodological quality to establish appropriate pharmacological management.

Effects of Respiratory Muscle Training on Functional Ability, Pain-Related Outcomes, and Respiratory Function in Individuals with Low Back Pain: Systematic Review and Meta-Analysis.

Objectives: The aim of this meta-analysis was to determine the effects of respiratory muscle training (RMT) on functional ability, pain-related outcomes, and respiratory function in individuals with sub-acute and chronic low back pain (LBP). Methods: The study selection was as follows: (participants) adult individuals with >4 weeks of LBP; (intervention) RMT; (comparison) any comparison RMT (inspiratory or expiratory or mixed) versus control; (outcomes) postural control, lumbar disability, pain-related outcomes, pain-related fear-avoidance beliefs, respiratory muscle function, and pulmonary function; and (study design) randomized controlled trials. Results: 11 studies were included in the meta-analysis showing that RMT produces a statistically significant increase in postural control (mean difference (MD) = 21.71 [12.22; 31.21]; decrease in lumbar disability (standardized mean difference (SMD) = 0.55 [0.001; 1.09]); decrease in lumbar pain intensity (SMD = 0.77 [0.15; 1.38]; increase in expiratory muscle strength (MD = 8.05 [5.34; 10.76]); and increase in forced vital capacity (FVC) (MD = 0.30 [0.03; 0.58]) compared with a control group. However, RMT does not produce an increase in inspiratory muscle strength (MD = 18.36 [-1.61; 38.34]) and in forced expiratory volume at the first second (FEV1) (MD = 0.36 [-0.02; 0.75]; and in the FEV1/FVC ratio (MD = 1.55 [-5.87; 8.96]) compared with the control group. Conclusions: RMT could improve expiratory muscle strength and FVC, with a moderate quality of evidence, whereas a low quality of evidence suggests that RMT could improve postural control, lumbar disability, and pain intensity in individuals with sub-acute and chronic LBP. However, more studies of high methodological quality are needed to strengthen the results of this meta-analysis.

Can resistance training improve throwing performance in handball players? A Systematic review and meta-analysis

BackgroundThrowing is one of the most important movement in handball. Throwing performance is crucial for success in handball.ObjectiveΤo investigate the level of evidence for the effect of resistance training (RT) on throwing performance in handball players.MethodsSystematic searches of Pubmed, Medline complete, Cinahl, Sport Discus and Scopus were undertaken for peer reviewed articles published between 18 March 1995 to 18 March 2023. Randomized, controlled, clinical studies, written in English, aiming to investigate the effect at least one modality of RT on throwing performance (velocity or/and accuracy) in handball players were considered for inclusion in the study. The eligible studies were assessed for methodological quality using the Physical Therapy Evidence Database (PEDRO) scale. The Best Evidence Synthesis (BES) approach was used for synthesizing and reporting the results. Furthermore, the random-effects model was used for the meta-analysis and the Q-statistic was used to test the null hypothesis that all studies in the analysis share a common effect size.ResultsOne hundred ninety-eight studies were identified, of which 30 were included. A total of 727 handball players (males = 388, females = 292) were included. 28 of the 30 studies were rated as high methodological quality studies (PEDRO score > 70%) while the rest of the studies were rated as moderate methodological quality studies (PEDRO score ≤ 60%). The mean effect size for the effectiveness of resistance training (RT) in improving jumping throw, running throw, and standing throw velocity were 1.128 (95% CI 0.457 – 1.798), 1.756 (95% CI 1.111 – 2.400), and 1.098 (95% CI 0.689 – 1.507) correspondingly. Traditional weight training using barbells in mostly compound lifts yielded the most significant and robust results. Other RT modalities such as elastic bands, medicine balls, core training and ballistic training showed no significant results or positive effects due to the limited number of the studies.ConclusionStrong evidence exists only for the effectiveness of RT using barbells in increasing throwing velocity. In contrast, the remaining RT modalities, while yielding positive results, have limited support due to limited number of studies and the high heterogeneity between studies. Furthermore, there is insufficient evidence to support various forms of RT in increasing throw distance. Finally, medicine ball training and elastic band training demonstrated no benefits in improving throwing accuracy.Trial registrationPROSPERO ID: CRD42023393574.

Conservative non-pharmacological treatments for chemotherapy-induced peripheral neuropathies in women treated for breast cancer: a systematic review.

Over the last few decades, the use of neo/adjuvant therapies has significantly increased the number of breast cancer survivors who experience chemotherapy-induced peripheral neuropathy (CIPN). To date, few, low-efficacy, pharmacological remedies exist to manage this side effect. For this reason, alternative treatments are increasingly being investigated as possible strategies to prevent or promote faster recovery from CIPN. In this review we aimed to provide an overview of the literature evidence regarding all the non-pharmacological and rehabilitative interventions for patients affected by CIPN secondary to breast cancer care. A comprehensive literature search was conducted on PubMed, Scopus and Web of Science and included a total of 1895 patients (1528 with breast cancer) with a wide range of CIPN (motor, sensory and autonomic neuropathies) and chemotherapy treatments (e.g., Taxanes, Platins, Vinca alkaloids or monoclonal antibody drugs). Of the initial 1108 hits, only 25 studies - describing different treatment modalities for peripheral neuropathies - were finally included in the qualitative synthesis. Most studies focused on acupuncture, physiotherapy, cryotherapy, and yoga. There is still controversial evidence on conservative non-pharmacological interventions for the management of CIPN symptoms. We believe however that moderate exercise, as well as all types of stress reducing activities like sport, yoga and mindfulness, should be encouraged in cancer patients for their positive effect on global physical and psychological health. Further studies of higher methodological quality are needed to determine the best conservative approach to CIPN.

Characterization of injuries and dressings of left ventricular assist device drivelines

Aim: To Identify and characterize driveline-related injuries among patients with HeartMate II® or HeartMate 3® and assess the dressings used during hospital stay. Method: Observational, cross-sectional study conducted between 2015 and 2023 at a large hospital in São Paulo, Brazil. Results: The sample consisted of 18 patients, with driveline injuries identified in 66.7%, categorized into stages one (83.3%), two (8.3%), and four (8.3%). Of these, 66.6% were diagnosed with driveline infection according to the Utah classification: stages two (50%), three (37.5%), and four (12.5%). A correlation was found between the occurrence of injuries and longer support time (p=0.035) and the presence of a diagnosis of driveline infections (p=0.013). The solutions most frequently used were Chloraprep™ (27.8%), Aqueous Chlorhexidine 0.5% (22.2%), and Saline 0.9% (22.2%), while the dressings were IV3000™ (72.2 %), Excilon™ (44.4%), and Biatain®Ag (33.3%). Conclusion: Driveline dressings are not standardized, indicating the need for new protocols and guidelines based on studies of high methodological quality and presenting robust evidence of the best solutions and dressings to prevent complications and promote better outcomes.

Sensorimotor Uncertainty of Immersive Virtual Reality Environments for People in Pain: Scoping Review.

Decision making and action execution both rely on sensory information, and their primary objective is to minimise uncertainty. Virtual reality (VR) introduces uncertainty due to the imprecision of perceptual information. The concept of "sensorimotor uncertainty" is a pivotal element in the interplay between perception and action within the VR environment. The role of immersive VR in the four stages of motor behaviour decision making in people with pain has been previously discussed. These four processing levels are the basis to understand the uncertainty that a patient experiences when using VR: sensory information, current state, transition rules, and the outcome obtained. This review examines the different types of uncertainty that a patient may experience when they are immersed in a virtual reality environment in a context of pain. Randomised clinical trials, a secondary analysis of randomised clinical trials, and pilot randomised clinical trials related to the scope of Sensorimotor Uncertainty in Immersive Virtual Reality were included after searching. Fifty studies were included in this review. They were divided into four categories regarding the type of uncertainty the intervention created and the stage of the decision-making model. Immersive virtual reality makes it possible to alter sensorimotor uncertainty, but studies of higher methodological quality are needed on this topic, as well as an exploration into the patient profile for pain management using immersive VR.

Microvessel density in patients with gastrointestinal stromal tumors: A systematic review and meta-analysis.

Gastrointestinal stromal tumors (GISTs) are considered the most common mesenchymal tumors of the gastrointestinal tract. Microvessel density (MVD) constitutes a direct method of vascularity quantification and has been associated with survival rates in multiple malignancies. To appraise the effect of MVD on the survival of patients with GIST. This study adhered to Systematic reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Electronic scholar databases and grey literature repositories were systematically screened. The Fixed Effects or Random Effects models were used according to the Cochran Q test. In total, 6 eligible studies were identified. The pooled hazard ratio (HR) for disease free survival (DFS) was 8.52 (95%CI: 1.69-42.84, P = 0.009). The odds ratios of disease-free survival between high and low MVD groups at 12 and 60 mo did not reach statistical significance. Significant superiority of the low MVD group in terms of DFS was documented at 36 and 120 mo (OR: 8.46, P < 0.0001 and OR: 22.71, P = 0.0003, respectively) as well as at metastases rate (OR: 0.11, P = 0.0003). MVD significantly correlates with the HR of DFS and overall survival rates at 36 and 120 mo. Further prospective studies of higher methodological quality are required.

Risk factors for shoulder injuries in handball: systematic review

BackgroundHandball is a sport with a high number of severe injuries. The shoulder is one of the most commonly injured joints, with an average prevalence of 17–41%.ObjectiveThe primary aim is to identify the most significant risk factors related to shoulder injuries in handball. The secondary aim is to propose recommendations based on the available evidence concerning potential injury prevention strategies.MethodsSystematic searches of PubMed, MEDLINE, CINAHL, Proquest, SPORTDiscus, Web of Science, EMBASE, and Scopus were undertaken for peer reviewed articles published between 15 July 1995 and 15 July 2019. The same search strategy was repeated on 24 April 2022. Prospective cohort studies, written in English and published in a journal with a peer-review process aiming to investigate at least one modifiable or/and a non-modifiable potential risk factor for shoulder injuries, specifically in handball players, were included. Only papers published after 1995 were included. The methodological quality of the eligible studies was assessed using the modified version of the Downs and Black Checklist. The Best Evidence Synthesis (BES) approach was used for synthesizing and reporting the results.Results1849 studies were identified, of which 8 were included. A total of 2536 (males = 1354, females = 1182) participants of which 2522 were handball athletes, were included. Four of the eight studies were rated as high methodological quality studies (> 85%) while the rest were rated as medium (50–85%). The risk factors for shoulder injuries in handball identified in the studies were strength imbalances (n = 6), glenohumeral range of motion (ROM) imbalances (n = 5), scapular dyskinesis (n = 5), incorrect dosage of training load (n = 2), previous injury (n = 1), sex (n = 2), player’s position, school grade, playing level (n = 1), altered shoulder joint position sense (n = 1).ConclusionOverall, from all the risk factors evaluated, there was strong evidence that the weakness of the shoulder external rotator muscles and the female sex increase the probability of shoulder injury in handball athletes. Nevertheless, the evidence for the other risk factors was moderate due to the methodological quality and the limited number of studies.Protocol registration: PROSPERO ID: CRD42020138233.

NCOG-31. ROLE OF AGE IN CSF LEAK FOLLOWING TRANSSPHENOIDAL RESECTION OF CRANIOPHARYNGIOMA: ANALYSIS OF OUTCOMES IN PEDIATRIC VERSUS ADULT POPULATION

Abstract Postoperative cerebrospinal fluid (CSF) leak is a serious complication after surgical treatment of craniopharyngioma. The objective of this study is to analyze postoperative CSF leak rates following transsphenoidal resection of craniopharyngioma in adult versus pediatric patient populations. PRISMA guidelines were used to query the Pubmed, Web of Science, and Cochrane databases for studies of craniopharyngioma resection in adult or pediatric patients from the past three decades. The following search terms, ("craniopharyngioma") AND ("cerebrospinal fluid" OR "CSF") AND ("leak" OR "rhinorrhea") AND ("resection" OR "surgery") AND ("transsphenoidal" OR "endonasal"), were used. The primary outcome variable collected was presence of postoperative CSF leak. Pooled analyses were performed to determine the rates of CSF leak in adult and pediatric cases. In addition, a meta-analysis was performed to compare the rates of CSF leak in the adult versus pediatric cohort. Of the 21 included studies, 8 studies reported adult cases, 9 studies reported pediatric cases, and 4 studies reported both adult and pediatric cases, for a total of 468 cases. The majority of studies were level 4 evidence (90.5%, 19/21), while two studies were level 3 evidence (9.5%, 2/21). Analysis of postoperative CSF leak in adult and pediatric cases revealed rates of 29% (95% CI: 21%-39%) and 13% (95% CI: 9%-19%), respectively. Using a random-effects meta-analysis model, we found that there was no significant difference between the two cohorts (RR: 1.56; 95% CI = 0.52-4.71; P = 0.43). The present study is the first to analyze postoperative CSF leak rates in adult and pediatric patients undergoing transsphenoidal resection of craniopharyngiomas. While we found that there is no significant difference in CSF leak rates between adult and pediatric patients, further studies of higher methodological quality are warranted to provide a better understanding of complication profiles following resection of adult and pediatric craniopharyngiomas.

Creativity training programs in primary education: A systematic review and meta-analysis

The aim of the systematic review was to examine the effectiveness of creativity training programs, interventions, or practices on creativity or divergent thinking in typical developing primary education pupils. A systematic review protocol was designed and implemented, and a systematic literature search was conducted across diverse electronic platforms and databases, as well as other resources. The final sample of high methodological quality studies reviewed was 6. A narrative content analysis approach was adopted, and a random effects analysis with restricted maximum likelihood was used to conduct the meta-analysis. The meta-analytic estimate of the overall effect size of the combined studies shows moderate effect across all studies. The results suggest that some programs, interventions, or practices exist that can effectively help teachers, practitioners, and policy makers to promote creativity or divergent thinking in school-aged children.

Foam Rolling Acute Effects on Myofascial Tissue Stiffness and Muscle Strength: A Systematic Review and Meta-Analysis.

Glänzel, MH, Rodrigues, DR, Petter, GN, Pozzobon, D, Vaz, MA, and Geremia, JM. Foam rolling acute effects on myofascial tissue stiffness and muscle strength: a systematic review and meta-analysis. J Strength Cond Res 37(4): 951-968, 2023-Foam rolling (FR) is widely used in rehabilitation and physical training. However, the effects of FR on myofascial tissue stiffness and muscle strength remain unclear. This study aimed to perform a systematic review with meta-analysis of trials that tested the FR acute effects during warm-up on the myofascial tissue stiffness and muscle strength in healthy adults or athletes. This systematic review (CRD42021227048) was performed according to Cochrane's recommendations, with searches performed in PubMed, Web of Science, Embase, and PEDro databases. Syntheses of included studies' data were performed, and the PEDro scale was used to assess the methodological quality of the studies. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluations approach. Twenty included studies assessed trunk and thigh fascial tissue stiffness, and thigh and calf muscle stiffness, whereas muscle strength was assessed in the knee extensors and flexors, and plantar flexors muscles. Qualitative analysis showed decreases in fascial ( n = 2) and muscle ( n = 5) stiffness after FR. However, the meta-analysis showed no effects of FR on myofascial tissue stiffness. Both qualitative and quantitative analyses showed no effects of FR on isometric muscle strength, eccentric torque, and rate of force development. However, the knee extensor concentric torque increased after FR. Foam rolling increases the knee extensor concentric torque, but it does not acutely change the myofascial tissue stiffness and isometric muscle strength. However, evidence of these studies provides low certainty to state that FR does not change these parameters. Therefore, high methodological quality studies should be performed to better ascertain the effects of FR on the myofascial tissue stiffness and muscle strength.

Epidemiology of Medical Errors and Incidents in Emergency Medicine

Relevancethe issues of patient care and quality management have acquired particular relevance in modern healthcare. Improvement in the clinical performance of medical technologies has led to a significant reduction in deaths and complications associated with the disease and side effects of interventions. As a result, the share of additional harm related to the process of providing medical services has become more noticeable. Accurate data regarding the type, frequency and severity of active threats and incidents they cause are needed to reduce the likelihood and severity of additional harm. In this respect, emergency medical care is the subject of special attention and is characterized by the greatest difficulty in terms of obtaining valid and relevant information about deviations associated with health worker performance, equipment operation and patient behavior.The aim of the studywas to explore the main epidemiological characteristics of medical errors and incidents associated with the provision of emergency medical care.Material and methodsWe present a literature review followed by an analytical study of the epidemiology of incidents and active threats (including medical errors) that precede those incidents in various areas of emergency medical care. By an incident, the authors understood an event with a patient that was more related to the process of providing medical care than to the course of the disease or comorbid conditions which led or could lead to causing additional harm. Active threats included events that subsequently became the direct cause of the incident (medical errors and malpractice, mistakes and deviations in patient behavior, emergency situations in the physical environment). By the “mortality from adverse events”, the authors understood the proportion of deaths from adverse events among all hospitalized patients. By the concept of “lethality associated with adverse events”, the authors denoted the proportion of deaths from adverse events among all the patients affected by adverse events. The search for information was carried out for the period of 1995–2021 using the following medical databases: medline; cochrane collaboration; embase; scopus; isi web of science. For analysis, we used prospective and retrospective observational studies of high methodological quality, meta-analyses and systematic reviews. For the statistical evaluation of frequency characteristics, indicators of incidence, prevalence, and incidence density were used. The calculation of generalized frequency indicators for large samples was carried out with a 95% confidence interval.Results The epidemiology of medical errors and incidents depends on the area in which emergency care is provided. For prehospital emergency medical care, there are 12.45 medical errors and 4.50 incidents with consequences for every 100 visits. In emergency departments, one in fourteen patients suffers additional harm which in 10.14% of cases has severe consequences, and in 3.18% of cases leads to unexpected death. In intensive care units, incidents related to the provision of medical care are recorded in every third patient in the amount of 1.55 per 1 patient. Of these, 58.67% of incidents are accompanied by harm, but the fatality associated with the incidents is only 0.77%. The prevalence of patients affected by incidents during the provision of anesthesia for children is almost 2 times higher than for adults (4.79% vs. 2.03%). At the same time, mortality due to anesthesia-related incidents in children is 11 times lower than in adults (0.27% versus 3.09%). The author draws attention to a number of factors contributing to the development of incidents during the provision of emergency medical care. These include environmental complexity, suboptimal configuration of the workspace, technological interface complexity, the effects of acute stress on performers, and organizational vulnerabilities. A special role was assigned to environmental complexity which was studied in detail both in terms of the complexity of the tasks being solved, and in connection with obstacles to solving problems. It was shown that the intensity of the influence of various components of environmental complexity is not the same in different departments providing emergency care. Particular attention was paid to the fact that organizational vulnerabilities reduce the effectiveness of protective mechanisms during the interaction of the human factor with a complex environment.ConclusionThe study showed that the provision of emergency medical care is associated with moderately high risks of incidents, including severe and critical consequences for patients. The main factor contributing to the development of incidents is environmental complexity which becomes much harder to counter under the influence of organizational vulnerabilities. Identification and registration of errors and incidents in units providing medical care is difficult due to the short time of contact with patients, the high speed of situation update, and the constant impact of chronic and acute stressors on staff. In this connection, the optimization and improvement of the efficiency of the system for recording errors and incidents in departments providing emergency medical care remains an area for improvement.

Efeitos da vibração do tendão muscular no equilíbrio após acidente vascular cerebral: revisão sistemática

ABSTRACT After cerebrovascular accident (CVA), people have complex combinations of sensory, motor, cognitive, and emotional deficits, which can affect static and dynamic balance. This study aimed to compile and summarize the main features and findings of protocols used in research that investigated the effects of muscle tendon vibration on static and dynamic balance in adults with stroke. This is a systematic review, registered in PROSPERO (CRD42022303874), in which searches were performed in the databases PubMed, Cochrane, LILACS, SciELO, MEDLINE, Science Direct, and PEDro, during the month of January 2022, using the combination of keywords related to “stroke,” “balance,” “muscle tendon vibration,” “randomized controlled trial.” Methodological quality was assessed using the PEDro scale. A total of 1,560 studies were identified, 11 of which were included, between the years 1994 to 2020, involving 242 post-stroke adults. Only five studies used vibration as an intervention and found an improvement in static and dynamic balance. Six studies analyzed the interference of vibration on postural control, showing that balance was affected during the application of vibration and that individuals needed more time to recover or did not experience significant differences. We found that the effects of muscle tendon vibration may be able to improve balance in people with stroke and influence postural control by proprioceptive mechanisms of vibration. However, more studies of high methodological quality are needed to reach a consensus regarding muscle tendon vibration treatment protocols and their recommendation in clinical practice.

Sedentary Behaviors and Health Outcomes among Young Adults: A Systematic Review of Longitudinal Studies.

Objective: This study aimed to review and provide an informative synthesis of the findings from longitudinal studies that describe the relationship between sedentary behavior and various health outcomes among young adults. Methods: A literature search was conducted in Web of Science, PubMed, APA PsycInfo, MEDLINE, Embase, and the Cochrane Library for articles that examined the association between sedentary behavior and health outcomes among young adults aged 18–34 years. Two reviewers independently examined the articles and performed data extraction and quality assessment. The level of evidence was determined using the best-evidence synthesis. Results: A total of 34 studies were included in the analysis, 18 of which were high-quality studies. On the basis of inconsistency in the findings among studies, insufficient evidence was concluded for sedentary behavior and adiposity indicators, physical fitness, metabolic syndrome/cardiovascular disease risk factors, cognitive function, and mood disorders. Based on one high-quality study, moderate evidence for a negative relationship between sedentary behavior and physical fitness was observed. Conclusions: Given the trend toward increased time in sedentary behaviors and the inconsistent current findings, additional longitudinal studies of high methodologic quality are recommended to clarify the relationships between sedentary behavior and health outcomes among young adults.